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Combined Impact of Traditional and Nontraditional Healthy Behaviors on Frailty and Disability: A Prospective Cohort Study of Older Adults

Abstract:

Objectives: To assess the short- and long-term association of 6 healthy behaviors (not smoking, vigorous to moderate physical activity, healthy diet, adequate sleeping duration, not being sedentary, and daily social interaction) with incident frailty and disability. Design: Prospective population-based study. Settings and Participants: In 2001, 4008 community-dwelling individuals aged ≥60 years in Spain were recruited. Participants were followed up until 2003, when a short-term phone interview of the remaining 3235 individuals was performed. Then, the participants were followed up until 2009, when a long-term phone interview was conducted with 1309 participants. Measures: At baseline, a home interview and a physical examination were conducted to assess healthy behaviors. At baseline and at follow-ups, we ascertained frailty and 4 domains of disability: limitation in instrumental activities of daily living, restriction in daily activities, limitation in mobility, and self-care limitation. Results: In the short-term analyses, vigorous to moderate physical activity and not being sedentary were associated with a reduction in frailty, multivariable odds ratios (OR) (95% confidence interval) 0.55 (0.35-0.85) and 0.43 (0.26-0.72). Vigorous to moderate physical activity and adequate sleeping duration decreased instrumental activities of daily living limitation OR 0.63 (0.44–0.91) and 0.69 (0.53–0.89) as well as self-care limitation OR 0.62 (0.41–0.92) and 0.65 (0.45-0.94). Adequate sleep duration and not being sedentary decreased restriction in daily activities OR 0.67 (0.49–0.90) and 0.57 (0.36–0.91). Vigorous to moderate physical activity and healthy diet decreased limitation in mobility OR 0.58 (0.35–0.96) and 0.73 (0.54–0.97). Considering these 5 healthy behaviors, participants who scored 5 (vs ≤ 2) in the combined score had a lower risk of frailty and disability. In the long-term analyses, results showed the same direction as in short-term analyses. Conclusions and Implications: The combination of healthy behaviors is associated with a substantial reduction in the risk of frailty and of most disability outcomes in older adults.