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Responsibility for vitamin D supplementation of elderly care home residents in England: falling through the gap between medicine and food
  1. Joseph Williams1 and
  2. Carol Williams2
  1. 1 Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
  2. 2 School of Health Sciences, University of Brighton, Brighton, UK
  1. Correspondence to Ms Carol Williams, School of Health Sciences, University of Brighton, Brighton BN1 9PH, UK; c.williams2{at}


Introduction Daily vitamin D supplements are recommended for elderly care home residents; however, they are rarely given and vitamin D deficiency in care homes is widespread. This study aimed to understand the determinants of current practice and perceived responsibility for the vitamin D status of residents.

Methods Thirteen semi-structured interviews were conducted with key informants in two areas of Southern England including care home managers, general practitioners (GPs) and public health professionals. Interviews were audio recorded and transcribed verbatim.

Results Inductive thematic analysis identified four themes: framing of vitamin D supplements as medicines; professional and sector boundaries whereby GPs are perceived as responsible for the vitamin D status of residents and care home managers felt unable to administer over-the-counter vitamin tablets; low awareness of national guidance; and ethical and practical issues. This results in vitamin D supplements requiring prescription by medical professionals and few residents receiving them.

Conclusion The medical framing of vitamin D supplements in care homes is a practical barrier to implementation of longstanding nutrition guidelines. A paradigm shift is needed so that vitamin D is understood as a protective nutrient as well as a medicine, and a public health as well as a medical responsibility. Vitamin D is important for musculoskeletal health. Possible links with COVID-19 are still being investigated. The pandemic has drawn attention to conditions in care homes and there is an opportunity to revise current guidance on vitamin D supplementation which will have lasting benefit for this vulnerable group.

  • nutrient deficiencies
  • malnutrition

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  • Contributors JW: conceptualisation, planning and data collection, transcription, analysis and manuscript writing. CW (not related): conceptualisation, analysis and manuscript writing. Both authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the University of Brighton, School of Health Sciences Research Ethics and Governance Panel, February 2018.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are stored in a private repository. Redacted data to ensure anonymity are available on reasonable request.

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