To examine the impact of body mass index (BMI) on the effectiveness of a disease management—health promotion intervention among community-dwelling Medicare beneficiaries with disabilities.
Design.
Secondary data analyses of a randomized controlled trial.
Settings.
Nineteen counties in upstate New York and on the West Virginia—Ohio border.
Subjects.
Four hundred fifty-two Medicare beneficiaries who participated in the Medicare Primary and Consumer-Directed Care Demonstration between August 1998 and June 2002 and completed the 22-month follow-up.
Intervention.
Multicomponent disease management—health promotion intervention involving patient education, individualized health promotion coaching, medication management, and physician care management.
Measures.
Body mass index and dependence in Activies of Daily Living (ADLs).
Analysis.
Multivariate linear regression.
Results.
The intervention resulted in significantly less worsening in ADLs dependence among normal-weight participants (coefficient, − .42; p = .04). However, the intervention did not have a significant effect for underweight participants (F test p = .33 vs. underweight participants in the control group) or overweight or obese participants (F test p = .78 vs. overweight or obese participants in the control group).
Conclusions.
A positive effect of the intervention on disability was found among normal-weight participants but not among underweight or overweight or obese participants. Future health promotion interventions should take into consideration the influence of BMI categories on treatment effects.
Federal Interagency Forum on Aging-Related Statistics. Older Americans 2008: Key Indicators of Weil-Being.Washington, DC: US Government Printing Office; 2008.
2.
MantonKG. Recent declines in chronic disability in the elderly U.S. population: risk factors and future dynamics. Annu Rev Public Health.2008;29:91–113.
3.
SpillmanBC. Changes in elderly disability rates and the implications for health care utilization and cost. Milbank Q.2004;82:157–194.
4.
JensenGLRoyMABuchananAEBergMB. Weight loss intervention for obese older women: improvements in performance and function. Obes Res.2004;12:1814–1820.
5.
VillarealDTBanksMSienerG. Physical frailty and body composition in obese elderly men and women. Obes Res.2004;12:913–920.
6.
VillarealDTBanksMSinacoreDR. Effect of weight loss and exercise on frailty in obese older adults. Arch Intern Med.2006;166:860–866.
7.
AckermannRTGheadleASandhuN. Community exercise program use and changes in healthcare costs for older adults. Am J Prev Med.2003;25:232–237.
8.
WoolfSHCoffieldAB. The “Welcome to Medicare” visit: a chance to raise the profile of prevention among older adults. BMJ.2005;330:E337–E338.
9.
ChodoshJMortonSCMojicaW. Meta-analysis: chronic disease self-management programs for older adults. Ann Intern Med.2005;143:427–438.
10.
LiebelDVFriedmanBWatsonNMPowersBA. Review of nurse home visiting interventions for community-dwelling older persons with existing disability. Med Care Res Rev.2009;66:119–146.
11.
FriedmanBWamsleyBRLiebelDV. Patient satisfaction, empowerment, and health and disability status effects of a health promotion-disease management nurse intervention among Medicare beneficiaries with disabilities. Gerontologist.2009. In press.
12.
ChenHGuoX. Obesity and functional disability in elderly Americans. J Am Geriatr Soc.2008;56:689–694.
13.
ImaiKGreggEWChenYJ. The association of BMI with functional status and self-rated health in US adults. Obesity.2008;16:402–408.
14.
Al SnihSSOttenbacherKJMarkidesKS. The effect of obesity on disability vs mortality in older Americans. Arch Intern Med.2007;167:774–780.
15.
EliaM. Obesity in the elderly. Obes Res.2001;9(suppl 4):244S–248S.
16.
RossnerS. Obesity in the elderly: a future matter of concern?Obes Rev.2001;2:183–188.
17.
DaviglusML. Health care costs in old age are related to overweight and obesity earlier in life. Health Aff (Millwood).2005;24(suppl 2):W5R97–W5R100.
18.
FinkelsteinEAFiebelkornICWangG. National medical spending attributable to overweight and obesity: how much, and who's paying?Health Aff (Millwood).2003;suppl Web exclusives:W3219–W3-226.
19.
ArterburnDECranePKSullivanSD. The coming epidemic of obesity in elderly Americans. J Am Geriatr Soc.2004;52:1907–1912.
20.
WongCHWongSFYusoffAM. The effect of later-life health promotion on functional performance and body composition. Aging Clin Exp Res.2008;20:454–460.
21.
JainNBAl-AdawiSDorvloASSBurkeDT. Association between body mass index and functional independence measure in patients with deconditioning. Am J Phys Med Rehabil.2008;87:21–25.
22.
GitlinLNWinterLDennisMPHauckWW. Variation in response to a home intervention to support daily function by age, race, sex, and education. J Gerontol A Biol Sci Med Sci.2008;63:745–750.
23.
ShaughnessyPWCrislerKSSchlenkerRE. Medicare's OASIS: Standardization Outcome and Assessment Information Set for Home Health Care: OASIS B.Denver, Colo: Center for Health Services and Policy Research; 1997.
24.
MadiganEAFortinskyRH. Additional psychometric evaluation of the Outcomes and Assessment Information Set (OASIS). Home Health Care Serv Q.2000;18:49–62.
25.
MadiganEAFortinskyRH. Interrater reliability of the Outcomes and Assessment Information Set: results from the field. Gerontologist.2004;44:689–692.
26.
World Health Organization. Obesity: Preventing and Managing the Global Epidemic.Geneva. Switzerland: World Health Organization; 1998.
MettlerMKemperDWStilwellDL. Healthwise for Life: Medical Self-Care for Healthy Aging.Boise. Idaho: Healthwise Inc; 1996.
29.
GreenLWKreuterMW. Health Promotion Planning: An Educational and Environmental Approach.2nd ed.Mountain View, Calif: Mayfield; 1991.
30.
ProchaskaJODiClementeCG. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol.1983;51:390–395.
31.
BeckerMH. The Health Belief Model and Personal Behavior.Thorofore, NJ: Charles B. Slack; 1974.
32.
BanduraA. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev.1977;84:191–215.
33.
MaddalaGS. Limited Dependent and Qualitative Variables in Economics.New York, NY: Cambridge University Press; 1983.
34.
McCullaghPNeiderJA. Generalized Linear Models.London, England: Chapman & Hall; 1989.
35.
PregibonJO. Goodness of link tests for generalized linear models. Appl Stat.1980;29:15–24.
36.
BodenheimerT. Interventions to improve chronic illness care: evaluating their effectiveness. Dis Manag.2003;6:63–71.
37.
LorigKRHolmanH. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med.2003;26:1–7.
38.
GoldMLakeTBlackWESmithM. Challenges in improving care for high-risk seniors in Medicare. Health Aff (Millwood).2005;suppl Web exclusives:W5-199–W5-211.
39.
JanceyJMLeeAHHowatPA. The effectiveness of a physical activity intervention for seniors. Am J Health Promot.2008;22:318–321.
40.
BoumanAvan RossumENelemansP. Effects of intensive home visiting programs for older people with poor health status: a systematic review. BMC Health Serv Res.2008;8:74–85.
41.
HussAStuckAERubensteinLZ. Multidimensional preventive home visit programs for community-dwelling older adults: a systematic review and meta-analysis of randomized controlled trials. J Gerontol A Biol Sci Med Sci.2008;63:298–307.
42.
WoodsNLaCroixAGrayS. Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study. J Am Geriatr Soc.2005;53:1321–1330.
43.
BlaumCSXueQLMichelonE. The association between obesity and the frailty syndrome in older women: the Women's Health and Aging Studies. J Am Geriatr Soc.2005;53:927–934.
44.
HeiatAVaccarinoVKrumholzHM. An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons. Arch Intern Med.2001;161:1194–1203.
45.
LangIAGuralnikJMMelzerD. Physical activity in middle-aged adults reduces risks of functional impairment independent of its effect on weight. J Am Geriatr Soc.2007;55:1836–1841.
46.
FosterGDMakrisAPBailerBA. Behavioral treatment of obesity. Am J Clin Nutr.2005;82:230S–235S.
47.
McTigueKMHessRZiourasJ. Obesity in older adults: a systematic review of the evidence for diagnosis and treatment. Obesity.2006;14:1485–1497.
48.
SharkeyJROryMGBranchLG. Severe elder obesity and 1-year diminished lower extremity physical performance in homebound older adults. J Am Geriatr Soc.2006;54:1407–1413.
49.
GillTMBakerDIGottschalkM. A program to prevent functional decline in physically frail, elderly persons who live at home. N Engl J Med.2002;347:1068–1074.
50.
KuczmarskiMFKuczmarskiRJNajjarM. Effects of age on validity of self-reported height, weight, and body mass index: findings from the Third National Health and Nutrition Examination Survey, 1988–1994. J Am Diet Assoc.2001;101:28–34.
51.
LiebelD. Process Evaluation of a Nurse Home Visiting Intervention That Postponed Functional Declines in Older Adults [doctoral thesis]. Rochester, NY: School of Nursing, University of Rochester; 2007.
