Elder Care Facilities

Reducing Covid-19 Illness in Elder Care Residents

   Download:    Handout for Aged Care October             Prepared by Connie Eash, M.S.    cneash@gmail.com

Large Percentage of Covid-19 Deaths in Aged Care Homes

As of June 19, 43% of COVID-19 deaths have been in nursing homes or care facilities.  New Hampshire, North Dakota, Rhode Island and Minnesota each experienced 78-80% of their COVID deaths in those facilities. (1)  As in other high risk groups, such as dark skinned people and the obese, the elderly are especially at risk for both severe illness and death due to Covid-19 and for low 25(OH)D levels.

The Vitamin D – Covid-19 Connection

  • A study of 212 Covid patients found that D Levels over 30 ng/ml increased the odds of a mild outcome vs. a critical outcome by 19.6 times. (2)
  • In 780 hospitalized Covid patients, the death rate of those with D levels below 20 ng/ml was 98.9%, for those with 20-30 ng/ml it was 87.8%, and for those with more than 30 ng/ml, the death rate was 4.1%. (3)
  • Several studies found that countries with lower average D levels had more cases and deaths from Covid-19. (4,5),
  • No other factor has been this significant in preventing severe illness and death.

What is Vitamin D?

  • The main source of D3 is synthesis in the skin when exposed to the sun. Food    supplies only a minor amount of D.
  • With the same sun exposure, our old skin makes half as much as our young skin did. (6)
  • Our kidneys and liver turn D3 into     hormones that regulate many bodily    functions.  D3 is vital for a functioning immune system.
  • Vitamin D3 protects against Covid-19,  influenza (7), respiratory infections (8,9), certain cancers: colon(10), prostate(11) and breast (12); diabetes type 2 (13), and cardiovascular disease. (14).

Why Are the Elderly More at Risk?

  1. The elderly have less of the precursor, 7-dehydrocholesterol in the skin, leading to a decrease in D3 synthesis.
  2. They spend less time outdoors.
  3. They do not absorb as much nutrients from their digestive tract.
  4. Diseased liver and kidneys fail to change D3 into active hormones.

Vitamin D Supplements Work

Using D supplements in nursing homes has been show to prevent deficiency. (15)

Out of a concern for falls and bone fractures, New Zealand offers government sponsored Vitamin D supplements, 50,000 IU/month, to all residents of aged care facilities, thus    raising serum 25(OH)D to sufficient levels. Out of the 75% of the residents who took the supplement, 98.5% had sufficient serum 25(OH)D levels, compared to only 35% of those not on a supplement. (16)

Doctors Should Measure and Correct D Levels

  • The test for D is the serum 25(OH)D test.
  • Although there is some confusion over what the numbers should be, The Endocrine Society has set the lower limit to 30 ng/ml, based on a thorough review of the scientific evidence.
  • CDC statistics show that most of us have low vitamin D levels, but the elderly and dark skinned people are more at risk. (17)           
  • The Endocrine Society recommends these doses of vitamin D3 supplements:
    • 600-1000 IU/day for children 1-18
    • 1500-2000 IU/day in adults
    • 3000 – 6000 IU/day if obese.
    • If 25(OH)D levels are lower than 30 ng/ml, initial doses should be higher. (18)

Vitamin D is the Most Important Nutrient

Vitamin D has been our focus, because research has shown more protection against Covid-19 than any other nutrient or drug.  Vitamin D3 works with vitamin K2 and magnesium, so those supplements would also be beneficial.    

Work with Your Doctor

Pharmaceutical companies will not put money into marketing for vitamins.  Patients usually have to ask for the test and recommendations for supplementation.

Note: This is not meant to replace sanitation and personal protection, nor the recommendations of your physician.

References:

1 Girvan G, Roy A. The Foundation for Research on Equal Opportunity, June 19, 2020.  https://freopp.org/the-covid-19-nursing-home-crisis-by-the-numbers-3a47433c3f70

2 Alipio M. Vitamin D supplementation could possibly improve clinical outcomes of patients infected with Coronavirus-2019. Preprint posted: 9 Apr 2020 Last revised: 7 May 2020. https://papers.ssrn.com/sol3/Papers.cfm?abstract_id=3571484

3 Raharusun P, Sadiah P, Cahni B, Erdie A, Cipta B. Patterns of COVID-19 Mortality and Vitamin D: An Indonesian Study (April 26, 2020). Available at SSRN: https://ssrn.com/abstract=3585561 or http://dx.doi.org/10.2139/ssrn.3585561

4 Ilie, PC, Stefanescu S. & Smith L. The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality. Aging Clin Exp Res (2020). https://doi.org/10.1007/s40520-020-01570-8

5 Laird E, Rhodes J, Kenny RA. Vitamin D and Inflammation: Potential Implications for Severity of Covid-19. Ir Med J; Vol 113; No. 5; P81.  http://imj.ie/vitamin-d-and-inflammation-potential-implications-for-severity-of-covid-19/

6 J MacLaughlin and M F Holick, Aging decreases the capacity of human skin to produce vitamin D3.  J Clin Invest (1985). https://www.jci.org/articles/view/112134

7 Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H.  Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren.  The American Journal of Clinical Nutrition, May 2010, 91(5): 1255–1260, https://doi.org/10.3945/ajcn.2009.29094

8 Jolliffe DA, Greenberg L, Hooper RL, Mathyssen C, Rafiq R, de Jongh RT, Camargo CA, Griffiths CJ, Janssens W, Martineau AR. Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials.  Thorax April 2019; 74(4).

9 Martineau Adrian R, Jolliffe David A, Hooper Richard L, Greenberg Lauren, Aloia John F, Bergman Peter et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data BMJ 2017; 356 :i6583

10 McCullough ML, Zoltick ES, Weinstein SJ, Fedirko V, Wang M, Cook NR, Eliassen AH, et al. Circulating Vitamin D and Colorectal Cancer Risk: An International Pooling Project of 17 Cohorts, JNCI: Journal of the National Cancer Institute, Volume 111, Issue 2, February 2019, Pages 158–169. https://doi.org/10.1093/jnci/djy087

11 Nyame YA, Murphy AB, Bowen DK, et al. Associations Between Serum Vitamin D and Adverse Pathology in Men Undergoing Radical Prostatectomy. J Clin Oncol. 2016;34(12):1345‐1349. doi:10.1200/JCO.2015.65.1463

12 Yao S, Kwan ML, Ergas IJ, Roh JM, Cheng TYD, Hong CC, McCann SE, Tang L, Davis W, Liu S, Quesenberry CP Jr, Lee MM, Ambrosone CB, Kushi LH, Association of Serum Level of Vitamin D at Diagnosis With Breast Cancer Survival: A Case-Cohort Analysis in the Pathways Study, March 2017, JAMA Oncol. 2017;3(3):351-357. doi:10.1001/jamaoncol.2016.4188

13 Rafiq S, Jeppese PB. Is Hypovitaminosis D Related to Incidence of Type 2 Diabetes and High Fasting Glucose Level in Healthy Subjects: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients. 2018 Jan; 10(1): 59.  doi: 10.3390/nu10010059

14 Saponaro F, Marcocci C, Zucchi R. Vitamin D status and cardiovascular outcome. J Endocrinol Invest 42, 1285–1290 (2019) https://doi.org/10.1007/s40618-019-01057-y

15 Wyskida M, Wieczorowska-Tobis K, Chudek J. Prevalence and factors promoting the occurrence of vitamin D deficiency in the elderly. Postepy Higieny i Medycyny Doswiadczalnej (Online). 2017 Mar;71(0):198-204. DOI: 10.5604/01.3001.0010.3804.

16 MacDonell SO, Miller JC, Harper MJ, Wa DL. Vitamin D status and its predictors in New Zealand aged-care residents eligible for a government-funded universal vitamin D supplementation programme. Public Health Nutrition, Dec 2016, 19(18):3349-3360.  DOI: https://doi.org/10.1017/S1368980016001683

17 National Report on Biochemical Indicators of Diet and Nutrition in the U.S. Population 1999-2002. https://www.cdc.gov/nutritionreport/99-02/pdf/nr_ch2b.pdf

18 Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM, Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul; 96(7):1911-30