Healthy lifestyle in 60s linked to avoiding aged care when older

Having a healthy lifestyle in your 60s is linked to a dramatically lower risk entering a nursing home in later life,according to new research from Sydney University using data from the 45 and Up Study.

The study of 125,000 Australians aged 60 years or older, published in the Journal of Epidemiology & Community Health, found that having the healthiest type of lifestyle is linked to a lower risk of entering aged care compared to those with the unhealthiest lifestyles across all age groups. This link is strongest among 60 to 64 year olds – the unhealthiest in that age bracket were more than twice as likely to be admitted to aged care than those with the healthiest lifestyle.

“This study is more evidence that the earlier you start living a healthier lifestyle, the better,” says Dr Alice Gibson of the University of Sydney’s Charles Perkins Centre and Menzies Centre for Health Policy and Economics.

Researchers used survey responses from 45 and Up Study participants on physical activity, smoking status, sitting time, sleeping time and diet to give them a ‘lifestyle score’ between 0 and 10. The researchers then linked this data with participants medical records via the Medicare Benefits Schedule (MBS) and hospital data, allowing them to monitor for aged care admissions over 10 years. Of the 125,000 participants, 18% (23,000) were admitted to a nursing home in that period.

Those with a lifestyle score of less than two had half the chance of entering aged care than those with the highest score of 10. Smoking had the most impact on its own out of all lifestyle factors – the risk of admission was 55% higher for current smokers compared with those who had never smoked.

While this study can’t show a direct cause between lifestyle factors and nursing home admission, the link is significant, says Dr Gibson. It’s also particularly relevant given the latest Intergenerational Report suggesting the number of people aged 65 and over in Australia will more than double over the next four decades, which will put unprecedented pressure on the aged-care sector.

“People in their twenties now will be in the cohort of people aged over 60 in four decades time,” says Dr Gibson. “Now is the time to invest in preventive health interventions aimed at improving lifestyle behaviours.”

Lifestyle in the spotlight thanks to 45 and Up

Participants needed to report these lifestyle behaviours to have the best lifestyle score: be physically active for more than 300 minutes a week; be a non-smoker; sleep between 7 and 9 hours a day; sit less than 7 hours a day; and follow a diet with high intake of fruit and vegetables and low intake of red and processed meat.

“You can still be considered ‘low-risk’ overall even if you’re ‘high-risk’ in one behaviour,” notes Dr Gibson. “Another positive message from our research is that a person’s body mass index has no link to risk of nursing home admission. This supports the notion in wider literature that some excess weight can be protective in older age.”

This is the first time in Australia that a study has quantified the individual and combined association of lifestyle factors with nursing home admission, and the 45 and Up Study played a key role.

“This kind of study is hard to do, because it requires a long follow-up, which is where the value of the 45 and Up Study’s data linkage comes in with such a large cohort,” says Dr Gibson.

Using MBS items in in combination with hospital admission and discharge data to identify nursing home admissions is a novel but robust method, she adds. “For instance, nursing homes require people to have a GP when entering, and GPs are incentivised to bill Medicare for nursing home visits. Hospital data also contains information on where people are admitted from and where they are discharged too. There are very few reasons an admission wouldn’t be captured by this data.”

The 45 and Up Study is one of the largest ongoing studies of healthy ageing in the world, with more than 250,000 Australians recruited to it since its launch in 2005. The Study is administered by the Sax Institute and has been used in more than 500 published research papers world-wide.