Original Study
Vitamin D Deficiency/Insufficiency Practice Patterns in a Veterans Health Administration Long-Term Care Population: A Retrospective Analysis

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Objectives

To evaluate the prevalence of vitamin D deficiency/insufficiency in long-term care patients at a Veterans Health Administration (VHA) hospital and to assess treatment and follow-up of low vitamin D levels.

Design

Observational cohort study.

Setting

VA hospital extended care center (ECC).

Participants

2218 ECC patients between January 2001 and December 2006 were screened.

Measurement

Serum 25-hydroxyvitamin D (25[OH]D) level, vitamin D therapy regimen, time to follow-up, documented adverse event to vitamin D therapy.

Results

Of 2218 patients admitted to the ECC during the study period, 229 (10%) had a vitamin D level measured. Among these 229 patients, 49% were vitamin D sufficient (25[OH]D ≥30 ng/mL), 14% were insufficient (25[OH]D = 21–29 ng/mL), and 37% were deficient (25[OH]D ≤20 ng/mL). Sixty-nine percent of patients with low vitamin D levels received some form of vitamin D therapy, whereas 43% received treatment as well as follow-up evaluation of vitamin D status within 3 months. Only 13% received a formulation of vitamin D appropriate for the severity of their deficiency/insufficiency with concurrent calcium supplementation and had a repeat vitamin D level within 3 months.

Conclusion

Vitamin D levels were measured infrequently in long-term care patients. Among those monitored, the rate of vitamin D deficiency/insufficiency is high. Few patients with low vitamin D status received proper treatment and follow-up. These data support the need to educate physicians regarding the high prevalence of vitamin D insufficiency/deficiency among long-term care patients to ensure that patients with low vitamin D levels are identified and treated appropriately.

Section snippets

Methods

A list of veterans residing in the ECC between January 1, 2001, and December 31, 2006, was extracted from the computerized patient record system (CPRS). All ECC patients during this time period were screened for inclusion; patients younger than 65 years old, hemodialysis patients, and patients with history of parathyroidectomy were excluded. All ECC patients meeting inclusion criteria with documented vitamin D levels during the specified time period were evaluated. This research protocol was

Results

There were 2218 unique admissions to the ECC between January 1, 2001, and December 31, 2006 (Figure 1). A total of 229 patients (10%) had at least one serum vitamin D measurement; 90% of patients did not have a serum vitamin D level measured. Seventy-two percent of patients with a serum vitamin D level met inclusion criteria for the study (n = 164). Patients who were younger than 65 and/or were receiving hemodialysis were excluded (n = 65). Of those 164 patients meeting inclusion criteria,

Discussion

Few studies have examined vitamin D status in elderly, male, long-term care patients. Our study revealed a very low frequency (10%) of vitamin D screening in our study population. In addition, among those patients in our predominantly male, long-term care, veteran population who had vitamin D levels assessed, our study found a high rate of vitamin D insufficiency and deficiency.

The high prevalence of vitamin D deficiency among screened ECC residents is consistent with the results of a study in

Conclusions

Our study suggests that vitamin D insufficiency/deficiency is prevalent among elderly, institutionalized, predominantly male veterans in a VA hospital Extended Care Center. In addition, few patients in our study who were identified to have low vitamin D levels received adequate treatment and follow-up. Based on our findings and the known benefits of vitamin D repletion therapy for preventing falls and fracture, as well as the emerging benefits reported in studies of numerous other chronic

Acknowledgments

We thank Nicholas Emanuele, MD, Professor and Division Director, Division of Endocrinology & Metabolism, Department of Medicine, Loyola University Health System for his review of this manuscript and suggestions. There are no conflicts of interest to report.

References (13)

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