Michigan Study Finds Obesity Lowers Hospice Use Among Seniors

A long-term health study has found that seniors with a higher body mass index (BMI) were less likely to make use of hospice care. Additionally, obese seniors spent significantly fewer days in hospice care than their nonobese counterparts.

This Health and Retirement Study (HRS) evaluated the association between BMI, hospice use, and Medicare expenditure among 5677 community-dwelling fee-for-service Medicare enrollees who died between 1998 and 2012. The primary outcomes evaluated by the researchers were:

• Hospice enrollment
• Days enrolled in hospice
• In-home death
• Total Medicare expenditures in the 6 months before death

According to senior author Jennifer Griggs, MD, MPH, hospice teams might require more staff to take care of people who are obese, “but Medicare hospice reimbursement is capped no matter what a person’s BMI.” Griggs also believes that obesity could potentially mask the typical signs and changes that physicians might use to determine the appropriate time to pass a patient on to hospice care. Although signs of cachexia might be visible even in an obese individual, the more gradual changes could be missed.

The authors reported the following for the decedent population in their study:

• BMI of 20 kg/m² 38.3% probability of hospice enrollment (95% CI, 36.5%-40.2%) Hospice duration, 42.8 days (95% CI, 42.3-43.2 days) 61.3% probability of in-home death (95% CI, 59.4%-63.2%) Total Medicare expenditure, $42 803 (95% CI, $41,085-$44,521)
• BMI of 30 kg/m² Probability of hospice enrollment decreased by 6.7 percentage points (95% CI, -9.3 to -4.0) Hospice duration decreased by 3.8 days (95% CI, -4.4 to -3.1 days) Probability of in-home death decreased by 3.2 percentage points (95% CI, -6.0 to -0.4 percentage points) Total Medicare expenditure increased by $3471 (95% CI, $955-$5988)
• BMI ≥40 kg/m² Probability of hospice enrollment decreased by 15.2 percentage points (95% CI, -19.6 to -10.9) Hospice duration decreased by 4.3 days (95% CI, -5.7 to -2.9 days) Probability of in-home death decreased by 6.3 percentage points (95% CI, -4.4 to -3.1 percentage points)

The lowest BMI group was used as the comparator for the 30 kg/m² and ≥40 kg/m² BMI groups.

“Obesity is a complex disease, and this study has shown another side of its effect on patients and the healthcare system. Patients with obesity are less likely to receive high-quality end-of-life care,” said John Harris, MD, MSc, who led the study during a fellowship at the University of Michigan. He is currently an assistant professor at the University of Pittsburgh School of Medicine.

Reference

Harris JA, Byhoff E, Perumalswami CR, Langa KM, Wright AA, Griggs JJ. The relationship of obesity to hospice use and expenditures: a cohort study [published online February 7, 2017]. Ann Intern Med. 2017. doi: 10.7326/M16-0749.