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

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New research from the University of Pittsburgh Graduate School of Public Health shows that leading a healthy lifestyle not only extends one’s lifespan, but it also shortens the time that is spent disabled.

We discovered that, fortunately, by improving lifestyle we can postpone both death and disability. In fact, it turns out that we’re compressing that disabled end-of-life period.

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

An analysis of a quarter century of data by scientists at the University of Pittsburgh Graduate School of Public Health and their colleagues nationwide 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 results are online and scheduled for the October issue of the Journal of the American Geriatrics Society.

“The duration of the disabled period near the end of one’s life has enormous personal and societal implications, ranging from quality of life to health care costs,” said senior author Anne B. Newman, M.D., M.P.H., chair of the Department of Epidemiology at Pitt Public Health and Katherine M. Detre Professor of Population Health Sciences. “We discovered that, fortunately, by improving lifestyle we can postpone both death and disability. In fact, it turns out that we’re compressing that disabled end-of-life period.”

Dr. Newman and her colleagues examined data collected by the Cardiovascular Health Study, which followed 5,888 adults from Sacramento County, Calif.; Forsyth County, N.C.; Washington County, Md.; and Allegheny County, Pa., 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 their social support system. The researchers took into account and 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 (those who were 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.

Put another way, that man’s healthy lifestyle has given him nearly three more years of active life free of disability than his unhealthy counterpart, who not only died earlier but spent the last three-and-a-half years of his life disabled—a larger percentage of those remaining years.

“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 E. Jacob, M.D., Ph.D., who completed this project during her doctoral studies at Pitt Public Health and currently is of the Boston University School of Public Health, Harvard Medical School and Veterans Affairs Boston Healthcare System. “We are not discounting the role of factors like income and chronic conditions, which we adjusted for in our analyses. 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.”

Additional authors are Laura M. Yee, Ph.D., Paula H. Diehr, Ph.D., and Alice M. Arnold, Ph.D., all of the University of Washington; Stephen M. Thielke, of the University of Washington and Seattle Veterans Affairs Medical Center; Paulo H.M. Chaves, M.D., Ph.D., of Florida International University; Liana Del Gobbo, Ph.D., of Stanford University; Calvin Hirsch, M.D., of the University of California Davis Medical Center; and David Siscovick, M.D., M.P.H., of the New York Academy of Medicine.

This research was supported by National Institute on Aging grant AG023629, with additional support from National Institutes of Health contracts HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85081, N01HC85082, N01HC85083, and N01HC85086; and National Heart, Lung, and Blood Institute grant HL080295, with contribution from the National Institute of Neurological Disorders and Stroke. Additional support was provided by the University of Pittsburgh Claude D. Pepper Older Americans Independence Center grant P30-AG-024827.

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About the University of Pittsburgh Graduate School of Public Health
The University of Pittsburgh Graduate School of Public Health, founded in 1948 and now one of the top-ranked schools of public health in the United States, conducts research on public health and medical care that improves the lives of millions of people around the world. Pitt Public Health is a leader in devising new methods to prevent and treat cardiovascular diseases, HIV/AIDS, cancer and other important public health problems. For more information about Pitt Public Health, visit the school’s Web site at http://www.publichealth.pitt.edu.

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