improving vitamin d status in home-bound elders

Conditions: Vitamin D Deficiency; Accidental Falls

Summary: in the past two decades, the role of vitamin d has extended beyond bone health to encompass a wide range of biological activities important to physical function in older adults. a growing body of evidence now shows that circulating 25-hydroxyvitamin d (25(oh)d) levels \< 75 nmol/l (\< 30 ng/ml)) are associated with physical impairments such as reduced walking speed and impaired balance as well as falls. older adults are at risk for low levels of 25-hydroxyvitamin d because of reduced exposure to ultraviolet b radiation, reduced efficiency of previtamin d synthesis in the skin, and low dietary intake. although data from the national health and nutrition examination survey (nhanes) 2000-2004 indicate that frank vitamin d deficiency (serum 25(oh)d \< 25 nmol/l \[10 ng/ml\]) is rare in the u.s. (5% or less), vitamin d insufficiency (serum 25(oh)d \< 75 nmol/l \[30 ng/ml\]) is prevalent (\~75%) among older adults. older home-bound adults are a vulnerable subgroup of older adults for poor dietary intake and nutritional health, nutrition-related health conditions, and functional decline and disability. the primary goal of this pilot study is to assess the feasibility of a partnership with senior services of forsyth county to address vitamin d insufficiency in home-bound older adults receiving home-delivered meals. a secondary goal is to obtain preliminary data on the effectiveness of vitamin d supplementation on improving vitamin d levels and reducing falls.

in the past two decades, the role of vitamin d has extended beyond bone health to encompass a wide range of biological activities important to physical function in older adults. a growing body of evidence now shows that circulating 25-hydroxyvitamin d (25(oh)d) levels \< 75 nmol/l (\< 30 ng/ml)) are associated with physical impairments such as reduced walking speed and impaired balance as well as falls. older adults are at risk for low levels of 25-hydroxyvitamin d because of reduced exposure to ultraviolet b radiation, reduced efficiency of previtamin d synthesis in the skin, and low dietary intake. although data from the national health and nutrition examination survey (nhanes) 2000-2004 indicate that frank vitamin d deficiency (serum 25(oh)d \< 25 nmol/l \[10 ng/ml\]) is rare in the u.s. (5% or less), vitamin d insufficiency (serum 25(oh)d \< 75 nmol/l \[30 ng/ml\]) is prevalent (\~75%) among older adults. older home-bound adults are a vulnerable subgroup of older adults for poor dietary intake and nutritional health, nutrition-related health conditions, and functional decline and disability. the primary goal of this pilot study is to assess the feasibility of a partnership with senior services of forsyth county to address vitamin d insufficiency in home-bound older adults receiving home-delivered meals. the investigators will accomplish this goal by conducting a 5-month randomized, controlled trial in 200 older meals-on-wheels (mow) recipients randomized to receive monthly either (1) 100,000 iu vitamin d3 or (2) an active placebo (vitamin e) to achieve the following specific aims: aim 1: determine the prevalence of falls and risk of vitamin d insufficiency in 200 mow recipients. aim 2: assess the feasibility of the vitamin d intervention delivered through the mow program. aim 3: obtain preliminary data on the effectiveness of the intervention on improving vitamin d status and reducing falls. data from this pilot study will: 1) provide estimates of the prevalence of falls and vitamin d insufficiency in home-bound older adults participating in the forsyth county mow program; 2) provide estimates of participant compliance and drop-out to a vitamin supplementation trial delivered as part of the mow program; 3) provide evidence for the efficacy of the vitamin d dose proposed in remediating vitamin d insufficiency; and 4) provide preliminary data on the potential benefit of vitamin d supplementation on falls in a home-bound older population.

Eligibility criteria:
inclusion criteria: * age ≥ 65 years old * forsyth county senior services meals-on-wheels recipient * willing to provide informed consent * willing to be randomized to vitamin d or active placebo control exclusion criteria: * hyperparathyroidism * kidney stones (within the past 2 years) * history of hypercalcemia * on dialysis * inability or contraindications to consume vitamin d supplements * taking prescription vitamin d2 or vitamin d3-containing supplements totaling \> 1000 iu/d * planning to move within the next 6 months

Keywords: vitamin d falls deficiency insufficiency