Preventing Falls in the Elderly

hipfracture1In elderly adults, falls occur frequently and are associated with significant morbidity and mortality. Research suggests that vitamin D may help prevent these dangerous falls.

Cross-sectional studies have shown that elderly adults with higher serum levels of vitamin D demonstrate a lower number of falls, as well as increased muscle strength. One meta-analysis found that vitamin D supplementation helped reduce the risk of falling by more than 20%. A randomized, controlled trial found that three months of supplementing with 1200 mg of calcium and 800 IU of vitamin D3 daily reduced the risk of falling by 49% in adults in a long-term geriatric care facility.

To maintain strong bones, older adults need more vitamin D than current guidelines recommend, according to a just-released report. While the Institute of Medicine suggests 400-600 IU of vitamin D daily, the American Medical Women's Association (AMWA) advises that all men and women over the age of 50 should consume 800-1000 IU of vitamin D each day.

The AMWA noted that In elderly adults, falls occur frequently and are associated with significant morbidity and mortality. Research suggests that vitamin D may help prevent these dangerous falls. Fatty fish and fortified milk or juice may provide dietary sources of vitamin D, though supplemental sources may be the easiest way for Americans to boost their vitamin D consumption.

While calcium has traditionally been considered the key to promoting bone strength, recent studies suggest vitamin D intake and exercise may be no less important in preventing osteoporosis. In fact, a study published last year demonstrated that serum levels of vitamin D, rather than dietary calcium intake, was most intimately connected with optimal calcium balance in the body, as measured by serum parathyroid hormone.


Vitamin D is typically well tolerated in adults at doses up to 2000 IU daily, with some research indicating that even higher levels up to 10,000 IU daily may be used safely without adverse effects.22, Excess vitamin D can lead to symptoms such as nausea, vomiting, poor appetite, constipation, and weakness. Vitamin D is contraindicated in individuals with elevated blood calcium levels or hypercalcemia. Individuals with kidney disease and people who use digoxin or other cardiac glycoside drugs should consult a physician before using supplemental vitamin D.

Patients should consult with their personal physicians to determine how much vitamin D best supports their unique health needs.

Special considerations for calcium and vitamin D in the elderly

Elderly persons are at increased risk for calcium and vitamin D insufficiency. There are also several alterations in body functions that can contribute to calcium loss from bone, and hence increased risk of osteoporosis.

hipfracture2With ageing there is:

* A decrease in dietary calcium intake, usually as a result of decreased overall dietary energy intake (e.g. poorer appetite, intercurrent illnesses, social and economic factors)
* A decrease in the intestinal absorption of calcium (exacerbated if vitamin D status is low)
* A decrease in the capacity of the intestinal cells to adapt to a low calcium intake, and increase their absorptive capacity
* Less frequent exposure to sunlight (e.g. elderly who are housebound, or institutionalized, or have reduced mobility), hence poorer vitamin D status
* A decrease in the capacity of the skin to synthesize vitamin D
* A decrease in the efficiency with which the kidneys can retain calcium, leading to increased calcium loss in the urine
* A decrease in the capacity of the kidneys to convert vitamin D into the most active form, 1,25-dihydroxyvitamin D



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