Outcomes/Effectiveness Research

Modifying unhealthy habits in middle age may reduce the likelihood of nursing home admissions later in life

Middle-aged adults who make lifestyle changes such as quitting smoking, boosting activity levels, and controlling their hypertension may reduce their future risk of nursing home admission. Researchers tracked a nationally representative sample of middle-aged (45 to 64 years at baseline) and elderly people (65 to 74 years at baseline) surveyed in the National Health and Nutrition Examination Survey between 1971 and 1975 and tracked in the Epidemiologic followup Study until 1992. Over the 20-year followup period, 6.5 percent of middle-aged and nearly 25 percent of elderly respondents had one or more nursing home admissions. Researchers examined which lifestyle-related risk factors identified by major national disease prevention guidelines (smoking, inactivity, obesity, elevated blood pressure, elevated total cholesterol level, and diabetes mellitus) were linked to later nursing home admissions.

All of these lifestyle-related factors, except total cholesterol level, were associated with higher risk of later nursing home admission in one or both age groups. However, the risk was higher in middle-aged than elderly people. In those age 45 to 64 years at baseline, diabetes more than tripled the risk of nursing home admission. Smoking, inactivity, and elevated systolic blood pressure increased the risk by 56, 40, and 35 percent, respectively.

Obesity was a risk factor for those age 65 to 74 years at baseline, but was not statistically significant for middle-aged adults. People with two lifestyle-related factors were at greatly increased risk, especially if one was diabetes. Given the prevalence of these risk factors among the middle-aged population, simple lifestyle changes could dramatically reduce nursing home admissions. For example, more than half of middle-aged respondents were inactive; more than 40 percent had high blood pressure; and 38 percent were smokers. The study was supported in part by the Agency for Healthcare Research and Quality (HS11477).

More details are in "Lifestyle-related risk factors and risk of future nursing home admission," by Elmira Valiyeva, Ph.D., Louise B. Russell, Ph.D., Jane E. Miller, Ph.D., and Monika M. Safford, M.D., in the May 8, 2006, Archives of Internal Medicine 166, pp. 985-990.

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