Giving people living in nursing facilities vitamin D can reduce the rate of falls, according to a new Cochrane Review. This finding comes from a study of many different interventions used in different situations. In hospitals, multifactorial interventions and supervised exercise programs also showed benefit.
Older people living in nursing facilities or who have been admitted to hospital are much more likely to suffer a fall than those living in the community. In these settings, falls fairly often result in head injuries and fractures, with rates of hip fracture more than ten times higher in nursing facilities than in the community. It is important to try to prevent falls to avoid unnecessary stress for older people and their families, and to reduce pressure on staff and resources. However, prevention is complicated as falls usually happen for several or many different reasons.
“Many of the preventive measures used to avoid falls in older people are combined in what are called multifactorial interventions, so it can be very difficult to separate out the effects of all the different measures,” said lead researcher Ian Cameron, who is based at Sydney Medical School at the University of Sydney in Ryde, Australia.
The current review included 41 trials involving 25,422 older people, who were mostly women. Five trials tested the effects of giving vitamin D to patients in nursing facilities, where it was found to be an effective measure for preventing falls. The researchers found that multifactorial interventions, which often incorporated exercise, medication, or environmental factors including appropriate equipment, reduced the risk of falls in hospitals. In nursing homes, the effects of multifactorial interventions were not significant overall. However, the researchers concluded that multifactorial interventions provided by multidisciplinary teams in these facilities may reduce the rate and risk of falls.
“In our review, we saw limited evidence that these combined interventions work, but we could more confidently recommend them if they were delivered by a multidisciplinary team,” said Cameron. “Currently, there’s no one component of any of these programmes that stands out as more important than any other and we’re also missing data on whether increased supervision or new technologies such as alarm systems are of any benefit.”
Those Over 65 Should Take High Dose Vitamin D To Prevent Falls, Say Researchers
A daily supplement of vitamin D at a dose of 700-1000 IU reduces the risk of falling among older people by 19% according to a study published on the British Medical Journal website. But a dose of less than 700 IU per day has no effect.
Each year, one in three people aged 65 and older experience at least one fall, with around 6% resulting in a fracture. Fall prevention has therefore become a public health goal especially as the older segment of the population grows.
Several trials have shown that vitamin D improves strength and balance among older people, while others have found no significant effect on the risk of falling.
So an international team of researchers analysed the results of eight fall prevention trials to assess the effectiveness of vitamin D in preventing falls among older individuals (aged 65 or more). Differences in study design and quality were taken into account to minimise bias.
The pooled results showed that benefit from supplemental vitamin D on fall prevention depended on treatment dose.
Supplemental vitamin D2 and Vitamin D3 were investigated. 700-1000 IU supplemental vitamin D per day (vitamin D2 or vitamin D3) reduced falls by 19% and up to 26% with vitamin D3.
This effect was independent of age, type of dwelling or additional calcium supplementation. The effect was significant within two to five months of starting treatment and extended beyond 12 months.
Supplemental vitamin D did not reduce falls at a dose of less than 700 IU per day.
The use of active forms of vitamin D did not appear to be more effective than 700-1000 IU supplemental vitamin D. Active forms of vitamin D also cost more and are associated with a higher risk for hypercalcaemia (elevated calcium levels in the blood) than standard supplemental vitamin D.
To reduce the risk of falling, a daily intake of at least 700-1000 IU supplemental vitamin D is warranted in all individuals aged 65 and older, say the authors.
Higher doses may be even more effective and should be explored in future research to optimise the fall prevention benefit with vitamin D, they conclude.
Source: 1. Wiley-Blackwell (2010, January 24). Vitamin D supplementation can reduce falls in nursing care facilities. ScienceDaily. Retrieved January 24, 2010, from http://www.sciencedaily.com /releases/2010/01/100119213051.htm
