There has been some disagreement in the last 12+ years regarding the role of vitamin D and calcium in the prevention of falls in older adults. Some studies have yielded strong findings stating that the use of vitamin D and calcium is effective in preventing falls; others have refuted the claim based on multiple variables. This short article provides a survey of current thought and opinion, and identifies ways in which medically directed home care can implement holistic fall prevention for older adults.

The Variables of Vitamin D Study

A 2018 study entitled “To D or not to D” summed up the many variables related to the study of vitamin D usage in fall prevention for older adults. Among them:

  • Whether the patient has/does not have osteoporosis
  • Homeostatic vitamin D level of the patient
  • Residence of the patient: In the community or a care facility
  • Predisposition to risk of fracture
  • Whether vitamin D was taken in conjunction with calcium
  • Dosage levels

The report admits that “There is much confusion in the enormous literature published in the latest decades dedicated to this topic.” It also notes that “The problem comes with the use of supplementation in non-deficient community-dwelling adults, with and without osteoporosis.” For this group, “vitamin D supplementation has no benefit in preventing falls in older adults.”

Yet this raises the question: Do other older adult groups benefit from vitamin D?

The Essentials of Vitamin D

The facts surrounding vitamin D are reported by numerous clinical sources, studies, and articles as follows:

Overall, a review of the research indicates that there is enough evidence to justify the use of vitamin D and calcium for the right type of older adult - particularly those with a vitamin D deficiency. The vitamin appears strongly to reduce falls by improving bone mass, muscle function and strength.

Recommended daily dosage levels are often suggested to be in the 700-1000 IU range. But higher doses (4000+ IU daily) were associated with an increased risk of falls in a 2019 Canadian study – one reason why involvement of the patient’s physician in any supplemental program is critical.

39%

Decrease in falls among older adults 20 months after vitamin D + calcium supplements

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The magazine Chiropractic Economics (2021) reported that research in Osteoporosis International found that seniors taking vitamin D and calcium experienced a 27% decrease in falls after one year and a nearly 40% decrease after 20 months.

How Vitamin D Helps

Explaining the actions of vitamin D at the cellular level was summed up in an article appearing in Today’s Geriatric Medicine: “Vitamin D regulates calcium transport into muscle cells, which is necessary for muscle contraction,” said Denise Houston, PhD, RD, of the Sticht Center on Aging at Wake Forest University School of Medicine. “Vitamin D also plays a role in regulating protein synthesis within muscle cells, which is necessary for building and repairing muscle fibers.”

This is why, in her words, “individuals with low vitamin D levels are more likely to have worse physical function, slower gait, and worse physical performance and balance, as well as lower strength.”

“Lots of adults are vitamin D deficient. We all stay inside more, especially since the pandemic, so there’s less sunlight exposure. But older adults need to be sure they get enough vitamin D because it can reduce the risk of falls, which means it can reduce the risk of fractures.”

Christina Hahn, RN, MSN, and SeniorBridge Supervisor of Care Managers.

Vitamin D/Calcium as Part of a Home Care Plan

While the potential of vitamin D-calcium supplements – when used for appropriate patients – seems clearly positive, it is only one part of the picture for older adults trying to remain safe in his or her surroundings. Other care components include:

Safety. In the words of SeniorBridge Supervisor Christina Hahn: “First we look at the ground. Throw rugs, clutter and all tripping hazards should be cleared. We also avoid loose clothes that can interfere with steps, and make sure nonslip footwear is being used. It’s just lowering the risks in the environment.”

Medication. Many types of medications may increase a patient’s risk of falling. Polypharmacy concerns must be identified early and monitored regularly to have a holistic view of the patient’s health.

Exercise. This may include both aerobic and resistance training, balance and gait training, as well as weight-bearing exercises.

Sunlight. Over time, skin produces less vitamin D when exposed to sunlight, a natural part of aging – and another part of the rationale for supplements. But older adults still need to be outside, and according to a recent qualitative study, being outdoors often has strong value for reasons that go beyond vitamin D levels, such as mental health.

Diet. The list of foods that are naturally high in vitamin D is not long. Fortified milk and fish lead the way, particularly salmon, tuna, mackerel, and cod liver oil. Eggs, yogurt, and fortified orange juice join the list as well.

illustration of older man falling down

1 in 3

adults age 65+ fall at least once a year.

The 2018 report entitled “Prevention of Falls and Fractures: To “D” or not to “D” states that nearly a third of adults 65+ will fall in a year, with many adults experiencing recurring falls resulting in hip and other non-vertebral fractures, as well as hospitalizations and long-term care admissions. Sometimes even death.

In closing, we would simply say that fall prevention is ideally a holistic effort that includes vitamin D and calcium as part of an ongoing effort to keep older adults conscious of and safe within their surroundings.

The integrated care management model by SeniorBridge

Home care services vary widely in the services they provide.

SeniorBridge offers an integrated care management practice model that involves two components:

  1. Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
  2. A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.

NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.

For more information on medically directed home care, contact SeniorBridge.

Sources consulted:
National Library of Medicine/NIH (2018)
NIH (2021)
Springer (2016)
CADTH (2019)
Chiropractic Economics (2021)
Today’s Geriatric Medicine (2021)Springer (2020)

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