Abstract
BackgroundData on the combined effect of lifestyles on mortality in older people have generally been collected from highly selected populations and have been limited to traditional health behaviors. In this study, we examined the combined impact of three traditional (smoking, physical activity and diet) and three non-traditional health behaviors (sleep duration, sedentary time and social interaction) on mortality among older adults.MethodsA cohort of 3,465 individuals, representative of the Spanish population aged ≥60 years, was established in 2000/2001 and followed-up prospectively through 2011. At baseline, the following positive behaviors were self-reported: never smoking or quitting tobacco >15 years, being very or moderately physically active, having a healthy diet score ≥ median in the cohort, sleeping 7 to 8 h/d, spending <8 h/d in sitting time, and seeing friends daily. Analyses were performed with Cox regression and adjusted for the main confounders.ResultsDuring an average nine-year follow-up, 1,244 persons died. Hazard ratios (95% confidence interval) for all-cause mortality among participants with two, three, four, five and six compared to those with zero to one positive behaviors were, respectively, 0.63 (0.46 to 0.85), 0.41 (0.31 to 0.55), 0.32 (0.24 to 0.42), 0.26 (0.20 to 0.35) and 0.20 (0.15 to 0.28) (P for trend <0.001). The results were similar regardless of age, sex and health status at baseline. Those with six vs. zero to one positive health behaviors had an all-cause mortality risk equivalent to being 14 years younger. Adding the three non-traditional to the four traditional behaviors improved the model fit (likelihood ratio test, P <0.001) and the accuracy of mortality prediction (c-statistic: + 0.0031, P = 0.040).ConclusionsAdherence to some traditional and non-traditional health behaviors may substantially reduce mortality risk in older adults.
Highlights
Data on the combined effect of lifestyles on mortality in older people have generally been collected from highly selected populations and have been limited to traditional health behaviors
We developed a health behavior score where each study participant was given one point for each of the following six positive behaviors: never smoker or quitting smoking >15 years, very or moderately physically active, healthy diet score ≥ median in the cohort, sleeping 7 to 8 h/d, sitting time
After additional adjustment for all potential confounders and the other health behaviors, the associations were slightly attenuated but remained statistically significant, with the exception of seeing friends daily, which showed a marginal association with reduced mortality (HR = 0.92, 95% confidence intervals (CI): 0.79 to 1.08)
Summary
Data on the combined effect of lifestyles on mortality in older people have generally been collected from highly selected populations and have been limited to traditional health behaviors. Older adults are the fastest growing population subgroup in recent decades and make the highest use of healthcare services [13] This has spurred research on the effect of individual health behaviors in older adults [14,15,16,17,18,19]. It is surprising, that to date only the HALE project has examined the combined impact of health behaviors on mortality inolder persons; the data were limited to traditional lifestyles and were obtained in highly selected populations, which limit generalization of the results [7]. It is unclear whether greater adherence to the non-traditional health behaviors may improve survival beyond what is achieved by adhering to traditional healthy lifestyles
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