Nursing Home and Assisted Living Facility Staff Must Properly Care for Patients At Risk of Falls

Many older adults are at high risk of falls that can cause serious injury and debilitation.  Impaired lower extremity function increases the likelihood for falls, hip fractures, sarcopenia, and loss of independence.  Given that the elderly population has been experiencing major growth worldwide, interventions to prevent functional decline and the impending undesirable and costly consequences are in critical need.

Vitamin D supplementation has been studied as a possible preventative strategy in slowing the process of functional decline through its direct association on muscle strength.  However, there is a lack of strong evidence on vitamin D’s effectiveness in improving lower extremity function.

On a mechanical level, there is evidence that vitamin D is associated to muscle strength and lower extremity function.  First, a clinical lack of vitamin D is associated to proximal muscle weakness. Second, human muscle tissue expresses vitamin D receptor. Third, studies have shown that in elderly individuals, vitamin D receptor activation in muscle encourages the synthesis of protein in type II fast twitch muscle fibers associated with the prevention of falls.

A recent study published in an article from The Journal of the American Medical Association (JAMA) explored the hypothesis that higher monthly doses of vitamin D would decrease the risk of functional decline and consequently prevent falls. Study participants were seniors who were 70 years and older who had a previous experience of falls and who were at high risk of vitamin D deficiency and functional decline.

The study’s results showed that seniors who took higher doses of vitamin D did not experience benefits in lower extremity function, had the highest percentages of fallers, and experienced the most falls compared with seniors who did not take vitamin D supplementation.

The study concludes that compared with a monthly standard-of-care dose of vitamin D, seniors ages 70 years and older with prior experience of falls who took two monthly higher doses of vitamin D showed no improvement on the prevention of functional decline and exacerbated risk of falls. The researchers of the study therefore concluded that vitamin D taken in high doses may not be effective in elderly people with a fall history because of a potentially negative effect on falls. More research is needed to properly assess the study’s findings for daily dosing regimens.

Falls are a major concern in regard to the older adult population and must be addressed in nursing homes and assisted living facilities. Staff in these long-term care facilities must develop and follow an effective and detailed plan of care to prevent falls from occurring, especially for those residents most vulnerable to a fall incident.  Mobility functioning is critical for elderly patients and must be maintained for as long as possible. Nursing home and assisted living facility staff should encourage residents to engage in appropriate physical activities that include resistance training, which can enhance muscle strength and incur psychological benefits, as well. Maintaining patients’ physical functioning by incorporating the proper regimes and care will contribute to the protection of their quality of life and life satisfaction.