Lifestyle factors in 60s linked to aged care admissions

A study involving over 125,000 Australians has found that physical inactivity, smoking, poor diet and sleep disorders between the age of 60 and 64 more than double the risk of admission to aged care.

The research by The University of Sydney reported that those over 60 with the unhealthiest lifestyles were significantly more likely to require admission to aged care than their peers with the healthiest lifestyles.

“We know that factors like poor sleep and inactivity increase people’s risk of developing diseases like dementia and diabetes, but this is the first study to look at the independent and combined impact these established and emerging lifestyle behaviours have on a person’s risk of admission into aged care,” said Dr Alice Gibson of the University of Sydney’s Charles Perkins Centre and Menzies Centre for Health Policy and Economics.

“While further research is needed, our results suggest that people could potentially modify their lifestyle to alter their risk of admission to a nursing home or aged care facility in the future.”

“This is incredibly timely with the latest Intergenerational Report suggesting the number of people aged 65 and over in Australia will more than double over the next four decades, with an unprecedented demand on the aged care sector.”

Risk factors

Published in the Journal of Epidemiology & Community Health, the researchers used data from 127,108 men and women aged 60 and above who had been recruited to Sax Institute’s 45 and Up Study between 2006 and 2009.

At study entry participants filled in a lifestyle questionnaire on five key risk factors: 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 1 in 4 (24%) were allocated to the low-risk group, nearly two-thirds (62%) to the medium-risk group, and 14% to the high-risk group.

Those in the low-risk group needed to score in the lower risk category for all but one lifestyle factor and, conversely those in the high-risk group could not score at low risk for more than two of the lifestyle factors. Low risk was defined as adhering to national preventative health guidelines.

The researchers then linked this data with participants’ medical records via the Medicare Benefits Schedule and hospital data, allowing them to monitor for aged care admissions over 10 years.

The findings

Among the 127,108 participants with a mean follow-up of 10 years, 23,094 participants (18%) were admitted to a nursing home. Compared with over-60s in the low-risk lifestyle group, the risk of aged care admission was 43% higher for those in the high-risk group and 12% higher for those in the medium-risk group.

The association between lifestyle score and risk of aged care admission was linear, meaning that as the lifestyle score increased, the risk of admission to a nursing home decreased. However, this trend differed by age and physical impairment.

• For instance, lifestyle factors were especially influential among 60- to 64-year-olds, those in this age bracket with the unhealthiest lifestyle were more than twice as likely to be admitted to aged care than those with the healthiest lifestyle.
• All key lifestyle factors — bar diet — were independently associated with aged care admission.
• The risk of admission was highest (55% higher) for current smokers, compared with those who had never smoked.
   

The researchers emphasised that this is an observational study and as such can’t establish direct cause. The study also has some limitations.

For example, while common in large observational studies, the study relied on questionnaire data at one point in time so is unable to account for lifestyle behaviour changes over time. The reasons for aged care admissions and what coexisting health conditions were present at admission are also unknown.

Dietary assessment was only based on a few questions which assessed fruit, vegetable, fish, red and processed meat consumption, which might explain why no independent association was found between diet and nursing home admission, the researchers said.

Improving outcomes

The researchers concluded that in the Australian population: “Lifestyle factors are strongly associated with the risk of long-term nursing home admission in men and women older than 60 years. This evidence is an important contribution to aged care policy and might also serve as a personal motivator for lifestyle changes among younger at-risk individuals who do not want to lose their future independence and want to remain in their homes for as long as possible.”

“On a public health level this study suggests we should be looking at strategies to encourage older people to improve their lifestyle including focusing on smoking cessation, reducing sitting time, increasing physical activity and improving sleep to help reduce the burden on our aged care system,” Gibson said.

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