Prevalence of Vitamin D Deficiency in Elderly Patients Admitted to an Inpatient Rehabilitation Unit in Tropical Singapore

Abstract

Background. Data on hypovitaminosis D in elderly patients admitted to rehabilitation units in tropical countries are scarce. Objective. To assess the prevalence of vitamin D deficiency and its associated risk factors in elderly patients admitted to a rehabilitation unit in tropical Singapore. Methods. Prospective, cohort study of 134 subjects ≥ 65 years old admitted to a tertiary rehabilitation centre. Serum 25-hydroxyvitamin D3 (25OHD3) was measured on rehabilitation admission. Results. Mean age was 72.0 ± 5.7 years, and stroke was the commonest rehabilitation diagnosis (49.3%). Low 25OHD3 levels were present in 115 patients (85.6%) and 59 patients (44%) were deemed to be vitamin D deficient. The mean PTH level was significantly higher in patients with low 25OHD3 levels. (p = 0.002) Age, gender, vitamin D supplementation, premorbid ambulatory status, and admission/discharge Functional Independence Measure scores were not significantly associated with vitamin D deficiency. Malays/Indians (p = 0.013) and recurrent fallers (p = 0.029) were at significantly higher risk of vitamin D deficiency. Conclusions. Despite the tropical weather, vitamin D deficiency is common in elderly subjects admitted to a rehabilitation unit in Singapore. Routine assessment of vitamin D levels is recommended especially in those with a history of recurrent falls and patients of Indian/Malay ethnicity.

Impact of Vitamin D deficiency on Rehabilitation Outcome

“…Malays, Indians and patients with recurrent falls were at higher risks for vitamin D deficiency [9]. The findings were largely in congruent with the our pilot study, apart from the racial difference.…”

Serum folate predicts muscle strength: a pilot cross-sectional study of the association between serum vitamin levels and muscle strength and gait measures in patients >65 years old with diabetes mellitus in a primary care setting

“…However, almost twice as many women as men were vitamin D deficient, although this difference was not statistically significant. In a study of 134 inpatients ≥65 years old in a rehabilitation centre in Singapore, although 26.9 % reported taking calcium and/or vitamin D supplementation, 44 % were vitamin D deficient, and a further 41.8 % were vitamin D insufficient, with no significant difference in vitamin D levels between those who were taking vitamin D supplementation and those who were not [ 6 ]. These results demonstrate the need for future studies of the effects of age and diabetes mellitus on the bioavailability of vitamin D supplements.…”

“…The prevalence of vitamin D deficiency in Singapore has been reported to be 44 % in an inpatient rehabilitation unit [ 6 ], 34.5 % among patients admitted to a local hospital with hip fractures [ 7 ] and 14.3 % in an ethnic Chinese cohort 45–74 years old [ 8 ].…”

Vitamin D Supplementation and Post-Stroke Rehabilitation: A Randomized, Double-Blind, Placebo-Controlled Trial

“…Before enrollment, patients who met the eligibility criteria on admission were required to provide written informed consent after being provided with an explanation of the study’s aims and procedures by the attending physiatrist. In view of previous findings indicating that almost all elderly patients undergoing rehabilitation have vitamin D deficiency [4,5], we did not include the serum 25-hydroxyvitamin D level as an inclusion criterion. We did not specifically include controls for sun exposure.…”

“…In previous research, 86%–89% of elderly patients in a rehabilitation facility were found to have vitamin D deficiency [4,5], and several further studies have reported an association between serum vitamin D levels and functional recovery after stroke [6,7,8,9,10,11,12,13]. Vitamin D is a neurosteroid that is thought to play a neuroprotective role because of the widespread distribution of vitamin D receptors on neuronal and glial cells [14,15].…”