Obesity, Disability, and Nursing Home Admission
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Holly C. Felix, PhD, MPA
The U.S. long-term care (LTC) system is faced with potentially greater demand for services as the population ages. Current projections indicate that by 2030, 20% of the U.S. population will be over age 65 years, compared to only 12% of the population in 2000.1 There are mixed opinions as to whether this growing population of older adults will increase demand for LTC services.2-3 However, the emergence of the U.S. obesity epidemic,4 which could reverse recent declining trends in disability rates among the elderly,5 may present new, unforeseen demands on and challenges for the LTC system. This article reviews the literature on the association between obesity and disability, and on obesity and nursing home admissions. In addition, it reviews the few articles that exist in the literature that discuss the known and potential impacts of obesity among the elderly on the delivery of care within nursing homes.
Prevalence of Obesity in the United States
Currently, more than two-thirds of all U.S. adults are overweight or obese (body mass index [BMI] ≥ 25).6 The prevalence of overweight (BMI = 25-29.9) and obesity (BMI ≥ 30) among older adults in the United States is also high and has seen modest increases in recent years. The Figure shows the percentage of older adults age 65-74 years and age 75 years and older who are overweight or obese using data from selected years of the National Health And Nutrition Examination Survey (NHANES). Between the time periods of 1988-1994 and 2001-2004, the percentage of adults age 65-74 years and the percentage of adults age 75 years and older who are obese has increased 9.6 percentage points and 5 percentage points, respectively. During the same time period, the percentage of adults age 65-74 years who are overweight remained at approximately 38%, while the percentage of adults age 75 years and older who are overweight increased 6 percentage points.7
One growing concern is that those in the “pre-elderly” age group, those age 50-64 years, will continue to be overweight and/or obese as they age, increasing the proportion of elderly individuals who are obese. In fact, current analysis indicates this will be the case: Arterburn and colleagues8 have projected that between 34% and 40% of Americans age 60 years and older will be obese by 2010. This concern is magnified when considering the aforementioned demographic changes in the U.S. elderly population, with the aging of the Baby Boom generation. The coupling of the increasing numbers of elderly individuals with the higher rates of obesity in this subpopulation will most likely present significant problems for the LTC system in the near future.
The Burden of Obesity
The rising rates of obesity raises a number of public concerns due to the individual and societal impacts associated with obesity, including increased prevalence of a number of chronic conditions,9 and increased service utilization and cost.10-11 As these impacts have been reviewed in other publications,9-11 they will not be covered here. Less discussed is the association of obesity with increased cognitive and functional decline, and with increased nursing home admission. As these impacts are of particular concern for the long-term care system, they are the focus of this review.
Obesity has been shown to be independently related to cognitive decline, due to its association with known risk factors for vascular disease (eg, hypertension, coronary heart disease).
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2. Walker DM. Long-term care: Aging baby boom generation will increase demand and burden on federal and state budgets. Testimony before the Special Committee on Aging, U.S. Senate. United States General Accounting Office Website. www.gao.gov/new.items/d02544t.pdf. Accessed May 14, 2008.
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