Obesity a Hindrance to End-of-Life Care Access

Obese patients are more likely to die at home, with their weight often directly impacting their access to end-of-life care. While there’s no clear explanation for that, researchers surmised that health care professionals still harbor bias against the obese. “People who are more obese do sometimes feel stigma from providers and may get less care,” said John Harris, MD, lead author of a study on the hospice care for the obese and assistant professor at the University of Pittsburgh School of Medicine.

Researchers did a retrospective analysis of cohort of obese patients to analyze the influence body mass index (BMI) has on hospice use and Medicare expenditures during an obese person’s end-of-life care.

The study authors assessed the experiences of 5,677 Medicare beneficiaries who died between 1998 and 2012 to specifically look at weight levels and circumstance of death — specifically whether they were home or in hospice care.

The team categorized patients by three BMI measurements: 20 (normal), 30 (obese), and 40 (morbidly obese). The study results showed that 117 severely obese patients died earlier at an average age of 72. However, 2,509 patients with normal weight died a decade later at age 82.

Although almost 35% of study participants received hospice care, only 23% of the severely obese group were given hospice care and spent four fewer days in hospital settings than the group with at a BMI of 20 or less.

The team also noted certain challenges in providing obese patients with proper medical treatment including good skin care, bathing, and restroom assistance, which significantly impacted their end-of-life care.

Study authors said that obesity also, “challenges the ability of health care providers and caregivers to conduct thorough physical assessments, assist with mobility and self-care, recognize frailty and malnutrition, and perform certain indicated procedures."

David Casarett, MD, chief of palliative care, Duke University, Durham, NC, said in a news release that some patients become homebound, skip appointments, and ignore symptoms of devastating conditions that contribute to early death.

Study authors concluded, “Among community-dwelling decedents in the HRS, increasing obesity was associated with reduced hospice use and in-home death and higher Medicare expenditures in the last six months of life.”

Eric Widera, MD, associate professor of clinical medicine at the University of California, San Francisco explained in a news release that often times obese people lack the necessary support at home for end-of-life care.

While researchers continue to understand the relationship between increasing obesity and reduced hospice use, they urge health care providers to consider hospice at earlier points in patients who have more severe illnesses than they would for standard patients. Some even consider providing higher reimbursement rates for caregivers given the unique situations.

The study, “The Relationship of Obesity to Hospice Use and Expenditures: A Cohort Study,” was published in Annals of Internal Medicine.