Introduction and objective:
The elderly are particularly affected by vitamin D deficiency. However, screening tests are not required to begin vitamin D supplementation in the elderly. The aim of the study was to analyze the vitamin D level among patients at least 60 years old referred by primary general practitioners to the Geriatric Department of the District Hospital in Jasło, southeastern Poland, depending on age, referral mode and presence of frailty syndrome.

Material and methods:
The study included 601 patients aged 60 years and over, hospitalized during the period 1 October 2016 – 31 December 2017 at the Geriatric Department of the District Hospital in Jasło. The serum concentration of 25OH-D was tested on the first day of their hospitalization.

The proper level of 25OH-vitamin D (>75 nmol/l) was found in 17.35 % (N=104) of patients, the least frequent in the oldest (15.0%, N=41 of 80-year-olds; 7.1%, N=5 of 90-year-olds; p=0.000). The low level of 25OH-vitamin D (< 50 nmol/l) was present in 59.7% (N= 359), including significantly low (<25 nmol/l) in 27.6% (N=166) of patients. Significant deficiency was more frequent among the oldest (61.4%, N=43 of 90-year-olds), with frailty syndrome (43.9%, N=132; p=0.000) and referred urgently (49.7%, N=96; p=0.000). Before hospitalization, vitamin D had been used by 15.5% (N=53) of patients, more often women than men (18.8%, N=81 v. 7.0%, N=12; p=0.000) and referred on schedule than urgently (18.1%, N=73 v. 9.8 %, N=19; p=0.000). No differences were fund by age and frailty syndrome.

Despite common knowledge of the pleiotropic role in maintaining health, supplementation of vitamin D is still an unsolved problem among the elderly.

Cesari M, Incalzi RA, Zamboni V, et al. The vitamin D hormone: a multitude of actions potentially influencing the physical function decline in older persons. Geriatr Gerontol Int. 2011;11(2):133–42.
Giustina A, Adler RA, Binkley N, et al. Consensus statement from 2nd International Conference on Controversies in Vitamin D. Rev Endocr Metab Disord. 2020;21(1):89–116.
Kirst AH, Davidson KW, Mangione CM, et al. Screening for itamin D Deficiency in Adults: US Preventive Services Task Force Recommendation Statement. JAMA 2021;325(14):1436–42.
Meehan M, Penckofer S. The role of vitamin D in the aging adults. J Aging Gerontol. 2014;2(2):60–71.
Rusińska A, Płudowski P, Walczak M, et al. Vitamin D Supplementation uidelines for General Population and Groups at Risk of Vitamin D Deficiency in Poland-Recommendations of the Polish Society of Pediatric Endocrinology and Diabetes and the Expert Panel With Participation of National Specialist Consultants and Representatives of Scientific Societies-2018 Update. Front Endocrinol (Lausanne). 2018;9:246.
Lips P, Cashman KD, Lamberg-Allardt CL, et al. Current vitamin D status in European and Middle East countries and strategies to prevent vitamin D deficiency: a position statement of the European Calcified Tissue Society. Eur Soc Endocrinol. 2019;180(4):P23-P54.
Marcinowska-Suchowierska E, Kupisz-Urbańska M, Łukaszkiewicz J, et al. Vitamin D Toxicity-A Clinical Perspective. Front Endocrinol (Lausanne). 2018;9:555.
Płudowski P, Holick MF, Grant WB, et al. Vitamin D supplementation guidelines. J Steroid Biochem Mol Biol. 2018;175:125–35.
Remelli F, Vitali A, Zurio A, et al. Vitamin D Deficiency and Sarcopenia in Older Persons. Nutrients. 2019;11(12): 2861.
Suryanarayana P, Arlappa N, Sai Santhosh V, et al. Prevalence of vitamin D deficiency and its associated factors among the urban elderly population in Hyderabad metropolitan city, South India. Ann Hum Biol. 2018;45(2):133–139.
Hirani V, Cumming RG, Blyth FM, et al. Vitamin D status among older community dwelling men living in a sunny country and associations with lifestyle factors: the Concord Health and Ageing in Men Project, Sydney, Australia. J Nutr Health Aging. 2013;17(7):587–593. 10.1007/s12603-013-0013-z.
Breysse C, Guillot P, Berrut G. Étude de la supplémentation en vitamine D chez les personnes de plus de 65 ans en médecine générale [Study of vitamin D supplementation in people over 65 years in primary care]. Geriatr Psychol Neuropsychiatr Vieil. 2015;13(2):123–132. 10.1684/pnv.2015.0530.
Orces CH, López Gavilánez E. Determinants of vitamin D supplementation among older adults and its effect on 25(OH)D levels according to bone mineral density status. Determinantes de la suplementación con vitamina D entre los adultos mayores y su efecto en los niveles de 25(OH)D según la densidad ósea. Nutr Hosp. 2020;37(1):28–36.
Mossakowska M, Więcek A, Błędowski P. PolSenior. Aspekty medyczne, psychologiczne, socjologiczne i ekonomiczne starzenia się ludzi w Polsce. 1st ed. Termedia Wydawnictwo Medyczne, 2012.
Aspell N, Laird E, Healy M, et al. Vitamin D Deficiency Is Associated With Impaired Muscle Strength And Physical Performance In Community-Dwelling Older Adults: Findings From The English Longitudinal Study Of Ageing. Clin Interv Aging. 2019;14:1751–61.
Pennisi M, Malaguarnera G, Di Bartolo G, et al. Decrease in Serum Vitamin D Level of Older Patients with Fatigue. Nutrients. 2019;11(10):2531.
Brenner H, Holleczek B, Schöttker B. Vitamin D Insufficiency and Deficiency and mortality from Respiratory Diseases in Cohort of Older Adults: Potential for Limiting the Death Toll during and Beyond the COVID-19 Pandemic? Nutrients. 2020;12(8):2488.
Knutsen KV, Brekke M, Gjelstad S, et al. Vitamin D status in patients with musculoskeletal pain, fatigue and headache: A cross-sectional descriptive study in a multi-ethnic general practice in Norway. Scand J Prim Health. 2010;28:166–171.
Antoniak AE, Greig CA. The effect of combined resistance exercise training and vitamin D3 supplementation on musculoskeletal health and function in older adults: a systematic review and meta-analysis. BMJ Open. 2017;7(7):e014619.
De Koning EJ, Lips P, Penninx BWJH, et al. Vitamin D supplementation for the prevention of depression and poor physical function in older persons: the D-Vitaal study, a randomized clinical trial. Am J Clin Nutr. 2019;110(5):1119–30.
Manson JE, Cook NR, Lee I-M, et al. Vitamin D Supplements and Prevention of Cancer and Cardovascular Disease. N Engl J Med. 2019;380(1):33–44.
Zhang Y, Fang F, Tang J, et al. Association between vitamin D supplementation and mortality: systematic review and meta-analysis. BMJ. 2019;366:14673.
Hassan-Smith ZK, Hewison M, Gittoes NJ. Effect of vitamin D deficiency in development countries. British Medical Bulletin. 2017;122(1):79–89.
Avenell A, Mak JCS, O’Connell D et al. Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database Syst Rev. 2014;2014(4).
Zhao J-G, Zeng X-T, Wang J, et al. Association Between Calcium Or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults: A Systemic Review and Meta-analysis. JAMA. 2017;318(24):2466–82.
Martineau AR, Jolliffe DA, Greenberg L, et al. Vitamin D supplementation to prevent acute respiratory infections: Individual participant data meta-analysis. HealthTechnol Assess. 2019;23(2):1–44.
Płudowski P, Karczmarewicz E, Bayer M, et al. Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe- recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency. Endokrynolog Pol. 2013;64(4):319–27.
Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Endocrine Society: Evaluation, treatment and prevention of vitamin D deficiency: an endocrine society, clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911–30.