Responsibility for vitamin D supplementation of elderly care home residents in England: falling through the gap between medicine and food

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.