Original Study
Functionality and Mortality in Obese Nursing Home Residents: An Example of ‘Risk Factor Paradox’?

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Background

Although the percentage of obese nursing home residents is increasing, few longitudinal studies have reported on functionality and mortality in this subpopulation. The aim of the present study was to explore functionality and mortality in obese nursing home residents during a 1-year follow-up and to compare these results with those of residents within the normal and low BMI range.

Methods

Two hundred residents (147 female, 53 male, mean age 85.6 ± 7.8 years) from 2 Nuremberg nursing homes were included. Body weight and height were measured in all participants. BMI was calculated and categorized as low (<20 kg/m2), normal (20–30 kg/m2), and high (>30 kg/m2). Handgrip strength, timed “up and go” test, and Barthel's Activities of Daily Living were applied as functional parameters. All measurements were done at baseline and after a 1-year follow-up.

Results

At baseline, the prevalence of obesity was 23.5%, whereas low BMI values were present in 8.5% of the residents. After 1 year, there was no significant decline of functionality in the obese group, whereas functional parameters deteriorated significantly in study participants with normal BMI. One-year mortality was lowest in the obese (12.8%), with no deaths in residents with BMI of 35 kg/m2 or higher. Mortality was highest in residents with low BMI (58.8%).

Conclusion

In nursing home residents, obesity is associated with increased survival and stable functionality. These observations may therefore be regarded as an expression of “risk factor paradox” in this specific population of older individuals.

Section snippets

Methods

All residents of 2 communal nursing homes in Nuremberg, Germany, were approached to participate in the present study from June 2007 until December 2008. Residents younger than 65 years and in palliative care with a very limited life expectancy were excluded. Informed consent was obtained from all participating residents or their legal proxies. The study protocol was approved by the ethics committees of the Friedrich-Alexander-University of Erlangen-Nuremberg, Germany, and the Rheinische

Study Population

From 322 potentially eligible residents, 10 residents younger than 65 years (8.2%) and 10 residents (8.2%) in palliative care were excluded. There were 102 residents not included for the following reasons: 28 (23.0% of nonparticipating residents) residents did not wish to participate in the study; the legal proxies of 42 (34.4%) residents did not agree to their participation in the study; proxies were inaccessible in another 14 (11.5%) cases; 4 (3.3%) residents did not participate because of

Discussion

Although during the past 2 decades a high prevalence of malnutrition was frequently found in nursing home residents,29, 30 the present study showed only a low prevalence of this condition. In contrast, we observed a high prevalence of obesity. In 2 European studies and 1 Australian study in nursing home residents the prevalence of obesity was similar to ours, with 22.9%, 21.0%, and 20.0%, respectively31, 32, 33; 21% of obese female and 20% of obese male residents were found in German nursing

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    This study was supported by a grant of the Else Kroener-Fresenius-Foundation (Bad Homburg, Germany). Juergen M Bauer was supported by the Robert-Bosch-Foundation fellowship program (Stuttgart, Germany).

    The authors have no conflicts of interest.

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