Abstract
Objectives
Evaluate the association between insufficient 25-hydroxyvitamin D [25(OH)D] serum levels and healthcare payer source of older adults living in long-term care (LTC) communities.
Methods
Residents (age >65 yo) of five LTC communities in Central, Texas were recruited to participated in the multi-site, cross-sectional study. A one-year medical history was abstracted from medical records using double-blinded data abstraction and entry protocols. Medical history included but not limited to: diagnosis, medications, history of supplementation, BMI, mini-nutritional assessment, diet order, total mood assessments, hospitalizations and number of infections. Data on payer source and other demographics were also obtained via medical records. Blood draws were collected to measure serum 25(OH)D levels. Logistic regression models were uses to assess the association between insufficient25(OH)Dserum levels (defined as <30 ng/ml) and healthcare payer source. Total vitamin D supplemented per day along with amount provided in meals, body mass index, race, gender, age, years living in community, and diagnosis of liver and renal disease were used as confounders.
Results
The 174 participants (89% Caucasian, mean age 83 yo) included 63% females. Payer source was distributed as follows: 55% private pay, 8.6% Medicare, 35% Medicaid, and 1% insurance. Fifty-five % had insufficient25(OH)D serum levels (mean serum level = 32.6 ng/ml; mean supplementation rate of 1138 IU per/d). Insufficient serum levels were seen in 48% of participants with private pay (mean serum level = 36 mg/ml) and 58% with Medicaid (mean serum level = 30.5 ng/ml). Adjusted logistic regression showed that payer source was a significant determinant of insufficient25(OH)D serum levels. Medicaid residents had significantly greater odds of having insufficient 25(OH)D serum levels (adjusted odd ratio (OR) 3.26; CL: 1.25, 8.48; P = 0.015) than private pay participants.
Conclusions
Practitioners working in LTC can use these results to ensure equity in the provision of medical nutritional therapy across Medicaid residents and private pay residents.
Funding Sources
Funding for study was provided through the private funds of research team.