Seating Patients with a Bariatric Condition

Obesity is becoming a worldwide challenge with a growing number of people becoming overweight.  According to a recent global study that reviewed the prevalence of obesity in the world, 2.1 billion people (close to 30% of the population) are overweight or obese, putting themselves at risk for diabetes, heart disease and cancers.

  • In Western Europe, 61% of men, 47% of boys and 22% of girls are overweight and obese and in North America, 70% of men, 60% of women, 28% of boys and 29% of girls are overweight and obese.
  • According to another study, the number of severely obese patients quadrupled between 1986 and 2000 from 1 in 200 to 1 in 50 people.
  • Close to 10% of medical spending is spent on bariatric patients.

For the healthcare system, this presents a unique challenge.

Moving and handling concerns are magnified with bariatric patients due to their size and weight and the risk of injury to staff and patients alike.  There is also a lack of proper bariatric seating available, meaning a person is often spending significant amounts of time in bed.  However, in bed, the ability to do simple tasks such as reading, writing and personal care is greatly reduced.

In addition, inactivity due to bed rest can result in a 10-20% decrease in muscle strength per week.³   For patients spending prolonged periods of time in bed, this reduces their ability to sit upright, stand and walk, leading to longer hospital stays and increased costs to the healthcare system.

What Are the Risks?

Seating bariatric patients can often present several challenges to both the patient and caregivers.  The weight and size of the patient, limitations in mobility and independence combined with a lack of proper equipment can significantly increase the risk of manual handling injuries, pressure damage and increased hospital stays.  In terms of seating; postural support, pressure management and increased independence are important requirements that unfortunately are not available in many chairs for this patient group.
There are many details that need to be taken into consideration such as the weight of the client, the body proportions, physical dimensions, range of movement, mobility and transfers.  The needs of the caregiver should also be incorporated into the selection of the chair.

Accommodating the Gluteal Shelf

Bariatric support is unique in that unlike most patients, the gluteal shelf, or bulbous gluteal region makes it more difficult to give patients the full back support that they need.  The extra tissue in the posterior lumbar region often forces patients to sit forward in the chair, without proper support given to their legs and upper back.  This position can be dangerous, causing long-term postural complications such as posterior pelvic tilt.  It can lead to instability in sitting and increased risk during sit-to-stand movements.

It is important to seat bariatric patients in a chair which can accommodate the gluteal shelf while also giving upper body support.  A chair with a removable cushion at the lumbar level to accommodate the gluteal shelf allows the patient to sit back into the chair, with their legs and back supported.

WATCH: How to Seat Bariatric Patients

In this informative and educational video, Martina Tierney OT outlines the common mistakes, challenges and risks associated with seating patients with a bariatric condition and how to overcome these.

Find out more about seating bariatric patients on our blog here.

Key Chair Features Required

A proper seat depth gives full support to the patient’s legs and in some cases their abdomen. A proper seat depth increases their surface area contact with the chair, reducing interface pressure. It can also reduce the effort of gravity pulling the body forward and thus decreasing the strain on the back musculature and spine that are constantly working to keep the patient upright.
A leg rest that retracts underneath the chair can accommodate larger calves and allow the patient to maintain a typical 90 degree knee flexion posture with their weight distributed evenly through the feet. In sitting, this reduces the risk of the patient having to rest their weight on his or her heels or toes, decreasing the risk of pressure ulcers over the more bony areas in the feet.

In sit to stand transfers, anterior tilt empowers the patient to be more independent and reduces the need for caregiver assistance and/or the use of patient lifts (hoist). By giving the patient more independence for safe transfers, he or she may feel better about the ability they have to care for themselves and may not be embarrassed about relying on others for help.

A chair that has removable arms will also help with transfers by giving caregivers more space to put a sling in place. If a patient is able to side- transfer, removing the arms will be an important feature to assist with this function.

The Solution.  The Bariatric Sorrento™

Seating Matters developed the Bariatric Sorrento™ chair as the only chair of it’s kind to be designed exclusively for patients of up to 650lbs / 294kg / 45 stone.  The Bariatric Sorrent greatly helps with a patient’s rehab, enabling earlier mobilisation, and less time spent on bed rest.  The unique features of the Bariatric Sorrento  assist the patient with sit to stand transfers and can lead to shorter hospital stays.  It has optimum pressure management properties included as standard, allowing full body loading ensuring the body weight is distributed over the surface area of the chair, and when used in conjunction with The Four Principles of Pressure Management in Seating it can reduce pressure ulcers by up to 88%.  The Bariatric Sorrento™ is the worlds only tilt in space bariatric wheelchair.

DISCOVER MORE

Now with the option of DRIVE ASSIST™

DRIVE ASSIST™ enables safer mobility at the touch of a button.  A power pack controls the movement of the chair, steered easily by a caregiver.  This added motorized movement will enable safer handling of patients with a bariatric condition by safely driving the chair, allowing caregivers to easily steer and control the movement of the chair throughout a home or care facility.

This is a revolutionary development and enhancement which will improve the lives of patients with a bariatric condition, and ensure safer handling of bariatric patients using the Seating Matters Bariatric Sorrento™.

References

1. Ng M, Fleming T, Robinson M, et al, Global, regional and national prevalence of overweight and obesity in children and adult during 1980-2013: A systematic analysis for the global burden of disease study 2013. The Lancet. 2014; 384(9945);766-81.

2. Berger E. Emergency departments shoulder challenges of providing care, preserving dignity for the ‘super obese.’ Animals of Emergency Medicine, 50(4): 443-45, 2007.

3.  Jiricka, M.K. (2008) Activity tolerance and fatigue pathopyysiology: concepts of altered health states.  Essentials of Pathophysiology: Concepts of Altered Health States.  Philadelphia: Lippincott Williams & Wilkins.

4. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W, Annual Medical Spending Attributable to Obesity; Payer-and Service-specification Estimates. Health Affairs. 28(5): w822-831, 2009.

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