Weighing in

The disease of obesity is growing in long-term care as the overweight population increases. It is not uncommon to find residents weighing more than 300 pounds with compromising medical conditions.

Advanced clinical skills along with available beds in long-term care are offering options to the sometimes hard to place morbidly obese resident, offering care and hope. The promotion of the bariatric (Greek word meaning weight) unit is becoming as common in long-term care as specialty units in airway management, in-house dialysis, or wound care. In 30 states there is a prevalence of obesity equal to or greater than 25%, with three of these states (Alabama, Mississippi, and Tennessee) greater than 30%. Percentage of obese resident admissions in long-term care increased from ∼15% in 1992 to 25% in 2002.1

How to manage?

The increase in bariatric admissions has raised concern among the interdisciplinary team on how to manage the morbidly obese resident. There are causative factors regarding the disease of obesity with genetics being the strongest factor, but it is unlikely that genetics has caused the 60% increase in our now thriving overweight population.

Obesity is defined as “having too much body fat” and can impact many areas of health including: diabetes, heart disease, stroke, arthritis, sleep apnea, coronary artery disease, and hypertension. The implications for providers may include higher costs because of the need to purchase specialized equipment (beds, wheelchairs, walkers, floor-mounted toilets), increased direct care staff to assist with activities of daily living, dietary, transfer, and mobility needs. Because of the weight variance, education and safety for staff is important to lower the risk of injury to the resident and healthcare providers.

Addressing the needs of the bariatric resident through a holistic and dignified manner can be a challenge. The morbidly obese are often labeled as lazy, dirty, or ugly and are blamed for causing the condition. They are not afforded the same consideration as others who suffer from other disabilities. Obese persons are often ridiculed by others resulting in self-doubt and the feeling of inadequacy. They often experience problems in public settings such as restaurants, theaters, airplanes, buses, and trains because of inadequate seat size and features such as seat belts. Obesity even robs a person of the choice of how and where to sit, always fearing equipment and furniture might not fit or break. They are victims of discrimination, and studies show they are not treated equally. Many people feel humiliated and are severely depressed, leading to isolation, inability to perform routine tasks that can result in family conflict, and often self-medicate with alcohol or drugs.

Interdisciplinary training

Sensitivity training of staff along with proper transfer techniques and safe resident handling can be difficult for most facilities. Through an interdisciplinary team training approach, all staff members need to know and understand the disease of obesity and the comorbidities that can accompany it. It is important for staff to maintain or improve the physical, mental, and psychosocial well-being of the residents through assessments and plan of care. This is important for the resident who suffers from obesity as a result of the complications that can occur. Obese residents usually live a sedentary lifestyle so education will be important for staff to encourage participation through movement and activities of daily living. Accepting morbidly obese residents in the facility needs to be well thought out. The questions that must be considered are:

• What type of equipment is necessary in the management of the obese resident?

• Does the bed, transfer lift, chairs, wheelchair, shower equipment, toilet meet the weight requirements?

• Do employees know and understand how to lift and transfer the resident so that everyone remains safe and free from injury?

• Can the staff communicate with residents to encourage them to feel safe in their environment so they can maximize their abilities and quality of life and care?

• Can staff identify complications that can arise in the post-acute care of a resident who has been admitted from a bariatric surgical procedure?

Addressing the needs of the bariatric resident through a holistic and dignified manner can be a challenge.

Communication is very important in the holistic approach to person-centered care. Empowering and engaging all residents and especially those who suffer from the disease of obesity is essential in the health and well-being of the resident, the staff, and the facility. As the obese population grows, so does proper education, equipment, and supportive surroundings. The interdisciplinary team will need to work together to meet the special needs of the resident to decrease complications and provide quality outcomes. Bariatrics as a long-term care specialty can meet the needs of many. The starting point is treating everyone with dignity and respect, no matter what their size.

Lori Gutierrez, BS, RN-C, DON-CLTC, RAC-CT, CBN, is President of Clinical Advisors for Resources and Educational Services, LLC, (C.A.R.E.S.) in Phoenix. She can be reached at (800) 326-7176 or

lorigutierrez@clinicaladvisorsllc.com

References

1. CDC. State-specific prevalence of obesity among adults-United States, 2005; 55 (36): 985-8
2. Mokdad AH, et al. The spread of the obesity epidemic in the United States. JAMA 1991-1998; 282:1519-22

Long-Term Living 2010 September;59(9):46-47