Staffing Assistance Needs Rise With Increasing Resident Obesity

Abstract

New research has demonstrated an increase in the need for extensive staffing assistance with reported activities of daily living (ADLs) when residents’ body mass index (BMI) increases. “We found that as BMI increases, the amount of two or more person assistance with ADLs increased, with the largest increases at a body index of 40 kg/m2 or more,” study researcher John Alexander Harris, MD, MSc, of the University of Pittsburgh, told Caring. “This represents a substantial number of people in nursing homes each year and a substantial amount of staff assistance with every activity.” According to Dr. Harris, delivering high-quality care for people with obesity in outpatient, inpatient, and long-term care settings remains a challenge, and nursing homes may be one of the more difficult settings. “Residents need significant amounts of nursing and rehabilitation care around the clock for weeks, months, or years, and there is limited staff to provide the care,” he said. “Obesity is defined by the cutoff of 30 kg/m2, but this may not be the right measurement to signify the most difficulty with nursing care. The goal of this study was to understand how nursing homes assessed the amount of extensive care needed (two or more person assistance) with ADLs as BMI increased.” For the study, Dr. Harris and fellow researchers defined the outcome of interest as the need for extensive (two or more staff members) assistance for ADLs as reported by nursing homes. ADLs included bed mobility, transfer, walking in room, walking in corridor, locomotion on unit, locomotion off unit, dressing, eating, toilet use, personal hygiene, and bathing [Geriatr Nurs June 5, 2018; doi:10.1016/j.gerinurse.2018.05.006]. The BMI category definitions (in kg/m2) were as follows: underweight, less than18.5; normal weight, 18.5 to less than 25; overweight, 25 to less than 30; obesity class I, 30 to less than 35; obesity class II, 35 to less than 40; obesity class III, 40; obesity class IIIA, 40 to less than 50; and obesity class IIIB, 50. The researchers used data from the Centers for Medicare & Medicaid Services Minimum Data Set (MDS) for 2013. After the exclusion of residents with missing information for age, height, or weight, urinary or bowel incontinence, medical conditions, or functional status, the final cohort included 1,627,141 residents. Overall, 5.7% of residents were underweight, 34.6% were normal weight, 29% were overweight, 16.2% were class I obese, 7.7% were class II obese, 5.2% were class IIIA obese, and 1.7% were class IIIB obese. After the researchers adjusted for age, gender, and dementia status, they found that an increasing BMI yielded a greater likelihood that a two or more person assist was needed for all activities except eating assistance. Specifically, for class IIIB obese vs. normal weight residents, the odds ratio of needing assistance from two or more people for all ADL categories except eating assistance ranged from 1.23 to 2.23. Furthermore, the odds ratio for receiving a two-person assist with any ADL was 1.33 for class IIIA obese residents and 1.9 for class IIIB obese residents. The study limitations included that MDS assessors reported all heights and weights using facility-specific standard practices, that the main outcome only reported the assessor’s perception, and that the statistical models controlled for a limited number of demographic variables. “Nursing needs of people with a BMI of 40 kg/m2 or more are significantly more challenging than people with lower BMI,” Dr. Harris concluded. “Innovative solutions to meet the needs for staffing and equipment in nursing homes will be critical as the number of residents with obesity increases each year in U.S. nursing homes.” Brian Ellis is a freelance writer and editor based in NJ.