Ready or Not

toddFall 2012

By David Robinson

UAMS’ Holly Felix, Ph.D., is studying the impact obesity has on access to nursing home care.

UAMS’ Holly Felix, Ph.D., is studying the impact obesity has on access to nursing home care.

Holly Felix, Ph.D., recalls a day six years ago when she learned about an obese elderly woman whose family couldn’t find a nursing home that would admit her.

Felix, an assistant professor in the UAMS College of Public Health, said the story helped crystallize her research focus. The patient’s experience raised many questions about the impact of obesity on access and quality of care.

To help her devote time to the issue, she received a $180,000 KL2 Scholar Award from the UAMS Translational Research Institute, which is funded by the National Institutes of Health.

“Obesity has a major impact on our ability to function, to perform the activities of daily living,” Felix said. “When people lose the ability to be independent, they usually need care that may only be provided in a long-term care setting. But if long-term care facilities won’t take them, then what happens to them?”

Felix said she’s learned from nursing homes that sometimes they simply lack the ability to care for obese patients. They may not have bariatric equipment or a bed to hold an obese person, or may not have enough staff to move someone who is obese, and they don’t want to risk injury to the resident or staff.

Given their numbers, baby boomers will practically overwhelm the supply of existing nursing home beds. When obesity is factored in, access becomes a bigger issue. In a pilot study, Felix found that obese patients are much younger when admitted to a long-term care facility than non-obese patients. This means they potentially will need care for longer periods of time, which would further tighten the supply of available beds.

Felix said she’s still documenting this as an emerging issue. “I’m trying to understand what it means for those facilities and their residents.”

Some preliminary work suggests that long-term care for the obese differs from that of lean nursing home residents. In a study in partnership with the University of Pennsylvania, patients are interviewed regarding their continence care.

“We’ve had obese patients report that they’ve had to sit in wet incontinence pads waiting for help because staff weren’t readily available, and they couldn’t manage themselves to the toilet,” Felix said.

Interventions that reduce obesity rates and help people remain independent are part of the solution.

Felix has joined Delia Smith West, Ph.D., principal investigator of a weight-loss study that involves 16 senior centers around the state. Funded by the federal Centers for Disease Control and Prevention, the study incorporated a weight-loss program that was taught to staff and volunteers at the senior centers. Study results, published in the American Journal of Preventive Medicine, show 38 percent of those in the program experienced at least a 5 percent weight loss. That compares to less than 5 percent of study participants not in the weight-loss program.

Felix notes that a 5 percent weight loss has been shown in other studies to produce significant health benefits.

“Part of translational research is trying to get solutions that can sustain themselves out in the communities,” Felix said. “So we took this evidence-based program that was studied and developed in a very controlled setting, and we repackaged it and trained senior center staff and volunteers to deliver it. Now the researchers have gone away, but those people are still there helping participants.”