Healthy Lifestyle in Elderly Shortens End-of-Life Disability

Leading a healthy lifestyle not only extends one’s lifespan, but it also shortens the time that is spent disabled—a finding that demonstrates the value of a public health investment 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 (GSPH) 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, chair of the GSPH’s Department of Epidemiology and the Katherine M. Detre Endowed Chair 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.” 

Newman and her colleagues examined data collected by the Cardiovascular Health Study, a project sponsored by the National Heart, Lung, and Blood Institute, which followed 5,888 adults from Sacramento County, Calif.; Forsyth County, N.C.; Washington County, Md.; and Allegheny County, Pa.; for 25 years. All 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 (nonsmokers of a healthy weight and diet and getting regular exercise) lived longer and 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 gave him nearly three more years of active life free of disability. This compares to his unhealthy counterpart, who not only died earlier, but spent a larger percentage of those remaining years disabled.

“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, who completed this project during her doctoral studies at GSPH and is now a postdoctoral fellow at Harvard Medical School, Boston University School of Public Health, 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,” Jacob said. “However, our results do indicate that the increasing obesity levels of older Americans can herald a disability epidemic. By urging healthy lifestyles, we may still be able to reduce the public health burden due to disability as more adults reach old age.”