Understanding the Impact of Vitamin D Supplement Formulation, Quality and Provision to Older Adults in UK Residential Care Homes

Abstract

Supplying vitamin D supplements to all older adults is beneficial and cost-effective. However, operationalising this supply to residents in long-term care is problematic. This study aimed to understand the challenges of safe vitamin D supplement provision by auditing the extent of supplementation, measuring the quality of the supplements and investigating the attitudes towards supplement provision in UK care homes. This case study investigated the supply of vitamin D supplements formulation in four UK care homes and analysed the vitamin D content of nine formulation types. It employed semi-structured interviews with stakeholders from each of the four care homes. The study showed that only 10% of supplements supplied in the care homes were of the highest quality (prescription-only only products, vitamin D contents 95 - 103% of the label), the remaining 90% showed >50% variability in their quality (75 - 137% of the label). One tablet from a food-grade product contained 167% vitamin D. Interviews with care home staff highlighted four challenges to providing supplements: the perceived responsibility of healthcare professionals to supplement, difficulties obtaining prescription medications, absence of national/local strategies, and financial burden. This study demonstrated sub-optimal vitamin D supplement formulations were being supplied to care homes and staff were unclear about who was responsible for choosing the correct type of vitamin D supplement, who paid for it, and who was to supply it. It is evident that a new approach to the design and delivery of vitamin D supplements to older adults is needed.