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Modifiable Factors Associated With Survival and Function to Age 90 Years

Laurel B. Yates, MD, MPH; Luc Djoussé, MD, MPH, DSc; Tobias Kurth, MD, ScD; Julie E. Buring, ScD; J. Michael Gaziano, MD, MPH

Arch Intern Med. 2008;168(3):284-290.

Background  Prospective data on nongenetic determinants of exceptional longevity are limited, and information on long-lived men and their functional status is particularly sparse. We examined modifiable factors associated with a life span of 90 or more years and late-life function in men.

Methods  In this prospective cohort study of 2357 healthy men (mean age, 72 years) within the Physicians' Health Study (1981-2006), biological and lifestyle factors and comorbid conditions were assessed by self-report with baseline and annual questionnaires. Mortality and incidence of major diseases were confirmed by medical record review. Late-life function was assessed 16 years after baseline by the Medical Outcomes Study 36-Item Short-Form Health Survey.

Results  A total of 970 men (41%) survived to at least age 90 years. Smoking was associated with increased risk of mortality before age 90 years (hazard ratio [HR]; 2.10; 95% confidence interval [CI], 1.75-2.51), and similar associations were observed with diabetes (HR, 1.86; 95% CI, 1.52-2.26), obesity (HR, 1.44; 95% CI, 1.10-1.90), and hypertension (HR, 1.28; 95% CI, 1.15-1.43). Regular exercise was associated with a nearly 30% lower mortality risk (HR, 0.72; 95% CI, 0.62-0.83). The probability of a 90-year life span at age 70 years was 54% in the absence of smoking, diabetes, obesity, hypertension, or sedentary lifestyle. It ranged from 36% to 22% with 2 adverse factors and was negligible (4%) with 5. Compared with nonsurvivors, men with exceptional longevity had a healthier lifestyle (67% vs 53% had 1 adverse factor), had a lower incidence of chronic diseases, and were 3 to 5 years older at disease onset. They had better late-life physical function (mean ± SD score [maximum 100], 73 ± 23 vs 62 ± 30; P < .001) and mental well-being (mean score, 84 ± 14 vs 81 ± 17; P = .03). More than 68% (vs 45%) rated their late-life health as excellent or very good, and less than 8% (vs 22%) reported fair or poor health (P < .001 for trend). Regular exercise was associated with significantly better—and smoking and overweight with significantly worse—late-life physical function. Smoking also was associated with a significant decrement in mental function.

Conclusion  Modifiable healthy behaviors during early elderly years, including smoking abstinence, weight management, blood pressure control, and regular exercise, are associated not only with enhanced life span in men but also with good health and function during older age.

Author Affiliations: Divisions of Aging (Drs Yates, Djoussé, Kurth, Buring, and Gaziano) and Preventive Medicine (Drs Kurth, Buring, and Gaziano), Department of Medicine, Brigham and Women's Hospital (Drs Yates, Djoussé, Kurth, Buring, and Gaziano), and Department of Ambulatory Care and Prevention (Dr Buring), Harvard Medical School; Department of Epidemiology, Harvard School of Public Health (Drs Kurth and Buring); and Massachusetts Veterans Epidemiology Research and Information Center, Boston VA Healthcare System (Dr Gaziano); Boston, Massachusetts.

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