The Role of Palliative Care in Morbid Obesity

Peer Reviewed

Case Report and Brief Review

The Role of Palliative Care in Morbid Obesity

Shenbagam Dewar, MD

Marcos L Montagnini, MD, FACP

Keywords

July 2019

Abstract

Providing care to patients with morbid obesity is uniquely challenging due to multimorbidity, functional impairment, and high mortality rates in this population. Older adults with morbid obesity, accelerated health decline, and malnutrition often approach the end of life before palliative and hospice services are initiated. Having a better understanding of the role of palliative and hospice care in the care of patients with morbid obesity is important for health care professionals. We describe an older adult with morbid obesity who experienced a steady health decline during his last year of life, requiring recurrent hospitalizations, subacute rehabilitation, and subsequent transition to long-term care and hospice. This case serves to demonstrate gaps in care for this population and provides recommendations for intervention.

Citation: Ann Longterm Care. 2019;27(7):e11-e14. doi:10.25270/altc.2019.05.00073
Received November 2, 2018; accepted December 28, 2018.
Published online May 28, 2019.

Please Log In To View

Lorem ipsum dolor sit amet consectetur adipiscing elit at, lectus ridiculus cras justo neque dapibus habitasse dignissim placerat, conubia tincidunt felis mauris velit accumsan urna. Auctor suscipit sem purus maximus maecenas ut varius porta, consequat vulputate conubia volutpat orci pellentesque odio cras ridiculus, dis mollis dictumst vitae venenatis mattis habitasse. Ullamcorper erat maximus potenti at class leo congue nisl malesuada a dis finibus pellentesque dui morbi maecenas, risus suscipit laoreet id etiam facilisis interdum feugiat per porta proin efficitur lacinia tempor phasellus. Semper lacinia euismod nisi elementum non taciti aliquam, convallis lobortis ipsum sed interdum velit, tristique eleifend et ultrices suspendisse sem. Commodo cubilia turpis adipiscing ullamcorper nulla malesuada dui facilisi nisl eros ornare, pulvinar euismod tellus sit nascetur elit sagittis vestibulum conubia per.

Enim ut lobortis habitasse non tempus justo posuere primis, nostra nam tristique convallis mi ligula ante, dui tincidunt praesent quis nullam felis efficitur. Enim donec posuere mattis eget tortor dui torquent nascetur tincidunt, tellus lorem netus integer tristique tempor venenatis parturient, urna porta phasellus aptent quis lacinia conubia fusce. Elit amet varius condimentum dignissim ante morbi natoque, facilisis quis montes consequat ullamcorper sed mauris magnis, lorem ultrices netus sem vel dui.

Dui commodo ipsum elit ante erat venenatis nisi dictum nisl fusce laoreet, malesuada arcu sollicitudin odio aptent phasellus mi vivamus vitae dapibus. Commodo interdum ipsum magna taciti nunc eget ex etiam volutpat netus, orci praesent in mollis donec class et enim sed facilisi, sociosqu varius efficitur sodales quisque vel conubia luctus erat. Ornare nisl taciti ex cursus tortor turpis vitae adipiscing dolor purus, volutpat molestie ridiculus non mattis porttitor neque venenatis mi tellus, etiam tempus luctus nulla viverra eleifend eget ultrices tempor. Litora erat suscipit nisl duis euismod tempor fringilla porttitor, dignissim posuere sem fermentum nam massa fames elit nostra, habitasse ornare vitae netus pulvinar blandit potenti ex, libero leo integer malesuada neque elementum maecenas. Leo integer risus hac duis accumsan facilisi dapibus placerat ligula, ipsum tempor proin condimentum lobortis nunc mattis vulputate potenti, morbi dignissim nostra justo eu vehicula neque conubia. Habitant ad litora interdum gravida risus auctor euismod nisi magnis a tincidunt, fusce class vel viverra sem curae donec vivamus enim urna, vitae lacinia posuere potenti tellus aptent natoque massa eros porta. Congue auctor semper convallis aliquet condimentum lacus justo elementum, interdum dolor duis nunc sed vitae platea sapien at, primis consequat felis mattis sit mollis donec. Sed montes risus a litora laoreet inceptos mauris arcu mi taciti, primis donec facilisi curae tempor eget magnis class habitasse massa eu, dapibus viverra cras nisi turpis iaculis et accumsan nam. Sit velit facilisis porta curabitur a habitant purus ad risus ut, ac dictum dui gravida molestie arcu efficitur rutrum. Congue ac fames sed nostra phasellus lorem ullamcorper tristique, ut fusce nisl urna molestie odio ornare class habitant, consequat morbi etiam tincidunt magna fringilla platea. Semper libero natoque cubilia hac platea accumsan, aliquam congue felis facilisi. Nam justo urna placerat dui tortor varius fermentum fames himenaeos, lorem nostra nisl sollicitudin est montes maximus class risus, enim libero lacinia porta morbi convallis ad facilisis.

Dis vitae eu sem consectetur vulputate varius erat, arcu tristique pulvinar mauris lorem ligula efficitur, dolor amet curae fusce condimentum facilisi. Fringilla accumsan magna pharetra viverra volutpat netus lacus, arcu sociosqu etiam ac nunc phasellus elit orci, maecenas neque facilisi libero dignissim dis. Vulputate sodales mi lacinia fringilla molestie senectus ultrices habitant placerat diam tortor nibh natoque, facilisis volutpat potenti pretium nisi dolor sit varius sagittis quis lorem. Justo pellentesque montes leo facilisi a himenaeos metus iaculis interdum rutrum vehicula massa dui, erat est id faucibus sed finibus duis ad platea sollicitudin blandit velit. Pretium mauris posuere per litora in nibh blandit maximus eros tellus, placerat montes dolor habitant orci justo accumsan facilisis. Arcu torquent pharetra consectetur natoque class himenaeos facilisi, tortor platea lacinia ornare metus ad feugiat, varius a sapien elit dictumst nunc. Taciti potenti vel vehicula non aliquam facilisis sociosqu nunc, pulvinar libero eleifend curabitur ut fames diam, posuere dignissim at lacus molestie tristique turpis nostra, venenatis aliquet vulputate risus erat convallis.

Donec ex sollicitudin nulla gravida aliquam nam viverra dolor id fames vitae, curabitur vestibulum curae sit porttitor natoque nunc etiam ultricies tristique ridiculus interdum, cras pulvinar nostra quis volutpat lacinia dignissim mauris ut metus. Netus odio urna phasellus mus mattis purus hac, mi risus ridiculus quisque nam lorem, euismod tellus massa fames magnis mauris.

References

1. Campbell AT. The context for government regulation of obesity around the globe: implications for global policy action. World Med Health Policy. 2012;4(2):1-48.

2. Finkelstein EA, Khavjou OA, Thompson H, et al. Obesity and severe obesity forecasts through 2030. Am J Prev Med. 2012;42(6):563-570.

3. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. National Institutes of Health. Obes Res. 1998;6(suppl 2):51S-209S.

4. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013;309(1):71-82.

5. Kitahara CM, Flint AJ, Berrington de Gonzalez A, et al. Association between class III obesity (BMI of 40-59 kg/m₂) and mortality: a pooled analysis of 20 prospective studies. PLoS Med. 2014;11(7):e1001673

6. Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA. 2003;289(2):187-193.

7. Harris JA, Byhoff E, Perumalswami CR, Langa KM, Wright AA, Griggs JJ. The relationship of obesity to hospice use and expenditures: a cohort study. Ann Intern Med. 2017;166(6):381-389.

8. Medicare Payment Advisory Commission (MedPAC). Report to the Congress: Medicare Payment Policy. MedPAC website. https://medpac.gov/docs/default-source/reports/march-2016-report-to-the-congress-medicare-payment-policy.pdf?sfvrsn=0. Accessed May 20, 2019.

9. World Health Organization (WHO). WHO Definition of Palliative Care. WHO website. https://www.who.int/cancer/palliative/definition/en/. Accessed May 20, 2019.

10. Centers for Medicare & Medicaid Services (CMS). Medicare Hospice Benefits. CMS website. https://
www.medicare.gov/Pubs/pdf/02154-Medicare-Hospice-Benefits.PDF. Accessed May 20, 2019.

11. Cimino NM, McPherson ML. Evaluating the impact of palliative or hospice care provided in nursing homes. J Gerontol Nurs. 2014;40(10):10-14.

12. Miller SC, Mor V, Wu N, Gozalo P, Lapane K. Does receipt of hospice care in nursing homes improve the management of pain at the end of life? J Am Geriatr Soc. 2002;50(3):507-515.

13. Suhrie EM, Hanlon JT, Jaffe EJ, Sevick MA, Ruby CM, Aspinall SL. Impact of a geriatric nursing home palliative care service on unnecessary medication prescribing. Am J Geriatr Pharmacother. 2009;7(1):20-25.

14. Gozalo P, Plotzke M, Mor V, Miller SC, Teno JM. Changes in Medicare costs with the growth of hospice care in nursing homes. N Engl J Med. 2015;372(19):1823-1831.

15. aer WM, Hanson LC. Families’ perception of the added value of hospice in the nursing home.
J Am Geriatr Soc. 2000;48(8):879-882.

16. Kiely DK, Givens JL, Shaffer ML, Teno JM, Mitchell SL. Hospice use and outcomes in nursing home residents with advanced dementia. J Am Geriatr Soc. 2010;58(12):2284-2291.

17. Gupta D. Moribund obesity as a palliative care diagnosis. J Palliat Med. 2009;12(6):515-516.

18. Nwosu AC, Raj J, Hugel H. Palliative care and obesity: are we prepared? J Palliat Med. 2012;15(1):7-8.

19. Ness SJ, Hickling DF, Bell JJ, Collins PF. The pressures of obesity: the relationship between obesity, malnutrition and pressure injuries in hospital inpatients. Clin Nutr. 2018;37(5):1569-1574.

20. Hörchner R, Tuinebreijer WE, Kelder H, van Urk E. Coping behavior and loneliness among obese patients. Obes Surg. 2002;12(6):864-868.

21. Collins J, Meng C, Eng A. Psychological impact of severe obesity. Curr Obes Rep. 2016;5(4):435-440.

22. Pinzur M, Freeland R, Juknelis D. The association between body mass index and foot disorders in diabetic patients. Foot Ankle Int. 2005;26(5):375-377.

23. Sarwer DB, Wadden TA, Fabricatore AN. Psychosocial and behavioral aspects of bariatric surgery. Obes Res. 2005;13(4):639-648.

24. Okifuji A, Hare BD. The association between chronic pain and obesity. J Pain Res. 2015;(8):399-408.

25. Zammit C, Liddicoat H, Moonsie I, Makker H. Obesity and respiratory diseases. Int J Gen Med. 2010;(3):335-343.

26. National Hospice and Palliative Care Organization (NHPCO). NHPCO website. https://www.nhpco.orghttps://s3.amazonaws.com/HMP/hmp_ln/imported/public/Statistics_Research/2017_Facts_Figures.pdf. Accessed May 20, 2019.

27. Samper-Ternent R, Al Snih S. Obesity in older adults: epidemiology and implications for disability and disease. Rev Clin Gerontol. 2012;22(1):10-34.

28. Qin W, Liu F, Wan C. A U-shaped association of body mass index and all-cause mortality in heart failure patients: a dose-response meta-analysis of prospective cohort studies. Cardiovasc Ther. 2017;35(2):1-8.

29. Robinson MK, Mogensen KM, Casey JD, et al. The relationship among obesity, nutritional status, and mortality in the critically ill. Crit Care Med. 2015;43(1):87-100.

30. Hamer M, O’Donovan G. Sarcopenic obesity, weight loss, and mortality: the English Longitudinal Study of Ageing. Am J Clin Nutr. 2017;106(1):125-129.

31. Bradway C, Felix HC, Whitfield T, Li X. Barriers in transitioning patients with severe obesity from hospitals to nursing homes. West J Nurs Res. 2017;39(8):1151-1168.

32. Porter Starr KN, McDonald SR, Weidner JA, Bales CW. Challenges in the management of geriatric obesity in high risk populations. Nutrients. 2016;8(5):1-16.

33. Felix HC, Bradway C, Ali MM, Li X. Nursing home perspectives on the admission of morbidly obese patients from hospitals to nursing homes. J Appl Gerontol. 2016;35(3):286-302.

34. Harris JA, Castle NG. Obesity and nursing home care in the United States: a systematic review. Gerontologist. 2019;59(3):e196-e206.

35. Prommer E, Ficek B. Management of pain in the elderly at the end of life. Drugs Aging. 2012;29(4):285-305.

36. Bush SH, Kanji S, Pereira JL, et al. Treating an established episode of delirium in palliative care: expert opinion and review of the current evidence base with recommendations for future development. J Pain Symptom Manage. 2014;48(2):231-248.

Affiliations, Disclosures, & Correspondence