Very frail older people constitute an increasing proportion of ageing populations and often have vitamin D deficiency. Falls are frequent in this population and have usually been associated with vitamin D deficiency. In this prospective study we measured serum 25-hydroxyvitamin D (25OHD), serum PTH, and falls in 637 ambulatory subjects living in institutional aged care facilities (intermediate-care hostels or nursing homes). The study sample comprised 121 men (mean age, 82.1 yr) and 516 women (mean age, 86.7 yr). Two hundred and seventy-four subjects fell one or more times over a mean duration of follow-up of 10.2 months. Vitamin D deficiency, defined as a serum 25OHD level below 39 nmol/liter was present in 73.6%. Baseline serum 25OHD and PTH were significantly associated with falls in univariate analyses. In multivariate analyses that also corrected for balance and health status, PTH remained a significant predictor of falls independent of 25OHD. Serum PTH is a predictor of time to first fall in the frail elderly independent of vitamin D status and measures of general health.

It is recognised that the focus of health-care interventions for frail older persons should not be restricted to increasing longevity, but should encompass measures aimed at improving or maintaining the health-related quality of life (HRQoL) of these individuals. We studied the HRQoL profile of 612 frail older persons residing in nursing homes and hostels in northern Sydney, Australia, and sought to ascertain some of the factors that affect their perceived quality of life. Our findings suggest that common health states that may cause loss of independence and dignity (e.g. presence of osteoarthritis, presence of urinary incontinence, previous fracture, Parkinson's Disease and increasing frailty as reflected by residence in nursing homes) are strongly, and independently, associated with the HRQoL of institutionalised older persons. Some of these conditions may be amenable to intervention.