Media release

From: International Congress on Obesity

Older adults with the unhealthiest lifestyles can see their risk of nursing home admission doubled

·       Study is the first to measure the individual and combined association of lifestyle factors with nursing home admission

*Note – this is an early release from the International Congress on Obesity in Melbourne, 18-22 October. Please credit the congress if using this story*

*Note – press release available in Spanish and Portuguese, see links below*

New research presented at this year’s International Congress on Obesity (ICO 2022) in Melbourne, Australia (18-23 October) (a biennial meeting of the World Obesity Federation) shows that older adults with the unhealthiest lifestyles can see the risk of nursing home admission doubled, with the risk most pronounced in those aged 60 to 75 years. The study is by Dr Alice Gibson, The Menzies Centre for Health Policy and Economics, University of Sydney, NSW, Australia, and colleagues.

Population aging is one of the most significant social and economic changes affecting almost every country in the world. “Effective strategies to prevent or delay older adults entering nursing home care will help ensure society can adequately care for its increasing number of older people,” explains Dr Gibson.

The study used data from 127,108 men and women, aged 60 years and over, recruited to The 45 and Up Cohort Study (a long-term study to investigate healthy ageing in NSW Australia) between 2006 and 2009, with data linkage to health records. A healthy lifestyle score divided participants into three risk groups based on five equally contributing risk factors (up to 2 points awarded for each, total 10 points): smoking, physical activity, sitting, sleep, and diet quality. The main outcome was the risk for incident nursing home admission, estimated using statistical modelling. Results were also investigated by age and body mass index (BMI) groups.

One-quarter of participants (24%) were in the low-risk healthy lifestyle group (9-10 points), 62% were in the medium-risk group (6-8 points), and 14% in the high-risk (least healthy 0-5 points) group. During a median (IQR) follow-up of 11.3 years, 23,094 (18%) participants were admitted to a nursing home for the first time.

Compared with those in the low-risk group, risk of nursing home admission was 43% higher among participants in the high-risk group and 12% higher in the medium risk group. The risk of nursing home admission increased linearly, on average, by 19% with every unit decrease in healthy lifestyle score. Those with the lowest lifestyle score (less than 2 points out of 10) saw their risk of nursing home admission doubled compared with those with the highest ‘healthiest’ scores (9 or 10 points). This increased risk was slightly higher for the unhealthiest 60-64 year olds (2.15 times), compared with 65-74 year olds (61% increased risk) and 75-84 year olds (36% increased risk). Interestingly, risk estimates were not altered by overweight or obesity.

Four of the five lifestyle factors (the exception being diet) were independently associated with nursing home admission, which was highest amongst current smokers, who had a 55% increased risk of nursing home admission compared with non-smokers.

The authors say the findings “add to the growing body of work supporting healthy lifestyle factors as strong contributors of metabolic and cognitive health, successful and independent ageing, resulting in reduced likelihood of nursing home admission”.

They add: “Our study highlights the potential of preventing or delaying nursing home admission among at-risk individuals during ageing with interventions that promote a healthy lifestyle… This could be a powerful motivator for many individuals to adopt or maintain a healthier lifestyle. Further, our findings may also incentivise government investment in preventative healthcare and health promotion given the greater cost associated with caring for people in institutions. This will require a shift in health policy towards preventative health.”

The authors conclude: “An unhealthy lifestyle, irrespective of overweight or obesity, was associated with a marked increased risk of admission to a nursing home in adults aged 60 years and over. This association was strongest in men and women aged 60– 74 years compared to those aged 75 years and over. It is important to consider lifestyle risk factors not only in the prevention of chronic diseases but also in reducing or delaying long-term nursing home admission.”