Vitamin D and Exercise May Help Prevent Falls in Elderly

By Christine S. Moyer, amednews staff.

Prescribing a vitamin D supplement and recommending exercise for patients 65 and older could reduce their risk of falling, according to a recent evidence review.

The review, published in the Dec. 21, 2010, issue of Annals of Internal Medicine, was commissioned by the U.S. Preventive Services Task Force to help the agency update its recommendation for preventing falls in the elderly. Before the guidelines are published, a draft will be posted for public comment online.

The task force does not have recommendations on primary care physicians counseling patients on fall prevention. But in 1996, the task force reviewed the effectiveness of counseling to prevent household and recreational injuries, including falls, by age group.

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Medical News: Vitamins and Exercise Key to Fall Prevention - in Geriatrics, General Geriatrics from MedPage Today

By Crystal Phend, Senior Staff Writer, MedPage Today

Exercise and vitamin D supplements top the list for primary care interventions to prevent falls in older adults, according to a review that will be the basis for updated U.S. Preventive Services Task Force (USPSTF) recommendations.

Some comprehensive multifactorial fall assessment and management interventions can be considered safe options to reduce falls in older adults in the community as well, Yvonne L. Michael, ScD, SM, of Drexel University School of Public Health in Philadelphia, and colleagues reported in the Dec. 21 issue of the Annals of Internal Medicine.

The update to USPSTF recommendations on primary care interventions for fall prevention is due in draft form for public comment soon.

The approach represents a shift for the Task Force from its traditional model, which focused on specific diseases, well-defined preventive interventions, and evidence for improved health outcomes before making recommendations, noted an accompanying article by the USPSTF Geriatric Workgroup.

"However, applying this model to prevention for very old patients has been problematic," they wrote in Annals.

Many geriatric disorders are multifactorial, while older adults are often excluded from clinical trials; and important outcomes -- such as functional disability and quality of life -- may not be measured and reported in ways that are conducive to evidence synthesis and interpretation, they pointed out.

An accompanying editorial by Mary E. Tinetti, MD, of Yale, applauded the USPSTF's willingness to change to better address the needs of older adults.

"The timing is excellent," she wrote in Annals, noting that Medicare will soon cover annual health risk assessment visits and customized prevention plans.
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Vitamin D in the Older Adult: The Vitamin D Conundrum

by Laura A. Stokowski, RN

Vitamin D has received a great deal of attention of late in the scientific and lay literature. Scores of mostly observational studies have investigated the possible role of vitamin D in the prevention of chronic diseases ranging from cancer to cardiovascular disease to autoimmune disorders. No one doubts that vitamin D is essential to the health of older adults; the abundance of vitamin D receptor binding sites throughout the human genome highlight the pleiotropic nature of vitamin D in the human body.^[1] However, this evidence has not consistently translated into proof of clinical benefit, leaving many wondering whether vitamin D supplementation should be recommended for older adults, or if they are fine without it.

The Institute of Medicine (IOM) recently released a new report^[2] that attempts to clear up some of this confusion, at least as far as is possible with current evidence. Dietary Reference Intakes for Calcium and Vitamin D is the product of a comprehensive review of literature and data on the health effects of vitamin D. On the basis of this review, the IOM has revised its 1997 recommendations for dietary intake of vitamin D to maintain the health of North Americans.
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Vitamin D Marker for HF Deaths from MedPage Today

By Charles Bankhead, Staff Writer, MedPage Today

Heart failure death occurred two to three times more often in people with vitamin D insufficiency or deficiency compared with those who had normal levels of the vitamin, according to data from a government survey.

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Vitamin D Deficiency May Be Linked to Cognitive Decline

By Michael Smith, North American Correspondent, MedPage Today

Low levels of vitamin D appear to be associated with an increased risk of cognitive decline among older people, according to researchers.

In an observational study conducted among more than 800 Italians ages 65 and older, severe vitamin D deficiency was associated with a 60% increase in the risk of substantial cognitive decline (by a standard measure), according to David Llewellyn, PhD, of the University of Exeter in Exeter, England, and colleagues.

The findings -- if confirmed by further studies and randomized clinical trials -- "open up important new possibilities for treatment and prevention," Llewellyn and colleagues wrote in the July 12 issue of the Archives of Internal Medicine.
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Low Vitamin D Linked To The Metabolic Syndrome In Elderly People

from Medical News Today

A new study adds to the mounting evidence that older adults commonly have low vitamin D levels and that vitamin D inadequacy may be a risk factor for the metabolic syndrome, a condition that affects one in four adults. The results were presented at The Endocrine Society's 92nd Annual Meeting in San Diego.

"Because the metabolic syndrome increases the risk of diabetes and cardiovascular disease, an adequate vitamin D level in the body might be important in the prevention of these diseases," said study co-author Marelise Eekhoff, MD, PhD, of VU University Medical Center, Amsterdam.

The researchers found a 48 percent prevalence of vitamin D deficiency. The study consisted of a representative sample of the older Dutch population: nearly 1,300 white men and women ages 65 and older.

Nearly 37 percent of the total sample had the metabolic syndrome, a clustering of high blood pressure, abdominal obesity, abnormal cholesterol profile and high blood sugar.

Subjects with blood levels of vitamin D (serum 25-hydroxyvitamin D) lower than 50 nanomoles per liter, considered vitamin D insufficiency, were likelier to have the metabolic syndrome than those whose vitamin D levels exceeded 50. That increased risk especially stemmed from the presence of two risk factors for the metabolic syndrome: low HDL, or "good" cholesterol, and a large waistline.

There was no difference in risk between men and women, the authors noted.

The study included subjects who were participating in the Longitudinal Aging Study Amsterdam. Although the data were from 1995 and 1996, Eekhoff said they expect that vitamin D inadequacy remains prevalent among whites in the Netherlands.
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Cardiovascular Risk Declines When Vitamin D Is Normalized

by Shelley Wood

Adding heft to the hypothesis that vitamin-D deficiency is linked to cardiovascular disease, a new study has found that people with low vitamin-D levels who managed to normalize their levels were significantly less likely to develop cardiovascular events over up to six years of follow-up.

The study was presented as a poster by Dr Tami L Bair (Intermountain Medical Center Heart Institute, Murray, UT) earlier this week at the American College of Cardiology (ACC) 2010 Scientific Sessions.

According to coauthor Dr Joseph B Muhlestein (Intermountain Medical Center Heart Institute), the study looked at baseline and subsequent vitamin-D levels in 9491 subjects with known vitamin-D deficiency, rechecked their vitamin D, then compared subsequent rates of death, coronary artery disease, MI, heart failure, stroke, and renal failure among those who managed to bring up their vitamin-D levels with those who remained vitamin-D deficient. A cut point of <30 ng/mL was used to define vitamin-D deficiency.
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Trial Of Vitamin D Supplementation To Reduce Falls In Nursing Care Facilities

from Medical News Today

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.

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Lack of Vitamin D Linked to High Blood Pressure - Forbes.com

(HealthDay News) -- Low blood levels of vitamin D in younger women tripled their risk of high blood pressure 15 years later, new research has found.

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We All Need a Little More D. A New Report on The Sunshine Vitamin

We All Need a Little More D. A New Report on The Sunshine Vitamin Click above for a video presentation

Cognitive Impairment in Older Persons Linked to Vitamin D Deficiency

By Kristina Fiore, Staff Writer, MedPage Today Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston. A low level of vitamin D in older patients is associated with a higher risk of cognitive impairment, researchers here said.

Those with the lowest levels were more than twice as likely to have cognitive impairment (P<0.001),>Journal of Geriatric Psychology and Neurology.

"Our results suggest that high levels of serum 25-hydroxyvitamin D are associated with lower odds of cognitive impairment," the researchers said.

As patients age, however, the capacity of their skin to absorb vitamin D from sunlight decreases, often requiring they obtain it from other sources, they said.

Evidence from in vitro and animal studies suggests vitamin D may be neuroprotective, but there is a "paucity of reliable evidence" from clinical and population studies, the researchers said.

So to examine the association between serum vitamin D and cognitive impairment, the researchers conducted a cross-sectional study of 1,766 persons 65 and older in the Health Survey for England 2000.

The researchers found that vitamin D levels were higher in those with normal cognition than in those who were cognitively impaired.

About half of patients with cognitive impairment had the lowest serum levels of the vitamin.

In a multivariate analysis, those with the lowest levels of vitamin D were 2.3-fold more likely to be cognitively impaired than those with the highest levels (95% CI 1.4 to 3.8, P=0.001).

In that analysis, the association was stronger in men, which may be attributable to differences in BMI, the researchers said.

Defending Against Disease -- With Vitamin D

New Studies Suggest It Isn't Just Bones That Might Benefit By MELINDA BECK Wall Street Journal, July 15, 2008; Page D1 It's long been known that D is crucial for strong bones. But new research suggests that it also protects against a wide variety of diseases. A study in the Archives of Internal Medicine last month found that men with low D had a higher risk for heart attacks. Other studies have linked low D with cancer of the breast, ovary, prostate, stomach, bladder, esophagus, kidney and lung. Low levels of D also have been associated with high blood pressure, stroke, diabetes, periodontal disease, rheumatoid arthritis, multiple sclerosis, macular degeneration, mental illness and chronic pain.

Vitamin-D Deficiency Now Associated With Increased Mortality

News Author: Sue Hughes Another study suggesting a link between low levels of vitamin D and cardiac risk has been published, this time showing that vitamin-D deficiency is associated with both cardiovascular mortality and all-cause mortality. The study, published in the June 23, 2008 issue of the Archives of Internal Medicine, was conducted by a group led by Dr Harald Dobnig (Medical University of Graz, Austria). They note that it has been estimated that 50% to 60% of people do not have satisfactory vitamin-D status, and this is probably related to factors such as urbanization, demographic shifts, decreased outdoor activity, air pollution and global dimming, and decreases in the cutaneous production of vitamin D with age.