Abstract
Background/Objectives
Studies show that in nursing homes (NHs), the prevalence of moderate-to-severe obesity
has doubled in the last decade and continues to increase. Obese residents are often
complex and costly, and this increase in prevalence has come at a time when NHs struggle
to decrease hospitalizations, particularly those that are potentially avoidable. This
study examined the association between obesity and hospitalizations.
Design
We linked 2011-2014 national data using Medicare NH assessments, hospital claims,
and the NH Compare.
Setting and Participants
Individuals aged ≥65 years, newly admitted to NHs, who became long-term residents
between July 1, 2011 and March 26, 2014. The analytical sample included 490,086 residents.
Methods
NH-originating hospitalization was the outcome; a categorical variable defined as
no hospitalization, potentially avoidable hospitalization (PAH), and other hospitalization
(non-PAH). The main independent variable was body mass index (BMI) defined as normal
weight (30 >BMI ≥18.5 kg/m2), mildly obese (35 >BMI ≥30 kg/m2), or moderately-to-severely obese (BMI ≥35 kg/m2). Covariates included individual and NH characteristics. Multinomial models with
NH random effects and state dummies were estimated.
Results
After adjusting for individual level covariates, the risk of non-PAH for the mildly
and moderate/severely obese was not different from normal weight residents. But the
risk of PAH remained significantly higher for the moderate/severely obese (relative
risk ratio = 1.055; 95% confidence interval 1.018, 1.094). Several NH-level factors
also influenced hospitalization risk.
Conclusions and Implications
Obese residents are more likely to experience PAH but not non-PAH. Efforts to improve
care for these residents may need to broadly consider the ability of NHs to commit
additional resources to fully integrate care for this growing segment of the population.
Keywords
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Article info
Publication history
Published online: July 04, 2020
Footnotes
Funded by the National Institutes of Health/National Institute on Aging, grant R01AG052451.
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
