Obesity prevalence is escalating in all ages, including older people (persons 65 years and above). Nonetheless, the suitable clinical strategy to obesity in the elderly is controversial because of the minimization of relative health risks linked to increased body mass index (BMI) in the old people, the uncertain efficacy of obesity therapy in the group, alongside the possible harmful impacts of weight loss on bone and muscle mass. These concerns affect the public, policymakers, and healthcare providers.
The Older Population in the U.S
In 2014, (the most current available information) the elderly, people 65 years and over, numbered 46.2 million representing 14% of the population of the U.S, approximately one in every six people (Haber, 2015). There were 26 million older women compared to 20 million older men, or a sex ratio of 127 women for every 100 men (Haber, 2015). At 85 years and above, the rate escalates to 192:100. 22% of the older populations were members of ethnic or racial minority communities (Haber, 2015). Notably, 10% were African-Americans, 4% were Pacific Islanders or Asian, 0.5% was Native Americans, 0.1% was Native Pacific/Hawaiian Islanders, and 0.7% identified themselves of the two or numerous races.
People of Hispanic origin accounted for 8% of the group (Haber, 2015). Moreover, the median income was $31,170 for males and $17,380 for females (Haber, 2015). As such, over 4.5 million of this population was below the poverty line in 2014. In regards to employment, 9 million (19%) of this population were in the labor force including 4.2 million females (15%) and 5% males (23%) (Haber, 2015). Concerning education, those that had finished high school rose from 28% in 1970 to 84% in 2015 and approximately 28% had a bachelor’s degree (Haber, 2015).
Why the Elderly are At-risk of Obesity
Aging is correlated with significant transforms in body composition. After the ages of 20 and 30 years, fat-free mass (FFM) gradually reduces, while fat mass escalates. FFM (mainly skeletal muscle) reduces by about 40% from between 20 and 70 years. The highest FFM is typically attained at the age of 20 years, the highest fat mass is achieved at between 60 and 70 years, and both measures reduce subsequently. Thus, both fat mass and FFM reduce during old age. Moreover, aging is also linked to a redistribution of both FFM as well as body fat. Therefore, with aging, there is a superior relative escalation in inta-abdominal fat compared to total or subcutaneous body fat, and there is a superior relative decline in peripheral compared to central FFM because of the skeletal muscle loss. Additionally, the increase in intrahepatic and intramuscular fat in the seniors is correlated with the resistance of insulin (Haber, 2015).
Accordingly, obesity prevalence in all categories of age has escalated during the past two decades in the U.S. the number of older individuals with obesity has markedly intensified due to both increase in their population as illustrated above, and in the number of the elderly with obesity. In 1990, 14% of this population who were between 60 and 69 years and 11% of those above 70 years were obese. In 2014, the obesity prevalence in the group escalated to 22% and 16% respectively, representing an increase of 56% and 37%, respectively (Haber, 2015).
Evidence-Based Strategies to Enhance Outcomes
Weight-loss treatment, which minimizes bone and muscle loss, is recommended for the elderly obese individuals who have metabolic or functional impairments, which can benefit from the loss of weight (Allison & Pi-Sunyer, 2013). A thorough physical examination, medical history, suitable laboratory tests, evaluation of readiness to lose weight and medication review are vital before weight-loss treatment is started. The primary approach is to attain a sustained change in lifestyle. Modifications in lifestyle include methods, which assist the elderly in overcoming barriers to conform to dietary changes alongside physical activity.
As such, clinicians should help obese older individuals in setting personal goals, use motivational approaches, and monitor progress to enhance adherence to the program for weight-loss. Particular cognitive behavioral treatment methods, such as self-monitoring, social support, goal setting, as well as stimulus control, should be considered (Allison & Pi-Sunyer, 2013). The utilization of medication in the elderly population is common, and the group has the highest risk of problems, which are related to drugs. As such, all medication should be vigilantly reviewed, specifically, since some may result in weight gain, for instance, antipsychotics, antidepressants, anticonvulsants, and steroids (Allison & Pi-Sunyer, 2013). Moreover, clinical improvements that are induced by weight-loss might need changes in medications to avert iatrogenic complications.
Healthcare Resources that serve the elderly with obesity
As obesity in older adults continues to increase, healthcare providers have set aside professionals to assist them in losing weight. Such experts include dietitians, psychologists, exercise specialists, and medical doctors, who give professional advice to the elderly concerning losing weight or maintaining. As such, the elderly has a multiplicity of healthcare resources that could assist them in preventing or treating obesity. Dietitians help them in making healthy food choices while medical doctors carry out medical treatments such as surgery to those who are already obese (Moats et al., 2012).
Appropriate Nursing Interventions
The immediate nursing interventions for weight management in the elderly include lifestyle intercession and surgery. In regards to lifestyle intervention, an amalgamation of increased physical activity, energy-deficit-diet, and behavior therapy such as social support, goal setting, self-monitoring, alongside stimulus control, results in moderate loss of weight. It is also associated with a decreased risk of therapy-induced impediments than are other therapies of weight-loss (Moats et al., 2012). Additionally, bariatric surgery is the main treatment for weight reduction for obese older adults. Accordingly, older adults with morbid obesity in addition to at least one severe obesity associated with medical complications, for instance, heart failure, and hypertension, and a reduced probability of success with non-surgical treatment were potential candidates for surgery. Additionally, postoperative management and preoperative assessment of the patients should be carried out by a multidisciplinary team with access to nutritional, psychological, surgical, and medical expertise (Moats et al., 2012).
Strategies to Support Plan implementation
The plan is to reduce bone and muscle loss in the elderly to prevent obesity. Therefore, to implement the plan, it is required that the elderly is advised perform more physical exercises such as walking and jogging (Fakhouri & National Center for Health Statistics (U.S.), 2012). As such, clinicians are required to help them in setting out a timetable for such exercises. Another issue is in regards to diet. Clinicians should assist the elder people with obesity in establishing a balanced diet that will help them in reducing weight.
Nonetheless, this plan could be affected by cultural, ethnic, and social aspects of the particular individuals. For instance, the people that have a culture of eating more calories may find in difficult to adjust to the new diet that discourages the intake of increased calories (Fakhouri & National Center for Health Statistics (U.S.), 2012). Therefore, such people may find themselves going back to the old habit. Additionally, older adults from ethnicities that are used to eating junk food may also find it difficult to adjust (Fakhouri & National Center for Health Statistics (U.S.), 2012). Finally, the social background may also influence the plan. Accordingly, individuals from families that are not used to exercising or who visit fast food restaurants may find it extremely hard to adjust (Fakhouri & National Center for Health Statistics (U.S.), 2012).
In conclusion, the rate of obesity in older adults has increased tremendously as the more elderly population increases. Nonetheless, weight-loss treatment, which minimizes bone and muscle loss, is recommended for the elderly obese individuals who have metabolic or functional impairments, which can benefit from the loss of weight. However, the plan could be impacted by social, ethnicity, and cultural backgrounds. Therefore, clinicians should be exceedingly watchful of the patients while placing them on such programs so that they do not deviate from the fundamental objectives.
- Allison, D. B., & Pi-Sunyer, F. X. (2013).’Obesity Treatment: Establishing Goals, Improving Outcomes, and Reviewing the Research Agenda. Boston, MA: Springer US.
- Fakhouri, Tala H. I., & National Center for Health Statistics (U.S.). (2012).’Prevalence of Obesity Among Older Adults in The United States, 2007-2010. Hyattsville, Md: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 106(106), 1-8.
- Haber, D. (2015).’Health Promotion and Aging: Practical Applications for Health Professionals.
- Moats, S. A., Hoglund, J., & Institute of Medicine (U.S.). (2012).’Nutrition and Healthy Aging in the Community: Workshop Summary. Washington, D.C: National Academies Press.