Home and Community Care Digest
Methods: Data were analysed from a nursing home data set in the United States containing information for all Medicare/Medicaid-certified nursing facilities (n=16, 110) over a ten-year period from 1992 to 2002. Statistical analyses were used to estimate trends in the prevalence of obesity in nursing homes in five U.S. states (n=1625), to characterize the obese nursing home population, and to evaluate how obesity rates vary by facility and geographical location. The study population consisted of newly admitted residents with height and weight data (n=847) in the five U.S. states from 1992 to 2002. Obesity was defined using the body mass index (BMI). Associations between obesity and sociodemographic variables (e.g., race/ethnicity), physical and cognitive functioning (using the seven-point Cognitive Performance Scale), and active clinical diagnoses were evaluated. Activities of daily living were also examined. The proportion of obese residents (defined as BMI P30kg/m²) was determined for each facility and for the overall population.
Findings: The prevalence of obesity in newly admitted nursing home residents almost doubled between 1992 and 2002, increasing from 15% to more than 25%. The prevalence of obesity in the U.S. population was lower, at 17.8% in 2002. Because nursing home residents weighing more than 250 to 300 pounds require special equipment (e.g., hydraulic lifts and shower chairs have weight restrictions), the prevalence of obesity in this segment of the nursing home population was of particular interest. In 2002, 3.1% of residents weighed at least 250 pounds and 1% weighed more than 300 pounds. Almost 30% of residents with a BMI P35kg/m² were younger than 65, and more than three-fourths were women. A disproportionate percentage of obese residents were non-Hispanic black. Obesity was positively associated with increased comorbidities including diabetes mellitus, arthritis, and hypertension, but was negatively associated with dementia and Alzheimer's disease. Obese residents were less likely than nonobese residents to be dependent in ADLs and severely cognitively impaired, but were more likely to require moderate assistance with ADLs. These findings remained unchanged after controlling for other variables. Significant variation in the distribution of obesity across facilities was found. The overall prevalence of obesity in the U.S. in 2002 was 17.8%. This prevalence was found in two-thirds of the nursing home facilities with a wide distributional range from 0% to 40%. In four states, at least 62.5% of the facilities had an obesity prevalence of at least 17.8%.
Conclusions: This study found a near doubling of obesity in nursing homes over a ten-year period in five U.S. states. Estimates suggest this trend will continue, heightening the importance of studying the impacts of obesity on the nursing home sector. The substantial variation within facilities raises concerns about nursing home preparedness and access to care for obese individuals. Moreover, the risk of injury to nursing home staff from caring for obese individuals (e.g., from lifting) warrants concern. Decision makers may wish to consider the need for greater staffing levels, additional equipment, and new clinical approaches.
Reference: Lapane KL, Resnik L. (2005). "Obesity in Nursing Homes: An Escalating Problem". Journal of American Geriatrics Society 53: 1386-111.
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