Bariatric Care Requires Much More Than Just Bigger Beds

Abstract

LOS ANGELES — More than a third of people in the United States older than 65 are estimated to be obese, and the percentage may be higher than 40% among those 65 to 74. These numbers could translate to millions of seniors who will need bariatric care when they arrive in American nursing homes. The problem: Many nursing facilities aren’t ready to meet the special needs of the extremely obese. It’s not just a matter of seeking heavy-duty walkers, wheelchairs, and Hoyer lifts. A huge variety of extra-large devices and supplies are needed, ranging from slippers, incontinence pads, and toilets to armchairs, stretchers, shower chairs, and much more. The key is to understand and meet the unique needs of obese individuals, said Traci Clark, RN, director of nursing at Creekside Rehabilitation & Behavioral Health in Santa Rosa, CA. And that’s not all. Nursing staff must also understand how the size of residents affects their medical care in unexpected ways. “There’s no way to do CPR on someone who’s bariatric,” Ms. Clark said at the California Association of Long-Term Care Medicine’s annual meeting.Similarly, the Heimlich maneuver may require more than one person. “You can’t do a Heimlich maneuver if you can’t get your arms around them,” she said. “My arms will not go around a 56-inch chest. You need to have two people do it. These are some of the things that no one thinks about.” Five years ago, the Centers for Disease Control & Prevention examined statistics from 2007–2010 and estimated that 35% of adults 65 and older were obese — about 13 million people. The CDC estimated that 41% of those 65 to 74 years old were obese, as were 28% of those 75 and older. Researchers noted that several groups were at higher risk of obesity as seniors: black women (49% of those 75 and older were obese) and women with less than a high school education. Over time, from 1999 to 2010, senior men saw a major jump in obesity levels, including a remarkable rise from 18% in 1999–2002 to 27% in 2007–2010 (NCHS Data Brief, no. 106, September 2012). Although bariatric patients may need extra nursing care because of their comorbid conditions, there is a major gap in one area of nursing home medicine — hospice. Ms. Clark pointed to a 2017 study that looked at 5,677 Medicare beneficiaries who died from 1998 to 2012. Of those, 117 had BMIs of at least 40; only 23% of them received care in hospice compared with 34% of all beneficiaries (Ann Intern Med 2017;166:381–389). Ms. Clark recommended that nursing homes lease or buy these supplies and devices to serve a bariatric population: •Tape measures.•Extra-wide bedpans, commodes (up to 42 inches wide), beds (expandable up to 54 inches wide), armchairs and stretcher chairs (up to 32 inches wide), and wheelchairs (with widths of 26 inches, 28 inches, and larger).•Bariatric-size friction-reducing devices such as slider sheets.•Trapeze bar systems over beds.•Extra-capacity walkers, floor and ceiling lifts, slings, shower chairs (or shower stretchers), aids for standing and raising, and stepstools.•Extra-large or even larger clothing, including gowns, briefs, incontinence pads, and slippers.•Extra-wide stretchers with 1,000-pound capacity.•Appropriately sized medical tools such as longer needles and larger blood pressure cuffs. Everyone must keep in mind the Hoyer lift’s weight capacity, Ms. Clark advised, and understand that even 450 pounds may not be enough. Ms. Clark also advised nursing facilities to consider whether their rooms are large enough to handle bariatric patients. “Think about six people simultaneously turning someone, plus a lift,” she said. “Sleep apnea is almost guaranteed,” she added, so accommodations may need to include a continuous positive airway pressure (CPAP) machine and an oxygen concentrator, as well as a bedside commode. Ms. Clark pointed to other challenges such as the need for intensive skin management, and she encouraged acceptance of patients who don’t change their eating habits. “We need to support these people even though they’re bringing this on themselves. We have to honor that choice and not chastise.” Randy Dotinga is a San Diego-based freelance writer.