Are You Headed For the Nursing Home?

Summarized by Robert W. Griffith, MD
October 10, 2006

Summary

Middle-aged people who have one or more major lifestyle risk factors are at increased likelihood of entering a nursing home in the next 20 years. The risk factors are: cigarette smoking, physical inactivity, obesity, raised systolic blood pressure, and diabetes.

Introduction

If you've recently visited a friend or relative in a nursing home, you may have felt, consciously or unconsciously, a deep desire to avoid being put in such a place. Yet more and more people end their days in nursing homes. This means one should know what risk factors contribute to nursing home admission, so that one can take active steps to postpone the event. A study along these lines has been conducted by Rutgers University scientists, and published in the Archives of Internal Medicine here's a summary of the findings.

What was done

Lifestyle risk factors are usually established by middle age or even earlier, so the study analyzed 2 decades of follow-up after enrollment into a representative survey of adults aged over 45 at baseline. The scientists used the National Health and Nutrition Examination Survey (NHANES I) data, which has tracked 14,400 adults who were aged 25 to 74 at baseline in 1971-1975. Participants 45 or over at entry were used for this study.

Physical exam, lab tests, and medical history were undertaken at intervals up to 1992, to get information on health-related outcomes, including nursing home admissions.

Six major risk factors were defined at baseline: cigarette smoking, physical inactivity, obesity, systolic blood pressure, total cholesterol level, and diabetes. For the analyses, age, gender, race, underweight, and 6 chronic conditions (such as arthritis or asthma) were taken into consideration.

Two populations were analyzed separately; middle-aged (45 to 64 at baseline) and elderly (65 to 74 at baseline). The number of nursing home admissions for each individual was recorded.

What was found

In the 45 - 64 age group, the average age was 54 years, 52% were female, 9% were black, and 4% were underweight. In the older age group, the average age was 69, 59% were female, 7% were black, and 4% were underweight. As one might expect, chronic conditions such as arthritis, stroke or cancer were more frequently reported in the 65 to 74-year-olds.

Overall, 15% of participants had at least one nursing home admission during follow-up - 6.5% in the middle-aged and 25% in the elderly group. Over half the middle-aged group was inactive, more than 40% had high blood pressure or high blood lipids, and 38% were smokers. In the elderly group, two-thirds were inactive or had raised blood pressure, half had raised lipid levels, but only one in five smoked.

All the major lifestyle factors, except total cholesterol level, were associated with a higher risk of nursing home admission during the 20 years following baseline. The increased likelihood is given in the following table:

Risk Factor	45 - 64 Age Group	65 - 74 Age Group
Smoker	56%	32%
Physically inactive	40%	14%
Obese (BMI 30 or more)	35%	31%
Systolic BP 140 mmHg or more	35%	29%
Total cholesterol over 240 mg/dL	14%	-10%
Diabetes	3.25 times as likely	50%

All these increases were statistically significant (i.e. they could not have occurred by chance alone), except for the total cholesterol levels in both age groups, inactivity in the elderly, and obesity in the middle-aged.

Less severe changes (e.g. prehypertension with systolic BP 120-139 mmHg, overweight with BMI 25-29) had no significant influence on nursing home admissions. When pairs of risk factors were analyzed, it was found that two risk factors in the middle-aged group were associated with greatly increased risk of nursing home admission (up to 5 times), especially if one of the factors was diabetes. A similar tend was seen in the elderly group, but was less pronounced.

What these results mean

The risks for admission to nursing home within the next 20 years were greater for those who were middle aged at baseline than for those who were elderly. But the good news is that these risks were modifiable. Baby boomers examining their health-related futures need to know that it should be possible to correct, or control, most of the factors that could put them into a home. Stopping smoking, getting enough exercise, losing weight, and treating raised blood pressure and diabetes, are all things within reach of everybody, given the necessary drive and access to facilities.

The prominent role of diabetes as a factor for nursing home admissions requires attention. Unfortunately, many people with diabetes don't know it; this is most frequent in the overweight and obese. The super-obese (those with BMIs over 35) are often tested for diabetes, but the merely overweight may have the disease but it goes undetected. A good starting point would be for all people over 45 to have a fasting blood sugar level done every three years.

Even if one doesn't have diabetes, admission to a nursing home will be less likely if one's lifestyle is healthy, from all aspects: no smoking, no overweight, plenty of exercise, and good nutrition. You can find advice on all these aspects elsewhere on HealthandAge.com.

Source

• Lifestyle-related risk factors and risk of future nursing home admission E. Valiyeva, LB. Russell, JE. Miller, MM. Safford, Arch Intern Med, 2006, vol. 166, pp. 985--990

Related Links
Administration on Aging: Nursing Homes
Aging in Place
Disease Control Priorities Project: Risk Factors

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