Old people and nursing home residents get too little vitamin D

- and lacking responsibility contributes to the complicated COVID-19 infections

Health authorities worldwide recommend supplements of vitamin D to older people, nursing home residents, and people who get too little sun. However, most old people are not familiar with these recommendations, and vitamin D supplements are not handed out routinely in old age homes. Because of the widespread problems with vitamin D deficiency in these vulnerable groups, their risk of disease is increased. Also, they risk that a COVID-19 infection becomes complicated and life-threatening. A new British study set out to investigate the current practical guidelines for administering vitamin D supplements to nursing home residents and the responsibility for making sure this happens. The investigators believe that we desperately need a solution to this serious problem right now, considering the scope of the pandemic.

Vitamin D controls a number of different genes and physiological functions that are important for bones, cardiovascular health, cancer prevention, and many other things. Vitamin D is also vital for the immune defense and for making sure that it does not overreact with hyperinflammation that can complicate COVID-19 infections and influenza and make them life-threatening. We only get a very limited amount of vitamin D from our diets. The sun is our primary source. However, during the winter period the sun at our latitudes is not strong enough to enable vitamin D synthesis. Furthermore, older people tend to have very thin skin that does not synthesize vitamin D all that effectively. Many older people and nursing home residents do not get enough sun in general and risk a chronic vitamin D deficiency. What makes matters worse is that the health authorities’ guidelines for vitamin D are not enforced systematically, most likely because vitamin D is neither considered a food nor a medicine but belongs somewhere in between the two categories.

Nursing home residents have a blatant vitamin D deficiency

The aim with the new British study was to find out who is responsible for making sure nursing home residents get enough vitamin D. By conducting 13 interviews of nursing home managers, general practitioners, and health professionals in two regions of southern England, the scientists discovered that nursing home residents were not routinely supplemented with vitamin D. Most of the participants in the survey, including the doctors, were of the opinion that the monitoring of vitamin D status of nursing home residents should be handled by the physicians.
Nursing home managers felt that they were incapable of making the right decisions about vitamin D or administering supplements of the nutrient without a prescription.
The scientists ended up concluding that the heath authorities’ recommendations for vitamin D do not necessarily help identify which individuals actually need a supplement. What is needed is essentially a shift of paradigm, one that would allow to view vitamin D both as a nutrient and as a type of medicine that offers protection for vulnerable nursing home residents. Also, it is crucial to place a responsibility for making sure that nursing home residents get both their medicine and their vitamin D.
The researchers behind the new study explain that the widespread vitamin D deficiency among nursing home residents may cause COVID-19 to spread more easily and may also increase its severity. Old people in nursing homes are very vulnerable and there is an urgent need for a quick solution to this problem.

How much vitamin D do we need?

In Denmark, the reference intake (RI) for vitamin D for white adults up to 70 years of age is 5 micrograms. The Danish Health Authority recommends 10 micrograms/day for pregnant women, infants, dark-skinned individuals, and people who do not expose themselves to direct sunlight. A daily 20-microgram supplement is recommended for nursing home residents and people older than 70.
Many scientists claim that our actual need for vitamin D is a lot higher. Their recommendations typically lie in the range between 30 and 100 micrograms per day. Levels of vitamin D in the blood should at least be 50 nmol/L. A 75-120 nmol/L level would be even better. In order to reach these levels, it would require daily supplementation from October to May. Supplementation all year is necessary if you don’t get enough sun during the summer period.
Vitamin D is a lipid-soluble vitamin. Therefore, you get the best absorption and utilization with a supplement that contains vitamin D in oil.

References:

Joseph Williams, Carol Williams. Responsibility for vitamin D supplementation of elderly care home residents in England: falling through the gap between medicine and food.

Northwestern University. Vitamin D levels appear to play role in COVID-19 mortality rates. Science Daily. May 2020

Ali Daneshkhah et al. The Possible Role of Vitamin D in Suppressing Cytokine Storm and Associated Mortality in COVID-19 Patients. medRxiv April 30, 2020

Eamon Laird, Rose Anne Kenny. Vitamin D deficiency in Ireland – implications for COVID 19. Results from the Irish Longitudinal Study on Ageing (TILDA) April 2020