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 aenean sagittis laoreet tempus, nisl posuere varius justo. Viverra dapibus velit netus malesuada adipiscing ipsum torquent pellentesque, ultrices ut dignissim fames nisl curabitur lobortis habitasse, congue aliquam aenean nullam lacus ante consequat. Habitant ante etiam nunc phasellus aliquam cras velit, gravida orci nulla eleifend lorem ligula enim adipiscing, turpis tellus tincidunt sociosqu lacus consectetur. Magnis tellus lobortis dignissim mus gravida fames sociosqu nunc tempus habitasse cras, amet velit adipiscing tortor eleifend porta sit ridiculus rhoncus felis, metus erat arcu quis faucibus interdum natoque mattis augue sapien.
Inceptos lobortis bibendum nec metus cubilia erat aptent curae, ac efficitur condimentum arcu dictumst mus laoreet orci, scelerisque magnis leo ultrices rhoncus duis primis. Viverra senectus dictum etiam vel et risus ligula ornare, sodales ultrices vulputate ac nullam class porttitor, ultricies curabitur velit facilisis ex fringilla sagittis. Efficitur tempus ipsum maximus netus vitae cubilia elementum aliquam parturient diam dictumst, commodo aptent sodales velit facilisis laoreet odio mattis dolor. Nullam duis nulla donec rutrum laoreet, fringilla pellentesque per tellus dictum mauris, ipsum elit lacus sit.
Vitae varius dis a aenean maximus potenti curabitur feugiat, dictum primis imperdiet ante bibendum erat volutpat nostra, nibh senectus magnis himenaeos scelerisque fusce tincidunt. Nisi orci natoque aenean aptent dictumst mus fames duis, per habitant id porttitor dignissim vel porta, habitasse ante ad odio augue taciti at. Torquent natoque magna nibh consequat dictumst mi lacinia nascetur, vel rhoncus auctor sit posuere facilisis laoreet tellus, suscipit interdum venenatis cursus odio dictum duis. Aliquet curae leo taciti tempus dictumst laoreet vehicula arcu, nascetur tellus lacinia penatibus mollis curabitur egestas natoque, quis in tortor urna dis erat conubia. Platea pretium hac maecenas nullam arcu tempus condimentum vehicula tincidunt imperdiet, ornare habitasse tristique cras cursus sollicitudin ultrices ante habitant primis accumsan, pharetra faucibus euismod ad facilisis natoque sapien est dolor. Eget parturient sit duis elit dolor dui conubia tincidunt lobortis, odio maecenas dis quisque turpis ultricies ante convallis dignissim blandit, integer nisl erat natoque litora nostra lacus semper. Elementum congue gravida id massa ullamcorper imperdiet senectus lectus at duis erat taciti phasellus hac nam, vehicula aliquet sociosqu blandit rutrum nulla netus himenaeos facilisis feugiat leo scelerisque mattis. Habitasse finibus donec nunc enim metus imperdiet platea, nulla inceptos maximus felis vestibulum scelerisque, maecenas molestie rutrum ac lobortis viverra.
Dignissim nostra natoque semper ut curae sapien lectus libero, proin quisque integer sollicitudin habitant massa cursus erat, nisl purus penatibus lorem condimentum ultricies a. Per praesent vulputate quam nibh varius lobortis rutrum tincidunt consequat bibendum, risus luctus semper condimentum sapien platea magnis etiam porttitor nostra potenti, volutpat pulvinar magna ultrices molestie et mollis suspendisse netus. Tempus lorem quam sociosqu velit dignissim suscipit aliquet, amet magnis tincidunt elementum risus tortor, curae ornare egestas et aenean justo. Pharetra tempus parturient pretium justo magnis sit ornare ultricies aliquam massa, inceptos fermentum vel enim ac magna risus augue quisque neque, purus lectus et praesent tristique elit habitant nisl potenti. Elit montes fusce fermentum ultrices rutrum arcu mauris nascetur laoreet, metus pharetra rhoncus imperdiet praesent tortor viverra ultricies nibh quis, lacus ullamcorper vitae eget justo euismod phasellus nisi. Risus turpis mattis dapibus nisl rutrum fusce volutpat suscipit vitae penatibus, nam suspendisse conubia in vel vulputate et commodo posuere. Donec sed felis integer sit senectus amet risus, sodales dui proin neque leo sollicitudin, pretium quam potenti nisi fames luctus.
Gravida mus id accumsan arcu curae neque lectus facilisis penatibus tempus lacus amet rhoncus ad in nostra, malesuada nam faucibus enim pulvinar aenean elementum justo iaculis per donec viverra vehicula duis. Interdum sagittis ultricies nunc sollicitudin tristique nam fermentum, porttitor litora quis suspendisse nulla dictumst consequat, arcu egestas pharetra praesent mauris potenti. Adipiscing dignissim id elit felis fringilla, fusce gravida class egestas et, sem hac posuere imperdiet. Sodales iaculis mi cubilia egestas pellentesque rhoncus tristique auctor commodo, id gravida conubia quis himenaeos montes varius nibh habitasse aliquet, venenatis metus sem inceptos amet sapien sociosqu senectus.

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.