(Preventing) two birds with one stone: improving vitamin d levels in the elderly.

J Prim Health Care. 2011 Jun 1;3(2):150-2.
Lawless S, White P, Murdoch P, Leitch S.
Amity Health Centre, 343 Highgate, Roslyn, Dunedin 9010, New Zealand. susie at amityhc.co.nz.

BACKGROUND AND CONTEXT: A majority of adults have sub-optimal vitamin D levels in the winter in southern New Zealand. This is associated with an increased risk of falls and fragility fractures in the elderly, with long-term adverse outcomes likely. Vitamin D supplementation decreases the risks of both falls and fractures.

ASSESSMENT OF PROBLEM: An intervention was undertaken by a small urban general practice to increase the number of elderly patients receiving vitamin D supplementation by linking vitamin D prescription to the annual flu vaccination campaign.

RESULTS: Uptake of the supplementation was high and costs to the practice low. Thirty-eight patients were identified for whom long-term supplementation with vitamin D was indicated.

STRATEGIES FOR IMPROVEMENT: The study could have been strengthened by incorporating a more formal method of evaluating uptake.

LESSONS: Encouraging patients to take supplements as a population-based strategy is a realistic intervention, and linking it to the flu vaccination campaign is both seasonally appropriate and efficient.

PMID: 21625664
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Just mark it on the calendar

With the current large sizes of vitamin D doses vitamin D can be taken just once a week or even every other week.
Just mark it on the calendar, say on Saturday
When Saturday comes along, take the vitamin D and mark it off the calendar
If happen to not notice the calendar for a few days, just proceed as above - it does not matter if you take the dose as much as a week late.
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A blister pack might be a good solution for vitamin D for the elderly.

Only have to take one gel-cap per week.
Each blister would be labeled for the week.
The person could take the tiny gel-cap anytime during the week.
Everyone can easily see if a gel-cap had been taken - the blister is broken and pill is missing
If forgotten, gel-cap could be taken as much as 4 weeks late - 4 at a time is OK

The following is an example of a blister pack with 4 columns and 12 rows.
Columns = weeks 1, 2, 3, 4
Rows = months: Jan, Feb, Mar, April, …

Last row would have 4 extra pills to be taken for flus, colds, etc.
For the elderly 4,000 IU daily is good, so the weekly gel cap would be 28,000 IU: 25,000 IU caps are available as of June 2011

Vitamin D can eliminate many reasons people STOP taking a pill

• Cost
• Not feel the benefit
• Strong side effects
• Worry about future side effects/interactions

Blister pack can eliminate some other reasons people stop

• Taking too many pills – too complex
• Bother
• Forgot

Blister pack can also eliminate some reasons people do not start initially

• Do not want to have to do something new daily
• Feel that should not have to take supplements (maybe)
• Fear ridicule by family and friends
• Feel that will forget to take them, then will feel bad
• Already taking too many pills everyday
• Think that will not feel benefit in the short term
• Worry about side effects – kidney stones, toxicity, etc
• Do not want to feel controlled by someone else – how to deal with this??
  • Give them freedom of day of week
  • Give them freedom to take more or less
  • Give them freedom to skip a week or so
  • Give them freedom of time of the day to take it
  • Give them freedom to spread it out over the day or several days
  • Give them freedom to take Before. During, After, or Without a meal
  • Give them freedom to not have to take it along on a vacation/trip

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See also VitaminDWik

• A proposed way to confirm that you have taken your vitamin D more on blister pack idea
• Just mark your calendar for vitamin D days which has the following graphic

See on the web

• Google images of medical blister packs
• WikiPedia
• A company which might do custom blisters
• A company which provides a kit to make your own blister packs
  • Their 7 X 4 format would allow 7 months with 4 weeks in each month - but the labels would show days of the week and time of day
  • Their home kit that can be filled by an individual includes 52 blisters and 52 labels with a mounting tray for $120.00 US.
• Blister pack for home use
  • requested information about blank label for monthly use - June 2011