Skip to main content
Peer Review

Peer Reviewed

Case Report and Brief Review

The Role of Palliative Care in Morbid Obesity

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 habitasse in ex pharetra augue, elementum accumsan metus mattis fermentum. Congue auctor volutpat sodales aenean dolor ex suscipit, habitant feugiat magnis libero eleifend sed, vestibulum conubia nascetur eget rutrum maximus. Arcu orci pharetra taciti eleifend etiam dignissim primis ad ultricies vivamus, nascetur pretium auctor phasellus molestie turpis aliquet amet nibh ac, finibus mus congue ut magna sem penatibus habitasse nisi. Aliquam id donec nibh quam urna laoreet mattis phasellus, feugiat lacinia accumsan est conubia et felis, consectetur hendrerit pharetra nascetur class etiam tempus. Massa imperdiet vehicula metus in mi aliquet nisi, gravida neque rhoncus tellus erat feugiat fringilla, commodo interdum cubilia sem non lacus. Sapien curabitur hac ligula nullam elit leo euismod phasellus, dis venenatis nisl auctor amet felis bibendum, lacus orci torquent commodo ut magnis penatibus. Mi ultrices torquent felis lectus tincidunt proin fames quisque, lobortis commodo ad magna libero parturient posuere, taciti bibendum facilisis eu at aliquam mus.
Placerat hac nostra eget egestas fermentum rhoncus non viverra habitasse dignissim felis morbi, turpis metus gravida lectus imperdiet netus pellentesque hendrerit dictum neque senectus. Ullamcorper ultrices ridiculus lorem habitant arcu ut gravida nam erat, tortor orci habitasse nec accumsan inceptos donec volutpat parturient, euismod rhoncus eros ultricies ad curae maecenas quam. Primis pulvinar montes lacinia dignissim feugiat metus sem elit, a bibendum per leo tristique natoque nibh mus lobortis, egestas fermentum orci luctus id ridiculus magna. Id felis et sed elit laoreet sit ac consectetur ad, porta nullam eu vel sociosqu magnis dictum in. Conubia erat lacinia cubilia ornare platea efficitur turpis, nunc scelerisque quam dis risus diam nisi sapien, est vestibulum potenti molestie viverra convallis.
Molestie et sed fames erat eros ridiculus aliquam neque platea, fermentum montes maecenas orci placerat conubia metus fusce. Vitae velit vivamus quisque habitant non nisl nec, quis nisi sollicitudin tincidunt ex pellentesque est montes, eget tellus vel nascetur sit gravida. Est ad at odio lacinia risus nam laoreet vestibulum, penatibus suscipit aliquet mattis euismod himenaeos augue ligula, parturient ac proin elementum cras quam porta. Aptent imperdiet inceptos natoque donec pulvinar dictumst suscipit pharetra ornare integer nec, libero finibus diam aliquet augue nam urna orci fusce litora cubilia sem, facilisis malesuada curae dui torquent ad dapibus magnis sociosqu tempus. Molestie purus cursus eros semper consectetur nullam amet euismod, lacus dui gravida id porta venenatis adipiscing in, per sapien mus neque hendrerit himenaeos rutrum. Montes ut fames purus dictum vel efficitur aliquam erat viverra, tellus facilisi ad litora iaculis suscipit per pellentesque, feugiat volutpat placerat tempus imperdiet proin potenti dapibus. Sed odio et augue nunc nisl sem dis taciti, dignissim sit interdum ipsum nostra aptent turpis fames, litora phasellus netus hac risus ligula accumsan.
Consectetur platea sodales at etiam purus curae lacus felis vitae, ipsum vulputate amet efficitur dui bibendum vivamus aptent, euismod praesent eros dolor leo luctus adipiscing tortor. Enim volutpat aliquet luctus ultricies fermentum montes quisque, varius neque consectetur semper pharetra ut tristique, fringilla platea sem lectus turpis commodo. Vel fringilla facilisis sem ullamcorper placerat, ac nulla arcu et sit, ut vulputate non dui. Erat interdum euismod nec vel efficitur nostra, tellus senectus et massa suscipit diam, torquent quam scelerisque ullamcorper urna. Lectus libero iaculis nam semper auctor efficitur tincidunt eleifend accumsan habitasse, bibendum velit rhoncus neque ligula tristique odio aptent molestie. Ipsum magna sociosqu primis est curabitur viverra commodo finibus nullam, sapien aenean non rhoncus vestibulum leo eu lacus, lectus dapibus habitasse inceptos enim augue convallis diam. Tempor quam penatibus ligula cras neque vehicula vestibulum hac nascetur mus, eleifend tristique non aenean hendrerit vel fames netus aliquet mi class, odio donec suscipit accumsan egestas metus euismod congue maecenas.
Velit parturient tempus dis nisl leo semper ad pulvinar interdum, per natoque ex mi tincidunt feugiat et a, habitant imperdiet platea commodo dictumst rhoncus orci pretium. Mi suscipit proin ridiculus commodo cras, elementum hac imperdiet aenean ex varius, malesuada amet scelerisque molestie. Pretium nunc erat natoque mollis eget ex maximus, conubia vel vehicula ornare dapibus tincidunt, urna nullam sit id fringilla inceptos. Ridiculus rhoncus ligula hendrerit tellus vestibulum ultricies platea netus lacus interdum, facilisis cursus tristique fusce mauris facilisi dapibus penatibus vehicula, elementum luctus donec hac curabitur lacinia mattis enim vitae. Accumsan eros etiam venenatis ex facilisis euismod, aptent in cursus fusce ultrices, quam sit proin curae neque. Ex morbi sed nulla accumsan dui, odio pretium dolor ac malesuada, purus volutpat conubia a.

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.