The High Price of Obesity in Nursing Homes

By Marihart, Cindy L.; Brunt, Ardith R. et al. | Care Management Journals, April 1, 2015 | Go to article overview

The High Price of Obesity in Nursing Homes


Marihart, Cindy L., Brunt, Ardith R., Geraci, Angela A., Care Management Journals


This article provides a commentary on the costs of obese nursing home patients. We conducted a comprehensive literature search, which found 46 relevant articles on obesity in older adults and effects on nursing home facilities. This review indicated obesity is increasing globally for all age groups and older adults are facing increased challenges with chronic diseases associated with obesity more than ever before. With medical advances comes greater life expectancy, but obese adults often experience more disabilities, which require nursing home care. In the United States, the prevalence of obesity in adults aged 60 years and older increased from 9.9 million (23.6%) to 22.2 million (37.0%) in 2010. Obese older adults are twice as likely to be admitted to a nursing home. Many obese adults have comorbidities such as Type 2 diabetes; patients with diabetes incurred 1 in every 4 nursing home days. Besides the costs of early entrance into nursing facilities, caring for obese residents is different than caring for nonobese residents. Obese residents have more care needs for additional equipment, supplies, and staffcosts. Unlike emergency rooms and hospitals, nursing homes do not have federal requirements that require them to serve all patients. Currently, some nursing homes are not prepared to deal with very obese patients. This is a public health concern because there are more obese people than ever in history before and the future appears to have even a heavier generation moving forward. Policymakers need to become aware of this serious gap in nursing home care.

Keywords: obesity; nursing homes; aging; gerontology

The prevalence of obesity in older adults living in nursing homes has more than doubled within the last 20 years (Zhang, Li, & Temkin-Greener, 2013). This reflects the estimates of obesity in older Americans, which increased from 9.9 million (24%) in 1990 to 14.6 million (32%) in 2000 to 22.2 million (37%) in 2010 (Salihu, Bonnema, & Alio, 2009). The baby boomers, those born between 1946 and 1964, weighed more and became obese at younger ages than previous generations such as the silent generation, born between 1926 and 1945 (Leveille, Wee, & Iezzoni, 2005). When the members of the silent generation were aged 35-44 years, 14%-18% were obese, but when the baby boomers were reached that age span, those percentages doubled to 28%-32% (Leveille et al., 2005). Because the baby boomers are reaching their sixth decade heavier than previous generations, there is a public health concern that these overweight adults will become obese. This may create a greater risk of chronic disease and immobility requiring more frequent and earlier nursing home placements (Bradway, DiResta, Fleshner, & Polomano, 2008; Zevin, Aggarwal, & Grantcharov, 2012).

Given the increased obesity rates for older adults, increased life expectancy does not necessarily mean increased healthy years (Han, Tajar, & Lean, 2011). Instead, obese older adult may be facing additional years of discomfort, immobility, and chronic ill health (Mathus-Vliegen, 2012; Mathus-Vliegen et al., 2012). The most common obesity-related chronic diseases are Type 2 diabetes, hypertension, heart disease, stroke, certain types of cancers, metabolic syndrome, respiratory disease, sleep apnea, fatty liver disease, osteoarthritis, gallbladder disease, pulmonary embolism, gastroesophageal reflux disease, urinary incontinence, chronic renal failure, gout, and depression (Bradway et al., 2008; Zamosky, 2013). Obesity is also associated with increased disability and functional decline which often coexists with sarcopenia and frailty (Zhang et al., 2013). People are living longer but are less able to care for themselves because of disability caused by obesity. This will require care provided in nursing homes, leading to skyrocketing health care costs (Kennedy, Malabu, Kazi, & Shahsidhar, 2008).

The purpose of this commentary is to draw attention to two issues about obesity in the United States. …

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