Can a Healthy Lifestyle Compress the Disabled Period in Older Adults?
To determine whether lifestyle factors, measured late in life, could compress the disabled period toward the end of life.



Community-based cohort study of older adults followed from 1989 to 2015.



Four U.S. communities.



Community-living men and women aged 65 and older (N = 5,248, mean age 72.7 ± 5.5, 57% female, 15.2% minority) who were not wheelchair dependent and were able to give informed consent at baseline.



Multiple lifestyle factors, including smoking, alcohol consumption, physical activity, diet, body mass index (BMI), social networks, and social support, were measured at baseline. Activities of daily living (ADLs) were assessed at baseline and throughout follow-up. Years of life (YoL) was defined as years until death. Years of able life (YAL) was defined as years without any ADL difficulty. YAL/YoL%, the proportion of life lived able, was used to indicate the relative compression or expansion of the disabled period.



The average duration of disabled years was 4.5 (out of 15.4 mean YoL) for women and 2.9 (out of 12.4 mean YoL) for men. In a multivariable model, obesity was associated with 7.3 percentage points (95% confidence interval (CI) = 5.4-9.2) lower YAL/YoL% than normal weight. Scores in the lowest quintile of the Alternate Healthy Eating Index were associated with a 3.7% (95% CI = 1.6-5.9) lower YAL/YoL% than scores in the highest quintile. Every 25 blocks walked in a week was associated with 0.5 percentage points (95% CI = 0.3-0.8) higher YAL/YoL%.



The effects of healthy lifestyle factors on the proportion of future life lived free of disability indicate that the disabled period can be compressed, given the right combination of these factors.
Geriatric Research, Education, and Clinical Center, Boston, Massachusetts.|Health and Disability Research Institute, School of Public Health, Boston University, Boston, Massachusetts.|Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts.
Mini E
ME
Jacob
Department of Biostatistics, University of Washington, Seattle, Washington.
Laura M
LM
Yee
Department of Biostatistics, University of Washington, Seattle, Washington.|Department of Health Services, University of Washington, Seattle, Washington.
Paula H
PH
Diehr
Department of Biostatistics, University of Washington, Seattle, Washington.
Alice M
AM
Arnold
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.|Geriatric Research, Education, and Clinical Center, Seattle Veterans Affairs Medical Center, Seattle, Washington.
Stephen M
SM
Thielke
Benjamin Leon Center for Geriatric Research and Education, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
Paulo H M
PH
Chaves
Division of Cardiovascular Medicine, Stanford University, Palo, Alto.
Liana Del
LD
Gobbo
Division of General Medicine, University of California Davis Medical Center, Sacramento, California.
Calvin
C
Hirsch
New York Academy of Medicine, New York, New York.
David
D
Siscovick
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania. newmana@edc.pitt.edu.
Anne B
AB
Newman
D000203:Activities of Daily Living; D000368:Aged; D000375:Aging / Q000502:physiology / Q000523:psychology; D015992:Body Mass Index; D000072001:Diet, Healthy / Q000379:methods / Q000706:statistics & numerical data; D004185:Disability Evaluation; D015444:Exercise; D005260:Female; D000070497:Healthy Lifestyle / Q000502:physiology*; D006801:Humans; D008017:Life Expectancy; D008297:Male; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D012907:Smoking / Q000453:epidemiology*; D012944:Social Support; D014481:United States / Q000453:epidemiology
active life expectancy; disability; lifestyle; older adults