Why Obese Seniors Are Less Likely to Use Hospice

A senior’s weight may directly impact whether they’ll receive hospice services at the end of life, how long they’ll remain in hospice and whether they’ll die at home, according to a study recently published in the Annals of Internal Medicine.

The higher a senior’s body mass index (BMI), the less likely they are to receive hospice services at the end of life, Medical Xpress reported. Additionally, among seniors who do use hospice services at the end of life, those who aren’t obese spend more days in hospice than those who are obese.

The study was authored by Jennifer Griggs, a professor at the University of Michigan Medical School, and her colleagues. Together, the researchers analyzed how the BMIs of 5,677 seniors who died between 1998 and 2012 correlated to their use of certain end-of-life measures, like hospice services. None of the study participants were living long-term in a skilled nursing facility, and all were Medicare beneficiaries.


About 2% of the participants classified as “morbidly obese,” which means their BMIs were higher than 40. Approximately 15% of the participants were “obese,” which means their BMIs were between 30 and 40, and 31% were “overweight,” which means their BMIs were between 25 and 29.9.

Almost 60% of the study participants died at home, but seniors with high BMIs had a lower chance of doing so, the study found.

Additionally, of all of the study participants, 38% used hospice services. Patients who had a BMI of 20 had a 38% chance of receiving hospice services at the end of life, while patients who had a BMI of 40 had less than a 23% chance of having hospice services.


The reasons for this discrepancy are twofold, Griggs explained.

“For hospice teams, as for hospital and home health teams, 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,” Griggs said. “Also, obesity may mask the signposts and changes that physicians might use to determine when it is time for a person to enter hospice.”

Heavier seniors also used more Medicare dollars in their final six months of life, the study found. In the last six months of life for a senior with a BMI of 30, the Medicare system spent about $46,500 for all types of care. For a senior with a BMI of 20, the Medicare system spent about $43,000.

The study’s findings make clear that various policy changes must occur, according to John Harris, who co-authored the study and now works at the University of Pittsburgh School of Medicine.

“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,” Harris said. “More attention should be paid to payment structures that recognize the challenges involved with health care for men and women with obesity.”

Written by Mary Kate Nelson

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