Obesity and hospice usage

The more a person weighs, the less likely that person will use hospice services, according to a new study published in the Annals of Internal Medicine.

The retrospective cohort study reviewed claims of more than 5,600 terminally ill Medicare beneficiaries who died between 1998 and 2012. Researchers looked for correlations between body mass index (BMI) and the enrollment in hospice services at home during the final six months of life.

At a BMI of 20 kg/m2,  the study showed a 38.3 percent probability for hospice enrollment. At a BMI of 30 kg/m2,  the probability drops to about 33 percent. At a BMI of 40 kg/m2—or morbidly obese—the probability is just 23.1 percent.

Hospice length of stay also was related to BMI. Those with a BMI of 20 had an average hospice duration of 42.8 days, but those with a BMI of 40 used the services for about 38 days.

Obese patients cost more in their final year, too, the study concluded. A reduced use of hospice services means a greater chance the patient will end up in the more expensive hospital setting instead.

The study did not examine why obese people received less hospice care, but the reason is likely multi-faceted. "For hospice teams, as for hospital and home-health teams, it can require more staff to take care of people who are obese, but Medicare hospice reimbursement is capped no matter what a person's BMI," Jennifer Griggs, MD, MPH, one of the study authors and a professor at the University of Michigan medical school told ScienMag. "Also, obesity may mask the signposts and changes that physicians might use to determine when it is time for a person to enter hospice."


Topics: Clinical