Professional view of vitamin D jeopardizing elderly care home residents' health

https://www.eurekalert.org/pub_releases/2020-10/b-pvo100920.php

News Release 12-Oct-2020
In light of COVID-19 impact, review of nutritional guidelines and regulations urgently needed
BMJ

The professional perception of vitamin D as a medicine, rather than as a key nutrient, is constraining practice and jeopardising the health of elderly care home residents in England, conclude researchers in the journal BMJ Nutrition Prevention & Health.

At a time when the vulnerability of elderly care home residents is under the spotlight because of the impact of COVID-19, an urgent review is needed of the nutritional guidelines and regulations around the use of the vitamin, they argue.

The main source of vitamin D is exposure to sunlight, levels of which plummet during the winter in many countries in the northern hemisphere. With few major food sources, it's difficult to get enough vitamin D from diet alone, and vitamin D deficiency in care homes is widespread in many parts of the world, say the researchers.

Vitamin D is essential for good bone health and is thought to have a role in immunity, cardiovascular health, neurological conditions, respiratory infections, lung function and cancer. Most recently, it has been linked to susceptibility to, and severity of, COVID-19.

People who spend less time outdoors, such as the elderly in residential care, or who regularly cover up their skin, or who have darker skin tones, are all at heightened risk of vitamin D deficiency.

Vitamin D supplements have been recommended for care home residents for nearly 30 years. In 2016, recommendations for daily vitamin D supplements were extended to the entire population in the winter months, and throughout the year for those living in care homes.

National bodies from around the world have issued similar recommendations for care home residents, including Australia, Canada, France, Norway, New Zealand and the USA. 

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Apart from the dietitian, none of the interviewees seemed familiar with the recommendation that all elderly care home residents should receive vitamin D supplements without the need for a confirmatory blood test, which itself costs more than a year's supply of supplements.

And not everyone was aware that diet and sunlight can't provide adequate vitamin D levels even for the general population in the UK during winter months.

Current nutritional recommendations for supplementary vitamin D also heavily rely on personal responsibility, the researchers point out.

"It is questionable whether this is appropriate in populations with limited autonomy," they say, especially as it effectively creates "a two-tier system, discriminating against those with the least cognitive independence."

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