Functional assessment of older obese patients candidates for bariatric surgery.
BACKGROUND
Obesity in the elderly is associated with exacerbation of functional decline (dependency), that occurs with aging, because of decreased muscle mass and strength, and increased joint dysfunction. Consequently, there is progressive loss of independence, autonomy, chronic pain and impaired quality of life. The weight loss can bring benefits in all these aspects, especially when accompanied by exercises. Elderly patients with morbid obesity may be submitted to surgical treatment, taking into account that the massive weight loss, eventually caused by bariatric surgery, may exacerbate the loss of muscle mass and nutritional complications that may bring harm to the overall health and quality of life of these patients. The functional assessment of elderly patients, candidates for bariatric surgery and the extent to which surgery can bring benefits to the patients, in the field of functionality, has still to be determined.


OBJECTIVE
To describe profile functionality in obese elderly referred to a bariatric surgery program.


METHODS
Patients with age ≥ 60 and BMI ≥ 35 underwent comprehensive geriatric assessment that evaluates co morbidities, medication use, ability to perform basic activities of daily living and instrumental activities of daily living, and the "Timedupandgo" test to evaluate mobility, whose cut-off point was ≤ 10 seconds. Statistical analysis was performed in order to see if there is a positive correlation of dependency with BMI and age (over or under 65 years). Results Forty subjects have completed evaluation. The mean age was 64.1 years (60-72) and 75% were women. They had an average weight of 121.1 kg (72.7-204) and a mean BMI of 47.2 kg/m2 (35.8-68.9). 16 patients (40%) have shown dependency for activities of daily living, 19 (47,5%) for instrumental activities of daily living and 20 patients (50%) had a "Timedupandgo" test over 10 seconds. Statistical analysis (t-Student, Mann-Whitney, Binary Logistic Regression) has shown positive correlation of dependency in activities of daily living for BMI >49 kg/m2, dependency in instrumental activities of daily living for BMI >46,5 kg/m2, and "Timedupandgo" test greater than 10 seconds for BMI >51 kg/m2 (P<0,05). No dependency difference was observed for patients over or under 65 years age.


CONCLUSIONS
Functional decline is observed in almost half of the morbid obese patients over 60 years old. It is related to increasing BMI (BMI >46,5 kg/m2) but not related to age (60 to 65 years or over 65 years). Functional decline should be considered a co-morbidity in the elderly obese patients and should be assessed before bariatric surgery in this population.
Unidade de Cirurgia Bariátrica e Metabólica, Departamento de Gastroenterologia, Divisão Cirúrgica, Faculdade de Medicina da Universidade de São Paulo ? HC-FMUSP, São Paulo, SP, Brasil.
Denis
D
Pajecki
Unidade de Cirurgia Bariátrica e Metabólica, Departamento de Gastroenterologia, Divisão Cirúrgica, Faculdade de Medicina da Universidade de São Paulo ? HC-FMUSP, São Paulo, SP, Brasil.
Marco Aurélio
MA
Santo
Unidade de Cirurgia Bariátrica e Metabólica, Departamento de Gastroenterologia, Divisão Cirúrgica, Faculdade de Medicina da Universidade de São Paulo ? HC-FMUSP, São Paulo, SP, Brasil.
Ana Lumi
AL
Kanagi
Unidade de Cirurgia Bariátrica e Metabólica, Departamento de Gastroenterologia, Divisão Cirúrgica, Faculdade de Medicina da Universidade de São Paulo ? HC-FMUSP, São Paulo, SP, Brasil.
Daniel
D
Riccioppo
Unidade de Cirurgia Bariátrica e Metabólica, Departamento de Gastroenterologia, Divisão Cirúrgica, Faculdade de Medicina da Universidade de São Paulo ? HC-FMUSP, São Paulo, SP, Brasil.
Roberto
R
de Cleva
Unidade de Cirurgia Bariátrica e Metabólica, Departamento de Gastroenterologia, Divisão Cirúrgica, Faculdade de Medicina da Universidade de São Paulo ? HC-FMUSP, São Paulo, SP, Brasil.
Ivan
I
Cecconello
D000203:Activities of Daily Living; D000368:Aged; D050110:Bariatric Surgery / Q000009:adverse effects; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009765:Obesity / Q000601:surgery*; D016896:Treatment Outcome