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ExerciseAug 23, 2023

Increasing physical activity levels among over-60s helps cut higher risk of nursing home admission

People aged over 60 who have the unhealthiest lifestyles are significantly more likely to end up in nursing homes than their counterparts with the healthiest lifestyles. That is the conclusion of a team that conducted a large population study that appeared online in the Journal of Epidemiology & Community Health today (24 August).

A series of factors – being physically inactive, smoking, poor diet and sleep disorders from the ages of 60 to 64 – appeared to be particularly influential and were associated with a more than doubling in the risk of admission, the researchers found.

The question over whether modifiable lifestyle risk factors are linked to the development and progression of several long-term conditions, such as diabetes and dementia, has been looked at before. But it has not been clear whether these lifestyle factors, separately or combined, might influence the subsequent need for nursing home care.

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People's 'unhealthy lifestyles' - such as sitting down too much - need to be addressed

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Five key risk factors revealed

To explore this issue, the researchers accessed data for 127,108 men and women aged from 60 onwards who had been recruited to the Australian 45 and Up Study from 2006 to 2009. 

At study entry all participants filled in a lifestyle questionnaire on five key risk factors for nursing home care: smoking; physical activity levels; sitting time; sleep patterns; and diet.

Based on the responses, participants were categorised into low, medium, or high-risk lifestyle groups. Around one in four (24 per cent) was allocated to the low-risk group, nearly two thirds (62 per cent) to the medium risk group, and 14 per cent to the high risk group.

Linkage with medical records (Medicare Benefits Schedule) showed that during an average monitoring period of 10 years, 23,094 participants (18 per cent) were admitted to a nursing home.

The researchers calculated that, compared with over-60s in the low-risk lifestyle group, the risk of nursing home admission was 43 per cent higher for those in the ‘high risk’ group, and 12 per cent higher for those deemed to be ‘medium risk’.  

The association between lifestyle score and risk of nursing home admission was linear but was modified by age and physical impairment. Further in-depth analysis indicated that lifestyle factors seemed to be especially influential among those aged from 60 to 64 years. Those in this age bracket with the unhealthiest lifestyles were more than twice as likely to be admitted to a nursing home than those with the healthiest lifetyle.

All key lifestyle factors – exept diet – were independently associated with nursing home admission, with the risk of admission highest (55 per cent higher) for current smokers.

Strategies to improve lifestyle factors, including smoking cessation, reducing sitting time, increasing physical activity and improving sleep, should be explored ... to help reduce the future risk of nursing home admission [Alice A Gibson et al]

Caveats and conclusions

As this was an observational study, it cannot establish cause, added to which the researchers acknowledge various limitations to their findings. For example, the study relied on questionnaire data at one point in time, so was unable to account for lifestyle behaviour changes. The reasons for nursing home admission and what coexisting health conditions were present at admission were also unknown.

The dietary assessment wasn’t comprehensive, which might explain why no independent association was found between diet and nursing home admission, say the researchers.

Nevertheless, they conclude their findings show that ‘lifestyle factors are strongly associated with the risk of long-term nursing home admission in men and women older than 60 years’ – at least in Australia.

The need for nursing home care is ‘an outcome of great societal and economic importance with increased population ageing’, the research team, led by Alica A Gibson from the University of Sydney, points out.

‘Strategies to improve lifestyle factors, including smoking cessation, reducing sitting time, increasing physical activity and improving sleep, should be explored as new public health measures to help reduce the future risk of nursing home admission,’ Dr Gibson and her colleagues add.

To access the full version of the article – titled Impact of lifestyle risk factors on admission to nursing home care: a cohort study of 127,108 people aged 60 years and over doi 10.1136/jech-2023-220518 – click

Author: Ian A McMillan
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