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Beitz JM, Kennedy-Evans KL. Good Things Don't Always Come in Small Packages: Comprehensive Care of Patients With Class 3 Obesity: An Integrative Review. J Wound Ostomy Continence Nurs 2023; 50:365-374. [PMID: 37713346 DOI: 10.1097/won.0000000000001010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
The epidemic of obesity and morbid obesity is straining the American health care system's ability to provide quality patient care. Patients with Class 3 (also referred to as morbid or severe) obesity require specialized equipment, unique approaches in the delivery of care, and understanding of the biopsychosocial pathophysiologic mechanisms underlying their condition. This article defines Class 3 obesity, its pathophysiology, and discusses issues that arise when providing quality care of these individuals including safe patient handling, right-sized equipment, and empathetic interpersonal care. We also discuss skin and wound care issues associated with Class 3 obesity.
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Affiliation(s)
- Janice M Beitz
- Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN-AP, MAPWCA, ANEF, WOCNF, FNAP, FAAN, School of Nursing-Camden, Rutgers University, Camden, New Jersey
- Karen Lou Kennedy-Evans, RN, APRN-BC, FNP, University of Arizona College of Nursing, Tucson, and K.L. Kennedy LLC, Tucson, Arizona
| | - Karen Lou Kennedy-Evans
- Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN-AP, MAPWCA, ANEF, WOCNF, FNAP, FAAN, School of Nursing-Camden, Rutgers University, Camden, New Jersey
- Karen Lou Kennedy-Evans, RN, APRN-BC, FNP, University of Arizona College of Nursing, Tucson, and K.L. Kennedy LLC, Tucson, Arizona
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2
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Felix HC, Brown CC, Narcisse MR, Vincenzo JL, Weech-Maldonado R, Bradway CK. Characteristics of nursing homes with high percentages of falls and falls with injuries among residents with obesity. Geriatr Nurs 2023; 53:191-197. [PMID: 37540915 PMCID: PMC10976471 DOI: 10.1016/j.gerinurse.2023.07.017] [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: 06/02/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Obesity among United States nursing home (NH) residents is increasing. These residents have special care needs, which increases their risk for falls and falls with injuries. NH are responsible for ensuring the health of their residents, including minimizing falls. However, given the special care needs of residents with obesity, different factors may be important for developing programs to minimize falls among this group. AIM We aimed to identify NH characteristics associated with falls and falls with injuries among residents with obesity. METHOD We used resident assessment data and logistic regression analysis. RESULTS We found that rates of falls and falls with injuries among residents with obesity varied significantly based on for-profit status, size, acuity index, obesity rate among residents, and registered nurse hours per patient day. CONCLUSION Recommendations are made as to how NH may be able to lower risk for falls and falls with injuries among their residents with obesity.
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Affiliation(s)
- Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 820, Little Rock, Arkansas 72205, USA.
| | - Clare C Brown
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 820, Little Rock, Arkansas 72205, USA
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences, 2708 South 48th Street, Springdale, Arkansas 72762, USA
| | - Jennifer L Vincenzo
- College of Health Professions, University of Arkansas for Medical Sciences, 1125 North College Avenue, Fayetteville, Arkansas 72703, USA
| | - Robert Weech-Maldonado
- School of Health Professions, University of Alabama at Birmingham, 1720 2nd Avenue South, SHPB 558, Birmingham, AL 35294, USA
| | - Christine K Bradway
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Fagin Hall, Room 312, Philadelphia, PA 19104-4217, USA
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Williamson K, Blane DN, Grieve E, Lean MEJ. Overlooked and under-evidenced: Community health and long-term care service needs, utilization, and costs incurred by people with severe obesity. Clin Obes 2023; 13:e12570. [PMID: 36447339 DOI: 10.1111/cob.12570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022]
Abstract
Numbers of people with severe obesity (BMI ≥ 40 kg/m2 ), with need for community health and long-term care (LTC) services, are increasing, but documentation is lacking. We identified individuals with severe obesity known to community health and care professionals in a representative United Kingdom region and used an investigator-administered questionnaire to record needs and use of community health and LTC services. Data were verified against health and LTC records. Local and published sources informed detailed micro-costing. Twenty-five individuals (15 women) consented, aged 40-87 (mean = 62) years, BMI 40-77 (mean = 55) kg/m2 : 20 participants (80%) were housebound. Twenty-two different cross-sector community health and LTC services were used, including community equipment service (n = 23), district nursing (n = 20), occupational therapy (n = 14), and LTC (n = 12). Twenty-four (96%) participants used three or more services, with longest care episode lasting over 14 years. Total annual service costs incurred by participants varied from £2053 to £82 792; mean £26 594 (lower estimate £80 064; mean £22 462/upper estimate £88 870; mean £30 726), with greatest costs being for LTC. Individual costs for equipment (currently provided) and home adaptations (ever provided) ranged widely, from zero to £35 946. Total mean annual costs increased by ascending BMI category, up to BMI 70 kg/m2 . This study provides a framework with which to inform service provision and economic analysis of weight management interventions. People with severe obesity may need sustained care from multiple community care services.
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Affiliation(s)
- Kath Williamson
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
- NRS Clinician, Weight Management Team, NHS Lothian, Edinburgh, UK
| | - David N Blane
- General Practice & Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Eleanor Grieve
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Michael E J Lean
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
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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.
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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
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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.
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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
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Schuldt RF, Felix HC, Bradway CK. The impact of severe obesity on home health care agency admission: An organizational perspective. Home Health Care Serv Q 2020; 40:27-38. [PMID: 33327895 DOI: 10.1080/01621424.2020.1856747] [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] [Indexed: 10/22/2022]
Abstract
Home health care is a growing treatment option for older adults who wish to remain in their homes and communities. However, the growing number of older adults with severe obesity presents a challenge for home health professionals. This study utilizes survey data from 128 home health care agencies in Arkansas and Pennsylvania to explore home health care agencies' decision-making in admitting patients with severe obesity. The responding agencies indicated that concerns about adequate staffing levels were the primary barriers to entry for severe obesity patients. Existing research on the intersection of obesity and home health care is sparse, and this study adds an organizational perspective to the scant literature on the topic. Additional research on this topic is advised to accommodate the expected growth in home health care utilization and rising obesity rates among older adults.
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Affiliation(s)
- Robert F Schuldt
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences , Little Rock, Arkansas, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences , Little Rock, Arkansas, USA
| | - Christine K Bradway
- Biobehavioral Health Sciences Department, University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania, USA
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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.
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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.
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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.
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Thompson J, Parkinson M, Collery R. Care home staff's experiences and views of supporting the dietary management and choices of older residents with obesity. Int J Older People Nurs 2020; 15:e12343. [DOI: 10.1111/opn.12343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Juliana Thompson
- Department of Nursing, Midwifery and Health Faculty of Health and Life Sciences Northumbria University Newcastle upon Tyne UK
| | - Mark Parkinson
- Department of Social Work, Education and Community Wellbeing Northumbria University Newcastle upon Tyne UK
| | - Robyn Collery
- Nutrition and Dietetics Department: Clinical Support and Screening Services Gateshead Health NHS Foundation Trust Gateshead UK
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10
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Harris JA, Castle NG. Obesity and Nursing Home Care in the United States: A Systematic Review. THE GERONTOLOGIST 2020; 59:e196-e206. [PMID: 29253135 DOI: 10.1093/geront/gnx128] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Obesity is increasing among people residing in nursing homes, and resident obesity substantially affects services needed, equipment and facilities provided, and morbidity in this setting. The purpose of this article is to describe the scope and depth of evidence regarding the impact of obesity among nursing home residents in the United States. RESEARCH DESIGN AND METHODS A systematic literature review was performed in PubMed, EMBASE, CINAHL, and Web of Science databases as well as additional hand-searched documents. Included articles were published from 1997 to March 2017. The characteristics and content of the included articles were systematically reviewed and reported. RESULTS Twenty-eight studies met inclusion criteria for review. The median study size was 636 residents (interquartile range 40-11,248); 18 (64%) studies were retrospective and 10 (36%) were prospective in nature. Ten (36%) studies examined medical and functional morbidity, 10 (36%) examined health system effects, and 5 (18%) examined the risk of admission to nursing homes. Most studies found that obesity poses serious issues to resident health and the provision of health care, as well as broad health system and nursing challenges in the provision of high-quality nursing home care and services. DISCUSSION AND IMPLICATIONS Although obesity affects about one in four nursing home residents in the United States, relatively limited evidence exists on the complex challenges of obesity for their residents and their care. A continued focus on resident quality of life, health system improvement, and nursing best practices for properly caring for individuals with obesity is needed.
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Affiliation(s)
| | - Nicholas George Castle
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
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11
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Zhang N, Field T, Mazor KM, Zhou Y, Lapane KL, Gurwitz JH. The Increasing Prevalence of Obesity in Residents of U.S. Nursing Homes: 2005–2015. J Gerontol A Biol Sci Med Sci 2019; 74:1929-1936. [DOI: 10.1093/gerona/gly265] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Indexed: 01/06/2023] Open
Abstract
Abstract
Background
Obesity prevalence has been increasing over decades among the U.S. population. This study analyzed trends in obesity prevalence among long-stay nursing home residents from 2005 to 2015.
Methods
Data came from the Minimum Data Sets (2005–2015). The study population was limited to long-stay residents (ie, those residing in a nursing home ≥100 days in a year). Residents were stratified into body mass index (BMI)-based groups: underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30); residents with obesity were further categorized as having Class I (30 ≤ BMI < 35), Class II (35 ≤ BMI < 40), or Class III (BMI ≥ 40) obesity. Minimum Data Sets assessments for 2015 were used to compare clinical and functional characteristics across these groups.
Results
Obesity prevalence increased from 22.4% in 2005 to 28.0% in 2015. The prevalence of Class III obesity increased from 4.0% to 6.2%. The prevalence of underweight, normal weight, and overweight decreased from 8.5% to 7.2%, from 40.3% to 37.1%, and from 28.9% to 27.8%, respectively. In 2015, compared with residents with normal weight, residents with obesity were younger, were less likely to be cognitively impaired, had high levels of mobility impairment, and were more likely to have important medical morbidities.
Conclusions and Relevance
There was a steady upward trend in obesity prevalence among nursing home residents for 2005–2015. Medical and functional characteristics of these residents may affect the type and level of care required, putting financial and staffing pressure on nursing homes.
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Affiliation(s)
- Ning Zhang
- Department of Health Policy and Promotion, School of Public Health and Health Sciences, University of Massachusetts Amherst, Worcester
- Meyers Primary Care Institute, University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
| | - Terry Field
- Meyers Primary Care Institute, University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
| | - Kathleen M Mazor
- Meyers Primary Care Institute, University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
| | - Yanhua Zhou
- Meyers Primary Care Institute, University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
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Felix HC, Bradway C, Bird TM, Pradhan R, Weech-Maldonado R. Safety of Obese Persons in Nursing Homes. Med Care 2018; 56:1032-1034. [PMID: 30418962 PMCID: PMC6234852 DOI: 10.1097/mlr.0000000000000997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Holly C. Felix
- Associate Professor of Health Policy, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 820, Little Rock, Arkansas 72205, / 501-526-6633 / 501-562-6620 fax
| | - Christine Bradway
- Associate Professor of Gerontological Nursing, University of Pennsylvania School of Nursing, 418 Curie Boulevard, Fagin Hall, Room 312, Philadelphia, Pennsylvania 19104-4217, / 215-573-3051
| | - T. Mac Bird
- Assistant Professor of Health Policy, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 820, Little Rock, Arkansas 72205, / 501-526-6633 / 501-562-6620 fax
| | - Rohit Pradhan
- Assistant Professor of Health Policy, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 820, Little Rock, Arkansas 72205, / 501-526-6633 / 501-562-6620 fax
| | - Robert Weech-Maldonado
- Professor & LR Jordan Endowed Chair of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, 1720 2nd Ave. S., SHPB 558, Birmingham, AL 35294, / 205-996-5838 / 205 975-6608 fax
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Kosar CM, Thomas KS, Gozalo PL, Mor V. Higher Level of Obesity Is Associated with Intensive Personal Care Assistance in the Nursing Home. J Am Med Dir Assoc 2018; 19:1015-1019. [PMID: 29935981 PMCID: PMC6237619 DOI: 10.1016/j.jamda.2018.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 03/29/2018] [Accepted: 04/20/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine whether higher obesity level was associated with extensive staffing assistance (from 2 or more persons) for completing activities of daily living (ADL) among older nursing home residents. DESIGN Retrospective cross-sectional study. SETTING US government-certified nursing homes. PARTICIPANTS Medicare beneficiaries residing in a nursing home on April 1, 2015. Exclusion criteria were age less than 65 years and body mass index (BMI) below 18.5 (underweight). MEASURES Residents were divided by obesity level according to established BMI cutoffs, as follows: nonobese (BMI = 18.5-29.9) or mild (BMI = 30.0-34.9), moderate (BMI = 35.0-39.9), or severe (BMI ≥40) obesity. Level of staffing assistance for completing each of 10 ADL (bed mobility, transfer, walking in room, walking in corridor, on- and off-unit locomotion, dressing, eating, toileting, and personal hygiene) was dichotomized as below 2 and 2 or more. Robust Poisson regression was used to test whether obesity conferred excess risk for needing 2 or more staff to complete each ADL. Adjusted models included individual-level covariates and nursing home fixed effects. RESULTS A total of 1,063,383 nursing home residents were identified, including 309,263 (29.0%) with obesity. Adjusted relative risks (95% confidence intervals) for 2-person assistance with bed mobility associated with mild, moderate, and severe obesity were 1.17 (1.15, 1.18), 1.28 (1.25, 1.31), and 1.40 (1.36, 1.43), respectively. Adjusted relative risks for 2-person assistance with transferring associated with mild, moderate, and severe obesity were 1.15 (1.13, 1.17), 1.24 (1.22, 1.27), and 1.36 (1.33, 1.39), respectively. Obesity was associated with 2-person assistance for all other ADL except for eating. CONCLUSIONS Higher obesity level was significantly associated with assistance from 2 or more staff for completing 9 of 10 ADL. Given increasing obesity rates in nursing homes, payment mechanisms that do not adjust for obesity or comprehensively account for excess ADL assistance may need revision to prevent adverse impacts on the long-term care system.
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Affiliation(s)
- Cyrus M Kosar
- Center for Gerontology and Healthcare Research, Brown University, Providence, RI.
| | - Kali S Thomas
- Center for Gerontology and Healthcare Research, Brown University, Providence, RI; Department of Veteran Affairs Medical Center, Providence, RI
| | - Pedro L Gozalo
- Center for Gerontology and Healthcare Research, Brown University, Providence, RI
| | - Vincent Mor
- Center for Gerontology and Healthcare Research, Brown University, Providence, RI; Department of Veteran Affairs Medical Center, Providence, RI
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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.
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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
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Vincent HK, Vasilopoulos T, Zdziarski-Horodyski LA, Sadasivan KK, Hagen J, Guenther R, McClelland J, Horodyski M. Preexisting psychiatric illness worsens acute care outcomes after orthopaedic trauma in obese patients. Injury 2018; 49:243-248. [PMID: 29249534 DOI: 10.1016/j.injury.2017.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/05/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Pre-existing psychiatric illness, illicit drug use, and alcohol abuse adversely impact patients with orthopaedic trauma injuries. Obesity is an independent factor associated with poorer clinical outcomes and discharge disposition, and higher hospital resource use. It is not known whether interactions exist between pre-existing illness, illicit drug use and obesity on acute trauma care outcomes. PATIENTS AND METHODS This cohort study is from orthopaedic trauma patients prospectively measured over 10 years (N = 6353). Psychiatric illness, illicit drug use and alcohol were classified by presence or absence. Body mass index (BMI) was analyzed as both a continuous and categorical measure (<30 kg/m2 [non-obese], 30-39.9 kg/m2 [obese] and ≥40 kg/m2 [morbidly obese]). Main outcomes were the number of acute care services provided, length of stay (LOS), discharge home, hospital readmissions, and mortality in the hospital. RESULTS Statistically significant BMI by pre-existing condition (psychiatric illness, illicit drug use) interactions existed for LOS and number of acute care services provided (β values 0.012-0.098; all p < 0.05). The interaction between BMI and psychiatric illness was statistically significant for discharge to locations other than home (β = 0.023; p = 0.001). DISCUSSION Obese patients with orthopaedic trauma, particularly with preexisting mental health conditions, will require more hospital resources and longer care than patients without psychiatric illness. Early identification of these patients through screening for psychiatric illness and history of illicit drug use at admission is imperative to mobilize the resources and provide psychosocial support to facilitate the recovery trajectory of affected obese patients.
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Affiliation(s)
- Heather K Vincent
- Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, 32611, USA.
| | | | | | - Kalia K Sadasivan
- Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, 32611, USA.
| | - Jennifer Hagen
- Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, 32611, USA.
| | - Robert Guenther
- Clinical Psychology, University of Florida, Gainesville, FL, 32611, USA.
| | - JoAnna McClelland
- Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, 32611, USA.
| | - MaryBeth Horodyski
- Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, 32611, USA.
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Bradway C, Felix HC, Whitfield T, Li X. Barriers in Transitioning Patients With Severe Obesity From Hospitals to Nursing Homes. West J Nurs Res 2016; 39:1151-1168. [PMID: 28322638 DOI: 10.1177/0193945916683682] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This cross-sectional, descriptive study explored perspectives of discharge planners regarding transitions of hospitalized patients who are severely obese seeking discharge to a nursing home. Attention has been focused on care transitions regarding high hospital readmission rates, yet specific needs of patients who are severely obese have been largely overlooked. Ninety-seven (response rate 39.8%) discharge planners returned surveys addressing frequency of, and issues encountered when, arranging placements. Community and hospital characteristics were also collected. One third of the respondents from Pennsylvania and Arkansas reported inability to transfer patients; barriers included reimbursement, staffing, and equipment. Respondents perceiving nursing homes to have equipment concerns were nearly 7 times more likely to report patient size as a barrier ( p = .001). Given increasing obesity rates, health care delivery systems must be prepared to provide necessary resources and all levels of care, including transitions for hospitalized patients who are severely obese needing nursing home care post-discharge.
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Affiliation(s)
| | | | | | - Xiaocong Li
- 2 University of Arkansas at Little Rock, USA
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17
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Challenges in the Management of Geriatric Obesity in High Risk Populations. Nutrients 2016; 8:nu8050262. [PMID: 27153084 PMCID: PMC4882675 DOI: 10.3390/nu8050262] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/12/2016] [Accepted: 04/25/2016] [Indexed: 01/26/2023] Open
Abstract
The global prevalence of obesity in the older adult population is growing, an increasing concern in both the developed and developing countries of the world. The study of geriatric obesity and its management is a relatively new area of research, especially pertaining to those with elevated health risks. This review characterizes the state of science for this “fat and frail” population and identifies the many gaps in knowledge where future study is urgently needed. In community dwelling older adults, opportunities to improve both body weight and nutritional status are hampered by inadequate programs to identify and treat obesity, but where support programs exist, there are proven benefits. Nutritional status of the hospitalized older adult should be optimized to overcome the stressors of chronic disease, acute illness, and/or surgery. The least restrictive diets tailored to individual preferences while meeting each patient’s nutritional needs will facilitate the energy required for mobility, respiratory sufficiency, immunocompentence, and wound healing. Complications of care due to obesity in the nursing home setting, especially in those with advanced physical and mental disabilities, are becoming more ubiquitous; in almost all of these situations, weight stability is advocated, as some evidence links weight loss with increased mortality. High quality interdisciplinary studies in a variety of settings are needed to identify standards of care and effective treatments for the most vulnerable obese older adults.
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18
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Gaugler JE. Understanding Quality of Care in Nursing Homes and Other Residential Settings. J Appl Gerontol 2016; 35:263-6. [DOI: 10.1177/0733464815623430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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