THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Week: 536.3 Guest: Dr. F. Michael Gloth, Johns Hopkins Hospital Researcher Topic: The Elderly and Vitamin D Producer/Host: Steve Girard

NEMA: Today, we're talking about the role of Vitamin D in the health of the elderly...and we're here with researcher Dr. Michael Gloth of the Helix Health System...what does the latest information show?

GLOTH: What we've done is taken individuals who get very little sunlight, individuals we describe as homebound, so they have not been outdoors for, at least in the study that we've done, for at least a six month period of time. We also focused on elderly being individuals over the age of 65 years. What we determined was that individuals, whether they be in the nursing home setting, or out in the community, if they didn't get a contribution of sunlight, which is our primary source of vitamin D, they didn't get a contribution of sunlight to their vitamin D stores, that they were very likely to be vitamin D deficient. In the nursing home population, we found that a little more than a third of the people in the nursing home population who were indoors and over the age of 65 turned out to be vitamin D deficient. If we looked at the community dwellers, it was actually worse...a little more than half those individuals who were confined indoors over the age of 65 were found out to be vitamin D deficient.

NEMA: What are the effects of these deficiencies?

GLOTH: The concern is vitamin D deficiency has been associated with pain syndromes, with loss of bone, making them more susceptible to fracture. It's also been associated with muscle weakness, and decreases in functional levels. So, getting inadequate amounts of vitamin D may make a person less independent, and also impair their quality of life, because in addition to being less independent, therefore less mobile, it also may make them more uncomfortable, because of various pain syndromes..or, obviously, if a fracture develops because of that, it complicates both pain and mobility.

NEMA: In nursing homes, you see people sitting by the window, even people in their own homes, elderly people sitting by the windows, soaking up some rays, but that really doesn't help, does it?

GLOTH: No...one of the problems with glass is that it blocks out the wavelength of ultraviolet radiation necessary to convert the precursor molecules in the skin to Vitamin D...so, you can sit in a solarium all you want, but you're not gonna get adequate supplies of Vitamin D through that mechanism. You really have to get outdoors, or you have to take a supplement of Vitamin D in order to get adequate amounts.

NEMA: But in nursing homes, they get vitamin supplements....is there a new idea then of how much vitamin D is enough for the elderly?

GLOTH: Well, it is a difficult question to answer. We haven't come up with exactly the right amount, but one of the things we've been able to determine is that the recommended dietary allowance is probably fine for most ambulatory, older individuals...but when you get somebody who gets no contribution from sunlight to their vitamin D stores, it probably is not an adequate amount. So that, most individuals who are confined indoors need a level certainly more than 400 international units, but probably along the range of 800 to 16 hundred international units a day in order to maintain normal stores. Normally, a multiple vitamin tablet contains about 400 international units of Vitamin D, so we're talking more than would be in a normal multi-vitamin tablet.

NEMA: Dr. Michael Gloth, affiliated with Helix Health Systems and with a new Johns Hopkins Hospital study on Vitamin D and the elderly. I'm Steve Girard.