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Elmira Valiyeva, PhD; Louise B. Russell, PhD; Jane E. Miller, PhD; Monika M. Safford, MD

Arch Intern Med. 2006;166:985-990.

Background  While risks of disease, hospitalization, and death attributable to lifestyle-related factors such as smoking, inactivity, and obesity have been well studied, their associations with nursing home admission are less well known. These risk factors are usually established by middle age, but nothing is known about how they relate to long-term risk of nursing home admission in this age group.

Methods  Cox proportional hazards regressions were used to analyze risk of nursing home admission over 2 decades of follow-up (1971-1975 to 1992) in a nationally representative, longitudinal survey of community-dwelling adults aged 45 to 74 years at baseline. Middle-aged (45-64 years at baseline) and elderly persons (aged 65-74 years at baseline) were analyzed separately: 230 (6.5%) of 3526 middle-aged respondents and 728 (24.7%) of 2936 elderly ones had 1 or more nursing home admissions. Baseline risk factors included smoking, inactivity, obesity, elevated blood pressure, elevated total cholesterol level, and diabetes mellitus, which were defined according to national guidelines.

Results  All lifestyle-related factors, except total cholesterol level, were associated with higher risk of nursing home admission during follow-up in one or both age groups. Risk ratios were higher in middle-aged than in elderly persons. In those aged 45 to 64 years at baseline, diabetes more than tripled the risk of nursing home admission (relative risk, 3.25; 95% confidence interval, 2.04-5.19); smoking, inactivity, and elevated systolic blood pressure had relative risks of 1.56, 1.40, and 1.35, respectively. Obesity was a risk factor for those aged 65 to 74 years at baseline, but not for the middle-aged subjects. Persons with 2 lifestyle-related factors were at greatly increased risk, especially if 1 was diabetes.

Conclusions  Lifestyle factors are important contributors to the long-term risk of nursing home admission. Modifying lifestyle, especially in middle age, may reduce the risk of admission.

Author Affiliations: Institute for Health, Health Care Policy, and Aging Research (Drs Valiyeva, Russell, and Miller), Department of Economics (Drs Valiyeva and Russell), and Bloustein School of Planning and Public Policy (Dr Miller), Rutgers University, New Brunswick, NJ; Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ (Dr Valiyeva); and Deep South Center on Effectiveness at the Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham School of Medicine (Dr Safford). Dr Valiyeva is not currently affiliated with an institution.

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