Promoting best outcomes in the bariatric elder

The proportion of individuals 65 and older is increasing in the United States, and so is the burden of chronic illness and disability. Additionally, the prevalence of obesity in this country is also increasing among all age groups. According to Patterson, Frank, Kristal and White,

1 the proportion of older adults who are obese has doubled over the past 30 years. Jenkins

2 found that obese older adults are more likely to have impairments in strength, lower body mobility, and activities of daily living (ADLs). All of the above factors increase the likelihood that you will have the opportunity to care for bariatric patients as part of your long-term care older adult population.

Body weight and composition results from the interaction of two processes: caloric intake and energy expenditure. When energy expenditure is less than calories consumed, the result is weight gain, with the excess calories stored as fat. Age-related physiological changes, genetic conditions, and social and environmental influences can also contribute to obesity. Research is ongoing in these areas.

All body systems and functions are impacted by excess weight. Respiratory function is affected when the heavy chest wall compresses the lungs, resulting in impaired gas exchange. This increases the risk of restrictive lung disease and obstructive sleep apnea. Age-associated changes, such as decreased compliance of the lungs and chest wall and a decline in aerobic capacity due to shrinkage of alveolar tissue, can result. Problems ranging from altered mental status to structural changes in the brain due to hypoxia and increased risk of pneumonia and cardiovascular compromise can result, to name just a few.

Changes in the musculoskeletal system put the obese older adult most at risk for dependency and disability. There is less joint flexibility and often increased pain with activity especially if an arthritic condition exists. Bone mass also declines with age. Another physiologic change is a decrease in muscle mass (sarcopenia), with an increase in the proportion of adipose tissue.

Obesity also increases the risk for developing serious health conditions, including Type II diabetes, hypertension, coronary artery disease, stroke, and certain cancers.3 If the older adult already has diabetes, hypertension, or coronary artery disease, being obese may worsen the condition. This contributes to increased healthcare costs for care of chronic health conditions.

Equipment needs

Effective long-term care of the obese older adult requires careful planning and a multidisciplinary approach. These patients will require special equipment, such as bedside commodes, shower chairs, beds, and lifting devices. An inventory of equipment already available in the institution should be taken early in the planning process. Be sure to include bathroom fixtures. All-mounted commodes have a safe weight limit. If this is exceeded, the commode will separate from the wall. All equipment must be able to accommodate bariatric patients and support their weight safely. The width of doorways should be measured to make sure bariatric equipment, such as beds, can safely go through. Some beds have features such as collapsible siderails and folding mechanisms that aid in getting the bed through the doorway. Most facilities have implemented a “no-lift” policy, and this can help prevent injury to patients and staff. The importance of initial and ongoing staff training cannot be overemphasized. In general, more space is needed to safely care for the bariatric patient. This is especially important in the design of bathrooms and patient rooms.

Multidisciplinary approach

Involvement and coordination of care among medical and nursing staff, rehabilitation therapies, nutrition therapy, respiratory therapy, recreation therapy, and other disciplines has long been a practice in long-term care. As with any other long-term care patient, the obese older adult will need an individualized plan of care with appropriate and meaningful goals. For example, efforts may be directed toward helping the patient lose weight so that serious health conditions can be better controlled or eliminated. In this case, rehabilitation and nutrition therapies would have significant roles, but other staff caring for the patient should be able to reinforce interventions recommended by the entire team.

The patient is a human being

There are many misconceptions and beliefs about obese individuals that can be detrimental to a caring environment. It is vitally important that the staff become aware of them and how they negatively impact their behavior. In-service training to help develop sensitivity to the needs of the obese older adult is fundamentally important to the success of the entire bariatric program.

The best outcomes

Caring for the obese older adult is an opportunity to make a positive difference on an individual and at a societal level. Your care and encouragement can improve health status and increase functional abilities while assisting the patient toward optimal health as an older adult.

Suzanne V. Keogh, MS, APRN-BC, is employed by AnMed Health, Central, South Carolina. She can be reached at

suzannekeogh@bellsouth.net.

To send your comments to the editor, e-mail mhrehocik@iadvanceseniorcare.com.

References

1. Patterson R, Frank L, Kristal A, White E. A comprehensive examination of health conditions associated with obesity in older adults. American Journal of Preventive Medicine 2004; 27:385-90.
2. Jenkins K. Obesity’s effects on the onset of functional impairment among older adults. Gerontologist 2004; 44 :(2): 206-16.
3. Kruger J, Ham S, Prohaska T. Behavioral risk factors associated with overweight and obesity among older adults: The 2005 National Health Interview Survey. Preventing Chronic Disease 2009; 6 :(1).

Long-Term Living 2010 January;59(1):14-16