I live near a nursing home and regularly see the staff coming in and out during their shift change when I walk past. What I have not seen, despite the warm, sunny weather, are residents sitting outside in the garden, or being pushed in a wheelchair.
This is not surprising. Few nursing homes have the sufficient staff to permit taking residents outside, and so rely on visitors to do so. The residents themselves often prefer to stay inside. An elderly aunt of mine always had an excuse as to why she did not want me to take her out when I visited. I wanted to take her for a stroll in her wheelchair, but she preferred staying in.
One consequence of being a “shut-in” in a nursing home has been noted for years: a significant decrease in vitamin D levels because of the absence of exposure to sunlight. The predictable osteoporosis, bone breakage from falls, and decreased mobility affects quality of life, making many unable to move independently, and so is linked to increased mortality. Vitamin D supplementation is strongly recommended, and shown in many studies to be effective in reducing this vitamin deficiency effects on bone strength.
But what about the staff? The nursing staff who leave the residence early in the morning, sometimes just as the sun rises, are going home to sleep. They will be back the next evening, but even though their time off is during the day? The need to rest for at least 7 hours of sleep and the necessity of managing their daily obligations leaves little time for outside exposure to sunlight. This, of course, is especially true during the short hours of daylight during the late fall and winter. Depression has a high incidence among shift workers, and their failure to be exposed to sufficient sunlight has been suggested as one possible cause.
Those who work a traditional daytime shift should not be vulnerable to vitamin D deficiency due to the absence of sunlight, but is this really true? The reality is that many are stuck in their offices from sunrise to moonrise and later. Exposure to the sun is limited to weekends and, in some employment situations, such as law associates (recent graduates from law school) priority to work supersedes any weekend plans (including going outside.) These employees could be described as ‘corporate shut-ins.’ They may be tethered to the “clock” that is tracking their billable hours, and like a galley slave chained to his oars, will not be released until their supervisor (task master) permits time off. Whatever leisure time they have is spent carrying out the essential tasks necessary for their daily life such as buying food, doing laundry, paying bills, and maybe cleaning their apartments.
As we have seen, clinicians are worried (and rightly so) about the low vitamin D levels of nursing home residents, at home elderly shut-ins, and anyone else who is unable to obtain regular exposure to sunlight. But look in vain for concern about corporate shut-ins who don’t see the sun from Sunday to Saturday during the months of year when daylight is scarce. According to Dr. Barbara Gilchrest, who discussed vitamin D status at a recent American Academy of Dermatology meeting in Orlando, sun and diet should be enough to supply adequate levels of this essential nutrient for most patients. But can her advice be applied to those whose exposure to sun is severely limited, and whose diet lacks vitamin D fortified foods?
In an ideal work setting, shift workers would be advised on how to eat to minimize the health problems associated with their work schedule such as obesity, high blood pressure, diabetes and depression. Taking vitamin D supplements or finding time during the day to go outside and get some sunshine might be suggested. Much of this advice, however, comes not from the workplace or health care providers, but from anecdotal reports posted on Internet sites by those who also do this type of work.
But even less advice is given to daytime employees whose work hours are long and who may go days without any time off. They will not find bottles of vitamin D on their desk, nor will their supervisors encourage them to go outside during lunch to get some sun. Indeed, they are encouraged not to leave the building. And the meals provided in these organizations so they can work late are probably not planned to ensure that they consume vitamin D fortified foods.
We know already the long-term health consequences of nursing home residents who are shut-ins and get no sun exposure. So too, we know the long-term health consequences of shift workers who rarely see the sun.
We do not yet know the long-term health consequences of the corporate shut-in, the Silicon Valley twenty-four hour programmer, the investment banker who works during Asian, European and American time zones, or the surgical resident who arrives at the hospital at 5:30 AM and leaves at midnight. They, like the nursing home resident, have too little exposure to the sun. Do we have to wait until this generation of workers ages into the nursing home before we start to worry about their vitamin D status?
Research Cites Supportive Available Upon Request.