Objectives
To examine the prevalence of obesity and its relationship with
pressure ulcers among nursing home (NH) populations, and whether such
relationship varies with certified nursing assistant (CNA) level in NHs.
Data and study population
The 1999–2009 nationwide Minimum Data Sets were linked with
Online Survey of Certification and Reporting records. We identified newly
admitted NH residents who became long-stayers and followed them up to 1
year.
Analyses
The outcome variable was presence of pressure ulcers during the
1-year follow-up period. Residents were categorized as normal
(18.5<=BMI<30 kg/m2), mild obesity (30
<=BMI <35 kg/m2) and moderate or severe obesity
(BMI>=35 kg/m2). Pooled and stratified analyses were
performed to examine the relationship between obesity and pressure ulcers,
and how it varied by facility CNA level.
Results
The prevalence of obesity increased from 16.9% to
25.8% among newly admitted NH residents over the last decade.
Obesity was associated with higher risks of pressure ulcers among long-stay
residents. The relationship between obesity and pressure ulcers persisted
after accounting for individual health conditions at the baseline and
facility-level variations. Further, the within-facility relationship between
obesity and pressure ulcers varied by facility CNA levels. The odds of
pressure ulcers were 18.9% higher for residents with moderate or
severe obesity than for non-obese residents within NHs with low CNA levels.
The percents for medium and high CNA level facilities were 14.0% and
12.8%, respectively.
Conclusion
To prepare for the growing obesity epidemic in NHs, policies should
focus on strategies to improve care provided for obese residents.