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. 2022 Nov 11;81(7):804–822. doi: 10.1093/nutrit/nuac091

Table 2.

Vitamin D status of older adults in nursing homes

Reference type of study recruitment locations Country No. of participants Age, mean (SD), y Sex (no.) 25(OH)D status, mean (SD), nmol/L 25(OH)D cutoff for deficiency, nmol/L Deficiency, % Additional % 25(OH)D cutoff data BMI, kg/m2 sunlight exposure, mean (SD) Dementia/cognitive impairment, % vitamin D supp use, % Dietary vitamin D, IU/d Dietary calcium, mg/d mean (SD)

  • Portela et al (2010)21

  • NR

  • Social-status institutions

 Spain and Argentina 97 C

  • Spain: 82 (7.1)

  • Argentina: 81.3 (7.9)

 97 F; 0 M

  • Spain: 29.25 (5.8)

  • Argentina: 34 (6.1)

 <50

  • Spain: 90

  • Argentina: 86

  • Spain: 47% severely deficient (<25 nmol/L)

  • Argentina: 32% severely deficient

  • 0% >75 nmol/L

  • NR

  • Active day: few minutes between 10 am and 4 pm

  • NR

  • Excluded if taking vit D supp

  • Spain: 50.8 (NR)

  • Argentina: 160 (NR)

  • 800 (NR)

  • Kuwabara et al (2010)22

  • Cross-sectional

  • 1 NH

 Japan 50 C 87.6 (8.0) 35 F; 15 M 27.75 (3.1) NR NR

  • Hypovitaminosis: <50 nmol/L

  • 40% <25 nmol/L

  • 58% 25–50 nmol/L

  • n = 1 ≥ 50 nmol/L

  • 21 (3.8)

  • NR

  • NR

  • NR

  • 160 (1.4)

  • 494 (53)

  • McWilliams et al (2011)23

  • Prospective cohort

  • NH residents admitted to hospital

 USA 71C 81.5 (10.9) 49 F, 29 M 22.7 ± 11.0 47.5 NR 72% had low status (<75 nmol/L)

  • NR

  • NR

  • 53.5% Dementia

  • NR

  • NR

  • NR

  • Sitter et al (2011)24

  • NR

  • Two personal NHs

 Canada

  • 14 P

  • 13 C

 83 (9.8) 9 F; 5 M

  • Time A (2–3 mo after admission): 55 (25)

  • Time B (4 mo after time A): 58.5 (24.9)

 <25

  • Time A: 8

  • time B: 0

  • Time A

  • 75% insufficient (25–75 nmol/L); 17% optimal (75–250 nmol/L)

  • Time B

  • 83% insufficient; 17% optimal

  • NR

  • NR

  • Excluded if had either

  • NR

  • NR

  • NR

  • Kruavit et al (2012)25

  • Cross-sectional

  • 2 Elderly care institutions

 Thailand 93 C 75.2 (6.0) 93 F; 0 M 69.3 (15.4) NR NR

  • 61.3% Insufficiency (≤70 nmol/L)

  • 38.7% >70 nmol/L

  • 21.5% <50 nmol/L

  • 77.4% <75 nmol/L

  • 24.1 (3.6)

  • 16% >2 h/d

  • NR

  • Ca + vit D supp: 6.5%

  • NR

  • 322.3 (158.4)

  • Oudshoorn et al (2012)26

  • Cross-sectional

  • Residential homes

 The Netherlands 426 C 81 (7.2) 315 F; 111 M 39.1 (21.4) [25(OH)D3] NR NR

  • 67% <50 nmol/L

  • 27% <25 nmol/L

  • NR

  • NR

  • Mean (SD) MMSE score: 26.5 (2.6)

  • excluded if had dementia

  • prescribed Ca + vit D: 12%

  • not prescribed Ca + vit D: 7%

  • NR

  • 826 (242)

  • Pilz et al (2012)27

  • Prospective cohort

  • 95 NHs

 Austria 961 C 83.7 (6.1) 961 F; 0 M 17.5 (13.7–25.5)a NR NR

  • 7% >50 nmol/L

  • 93% <50 nmol/L

  • Q1: 25.2 (4.6)

  • Q2: 26 (5.3)

  • Q3: 26 (4.4)

  • Q4: 26.3 (4.5)

  • NR

  • NR

  • Q1–Q4

  • vit D supplementation:

  • 0.4%, 0%, 2.1%, 14.3%, respectively

  • Ca supplementation: 1.2%, 0.8%, 4.6%, 18.5%, respectively

  • NR

  • NR

  • Terabe et al (2012)28

  • Cross-sectional

  • 48 NHs

 Japan 403 C 86.5 (NR) 403 F; 0 M 41.75 (NR) [25(OH)D3] <50 78.1

  • <85 y: 20.7 (4.4)

  • ≥85 y: 20 (3.3)

  • NR

  • NR

  • NR

  • NR

  • NR

  • Trummer et al (2012)29

  • Prospective cohort

  • 95 NHs

 Austria 1093 C 84 (6) 926 F; 167 M

  • F: 22 (8)

  • M: 24.25 (5.9)

 <50 94 98% <75 nmol/L

  • NR

  • NR

  • NR

  • excluded if taking vit D supp

  • NR

  • NR

  • Verhoeven et al (2012)30

  • Cross-sectional

  • 53 NHs

 Belgium 589 C 83.8 (7.2) 448 F; 141 M NR <50 75.6 93.9% <75 nmol/L

  • NR

  • NR

  • Excluded if had either

  • NR

  • NR

  • NR

  • Diekmann et al (2013)31

  • Observational longitudinal

  • 2 Municipal NHs

 Germany

  • 189 P

  • 115 C

 86.3 (7.8) 84 F; 31 M

  • T1 (baseline): 20.8 (16.5–17)a

  • T2 (1 y follow-up): 21.3 (14.9–58.6)a

 <50

  • T1: 93.9

  • T2: 71.3

  • T1 and T2, respectively: 6.1% and 28.7% >50 nmol/L

  • 70.4% and 57.3% <25 nmol/L

  • 0 vs 4.3% severely deficient (<10 nmol/L)

  • 26.6 ± 5.3

  • NR

  • 71.8% Cognitive impairment

  • MMSE score, mean (SD): 16.5 (10.3)

  • 28.7%

  • NR

  • NR

  • Kojima et al (2013)32

  • Retrospective chart review/cross-sectional

  • 1 Veterans Affairs community NH

 USA 104 C 70.6 (12.6) 0 F; 10 4M

  • Total group: 52.5 (3.9)

  • deficient: 32.5 (4.4)

  • not deficient: 72.5 (6.9)

 <50 49

  • 26.7 (6.9)

  • NR

  • 33.7% Dementia

  • excluded if taking vit D supp

  • NR

  • NR

  • Maeda et al (2013)33

  • Cross-sectional

  • 2 NHs

 Brazil 177 C 76.2 (9) 128 F; 49 M 37.6 (29.9) NR NR NR

  • 26.3 (5.6)

  • NR

  • NR

  • 6.2%

  • NR

  • NR

  • Samefors et al (2014)34

  • Prospective cohort

  • 11 NHs

 Sweden 333 C

  • F: 86 (NR)

  • M: 83 (NR)

 226 F; 107 M

  • Total group [25(OH)D3]:

  • 40.2 (16)

  • Q1: 24.1 (4.1)

  • Q2: 33.4 (2.2)

  • Q3: 42.1 (2.8)

  • Q4: 62.3 (14.7)

 <50 80

  • 14.4% Severely deficient (<25 nmol/L)

  • 65.8% insufficient (26–50 nmol/L)

  • 15.3% 51–75 nmol/L

  • 4.5% >76 nmol/L

  • Q1: 24.6 (4.5)

  • Q2: 24.7 (4.6)

  • Q3: 25.9 (5.1)

  • Q4: 24.9 (3.9)

  • NR

  • NR

  • excluded if taking vit D supp

  • NR

  • NR

  • Peláez et al (2015)35

  • Prospective, observational, noninterventional cohort

  • 1 NH

 Spain 72 C 84.7 (NR) 56 F; 16 M

  • ABI >1.4: 19.95 (6.82)

  • ABI 1.4–0.9: 19.07 (8.23)

  • ABI <0.9: 17.01 (6.56)

 NR NR NR

  • 29 (5)

  • NR

  • NR

  • NR

  • NR

  • NR

  • Törmä et al (2015)36

  • Controlled

  • 4 NHs

 Sweden

  • 172P

  • 101 C

  • EF: 83.8 (7.4)

  • EOV: 86.5 (6.9)

 73 F; 28 M

  • EF: 34.9 (47.2)a

  • EOV: 35.8 (39.7)a

 <50 66.66

  • EF: 24.1 (5.9)

  • EOV: 23.8 (4.1)

  • NR

  • Dementia

  • EF: 42%

  • EOV: 37%

  • NR

  • NR

  • NR

  • MacDonell et al (2016)37

  • Cross-sectional

  • 16 Residential aged-care facilities

 New Zealand 309 C 85 (8) 209 F; 100 M

  • Mean (95%CI)

  • 89.9 (85.2–94.5)

 NR NR

  • 17.8% of total group insufficient (<50 nmol/L)

  • 65.3% non-supp users vs 1.5% supp users <50 nmol/L

  • supp users: 87.1% >75 nmol/L, 27.1% >125 nmol/L

  • Mean (95%CI)

  • 25.8 (25.1–26.4)

  • NR

  • NR

  • 75% 50 000 IU vit D3/mo

  • 18.4% not taking any form of vit D supp

  • NR

  • NR

  • Navarro-Martínez et al (2016)38

  • Cross-sectional

  • 4 NHs

 Spain 104 C 84 (75–99)b 104 F; 0 M

  • Robust: 115 (6)

  • Pre-frail: 71.5 (4)

  • Frail: 70 (3)

 NR NR NR

  • NR

  • NR

  • Excluded if severe cognitive impairment (MMSE score <21)

  • MMSE score: 24 (21–30)b

  • Excluded if on vit D supp

  • NR

  • NR

  • Shinkov et al (2016)39

  • Cross-sectional screening

  • 4 NHs

 Bulgaria 66 C 74.5 (69.8–78)a 26 F; 40 M 17.8 (9.4–28.6)a 25–50 65.2 4.5% Sufficient (>50 nmol/L)

  • 26 (4.5)

  • NR

  • NR

  • 0%

  • Average between 100 and 400

  • 800 (NR)

  • Arnljots et al (2017)40

  • Cross-sectional

  • 22 NHs

 Sweden 545 C 86 (6.9) 370 F; 175 M 34 (21) <25

  • Total group: N = 41

  • supp user: 44

  • non-supp users: 6.4

  • Total group: 3.7% <12.5 nmol/L

  • 82% <50 nmol/L

  • 94% <75 nmol/L

  • 6.4% >75 nmol/L

  • supp user vs non-supp user

  • 4.4% vs 0%

  • 45% vs 22

  • 4.9% vs 43%

  • 1.8% vs 29%

  • NR

  • April to August: 6.6 (7.1) h/wk

  • 20% ≤1 h/wk

  • 55% Dementia

  • 17%

  • NR

  • NR

  • Kucukler et al (2017)41

  • Cross-sectional

  • 2 NHs

 Turkey 71 C 76 (0.8) 0 F; 71 M 38.25 (0.8) NR NR NR

  • 25.6 (0.5)

  • NR

  • 24.3% Dementia

  • NR

  • NR

  • NR

  • Kojima et al (2017)42

  • Cross-sectional

  • 1 Veterans Affairs NH

 USA 238 C 73.4 (13.1) 0 F; 238 M

  • Total group: 58.5 (9.8)

  • supp users: 66.4 (9.3)

  • non-supp users with status <45: 29.25 (3.8)

  • non-supp users with status >45: 59.62 (7.0)

 NR NR 37.4% <50 nmol/L

  • 26.5 (6.7)

  • NR

  • NR

  • 36.1%

  • NR

  • NR

  • Schwartz et al (2018)43

  • Cross-sectional analysis

  • 1 NH

 USA 79 C 87.4 (8) 51 F; 28 M 87.25 (12.8) NR NR NR

  • 27.3 (5.8)

  • NR

  • NR

  • NR

  • NR

  • NR

  • Sousa et al (2019)44

  • Cross-sectional

  • 9 NHs

 Brazil 153 C 81.7 (9.2) 120 F; 33 M 59.75 (16.6–31)a NR NR 28.8% Sufficient (75–150 nmol/L)

  • Categories

  • thin: 46.4%; normal: 31.1%; excess weight: 22.7%

  • NR

  • Cognitive impairment

  • mild: 6.3%; moderate: 18.1%; severe: 66.7%

  • 5.9%

  • 112 (3.2)

  • 997.9 (291.8)

  • Griffin et al (2020)45

  • Cross-sectional

  • NHs

 Ireland 273C 81.5 (11.7)a 176 F; 97 M 29.7 (13–147.8)a <25 42

  • 25% Insufficient (25–50 nmol/L)

  • 33% sufficient (>50 nmol/L)

  • NR

  • NR

  • NR

  • NR

  • NR

  • NR

  • Okan et al (2020)46

  • Cross-sectional

  • 1NH

 Turkey 36C 74 (8) 13 F; 23 M 35.8 (8) 25–47.5 64% 100% Insufficient (50–72.5 nmol/L)

  • F: 29.4 (5.4);

  • M: 27.3±(4.7)

  • Positive association of 25(OH)D with sunlight exposure 11 am to 3 pm

  • NR

  • Excluded if taking vit D supp

  • NR

  • NR

Data are presented as mean (standard deviation) unless otherwise indicated.

a

Median (interquartile range).

b

Range.

Abbreviations: 25(OH)D, 25-hydroxyvitamin D; 25(OH)D3, 25-hydroxyvitamin D3; ABI, ankle-brachial index; BMI, body mass index; C, completed; Ca, calcium; EF, external facilitation; EOV, education outreach visits; F, female; M, male; MMSE, Mini-Mental State Examination; NH, nursing home; NR, not reported; P, participated; Q, quartile; Signif, significant; Supp, supplement; T, time; USA, United States of America; vit, vitamin.