IT has been well known that Vitamin D deficiency is fairly common in frail older people and many should have supplementation especially in winter months. Despite that Vitamin D has recently returned to the public media.

There are numbers of reasons for this.

Vitamin D is normally manufactured in the body from exposure of bare skin to sunlight. Accordingly the deficiency of this nutrient arises in those living indoors and not having enough sunshine. In such cases dietary intake becomes more important, failing that ‘medicinal’ supplementation becomes necessary. There have been many studies and community surveys revealing similar findings especially in Scotland, northern England and Northern Ireland ie in areas with less than average annual sunshine than the rest of the country. Whilst the younger people run to Southern Europe and other sun baked lands, that may not be feasible for the frail elderly. In some individual's dietary restrictions to oily and fatty food stuff /cheese etc rich in vitamin D does contribute.

Most of these will be well known to readers, but a recent ‘new’ finding does cause some worry. It has been noticed that older people with mental frailty and dementing disorders are more prone to Vitamin D deficiency. Although no definite causal relationship has yet been established scientifically, a lower level of Vitamin D in the blood has been noted in many older people with dementia.

Vitamin D ( along with Calcium) is needed for overall bone health and strength. Incidences of fractures is always higher among D deficient individuals. At the same time, postural unsteadiness and falls are frequent in the mentally frail. Hence it is likely that the additional problem of D deficiency in the demented would make them more prone to bone fractures. This is both socially and fiscally expensive and unacceptable. Looking after a mentally frail person is not easy, extra disability from fractures would make them even more of a ‘caring’ challenge.

It is therefore important that one pays more attention to dietary pattern and life styles of older citizens. If necessary regular dietary supplementation of Vitamin D may be justified. Years ago wheat used to be fortified with calcium and vitamin D to prevent rickets in South Asian immigrant children; perhaps this should be done again especially for the older and frailer housebound people.

People with osteoporosis, a dreadful brittle-bone disorder can also coexist, making regular vitamin D intake even more useful and perhaps essential

It is being suggested, that at the time of any physical assessment of the elderly, their vitamin D status should be borne in mind with necessary remedial steps and despite a ‘normal’ body content of the vitamin supplementation may be useful. Oily fish, cheese, fortified bread and butter are good sources of the vitamin. Unfortunately many do no longer consume these items for fear of a rise in their blood cholesterol. One must be sensible and take everything needed, in a measured amount, of course.

There are plenty of vitamin D preparations (usually with Calcium) available. A word of warning. Intake of Vitamin D should be monitored carefully as long term continuing consumption of these tablets can cause other bodily harm. The advice of the local high street pharmacist might be appropriate.