Study reveals factors of exceptional health in old age

Elderly people who have a positive outlook, lower stress levels, moderate alcohol consumption, abstention from tobacco, moderate to higher income and no chronic health conditions are more likely to thrive in their old age, according to a study in the October issue of the Journals of Gerontology, Medical Sciences.

The first study of its kind, researchers from Portland State University, the Kaiser Permanente Center for Health Research, Oregon Health & Science University, and Statistics Canada surveyed 2,432 older Canadians about their quality of life. The few who maintained excellent health over an entire decade were considered "thrivers." Most previous studies have been based on one-time surveys and focused on factors that contribute to poor health.

"Important predictors of 'thriving' were the absence of chronic illness, income over $30,000, having never smoked, and drinking alcohol in moderation," said Mark Kaplan, DrPH, lead author and professor of community health at Portland State University. "We also found that people who had a positive outlook and lower stress levels were more likely to thrive in old age."

"Many of these factors can be modified when you are young or middle-aged," said David Feeny, Ph.D., study co-author and senior investigator at the Kaiser Permanente Center for Health Research. "While these findings may seem like common sense, now we have evidence about which factors contribute to exceptional health during retirement years."

Study participants filled out an extensive health survey every other year, starting in 1994 and continuing through 2004. One measure, called the Health Utilities Index, asked people to rate their abilities in eight categories, including vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain. "Thrivers" were those who rated themselves as having no or only mild disability in all eight categories on at least five of the six surveys.

If respondents reported moderate or severe disability on any of the six surveys, they were classified as not having a high quality of life or excellent health. Just over half (or 50.8 percent) of the respondents started out as "thrivers," but by the end of the 10 years, only 8 percent of the respondents were considered thrivers. At the end of the study period, 47 percent of the respondents were classified as not having a high quality of life or excellent health. Thirty-six percent had died and 9 percent were institutionalized.

"Even though the study was conducted in Canada, the findings are certainly applicable to the United States and other industrialized nations," says Bentson McFarland, MD, Ph.D., co-author and professor of psychiatry, public health and preventive medicine at Oregon Health & Science University. "Our population here in the United States is similar demographically to Canada's, and both health care systems rely on the same underlying technologies."

The study was funded by a grant from the National Institute on Aging. Authors include Mark S. Kaplan, Ph.D., and Nathalie Huguet, PhD, from Portland State University; Heather Orpana, Ph.D., from Statistics Canada and the University of Ottawa; David Feeny, Ph.D., from the Kaiser Permanente Center for Health Research and Health Utilities Incorporated; Bentson H. McFarland, MD, Ph.D., from Oregon Health & Science University, and Nancy Ross, Ph.D., at McGill University in Canada.

Author David Feeny has a proprietary interest in Health Utilities Incorporated (HUInc.), Dundas, Ontario, Canada. The HUI survey instrument used in this study was developed in cooperation with the Canadian government. Neither Feeny nor HUInc. received any monetary reimbursement for use of the survey.