Abstract
Background Vitamin D is a fat-soluble vitamin which is safe and well tolerated.1 Although vitamin D prescribing and use is common in elderly population, the appropriate long-term dose supplementation and testing frequency is not clearly defined.2
Methods This is a cross sectional study to review Home Health Care Services’ (HHCS) patients dosing and frequency of vitamin D and its analogues based on the recommendations of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Patients.
Results The medical records of 63 patients who were maintained on vitamin D or analogues for at least three months were reviewed. Most patients were Qatari females with a mean age of 73 years old and on 12 medications on average. More than half of the tested patients (56%) were maintained on therapeutic vitamin D dose (figure 1). Hypercalcemia was detected in almost 10% of our population, while about 14% were borderline. At least 57% of our HHCS elderly patients needed cholecalciferol dose adjustment (adding supplement, shifting from therapeutic to maintenance dose or vice versa) (figure 2). Vitamin D level is over tested (more than once annually even with those with optimum level) in 44% of the patients (28 patients, of them 20 patients (71%) had optimal vitamin D level >30ng/ml), leading to increase treatment burden and healthcare costs. The majority of patients (77.7%) were on at least one medication that is known to induce osteoporosis.
Conclusion Polypharmacy is common in Qatar’s population. Vitamin D analogues are commonly used in the HHCS long-term population, however monitoring and periodically evaluating its chronic use are crucial to prevent medication errors and adverse drug reactions. HHCS multidisciplinary teamwork and collaboration has an important role to play in ensuring safe and effective medications and supplements use for patients.
Comparing vitamin D level to the active vitamin D dose received
Proportion of patients requiring vitamin D dose adjustment
References
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Yves Rolland, de Souto Barreto P, Abellan van Kan G, Annweiler C, Beauchet O, Bischoff-Ferrari H, Berrut G, Blain H, Bonnefoy M, Cesari M, Duque G, Ferry M, Guerin O, Hanon O, Lesourd B, Morley J, Raynaud-Simon A, Ruault G, Souberbielle JC, Vellas B. Vitamin D supplementation in older adults: searching for specific guidelines in nursing homes. The Journal of Nutrition, Health and Aging 2013;17(4):ISSN 1279-7707, https://doi.org/10.1007/s12603-013-0007 -x
Panel on prevention of falls in older persons, American geriatrics society and British geriatrics society. Summary of the updated American geriatrics society/British geriatrics society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011 Jan;59(1):148–57. doi: 10.1111/j.1532-5415.2010.03234.x
Ethical Approval This Drug Use Evaluation was reviewed and is supported by the Corporate Pharmacy department, Hamad Medical Corporation, Doha, Qatar
Disclosures and Acknowledgments We acknowledge the reviewers for reviewing and editing our abstract
