15 October 2020

Rethinking the role of vitamin D

Aged Care Clinical

Vitamin D needs to be thought of as a food rather than a medicine if we are going to come close to ensuring all elderly patients are receiving care in keeping with best practice guidelines.

A small qualitative study, published in one of the BMJ journals, Nutrition, Prevention and Health serves to highlight the barriers that exist for elderly people in aged care facilities to universally be given vitamin D supplements, a practice that has been recommended by evidence-based guidelines in most developed nations including the UK and Australia.

It seems, that in the UK – where this study was conducted – most people – carers, health personnel and doctors – saw the provision of vitamin D supplements as the treating doctor’s responsibility, and as a consequence they only tended to be prescribed to patients with a history of falls or fractures or proven osteoporosis.

“This study highlights that a gap exists between public health guidance and practice around vitamin D supplementation in the care sector: the professionals involved in the care of elderly residents perceive vitamin D as a medicine rather than a food”, the study authors said.

As the authors point out this is not a problem confined to the UK alone. Studies in Austria, Belgium, Germany and Sweden have found that almost all residents of care homes were vitamin D deficient.

Similarly in Australia, an audit conducted in late 2014 on residents in aged care facilities across three states found 47% were receiving inadequate vitamin D.

Interestingly the only country where vitamin D deficiency among aged care residents was not an issue was New Zealand, where publicly funded universal vitamin D supplementation for residents in aged care facilities was instituted back in 2011. An audit done some three years later confirmed the success of the program.

But getting back to this study, what the researchers did was simply conduct 13 semi- structured interviews key stakeholders in two areas of Southern England including care home managers, GPs and public health professionals such as a dietitian.

While not exactly a randomised trial, what came out of the study was the fact that not only did it appear that everybody though it was the responsibility solely of the doctor as to whether the patient got vitamin D supplements, but also most people considered there might be medico-legal consequences if anyone but the doctor sought to give the supplements. There was also little if any awareness of the guidelines that advise universal supplementation for aged care residents without any prerequisite for testing.

What the study authors suggest is that we reframe our thinking with regards vitamin D. Basically they say, vitamin D needs to be thought of an essential food rather than a medicine and people need to be personally responsible for this supplementation, and where that’s not possible, as in the aged care setting, it should be just part and parcel of the carer’s role.

“Supplementation with vitamin D as a food is considered a personal responsibility which, in a care home setting, could be passed on to family members or care home staff,” the UK study authors said.

And this was the purpose of the study. To not only understand why we don’t have universal vitamin D supplementation but also to come up with some proposals for the ongoing challenge of managing vitamin D deficiency in our aged care residents, a condition which is likely to have become even more prevalent with the current restrictions courtesy of the pandemic.

“The purpose was to generate insights which could be used to inform and advocate for a policy and practice review as a first step towards increasing vitamin D supplement uptake and reducing vitamin D deficiency in elderly care home residents”, they said.

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Kylie Fardell
Kylie Fardell
13 days 3 hours ago

Maybe we could institute a policy where infirm residents were given a daily option to spend some time outdoors instead?

Dr Rosemary Stanton
Dr Rosemary Stanton
15 days 10 hours ago
Vitamin D is not a food. It may be a component of a food, although few foods could be considered sufficient sources of vitamin D to meet daily needs. Australia does not have a recommended dietary intake (RDI). We do have what is called an Adequate Intake (AI). AIs are “set on the basis of observed or experimentally determined approximation or estimate of nutrient intake by a group of apparently healthy people that are assumed to be adequate”. Australia has also set an Upper Level of intake “likely to pose no adverse effects to almost all individuals in the general… Read more »