title: Midlife obesity and long-term risk of nursing home admission.
abstract: OBJECTIVE
  Obesity is a growing problem among middle-aged individuals. We investigated whether obesity in middle-aged individuals influences the need for future nursing home care and whether the risk of nursing home admission associated with obesity is greater in whites than in blacks.
  
  
  METHODS
  The study population (N = 8804) consisted of long-term members of the Kaiser Permanente Medical Care Plan ages 75 to 85 years in 1995 who had completed a standardized, multiphasic health checkup while in their 50s. The multiphasic health checkup examinations were performed as part of routine medical care between the years 1964 and 1973 and included standardized measurements of BMI. We used health plan records to assess incident nursing home admissions from 1995 to 2002. The risk of nursing home admission associated with standard categories of midlife BMI was estimated using Cox proportional hazard analysis.
  
  
  RESULTS
  During an average follow-up of 5.1 years, the nursing home admission rate was 6.8 per 100 person-years of observation. After adjustment for comorbidities, midlife obesity predicted incident nursing home admission approximately 25 years later [hazard ratio (HR), 1.30; 95% confidence interval (CI), 1.15 to 1.46; p < 0.001]. Overweight BMI at midlife was not associated with future nursing home admission (HR, 1.05; 95% CI, 0.97 to 1.14; p = 0.23). The risk of nursing home admission associated with midlife obesity was higher in whites (HR, 1.34; 95% CI, 1.17 to 1.54; p < 0.001) than in blacks (HR 1.15; 95% CI, 0.87 to 1.52; p = 0.32), but the difference between races was not significant (p for interaction = 0.65).
  
  
  CONCLUSIONS
  Obesity among middle-aged individuals is associated with an increased risk of nursing home admission in late life and may be an important target for reducing the future societal burden of nursing home care.
authors.affiliation: Department of Neurology, University of California, 505 Parnassus Avenue, Box 0114, San Francisco, CA 94143, USA. Jacob.elkins@ucsfmedctr.org
authors.forename: Jacob S
authors.initials: JS
authors.lastname: Elkins
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Whitmer
authors.forename: Stephen
authors.initials: S
authors.lastname: Sidney
authors.forename: Mike
authors.initials: M
authors.lastname: Sorel
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.forename: S Claiborne
authors.initials: SC
authors.lastname: Johnston
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D005500:Follow-Up Studies; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D009765:Obesity / Q000503:physiopathology*; D010343:Patient Admission / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012307:Risk Factors