Vitamin D status and its predictors in New Zealand aged-care residents eligible for a government-funded universal vitamin D supplementation programme

AbstractObjectiveThe provision of prescribed vitamin D to all aged-care residents has been implemented in New Zealand as part of a government-led falls prevention programme. To our knowledge, there has been no evaluation of this universal programme on vitamin D status and functional and health outcomes. Thus, we aimed to determine 25-hydroxyvitamin D (25(OH)D) concentrations and their predictors in aged-care residents across the country and to investigate whether the government-funded programme was associated with adequate vitamin D status.DesignCross-sectional survey of sociodemographic, biochemical, anthropometric, dietary and health characteristics. Blood samples were analysed for serum 25(OH)D and other biochemical measures. Multiple regression was used to examine predictors of vitamin D status.SettingSixteen residential aged-care facilities throughout New Zealand.SubjectsResidents aged ≥60 years with residency duration >12 weeks (n309).ResultsMean serum 25(OH)D was 89·9 (95 % CI 85·2, 94·5) nmol/l and monthly supplements (1250 µg (50 000 IU)) were taken by 75 % of all residents. Of those not taking a funded supplement, 65·3 % had serum 25(OH)D <50 nmol/l compared with only 1·5 % of supplement users. Being female, residing at lower latitude, increasing duration of aged-care residency and raised serum α1-acid glycoprotein were positively associated with higher 25(OH)D concentrations. Supplemental vitamin D from all sources was the strongest predictor, increasing serum 25(OH)D levels by more than 70 nmol/l. Furthermore, 25 % of participants had serum 25(OH)D levels >125 nmol/l.ConclusionsResidents taking supplemental vitamin D had adequate vitamin D status; however monitoring of long-term supplementation should be considered, due to the high proportion of participants with high serum 25(OH)D levels.

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Evaluation of older people's knowledge, awareness, motivation and perceptions about falls and falls prevention in residential aged care homes: a tale of two cities

Ageing and Society ◽

10.1017/s0144686x18000697 ◽

2018 ◽

Vol 39 (11) ◽

pp. 2541-2559 ◽

Cited By ~ 1

Author(s):

Jacqueline Francis-Coad ◽

Tessa Watts ◽

Christopher Etherton-Beer ◽

Gerwyn Panes ◽

Howard Griffiths ◽

...

Keyword(s):

Older People ◽

Aged Care ◽

Functional Mobility ◽

Falls Prevention ◽

Residential Aged Care ◽

Prevention Strategies ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Daily Lives ◽

Self Blame

AbstractFalls prevention strategies can only be effective in reducing falls amongst older people if they are adopted and enacted in their daily lives. There is limited evidence identifying what older people in residential aged care (RAC) homes understand about falls and falls prevention, or what may limit or enable their adoption of strategies. This study was conducted in two countries and explored older people's knowledge and awareness of falls and their preferences, opportunities and motivation to undertake falls prevention strategies. A cross-sectional survey was administered to participants (N = 70) aged 65 years and over, living in six RAC homes in Perth, Australia and six RAC homes in Swansea, Wales, United Kingdom. Participants had limited knowledge about intrinsic falls risk factors and strategies to address these and frequently expressed self-blame regarding falling. Almost all (N = 67, 95.7%) participants felt highly motivated to maintain their current functional mobility and independence in everyday tasks. Key preferences for receiving falls prevention messages favoured a positive approach promoting wellness and independence (N = 41, 58.6%) via pictorial posters or brochures (N = 37, 52.9%) and small group discussions preferably with demonstrations (N = 18, 25.7%). Findings from this study may assist organisations and staff to more effectively engage with older people living in RAC about falls prevention and design targeted resources to address the motivations and preferences of this population.

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Using a community of practice to evaluate falls prevention activity in a residential aged care organisation: a clinical audit

Australian Health Review ◽

10.1071/ah15189 ◽

2017 ◽

Vol 41 (1) ◽

pp. 13 ◽

Cited By ~ 7

Author(s):

Jacqueline Francis-Coad ◽

Christopher Etherton-Beer ◽

Caroline Bulsara ◽

Debbie Nobre ◽

Anne-Marie Hill

Keyword(s):

Vitamin D ◽

Community Of Practice ◽

Clinical Audit ◽

Aged Care ◽

Falls Prevention ◽

Residential Aged Care ◽

Prevention Policy ◽

Shared Interest ◽

Prevention Activity ◽

Clinical Audits

Objective This study evaluates whether a community of practice (CoP) could conduct a falls prevention clinical audit and identify gaps in falls prevention practice requiring action. Methods Cross-sectional falls prevention clinical audits were conducted in 13 residential aged care (RAC) sites of a not-for-profit organisation providing care to a total of 779 residents. The audits were led by an operationalised CoP assisted by site clinical staff. A CoP is a group of people with a shared interest who get together to innovate for change. The CoP was made up of self-nominated staff representing all RAC sites and comprised of staff from various disciplines with a shared interest in falls prevention. Results All 13 (100%) sites completed the audit. CoP conduct of the audit met identified criteria for an effective clinical audit. The priorities for improvement were identified as increasing the proportion of residents receiving vitamin D supplementation (mean 41.5%, s.d. 23.7) and development of mandatory falls prevention education for staff and a falls prevention policy, as neither was in place at any site. CoP actions undertaken included a letter to visiting GPs requesting support for vitamin D prescription, surveys of care staff and residents to inform falls education development, defining falls and writing a falls prevention policy. Conclusion A CoP was able to effectively conduct an evidence-based falls prevention activity audit and identify gaps in practice. CoP members were well positioned, as site staff, to overcome barriers and facilitate action in falls prevention practice. What is known about the topic? Audit and feedback is an effective way of measuring clinical quality and safety. CoPs have been established in healthcare using workplace staff to address clinical problems but little is known about their ability to audit and influence practice change. What does this paper add? This study contributes to the body of knowledge on CoPs in healthcare by evaluating the performance of one in the domain of falls prevention audit action. What are the implications for practitioners? A CoP is an effective model to engage staff in the clinical audit process. Clinical audits can raise staff awareness of gaps in practice and motivate staff to plan and action change as recommended in best practice guidelines.

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Faculty Opinions recommendation of "Prescribing sunshine": a national, cross-sectional survey of 1,089 New Zealand general practitioners regarding their sun exposure and vitamin D perceptions, and advice provided to patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717953722.793459338 ◽

2012 ◽

Author(s):

Robyn Lucas

Keyword(s):

Vitamin D ◽

New Zealand ◽

General Practitioners ◽

Sun Exposure ◽

Cross Sectional Survey ◽

Cross Sectional

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The state of physical environments in Australian residential aged care facilities

Australian Health Review ◽

10.1071/ah10932 ◽

2011 ◽

Vol 35 (4) ◽

pp. 412 ◽

Cited By ~ 4

Author(s):

Kirsten J. Moore ◽

Keith D. Hill ◽

Andrew L. Robinson ◽

Terry P. Haines ◽

Betty Haralambous ◽

...

Keyword(s):

Physical Environment ◽

Aged Care ◽

Falls Prevention ◽

Residential Aged Care ◽

Audit Process ◽

Cross Sectional ◽

Physical Environments ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities

Objective. This paper examines the quality and safety of the physical environment in Australian residential aged care facilities (RACFs). Design. Cross-sectional study. One assessor completed environmental audits to identify areas of the physical environment that needed to be addressed to improve the wellbeing and safety of residents. Setting. Nine RACFs participating in a broader falls prevention project were audited. RACFs were located in Queensland, Tasmania or Victoria and were chosen by convenience to represent high level, low level, dementia and psychogeriatric care, regional and metropolitan facilities, small and large facilities and a culturally specific facility. Main outcome measure. An environmental audit tool was adapted from a tool designed to foster older person friendly hospital environments. The tool consisted of 147 items. Results. Across all sites 450 items (34%) required action. This ranged from 21 to 44% across sites. The audit domains most commonly requiring action included signage, visual perception and lighting, and outdoor areas. Conclusions. Although not representative of all residential facilities in Australia, this audit process has identified common environmental problems across a diverse mix of residential care facilities. Results highlight the need for further investigation into the quality of physical environments, and interventions to improve physical environments in Australian RACFs. What is known about the topic? Despite the importance of the physical environment on the health, wellbeing and safety of older people in residential aged care facilities, few studies have comprehensively evaluated the physical environment in facilities in Australia. What does this paper add? This paper provides findings from comprehensive audits of nine residential aged care facilities representing a broad range of facility settings in terms of location, level and type of care and target population. Findings indicate that each facility had at least 21% of items requiring action with an average of 34% of items requiring action across all facilities. What are the implications for practitioners? There is a need to undertake intermittent, thorough assessments of the physical environments in which residents live and, if applicable, implement strategies or modifications to improve the environment. Areas requiring particular consideration may be lighting, colour contrasts, signage and outdoor areas.

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Advance care planning participation by people with dementia: a cross-sectional survey and medical record audit

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002550 ◽

2021 ◽

pp. bmjspcare-2020-002550

Author(s):

Jamie Bryant ◽

Marcus Sellars ◽

Amy Waller ◽

Karen Detering ◽

Craig Sinclair ◽

...

Keyword(s):

Advance Care Planning ◽

Aged Care ◽

Residential Aged Care ◽

Health Record ◽

Care Planning ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Substitute Decision Maker ◽

People With Dementia ◽

Advance Care

ObjectivesTo describe among individuals with dementia: (1) self-reported awareness of, and engagement in, advance care planning; (2) presence of advance care planning documentation in the health record and (3) concordance between self-reported completion of advance care planning and presence of documentation in the health record.MethodsAn Australian prospective multicentre audit and cross-sectional survey. Individuals diagnosed with dementia who were able to speak English and were judged by a healthcare provider as having decision-making capacity were recruited from self-selected hospitals, residential aged care facilities and general practices across Australia.ResultsFifty-two people with dementia completed surveys and were included. Overall, 59.6% of participants had heard about advance care planning and 55.8% had discussed advance care planning with someone, most often a family member (48.1%). While 38.5% of participants had appointed a medical substitute decision maker, only 26.9% reported that they had written down their values and preferences for future care. Concordance between self-reported completion of advance care planning and presence of documentation in the health record was low (56.8%, κ=0.139; 57.7%, κ=0.053).ConclusionEffective models that promote discussion, documentation and accessible storage of advance care planning documents for people with dementia are needed.

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Cross-sectional associations of vitamin D status with asthma prevalence, exacerbations, and control in New Zealand adults

The Journal of Steroid Biochemistry and Molecular Biology ◽

10.1016/j.jsbmb.2018.11.016 ◽

2019 ◽

Vol 188 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Shwe Sin Win ◽

Carlos A. Camargo ◽

Kay-Tee Khaw ◽

Carlene M.M. Lawes ◽

John Sluyter ◽

...

Keyword(s):

Vitamin D ◽

New Zealand ◽

Asthma Prevalence ◽

Vitamin D Status ◽

Cross Sectional ◽

And Control

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Vitamin D sufficiency in young Brazilian children: associated factors and relationship with vitamin A corrected for inflammatory status

Public Health Nutrition ◽

10.1017/s1368980019002283 ◽

2019 ◽

Vol 23 (7) ◽

pp. 1226-1235

Author(s):

Bárbara H Lourenço ◽

Lara LS Silva ◽

Wafaie W Fawzi ◽

Marly A Cardoso ◽

Keyword(s):

Vitamin D ◽

Vitamin A ◽

Maternal Education ◽

Lower Latitude ◽

Vitamin D Status ◽

Cross Sectional ◽

Inflammatory Status ◽

Level Model ◽

Sufficient Vitamin ◽

Brazilian Children

AbstractObjective:To assess sociodemographic, nutritional and health conditions associated with vitamin D sufficiency among young Brazilian children living at different latitudes.Design:Cross-sectional analysis with a four-level model of inflammation to correct micronutrient concentrations. Prevalence ratios (PR; 95 % CI) were estimated for factors associated with vitamin D sufficiency (≥50 nmol/l), adjusting for child’s sex, age, skin colour, stunting and vitamin A+D supplementation.Setting:Primary health-care units in four Brazilian cities located at lower (7°59′26·9016″S and 9°58′31·3864″S) and higher latitudes (16°41′12·7752″S and 30°2′4·7292″S).Participants:In total 468 children aged 11–15 months were included in the analysis.Results:Only 31·8 % of children were vitamin D sufficient (concentration <30 nmol/l and <50 nmol/l among 32·9 and 68·2 %, respectively). Living at higher latitudes was associated with reduced prevalence of vitamin D sufficiency compared with lower latitudes (PR = 0·65; 95 % CI 0·49, 0·85). Maternal education ≥9 years positively influenced a sufficient vitamin D status in children. After correction for inflammatory status, each increase of 1 µmol/l in vitamin A concentration was associated with a 1·38-fold higher prevalence of vitamin D sufficiency (95 % CI 1·18, 1·61). Progressive decline in the prevalence of vitamin D sufficiency was associated with marginal and deficient status of vitamin A (Ptrend = 0·001).Conclusions:Lower latitude, higher maternal education and vitamin A concentration were positively associated with vitamin D sufficiency in young Brazilian children. These findings are relevant for planning public health strategies for improving vitamin D status starting in early infancy.

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