Background:
Obesity is a critical health issue for older Australians and can increase the risk of developing long-term health conditions such as heart disease, type 2 diabetes and certain cancers. Obesity rates are higher in people with severe mental illness (SMI) than in the general population, owing to the effects of antipsychotic antidepressant medications, diet and lack of adequate physical activity.
Aims:
This audit aims to establish whether patients have their BMI measured and recorded following admission to the Older Persons mental health inpatient wards in Ipswich and whether, in those with a BMI >30 kg/m2, or >28 kg/m2 in those with weight-related comorbidities, they are referred to the dietetics service for input. The audit also aims to propose strategies and recommendations to improve the management of older adults considered overweight.
Method :
A list of all inpatients admitted to the Specialist Older Persons mental health unit in Queensland, Australia, from Jan 2021 to Apr 2021 was obtained in Feb 2022, producing a sample of 25 inpatients. The audit tool was designed to capture demographic data – gender, age, and ethnicity. The tool captured the following parameters – body mass index (BMI), blood pressure (BP), serum cholesterol level, QRISK score, and HbA1c level, and, if so, whether this was done within 24 hours of admission. The tool also captured if obese patients had any documented management of their obesity.
Results:
All patients had documented BMI values at some point during their admission; however, in 24%, this had not been completed within 24hrs of their admission.60% of inpatients were classified as overweight or obese. The average BMI of patients with a diagnosis of psychosis was >30 (obese), and 100% of patients with a diagnosis of psychosis were classified as either overweight (BMI >25) or obese (BMI >30). The most common obesity-related comorbidity was dyslipidaemia (40%), followed by cardiovascular disease (32%) and type 2 diabetes mellitus (28%).
Conclusions
The study showed a high prevalence of overweight and obesity in our patient group, but only a few were formally diagnosed with obesity during admission. Hence patients did not receive effective management strategies to address overweight and obesity. This audit identifies inadequate attention to the important clinical issue of obesity, associated with significant and avoidable mortality, morbidity and healthcare costs. The limitation of the study included a relatively small sample size and the retrospective nature and was based on a single site.