Higher Dose of Vitamin D May Reduce Risk for Falls in Nursing Home Residents

[Admin]

March 2, 2007 — Nursing home residents with a high intake of vitamin D have fewer falls, according to the results of a randomized study reported in the February issue of the Journal of the American Geriatric Society.

"Elderly nursing home residents have a high risk of falls and fracture and are often deficient in vitamin D," write Kerry E. Broe, MPH, of the Hebrew SeniorLife in Boston, Massachusetts, and colleagues. "Several randomized clinical trials have shown that vitamin D supplementation reduces falls 23% to 53% in residents of nursing homes or residential care, and a meta-analysis of vitamin D supplementation and falls (including elderly nursing home participants) found a 22% reduction.... Nevertheless, not all trials with elderly residential care populations have found an association between vitamin D supplements and falls or fracture risk."

In this secondary data analysis of a previously conducted randomized clinical trial, 124 nursing home residents, average age 89 years, were randomized to receive 1 of 4 vitamin D supplement doses (200, 400, 600, or 800 IU) or placebo daily for 5 months. Outcome measurements included the number of fallers and number of falls, evaluated with a facility incident tracking database.

During the 5-month study, falls occurred in 44% of residents in the placebo group (11/25), 58% (15/26) in the 200 IU group, 60% (15/25) in the 400 IU group, 60% (15/25) in the 600 IU group, and 20% (5/23) in the 800 IU group. Compared with residents taking placebo, those taking 800 IU had a 72% lower adjusted-incidence rate ratio of falls during the 5-month study (rate ratio = 0.28; 95% confidence interval, 0.11 - 0.75). There were no significant differences for the adjusted fall rates vs placebo in any of the other supplement groups.

"Nursing home residents in the highest vitamin D group (800 IU) had a lower number of fallers and a lower incidence rate of falls over 5 months than those taking lower doses," write the authors. "Adequate vitamin D supplementation in elderly nursing home residents could reduce the number of falls experienced by this high falls risk group."

Study limitations include continuation of multivitamin use for some but not all residents; limited generalizability of the findings because of small sample size, participants all Caucasian, and participants healthier than the other Hebrew Rehabilitation Center for the Aged residents; lack of data on how many residents were approached for the study and were excluded; possible underreporting of falls; lack of assessment of vitamin D intake from foods or vitamin D repletion through sun exposure; and use of vitamin D2 rather than vitamin D3.

"In this study cohort, elderly nursing home residents in the highest vitamin D supplement group (800 IU) had a lower rate of falling than those in placebo group or in the lower supplement groups," the authors conclude. "Ensuring that nursing home residents are receiving adequate daily supplemental vitamin D may reduce the number of falls in elderly nursing home residents and could potentially reduce the risk of fracture in this high-risk group."

The authors have disclosed various financial relationships with the National Institute on Aging.

J Am Geriatr Soc. 2007;55:234-239.