Editor's Note: Summary based on Jacob ME, Yee LM, Diehr PH, et al. Can a healthy lifestyle compress the disabled period in older adults? J Am Geriatr Soc 2016;64:1952-61. For accompanying commentary, please see the associated Expert Analysis.

Study Question: Does adopting a healthy lifestyle later in life prevent disability?

Methods: In this community-based cohort, the authors studied 5,248 adults ≥65 years of age (mean age 72.7 ± 5.5) from four US communities who were not wheelchair dependent or institutionalized and followed for up to 25 years. They examined the effect of multiple lifestyle factors on the proportion of able life (YAL/YoL%), where "years of able life" (YAL) was defined as the number of years spent since enrollment without difficulty in activities of daily living (ADL), and "years of life" (YoL) was defined as the number of years between enrollment and the subject's death. YAL/YoL% was used to indicate the relative compression or expansion of the disabled period. Multiple lifestyle factors, including smoking, alcohol consumption, physical activity, diet, body mass index (BMI), and social network and support, were measured at baseline. ADL were assessed at baseline and throughout the follow-up. A confounder-adjusted multivariable linear regression model was used to examine the effect of lifestyle factors on YAL, YoL, and YAL/YoL%. Potential confounders were sex, age, race, education, income, marital status, self-reported health, instrumental activity of daily living difficulties, weight change, cognition, and chronic conditions.

Results: The proportion of able life (YAL/YoL%) decreased with age, and women had more disabled years than men in all age groups. The mean duration of the disability period was approximately 2.9 years for men and 4.5 years for women. In a multivariable model, obesity was associated with a 7.3 point (95% confidence interval [CI]: 5.4–9.2) lower YAL/YoL% than normal weight. Being underweight (BMI <18.5 kg/m2) was associated with fewer YoL (3 fewer years) than normal BMI, but YAL and YAL/YoL% were not significantly different. Scores in the lowest quintile of the Alternate Healthy Eating Index were associated with a 3.7 point (95% CI: 1.6–5.9) lower YAL/YoL% than scores in the highest quintile. Every 25 blocks walked in a week was associated with a 0.5% point (95% CI: 0.3–0.8) higher YAL/YoL%. Current smoking conferred a drop of 2.6 points in YAL/YoL %, while having one drink or less per week was associated with a 1.9 point increase in YAL/YoL%.

Conclusion: In these community-dwelling older adults, physical activity and higher quality diet were associated with a relative compression of disability. Obesity was associated with a relative expansion of disability. These data indicate that disability in late life can be significantly compressed by of healthy lifestyle behaviors.

References

1. Jacob ME, Yee LM, Diehr PH, et al. Can a healthy lifestyle compress the disabled period in older adults? J Am Geriatr Soc 2016;64:1952-61.

Keywords: Geriatrics, Secondary Prevention

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