The Effect of Ultraviolet B Irradiation Compared with Oral Vitamin D Supplementation on the Well-being of Nursing Home Residents with Dementia: A Randomized Controlled Trial
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Participants
3.2. Adherence of Nursing Home Residents to the Intervention
3.3. Effect of UVB on the Outcome Variables
3.3.1. Effect of UVB Treatment on Well-Being
3.3.2. Effect of UVB Treatment on Secondary Outcomes
3.3.3. Harmful or Adverse Events
3.4. Additional (Sensitivity) Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
3 Months (n = 58) | 6 Months (n = 52) | p-Value | |||||||
---|---|---|---|---|---|---|---|---|---|
Estimated Mean | Adjusted MD | p-Value | Estimated Mean | Adjusted MD | p-Value | Pg | Pt | Pgt | |
Score (95% CI) | (95% CI) | Score (95% CI) | (95% CI) | ||||||
CMAI total score | 0.847 | 0.175 | 0.155 | ||||||
UVB | 49.3 (43.9, 54.7) | 3.3 (−3.6, 10.2) | 0.343 | 49.2 (43.5–54.8) | −2.2 (−9.4, 5.0) | 0.554 | |||
VD | 46.0 (41.7, 50.3) | 51.3 (46.7–55.8) | |||||||
Cornell scale for depression | 0.483 | 0.032 | 0.260 | ||||||
UVB | 8.5 (6.4, 10.7) | 2.1 (−1.9, 4.6) | 0.200 | 10.1 (8.0–12.2) | −0.5 (−2.7, 3.6) | 0.775 | |||
VD | 7.1 (5.0, 9.1) | 11.0 (8.8, 12.9) | |||||||
Care relationship (QUAL) | 0.575 | 0.617 | 0.285 | ||||||
UVB | 6.0 (5.4, 6.7) | −0.5 (− 1.3, 1.3) | 0.259 | 6.2 (5.5, 6.8) | 0.3 (−0.5, 1.2) | 0.820 | |||
VD | 6.5 (6.0, 7.0) | 6.1 (5.6, 6.7) | |||||||
Positive affect (QUAL.) | 0.827 | 0.602 | 0.171 | ||||||
UVB | 8.8 (7.8, 9.9) | 0.4 (−0.9, 1.6) | 0.561 | 8.5 (7.5, 9.6) | 0.0 (−1.3, 1.3) | 0.354 | |||
VD | 8.5 (7.7, 9.3) | 9.1 (8.3, 9.9) | |||||||
Negative affect (QUAL.) | 0.945 | 0.337 | 0.218 | ||||||
UVB | 3.6 (3.2, 4.0) | 0.2 (−0.3, 0.7) | 0.452 | 3.3 (2.8,3.7) | −0.2 (−0.7, 0.3) | 0.406 | |||
VD | 3.4 (3.1, 3.7) | 3.5 (3.2, 3.8) | |||||||
Restless/Tense (QUAL.) | 0.969 | 0.462 | 0.012 | ||||||
UVB | 4.8 (4.0, 5.6) | −0.6 (−1.7, 0.4,) | 0.207 | 5.7 (4.8, 6.5) | 1.2 (0.2, 2.3,) | 0.025 | |||
VD | 5.4 (4.8, 6.0) | 4.5 (3.7, 5.1) | |||||||
Social relations (QUAL.) | 0.939 | 0.857 | 0.324 | ||||||
UVB | 5.9 (5.2, 6.7) | 0.3 (−0.6, 1.2) | 0.484 | 5.6 (4.9, 6.4) | −0.3 (−1.2, 0.7) | 0.573 | |||
VD | 5.6 (5.1, 6.2) | 5.9 (5.3, 6.5) | |||||||
Social isolation (QUAL.) | 0.292 | 0.557 | 0.546 | ||||||
UVB | 6.0 (5.2, 6.8) | −0.6 (−1.6, 0.4) | 0.223 | 6.0 (5.2, 6.8) | −0.3 (−1.3, 0.7) | 0.596 | |||
VD | 6.6 (6.0, 7.2) | 6.2 (5.6, 6.7) | |||||||
25(OH)D3 | 0.039 | 0.237 | 0.005 | ||||||
UVB | 67.6 (59.1, 76.0) | −5.1 (−15.8, 5.6) | 0.344 | 64.1 (54.9, 73.3) | −16.8 (−28.0, −5.5) | 0.004 | |||
VD | 72.7 (66.5, 78.9) | 80.7 (74.5, 87.1) |
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Variable | UVB | Vitamin D | p-Value |
---|---|---|---|
Gender %,(n) | 0.20 a | ||
male | 24 (10) | 38 (14) | |
Female | 76 (31) | 62 (23) | |
Age in years, mean (SD) | 84.2 (79.5–87.5) | 83.6 (77.5–88.5) | 0.74 b |
Fitzpatrick skin scale %,(n) | 0.90 c | ||
1. always burns easily, never tans | 0 | 3 (1) | |
2. always burns easily, tans slightly | 66 (27) | 62 (23) | |
3. burns moderately, tans gradually | 30 (12) | 32 (12) | |
4. burns minimally, tans moderately | 0 | 0 | |
5. rarely burns, tans profusely | 5 (2) | 0 | |
6. never burns, tans profusely | 0 | 3 (1) | |
Dementia severity, mean BANS-S (SD) | 15.1 (4.3) | 16.6 (5.7) | 0.20 b |
Agitation (median CMAI, IQR) | 40.0 (30.3–62.5) | 41.0 (30.5–61.0) | 0.82 d |
Cornell Scale For Depression (Median, IQR) | 9.5 (4.9–13.0) | 9.5 (5.0–12.0) | 0.88 d |
QUALIDEM (Median, IQR) | |||
A. Care relationship | 6.0 (4.0–8.0) | 7.0 (5.0–8.5) | 0.28 d |
B. Positive affect | 10.0 (7.5–12.0) | 9.0 (8.0–11.5) | 0.63 |
C. Negative affect | 3.0 (3.0–4.0) | 4.0 (3.0–4.0) | 0.98 |
D. Restless/tense behavior | 6.0 (2.5–8.0) | 6.0 (3.0–8.0) | 0.91 |
E. Social relations | 6.0 (4.5–8.0) | 6.0 (4.0–7.0) | 0.45 |
G. Social isolation | 6.5 (4.0–9.0) | 8.0 (5.0–9.0) | 0.52 |
Blood tests (Median, IQR)) # | |||
Creatinine (µmol/L) | 73.0 (61.0–982.0) | 72.5 (56.0–988.2) | 0.82 d |
Calcium (mmol/L) | 2.3 (2.3–92.5) | 2.3 (2.3–92.4) | 0.81 |
Phosphate (mmol/L) | 1.1 (1.0–91.1) | 1.1 (0.9–91.3) | 0.60 |
Alkaline phosphatase (U/I) | 86.4 (65.3–9116.6) | 82.4 (70.0–997.9) | 0.96 |
25(OH)D3 (nmo/L) | 66.4 (53.6–978.7) | 86.4 (65.1–999.7) | 0.04 |
Parathyroid hormone (pmol/L) | 5.7 (3.0–97.6) | 3.5 (2.7–96.5) | 0.24 |
3 Months (n = 58) | 6 Months (n = 52) | p-Value | |||||||
---|---|---|---|---|---|---|---|---|---|
Estimated Mean | Adjusted MD | p-Value | Estimated Mean | Adjusted MD | p-Value | Pg | Pt | Pgt | |
Score (95% CI) | (95% CI) | Score (95% CI) | (95% CI) | ||||||
CMAI total score | 0.431 | 0.076 | 0.258 | ||||||
UVB | 49.4 (44.7, 54.0) | 4.4 (−2.3, 11.2) | 0.194 | 50.6 (45.7, 55.5) | −0.2 (−6.8, 7.2) | 0.953 | |||
VD | 45.0 (41.0, 49.8.2) | 50.4 (45.4, 55.5) | |||||||
Cornell scale for depression | 0.982 | 0.014 | 0.246 | ||||||
UVB | 8.5 (6.4, 10.7) | 1.3 (−1.9, 4.6) | 0.412 | 10.1 (8.0, 12.2) | −1.3 (−4.5, 1.9,) | 0.427 | |||
VD | 7.2 (4.8, 9.7) | 11.4 (9.0, 13.8) | |||||||
Care relationship (QUAL) | 0.776 | 0.421 | 0.307 | ||||||
UVB | 6.2 (5.8, 7.0) | −0.2 (−1.0, 0.6) | 0.684 | 6.3 (5.7, 6.7) | 0.3 (−0.5, 1.2) | 0.402 | |||
VD | 6.4 (5.4, 6.5) | 6.3 (5.7, 6.7) | |||||||
Positive affect (QUAL.) | 0.698 | 0.363 | 0.646 | ||||||
UVB | 8.8 (7.9, 9.7) | 0.4 (−0.9, 1.6) | 0.555 | 8.9 (8.0, 9.9) | 0.0 (−1.3, 1.3) | 0.947 | |||
VD | 8.4 (7.5, 9.3) | 8.9 (8.0, 9.8) | |||||||
Negative affect (QUAL.) | 0.303 | 0.507 | 0.866 | ||||||
UVB | 3.4 (3.0, 3.7) | −0.2 (−0.7, 0.3) | 0.483 | 3.3 (3.0, 3.7) | −0.2 (−0.7, 0.3) | 0.377 | |||
VD | 3.6 (3.2, 3.9) | 3.5 (3.1, 3.8) | |||||||
Restless/Tense (QUAL.) | 0.937 | 0.520 | 0.003 | ||||||
UVB | 4.6 (3.9, 5.1) | −1.1 (−2.1, −0.1,) | 0.025 | 5.5 (4.8, 6.2) | 1.1 (0.1, 2.1,) | 0.042 | |||
VD | 5.7 (5.0, 6.4) | 4.4 (3.7, 5.1) | |||||||
Social relations (QUAL.) | 0.960 | 0.920 | 0.763 | ||||||
UVB | 5.7 (5.1, 6.3) | −0.1 (−1.0, 0.8) | 0.813 | 5.8 (5.1, 6.5) | 0.1 (−0.8, 1.0) | 0.879 | |||
VD | 5.8 (5.1, 6.4) | 5.7 (5.1, 6.4) | |||||||
Social isolation (QUAL.) | 0.329 | 0.441 | 0.158 | ||||||
UVB | 5.9 (5.3, 6.6) | −0.8 (−1.7, 0.2) | 0.104 | 6.2 (5.5,6.8) | 0.0 (−1.0, 1.0) | 0.988 | |||
VD | 6.7 (6.1, 7.4) | 6.2 (5.5, 6.8) | |||||||
25(OH)D3 | 0.003 | 0.141 | 0.001 | ||||||
UVB | 66.3 (59.1, 73.5) | −9.3 (−19.4, 1.0) | 0.073 | 62.7 (54.9, 70.5) | −21.9 (−32.6, −11.2) | 0.000 | |||
VD | 75.6 (69.0, 82.1) | 84.6 (77.9, 91.3) |
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Veleva, B.I.; Caljouw, M.A.A.; van der Steen, J.T.; Mertens, B.J.A.; Chel, V.G.M.; Numans, M.E. The Effect of Ultraviolet B Irradiation Compared with Oral Vitamin D Supplementation on the Well-being of Nursing Home Residents with Dementia: A Randomized Controlled Trial. Int. J. Environ. Res. Public Health 2020, 17, 1684. https://doi.org/10.3390/ijerph17051684
Veleva BI, Caljouw MAA, van der Steen JT, Mertens BJA, Chel VGM, Numans ME. The Effect of Ultraviolet B Irradiation Compared with Oral Vitamin D Supplementation on the Well-being of Nursing Home Residents with Dementia: A Randomized Controlled Trial. International Journal of Environmental Research and Public Health. 2020; 17(5):1684. https://doi.org/10.3390/ijerph17051684
Chicago/Turabian StyleVeleva, Bistra I., Monique A. A. Caljouw, Jenny T. van der Steen, Bart J. A. Mertens, Victor G. M. Chel, and Mattijs E. Numans. 2020. "The Effect of Ultraviolet B Irradiation Compared with Oral Vitamin D Supplementation on the Well-being of Nursing Home Residents with Dementia: A Randomized Controlled Trial" International Journal of Environmental Research and Public Health 17, no. 5: 1684. https://doi.org/10.3390/ijerph17051684