Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Surg Obes Relat Dis. 2012 Sep-Oct;8(5):616-22; discussion 622-4. doi: 10.1016/j.soard.2011.11.005. Epub 2011 Nov 25.
Although severe obesity is dramatically increasing in older adults, many bariatric programs use age cutoffs due to concerns about greater perioperative morbidity and mortality risks. More recently, surgical outcomes have been reported in older adults. However, a paucity of data is available on the psychological risks of older bariatric candidates. Our objective is to examine psychiatric risk factors and weight loss outcomes in older (≥65 yr) versus midlife (40-55 yr) versus young adult (18-29 yr) patients.
Older, midlife, and young adults (n = 608) who underwent weight loss surgery (74.6% women, 75.6% white, mean body mass index 48.07 ± 9.61 kg/m2) at the Cleveland Clinic Bariatric and Metabolic Institute completed a psychiatric diagnostic interview, and the Minnesota multiphasic personality inventory-2-restructured form, binge eating scale, and Cleveland Clinic behavioral rating scale before surgery. The data gathered from follow-up visits and weight loss outcomes at 1, 3, 6, 9, 12, and 18 months after surgery were measured.
Young adults had a greater reduction in excess body mass index than those at midlife in the first 6 months but no age differences were noted in the following year. Older patients were less likely to have a suicide history but the groups were equivalent on other psychiatric variables and self-report measures. Psychologist evaluators rated older adults less favorably on the capacity to consent and realistic nature of expectations.
Although medical risks may cause concern, older adults do not demonstrate any increased psychological risk factors compared with midlife or young adult surgical candidates and evidenced equivalent weight loss. However, concerns with lower ratings on consent and expectations warrant additional research.
尽管老年人的严重肥胖症发病率显著上升，但由于对围手术期发病率和死亡率风险增加的担忧，许多减重计划都采用了年龄界限。最近，老年人的手术结果也已报告。然而，关于老年减重候选者的心理风险，数据仍然有限。我们的目的是研究年龄较大（≥65 岁）、中年（40-55 岁）和年轻成人（18-29 岁）患者的精神科危险因素和减重结果。
在克利夫兰诊所减重和代谢研究所接受减重手术的老年（≥65 岁）、中年（40-55 岁）和年轻成人（18-29 岁）患者（74.6%为女性，75.6%为白人，平均 BMI 为 48.07 ± 9.61 kg/m2）完成了精神病学诊断访谈以及明尼苏达多项人格问卷-2 重构形式、暴食量表和克利夫兰诊所行为评定量表，然后在手术前进行评估。在手术后的 1、3、6、9、12 和 18 个月随访期间收集了数据并测量了减重结果。
年轻成年人在头 6 个月内比中年人有更大的多余体重指数减轻，但在接下来的一年中没有年龄差异。老年患者自杀史较少，但在其他精神科变量和自我报告的测量方面，各组是相似的。心理评估师对老年人的同意能力和期望的现实性评价较低。
尽管医疗风险可能引起关注，但与中年或年轻成人手术候选者相比，老年患者并没有表现出任何增加的心理危险因素，并且表现出了相似的减重效果。然而，对同意和期望的低评分表示应进行进一步研究。
