Obesity and Pressure Ulcers Among Nursing Home Residents

Abstract

Objectives To examine the prevalence of obesity and its relationship with pressure ulcers among nursing home (NH) populations, and whether such relationship varies with certified nursing assistant (CNA) level in NHs. Data and study population The 1999–2009 nationwide Minimum Data Sets were linked with Online Survey of Certification and Reporting records. We identified newly admitted NH residents who became long-stayers and followed them up to 1 year. Analyses The outcome variable was presence of pressure ulcers during the 1-year follow-up period. Residents were categorized as normal (18.5<=BMI<30 kg/m2), mild obesity (30 <=BMI <35 kg/m2) and moderate or severe obesity (BMI>=35 kg/m2). Pooled and stratified analyses were performed to examine the relationship between obesity and pressure ulcers, and how it varied by facility CNA level. Results The prevalence of obesity increased from 16.9% to 25.8% among newly admitted NH residents over the last decade. Obesity was associated with higher risks of pressure ulcers among long-stay residents. The relationship between obesity and pressure ulcers persisted after accounting for individual health conditions at the baseline and facility-level variations. Further, the within-facility relationship between obesity and pressure ulcers varied by facility CNA levels. The odds of pressure ulcers were 18.9% higher for residents with moderate or severe obesity than for non-obese residents within NHs with low CNA levels. The percents for medium and high CNA level facilities were 14.0% and 12.8%, respectively. Conclusion To prepare for the growing obesity epidemic in NHs, policies should focus on strategies to improve care provided for obese residents.

Obesity and intensive staffing needs of nursing home residents

“…28 The rate of obesity among nursing home residents has increased from 16.9% in 2000 to 30.7% in 2013, and the prevalence of obesity has doubled since the turn of the century. 13 This growing mismatch between unchanging staffing hours and increasing obesity prevalence may lead to greater challenges in properly caring for residents with obesity. In a recent survey of nursing homes administrators, 31% of respondents reported that staffing was not adequate to care for morbidly obese residents (defined in this study as residents weighing 325 pounds or more), and a survey of hospital discharge planners found that 60% of respondents thought that nursing homes had staffing concerns regarding admission of someone with a BMI of 35 or more.…”

“…Cai et al noted a higher incidence of pressure ulcers among residents with obesity, and this relationship was moderated by staffing rates. 13 The increased risk of pressure ulcers may be related to biologic etiologies (increased skin pressure and shearing forces), nursing issues (difficulty assessing skin integrity) and system issues (staff availability to turn resident). Additionally, nursing homes with higher rates of obesity have been noted to have slightly higher rate of staffing as well as more inspection deficiencies.…”

“…13 Disabled nursing home residents with obesity often need specialized care in the form of greater staffing. 14 Various studies have detailed extended staffing time for care of residents with obesity.…”

Fatores predisponentes para o desenvolvimento da lesão por pressão em pacientes idosos: uma revisão integrativa

“…Desse modo, esses pacientes podem apresentar retardos na cicatrização da pele, além da redução da sua resistên-cia às lesões pela fragilidade advinda das referidas alterações 15 .…”

Type 2 diabetes mellitus treatment patterns in US nursing home residents

“…Increases in diabetes prevalence in NHRs have been accompanied by an increased prevalence of obesity. In turn, the increasing prevalence of obesity in NHRs in the United States has been associated with several comorbidities, including diabetes [30,31], pressure ulcers [32], and recurrent venous thromboembolism [33], and obese NHRs or hospitalized patients experience poorer outcomes of infections compared with normal-weight individuals [34]. In this study, >40% of NHRs with diabetes were obese.…”