BY DANIEL GAITAN | daniel@lifemattersmedia.org

Overweight and obese Americans who are nearing death are significantly less likely to be enrolled in a hospice program or die at home, according to a troubling new study.

Researchers with the University of Michigan Institute for Healthcare Policy and Innovation analyzed health records of more than 5,600 seniors who died while taking part in a long-term study.

They found that the seniors who were overweight or obese missed out on services provided to terminally ill people as they near death and endure pain. Their findings were published in the February issue of the Annals of Internal Medicine.

The problem is not expected to get better anytime soon: 70 percent of adults 60 and older are overweight or obese.

“As physicians and nurses talk with patients and decide if hospice care is appropriate, it may be that people with more weight may look slightly healthier than a patient 20 pounds lighter with the same clinical issues,” lead researcher Dr. John Harris told Life Matters Media. A patient’s appearance may influence physicians to hold off on hospice care until that patient looks sicker.

Hospice care is designed to provide comfort, not cure. It is most often used when curative treatments are no longer effective. Hospice is usually provided only in the last months or days of life.

To be eligible for hospice care, a physician must certify that a patient’s life expectancy is six months or less.

The Study

Researchers studied Medicare claims in the last six months of participants’ lives and their use of hospice services. They were provided additional information from participants’ loved ones about their end of life care and weight.

Fifteen percent of patients were obese with body mass indexes above 30. Two percent were morbidly obese with BMIs above 40. Almost a third percent were classified as overweight, with BMIs between 25 and 29.

Only about 40 percent of all of those in the study used hospice services. However, seniors with higher BMIs had lower rates of hospice use.

For example, among those with a BMI of 40, less than 25 percent received hospice care. Among those in the “normal” weight range – with BMI of about 20 – 40 percent accessed hospice.

Among those who did enroll in hospice, obese patients received fewer days of care than those who weighed less. The severely obese spent four fewer days in hospice.

Harris said his team did not focus on their “quality of death.” However, he acknowledged that it is often much more challenging caring for the overweight.

“The actual physical aspects of providing good skin care, personal care and toileting is more challenging for someone who weighs 50 pounds more than another person,” he said.

About 60 percent of the seniors in the study died at home – an experience that research shows the vast majority of Americans prefer for their own deaths. Not surprisingly, that percentage also dropped as body fat rose.

About 55 percent of those with a BMI of 40 – the standard measure of morbid obesity – died at home, while more than 60 percent of those with a normal weight died at home.

Recommendations

Researchers call for more equipment and interventions to better serve this vulnerable population.

According to the paper: “Interventions could include increased reimbursement for home care services of obese patients who require multiple support personnel, reimbursement for patient lifts and other special durable medical equipment in health care facilities, or concurrent palliative care for select patients with severe obesity.”

All people —regardless of body size— should have equal opportunities to experience the benefits of high-quality end of life care, Harris added.