Obesity leaves patients vulnerable to suboptimal end-of-life care

1. In this retrospective cohort, obesity was associated with reduced hospice use and in-home death during the last 6 months of life.

2. Higher Medicare expenditures were associated with increasing obesity among study participants.

Evidence Rating Level: Good (2)

Study Rundown: Obesity is a significant health concern in the United States; 70 per cent of U.S. adults aged 60 years or older are overweight or obese. Consequently, a large proportion of the elderly population faces significant morbidity associated with obesity, such as increased risk for hospitalization, higher use of intensive care services, and shorter life expectancy. While extensive studies have investigated the impact of obesity and its challenges to hospital care, there is little data regarding the association between obesity and hospice use. The authors of this study aimed to describe the associations between body mass index (BMI) and hospice use, as well as Medicare expenditures in the last 6 months of life. This study has several limitations. Primarily, baseline data was self-reported and the time between the collection of this data to death varied within the cohort. Overall, the results of this study suggest that increased BMI is associated with reduced hospice use and higher Medicare expenditures. This finding emphasizes that obese patients are vulnerable to suboptimal end-of-care life, suggesting a key area for improvement with respect to disparities in hospice use and Medicare expenditures.

Click to read the study in the Annals of Internal Medicine

Relevant Reading: Barriers to Transition of Obese Patients from Hospital to Community

In-Depth [retrospective cohort]: In this retrospective cohort, the Health and Retirement Study (HRS) was used to examine the relationship between BMI and hospice enrollment, days enrolled in the hospice, descents’ place of death, and Medicare expenditures. After applying inclusion/exclusion criteria, 5677 decedents were selected for the final cohort. Generally, participants with a higher BMI were associated with a significantly lower likelihood of enrolling in hospices. For instance, participants with a BMI of 40 kg/m² had a predicted probability of hospice enrollment of 23.1% (95%CI, 19.5% to 26.7%). In contrast, participants with a BMI of 20 kg/m² had a predicted probability of 38.3% (CI, 36.5% to 40.2%). Furthermore, total predicted Medicare expenditures increased as BMI increased, during the last 6 months of life. Specifically, patients with a BMI of 40 kg/m² had mean total predicted expenditures that were $3471 (CI, $955 to $5988) higher than participants with a BMI of 20 kg/m².

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