Unhealthy behaviours and disability in older adults: Three-City Dijon cohort study

Abstract

Objectives To examine the individual and combined associations of unhealthy behaviours (low/intermediate physical activity, consuming fruit and vegetables less than once a day, current smoking/short term ex-smoking, never/former/heavy alcohol drinking), assessed at start of follow-up, with hazard of disability among older French adults and to assess the role of potential mediators, assessed repeatedly, of these associations.Design Population based cohort study.Setting Dijon centre of Three-City study.Participants 3982 (2410 (60.5%) women) French community dwellers aged 65 or over included during 1999-2001; participants were disability-free at baseline when health behaviours were assessed.Main outcome measure Hierarchical indicator of disability (no, light, moderate, severe) combining data from three disability scales (mobility, instrumental activities of daily living, basic activities of daily living) assessed five times between 2001 and 2012.Results During the 12 year follow-up, 1236 participants (861 (69.7%) women) developed moderate or severe disability. Interval censored survival analyses (adjusted for age, sex, marital status, and education) showed low/intermediate physical activity (hazard ratio 1.72, 95% confidence interval 1.48 to 2.00), consuming fruit and vegetables less than once a day (1.24, 1.10 to 1.41), and current smoking/short term ex-smoking (1.26, 1.05 to 1.50) to be independently associated with an increased hazard of disability, whereas no robust association with alcohol consumption was found. The hazard of disability increased progressively with the number of unhealthy behaviours independently associated with disability (P<0.001); participants with three unhealthy behaviours had a 2.53 (1.86 to 3.43)-fold increased hazard of disability compared with those with none. Reverse causation bias was verified by excluding participants who developed disability in the first four years of follow-up; these analyses on 890 disability events yielded results similar to those in the main analysis. 30.5% of the association between the unhealthy behaviours score and disability was explained by body mass index, cognitive function, depressive symptoms, trauma, chronic conditions, and cardiovascular disease and its risk factors; the main contributors were chronic conditions and, to a lesser extent, depressive symptoms, trauma, and body mass index.Conclusions An unhealthy lifestyle is associated with greater hazard of incident disability, and the hazard increases progressively with the number of unhealthy behaviours. Chronic conditions, depressive symptoms, trauma, and body mass index partially explained this association.

Risk factors for potentially inappropriate prescribing to older patients in primary care

“…We did not make a distinction between necessary and unnecessary polypharmacy, using only the total amount of prescription drugs when defining this phenomenon, and this could potentially contribute to elucidation of this dilemma. The unhealthy behaviors put the patient at risk of increased morbidity, mortality, and functional decline [33,37] and can possibly lead to unnecessary use of medications to reduce such risks at the expense of far more effective nonpharmacological measures.…”

“…2. Unhealthy lifestyle habits of patients-set as a dichotomous variable; it encompassed at least two of four unhealthy behaviors such as sedentary lifestyle (i.e., physical inactivity, defined as lack of both walking at least a hour per day and exercising at least once per week or engaging in physical activity to a lesser extent than those allowed by the patient's objective health status if he/she was unable to walk, and exercise at the mentioned minimum frequency and duration due to severity of the existing diseases), improper nutrition (consuming fruits and vegetables less than once daily), active smoking or heavy alcohol consumption (intake of more than three drinks per day for men and more than two drinks daily for women); criteria for identifying bad lifestyle habits were taken from the recently published study by Artaud F et al, who found certain unhealthy behaviors to be associated with a significantly increased risk of disability in a large population-based cohort of communitydwelling older patients in France [33]. 3.…”

Disability trajectories and associated disablement process factors among older adults in Taiwan

“…As for the intra-and extra-individual factors, the disablement process asserts that these factors serve as buffers, which may increase the individual's capacity or decrease environmental demands in an attempt to retard or reverse the progression of disablement. Intra-individual factors, including better social relations, a healthier lifestyle, and LTAs, play roles in increasing older adults' functional capacities and preventing physical deterioration (Artaud et al, 2013;Boyle, Buchman, Wilson, Bienias, & Bennett, 2007;James, Boyle, Buchman, & Bennett, 2011;Mendes de Leon, Gold, Glass, Kaplan, & George, 2001;Tak, Kuiper, Chorus, & Hopman-Rock, 2013). Extraindividual factors, such as using assistive devices and technology, are seen as external supports that help older adults achieve better functioning.…”

Consumption of fruit and vegetables and risk of frailty: a dose-response analysis of 3 prospective cohorts of community-dwelling older adults

“…Despite the extensive evidence showing that FV consumption improves the health of young adults, the extent to which these benefits apply to older adults has received relatively little attention. The few existing prospective data suggest that consuming FVs during old age may help prevent the onset of depression (13), cognitive decline (14), mobility limitations, and disability (15)(16)(17)(18) while positively influencing muscle strength (19,20) and bone mineral status (21,22). In addition, the consumption of FVs in older adults has shown to decrease the risk of disease-specific and allcause mortality (23)(24)(25).…”