Florida State University College of Medicine, USA
Dr. Agens received his MD degree in 1986 from Rutgers Medical School, completed an internal medicine residency at Cooper Hospital University Medical Center, Camden, NJ in 1989. He is board certified in Internal Medicine and Geriatrics through the American Board of Internal Medicine. Prior to coming to Florida State University College of Medicine as Associate Professor in Geriatrics in 2008, Dr. Agens started and operated a solo internal medicine practice in his hometown of Blackwood, N.J 1989-1993. After moving to Eau Claire, Wisconsin, he served for 10 years as a geriatrician at Midelfort Clinic-Mayo Health System., 1991-2003. Throughout his career, Dr. Agens has taught and mentored medical students and residents as a clinical preceptor. In 2003, Dr. Agens moved to Tallahassee, Florida. He spent over five years as director of the Center for Chronic Care at Capital Health Plan, which delivered intensive primary care to some of its most complex patients and improved their functional and clinical outcomes. It was during this time he noted most of those patients were vitamin D deficient. He became acutely interested helping patients function better addressing their nutritional status as one component. During that time he served as Clinical Assistant Professor and as community faculty for multiple clinical rotations at Florida State University College of Medicine. Since 2008, Dr. Agens served as the Geriatrics Clerkship Director for fourth year medical students at the Tallahassee Regional Campus and since 2011 sees older patients in the Florida Medical Practice Plan. Still interested in vitamin D , he published with Gail Galasko, Ph. D. “Awareness of vitamin D deficiency states and recommended supplementation doses: Survey of faculty and staff at a medical school” in “e-SPEN Journal” suggesting an overall low awareness of the relationship between low vitamin D status and poor physical function/ falls.
Background: On November 30, 2010, new Dietary Reference Intake recommendations for vitamin D were published by the Institute of Medicine. The Recommended Daily Allowance was revised upward to 800 IU/day for adults 71 and older. At that time we reported in e-SPEN low self-reported vitamin D levels as prevalent in our survey sample of physician (MD) medical school faculty living in an area of the USA with plentiful sunshine. MD’s who had their own vitamin D level checked were 4.5 times more likely to recommend greater than or equal to 800 IU/day for their patients as compared to those who reported not having had their own levels checked. Awareness of conditions associated with vitamin D deficiency other than osteoporosis, rickets and osteomalacia was relatively low. One specific example is falls in older persons where vitamin D is recommended as part of a multi factorial fall-risk assessment and prevention strategy, the CDC STEADI protocol. Our fourth year medical students taking a required geriatrics clerkship perform functional assessment and a comprehensive medication review (including non-prescription medications) under the supervision of our faculty and write separate reports on each. After graduation consenting students have the opportunity to have their written reports studied in research approved by the IRB of Florida State University.
Research Question: We hypothesized that the proportion of patients noted as receiving 800 IU/day or more of supplemental vitamin D as noted in students’ written assignments would be low (less than 50%) where patients are functionally impaired and at risk for falls given overall low awareness in faculty of falls being a risk associated with vitamin D deficiency.
Subjects & Methods: Twenty two consenting students had their comprehensive medication review assignments reviewed representing 20 percent of all students taking the required geriatrics course at 6 regional campuses over one academic year. Each assignment represented one patient ages ranging from 55-97, mean age was 81 years. Prescription and non-prescription medications were reviewed and verified as required in the assignment.
Results: Four patients (18%) were on vitamin D: Calcitriol 0.25 mg daily, vitamin D 50,000 International IU once weekly (a known vitamin D deficient patient), vitamin D 200 IU once daily and vitamin D 800 IU daily. In one case a student recommended that the patient not on a vitamin D supplement recommended vitamin D 800 IU daily to prevent falls.
Conclusion: In this cohort of 4th year medical students and their geriatric patients at high risk for falls, use of vitamin D was low and recommendation for use to prevent falls was low.