Serum Vitamin D and Falls in Older Women in Residential

Care in Australia
Leon Flicker, PhD,

Kate Mead, B App Sc,

w
Robert J. MacInnis, G Dip epi biostat,
8
Caryl Nowson, PhD,
z
Sam Scherer, MB BS,
#
Mark S. Stein, PhD,

Jennifer Thomas, RN,

John L. Hopper, PhD,

z
and John D. Wark, PhD
w
OBJECTIVES: To determine the prevalence of vitamin D
deficiency in older people in residential care and the
influence that the level of vitamin D may have on their
incidence of falls.
DESIGN: Prospective cohort.
SETTING: Residential care facilities for older people in
several states of Australia.
PARTICIPANTS: Six hundred sixty-seven women in low-
level care and 952 women in high-level care, mean age 83.7
years.
MEASUREMENTS: Serum 25-hydroxyvitamin D (25D)
levels and recognized risk factors for falls including current
medication use, a history of previous fractures, weight,
tibial length (as a surrogate for height), cognitive function,
walking ability, and frequency of going outdoors were
determined. The women in low-level care and high-level
care were followed for an average of 145 and 168 days,
respectively. Falls were recorded prospectively in diaries
completed monthly by residential care staff.
RESULTS: Vitamin D deficiency (defined as a serum 25D
level below 25 nmol/L) was present in 144 (22%) women in
low-level care and 428 (45%) in high-level care. After
excluding 358 bed-bound residents and adjusting for
weight, cognitive status, psychotropic drug use, previous
Colles fracture, and the presence of wandering behavior, log
serum 25D level remained independently associated with
time to first fall. The adjusted hazards ratio was 0.74 (95%
confidence interval 5 0.590.94; P 5 .01), implying a 20%
reduction in the risk of falling with a doubling of the
vitamin D level.
CONCLUSION: Vitamin D deficiency is common in
residential care in Australia. A low level of serum vitamin
D is an independent predictor of incident falls. J Am Geriatr
Soc 51:15331538, 2003.
Key words: vitamin D; falls; fractures; residential facil-
ities; Australia
V
itamin D deficiency may lead to fracture through
increased falling and through an effect on bone mass
and quality. Falling may be a consequence of impaired
neuromuscular function,
1,2
whereas bone may be reduced
in mass and in matrix mineralization.
3
Studies of healthy
rural and urban Australians across a wide age range have
found a low prevalence of vitamin D deficiency.
46
Aus-
tralia has a generally sunny climate, and fortification of the
food supply with vitamin D has not been considered
necessary. For this reason, there is not widespread vitamin
D supplementation of food in Australia, except for
margarine.
The situation may be dramatically different in older
women who are frail or in residential care, because they are
often hampered physically and unable to move freely
outdoors. In Australia, there are two main forms of assisted
residential care for older people. In low-level care facilities,
often called hostels (assisted living facilities), residents are
provided with meals and may be assisted with bathing and
dressing but are generally independently mobile. There is no
specific requirement for care to be provided by registered
nurses. In high-level care facilities, commonly known as
nursing homes, most residents are dependent on help in their
activities of daily living and in mobility, and there is constant
supervision by registered nurses. Ninety percent of residents
in high-level care and 40% in low-level care are cognitively
This study was supported by the National He alth and Medical Research
Council (NHMRC), the Victorian Health Promotion Foundation, The
Shepherd Foundation, and The Gerontology Foundation. Dr. Stein received
support from The Wenkart Foundation and The Royal Australasian College
of Physicians Vincent Fairfax Family Foundation Research Fellowship.
Professor Hopper is supported by a NHMRC Principal Research Fellowship.
Address correspondence to Professor Leon Flicker, Department of
MedicineFGeriatric Medicine, University of Western Australia, Royal
Perth Hospital, Box X2213 GPO, Perth Wa 6001. Australia.
E-mail: leonflic@cyllene.uwa.edu.au
From the

Department of MedicineFGeriatric Medicine, University of

Western Australia, Perth, Australia;
w
Department of Medicine and
z
Centre
for Genetic Epidemiology, University of Melbourne, Melbourne, and

Department of Diabetes and Endocrinology, Royal Melbourne Hospital,

Melbourne, Australia;
8
Cancer Epidemiology Center, The Cancer
Council Victoria, Melbourne, Australia;
z
School of Health Sciences,
Deakin University, Burwood, Melbourne, Australia; and
#
Royal
Freemasons Homes of Victoria, Melbourne, Australia.
JAGS 51:15331538, 2003
r 2003 by the American Geriatrics Society 0002-8614/03/$15.00

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