Vitamin D deficiency and its importance in older people

Although the rates of vitamin D deficiency worldwide vary according to regions, itis between 30-90%. Vitamin D deficiency is frequently seen in our country, and vitamin D deficiency is more common in older people. 

Diagnosis and treatment of vitamin D deficiency in older people is performed by physicians who are experts in the field in Liv Hospital Vadistanbul Geriatrics Clinic. 

How is vitamin D synthesized and what does it do? 

Vitamin D is synthesized in the skin with the help of sunlight. Therefore it is also called the sun vitamin among the people. For synthesis; Direct  sun ray contact with the skin is required. It can only be taken in very small amounts through food. Vitamin D, which is synthesized in the skin and taken with food, is transformed into a more effective form by undergoing changes in the liver and kidney.

At the latitude of our country; Vitamin D synthesis takes place between May and November. It is recommended to go out in the sun during these hours for vitamin D synthesis, since the appropriate sunbeam angle (the hours when the sun's rays reach the earth's surface) is between 10.00-15.00. Outside of these hours, the effect of sun rays decreases in terms of vitamin D synthesis. With the fact that it varies according to the skin type; It is recommended that the sun exposure time be between 10-30 minutes.

Since vitamin D synthesis is more difficult in dark-skinned people, vitamin D deficiency is more common. 

Vitamin D ensures the absorption of calcium and phosphorus taken from the intestines with food. In this way, it provides the mineralization of the bone, that is, its hardness. It is also necessary for the health of the muscles. In vitamin D deficiency, weakness in bones, increased bone fragility, muscle weakness, increased risk of falling and fractures may occur. 

Why is vitamin D deficiency more common in older people?

With aging; decreased mobility, prolongation of the time spent indoors, decreased capacity of the skin to produce vitamin D, additionally insufficient intake of vitamin D with food, decrease in intestinal absorption and low kidney activity cause vitamin D deficiency to be seen more frequently in older ages. 

What happens in vitamin D deficiency in old age?

In vitamin D deficiency, softening of the bones (osteomalacia), decreased bone mass and increased bone fragility (osteoporosis) become the topic. Because it causes deterioration in balance and decrease in muscle strength; falls increase and fractures of bones, especially hips, may occur. In addition, pain, muscle cramps, muscle spasms, especially in the hands and legs are seen. The pain usually starts in the lower back and can spread to the hips, back and ribs. In vitamin D deficiency, the ability to walk and move decreases In some studies, it has been shown that vitamin D deficiency is associated with forgetfulness, depression, immunity, cancer and cardiovascular diseases. 

What are the sources of Vitamin D?

While only 10-20% of vitamin D need can be taken with food; 80-90% of it is met by being synthesized in the skin by the effect of sunlight (ultraviolet-B). That is to say, the main source of vitamin D for many people is direct contact with sunlight. The sun rays taken from the clothes or behind the glass are not effective in the synthesis of vitamin D. The sunscreens also prevent the production of vitamin D in the skin. From foods; Vitamin D is present in fatty fish (salmon, sardines, swordfish, mackerel, tuna…), fish oil, egg yolk, milk, butter, oats, sweet potatoes, oil and liver. From plants; Parsley, alfalfa and nettle contain vitamin D.

What is the daily requirement of Vitamin D? 

Higher doses of vitamin D (800-1000 IU/day cholecalciferol) are recommended for adults 65 years of age and older than for young people. In the meantime, according to the vitamin D measurement results and the targeted vitamin D values, the appropriate dose for the individual is determined by the physician. For bone and muscle health, adequate amount of calcium should be taken with it. A daily calcium intake of 1200 mg should be targeted. For example, each 100 mg of white cheese contains 169 mg of calcium, 100 mg of cheddar cheese contains 350 mg of calcium, and 100 mg of plain-low-fat yogurt contains 183 mg of calcium. 

It is important that the doses of vitamin D are adjusted by the physician, because as with low levels of vitamin D, its intake in high doses also has disadvantages. In vitamin D poisoning, the blood calcium level can rise too high, causing kidney stones, kidney failure, and other life-threatening conditions. In treatment; mostly, drops, capsules or tablet forms containing vitamin D are used. Since vitamin D in ampoules contains very high doses, it is used only in a limited patient group and is almost never preferred in older people. It is known that vitamin D supplementation in appropriate doses in elderly individuals helps to reduce hip and spine fractures. It has also been shown to reduce falls, aid bone strength, improve muscle strength, and reduce aches and cramps. There are also studies reporting positive effects on the cardiovascular system, dysmnesia, depression and cancer. 

What should older people pay attention to while sunbathing?

Older people are more vulnerable to heat. Because the ability to detect and correct changes in body temperature decreases with age. In addition, many older people have more than one chronic condition and many different medicines they use. Some of the drugs increase water loss from the body and thus can cause dehydration of the body in hot weather. And this may adversely affect many organs, especially the kidneys.  Dehydration is the primary result of health problems related to sunstroke, thus it is important to drink plenty of water in the diet of the elderly. Try to avoid alcoholic or caffeinated beverages as they can increase water loss from the body. It is appropriate to wear wide hats to protect the head area. Exercise and strenuous activities should be avoided at very hot times of the day, especially outdoors. When there is high humidity in the air, the body's ability to absorb itself through sweating becomes more difficult. Headache, dizziness, nausea, rapid heartbeat, chest pain, fainting, and difficulty breathing can all be indicators of overexposure to heat and sun. Care should be taken in such symptoms.   

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