Bariatric patients are no longer a segregated part of the patient population. In the United States, 65% of the population is overweight or obese. About a third of all patients weigh 350 pounds or more. And they are present in every sector of healthcare, including nursing homes. All furniture and spaces need to acknowledge and accommodate the special ergonomic needs of these patients and residents. Among today’s considerations:
•Regularly including an adequate proportion of bariatric seating in waiting rooms is a necessity. Even standard furniture is increasing in scale to fit bigger and heavier people. Providers need to make sure that there is sufficient space in the seating area for large patients to maneuver past others and position themselves conveniently in the furniture.
•Skin health is of particular concern for the bariatric patient, especially those who are seated for extended periods. Without adequate pressure relief and moisture control, skin breakdown occurs rapidly. The additional stress of extra weight applied to the buttocks and thighs, difficulty with continuous movement, and the stress incontinence associated with pressure on the bladder can result in fragile skin and the possibility of deterioration to decubitus ulcers. Skin folds can trap both moisture and germs and require diligent attention. Ventilation and surface contour become important furniture design features to deal with this issue.
•Infection control remains a top priority in healthcare facilities throughout the United States and Canada as deadly “superbugs” increase their resistance to available antibiotics. Increasingly, nontoxic surfaces are of choice. For example, nanotechnology has been developed to eliminate bacterial growth, and silicone—a material used in multiple healthcare applications—has been adapted to repel microbial infestation on surfaces. It is crucial that the design of bariatric furniture incorporate such features in the same way that all other hospital surfaces and structures must; cleanability is critical and odor control is desirable as sweat, urine, and feces will soil furniture.
•Comfort for the bariatric patient is regularly overlooked in much of healthcare furniture and equipment. Simply reinforcing and scaling up seats, beds, and treatment rooms is inadequate. The particular ergonomic needs of bariatric residents must be attended to, such as seating with a seat-back pitch that does not compress the diaphragm.
•Obesity is a medical condition, not a failure of personality. Caregivers, like the rest of society, are increasingly assessing their own prejudices about extra-large patients. Environmental toxins such as plasticizers in our food and water, disturbed sleep patterns, and medication side effects are emerging as compelling causes of obesity along with sedentary lifestyles and nutrition. Compassion and robust problem-solving are among the necessary tools to deal with the debilitating effects and medical risks of obesity. Any design feature that preserves the dignity of patients is desirable. This can be as simple as styling that unifies all the furniture in public spaces and providing spaces or features that permit the patient ease of self-propelled access and egress of chairs and beds. For example, armrests with gripable front edges to assist in standing allow patients to preserve some independence of movement.
•The caregiving demographic is aging and the workforce is shrinking, as nurses, aides and attendants are feeling the effects of a career full of heavy lifting and exposure to contaminants. Back strain is a persistent Workers Compensation issue, so much so that in-room lifts are becoming required equipment in new construction situations. Easy and effective access to patients, whether sitting or lying down, can improve treatment and prevent injury.
•Not all bariatric patients come in the same package. As understanding about the obese population becomes more elevated, it becomes clear that one solution truly does not fit all patients. Android obesity is manifested as “apple-shaped,” with large torsos and waists and difficulty bringing arms close to the sides of one’s body. Gynecoid obesity is referred to as “pear-shaped,” and these patients typically have their weight concentrated in hips, buttocks, and thighs, which can make sitting uncomfortable in poorly adapted furniture.
•Long-term care institutions will increasingly feel the effects of the bariatric reality as baby boomers begin to populate these facilities. Accommodation to this now is wise, as today’s frail elderly give way to larger seniors with many mobility problems.
Helen Kerr is principal of Kerr and Company (www.kerr-co.com), a product and system development company focused on evidence-based strategic innovation in Toronto, Canada. For the healthcare furniture manufacturer Sittris, Kerr developed a specialized research and design approach for furniture used in bariatric healthcare settings. For further information, visit www.Sittris.com.