Baseline Characteristics and Benefit/Risk Assessment of Elderly Obese Patients, Candidates for Bariatric Surgery

Abstract

Introduction Obesity is associated with exacerbation of the age-related decline in physical function. In the elderly, obesity is associated with loss of functionality and therefore with poor quality of life and loss of independence. Bariatric surgery in elderly people is controversial. By NIH 1991 statement, 65 years old is the age limit for patients who are candidates for surgical treatment of obesity, but in developing countries, elderly is considered as the population above 60 years. Since this population is increasing, the decision of operating is becoming a frequent concern and a big challenge for bariatric surgeons. The assessment of functionality is an important issue to evaluate the risk/benefit of the operation in this population. Objective To evaluate the baseline characteristics (co morbidities, medication use) and functionality (activities of daily living–ADL and instrumental activities of daily living-IADL) in morbid obese patients, who are candidates for bariatric surgery, with 60 years or more. Materials and Methods: Subjects from the bariatric surgery program of Hospital das Clinicas were prospectively evaluated by personal interview, chart revision and application of functionality tests (Lawton, Katz). Results Twenty six patients (18 women and 8 men) have completed the evaluation. The mean age was 64.7 years, mean weight was 121,9Kg and mean BMI was 47.9Kg/m2. All patients had hypertension, 53.8 % were diabetic, 11.5 % reported previous stroke and 30.7 % had cardiac co morbidities (which included myocardial infarction, angina, heart failure and arrhythmia). Pulmonary disease was present in 27.1 % of individuals and 73.1 % had sedentary lifestyle mostly due to pain. The prescription included 7.19 medications per patient with 57.7 % reporting regular pain medication use. With respect to functionality, 30 % and 57 % had impairment in at least one ADL and IADL, respectively. Discussion This characteristics of this population demands a structured and objective plan for the benefit/risk assessment and decision on whom of those patients should be operated and who should not. The application of functionality tests in the pre-op can be useful to separate the patients who will probably benefit of massive weight loss of those who will not. Conclusion In the study population there is a high prevalence of co morbidities, functionality impairment, sedentary lifestyle and polypharmacy.