Healthy Lifestyle in Old Age Shortens End-of-Life Disability.

Leading a healthy lifestyle not only extends one’s lifespan, but it shortens the time that is spent disabled—a finding that previously had eluded public health scientists and that demonstrates the value of investing in healthy lifestyle promotion among elderly adults.

An analysis led by a School of Public Health researcher and colleagues from the University of Pittsburgh Graduate School of Public Health revealed that older adults with the healthiest lifestyles could expect to spend about 1.7 fewer years disabled at the end of their lives, compared to their unhealthiest counterparts. The study is online and scheduled for the October issue of the Journal of the American Geriatrics Society.

“This clearly demonstrates the great value of investing in the promotion of a healthy lifestyle and encouraging people to maintain healthy behaviors into old age,” said lead author Mini Jacob, a postdoctoral associate at the SPH Health & Disabilities Research Institute who completed the project during her doctoral studies at Pittsburgh Public Health.

Jacob and colleagues examined data collected by the Cardiovascular Health Study, which followed 5,888 adults from Sacramento County, California; Forsyth County, North Carolina; Washington County, Maryland; and Allegheny County, Pennsylvania, for 25 years. All of the participants were aged 65 or older and were not institutionalized or wheelchair-dependent when they enrolled.

The participants reported or were assessed for various lifestyle factors, including smoking habits, alcohol consumption, physical activity, diet, weight, and social support systems. The researchers adjusted results for such factors as participants’ age, sex, race, education, income, marital status, and chronic health conditions.

Across all the participants, the average number of disabled years directly preceding death—years when the person had difficulty eating, bathing, toileting, dressing, getting out of bed or a chair, or walking around the home—averaged 4.5 years for women and 2.9 years for men.

For each gender and race group, those with the healthiest lifestyle (nonsmokers of a healthy weight and diet and getting regular exercise) not only lived longer, but had fewer disabled years at the end of their lives. For example, a white man in the healthiest lifestyle group could expect to live 4.8 years longer than his counterpart in the unhealthiest group—and at the end of his life, he’d likely spend only two of those years disabled, compared to 3.7 years for his unhealthy counterpart.

“We are not discounting the role of factors like income and chronic conditions, which we adjusted for in our analyses,” Jacob said. “However, our results do indicate that increasing obesity levels of older Americans can herald a disability epidemic, and by urging healthy lifestyles, we may still be able to reduce the public health burden due to disability as more adults reach old age.”

Senior author Anne Newman, chair of the Department of Epidemiology at Pittsburgh Public Health, said the duration of the disabled period near the end of a person’s life has “enormous personal and societal implications, ranging from quality of life to health care costs. We discovered that, fortunately, by improving lifestyle, we can postpone both death and disability.”

Additional authors were from the University of Washington, Florida International University, Stanford University, University of California Davis Medical Center, and the New York Academy of Medicine.

The research was supported by the National Institute on Aging, with additional support from the National Institutes of Health; National Heart, Lung, and Blood Institute; National Institute of Neurological Disorders and Stroke; and the University of Pittsburgh Claude D. Pepper Older Americans Independence Center grant.

—Lisa Chedekel