Much of the news shows that we are getting bigger-and not in a good way. In the United States, two thirds of adults and nearly one third of children and teenagers are obese or overweight. In fact, the number of obese adults has doubled since 1980. It is also known that obesity is attributed to many diseases and higher costs for those diseases. And specialty areas are developing around this "epidemic." Hospitals have service lines around the care and handling of heavier patients. There are implications for ergonomics, safe handling, equipment, and supplies.
Medicare had paid for bariatric surgery for some time, and the reports were not always positive. One new large study of 2,235 patients showed that nearly three quarters of obese patients with type 2 diabetes who undergo weight-loss surgery are able to stop insulin and other antidiabetes drugs within 6 months (Johns Hopkins Medicine, 2010). This study looked at "insured, obese, diabetic patients...[and] researchers also found that in the third year following surgery, average annual health care costs per patient decreased by more than 70 percent." The authors also noted that bariatric surgery has increased "200% in the last 5 years" (Johns Hopkins Medicine). In August, the Centers for Medicare and Medicaid Services announced that they will cover intensive diet and exercise programs under the Pritikin and Ornish plans in efforts to reduce cardiovascular event risk (Gever, 2010). Many of us know of these programs because of books or friends who have adopted these healthy lifestyles that integrate exercise and better food and nutrition choices that have been said to reduce low-density lipoprotein cholesterol, weight, blood pressure, and other aspects of health negatively impacted by sedentary lifestyle and poor food choices.
Older patients account for the majority of physician office visits and involve specialists who treat chronic conditions. The National Center for Health Statistics found that "as older patients have accounted for more ambulatory care, they have also accounted for a growing share of resources" (Cherry et al., 2010). In fact, among patients aged 65 and older, "primary diagnoses of chronic conditions increased by double and triple digits from 1998-2008 including hypertension, 62%, cardiac arrhythmias, 139%, diabetes, 45%, dyslipidemia, 150%, urinary symptoms, 139%, coronary atherosclerosis, 24%, and prostate cancer, 58%" (Cherry).
Interestingly, some of the articles in this issue of Home Healthcare Nurse address these topics. Janet E. Smith's "Post-Prostatectomy Incontinence: Implications for Home Health Clinicians" is timely, as the above-cited number of 139% for "urinary symptoms" implies. The Research Briefs column authored by Phyllis Russell and Rochelle Pinnock-Herring addresses an important component of weight and lifestyle choices and is entitled "Research on Diet and Nutrition in the Older Adult Population." For educators, life-long students, and those seeking to find articles on a particular topic, the continuing-education article by Judith S. Young, entitled "PubMed Searching for Home Care Clinicians," walks users through the complex process to success. This article has supplemental digital content links to the Home Healthcare Nurse Web site (http://www.homehealthcarenurseonline.com).
The patients listed with the increased chronic conditions needing additional care and resources are our same home care patient and hospice populations. We are in the perfect positions to be educators and role models for our communities-when visiting in homes, shopping at the grocery store, and participating in town meetings. We know that healthcare reform was passed because the costs of care are unsustainable-so we know "it wasn't working how it was working." There must be a better way, and all of us collectively can lead the charge to that better way!!
Tina M. Marrelli
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