Seating for bariatric or plus-sized patients is becoming more developed due to this increasing demographic in the population. This group of patients have unique needs when it comes to seating, may need seating for different lengths of time, or have other medical needs that need to be accommodated. As a supplier of bariatric equipment for many years, we have become accustomed to these needs and how they should be evaluated to ensure the best seating plan.
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Bariatric patients will have personal goals on a short to long-term scale, which they may have worked on with a nutritionist or personal carer. These could involve weight loss, surgery, physical and mental health goals. An occupational therapist will need to take these goals into account when carrying out a seating assessment.
The patient’s height, weight and shape are the key metrics that need to be accurately measured so that seat dimensions are correct. If these are not recorded accurately or manufactured to the correct size, the wrong-sized chair can cause a lot of discomfort and complications for a bariatric patient.
A person’s weight and shape can change over time, as can their personal objectives and lifestyle needs. These are important factors to consider when looking at the type of seating used, and whether the chair has sufficient adjustability to accommodate these changing needs over time.
The external environment is an important factor, crucially the amount of space needed for the patient’s daily needs, and space for carers to administer care and move around.
The importance of risk assessments cannot be underestimated; specifying bariatric seating should begin and end with a risk assessment. These will identify health risks to the patient and those caring for them, and a personal evacuation plan in the event of an emergency. These risks will need to be controlled and managed, which the choice of seating will play a large part in.
Weight fluctuations will vary depending on the patient’s level of exercise and personal mobility, as well as diet and nutrition. Large changes in weight loss and gain will directly impact size and the internal seat dimensions, therefore building adjustability into the chair is key which is where the Lento chair range comes into play. The Lento Bariatric Riser Recliner has simple adjustment mechanisms, providing extra seat width (28-32”), depth (extra 6”), and height (vertical rise function).
The standard Lento Bariatric riser recliner has a 50 stone weight limit. We piloted a 40-stone version for Derby Community Trust which fitted a wide distribution of bariatric patients within their Trust and was a resounding success. Both versions are currently available within our chair range.
Body dimensions in bariatric patients can vary; some of the more common distinctions include a pannus (large mass of tissue extending from the abdomen), a build-up of fluid around the legs and ankles and a large gluteal shelf (protruding posterior). Extra features can be added to seating to accommodate these needs, such as a sling to support the pannus, and reinforced legrests.
The patient’s level of mobility will influence how long they are in the chair, how well they can sit-to-stand, or whether they need assistance to transfer or carry out daily tasks. Higher-spec bariatric chairs have built-in features to help patients with less mobility. Removable or drop-down arms (e.g. the Arene chair) facilitate patient transfers and help carers access the patient easier. The Lento Bariatric is compatible with the Sara Stedy standaid, and has a graded vertical rise which can be adjusted to lift the patient out of the chair in a way that is most comfortable for them. This flexibility has been built into the Lento Bariatric to provide extra support for higher mobility needs.
Moving and handling needs will generally be greater the more limited mobility someone has. Carers may need to assist with washing, dressing and personal care, all requiring the correct moving and handling techniques. The patient’s natural lean and weight will need to be taken into account. The removable arms and adjustable arm height on the Lento Bariatric allow easier access to the patient for moving & handling.
The level of independence required by each patient should be addressed as a primary factor. The chair should be used to enhance the client’s independence rather than restrict them in any way.
The level of pressure relief required will be greater with bariatric patients due to the increased pressure on the contact surfaces of the chair. Gel or foam come as standard, but most specialist chairs should have the option to upgrade to high-risk gel or air in the seat cushion, to redistribute and prevent the build up of pressure as much as possible. The Lento Bariatric comes with a gel seat wrap covering the seat and legrest sections, the area that takes the most weight in an upright sitting position. The tilt-in-space function helps spread the weight more evenly, and the articulating legrest and independent backrest recline help adjust the patient’s position and avoid the build-up of pressure in any particular area.
If the patient is undergoing an exercise or rehabilitation program, the sit-to-stand function is key to help them in and out of the chair more regularly. As they increase in mobility and rehabilitate, the beauty of the Lento Bariatric is its versatility, in the way that sections of the chair are modular and can be swapped out for different versions. The backrest can be swapped from a more supportive lateral backrest to a standard waterfall or soft back.
The aim of seating standardisation is to accommodate a wider range of patients within a smaller range of chairs. With the many changing needs of bariatric patients, this is a concept that bariatric and moving & handling advisers are very enthusiastic about.
The growing need to optimise bariatric patient care is highlighted in a recent article in Nursing Times, where various care practitioners express the importance of seating standardisation in bariatric care.
Rob Harris, lead back adviser at Oxford UHFT, reported “We’re looking at standardising a lot of our equipment. What we’ve found in a lot of places is that a variety of suppliers are putting their products on trial. With slide sheets, for example, there’s [many types] out there. We’re looking at standardising it across the whole trust, which is a cost saving and ultimately improves patient care.”
Similarly, Claire Mowbray explained the incentive to standardise plus-sized equipment as much as possible. “We have high agency, high use of temporary staff. So in order for the training to be
easier, the equipment needs to be similar across the different wards.”
Derbyshire Community Health Service experienced the overwhelming benefits of a standardised seating package, reporting the following outcomes:
“Staff have access to appropriate chair for patient as soon as they arrive on the ward”
“Easy to tailor the chair to the patients’ individual needs”
“Very high pressure relief in seat and leg rest reduces the risk of skin damage”
Having a qualified occupational therapist assessing the individual needs of each bariatric patient is a real advantage in helping them overcome obstacles to their quality of life and cover all of their daily needs. Occupational Therapy (OT) Services are provided by local authorities and work in the community or care environments, and private occupational therapists are also available who work on a self-employed basis. We work with many OTs and therapists who support bariatric patients on a day-to-day basis.
When choosing specialist seating for bariatric patients, the seating provider or carer should not only take into account the contributing factors at that point in time, but also how their needs may change in the future. Doing this will future-proof the choice of seating and help increase the patient’s independence. Bariatric seating has become a more focused area of seating and offers the flexibility needed to accommodate changing needs over time.
We work closely with bariatric advisers to develop and improve our seating. Speak to one of our advisers about bariatric seating to find out more.