Center for Gerontology and Healthcare Research, Brown University, Providence, RI.
Center for Gerontology and Healthcare Research, Brown University, Providence, RI; Department of Veteran Affairs Medical Center, Providence, RI.
J Am Med Dir Assoc. 2018 Nov;19(11):1015-1019. doi: 10.1016/j.jamda.2018.04.013. Epub 2018 Jun 20.
To examine whether higher obesity level was associated with extensive staffing assistance (from 2 or more persons) for completing activities of daily living (ADL) among older nursing home residents.
Retrospective cross-sectional study.
US government-certified nursing homes.
Medicare beneficiaries residing in a nursing home on April 1, 2015. Exclusion criteria were age less than 65 years and body mass index (BMI) below 18.5 (underweight).
Residents were divided by obesity level according to established BMI cutoffs, as follows: nonobese (BMI = 18.5-29.9) or mild (BMI = 30.0-34.9), moderate (BMI = 35.0-39.9), or severe (BMI ≥40) obesity. Level of staffing assistance for completing each of 10 ADL (bed mobility, transfer, walking in room, walking in corridor, on- and off-unit locomotion, dressing, eating, toileting, and personal hygiene) was dichotomized as below 2 and 2 or more. Robust Poisson regression was used to test whether obesity conferred excess risk for needing 2 or more staff to complete each ADL. Adjusted models included individual-level covariates and nursing home fixed effects.
A total of 1,063,383 nursing home residents were identified, including 309,263 (29.0%) with obesity. Adjusted relative risks (95% confidence intervals) for 2-person assistance with bed mobility associated with mild, moderate, and severe obesity were 1.17 (1.15, 1.18), 1.28 (1.25, 1.31), and 1.40 (1.36, 1.43), respectively. Adjusted relative risks for 2-person assistance with transferring associated with mild, moderate, and severe obesity were 1.15 (1.13, 1.17), 1.24 (1.22, 1.27), and 1.36 (1.33, 1.39), respectively. Obesity was associated with 2-person assistance for all other ADL except for eating.
Higher obesity level was significantly associated with assistance from 2 or more staff for completing 9 of 10 ADL. Given increasing obesity rates in nursing homes, payment mechanisms that do not adjust for obesity or comprehensively account for excess ADL assistance may need revision to prevent adverse impacts on the long-term care system.
研究肥胖程度较高是否与老年人在疗养院完成日常生活活动（ADL）时需要更多的人员协助（2 人或以上）有关。
回顾性横断面研究。
美国政府认证的疗养院。
2015 年 4 月 1 日居住在疗养院的医疗保险受益人。排除标准为年龄小于 65 岁和身体质量指数（BMI）低于 18.5（体重过轻）。
根据既定的 BMI 切点，将居民分为肥胖水平，如下所示：非肥胖（BMI=18.5-29.9）或轻度肥胖（BMI=30.0-34.9），中度肥胖（BMI=35.0-39.9）或重度肥胖（BMI≥40）。对于完成 10 项 ADL（床上移动、转移、在房间内行走、在走廊内行走、单元内和单元外移动、穿衣、进食、如厕和个人卫生）中的每一项活动所需的人员协助程度，分为 2 人以下和 2 人或以上。使用稳健泊松回归来检验肥胖是否会导致需要 2 名或以上人员来完成每项 ADL 的风险增加。调整后的模型包括个体水平的协变量和疗养院固定效应。
共确定了 1063383 名疗养院居民，其中 309263 名（29.0%）患有肥胖症。与轻度、中度和重度肥胖相关的 2 人协助进行床上移动的调整后相对风险（95%置信区间）分别为 1.17（1.15，1.18）、1.28（1.25，1.31）和 1.40（1.36，1.43）。与轻度、中度和重度肥胖相关的 2 人协助进行转移的调整后相对风险分别为 1.15（1.13，1.17）、1.24（1.22，1.27）和 1.36（1.33，1.39）。肥胖与除进食外的其他 9 项 ADL 均需要 2 人或以上的协助有关。
肥胖程度较高与 2 人或以上人员协助完成 10 项 ADL 中的 9 项显著相关。鉴于疗养院肥胖率的不断上升，如果支付机制不考虑肥胖因素或不能全面考虑额外的 ADL 协助，可能需要进行修订，以防止对长期护理系统产生不利影响。
