The heavier someone is, the less likely they are to receive quality end-of-life care, including in hospice and the opportunity to die at home.
For a new study, researchers analyzed records from more than 5,600 senior citizens who took part in the long-running national Health and Retirement Study (HRS), examining how their body mass index (BMI) related to end-of-life measures, such as their use of hospice services.
The findings suggest that people with higher BMIs are less likely to enter hospice care, and among those who did, seniors with obesity spent fewer days in hospice than those with lower BMIs.
Further, about 60 percent of the seniors in the study died at home—an experience that most Americans say they would choose for their own deaths. But that percentage dropped as BMI rose.
The results point to a larger issue that will become more urgent as the increasingly overweight American population ages, says John Harris, assistant professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh.
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“Obesity is a complex disease, and this study has shown another side of its effect on patients and the health care system. Patients with obesity may need extra help, but they deserve the best health care and better health outcomes.”
For the study, published in the Annals of Internal Medicine, researchers focused on Medicare claims in the last six months of the participants’ lives, looking at use of hospice services and controlling for gender, race, marital status, multiple medical conditions, and household assets. They also included information from surveys of the participants’ loved ones about their end-of-life care in addition to all participants’ last measured BMI.
Fifteen percent of participants were obese, with BMIs over 30, and 2 percent were morbidly obese, with BMIs over 40. Another 31 percent were overweight, with BMIs between 25 and 29.9.
The differences in end-of-life care also translated into differences in cost. In the last six months of life for a person with a normal BMI, the Medicare system spent about $43,000 for all types of care. For an obese person, the costs for that same period were about $3,500 higher.
Although the study didn’t look at the reasons why people with obesity received less hospice care, senior author Jennifer Griggs, professor at the University of Michigan Medical School, suspects that several factors may be involved.
One possibility is that obesity can mask the changes physicians typically use to determine when it is time for a person to enter hospice, which include more pronounced cheekbones, collarbones and pelvic bones due to end-of-life weight loss. These changes in body weight are more noticeable in leaner patients. “To refer a patient for hospice, you have to believe that they are in the dying process,” Griggs says.
“Many policies focus on preventing or reducing obesity in the US, but we will also need policies to encourage the provision of high-quality care for people with obesity,” Harris says. “More attention should be paid to payment structures that recognize the challenges involved with health care for men and women with obesity.”
The Robert Wood Johnson Foundation, US Department of Veterans Affairs, and National Institutes of Health funded the work.
Source: University of Pittsburgh
