Abstract
Importance: Few studies have addressed the combined effects of health-promoting and self-care behaviors among older adults. Thus, new research is needed to assess the potential for behavior change to prolong independence in later life. Objectives: To determine the relationships between self-care behaviors and risks of mobility and activities of daily living (ADLs) over time. Design: Longitudinal data was used from the National Health and Aging Trends Study (NHATS) cohort. Eight baseline self-care behaviors were summarized using latent class analysis. Separately, longitudinal latent classes of mobility and ADLs were created. Setting: Annual in-person interviews conducted for a nationally representative sample. Participants: The baseline study sample included 7,609 Medicare beneficiaries aged ≥65 from NHATS who were living in community or residential care settings, with a 71% response rate. The average age was 75, with 57% female, 81% white and 78% high school graduates or higher. Approximately, 80% (n = 6,064) completed 5 years of follow-up. Exposures: Favorable vs. unfavorable self-care latent classes measured at baseline. Main outcomes and Measures: Associations were measured between baseline classes and longitudinal classes of mobility and ADLs difficulty. Among decedents, 5-year associations were measured between baseline classes and years of overall, healthy, able, and healthy/able life. Results: Two habitual baseline self-care behavioral patterns (46% favorable; 54% unfavorable) and three trajectories of change in mobility and ADLs disability (maintaining independence; shifting to accommodation/difficulty; shifting to assistance) emerged over time. Participants with a favorable baseline pattern had 92% (0.90–0.94) reduced risk in shifting to assistance class and 70% (0.64–0.76) reduced risk for shifting to accommodation/difficulty class for mobility disability. Participants with a favorable baseline pattern had 86% (0.83–0.89) reduced risk in shifting to assistance class and 24% (0.11–0.36) reduced risk in shifting to accommodation/difficulty class for ADLs disability. Those with an unfavorable pattern had 2.54 times greater risk of mortality by the end of the 5-year follow-up compared to those with a favorable pattern. Conclusion: Self-care behaviors in older age represent a habitual pattern. A favorable self-care behavioral pattern decreased the risk of moving towards a more disabled profile and added years of life. Interventions should encourage self-care behaviors constituting a favorable pattern.
Highlights
Healthy aging has been defined as “the process of developing and maintaining functional ability that enables well-being in older age.” (Michel and Sadana, 2017) Self-care encompasses behaviors that individuals may engage in to improve their health, wellbeing, and functioning as they become older (Levin and Idler, 1983) Examples of self-care may include healthy eating, sleep, financial fitness, healthy relationships, medication management, exercise, community engagement and falls prevention (Aging Mastery Program, 2020) Given that self-care practices are modifiable, individuals can maximize their health benefits
We modeled the association between baseline self-care behavioral patterns and change in mobility and ADLs disability over time using latent class regression (LCR)
Participants with a favorable baseline self-care behavioral pattern had a 92% reduced risk in shifting to the assistance class and a 70% reduced risk of shifting to the accommodation/difficulty class for mobility disability than those with an unfavorable pattern (Table 3) over 5 years
Summary
Healthy aging has been defined as “the process of developing and maintaining functional ability that enables well-being in older age.” (Michel and Sadana, 2017) Self-care encompasses behaviors that individuals may engage in to improve their health, wellbeing, and functioning as they become older (Levin and Idler, 1983) Examples of self-care may include healthy eating, sleep, financial fitness, healthy relationships, medication management, exercise, community engagement and falls prevention (Aging Mastery Program, 2020) Given that self-care practices are modifiable, individuals can maximize their health benefits. Previous research suggests that declines in mortality are greatest among those maintaining physical activity, and even low-intensity programs can contribute to longevity (Xue et al, 2012) there is much to learn about how changes across a range of healthy behaviors in older adults might prolong independence. Using a framework for studying patterns of change in longitudinal physical activity behaviors and mortality risk in older women (Xue et al, 2012), we used the nationally representative National Health and Aging Trends Study (NHATS) to: 1) identify subpopulations among Medicare beneficiaries 65 and older with distinct baseline patterns of self-care behaviors, 2) to examine the relationship of baseline individual self-care behavior patterns on mobility and ADLs disability over time, and 3) to explore how these self-care behavioral patterns influence the years of healthy and able life. We hypothesize that self-care behavioral patterns can compress the number of disabled years
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