Body Mass Index and 30-Day Adverse Outcomes Among Newly Admitted Residents to Skilled Nursing Facilities

Ning Zhang; Susan F Lu; Yanhua Zhou; Bo Zhang; Sybil Crawford; Jerry H Gurwitz

doi:10.1016/j.jamda.2018.10.020

Body Mass Index and 30-Day Adverse Outcomes Among Newly Admitted Residents to Skilled Nursing Facilities

J Am Med Dir Assoc. 2019 Mar;20(3):312-316. doi: 10.1016/j.jamda.2018.10.020.

Authors

Ning Zhang¹, Susan F Lu², Yanhua Zhou³, Bo Zhang⁴, Sybil Crawford³, Jerry H Gurwitz⁵

Affiliations

¹ Department of Health Policy and Promotion, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA; Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA; Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA. Electronic address: ningzhang@schoolph.umass.edu.
² Krannert School of Management, Purdue University, West Lafayette, IN.
³ Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA.
⁴ Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.
⁵ Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA; Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA.

PMID: 30824219
DOI: 10.1016/j.jamda.2018.10.020

Abstract

Objective: To examine the association between body mass index (BMI) and outcomes, including discharge to home, hospitalization, death, or continued residence in the skilled nursing facilities (SNFs), among residents newly admitted to SNFs.

Design: Retrospective observational design using the national Minimum Data Set 2.0 from 2006 to 2010.

Setting: SNFs in the United States.

Participants: Newly admitted SNF residents.

Measurements: Four discharge outcomes were assessed at 30 days subsequent to the initial admission to SNF, including discharge to home, hospitalization, death, or continued residence in the SNFs, and examined using a competing hazards model. SNF residents were categorized as underweight (BMI < 18.5), normal to overweight (18.5 ≤ BMI < 30), mildly obese (30 ≤ BMI < 35), and moderately to severely obese (BMI ≥ 35).

Results: The study sample was composed of 3,812,333 newly admitted SNF residents. As compared with normal to overweight SNF residents, underweight individuals were less likely [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.82-0.83] to be discharged home and more likely to be hospitalized (HR 1.06, 95% CI 1.05-1.07), or to die (HR 1.59, 95% CI 1.56-1.62), rather than continue to reside in the facility. Residents with mild obesity were more likely (HR 1.12, 95% CI 1.11-1.13) to be discharged home and less likely to be hospitalized (HR 0.96, 95% CI 0.95-0.97) or to die (HR 0.74, 95% CI 0.73-0.76). Moderately to severely obese individuals were also more likely to be discharged home (HR 1.11, 95% CI 1.10-1.11) and less likely to be hospitalized (HR 0.94, 95% CI 0.93-0.95) or die (HR 0.66, 95% CI 0.64-0.68).

Conclusions/implications: SNF residents with obesity experience more favorable short-term outcomes compared with underweight or normal to overweight residents. Underweight residents are at the greatest risk for adverse outcomes, emphasizing the need for special surveillance and preventive efforts targeting these individuals.

Keywords: Weight status; body mass index; obesity; skilled nursing facilities.

MeSH terms

Aged
Aged, 80 and over
Body Mass Index*
Female
Humans
Male
Obesity
Observation
Outcome Assessment, Health Care*
Patient Discharge
Retrospective Studies
Skilled Nursing Facilities*
United States