Original StudyFunctionality and Mortality in Obese Nursing Home Residents: An Example of ‘Risk Factor Paradox’?
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
References (56)
Personal care assistance needs of obese elders entering nursing homes
J Am Med Dir Assoc
(2008)- et al.
Is obesity bad for older persons? A systematic review of the pros and cons of weight reduction in later life
J Am Med Dir Assoc
(2008) - et al.
An overview of body weight of older persons, including the impact on mortality
J Clin Epidemiol
(1991) - et al.
Mini Mental State: A practical method for grading cognitive state of patients for the clinician
J Psychiatr Res
(1975) - et al.
Stature predictions equations for elderly non-Hispanic white, non-Hispanic black and Mexican American persons developed from NHANES-III data
J Am Diet Assoc
(1998) - et al.
ESPEN guidelines for nutrition screening 2002
Clin Nutr
(2003) A life course of adiposity and dementia
Eur J Pharmacol
(2008)Adiposity indices and dementia
Lancet Neurol
(2006)- et al.
Sarcopenia in nursing home residents
J Am Med Dir Assoc
(2008) - et al.
Reference values of handgrip dynamometry of healthy adults: A population-based study
Clin Nutr
(2008)
Handgrip dynamometry in healthy adults
Clin Nutr
High body fatness, but not low fat-free mass, predicts disability in older men and women: The Cardiovascular Health Study
Am L Clin Nutr
Obesity in nursing homes: An escalating problem
J Am Geriatr Soc
Obesity in nursing homes: A critical review
J Am Geriatr Soc
Percentage of body fat and body mass index are associated with mobility limitations in people aged 70 and older from NHANES III
J Am Geriatr Soc
Obesity is associated with functional decline in community-dwelling rural older persons
J Am Geriatr Soc
Obesity's effects on the onset of functional impairment among older adults
Gerontologist
The association between obesity and the frailty syndrome in older women: The Women ś Health and Aging Studies
J Am Geriatr Soc
Severe elder obesity and 1-year diminished lower extremity physical performance in homebound older adults
J Am Geriatr Soc
Midlife obesity and long-term risk of nursing home admission
Obesity
Obesity affects nursing-care facility admission among whites but not blacks
Obes Res
Body mass index and mortality among non-smoking older persons. The Framingham Heart Study
JAMA
High body mass index does not predict mortality in older people: Analysis of the Longitudinal Study of Aging
J Am Geriatr Soc
Assessment of nutritional status and obesity in elderly patients as seen in general medical practice
South Med J
Morbidity and mortality risk associated with an overweight BMI in older men and women
Obesity
Optimal body mass index in a nursing home population
J Nutr Health Aging
Body mass index, body cell mass, and 4-year all-cause mortality risk in older nursing home residents
J Am Geriatr Soc
Obesity and mortality in elderly nursing home residents
J Gerontol A Biol Sci Med Sci
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2016, European Geriatric MedicineA comparison of the malnutrition screening tools, MUST, MNA and bioelectrical impedance assessment in frail older hospital patients
2015, Clinical NutritionCitation Excerpt :There were correlations of body weight and BMI with MNA-SF score and the spread and relationship can be viewed clearly in Fig. 2, with a high proportion of patients being categorised as malnourished or ‘at risk’. This is an important finding as current research has indicated consistently that older people with higher BMI scores (including overweight and obese) have lower morbidity and mortality rates compared to those with lower BMI ranges, indicating a potential ‘body mass index/obesity paradox’ [25–29]. Beck and Ovesen [29], argued that the cut-off points for indicating nutritional risk in the elderly should be 24 kg/m2 and a healthy BMI range should be raised from 20 to 25 to 24–29 kg/m2.
Predictive factors associated with death of elderly in nursing homes
2014, Asian Nursing ResearchCitation Excerpt :This presents a similar trend to the causes of death per 100,000 persons in Organization for Economic Cooperation and Development countries, where the most common cause is cardiovascular disease, followed by neoplasm, respiratory system disease, and digestive system disease (Organization for Economic Cooperation and Development, 2012). Other factors, excluding disease, in predictive evaluation regarding cause of death include age, sex (Barba et al., 2009; Koch et al., 2009; Lee, Chau, Hui, Chan, & Woo, 2009), physical and cognitive functional disorder (Lee et al., 2009; Mattison, Rudolph, Kiely, & Marcantonio, 2006; van Dijk et al., 2005), weight loss and low body mass index (Kaiser et al., 2010; Kimyagarov et al., 2009), and high blood pressure (Barba et al.; Satish, Freeman, Ray, & Goodwin, 2001). In addition, there are various predictive factors by time point.
Obesity can benefit survival-A 9-year prospective study in 1614 Chinese nursing home residents
2014, Journal of the American Medical Directors Association
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.