Factors influencing adherence with therapeutic sunlight exposure in older people in intermediate care facilities.
Arch Gerontol Geriatr. 2011 Sep 14.
Durvasula S, Sambrook PN, Cameron ID.
Sydney Medical School, University of Sydney, Australia.
Purpose of research: The purpose of this study was to investigate the factors influencing low adherence with therapeutic sunlight exposure in a randomized controlled trial conducted with older people living in intermediate care facilities.
Materials and methods: The study involved participants in the FREEDOM (Falls Risk Epidemiology: Effect of vitamin D on skeletal Outcomes and other Measures) study, a randomized controlled trial of therapeutic sun exposure to reduce falls in older people in intermediate care facilities.
Semi-structured interviews were conducted with thirty participants in the FREEDOM trial, and with ten sunlight officers who were employed to facilitate the sun exposure. Two focus groups involving 10 participants in the FREEDOM trial were also held at the end of the intervention period. Common themes were derived from the interview and focus group transcripts.
Principal results: The study showed that the perceived health benefits did not influence adherence with the sun exposure.
Factors such as socializing with others and being outdoors were more important in encouraging attendance.
The main barriers to adherence included the perceived inflexibility and regimentation of daily attendance, clash with other activities, unsuitable timing and heat discomfort.
Major conclusions: This study showed that providing greater flexibility and autonomy to older people in how and when they receive sun exposure is likely to improve adherence.
Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
'SUNLIGHT officers' are being employed at Sydney nursing homes as part of a novel attempt to prevent vitamin D deficiency in elderly residents.
The NHMRC-funded three-year project will test whether employing the officers to encourage residents to sit out in the sun in the early morning will improve vitamin D levels and have additional health benefits.
The initiative is led by Professor Philip Sambrook and colleagues at Sydney's RoyalNorthShoreHospital.
"Previous studies in this area found that giving vitamin D supplements reduced falls," says researcher Professor Rebecca Mason. "Now we're trying to see if getting them into the sun provides additional effects from socialisation and sun exposure."
A recent US study suggested nursing home residents taking 800 IU of vitamin D daily had a lower rate of falls than those in placebo or lower-dose groups.1
Professor Mason believes encouraging elderly people to get out into the sun may be more successful than vitamin supplementation, where there can be a lack of compliance.
"The only supplements generally available in Australia are 1000 IU and they need to be taken pretty well daily," she says. "Most older people are already on a multitude of tablets. In most of the studies that have been done where people are asked to take supplements, compliance rates have been very poor — 50-60%."
However, Professor Mason says the sunlight officer approach is expensive, and organising and motivating residents can be time-consuming.
Reference Journal of the American Geriatric Society 2007; 55:234-39.
Does increased sunlight exposure work as a strategy to improve vitamin D status in the elderly: a cluster randomised controlled trial
In Osteoporosis International March 2011
P. N. Sambrook, I. D. Cameron, J. S. Chen, R. G. Cumming, S. Durvasula, M. Herrmann, C. Kok, S. R. Lord, M. Macara and L. M. March, et al.
clip: "However, in 66 participants who attended ?130 sessions per year (adherence, ?50% of 260 sessions–five per week), falls were significantly reduced (IRR, 0.52;"
Those who got enough sun had 50% fewer falls (but this could have been because the more more active anyway)