From the Guidelines
Vitamin D supplementation is not recommended for the prevention of depression and poor physical function in older persons without vitamin D deficiency or insufficiency, as it has been found to have no benefit in preventing falls in community-dwelling older adults not known to have vitamin D deficiency or insufficiency. The USPSTF recommendation statement, published in JAMA in 2018 1, updates the previous recommendation on interventions to prevent falls in older adults and concludes that vitamin D supplementation has no benefit in falls prevention in community-dwelling older adults not known to have vitamin D deficiency or insufficiency. This is based on newer evidence from trials reporting no benefit, including the exclusion of studies that enrolled persons with vitamin D deficiency or insufficiency, as vitamin D supplementation in these populations would be considered treatment rather than prevention.
Key points to consider:
- The USPSTF recommends against vitamin D supplementation for the prevention of falls in community-dwelling older adults, which may also apply to the prevention of depression and poor physical function in older persons.
- Vitamin D supplementation is important for bone health, but its benefits do not extend to preventing depression or improving physical function in older adults without vitamin D deficiency.
- The mechanisms of vitamin D, including regulating calcium absorption and roles in immune function and cell signaling, do not translate to meaningful improvements in mood or physical performance in the general older population when supplemented above normal requirements, as found in the D-Vital study and supported by the USPSTF recommendation statement 1.
In clinical practice, it is essential to prioritize the prevention of morbidity, mortality, and improvement of quality of life, and in this case, vitamin D supplementation is not a recommended intervention for preventing depression and poor physical function in older persons without vitamin D deficiency or insufficiency. However, vitamin D supplementation may still be necessary for those with documented deficiency or for maintaining bone health, highlighting the importance of individualized assessment and treatment plans.
From the Research
Vitamin D Supplementation for Depression and Poor Physical Function in Older Persons
- The D-Vitaal study, a randomized clinical trial, investigated the effect of vitamin D supplementation on depressive symptoms and physical functioning in older adults with low vitamin D status 2, 3.
- The study found that supplementation with 1200 IU/d vitamin D for 12 mo had no effect on depressive symptoms and physical functioning in older persons with relatively low vitamin D status, clinically relevant depressive symptoms, and poor physical functioning 3.
- Another study suggested that the maintenance of adequate vitamin D concentrations is an important issue, especially in older adults, which are a risk population for both vitamin D deficiency and depression 4.
Effects of Vitamin D Supplementation on Depression
- A study tested vitamin D3 and omega-3 fatty acids for late-life depression prevention and found that neither vitamin D3 nor omega-3s showed benefits for indicated and selective prevention of late-life depression 5.
- A review of the management of depression in older adults found that antidepressants are the best-studied treatment option, but psychotherapy, exercise therapy, and electroconvulsive therapy may also be effective 6.
- The review also noted that high-quality evidence does not support the use of pharmacologic treatment of depression in patients with dementia, and that polypharmacy in older patients can be minimized by using the Screening Tool of Older Persons Prescriptions and Screening Tool to Alert doctors to Right Treatment (STOPP/START) criteria 6.
Physical Functioning and Vitamin D Supplementation
- The D-Vitaal study found that vitamin D supplementation had no effect on physical functioning in older persons with relatively low vitamin D status, clinically relevant depressive symptoms, and poor physical functioning 3.
- A study on the effects of vitamin D3 and marine omega-3 fatty acids supplementation on indicated and selective prevention of depression in older adults found that there were no significant differences in physical performance comparing either supplement with placebo 5.