Obesity and Pressure Ulcers Among Nursing Home Residents

Objectives: To examine the prevalence of obesity and its relationship with pressure ulcers among nursing home (NH) populations, and whether such relationship varies with certified nursing assistant (CNA) level in NHs. Data and Study Population: The 1999-2009 nationwide Minimum Data Sets were linked with Online Survey of Certification and Reporting records. We identified newly admitted NH residents who became long-stayers and followed them up to 1 year. Analyses: The outcome variable was presence of pressure ulcers during the 1-year follow-up period. Residents were categorized as normal [18.5 <= body mass index (BMI) < 30 kg/m(2)], mild obesity (30 <= BMI < 35 kg/m(2)), and moderate or severe obesity (BMI >= 35 kg/m(2)). Pooled and stratified analyses were performed to examine the relationship between obesity and pressure ulcers, and how it varied by facility CNA level. Results: The prevalence of obesity increased from 16.9% to 25.8% among newly admitted NH residents over the last decade. Obesity was associated with higher risks of pressure ulcers among long-stay residents. The relationship between obesity and pressure ulcers persisted after accounting for individual health conditions at the baseline and facility-level variations. Further, the within-facility relationship between obesity and pressure ulcers varied by facility CNA levels. The odds of pressure ulcers were 18.9% higher for residents with moderate or severe obesity than for nonobese residents within NHs with low CNA levels. The percents for medium and high CNA level facilities were 14.0% and 12.8%, respectively. Conclusion: To prepare for the growing obesity epidemic in NHs, policies should focus on strategies to improve care provided for obese residents.