Nutrition of the elderly at home II. Intakes of vitamins

Vitamin D deficiency in older people

Because of changes that occur with aging, older people with any other risk factors for vitamin D deficiency are likely to have inadequate stores of this vitamin. The consequences of vitamin D deficiency are likely to be losses in bone, strength, and function and the development of pain. Many questions remain regarding screening, prevention, and treatment of vitamin D deficiency. Supplementation may be unnecessary in most healthy, ambulatory seniors. Excessive supplementation in this group may lead to vitamin D toxicity. There does seem to be a role for supplementation in homebound older people who will not get adequate vitamin D from sunlight exposure. This population is at particular risk of developing vitamin D deficiency. Issues such as inadequate diet, physiologic changes with aging, polypharmacy, and diseases that interfere with vitamin D metabolism contribute to this risk. In such circumstances, a recommendation of 800 IU per day is reasonable. An alternative to daily dosing is a single oral dose of 100,000 IU of vitamin D (ergocalciferol or cholecalciferol) every 3 to 6 months. A simple maneuver is for geriatricians, who see many chronically ill patients with low vitamin D stores (who are likely to be seen in the office every 3 to 6 months), to administer vitamin D during the office visits. These dosing schedules have not been associated with toxicity and can be considered safe in homebound (sunlight-deprived) older adults.(ABSTRACT TRUNCATED AT 250 WORDS)

Is the recommended daily allowance for vitamin D too low for the homebound elderly?

A population of sunlight-deprived elderly was studied to determine the daily intake of vitamin D and whether dietary intake was sufficient to maintain a normal vitamin D status. Twenty-two subjects over 65 years old with serum creatinine less than 180 mumols/L and confined indoors for more than 6 months were chosen from the community and a nursing home in Southeast Baltimore. Three-day food records were obtained along with serum levels of 25-hydroxyvitamin D (25-OHD), 1,25-dihydroxyvitamin D (1,25-(OH)2 D), and intact parathyroid hormone (PTH). The mean daily vitamin D intake was over twofold greater than the adult Recommended Daily Allowance (RDA) of 200 IU. The mean 25-OHD level was 40 nmol/L (normal 25-138 nmol/L) with seven patients less than 25 nmol/L. Of these participants with 25-OHD values less than 25 nmol/L, the mean vitamin D intake was 467 IU (range 36-1096 IU). We conclude that the current RDA seems inadequate for many older individuals who do not get sun exposure. This particular population of elderly is at risk to develop vitamin D deficiency and the associated complications.

Nutritional hypovitaminosis-D and the genesis of osteomalacia in the elderly

A review is presented of the genesis of osteomalacia due to dietary lack of vitamin D in the elderly in the United Kingdom. Subjects at high risk are identified and the diagnostic difficulties discussed. The importance of dietary vitamin D and exposure to sunlight in relation to vitamin status is stressed. The role of vitamin D in calcium metabolism is now much more clearly defined; the final active form of the vitamin is 1,25-dihydroxy-vitamin D, which acts like a hormone after the vitamin molecule has undergone two chemical modifications in the liver and kidney. A correlation between lack of vitamin D and femoral neck fractures has been established. Six illustrative cases of osteomalacia in the elderly due to dietary lack of vitamin D are reported.

A dietary survey of older people in Edinburgh

1. Dietary histories covering 1 week were obtained from 212 men and 263 women, aged 62--90 years, who formed a random sample of the older people living in a defined area of Edinburgh. The histories were validated by 2 d weighed-diet records for 219 of the subjects. 2. Nutrient intakes are given as mean values and standard deviations, and as percentage distributions of intake relative to the recommended intakes of nutrients. Intakes are also related to factors which might affect diet adversely. 3. Mean values obtained suggested that intakes were less than recommended intakes for more nutrients for women than for men, particularly values for energy and vitamin D. Values for percentage distributions indicated that a substantial proportion of all subjects had low intakes of ascorbic acid and vitamin D, that the energy intake of many women was low and that for most nutrients a greater proportion of men than of women had the recommended intake. Factors assocIATED With significant proportions of subjects with less than the recommended intakes were mental illness in women and deafness and severe dyspnoea in men. 4. Possible action to improve the diet of the elderly is discussed.

Vitamin-D status in long-stay geriatric patients

Very low concentrations of plasma-25-hydroxycholecalciferol, 25(OH) D3, were found in patinets in a long-stay geriatric hospital.