vitamin d and calcium supplementation at danish nursing homes

Conditions: Frailty; Physical Disability; Aging; Muscle Weakness

Summary: nursing home residents are in high risk of vitamin d deficiency, which negatively affects bone health. vitamin d and calcium supplements have shown to increase bone density and reduce fracture risk and may affect daily physical functioning. therefore, the danish health authority recommends all nursing home residents a daily supplement of 20 µg vitamin d and 800-1000 mg calcium. however, adherence to the recommendation is low. the present project hypothesizes that this low adherence results in a high number of residents with a deficient or insufficient vitamin d status, and that daily physical functioning can be improved or maintained by an improved adherence to the recommendation.

background: residents in nursing homes belong to one of the high-risk groups when it comes to vitamin d deficiency, which is associated with increased risk of osteoporosis, muscle weakness and generally decreased physical functioning and frailty. therefore, the danish health authority recommends that all residents in nursing homes receive a daily supplement of 20 µg of vitamin d in addition to 800-1000 mg of calcium. some systematic reviews and meta-analyses find that daily supplementation of 20 µg of vitamin d can improve physical functioning and muscle strength among older adults, whereas others do not find an effect. however, most studies are performed in non-institutionalized older adults. an online survey conducted in may 2020 has revealed that the recommendation of giving residents in nursing homes a daily supplement of 20 µg vitamin d and 800-1000 mg calcium is not routine clinical practice in denmark. the danish health authority highlights the model for improvement as a tool to use when working with evidence-based practice within prevention and health promotion in the municipalities. objectives: * to increase use of the recommended supplements with vitamin d and calcium among residents at nursing homes using the model for improvement as a methodological tool. * to investigate the effect of improved vitamin d and calcium supplement use on vitamin d status and daily physical functioning among residents at nursing homes. hypotheses: * vitamin d status among residents at nursing homes are low and the majority can be defined as vitamin d insufficient. * vitamin d status and daily physical functioning of the residents are positively affected by an improved implementation of the recommendation. design and methods: the project has a quasi-experimental design without control groups. it estimates the causal impact of the model for improvement on implementing the specific recommendation in a realistic setting at the nursing homes. the study includes the following endpoints related to the older adults at the nursing homes evaluated before and after the intervention: * number of residents at the participating nursing homes taking supplementation of ≥20 µg of vitamin d and/or ≥800 mg of calcium ≥5 days/week. * number of residents at the participating nursing homes classified as having an insufficient and deficient vitamin d status (serum 25-hydroxyvitamin d (25(oh)d \<50 nmol/l and \<25 nmol/l, respectively) * mean daily physical functioning measured as muscle strength, 30-s chair-stand test, and a timed-up-and-go test.

Eligibility criteria:
inclusion criteria: * being a resident at the participating nursing homes * understand and speak danish in order to understand the study procedures * be able to give informed consent exclusion criteria: * having kidney diseases * receiving medication which may induce adverse effects in combination with vitamin d and/or calcium supplements * being terminally ill * declared incompetent