People over 60s with the unhealthiest lifestyles more likely to require nursing home admission

Reviewed by Megan Craig, M.Sc.Aug 24 2023

Over 60s with the unhealthiest lifestyles are significantly more likely to require admission to a nursing home than their peers with the healthiest lifestyles, suggest the findings of a large population study published online in the Journal of Epidemiology & Community Health.

Physical inactivity, smoking, poor diet and sleep disorders between the ages of 60 and 64 seemed to be particularly influential: they were associated with a more than doubling in the risk of admission, the findings show.

Modifiable lifestyle risk factors are associated with the development and progression of several long term conditions, such as diabetes and dementia. But it's not clear whether these lifestyle factors, separately or combined, might influence the subsequent need for nursing home care.

To explore this further, the researchers accessed data for 127,108 men and women aged 60 and above who had been recruited to the Australian 45 and Up Study between 2006 and 2009.

At study entry all participants filled in a lifestyle questionnaire on five key risk factors for nursing home care: smoking; physical activity levels; sitting time; sleep patterns; and diet.

Based on the responses, participants were categorized into low, medium, or high risk lifestyle groups. Around 1 in 4 (24%) were allocated to the low risk group, nearly two thirds (62%) to the medium risk group, and 14% to the high risk group.

Linkage with medical records (Medicare Benefits Schedule) showed that during an average monitoring period of 10 years, 23,094 participants (18%) were admitted to a nursing home.

The researchers calculated that, compared with over 60s in the low risk lifestyle group, the risk of nursing home admission was 43% higher for those in the high risk group, and 12% higher for those in the medium risk group.

The association between lifestyle score and risk of nursing home admission was linear, but modified by age and physical impairment.

Further in-depth analysis indicated that lifestyle factors seemed to be especially influential among 60-64 year olds. Those in this age bracket with the unhealthiest lifestyles were more than twice as likely to be admitted to a nursing home than those with the healthiest.

All key lifestyle factors-;bar diet-;were independently associated with nursing home admission, with the risk of admission highest (55% higher) for current smokers.

This is an observational study, and as such, can't establish cause, added to which the researchers acknowledge various limitations to their findings.

For example, the study relied on questionnaire data at one point in time, so was unable to account for lifestyle behavior changes. The reasons for nursing home admission and what coexisting health conditions were present at admission were also unknown.

And dietary assessment wasn't comprehensive, which might explain why no independent association was found between diet and nursing home admission, say the researchers.

Nevertheless, they conclude their findings show that: "lifestyle factors are strongly associated with the risk of long-term nursing home admission in men and women older than 60 years," at least in Australia.

The need for nursing home care is "an outcome of great societal and economic importance with increased population aging," they point out.

"Strategies to improve lifestyle factors, including smoking cessation, reducing sitting time, increasing physical activity and improving sleep, should be explored as new public health measures to help reduce the future risk of nursing home admission," they suggest.