Functional Assessment of Older Obese Patients Candidates for Bariatric Surgery

Abstract

-Context -Obesity in the elderly is associated with exacerbation of functional decline (dependency), that occurs with aging, because of decreased muscle mass and strength, and increased joint dysfunction. Consequently, there is progressive loss of independence, autonomy, chronic pain and impaired quality of life. The weight loss can bring benefits in all these aspects, especially when accompanied by exercises. Elderly patients with morbid obesity may be submitted to surgical treatment, taking into account that the massive weight loss, eventually caused by bariatric surgery, may exacerbate the loss of muscle mass and nutritional complications that may bring harm to the overall health and quality of life of these patients. The functional assessment of elderly patients, candidates for bariatric surgery and the extent to which surgery can bring benefits to the patients, in the field of functionality, has still to be determined. Objective -To describe profile functionality in obese elderly referred to a bariatric surgery program. Methods -Patients with age ≥60 and BMI ≥35 underwent comprehensive geriatric assessment that evaluates co morbidities, medication use, ability to perform basic activities of daily living and instrumental activities of daily living, and the "Timedupandgo" test to evaluate mobility, whose cut-off point was ≤10 seconds. Statistical analysis was performed in order to see if there is a positive correlation of dependency with BMI and age (over or under 65 years). Results -Forty subjects have completed evaluation. The mean age was 64.1 years (60-72) and 75% were women. They had an average weight of 121.1 kg (72.7-204) and a mean BMI of 47.2 kg/m 2 (35.8-68.9). 16 patients (40%) have shown dependency for activities of daily living, 19 (47,5%) for instrumental activities of daily living and 20 patients (50%) had a "Timedupandgo" test over 10 seconds. Statistical analysis (t-Student, Mann-Whitney, Binary Logistic Regression) has shown positive correlation of dependency in activities of daily living for BMI >49 kg/m 2 , dependency in instrumental activities of daily living for BMI >46,5 kg/m 2 , and "Timedupandgo" test greater than 10 seconds for BMI >51 kg/ m 2 (P<0,05). No dependency difference was observed for patients over or under 65 years age. Conclusion -Functional decline is observed in almost half of the morbid obese patients over 60 years old. It is related to increasing BMI (BMI >46,5 kg/m 2 ) but not related to age (60 to 65 years or over 65 years). Functional decline should be considered a co-morbidity in the elderly obese patients and should be assessed before bariatric surgery in this population. HEADINGS -Morbit obesity, surgery. Bariatric surgery. Health of elderly.

Bariatric Surgery in the Elderly: Results of a Mean Follow-Up of Five Years

“…In the elderly there is a particular concern with the problem of loss of functionality 11 , 13 , which was shown in another publication, in different series 21 . The evolution of functionality in operated patients should be evaluated in a prospective study, with pre and postoperative data.…”

When and Why Operate Elderly Obese

“…Interference in some functional activity is more related with BMI than with age. Based on this observation, the greater the BMI greater the benefit for the elderly after the operation; it should be focused on high BMI instead of age at time of surgery 15 .…”

“…Among 70 and 79 years, 31.9% women and 28.9% of men are in this condition 20 . In Brazil, in people over 65 years the prevalence of obesity is 8.7% among men and 16.1% among women 1 , 3 , 9 , 15 .…”

Preoperative multidisciplinary program for bariatric surgery: a proposal for the Brazilian Public Health System

“…Despite the great amelioration of outcomes observed in the last decades, surgical risk, although low, is still significant, especially in some specific groups of patients (i.e. elderly, severe chronic disease carriers etc) (6,24) . In Brazil's public health system, we struggle against specific factors that are not so prominent in other countries.…”