If your loved one is obese, you know the struggle involved with his care, because he probably has a challenging (and often growing) list of unique care priorities that come with being obese. Addressing and managing these medical and personal needs can be daunting, and some of the necessary long-term care can stretch beyond what a family member can safely provide. With current obesity rates rising, the challenge of caring for an obese loved one is becoming a reality for many of us. Here are some of the challenges family members face in caring for an obese loved one at home.
An obese family member often requires help with basic movement, including standing, sitting, and moving around. It is very hard on him because he does not want to burden anyone, especially family members. When an obese person ages, his muscle mass that carries the extra weight decreases, and he can consequently become sedentary. Family members often struggle to both move obese loved ones and to encourage them to be mobile themselves. Between feelings of guilt burdening family members and physically feeling less able to move around, it can really be mentally taxing on him, and on family members who provide care.
While challenging, however, mobility is extremely important, because lack of mobility can result in an array of medical problems such as pneumonia, gastrointestinal issues, respiratory and circulatory complications, skin atrophy and tears, pressure ulcers, and overall sense of wellbeing.
Exercise and mobility on any level can help fight the negative feelings and physical outcomes of a sedentary lifestyle by improving overall health and mood. But the task of moving an obese loved one, or having him mobilize safely himself, can be daunting, and often can be emotionally and physically hard for both people.
With increased mobility comes the risk of falls. Fall prevention in the home care setting is very important for your loved one’s safety, as people who are obese can be at greater risk of falls.
Every year millions of people fall, many of which happen in and around the home. Many of these falls also result in moderate to severe injury, including lacerations, hip fractures, and head trauma. People who fall can also develop a fear of falling, which results in decreased mobility, which in turns increases fall risk and creates a cycle.
Your loved one’s regular annual visit to his physician is a great opportunity to ask about and evaluate fall risk. Doctors have assessment guides to determine fall risk in their patients, and there are also materials to assist family and home health aides in assessing a home for fall hazards.
Hygiene and Personal Care
People who are obese are at higher risk for skin changes and problems, because their skin is not as healthy as that of a healthy weight person. Skin folds that form with obesity can lead to heat rash, bacteria formation, and other skin problems. Also, heavy body fat can cause skin tears and pressure ulcers. These skin complications are very important to avoid, given the danger of infection, the added cost of treatment, and their negative impact on your loved one’s quality of life.
Therefore, maintaining personal hygiene that avoids these skin complications is a critical element of care for your obese loved one who is at increased risk.
In the healthcare setting, caregivers who care for obese patients are at increased risk of caregiver injury, and in the past decade there has been greatly increased awareness of this. Consequently, much research has been done and guidelines, recommendations, and protocols have been put in place to better help staff responsible for caring for obese patients. But there are no such guidelines for family members who provide a similar level of care at home. Assisting with basic tasks such as standing/sitting, bathing, dressing, walking, helping with skin care needs, and even preparing meals can be very taxing, and several of these supportive actions actually risk injury to you. Improper lifting and moving of your obese loved one can result in an immediate back or neck injury, and over time, those actions of lifting and moving can also cause more slow-developing bone and muscle injuries. Asking a doctor or home health aide how to properly assist in these tasks without increasing risk of injury to yourself is helpful to both you and your loved one. You can’t be of help to anyone if you injure yourself trying to provide all aspects of home care for your obese loved one.
Management of Other Health Conditions
Type 2 diabetes, hypertension, heart disease, arthritis, sleep apnea, joint disease, and chronic respiratory and skin infections are just some of the major diseases and conditions that often accompany being obese. The complex management of these diseases and conditions can be very difficult, as they each require their own individual treatment protocols and often include multiple medications, as well as sometimes equipment and device usage.
Potential issues family members face in helping with this care can be confusion in medication, insurance-related issues, equipment challenges, or just having quality communication with and among all doctors.
What Can We Do?
We as caregivers want to know how we can help our loved ones be as healthy as possible. Helping them mobilize and increase their ability to assist in their own activity and care is critical to ensuring better health. Homecare programs can be a critical help in providing support for your loved one in this regard and as needs change.
There are also some things you can do individually for your loved one to create a mobile-friendly environment, including:
- Developing and maintaining a daily routine. Develop a daily structure for your loved one that includes mobility and physical activity and socialization. These activities can include his visiting with family, walking with family members, friends, or pets, and even reading. Any kind of routine exercise that involves movement to maintain activity and flexibility is good for him.
- Addressing pain, or have care provider support that can help with this task. It’s important to address any persistent pain he has because pain can impede mobility and can cause additional problems such as falls, poor sleep, and depression.
- Oversight of medications. It’s critical that someone be responsible to make sure medications are correct and that there is collaboration in this regard among all care providers. Timing for medications, possible side effects, and medicine interactions are just some of the factors to discuss with either your loved one’s physician and/or home health care aide or nurse. Any time there is a change in medications, you should request a new medication review.
Fall prevention measures can differ depending on a person’s level of obesity, age, agility, and other general risk factors. It’s wise to enlist some professional help in both “fall-proofing” your loved one’s home and assessing their individual fall risk, but you can also make some simple changes that decrease risk of a fall. The CDC stresses the following four main points for fall prevention at home:
- Encourage regular exercise. Activity is the best prevention, and exercise that improved balance and coordination is key.
- Have a healthcare provider review medications. As mentioned above, all medications should be reviewed with a physician, including over-the-counter medications.
- Have your loved one’s vision checked. Older adults should have their vision checked annually. A fall can be caused by something as simple as wearing old glasses or ones that do not fit well anymore.
- Make a safe environment. Have the environment evaluated for ways to cut risk of falls at your loved one’s home (this includes identification of fall hazards such as poor lighting, uneven steps, floor coverings, lack of railings and/or grab bars, furniture positioning, floor surfaces, etc.).
With regard to hygiene and self-care, consider the following:
- Encourage a regular step in the daily routine of cleaning with use of soap and water and a thorough drying of all skin
- Do a regular assessment of skin, observing any problems such as skin breakdown or infection, and development of pressure ulcers
- Provide cleansers, body odor products, and lotions that do not cause skin reactions
- Have a regular assessment by a nurse or home care aide
- Make sure there is adequate cooling in warmer climates and seasons
- Make dressing an easier task: Sometimes for an obese loved one, the task of dressing is hard. Make sure clothes are large enough and have a style that requires less body movement. (A loved one’s inability, for instance, to bend or raise his arms can really compromise his ability to dress, so clothes that open up the front or back are helpful.) Assess footwear—shoes should be lightweight, supportive, and properly fitted, with non-slip bottom surfaces, and likewise socks with non-skid treads should be used for fall prevention. These efforts are helpful in making dressing easier for both your loved one and you.
Getting Help When Needed
Basic activities can be very hard for the average loved one who is obese. Developing strategies—and sometimes obtaining some level of outside support and services to help with many of these strategies—is critical to helping your obese loved one and you as a caregiver.
A home aide who is professionally trained in various aspects of home care can come in and help daily, weekly, or on an as-needed basis to provide hands-on support for the basic activities listed in this article. An aide can also regularly examine your loved one and his environment for needs assessment of the following:
- New health concerns
- Treatment for existing health conditions
- Hygiene protocol changes or improvements
- Skin conditions
- Level and quality of mobility
- Fall prevention
- The need for and proper use of home medical equipment, including lift and transfer or other assistive devices, handrails, raised toilets, shower seats, improved lighting fixtures, lower beds and chairs of various heights and dimensions
- And more…
The challenges family members face in caring for an obese loved one at home can be overwhelming. But there are ways to address and manage these complex medical and personal needs, and support is available for each aspect of home care discussed here. It is important to determine what you can you do, what your loved one can do, and what you may need additional support to do in order to provide quality care for your loved one at home.