1
|
McMahan C, Shieu B, Trinkoff A, Castle N, Wolf DG, Handler S, Harris JA. Factors Associated With the Ability of US Nursing Homes to Accept Residents With Severe Obesity. J Am Med Dir Assoc 2024; 25:912-916.e3. [PMID: 38640960 DOI: 10.1016/j.jamda.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVES Severe obesity in nursing home (NH) residents is associated with specialized care needs, limited mobility, and challenges in daily living. The COVID-19 pandemic strained NH resources and exacerbated staffing shortages. This study aimed to assess the ability of US NHs to accept and care for residents with severe obesity post-COVID, as well as associated NH factors. DESIGN Cross-sectional nationwide survey of NH administrators (2021-2022). SETTING AND PARTICIPANTS 290 NHs from a national sample (n = 224) and a targeted sample in Massachusetts and New Jersey (n = 66). METHODS A survey designed to assess how NHs approach admitting and caring for people with severe obesity before and after COVID was fielded from 2021 to 2022. Responses were linked to facility information from the Certification and Survey Provider Enhanced Reports, Minimum Data Set, Nursing Home Compare, Area Health Resources File, and US Diabetes Surveillance System. Multivariable logistic regression was used to assess the effect of organizational and survey response variables. RESULTS Of the 2503 surveys sent to US NHs, 1923 were sent to the national NH stratified sample, and 580 were sent to the MA/NJ sample. Overall, 12% (301 of 2503) of NHs surveyed responded. The response rates were similar between the 2 samples. Of 290 NHs with complete data, 34% reported being unlikely to accept residents with severe obesity after COVID-19, compared with 25% before the pandemic (P < .001). The main barriers to acceptance were staffing shortages and difficulties meeting equipment and space needs. NHs with higher proportions of Black residents were more likely to admit individuals with severe obesity. CONCLUSIONS AND IMPLICATIONS The decline in acceptance of residents with severe obesity during and after COVID-19 highlights potential challenges that this population faces in accessing care. Our results also raise concerns that an intersection of disparities may exist in Black patients with severe obesity.
Collapse
Affiliation(s)
- Cynthia McMahan
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Bianca Shieu
- School of Nursing, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Alison Trinkoff
- Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Nicholas Castle
- Department of Health Policy and Management, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - David G Wolf
- College of Business and Management, Lynn University, Boca Raton, FL, USA
| | - Steven Handler
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Technology Enhancing Cognition and Health - Geriatrics Research Education and Clinical Center (TECH-GRECC), Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - John A Harris
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, Magee-Womens Research Institute, Pittsburgh, PA, USA
| |
Collapse
|
2
|
Marshall V, Qiu Y, Jones A, Weller CD, Team V. Hospital-acquired pressure injury prevention in people with a BMI of 30.0 or higher: A scoping review. J Adv Nurs 2024; 80:1262-1282. [PMID: 37788102 DOI: 10.1111/jan.15882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023]
Abstract
AIM(S) To: (1) explore current best practices for hospital-acquired pressure injury prevention in high BMI patients; (2) summarize nurses' experiences in preventing and managing them; (3) explore the association between a high BMI and occurrence and severity of pressure injury. DESIGN Exploratory. METHODS Scoping review. DATA SOURCES Ovid MEDLINE, EBSCO CINAHL Plus, JBI Evidence Synthesis, Scopus, Embase, clinical registries and grey literature (search dates: January 2009 to May 2021). RESULTS Overall, 1479 studies were screened. The included studies were published between 2010 and 2022. Five interventional studies and 32 best practice recommendations (Objective 1) reported low-quality evidence. Findings of thematic analysis reported in nine studies (Objective 2) identified nurses' issues as insufficient bariatric equipment, inadequate staffing, weight bias, fatigue, obese-related terminology issues, ethical dilemmas and insufficient staff education in high BMI patients' pressure injury prevention. No association between hospital-acquired pressure injury occurrence and high BMI were reported by 18 out of 28 included studies (Objective 3). CONCLUSION Quality of evidence was low for the interventional studies and best practice recommendations. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Current (2019) International Pressure Injury Guideline to be used despite the low quality of evidence of most best practice recommendations. IMPACT STATEMENT This study addressed hospital-acquired pressure injury prevention in high BMI patients. Greater proportion of studies in this review found no association between high BMI and occurrence of hospital-acquired pressure injury. Nurses need educational interventions on pressure injury prevention in high body mass index people, sufficient staffing for repositioning and improved availability of bariatric equipment. REPORTING METHOD We adhered to relevant EQUATOR guidelines, PRISMA extension for scoping reviews. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Larger clinical trials are needed on repositioning frequency, support surfaces, prophylactic dressings and risk assessment tools to inform clinical practice guidelines on pressure injury prevention in high BMI people. PROTOCOL REGISTRATION Wound Practice and Research (https://doi.org/10.33235/wpr.29.3.133-139).
Collapse
Affiliation(s)
- Victoria Marshall
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Yunjing Qiu
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- School of Nursing and Midwifery, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Angela Jones
- Monash Partners Academic Health Science Centre, Clayton, Victoria, Australia
| | - Carolina D Weller
- School of Nursing and Midwifery, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Victoria Team
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- Monash Partners Academic Health Science Centre, Clayton, Victoria, Australia
| |
Collapse
|
3
|
Panda S, Maier G, Villareal DT. Targeting Energy Intake and Circadian Biology to Engage Mechanisms of Aging in Older Adults With Obesity: Calorie Restriction and Time-Restricted Eating. J Gerontol A Biol Sci Med Sci 2023; 78:79-85. [PMID: 37325958 PMCID: PMC10272989 DOI: 10.1093/gerona/glad069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Indexed: 06/17/2023] Open
Abstract
With the rise in obesity across age groups, it has been a hindrance to engaging in physical activity and mobility in older adults. Daily calorie restriction (CR) up to 25% has been the cornerstone of obesity management even though the safety in older adults remains incompletely understood. Although some adults can follow CR with clinically significant weight loss and improved health metrics, CR faces 2 obstacles-many fail to adopt CR and even among those who can adopt it short term, long-term compliance can be difficult. Furthermore, there is a continuing debate about the net benefits of CR-induced weight loss in older adults because of the concern that CR may worsen sarcopenia, osteopenia, and frailty. The science of circadian rhythm and its plasticity toward the timing of nutrition offer promise to alleviate some challenges of CR. The new concept of Time-Restricted Feeding/Eating (TRF for animal studies and TRE for human studies) can be an actionable approach to sustaining the circadian regulation of physiology, metabolism, and behavior. TRE can often (not always) lead to CR. Hence, the combined effect of TRE through circadian optimization and CR can potentially reduce weight and improve cardiometabolic and functional health while lessening the detrimental effects of CR. However, the science and efficacy of TRE as a sustainable lifestyle in humans are in its infancy, whereas animal studies have offered many desirable outcomes and underlying mechanisms. In this article, we will discuss the scope and opportunities to combine CR, exercise, and TRE to improve functional capacity among older adults with obesity.
Collapse
Affiliation(s)
| | - Geraldine Maier
- The Salk Institute for Biological Studies, La Jolla, California, USA
| | - Dennis T Villareal
- Division of Diabetes, Endocrinology, and Metabolism, Baylor College of Medicine, Houston, Texas, USA
- Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| |
Collapse
|
4
|
Harris JA, Kavalieratos D, Thoonkuzhy M, Shieu B, Schenker Y. Trends in Obesity Prevalence among US Older Adults in the Last Two Years of Life, 1998-2018. J Pain Symptom Manage 2023; 65:81-86. [PMID: 36384180 PMCID: PMC9910411 DOI: 10.1016/j.jpainsymman.2022.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/28/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
CONTEXT The prevalence of obesity has grown in the US over the decades. The temporal trends of body mass index categories in the last two years of life are poorly understood. OBJECTIVES To describe the trends in body mass categories in the last two years of life over the past two decades controlling for other demographic changes. METHODS We performed a cross-sectional study of prospectively collected survey data from the nationally representative Health and Retirement Study (HRS) among decedents who died between 1998 and 2018. We categorized BMI into five categories and calculated the proportion of decedents with each BMI category during each four epochs (1998-2003, 2004-2008, 2009-2013, 2014-2018). We examined trends in regression models with survey wave groupings modeled as an orthogonal polynomial and adjusted for factors commonly associated with BMI: sex, age, race, ethnicity, education, and tobacco use. RESULTS The analytic cohort included 14,797 decedents. From 1998-2003 to 2014-2018 time periods, those categorized as having mild-to-moderate obesity in the last two years of life increased from 12.4% to 14.8% (linear trend P < 0.001), a 19% increase. Severe obesity increased from 1.9% to 4.3%, a 126% increase (linear trend P < 0.001). Underweight decreased from 9.9% to 5.9%, a 40% decrease (linear trend P < 0.001), adjusted for demographic factors. Adjusted quadratic temporal trends for BMI category were nonsignificant, except for in mild-to-moderate obesity. CONCLUSION Severe obesity has increased greatly while underweight has decreased. As obesity increases in the final years of life, it is critical to assess how the existing and future palliative services and end of life care system address body size and weight.
Collapse
Affiliation(s)
- John A Harris
- Magee-Womens Research Institute (J.A.H., B.S.), University of Pittsburgh, Pittsburgh, PA.
| | | | | | - Bianca Shieu
- Magee-Womens Research Institute (J.A.H., B.S.), University of Pittsburgh, Pittsburgh, PA
| | | |
Collapse
|
5
|
Barreira LF, Paiva A, Araújo B, Campos MJ. Challenges to Systems of Long-Term Care: Mapping of the Central Concepts from an Umbrella Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1698. [PMID: 36767064 PMCID: PMC9914432 DOI: 10.3390/ijerph20031698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
The ageing of the population poses urgent challenges to the health and social protection sectors, including the need for greater adequacy and integration of health care services provided to older people. It is considered necessary and urgent to understand the state-of-the-art of community-based models of care for older people in institutional care and at home. This study aims to map the concepts that politicians and providers need to address through an umbrella review as a review method. Articles describing the structuring aspects of care models appropriate to the needs in long-term care and systematic reviews or meta-analyses targeting people aged 65 years or more were considered. A total of 350 studies met the inclusion criteria and were included in the review. The results identified the need to contribute to effective and more efficient integration and articulation of all the stakeholders, based essentially on professional care at the patient's homes, focused on their needs using the available technologies, empowering patients and families. Eight categories emerged that addressed factors and variables involved in care models for the long-term care needs of institutionalised and home-based older people as a guarantee of accessibility to healthcare and to enhance the well-being and quality of life of patients and family caregivers.
Collapse
Affiliation(s)
- Luís Filipe Barreira
- Center for Interdisciplinary Research in Health, Instituto Ciências da Saúde, Universidade Católica Portuguesa, Rua de Diogo Botelho 1327, 4169-005 Porto, Portugal
- Instituto de Ciências da Saúde do Porto, Universidade Católica Portuguesa, R. de Diogo Botelho 1327, 4169-005 Porto, Portugal
| | - Abel Paiva
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal
| | - Beatriz Araújo
- Center for Interdisciplinary Research in Health, Instituto Ciências da Saúde, Universidade Católica Portuguesa, Rua de Diogo Botelho 1327, 4169-005 Porto, Portugal
- Instituto de Ciências da Saúde do Porto, Universidade Católica Portuguesa, R. de Diogo Botelho 1327, 4169-005 Porto, Portugal
| | - Maria Joana Campos
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal
| |
Collapse
|
6
|
Parkinson M, Thompson J. An exploration of the challenges of providing person-centred care for older care home residents with obesity. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1112-e1122. [PMID: 34268838 DOI: 10.1111/hsc.13519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 05/27/2021] [Accepted: 07/04/2021] [Indexed: 06/13/2023]
Abstract
The aim of this study was to explore care home staff's views on the prevalence of obesity in older people and how well prepared they were for any rise in applications for placements. Thematic analysis was used to analyse focus group interview data collected from seven care homes/33 participants in N.E. England. Findings revealed rises in demand by older people with obesity for care home admittance, consistent with rising prevalence of obesity in this demographic nationally. Findings also highlight implications of rising prevalence of obesity in older people, particularly care home staff's ability to deliver person-centred care (PCC) and the importance of appropriate support/recognition of this as an emergent issue to be addressed at a higher executive level and by health/social care authorities. Ways of ensuring PCC are discussed. Given continuing trends towards rising prevalence of obesity in this population, the findings possess broader translational potential.
Collapse
Affiliation(s)
- Mark Parkinson
- Faculty of Health and Life Sciences, Northumbria University, Newcastle, UK
- Fuse, Centre for Translational Research in Public Health-a UK Clinical Research Collaboration Centre for Translational Research in Public Health & NIHR School for Public Health Research (SPHR) Centre of Excellence, Newcastle, UK
| | - Juliana Thompson
- Faculty of Health and Life Sciences, Northumbria University, Newcastle, UK
| |
Collapse
|
7
|
Arensberg MB, Brunton C, Drawert S, Richardson B. Prevalence Rates and Characteristics of Malnutrition, Frailty, and Other Nutrition and Muscle Mass-Related Conditions Document Potential Quality of Care Gap for Medicare Patients in US Skilled Nursing Facilities. Geriatrics (Basel) 2022; 7:geriatrics7020042. [PMID: 35447845 PMCID: PMC9027965 DOI: 10.3390/geriatrics7020042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 02/01/2023] Open
Abstract
Changes to the payment structure of the United States (U.S.) healthcare system are leading to an increased acuity level of patients receiving short-term skilled nursing facility care. Most skilled nursing facility patients are older, and many have medical conditions that cannot be changed. However, conditions related to nutrition/muscle mass may be impacted if there is early identification/intervention. To help determine the diagnosis and potential impact of nutrition/muscle mass-related conditions in skilled nursing facilities, this study evaluated 2016–2020 US Medicare claims data. Methods aimed to identify a set of skilled nursing facility claims with one or more specific diagnoses (COVID-19, malnutrition, sarcopenia, frailty, obesity, diabetes, and/or pressure injury) and then to determine length of stay, discharge status, total charges, and total payments for each claim. Mean values per beneficiary were computed and between–group comparisons were performed. Results documented that each year, the total number of Medicare skilled nursing facility claims declined, whereas the percentage of claims for each study diagnosis increased significantly. For most conditions, potentially related to nutrition/muscle mass, Medicare beneficiaries had a shorter length of skilled nursing facility stays compared to those without the condition(s). Furthermore, a lower percentage of these Medicare beneficiaries were discharged home (except for those with claims for sarcopenia and obesity). Total claim charges for those with nutrition/muscle mass-related conditions exceeded those without (except for those with sarcopenia). We conclude that although the acuity level of patients in skilled nursing facilities continues to increase, skilled nursing facility Medicare claims for nutrition/muscle mass-related conditions are reported at lower levels than their likely prevalence. This represents a potential care gap and requires action to help improve patient health outcomes and skilled nursing facility quality metrics.
Collapse
Affiliation(s)
- Mary Beth Arensberg
- Abbott Nutrition Division of Abbott, Columbus, OH 43219, USA;
- Correspondence:
| | - Cory Brunton
- Abbott Nutrition Division of Abbott, Columbus, OH 43219, USA;
| | | | | |
Collapse
|
8
|
Aytekin Sahin G, Caferoglu Z. The food service quality and its effects on nutritional status in nursing home residents. Clin Nutr ESPEN 2022; 47:233-239. [DOI: 10.1016/j.clnesp.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/21/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022]
|
9
|
Sefcik JS, Felix HC, Narcisse MR, Vincenzo JL, Weech-Maldonado R, Brown CC, Bradway CK. Nursing home directors of nursing experiences regarding safety among residents with obesity. Geriatr Nurs 2022; 47:254-264. [PMID: 36007426 PMCID: PMC9979081 DOI: 10.1016/j.gerinurse.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 11/04/2022]
Abstract
The prevalence of nursing home (NH) residents with obesity is rising. Perspectives of NH Directors of Nursing (DONs) who oversee care trajectories for residents with obesity is lacking. This study aimed to describe the experiences of NH DONs regarding care and safety for NH residents with obesity. An adapted version of Donabedian's structure-process-outcome model guided this qualitative descriptive study. Semi-structured interviews were conducted with 15 DONs. Data were analyzed using directed content analysis, and findings are presented under the model's constructs. We learned that admission decisions for NH referrals of patients with obesity are complex due to reimbursement issues, available space and resources, and resident characteristics. DONs described the need to coach and mentor Certified Nursing Assistants to provide safe quality care and that more staff education is needed. We identified novel findings regarding the challenges of short-term residents' experience transitioning out of care due to limited resources.
Collapse
Affiliation(s)
- Justine S. Sefcik
- College of Nursing and Health Professions, Drexel University, 1601 Cherry St., Room 377, Philadelphia, PA 19102, USA,Corresponding author. (J.S. Sefcik)
| | - Holly C. Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot 820-12, Little Rock AR 72205, USA
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences, 2708 S. 48th Street, Springdale, AR 72762, USA
| | - Jennifer L. Vincenzo
- Department of Physical Therapy, College of Health Professions, University of Arkansas for Medical Sciences, 1125 N. College Ave, Fayetteville, AR 72703, USA
| | - Robert Weech-Maldonado
- Department of Health Services Administration, University of Alabama at Birmingham, 1720 2nd Ave. S., Birmingham, AL 35294, USA
| | - Clare C. Brown
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot 820-12, Little Rock AR 72205, USA
| | - Christine K. Bradway
- Biobehavioral Health Sciences Department, University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
| |
Collapse
|
10
|
Stavrinou P, Aphamis G, Andreou E, Pantzaris M, Giannaki C. Association of body composition with functional capacity and cognitive function in older adults living in nursing homes. Curr Aging Sci 2021; 15:77-82. [PMID: 34465282 DOI: 10.2174/1874609814666210831155002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Older adults living in nursing homes have an increased risk of adverse outcomes. However, the role of body composition in vital health and quality of life parameters such as functional capacity and cognitive function is less studied in this group of older adults compared to community-dwelling counterparts. OBJECTIVE The aim of the present study was to examine the association of body composition with functional capacity and cognitive function in nursing home residents. METHODS Fifty-three older adults (82.8±7.3 years) were enrolled in this study and they underwent body composition evaluation, functional capacity and cognitive function measurements. RESULTS The results showed a high prevalence of obesity accompanied by functional capacity limitations and cognitive impairment in older adults living in nursing homes. Partial correlations, controlling for age, showed that body fat percentage was positively correlated with sit-to-stand-5 (r=0.310, p=0.025) and timed-up-and-go (r=0.331, p=0.017), and negatively correlated with handgrip strength test results (r=-0.431, p<0.001), whereas greater lean body mass was associated with better sit-to-stand-5 (r=-0.410, p=0.003), handgrip strength (r=0.624, p<0.001) and cognitive function performance (r=0.302, p=0.037). CONCLUSIONS These important associations reinforce the need to develop effective healthy lifestyle interventions targeting both lean mass and body fat to combat functional and cognitive decline in nursing home residents.
Collapse
Affiliation(s)
- Pinelopi Stavrinou
- Department of Life & Health Sciences, University of Nicosia, Nicosia. Cyprus
| | - George Aphamis
- Department of Life & Health Sciences, University of Nicosia, Nicosia. Cyprus
| | - Eleni Andreou
- Department of Life & Health Sciences, University of Nicosia, Nicosia. Cyprus
| | - Marios Pantzaris
- The Cyprus Institute of Neurology and Genetics, University of Cyprus, Nicosia. Cyprus
| | | |
Collapse
|
11
|
Zadworna M, Kossakowska K. Health behavior among Polish institutionalized older adults: the effect of resiliency mediated by satisfaction with life. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01301-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Abstract
Aim
Resiliency and satisfaction with life are identified as factors related to health behavior in the general population. However, little is known about health behavior and its predictors in public nursing home residents. The purpose of the study was to establish the nature of the relationship between resiliency, satisfaction with life, and health behavior in institutionalized older adults in Poland.
Subject and methods
A cross-sectional study with purposive sampling was performed in public nursing homes in Poland. A total of 161 male and female senior residents aged 60 to 99 (Mean = 76.65, SD = 9.23) were examined. Mediation analysis was performed with the Hayes’ PROCESS macro.
Results
This study revealed that resiliency, satisfaction with life, and health behavior are positively associated with each other in older persons. Satisfaction with life plays a mediating role in the relationship between resiliency and health behavior in residents of long-term care institutions.
Conclusion
Our findings underscore the important role played by personal resources in strengthening interventions and supporting the efforts of nursing home residents to engage in health behavior.
Collapse
|
12
|
Batsis JA, Zagaria AB, Brooks E, Clark MM, Phelan S, Lopez-Jimenez F, Bartels SJ, Rotenberg S, Carpenter-Song E. The Use and Meaning of the Term Obesity in Rural Older Adults: A Qualitative Study. J Appl Gerontol 2021; 40:423-432. [PMID: 32065013 PMCID: PMC7429325 DOI: 10.1177/0733464820903253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The term "obesity" is associated with societal stigma and discrimination. Eight individual semi-structured interviews and five focus groups with 29 community-dwelling, rural older adults with obesity, seven primary care clinicians, and four rural community leaders were completed using purposive and snowball sampling. Clinicians perceived that older adults are less affected by obesity stigma than younger adults, yet this was not observed by community leaders; however, older participants with obesity reported that they often felt ashamed and/or stigmatized because of their weight. There was also a disconnect between clinician and older adult understanding of obesity. For older adults with obesity, the word "obesity" was associated with negative connotations. Just as physiological aspects of obesity persist into older adulthood, so do psychological aspects, such as perceptions of stigma. The use of the word "obesity" in medical settings may hinder communication between clinician and older participants. Heightened awareness may change the dialogue around obesity.
Collapse
Affiliation(s)
- John A. Batsis
- Geisel School of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH
- Health Promotion Research Center at Dartmouth, Lebanon, NH
| | - Alexandra B. Zagaria
- Geisel School of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Emma Brooks
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH
- Section of Weight & Wellness, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Matthew M. Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Sean Phelan
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
| | | | | | - Sivan Rotenberg
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | | |
Collapse
|
13
|
Alvero-Cruz JR, Fernandez Vazquez R, Martinez Blanco J, Rosety I, Diaz AJ, Rosety MA, Rosety-Rodriguez M, Ordonez FJ. Proposed cut-off points for anthropometric and bioelectrical measures based on overweight and obesity criteria in Spanish institutionalised elderly people. PLoS One 2021; 16:e0248028. [PMID: 33684155 PMCID: PMC7939364 DOI: 10.1371/journal.pone.0248028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/18/2021] [Indexed: 11/19/2022] Open
Abstract
The increasing prevalence of obesity among the institutionalised elderly population and its severe consequences on health requires an early and accurate diagnosis that can be easily achieved in any clinical setting. This study aimed to determine new cut-off values for anthropometric and bioelectrical impedance measures that are superior to body mass index criteria for overweight and obesity status in a sample of Spanish institutionalised elderly population. A total of 211 institutionalised older adults (132 women, aged 84.3±7.3 years; 79 men, aged 81.5±7.3 years) were enrolled in the current cross-sectional study. Anthropometric and bioelectrical impedance measures included the body mass index, waist circumference, gluteal circumference, waist-hip ratio, sagittal-abdominal diameter, trunk fat, and visceral-fat ratio. In women, the waist circumference, gluteal circumference, sagittal-abdominal diameter, trunk fat, and visceral-fat index presented strongly significant specificity and sensitivity (area under the curve [AUC], p<0.0001) and elevated discriminative values (receiver operating characteristic [ROC] curves: 0.827 to 0.867) for overweight and obesity status. In men, the waist-hip ratio, waist circumference, gluteal circumference, sagittal-abdominal diameter, trunk fat, and visceral-fat ratio were strongly significant AUC (p<0.0001), with moderate-to-high values (ROC curves: 0.757-0.871). In conclusion, our findings suggest that gluteal circumference, waist circumference, and sagittal-abdominal diameter in women and trunk fat, visceral-fat ratio, and waist circumference in men may represent more suitable cut-off values superior to body mass index criteria for overweight and obesity in the Spanish institutionalised elderly population.
Collapse
Affiliation(s)
- Jose Ramon Alvero-Cruz
- Department of Physiology, Histology, Pathological Anatomy and Sport Sciences, School of Medicine, University of Malaga, Málaga, Spain
| | - Rosalia Fernandez Vazquez
- Department of Physiology, Histology, Pathological Anatomy and Sport Sciences, School of Medicine, University of Malaga, Málaga, Spain
| | | | - Ignacio Rosety
- Department of Human Anatomy, School of Medicine, University of Cádiz, Cádiz, Spain
| | | | | | | | | |
Collapse
|
14
|
Abstract
The population worldwide is aging and prevalence of obesity in this population is increasing. The range of consequences that effect these at-risk patients include increased risk of falls, fractures, reduced quality of life, and cognitive decline. This article describes the epidemiology of obesity, risks and benefits of weight loss, and importance of treating obesity to help promote healthy aging. Health care professionals should encourage older adults with obesity to implement healthy lifestyle behaviors including exercise and diet routine. Treating obesity in older adults mitigates the significant public health crisis, and reduces health care utilization and risk of long-term adverse events.
Collapse
Affiliation(s)
- Meredith N Roderka
- Section of Weight & Wellness, Department of Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Sadhana Puri
- Geisel School of Medicine, 1 Rope Ferry Road, Hanover, NH 03755, USA
| | - John A Batsis
- Section of Weight & Wellness, Department of Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA; Geisel School of Medicine, 1 Rope Ferry Road, Hanover, NH 03755, USA; The Dartmouth Institute for Health & Clinical Practice, 1 Medical Center Drive, Lebanon, NH 03756, USA; Dartmouth Centers for Health and Aging Hitchcock Loop Road, Lebanon, NH 03766, USA; Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
| |
Collapse
|
15
|
Harris JA, Engberg J, Castle NG. Organizational and Geographic Nursing Home Characteristics Associated With Increasing Prevalence of Resident Obesity in the United States. J Appl Gerontol 2020; 39:991-999. [PMID: 31018750 PMCID: PMC7192234 DOI: 10.1177/0733464819843045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nursing home resident obesity increases the complexity of nursing care, and nursing homes report avoiding residents with obesity when choosing which prospective residents to accept. The objective of this study was to examine the associations between nursing home obesity prevalence rate and nursing home organizational, staffing, resident, and geographic factors within a profit maximization framework. The study cohort included U.S. Centers for Medicare and Medicaid Services data from U.S. nursing homes in 2013. Study findings supported hypothesized associations between obesity prevalence rate and higher occupancy, higher bed capacity, and multi-facility affiliation, but findings did not support a relationship between obesity prevalence rate and for-profit status.
Collapse
|
16
|
Domenech-Cebrían P, Martinez-Martinez M, Cauli O. Relationship between mobility and cognitive impairment in patients with Alzheimer's disease. Clin Neurol Neurosurg 2019; 179:23-29. [PMID: 30798193 DOI: 10.1016/j.clineuro.2019.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 02/05/2019] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Alzheimer's disease (AD) is usually accompanied by impairments to mobility, performance of the basic activities of daily life (ADL), and progressive cognitive decline. We analyzed the relationship between cognitive performance and related cognitive subdomains and mobility. PATIENTS AND METHODS All AD patients of the recruited individuals were living in nursing homes; they underwent a blood analysis, cognitive examination by using the Mini-Mental State Examination, functional evaluation of independence in the ADLs with Barthel score and Katz index, and mobility assessment with the elderly mobility scale. RESULTS The mean sample age was 84 years and majority were women; more than 60% of the participants had severe cognitive impairment. Statistically significant relationships were found between the severity of cognitive impairment and functional capacity (p < 0.01) and their degree of mobility (p < 0.05). Among the different domains, memory impairment was not associated with impaired mobility or ability to perform the ADLs. Women had lower scores in the ADL and mobility assessments (p < 0.05) and an increased ratio of severe cognitive impairment (OR = 3.03 95% CI: [1.30, -7.05]) compared to men. Being overweight or obese and high blood levels of HDL cholesterol were directly (p < 0.05) and inversely (p < 0.01) associated with poor cognitive performance in individuals with mild to moderate cognitive dysfunction, respectively. CONCLUSIONS This study shows that better functional capacity and mobility are generally, but not exclusively, correlated with better cognitive function, depending on the severity of cognitive impairment. In contrast, lipid profile alterations might play a role in cognitive deficits in individuals with mild to moderate cognitive impairment who are overweight. Further longitudinal studies will be required to explore this possibility.
Collapse
Affiliation(s)
| | | | - Omar Cauli
- Department of Nursing, University of Valencia, Valencia, Spain.
| |
Collapse
|
17
|
Harris JA, Engberg J, Castle NG. Obesity and intensive staffing needs of nursing home residents. Geriatr Nurs 2018; 39:696-701. [PMID: 29884559 DOI: 10.1016/j.gerinurse.2018.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/18/2018] [Indexed: 01/20/2023]
Abstract
The objective of this study is to examine how increasing body mass index (BMI) among nursing home residents affects the amount of staffing assistance needed for activities of daily living (ADL). We analyzed 1,627,141 US nursing home residents reported in the 2013 Minimum Data Set in seven BMI categories, from underweight (BMI < 18.5 kg/m2) to obesity Class IIIB (≥50 kg/m2). Logistic regression models estimated the odds of nursing home-reported need for extensive (≥2 staff member) assistance needed for ADLs. The adjusted odds increased from 1.07 (95% Confidence Interval (95%CI) 1.06-1.08) for Class I, 1.16 (95%CI 1.14-1.17) for Class II, 1.33 (95%CI 1.31-1.35) for Class IIIA, and 1.90 (95%CI 1.86-1.95) for Class IIIB obesity residents compared to residents of normal weight. As a nursing home resident's BMI increases, especially for BMI ≥40 kg/m2, the need for extensive staffing assistance with ADLs also increases substantially.
Collapse
Affiliation(s)
- John Alexander Harris
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
| | | | - Nicholas George Castle
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|