Wabe Nasir, Meulenbroeks Isabelle, Firempong Desiree C, Raban Magdalena Z, Nguyen Amy D, Close Jacqueline T, Lord Stephen R, Westbrook Johanna I
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia.
St Vincent's Clinical School, University of New South Wales Medicine, UNSW Sydney, Sydney, Australia.
Bone Rep. 2024 Jul 23;22:101791. doi: 10.1016/j.bonr.2024.101791. eCollection 2024 Sep.
Vitamin D is vital for musculoskeletal health, and supplementation may lower risk of falls. Past research in residential aged care (RAC) settings on the effects of vitamin D on falls have reported inconclusive findings, partly due to study design limitations. We utilised a longitudinal study design to assess the association between the use of vitamin D and falls over 36 months in RAC.
A longitudinal cohort study was conducted using routinely collected electronic data spanning 9 years from 27 RAC facilities in Sydney, New South Wales, Australia. The study included 4520 permanent residents aged 65 years or older who were admitted for the first time from 1 July 2014 and stayed for a minimum of one month. We identified daily vitamin D usage over 36 months, and measured adherence using the Proportion of Days Covered (PDC) metric. A PDC value of ≥80 % signifies optimal adherence. Primary outcomes were the number of all falls and injurious falls. A rolling time-varying predictor-outcome approach and Generalized Estimating Equations (GEE) were applied to determine the longitudinal link between vitamin D supplement use and subsequent risk of falls.
Over two-thirds of residents (67.8 %; = 3063) received vitamin D supplements during their stay, with a median PDC of 74.8 % among users, and 44.6 % ( = 1365) achieving optimal adherence. Increasing age, osteoporosis or fracture history, and dementia were associated with a greater likelihood of achieving optimal adherence. Crude fall incident rates were 8.05 and 2.92 incidents per 1000 resident days for all falls and injurious falls respectively. After accounting for relevant demographic and clinical factors, no significant links were observed between vitamin D supplement usage and fall outcomes: all falls (Incident Rate Ratio [IRR] 1.01; 95 % CI 1.00-1.02; = 0.237) and injurious falls (IRR 1.01; 95 % CI 1.00-1.02; = 0.091).
Vitamin D supplementation was not associated with a reduced risk of falls, suggesting it is not an effective intervention for preventing falls in RAC. While clinicians should ensure adequate vitamin D intake for residents' nutritional and bone health, it should not be a standalone falls prevention intervention in RAC populations.
维生素D对肌肉骨骼健康至关重要，补充维生素D可能会降低跌倒风险。过去在老年护理机构（RAC）中关于维生素D对跌倒影响的研究结果尚无定论，部分原因是研究设计存在局限性。我们采用纵向研究设计来评估在RAC环境中维生素D的使用与36个月内跌倒之间的关联。
利用澳大利亚新南威尔士州悉尼市27个RAC机构9年期间常规收集的电子数据进行了一项纵向队列研究。该研究纳入了4520名65岁及以上的首次入住居民，他们于2014年7月1日入院，至少停留了一个月。我们确定了36个月内每日维生素D的使用情况，并使用覆盖天数比例（PDC）指标来衡量依从性。PDC值≥80%表示最佳依从性。主要结局是所有跌倒和伤害性跌倒的次数。采用滚动时变预测变量 - 结局方法和广义估计方程（GEE）来确定维生素D补充剂使用与随后跌倒风险之间的纵向联系。
超过三分之二的居民（67.8%；n = 3063）在住院期间接受了维生素D补充剂，使用者的PDC中位数为74.8%，44.6%（n = 1365）达到了最佳依从性。年龄增加、有骨质疏松或骨折病史以及患有痴呆症与达到最佳依从性的可能性更大相关。所有跌倒和伤害性跌倒的粗发生率分别为每1000居民日8.05次和2.92次。在考虑了相关的人口统计学和临床因素后，未观察到维生素D补充剂使用与跌倒结局之间的显著联系：所有跌倒（发生率比[IRR] 1.01；95%置信区间1.00 - 1.02；P = 0.237）和伤害性跌倒（IRR 1.01；95%置信区间1.00 - 1.02；P = 0.091）。
补充维生素D与降低跌倒风险无关，这表明它不是预防RAC中跌倒的有效干预措施。虽然临床医生应确保居民摄入足够的维生素D以维持营养和骨骼健康，但在RAC人群中它不应作为单独的跌倒预防干预措施。
