Peer Reviewed

Case Report and Brief Review

The Role of Palliative Care in Morbid Obesity

Keywords

July 2019

Abstract

Providing care to patients with morbid obesity is uniquely challenging due to multimorbidity, functional impairment, and high mortality rates in this population. Older adults with morbid obesity, accelerated health decline, and malnutrition often approach the end of life before palliative and hospice services are initiated. Having a better understanding of the role of palliative and hospice care in the care of patients with morbid obesity is important for health care professionals. We describe an older adult with morbid obesity who experienced a steady health decline during his last year of life, requiring recurrent hospitalizations, subacute rehabilitation, and subsequent transition to long-term care and hospice. This case serves to demonstrate gaps in care for this population and provides recommendations for intervention.

Citation: Ann Longterm Care. 2019;27(7):e11-e14. doi:10.25270/altc.2019.05.00073
Received November 2, 2018; accepted December 28, 2018.
Published online May 28, 2019.

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References

1. Campbell AT. The context for government regulation of obesity around the globe: implications for global policy action. World Med Health Policy. 2012;4(2):1-48.

2. Finkelstein EA, Khavjou OA, Thompson H, et al. Obesity and severe obesity forecasts through 2030. Am J Prev Med. 2012;42(6):563-570.

3. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. National Institutes of Health. Obes Res. 1998;6(suppl 2):51S-209S.

4. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013;309(1):71-82.

5. Kitahara CM, Flint AJ, Berrington de Gonzalez A, et al. Association between class III obesity (BMI of 40-59 kg/m₂) and mortality: a pooled analysis of 20 prospective studies. PLoS Med. 2014;11(7):e1001673

6. Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA. 2003;289(2):187-193.

7. Harris JA, Byhoff E, Perumalswami CR, Langa KM, Wright AA, Griggs JJ. The relationship of obesity to hospice use and expenditures: a cohort study. Ann Intern Med. 2017;166(6):381-389.

8. Medicare Payment Advisory Commission (MedPAC). Report to the Congress: Medicare Payment Policy. MedPAC website. https://medpac.gov/docs/default-source/reports/march-2016-report-to-the-congress-medicare-payment-policy.pdf?sfvrsn=0. Accessed May 20, 2019.

9. World Health Organization (WHO). WHO Definition of Palliative Care. WHO website. https://www.who.int/cancer/palliative/definition/en/. Accessed May 20, 2019.

10. Centers for Medicare & Medicaid Services (CMS). Medicare Hospice Benefits. CMS website. https://
www.medicare.gov/Pubs/pdf/02154-Medicare-Hospice-Benefits.PDF. Accessed May 20, 2019.

11. Cimino NM, McPherson ML. Evaluating the impact of palliative or hospice care provided in nursing homes. J Gerontol Nurs. 2014;40(10):10-14.

12. Miller SC, Mor V, Wu N, Gozalo P, Lapane K. Does receipt of hospice care in nursing homes improve the management of pain at the end of life? J Am Geriatr Soc. 2002;50(3):507-515.

13. Suhrie EM, Hanlon JT, Jaffe EJ, Sevick MA, Ruby CM, Aspinall SL. Impact of a geriatric nursing home palliative care service on unnecessary medication prescribing. Am J Geriatr Pharmacother. 2009;7(1):20-25.

14. Gozalo P, Plotzke M, Mor V, Miller SC, Teno JM. Changes in Medicare costs with the growth of hospice care in nursing homes. N Engl J Med. 2015;372(19):1823-1831.

15. aer WM, Hanson LC. Families’ perception of the added value of hospice in the nursing home.
J Am Geriatr Soc. 2000;48(8):879-882.

16. Kiely DK, Givens JL, Shaffer ML, Teno JM, Mitchell SL. Hospice use and outcomes in nursing home residents with advanced dementia. J Am Geriatr Soc. 2010;58(12):2284-2291.

17. Gupta D. Moribund obesity as a palliative care diagnosis. J Palliat Med. 2009;12(6):515-516.

18. Nwosu AC, Raj J, Hugel H. Palliative care and obesity: are we prepared? J Palliat Med. 2012;15(1):7-8.

19. Ness SJ, Hickling DF, Bell JJ, Collins PF. The pressures of obesity: the relationship between obesity, malnutrition and pressure injuries in hospital inpatients. Clin Nutr. 2018;37(5):1569-1574.

20. Hörchner R, Tuinebreijer WE, Kelder H, van Urk E. Coping behavior and loneliness among obese patients. Obes Surg. 2002;12(6):864-868.

21. Collins J, Meng C, Eng A. Psychological impact of severe obesity. Curr Obes Rep. 2016;5(4):435-440.

22. Pinzur M, Freeland R, Juknelis D. The association between body mass index and foot disorders in diabetic patients. Foot Ankle Int. 2005;26(5):375-377.

23. Sarwer DB, Wadden TA, Fabricatore AN. Psychosocial and behavioral aspects of bariatric surgery. Obes Res. 2005;13(4):639-648.

24. Okifuji A, Hare BD. The association between chronic pain and obesity. J Pain Res. 2015;(8):399-408.

25. Zammit C, Liddicoat H, Moonsie I, Makker H. Obesity and respiratory diseases. Int J Gen Med. 2010;(3):335-343.

26. National Hospice and Palliative Care Organization (NHPCO). NHPCO website. https://www.nhpco.orghttps://s3.amazonaws.com/HMP/hmp_ln/imported/public/Statistics_Research/2017_Facts_Figures.pdf. Accessed May 20, 2019.

27. Samper-Ternent R, Al Snih S. Obesity in older adults: epidemiology and implications for disability and disease. Rev Clin Gerontol. 2012;22(1):10-34.

28. Qin W, Liu F, Wan C. A U-shaped association of body mass index and all-cause mortality in heart failure patients: a dose-response meta-analysis of prospective cohort studies. Cardiovasc Ther. 2017;35(2):1-8.

29. Robinson MK, Mogensen KM, Casey JD, et al. The relationship among obesity, nutritional status, and mortality in the critically ill. Crit Care Med. 2015;43(1):87-100.

30. Hamer M, O’Donovan G. Sarcopenic obesity, weight loss, and mortality: the English Longitudinal Study of Ageing. Am J Clin Nutr. 2017;106(1):125-129.

31. Bradway C, Felix HC, Whitfield T, Li X. Barriers in transitioning patients with severe obesity from hospitals to nursing homes. West J Nurs Res. 2017;39(8):1151-1168.

32. Porter Starr KN, McDonald SR, Weidner JA, Bales CW. Challenges in the management of geriatric obesity in high risk populations. Nutrients. 2016;8(5):1-16.

33. Felix HC, Bradway C, Ali MM, Li X. Nursing home perspectives on the admission of morbidly obese patients from hospitals to nursing homes. J Appl Gerontol. 2016;35(3):286-302.

34. Harris JA, Castle NG. Obesity and nursing home care in the United States: a systematic review. Gerontologist. 2019;59(3):e196-e206.

35. Prommer E, Ficek B. Management of pain in the elderly at the end of life. Drugs Aging. 2012;29(4):285-305.

36. Bush SH, Kanji S, Pereira JL, et al. Treating an established episode of delirium in palliative care: expert opinion and review of the current evidence base with recommendations for future development. J Pain Symptom Manage. 2014;48(2):231-248.

Affiliations, Disclosures, & Correspondence