Body Mass Index and 30-Day Adverse Outcomes Among Newly Admitted Residents to Skilled Nursing Facilities.

OBJECTIVE:To examine the association between body mass index (BMI) and outcomes, including discharge to home, hospitalization, death, or continued residence in the skilled nursing facilities (SNFs), among residents newly admitted to SNFs. DESIGN:Retrospective observational design using the national Minimum Data Set 2.0 from 2006 to 2010. SETTING:SNFs in the United States. PARTICIPANTS:Newly admitted SNF residents. MEASUREMENTS:Four discharge outcomes were assessed at 30 days subsequent to the initial admission to SNF, including discharge to home, hospitalization, death, or continued residence in the SNFs, and examined using a competing hazards model. SNF residents were categorized as underweight (BMI < 18.5), normal to overweight (18.5 ≤ BMI < 30), mildly obese (30 ≤ BMI < 35), and moderately to severely obese (BMI ≥ 35). RESULTS:The study sample was composed of 3,812,333 newly admitted SNF residents. As compared with normal to overweight SNF residents, underweight individuals were less likely [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.82-0.83] to be discharged home and more likely to be hospitalized (HR 1.06, 95% CI 1.05-1.07), or to die (HR 1.59, 95% CI 1.56-1.62), rather than continue to reside in the facility. Residents with mild obesity were more likely (HR 1.12, 95% CI 1.11-1.13) to be discharged home and less likely to be hospitalized (HR 0.96, 95% CI 0.95-0.97) or to die (HR 0.74, 95% CI 0.73-0.76). Moderately to severely obese individuals were also more likely to be discharged home (HR 1.11, 95% CI 1.10-1.11) and less likely to be hospitalized (HR 0.94, 95% CI 0.93-0.95) or die (HR 0.66, 95% CI 0.64-0.68). CONCLUSIONS/IMPLICATIONS:SNF residents with obesity experience more favorable short-term outcomes compared with underweight or normal to overweight residents. Underweight residents are at the greatest risk for adverse outcomes, emphasizing the need for special surveillance and preventive efforts targeting these individuals.