Lifestyle habits and compression of morbidity.
ABSTRACT There has been much debate regarding the degree to which healthy lifestyles can increase longevity and whether added years will be offset by increased morbidity at older ages. This study was designed to test the compression of morbidity hypothesis, proposing that healthy lifestyles can reduce and compress disability into a shorter period toward the end of life.
Functional status in 418 deceased members of an aging cohort was observed between 1986 and 1998 in relationship to lifestyle-related risk factors, including cigarette smoking, physical inactivity, and under- or overweight. Three risk groups were created based on the number of these factors at study entry. Disability scores prior to death were modeled for each risk group to compare levels and rates of change, as well as to determine if and when acceleration in functional decline occurred.
The risk-factor-free group showed average disability scores near zero 10-12 years before death, rising slowly over time, without evidence of accelerated functional decline. In contrast, those with two or more factors maintained a greater level of disability throughout follow-up and experienced an increase in the rate of decline 1.5 years prior to death. For those at moderate risk, the rate of decline increased significantly only in the last 3 months of life. Other differences between groups provided no alternative explanations for the findings.
These results make a compelling argument for the reduction and postponement of disability with healthier lifestyles as proposed by the compression of morbidity hypothesis.
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ABSTRACT: Background To influence dietary behaviors, more insight in food choice motivations is necessary. This study identified what motivations older adults have to eat healthily and investigated to what extent these motivations are particular to specific subgroups according to socio-economic position and other demographic, lifestyle and health characteristics.Methods We used data from 1,050 older Dutch adults who participated in the Longitudinal Aging Study Amsterdam (65-80 years, independently living, normal cognitive status). Motivations to eat healthily and characteristics were measured with a self-reported questionnaire. We used logistic regression analyses to estimate odds ratios (OR) and 95% CI for the association between subgroups and motivations to eat healthily.ResultsThe most reported motivations to eat healthily were: ¿feeling fit¿ (51.7%), ¿current health¿ (49.7%) and ¿body weight¿ (39.2%). Multivariate analyses showed that older adults with chronic diseases (¿2 vs. no chronic disease OR: 4.41, 95% CI: 2.31-8.44) and a poor self-rated health (poor vs. good OR: 2.31, 95% CI: 1.22-3.73) were more likely to report ¿current disease¿ as a motivation to eat healthily. Groups from lower socio-economic positions were less likely to report ¿to prevent diseases¿ (low income vs. high OR: 0.52, 95% CI: 0.32-0.86, low education vs. high OR: 0.43, 95% CI: 0.27-0.70) and older adults with obesity were less likely to report ¿current health¿ (obese vs. normal weight OR: 0.47, 95% CI: 0.32-0.69) as motivations to eat healthily.Conclusion Multivariate analyses showed that the presence of a disease in older adults is an important motivation for them to eat healthily, which might indicate that older adults with health problems are aware of the link between their disease and nutrition. Older adults from lower socio-economic positions or those with obesity require a specific approach because disease prevention seems to be of lesser importance for these groups, even though a healthy diet could improve their health. Future research should investigate the reasons behind the motives of low socio-economic position and obese older adults.International Journal of Behavioral Nutrition and Physical Activity 11/2014; 11(1):141. · 3.68 Impact Factor
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ABSTRACT: Tobacco use remains the leading cause of morbidity and mortality in the US. Effective tobacco cessation aids are widely available, yet underutilized. Tobacco cessation brief interventions (BIs) increase quit rates. However, BI training has focused on conventional medical providers, overlooking other health practitioners with regular contact with tobacco users. The 2007 National Health Interview Survey found that approximately 20% of those who use provider-based complementary and alternative medicine (CAM) are tobacco users. Thus, CAM practitioners potentially represent a large, untapped community resource for promoting tobacco cessation and use of effective cessation aids. Existing BI training is not well suited for CAM practitioners' background and practice patterns, because it assumes a conventional biomedical foundation of knowledge and philosophical approaches to health, healing and the patient-practitioner relationship. There is a pressing need to develop and test the effectiveness of BI training that is both grounded in Public Health Service (PHS) Guidelines for tobacco dependence treatment and that is relevant and appropriate for CAM practitioners. The CAM Reach (CAMR) intervention is a tobacco cessation BI training and office system intervention tailored specifically for chiropractors, acupuncturists and massage therapists. The CAMR study utilizes a single group one-way crossover design to examine the CAMR intervention's impact on CAM practitioners' tobacco-related practice behaviors. Primary outcomes included CAM practitioners' self-reported conduct of tobacco use screening and BIs. Secondary outcomes include tobacco using patients' readiness to quit, quit attempts, use of guideline-based treatments, and quit rates and also non-tobacco-using patients' actions to help someone else quit. CAM practitioners provide care to significant numbers of tobacco users. Their practice patterns and philosophical approaches to health and healing are well suited for providing BIs. The CAMR study is examining the impact of the CAMR intervention on practitioners' tobacco-related practice behaviors, CAM patient behaviors, and documenting factors important to the conduct of practice-based research in real-world CAM practices.BMC Complementary and Alternative Medicine 12/2014; 14(1):510. · 1.88 Impact Factor