Home and Community Care Digest

Home and Community Care Digest January 2006 : 0-0

Using vitamin D to prevent falls in an elderly residential care population

Abstract

Falls and fractures in an elderly population can lead to higher rates of morbidity and mortality as well as decreased levels of mobility, independence, and quality of life. A randomized controlled trial was conducted in Australia to determine if supplementation with calcium and vitamin D is effective in reducing the number of falls and fractures in residents living in residential care facilities. A significant reduction in the number of falls was seen in residents who took at least half of the trial medications. The study was not able to show any differences in fracture rates.
Background: Falls and fractures in an elderly population can lead to higher rates of morbidity and mortality as well as decreased levels of mobility, independence, and quality of life. A previous study documented that calcium and vitamin D supplements reduced the number of fractures in a nursing home population. Other studies have shown that abnormal motor function, muscle weakness, and body sway were associated with low levels of vitamin D. This study was designed to discover whether vitamin D and calcium supplements can reduce the number of falls and fractures in an institutionalized elderly population.

Methods: Participants were recruited from hostels and nursing homes across Australia. Baseline characteristics such as age, cognitive performance, mobility, and vitamin D levels were collected from residents who agreed to participate. Eligibility for the study was based on vitamin D levels found to be in the lower half of the normal range. Residents who were found to be classically deficient or to have reasonably high levels of vitamin D were excluded from the study. Other exclusion criteria included current use of vitamin D supplements or medical reasons (medical conditions or drugs known to affect bone and mineral metabolism). Falls and fractures were recorded in diaries by care staff. Calcium carbonate (600mg) supplements were given to all study participants. Residents in the treatment group received vitamin D supplementation for 2 years. Pill counts were conducted to monitor compliance with the medication regimen.

Findings: The 625 (comparison group - 312, treatment group - 313) eligible residents were predominantly female (95%) with an average age of 83 years. Nearly half of the residents lived in nursing homes. With the exception of the hip fracture rate, no significant differences were found in the baseline rate of falls or fractures when the data from all participants were analyzed. A pre-planned analysis of the residents who were 50% or more compliant was carried out. The residents taking vitamin D in this group had a 30% reduced chance of falling compared to the comparison group. The rates of fractures among the two groups who were 50% or more compliant were not different. The number of residents who did not complete the study due to death or withdrawal was high, 130 in the study group and 128 in the comparison group.

Conclusions: This study demonstrates that the rate of falling can be decreased in an elderly institutionalized population that is not classically vitamin D deficient by using calcium and vitamin D supplements. The reduction in falls did not translate into a reduction in the number of fractures perhaps due to the high number of residents that did not complete the study. Vitamin D is available from Ontario Drug Benefits (ODB) formulary. This study suggests that routine measurement of vitamin D levels could identify two groups of residents in need of vitamin D supplements: residents who are classically deficient and require vitamin D for proper bone and mineral metabolism; and residents at the lower end of normal who would benefit from a reduced fall rate.

Reference: Flicker, L, MacInnis, R.J., Stein, M.S., Scherer, S.C., Mead, K.E., Nowson, C.A., Thomas, J., Lowndes, C., Hopper, J.L., Wark, J.D. "Should Older People in Residential Care Receive Vitamin D to Prevent Falls? Results of a Randomized Trial". Journal of the American Geriatric Society. 2005; 53: 1881-1888.

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