The effect of UVB irradiation compared with oral vitamin D supplementation on well-being in psycho-geriatric nursing home residents in the Netherlands

Vitamin D deficiency [25-hydroxyvitamin D (25(OH)D) < 25 nmol/l] and vitamin D
insufficiency [25(OH)D) < 50nmol/l] is common in older people, in particular in
nursing home residents. Vitamin D deficiency causes secondary
hyperparathyroidism, which leads to cortical bone loss. It may also lead to
fatigue, muscle weakness and falls. Vitamin D deficiency thus contributes to
the pathogenesis of osteoporosis and fractures.
Vitamin D receptors, however can be found in many other tissues and vitamin D
deficiency is associated with multiple other health problems such as increased
risk of common cancer, autoimmune and cardiovascular diseases, cognitive
impairment and depression. In older people, vitamin D supplementation by UVB
irradiation may be preferable to oral supplementation: it can not cause toxic
levels, it is cheap and easy and it helps in preventing polypharmacy. Moreover
there are indications that UVB exposure has beneficial effects on health and
well-being by other mechanisms than the vitamin D -pathway alone. In a pilot,
prior to this study, it was shown that the older skin is very well capable of
producing vitamin D: in this study weekly frontal half body irradiation with
UVB, at 0,5 MED (minimal erythema dose), during 8 weeks, led to an important
increase in serum vitamin D levels.

Comparing the additional effects of UVB irradiation to oral vitamin D
supplementation on well-being and quality of life in psycho-geriatric nursing
home residents.

Randomized trial on the effect of UVB irradiation compared with oral vitamin D
supplementation on well-being, quality of life and vitamin D serum levels in
psychogeriatric nursing home residents in the Netherlands.

Oral vitamin D supplementation (5600 IU/week) or UVB irradiation 2x/week (1,0
SED (standard erythema dose)=1 CIE dose (Comite International de l'Eclairage)
of 100 J/m² which is comparable with 50 % of the MED (minimal erythema dose) of
a person with skin type II (pale skin, blond hair, light eyes). For practical
reasons, in all participants the (safe) time of UVB irradiation will be the
same.
Participants get de UVB irradiation while they lie on their bed with their eyes
protected. A Hapro ® sunbed is used which is placed at a fixed distance above
the bed. Before use sunbeds will be tested, measured and inspected by the
Department of dermatology of the Leiden University Medical Center.
Well-being and quality of life will be measured by 2 scales: the CMAI ( Cohen -
Mansfield Agitation Inventory) and the Cornell scale for depression in
dementia.
The severity of dementia will be determined with the BANS-S (Bedford Alzheimer
Nursing Severity Scale)

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