Obesity in the Infirm Elderly
It worries me that, rather than focusing on why the numbers of morbidly obese people are skyrocketing and trying to address it from that end, many seem to be insisting instead on the absolute right of obese patients under the Americans with Disabilities Act. It is such a terrible problem (extreme obesity), and getting significantly worse all the time, and yet we don't seem to be doing much about it.
While I agree that no one should be precluded from nursing home care, I really wish far more attention was being paid to the epidemic of obesity. We are killing ourselves, one calorie at a time.
PeggyC said:
While I agree that no one should be precluded from nursing home care, I really wish far more attention was being paid to the epidemic of obesity. We are killing ourselves, one calorie at a time.
There is a whole lot of obesity research being conducted these days and quite a few national, state and local public health initiatives too.
The obesity epidemic is extremely complicated and multifactorial.
mjh said:
PeggyC said:
While I agree that no one should be precluded from nursing home care, I really wish far more attention was being paid to the epidemic of obesity. We are killing ourselves, one calorie at a time.
There is a whole lot of obesity research being conducted these days and quite a few national, state and local public health initiatives too.
The obesity epidemic is extremely complicated and multifactorial.
I am sure it is. But until we get a better grip on that, the problems for the elderly are only going to multiply, with no good answer in terms of care.
I have to confess that I haven't yet read the linked article. However if the sector discussions there are similar to those here, many of the issues concern workplace owners refusing to purchase the appropriate equipment (larger stronger beds, chairs, toilets, lifts and hoists etc) for the bigger weights we routinely work with these days, and unthinking staff who fail to use the recommended equipment every single time a bariatric patient or resident is in their care.
I'm really grateful for the past few years, sitting on the Consumer Advisory Group for the regional Hospital and Health Service and being on such committees as the Patient Care Committee. Discussions in such committees about nursing care of bariatric (very large) patients has uncovered subjects that are blurred by 'obesity epidemic stats':
*the cultural diversity mix within the wider population, and within individual families (some Pacific Islanders, for example, are very large-framed whereas the typical UK migrant mid-last century was smaller and lighter);
*There's a reluctance by 'busy' 'experienced' staff to not be bothered following instructions to collect special hoists, chairs, wheelchairs, take patients to special toilets, etc if they see the incident they're dealing with as "just this once" in the course of a working day. The attitude leads to injuries to both worker and sometimes the patient, damaged equipment, and to loss of dignity for the patient. Sometimes the injuries result permanent damage. Yet a proper strategy had been in place, just not consistently adhered to.
*"Fatshaming" of people already feeling unwell and vulnerable leads to greater risk of falls and poor-outcome incidents (there are studies that demonstrate the evidence). The disapproval may be an unconsciously negative attitude held by attending staff, yet it is still sufficient to adversely affect the care outcomes of the larger patient (the time in hospital or care, the extent of healing, mental health of patient, nutritional health and behaviours of patient, health behaviours and self-care, etc).
A very complex subject indeed.
A lot of the solution to obesity lies in the individual. The individual needs to be informed and willing to maintain a proper weight. There is a ton of disinformation about what to eat, and even when well equipped, many (or most?) of us have to overcome inertia to change our habits. The disinformation is in many forms, including advertising. Eat this! Eat that! Seems like a good idea at the time. And now that overeating is normal, it feels normal.
Thank you Joanne...you make very important points.
Of course we should (and do) work on the root causes of obesity.
But we should also treat obese elders with as much respect and care as their skinnier counterparts. Own the right equipment, use the right equipment and techniques, overcome the bias, or this does become a world of ADA lawsuits from people whose problems should have been managed without them.
I'm reading the article, and am appalled by the broad tendency of nursing homes to reject these patients, and the underlying failure of payor systems that makes it too expensive for them to take them, because they won't pay for the appropriate equipment.
Our payor system should not be allowed to ignore the needs of these patients, any more than they can ignore the medical needs of those who are ill/injured because of any other lifestyle choice or metabolic bad luck.
We've been told the statistics on higher death rates among the obese for so long...but it is only right for us to recognize that unequal treatment may be worsening the problem (as has also been documented for people of color in at least some medical conditions).
Tom_Reingold said:
A lot of the solution to obesity lies in the individual. The individual needs to be informed and willing to maintain a proper weight. There is a ton of disinformation about what to eat, and even when well equipped, many (or most?) of us have to overcome inertia to change our habits. The disinformation is in many forms, including advertising. Eat this! Eat that! Seems like a good idea at the time. And now that overeating is normal, it feels normal.
Yes, fine, people should eat better. But if they are in need of medical care, they should get appropriate medical care no matter what the cause of their injury. As the article says, many of the current infirm elderly are in conditions that would make attempts to lose weight medically unsafe.
We don't (or shouldn't) allow the grading patient worthiness based on lifestyle and refuse to invest in appropriate treatment equipment and staffing for illnesses/injuries complicated or caused by smoking, participation in high-risk sports, dangerous driving, unsafe sex, or a wide variety of other lifestyle choices and bad decisions.
Let's not let our culture's fat-bias make us apologists for poor medical treatment...our government, payors and nursing homes can see this problem coming, and need to be coming up with effective and dignity-sparing solutions, even as we try to deal with the underlying issues that have put us in this situation.
Tom_Reingold said:
A lot of the solution to obesity lies in the individual. The individual needs to be informed and willing to maintain a proper weight. There is a ton of disinformation about what to eat, and even when well equipped, many (or most?) of us have to overcome inertia to change our habits. The disinformation is in many forms, including advertising. Eat this! Eat that! Seems like a good idea at the time. And now that overeating is normal, it feels normal.
The epidemic of obesity is fueled by a complex interplay of environmental, social, economic, and behavioral factors, acting on a background of genetic susceptibility. Individual responsibility and access to accurate information are critical components but insufficient to address the problem.
Also, what susan1014 said.
@susan1014, I fully agree with you and didn't mean to imply anything contrary to what you say.
Examples I learned of, that surprised me, included very tall former athletes (think basketballers now in their 50s, perhaps with bad osteo or cancers), former boxers and footballers, weightlifters, rowers, forestry workers - people whose very muscle mass was once lauded and whose height gave them prominence and some social status - now regarded as health and workplace liabilities because as patients they don't fit insurance 'norms' for age-related guidelines. And then there are the people who needed cortisone-based medications for decades (for example) which have affected their ability to retain muscle tone, muscle mass, collagen elasticity and quality (integrity?), fluids (so that eventually lymph and kidneys are destroyed)... People who worked in physically demanding factory work that destroyed various senses, and created other damage not picked up until their 70s or 80s. (Many men have work-related colour blindness, affecting their ability to take the right meds, or affecting levels of literacy)
We live in a era when people are living longer than ever before. People are living in their own homes longer, alone or in very small family units, more than at any other time in history. People are living longer with disease, and with multiple diseases, for longer than at any time before. There really are very few relevant statistics or good reliable evidence for old, old age - nearly everything is based on assumptions as we transitioned through two vastly different health-eras post-WW2. We're really just starting to 'normalise' into evidence-based stats for old, old-aged living now.
Tom_Reingold said:
A lot of the solution to obesity lies in the individual. The individual needs to be informed and willing to maintain a proper weight. There is a ton of disinformation about what to eat, and even when well equipped, many (or most?) of us have to overcome inertia to change our habits. The disinformation is in many forms, including advertising. Eat this! Eat that! Seems like a good idea at the time. And now that overeating is normal, it feels normal.
But what about those that become obese due to disability...people prescribed meds that not only don't help the underlying condition, but cause weight gain...people that struggle just to bath and eat cold cereal and bologna sandwiches...who can't cook or clean for themselves....or have to depend on deliveries...people who the strain of basic housework causes severe pain and loss of body function and its all they can do to keep basic sanitation....and they can't get through the red tape to get the help they need because they are too sick to fight......
many people become obese as a result of a disability....
How does color blindness really affect the ability to take the right meds...For years, I have marked my pill bottles to make them easy to identify....a person could ask the pharmacist for help....it could be as simple as putting a piece of tape on the bottom for meds to be taken in the AM for example....you can get stickers to put on top of bottles, sun for day, star for night.....you could put 2 stars for take 2...you could get puffy stickers to make identifying them easier..use elastics to mark bottles....there are so many options to deal with color blindness or vision/literacy issues
It isn't just nursing. EMS has been affected by this too. There are obese stretchers made to take patients that weigh more, but getting the patient onto the stretcher in the first place still takes people lifting as the average person doesn't have a special lift in their home or other location where they may have fallen ill or injured.
When possible EMS can call for a lift assist, but in many cases additional manpower is just not available, or the patient may be sick enough that waiting for a lift assist would endanger the patient's life.
Also, in private homes EMS won't find elevators to bring patients down on a stretcher, and often have to resort to a stair chair if the patient is unable to walk under their own power. Same goes for older apartments where there are multiple floors but no elevators.
Saying "lift with your knees" only helps so much when the patient is in PSVT on the third floor and your lift assist is 20 minutes out.
Colour blindness (tone blindness) may affect a person's ability to read labels and instructions - they're rarely printed just white on black or black on white with no competing colour. Anything signalling danger is often in red, anything signalling 'OK' is usually in green or yellow, and often the markings for dosage packs or boxes are nifty/cute cartoon symbols in the wrong colours. Injections, drops, patch backings are all difficult to distinguish and manipulate...
If you see things in shades of blues, or browns, or greys, and then add in growing cataracts or AMD or glaucoma, and perhaps decreasing tactile sensitivity (through diabetes or poor circulation etc) an older person may have great difficulty managing their medication at home especially when it's something taken 'as needed'. Wishing to hold on to independence, older people often won't let on that they need more help to read or measure, or even to understand the Dr's directions; or they won't know that such assistance is available, freely.
jmitw said:
many people become obese as a result of a disability....
That's true. Has this number increased? I don't know.
I definitely don't think anyone should be denied a bed because of any stigma about weight. But when it costs significantly more to buy expensive equipment and add staff hours to compensate, nursing homes have to think hard. In particular, if a home doesn't have equipment that can safely support and manage morbidly obese people, it would be unsafe to admit those patients and not in the patients' best interests. How do facilities afford the upgrades they would have to make, and the additional staff and hours? It's not an easy thing for them to figure out.
If someone is already obese and becomes frail enough to need a nursing home, it is clearly not reasonable to expect them to do what needs to be done to lose that kind of weight. That needs to be addressed many years before that point, which is why I think it is so important to do the research and figure out how to help people avoid getting into that situation.
I am NOT talking about fat shaming, and I don't think the article is about that, either. It is a legitimate health crisis.
Not too long ago, I joined Weight Watchers for a brief period of time. The Weight Watcher leader passed around a picture of herself taken when she was at her largest. The group could not believe it was the same person who stood in front of us. After a cancer scare, the leader decided to get serious about her weight. Yes , of course, her health was a major concern. But her primary reason for wanting to lose the pounds was because she did not want to be a burden upon her loved ones or on those who would eventually care for her.
I thought of that W.W. meeting when I read this sober report about the obese elderly in nursing homes and the catastrophic costs and other impacts involved. In that same vein, I have a sister-in-law who suffered a major back injury from moving an obese patient. The angle at which health care providers must bend over a hospital bed puts unusual stress on the back. Add the pressure of moving a weight and it's a problem. Also noted in this article is the heartbreaking situations of the elderly obese in this dynamic.
NYT: Rising Obesity Rates Puts Strain on Nursing Homes
http://www.nytimes.com/2015/12/15/health/rising-obesity-rates-put-strain-on-nursing-homes.html