A review of the links between nutritional status, hydration, vitamin D and falls: The role of a dietitian

Abstract

Background: This review was conducted following an observation which revealed that over half of the inpatients referred to the frail elderly specialist dietitian at Airedale NHS Foundation Trust had been admitted to hospital following a fall in the community (unpublished data). Evidence was reviewed to identify if nutritional status, hydration, and vitamin D are related to falls risk. Methods: At the request of the dietetic department, Nutricia UK conducted a literature review, using Pubmed, Medline, CAB Abstracts and Embase, into the link between nutrition, hydration, and falls risk 1 . This was supplemented by a dietitian search. The evidence reviewed included position papers, consensus statements, expert group recommendations, clinical guidelines, systematic reviews, meta-analyses, review articles, randomised controlled trials (RCTs) and cohort studies.98 publications were included initially. A dietitian reviewed these for relevance, then sorted according to key themes and then conclusions, ie 'for', 'against' and 'inconclusive'. When drawing conclusions, emphasis was placed on the most recent evidence and the higher quality publications, including expert group recommendations and position statements, clinical guidelines eg NICE and systematic reviews eg Cochrane. Results: Some of the studies demonstrating the link between nutritional status, hydration, vitamin D status and falls risk are highlighted in the table below. Examples of findings from studiesA study of 6,701 care home residents (mean age 84) found malnourished individuals fell more often (OR 1.78) and nutritional intervention lowered falls risk. 2 An analysis of data relating to individuals aged ≥65 years receiving home care (n = 2,971) found malnutrition to be a potential reversible risk factor related to falls. 3 RCT of 210 malnourished older adults admitted to hospital found that additional energy and protein intake decreased the number of patients who fell. 4 1,2. Continued Examples of findings from studiesConsensus statement: Low vitamin D levels associated with balance problems, impaired lower extremity function, high fall rates, low bone mineral density and muscle weakness. 5 Increased availability, visibility, and regular reminders increased fluid intake in a care home setting resulting in a 50% decrease in falls. 6Discussion: There is a need to include nutrition, hydration and the role of vitamin D within falls strategies in both acute and community settings. A particular focus should be on identifying and treating malnutrition, especially in patients with sarcopenia, preventing and treating vitamin D deficiency in 'at risk groups', and providing adequate hydration. Adequate intake of energy and protein should also be encouraged, especially in adults aged over 65 years 7 .Conclusions: There is a clear link between nutritional status, hydration, vitamin D and falls risk. The authors would encourage dietitians and other health care professionals to think about how they can contribute to reducing falls risk locally and work with therapy, medic...