Volume 63, Issue 9 p. 1861-1867
Clinical Investigations

Delivery of a Vitamin D Intervention in Homebound Older Adults Using a Meals-on-Wheels Program: A Pilot Study

Denise K. Houston PhD

Corresponding Author

Denise K. Houston PhD

Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina

Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina

Address correspondence to Denise K. Houston, Sticht Center on Aging, Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157. E-mail: [email protected]Search for more papers by this author
Janet A. Tooze PhD

Janet A. Tooze PhD

Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina

Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina

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Jamehl L. Demons MD

Jamehl L. Demons MD

Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina

Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina

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Brooke L. Davis MS

Brooke L. Davis MS

Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina

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Rachel Shertzer-Skinner MA

Rachel Shertzer-Skinner MA

Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina

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Linda B. Kearsley BS

Linda B. Kearsley BS

Senior Services, Inc., Winston-Salem, North Carolina

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Stephen B. Kritchevsky PhD

Stephen B. Kritchevsky PhD

Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina

Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina

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Jeff D. Williamson MD

Jeff D. Williamson MD

Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina

Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina

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First published: 16 August 2015
Citations: 11
ClinicalTrials.gov Identifier: NCT01410084

Abstract

Objectives

To assess the feasibility of a vitamin D intervention delivered through a Meals-on-Wheels (MOW) program to improve 25-hydroxyvitamin D (25(OH)D) concentrations and reduce falls in homebound older adults.

Design

Single-blind, cluster randomized trial.

Setting

MOW, Forsyth County, North Carolina.

Participants

Community-dwelling homebound adults aged 65 to 102 (N = 68).

Intervention

MOW clients were randomized to vitamin D3 (100,000 IU/month; n = 38) or active placebo (400 IU vitamin E/month; n = 30) according to MOW delivery route.

Measurements

Serum 25(OH)D was assessed at baseline and 5-month follow-up; proportions of participants in 25(OH)D categories were compared using Fisher exact test. Falls were assessed using monthly fall calendars, and rate of falls was estimated using negative binomial generalized estimating equation models.

Results

Mean ± standard deviation 25(OH)D concentrations were 20.9 ± 11.5 ng/mL at baseline, with 57% having 25(OH)D concentrations less than 20 ng/mL. Retention and adherence were high (>90%). After the 5-month intervention, only one of 34 participants randomized to vitamin D3 had 25(OH)D concentrations less than 20 ng/mL, compared with 18 of 25 participants randomized to placebo (P < .001). In unadjusted analyses, the rate of falls over 5 months was not significantly different according to intervention group (risk ratio (RR) = 0.48, 95% confidence interval (CI) = 0.19–1.19), but after adjustment for sex, race, season of year, baseline 25(OH)D status, and history of falls, participants randomized to vitamin D3 had a lower rate of falling than those randomized to placebo (RR = 0.42, 95% CI = 0.21–0.87).

Conclusion

A vitamin D intervention delivered through MOW was feasible, resulting in improvements in 25(OH)D concentrations and a lower rate of falls in adjusted analyses. Further research is needed to validate the reduction in falls from this type of intervention.