Obese Residents Research Articles

High Medicaid Nursing Homes: Contextual Factors Associated with the Availability of Specialized Resources Required to Care for Obese Residents

ABSTRACT Obesity is an increasingly important concern in the delivery of high-quality nursing home care. Obese nursing home residents require specialized equipment and resources. As high Medicaid nursing homes have limited financial ability, they may lack the necessary resources to address the needs of obese residents. Moreover, there are variations in the availability of obesity-related specialized resources across these facilities. This study aims to investigate the organizational and market factors associated with the availability of obesity-related specialized resources in high-Medicaid nursing homes. Survey and secondary data sources for the study period 2017–2018 were utilized. The survey data were merged with Brown University’s Long Term Care Focus (LTCFocus), Nursing Home Compare, and Area Health Resource File datasets. The dependent variable was the composite score of obesity-related specialized resources, ranging from 0–19. An ordinary least square regression with propensity score weights (to adjust for potential survey non-response bias), along with appropriate organizational/market level control variables were used for our analysis. Our results suggest that payer-mix (>Medicare residents) and a higher proportion of obese residents were positively associated with the availability of obesity-related specialized resources. Policymakers should consider implementing incentives, such as increased Medicaid payments, to assist high Medicaid nursing homes in addressing the specific needs of obese residents.

Цитокиновые реакции при дислипопротеинемиях у взрослых жителей Европейского Севера России в зависимости от индекса массы тела

An increase in proinflammatory cytokine content in the blood is a stereotypical inflammatory response, regardless of the etiology or type of inflammation. Since cytokines exhibit pleiotropy, they serve as signalling molecules in intercellular interactions and stimulate the functional activity of cells, their proliferation and differentiation. The purpose of this study was to identify the frequency of elevated cytokine levels in dyslipoproteinemia in adults with different body weight living in the European North of Russia. Materials and methods. The study involved 313 residents of Arkhangelsk aged 45–60 years: with normal body weight (211 subjects; body mass index up to 30 kg/m2) and obesity (102 subjects; body mass index 31–40 kg/m2). The enzymatic and turbidimetric methods were applied to evaluate lipid profile parameters using an automatic biochemical analyser; cytokine levels were determined using solid-phase enzyme immunoassay. Results. In subjects with normal body weight, elevated blood concentrations of the cytokines under study coinciding with dyslipoproteinemia were detected in 2–11 % of cases. In obesity, elevated cytokine levels were 2–7 times more frequent; the sharpest differences were observed regarding IL-6, whose elevated concentrations reached 44 % of cases. A significant increase in IL-1ß concentrations in the blood of the subjects is associated with an increase in the levels of low-density lipoproteins (LDL) and very-low-density lipoproteins (VLDL) as well as triglycerides (TG). The frequency of increased TNF-α levels was the most significant (36.28 %) at abnormally high TG concentrations. Elevated IL-6 levels were most often associated with an increase in the blood concentration of several transport forms: LDL, VLDL, oxidized LDL, and TG. In over 40 % of cases, increased IL-10 was observed in the blood of individuals with abnormally high levels of LDL and VLDL. Thus, obese residents of the European North of Russia are characterized by a more pronounced cytokine response. At the same time, cytokine response (irrespective of the body mass) is primarily associated with an increase in the blood levels of LDL, VLDL and oxidized LDL.

Obesity and its associated factors in older nursing home residents in three European countries-Secondary data analyses from the "International Prevalence Measurement of Care Quality".

The prevalence of obesity has risen in recent decades and reached epidemic proportions worldwide. The proportion of those living with obesity is also increasing in nursing homes. This could impact the nursing care required, equipment and facilities provided, and morbidity in these settings. Limited evidence exists on clinical consequences of obesity in nursing home residents and their care. Therefore, the aim was to examine the rate and associated factors of obesity (BMI ≥30; class I (BMI 30.0-34.9kg/m2 ), class II (BMI 35.0-39.9kg/m2 ), and class III (BMI >40.0kg/m2 )) amongst older nursing home residents in European countries. We analysed data from 21,836 people who reside in nursing homes in Austria, the Netherlands, and the United Kingdom. They participated in the "International Prevalence Measurement of Care Quality", a cross sectional study between 2016 and 2019, where trained nurses interviewed the residents, reviewed care records, and conducted clinical examinations. A tested and standardised questionnaire comprised questions on demographic data, measured BMI, medical diagnosis according to ICD-10, and care dependency. Descriptive and logistic regression analyses were performed. Obesity rates were highest in Austria (17.1%) and lowest in the UK (13.0%) (p=.006). Residents with obesity were younger and less likely to be care dependent or living with dementia and had more often diabetes mellitus, endocrine, metabolic, and skin diseases compared to residents without obesity (p < .05). Most obese residents had obesity class I. Therefore, two subgroups were built (class I vs. class II + III). Residents with obesity class II + III were more frequently care dependent for mobility, getting dressed and undressed, and personal hygiene compared to residents with class I (p < .05). This study identified several factors that are associated with obesity amongst older nursing home residents in selected European countries. The division into obesity classes is important for planning targeted care according to the individual needs of nursing home residents.

S-36-4: STRATEGY OF HEALTH PROMOTION FOR HEALTH AND LONGEVITY IN OKINAWA, JAPAN

Okinawa was known as an area of longevity. The life expectance kept always top ranks in Japan, and centenarians kept their healthy and vigorous lives. In recent 10 years, however, their life expectancy of people did not increase as much as other areas in Japan. From epidemiological evidence, an increased intakes of fat after World War II (late 1940 s) and that of salt after the reversion to Japan after 1972 are considered as major causes. To recover health and longevity in Okinawa, we, team of University of the Ryukyus, designed, and then carried out the health promotion program. Main strategy to learn from old healthy Okinawa, namely healthy food and rich social capital. We campaigned to increase intake of vegetables including local Okinawan vegetables. We also promoted the health literacy through relationships with family and with neighbors. Such interventions decreased body weight of obese residents and increased vegetable intake. We also found that the promotion worked more effectively in an area where the social capital was rich. We are now accumulating evidence whether our approach is effective or not.

FACTORS ASSOCIATED WITH THE AVAILABILITY OF SPECIALIZED RESOURCES TO TACKLE OBESITY IN HIGH MEDICAID NURSING HOMES

Abstract The purpose of this research is to explore the factors associated with the availability of specialized resources required to care for obese residents in high Medicaid nursing homes (NHs) (85% or higher). Due to the vagaries of payment models---Medicaid payments lag other modes of NH reimbursements—high Medicaid NHs typically report poorer quality and financial performance. Operating in a financial perilous environment, and with obesity among the elderly on the rise, high Medicaid NH may particularly struggle to obtain the appropriate resources essential to cater to obese residents' needs.Utilizing the resource-dependent theory, we hypothesized that occupancy rate, acuity index, and payer mix may be positively associated with the availability of obesity related specialized equipment in high Medicaid NHs. The study was conducted by merging survey and secondary data sources for the year 2017-2018. Obesity related data was collected via mail surveys sent to Directors of Nursing in high Medicaid NHs, The survey data was merged with the following secondary data sources: Brown University’s LTC Focus, Area Health Resource File, and the Medicare cost reports. The dependent variable was the summative obesity score that ranged from 0-19 with the larger number indicating greater availability of obesity-related equipment/services. An ordinary least square regression with propensity score weights (to adjust for potential non-response bias), and appropriate organizational/market level control variables were used for our analysis. Results suggest that payer mix (&amp;gt;Medicare residents) and acuity index were positively associated with the summative obesity score (p &amp;lt; 0.05). Policy and managerial implications are discussed.

Improving the Physical Health of Psychiatric Hospital Residents: An Evaluation of an Obesity Education Program for Mental Health Professionals.

Background: People living with mental health disorders are at increased risk for developing obesity due to poor diet, physical inactivity, and antipsychotic medications. In the United States, the obesity rate is 36% in the general population and more than 50% for people living with mental health disorders. Although mental health clinicians concentrate on managing psychiatric disorders, they seldom recognize the gradual increase in body mass index of their patients. The result is a disconnection between the clinical management of psychiatric disorders and the medical management of obesity. Purpose: This study assessed the effectiveness of an evidence-based education program for improving the obesity management practices of mental health clinicians caring for residents at a state psychiatric hospital. Methods: This was a quasi-experimental study design with a pretest and posttest evaluation. Convenience sampling was used to recruit mental health professionals, or clinicians, at a large psychiatric hospital in the Southern region of the United States. Data was collected with the Advising and Treating Overweight and Obese Patient questionnaire (17 items). Data analysis included descriptive and inferential statistics. The findings were reported in accordance with the TREND and GREET guidelines. Results: The education program was completed by 50 MHCs. The pretest indicated that 76% of MHCs were not involved in helping obese residents manage their weight, but the posttest indicated 90% were involved. There was a significant increase in MHC knowledge about obesity management and reported actions 90-days after the program. MHCs were unable to arrange follow-up visits for residents, a task not directly within their control. Conclusions: Mental health clinicians reported increased knowledge and improved clinical practice after an education program. Because the outcomes were reported at 90-days after the program, further research needs to evaluate the longitudinal impact of this type of program, where the reported behaviors are correlated to process and clinical outcome measures for obesity.

The Challenge of Severe Obesity in Nursing Homes from the Perspective of Administrators

This study provides input from nursing home administrators on their challenges (financial, quality, staffing) in caring for severely obese residents. In addition, we report on how changes due to the COVID-19 pandemic have affected care for people with obesity in nursing homes (NHs). Caring for those with severe obesity is a major challenge in NHs and creates several dilemmas related to appropriate nursing care, equipment choice, and potential excess resident care costs. Little is known about how facilities respond to these dilemmas while maintaining the quality of care.

Women with Obesity Are More Likely to Have Long-Term Indwelling Bladder Catheterization in U.S. Nursing Homes

Reducing indwelling catheters and increasing clean intermittent catheterization is a key element of effective infection control and maintaining functional independence in nursing homes. Nursing care is often more difficult as obesity increases, leading to more nursing care or equipment to provide care. We hypothesized that nursing homes are more likely to use indwelling catheters for people with obesity because indwelling catheterization likely eases the nursing burden of toileting and personal hygiene care for residents with obesity. The study design was a retrospective cohort study of U.S. nursing home female residents in Minimum Data Set in 2013. Obesity and normal weight (the reference group) were categorized using National Institutes of Health criteria. Indwelling and intermittent bladder catheterization was defined during periodic assessment of residents. We modeled the outcomes using logistic regression using a robust variance estimator. Model covariates included obesity category, resident age, dementia status, comatose status, Stage 3 or 4 pressure ulcers, and the number of activities of daily living deficits. The study cohort included 1,068,388 female residents in 15,230 nursing homes. Obesity (BMI ≥ 30 kg/m2) prevalence was 31.9%. The prevalence of indwelling catheterization was 5.2% and of intermittent catheterization was 0.4%. The odds ratio of indwelling catheter use for obese residents varied from 1.05 to 1.74 (all with p-values <0.001), whereas the odds ratio. of intermittent catheter use varied from 0.84 to 0.46 (all with p-values <0.01) compared to residents of normal weight. Increasing obesity is independently associated with increased long-term indwelling bladder catheterization and decreased intermittent catheterization.

К вопросу развития артериальной гипертензии у городских жителей с ожирением

Актуальность исследования обусловлена необходимостью оптимизации профилактики артериальной гипертензии (АГ) среди городского населения Украины, в первую очередь с ожирением (Ож). Цель: детализировать особенности развития АГ у городских жителей с Ож, разработать метод прогнозирования АГ на основании определения особенностей взаимодействия параметров, которые характеризуют основные звенья патогенеза обеих патологий. Материалы и методы. Обследованы 1094 жителя г. Харькова, которые не лечились в прошлом по поводу Ож и АГ. Определяли индекс массы тела, окружность талии, измеряли артериальное давление. Методом биоимпедансного анализа исследовали состав тела пациентов, иммуноферментным методом — уровни инсулина, лептина, ренина, альдостерона и кластерина в сыворотке крови. Особенности центральной гемодинамики оценивались методом интегральной реографии тела: определяли ударный объем (мл), сердечный выброс (л/мин), ударный индекс (мл/м2), сердечный индекс (л/мин • м2). Результаты. Городские жители среднего возраста с ожирением нуждаются в интенсификации профилактической работы в отношении АГ. У мужчин ее нужно начинать уже в возрасте до 40 лет. Развитие сочетанной патологии (АГ и Ож) у лиц среднего возраста обусловлено наличием инсулинорезистентности, которая сопровождается изменениями циркулирующих уровней инсулина, лептина, альдостерона, изменениями ударного индекса и общего периферического сопротивления сосудов, возникновением системного низкоинтенсивного воспаления в организме. К факторам, которые в первую очередь обусловливают развитие и прогрессирование Ож у данной категории населения, следует отнести проявление инсулинорезистентности. Определение с помощью метода интегральной реографии тела изменений ударного индекса — информативный маркер развития и прогрессирования АГ. Наличие сочетанной патологии (АГ с Ож) характеризируется изменениями уровней лептина и кластерина по сравнению с пациентами с Ож без АГ, что также нужно учитывать при разработке терапевтических подходов. Выводы. Выявленные в процессе работы подходы к прогностической классификации, созданной с помощью дискриминантного анализа, городских жителей среднего возраста — представителей украинской популяции могут стать основой для оптимизации алгоритмов формирования средних групп риска развития Ож и АГ.

Health Access and Outcome Differentials Among Older Adults Age 50 Years or Above in Ghana

Health outcomes are substantially influenced by demographic and socioeconomic indicators. Their presence or absence can act to boost or curtail health opportunities and outcomes. These health indicators are often not evenly distributed across geographic regions. The focus of this study is to explore how Ghana’s north-south regional divide manifests in the health outcomes of its people. The study was based on a data from the Research on Early Life and Aging Trends and Effects (RELATE), a harmonized cross‐sectional dataset with 147,278 respondents from 14 countries including Ghana. This study pooled 4724 respondents from Ghana aged 50 years or above. The study found that several demographic and socioeconomic indicators had significant associations with optimal health. However, most of the associations were attenuated after other variables in the model were controlled. Specifically, the study found that being a male gender and doing rigorous work were risk factors for living below optimal health in both the North and South regions. However, using healthcare services and being single or unmarried were protective factors but only in the South region. The results of the study also showed that indicators for good health generally favored the South region but the North region reported higher self-rated health score, smaller proportions of overweight and obese residents, fewer numbers of chronic health conditions, and a smaller proportion of resident living below optimal health. This finding demonstrates that the link between positive health indicators and healthiness has subtle nuances that could be attributed to how people conceptualize health and healthiness.

Knowledge, Attitude and Practices about Obesity Management among Saudi Board of Family Medicine Residents in Makkah Al-Mukarramah: A Cross-sectional Study

Background: As obesity has become one of the most common health problems in Saudi Arabia, the Ministry of Health launched an initiative as a part of KSA national transformation program aims to decrease the incidence of obesity and chronic diseases, by applying prevention strategies and provide proper management. Objectives: to explore the knowledge, attitudes, and practices of the joint program of family medicine candidates in Makkah regarding obesity management. Materials and methods: A cross sectional study was carried out among a representative sample of resident physicians of the joint program of family medicine Ministry of Health, Makkah city during January 2020. A self-administered validated questionnaire was used for data collection. It consists of four main sections; sociodemographic data, knowledge related questions, attitude related statements and practice related statements. Results: The study included 116 family medicine residents. Females represent 58.6% of them. Majority of the participants (98.3%) aged between 25 and 34 years. Obesity was reported among 13.8%; 8.6% class I and 5.2% class II. More than half of the family medicine residents (51.7%) had attended course or workshop about obesity and its management. More than half (57.8%) of the participants had good level of knowledge regarding obesity and its management, with the highest rate was observed among postgraduate year 2 (73.5%) whereas the lowest level was reported among those of PGY 1 (28.6%), p=0.003. Also, more than half (54.3%) expressed positive attitude towards obesity management, and this was steadily increasing with the advancing in residency level (p=0.016) and years of experience (0.011). Adequate practice regarding obesity management was observed among 61.2% of them. Obese residents had higher rate of adequate practice regarding obesity management, p=0.008. The commonest barriers faced by the resident physicians when managing patients with obesity were lack of training in obesity management (47.4%), lack of knowledge (45.7%), lack of effective referral system (39.7%) and lack of time (38.8%). Conclusion: Good Knowledge, positive attitude and adequate practice of the family medicine residents, Makkah regarding obesity and its management are moderate with some defective elements.

Obesity among Nursing Home Residents: Association with Potentially Avoidable Hospitalizations

Background/ObjectivesStudies show that in nursing homes (NHs), the prevalence of moderate-to-severe obesity has doubled in the last decade and continues to increase. Obese residents are often complex and costly, and this increase in prevalence has come at a time when NHs struggle to decrease hospitalizations, particularly those that are potentially avoidable. This study examined the association between obesity and hospitalizations. DesignWe linked 2011-2014 national data using Medicare NH assessments, hospital claims, and the NH Compare. Setting and ParticipantsIndividuals aged ≥65 years, newly admitted to NHs, who became long-term residents between July 1, 2011 and March 26, 2014. The analytical sample included 490,086 residents. MethodsNH-originating hospitalization was the outcome; a categorical variable defined as no hospitalization, potentially avoidable hospitalization (PAH), and other hospitalization (non-PAH). The main independent variable was body mass index (BMI) defined as normal weight (30 >BMI ≥18.5 kg/m2), mildly obese (35 >BMI ≥30 kg/m2), or moderately-to-severely obese (BMI ≥35 kg/m2). Covariates included individual and NH characteristics. Multinomial models with NH random effects and state dummies were estimated. ResultsAfter adjusting for individual level covariates, the risk of non-PAH for the mildly and moderate/severely obese was not different from normal weight residents. But the risk of PAH remained significantly higher for the moderate/severely obese (relative risk ratio = 1.055; 95% confidence interval 1.018, 1.094). Several NH-level factors also influenced hospitalization risk. Conclusions and ImplicationsObese residents are more likely to experience PAH but not non-PAH. Efforts to improve care for these residents may need to broadly consider the ability of NHs to commit additional resources to fully integrate care for this growing segment of the population.

Susan D. Horn, PhD Tracey L. Yap, PhD, RN, CNE, WCC, FGSA, FAAN

This report examines 2 cases of obese nursing home residents and their movement behaviors in relation to their potential influence on overall PrI risk. Resident movements were monitored 24 hours/day using a wearable sensor, and repositioning events were observed as part of a larger study examining repositioning intervals. Braden Pressure Ulcer Risk Assessment was conducted weekly. Both residents (BMI 39 kg/m2 and 50 kg/m2) had limitations in movement with prolonged periods spent in a single body position. Each resident addressed movement challenges unique to their desire to remain mobile and level of dependency on nursing staff. Presence of obesity is a factor affecting resident movement and creates environmental and psychosocial barriers to health. Nurses can play a key role in PrI prevention by addressing these barriers and encouraging positive, long-term behavior changes that mitigate risk. Future research should guide tailored PrI prevention protocols and national/ international guidelines for obese residents.

Low-level radon exposure and lung cancer mortality

BackgroundIt is agreed that high level radon exposure is harmful to humans. However, some published literature suggests that low levels of radon show no adverse effects or may even be protective. Claims made using traditional methods of analysis on observational data often fail to replicate. Here, we use a simple, alternative data-analytic strategy for examining effects of low-level indoor radon exposure on lung cancer mortality. One objective will be to demonstrate that local population characteristics can alter expected effects. MethodsObservational data on indoor radon exposure levels and lung cancer mortality for 2881 U.S. counties were obtained from federal and state governmental agencies. A new “statistical thinking” step-by-step analysis strategy called Local Control (LC) allows us to perform analyses of observational data that are more objective and “fair” than regression-like methods. LC analytical strategy makes as few and as realistic assumptions as possible. As a result, key LC inferences are nonparametric, and estimates of potentially heterogeneous treatment effect-sizes are robust. ResultsOur LC analyses suggest that lung cancer mortality usually tends to decrease as background radon exposure increases. Local rank correlation (LRC) effect-sizes are shown to be predictable from confounding local characteristics like percentage of residents over 65, percentage of residents who currently smoke and percentage of obese residents. ConclusionsAt low indoor radon exposure levels, reverse (negative) LRCs between radon exposure level and lung cancer mortality predominate. The strengths of these associations vary with local demographics.

Associations between obesity and vitamin D availability depending on the rs2228570 polymorphism of the VDR gene and rs9939609 polymorphism of the FTO gene in the midland and the Extreme North of Russia

Background: It has been shown that vitamin D availability depends on the body mass index (BMI). Genetic polymorphisms contribute to the development of vitamin D deficiency.Aim: To study the availability of vitamin D in the population of various regions of the Russian Federation, depending on the BMI values and the rs2228570 polymorphisms of the VDR gene and rs9939609 of the FTO gene.Materials and methods: The rs2228570 polymorphisms of the VDR gene and rs9939609 of the FTO gene were identified in 311 subjects (136, from the midland of Russia, and 175 from the Far North). Serum 25-hydroxyvitamin D [25(OH)D] levels were measured by an immunoenzyme assay in the autumn and winter seasons. Genotyping was performed with the allele-specific amplification and real-time detection of results using TaqMan probes complementary to the polymorphic DNA segments and the CFX96 Real Time System amplifier (Bio-Rad, USA). We studied associations of the rs9939609 polymorphism of the fat mass and obesity-associated (FTO) gene located at 16q12.2, as well as the rs2228570 polymorphism of the vitamin D receptor gene (VDR) located at 12q13.11.Results: Frank vitamin D deficiency (serum 25 (OH) D level&lt;20 ng/ml) was observed in 39.7% (54/136) of the sample from the midland, in 40% (14/35) of the migrants and in 30.7% (43/140) of the indigenous inhabitants of the Far North (Nenets). Obese residents of the midland Russia had significantly lower serum 25(OH)D levels, and the indigenous population of the Far North had significantly higher levels than those with BMI&lt;30 (р&lt;0.05). In the indigenous population of the Northern Region, there was a significant association between vitamin D deficiency and C allele of the rs2228570 polymorphism of the VDR gene (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.46–4.27, p=0.0006) and the AA genotype of the rs9939609 polymorphism of the FTO gene (OR 8.83, 95% CI 0.94–82.5, p=0.02).Conclusion: The association between obesity and vitamin D availability in the individuals with the rs2228570 polymorphism of the VDR gene and the rs9939609 polymorphism of the FTO gene depends on their ethnicity.

Identifying Malnutrition in PALTC Communities

Identifying Malnutrition in PALTC Communities

Hospital Readmissions Among Post-acute Nursing Home Residents: Does Obesity Matter?

ObjectivesTo explore profiles of obese residents who receive post-acute care in nursing homes (NHs) and to assess the relationship between obesity and hospital readmissions and how it is modified by individual comorbidities, age, and type of index hospitalizations. DesignRetrospective cohort study. Setting and participantsMedicare fee-for-service beneficiaries who were newly admitted to free-standing US NHs after an acute inpatient episode between 2011 and 2014 (N = 2,323,019). MeasuresThe Minimum Data Set 3.0 were linked with Medicare data. The outcome variable was 30-day hospital readmission from an NH. Residents were categorized into 3 groups based on their body mass index (BMI): nonobese, mildly obese, moderate-to-severely obese. We tested the relationship between obesity and 30-day readmissions by fixed-effects logit models and stratified analyses by the type of index hospitalization and residents' age. ResultsForty percent of the identified residents were admitted after a surgical episode, and the rest were admitted after a medical episode. The overall relationship between obesity and readmissions suggested that obesity was associated with higher risks of readmission among the oldest old (≥85 years) residents but with lower risks of readmission among the youngest group (65-74 years). After accounting for individual co-covariates, the association between obesity and readmissions among the oldest old residents became weaker; the adjusted odds ratio was 1.061 (P = .049) and 1.004 (P = .829) for moderate-to-severely obese patients with surgical and medical index hospitalizations, respectively. The protective effect of obesity among younger residents reduced after adjusting for covariates. Conclusions/RelevanceThe relationship between obesity and hospital readmission among post-acute residents could be affected by comorbidities, age, and the type of index hospitalization. Further studies are also warranted to understand how to effectively measure NH quality outcomes, including hospital readmissions, so that policies targeting at quality improvement can successfully achieve their goals without unintended consequences.

Effect of gene polymorphisms in transmembrane protein 18 (TMEM18) and neuronal growth regulator 1 (NEGR1) on body mass index in obese subjects

Obesity is a complex disorder with nearly epidemic proportions in many parts of the world. Genome-wide association studies have demonstrated high heritability for obesity and body mass, with associations of certain candidate genes and their variations with respect to race, geographical location/country of origin. However, the functional mechanisms and different ethnic data of these loci are still poorly understood. In this case-control study, we investigated two single nucleotide polymorphisms, rs2815752 in the neuronal growth regulator 1 (NEGR1) gene and rs6548238 in the transmembrane protein 18 (TMEM18) gene, for association in a group of obese residents of Afyonkarahisar province (Turkey). Polymorphisms were genotyped in 172 obese subjects and 77 healthy controls. The results showed no significant differences between the obese subjects and the controls in terms of the allele and genotype frequencies of the NEGR1 gene rs2815752 and the TMEM18 gene rs6548238 polymorphisms. There were no significant associations of the rs2815752 polymorphism in obese subjects and controls with regard to anthropometric measurements and body composition parameters. However, several significant associations were found for the rs6548238 polymorphism with regard to anthropometric measurements and body composition. Consequently, there were no significant differences between the genotype and allele frequencies of NEGR1 gene rs2815752 and TMEM18 gene rs6548238 polymorphisms in the obese group and the controls. There were significant associations for the rs6548238 polymorphism, but not the rs2815752 polymorphism, with the anthropometric measurements and body composition parameters in the group of obese subjects.

Staffing Assistance Needs Rise With Increasing Resident Obesity

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.

237Diet and Lifestyle Changes in Overweight &amp; Obese Residents in HSE Residential Care Sites for Older Persons, CHO 8 (Midlands Area)

237Diet and Lifestyle Changes in Overweight &amp; Obese Residents in HSE Residential Care Sites for Older Persons, CHO 8 (Midlands Area)