Study Finds Heavier People Get Less Hospice Care
February 13, 2017 02:13 PM
The heavier a person is, the less likely they are to be treated with hospice care, according to a new study of 5677 senior citizens from the University of Michigan Institute for Healthcare Policy and Innovation and published in the Annals of Internal Medicine.
The researchers studied how the seniors’ body mass index (BMI), a measure of obesity, corresponded to their end-of-life medical treatment, such as the use of hospice services. The seniors studied were all Medicare beneficiaries who died between 1998 and 2012. None were long-term residents of a skilled nursing facility.
Almost half of the seniors studied were above ideal weight, with 31 percent in the “overweight” category (a BMI between 25 and 29.9), 15 percent classified as “obese” (BMI between 30and 40) and two percent called “morbidly obese” (BMI over 40).
The higher a person’s BMI, the less likely that person was to enter hospice at all, according to the study. Furthermore, obese people who did use hospice care still spent less time in hospice than those with a lower BMI.
About sixty percent of the seniors in the study died at home, which is what most Americans say would be their choice. Thirty-eight percent of seniors in the study used hospice, but patients with a BMI of 40 used hospice less than 23 percent of the time. Patients with a BMI of 20, which is considered normal or good, used hospice 38 percent of the time, on par with the average for study participants as a whole.
Seniors with higher BMI also, on average, cost more Medicare dollars than seniors with a lower BMI. In the last six months of life for a person with a BMI of 30, Medicare spent about $46,500 – or roughly $3500 more than was spent on someone with a BMI of 20.
The study did not analyze why obese people received less hospice care, though Jennifer Griggs, M.D., M.P.H., a study author and professor at the U-M Medical School, believes “obesity may mask the signposts and changes that physicians might use to determine when it is time for a person to enter hospice.” In addition, Griggs says “it can require more staff to take care of people who are obese, but Medicare hospice reimbursement is capped no matter what a person’s BMI.”
“Many policies focus on preventing or reducing obesity in the U.S., but we will also need policies to encourage the provision of high-quality care for people with obesity,” says John Harris, M.D., M.Sc., who led the study during a fellowship at U-M.