The Population Health Benefits Of A Healthy Lifestyle: Life Expectancy Increased And Onset Of Disability Delayed

The Asymmetric Spillover Effects of Retirement on Disability: Evidence From China

Background and Objectives

Recent research has explored the spillover effects of retirement on spousal well-being, yet limited attention has been given to the short-term impact on spousal disability. This study explored the asymmetric spillover impact of retirement on spouses' disability severity among a national cohort of urban residents in China.

Research Design and Methods

Utilizing 4 waves of data (2011-2018) from the China Health and Retirement Longitudinal Survey, we employ a nonparametric regression discontinuity design to estimate the short-term effect of retirement on spousal disability severity. Disability is assessed based on their ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Furthermore, we conduct heterogeneity analysis stratified by factors such as the husband's retirement status, health conditions, lifestyle behaviors, and the wife's educational level. Additionally, we explore potential mechanisms including changes in health behaviors, emotions, and disease diagnoses.

Results

Our findings indicate that wives' retirement has a significant favorable short-term effect on husbands' ADL scores, with a magnitude of -0.644 points (-9.78% relative to baseline). A significant beneficial effect of wives' retirement on the prevalence of husbands' difficulty in dressing, bathing, and eating was observed with substantial magnitudes of 0.075, 0.201, and 0.051 points, respectively. Various heterogeneity analyses and sensitivity tests confirmed the robustness of our results. The positive spillover effect of wives' retirement likely results from reduced negative emotions in husbands. In contrast, husbands' retirement does not affect the prevalence of ADL/IADL disability in their wives.

Discussion and Implications

Underscoring the gender asymmetry in the effects of spousal retirement on disability, this study emphasizes the need for tailored policies considering men's and women's distinct disability experiences.

Inequalities in Disability-Free and Disabling Multimorbid Life Expectancy in Costa Rica, Mexico, and the United States

OBJECTIVES

To better understand variations in multimorbidity severity over time, we estimate disability-free and disabling multimorbid life expectancy (MMLE), comparing Costa Rica, Mexico, and the United States (US). We also assess MMLE inequalities by sex and education.

METHODS

Data come from the Costa Rican Study on Longevity and Healthy Aging (2005-2009), the Mexican Health and Aging Study (2012-2018), and the Health and Retirement Study (2004-2018). We apply an incidence-based multistate Markov approach to estimate disability-free and disabling MMLE and stratify models by sex and education to study within-country heterogeneity. Multimorbidity is defined as a count of 2 or more chronic diseases. Disability is defined using limitations in activities of daily living.

RESULTS

Costa Ricans have the lowest MMLE, followed by Mexicans, then individuals from the US. Individuals from the US spend about twice as long with disability-free multimorbidity compared with individuals from Costa Rica or Mexico. Females generally have longer MMLE than males, with particularly stark differences in disabling MMLE. In the US, higher education was associated with longer disability-free MMLE and shorter disabling MMLE. We identified evidence for cumulative disadvantage in Mexico and the US, where sex differences in MMLE were larger among the lower educated.

DISCUSSION

Substantial sex and educational inequalities in MMLE exist within and between these countries. Estimating disability-free and disabling MMLE reveals another layer of health inequality not captured when examining disability and multimorbidity separately. MMLE is a flexible population health measure that can be used to better understand the aging process across contexts.

Impact of Healthy Lifestyle Factors on Life Expectancy and Lifetime Health Care Expenditure: Nationwide Cohort Study

BACKGROUND

The association between lifestyle risk factors and the risk of mortality and chronic diseases has been established, while limited research has explored the impact of healthy lifestyle factors on lifetime health care expenditure using longitudinal individual data.

OBJECTIVE

We aimed to determine the individual and combined effects of 5 healthy lifestyle factors on life expectancy and lifetime health care expenditure in Taiwan.

METHODS

Using data from the National Health Interview Survey cohort, 5 healthy lifestyle behaviors were defined and analyzed: nonsmoking, avoiding excessive alcohol consumption, engaging in sufficient physical activity, ensuring sufficient fruit and vegetable intake, and maintaining a normal weight. We used a rolling extrapolation algorithm that incorporated inverse probability of treatment weighting to estimate the life expectancy and lifetime health care expenditure of the study populations with and without healthy lifestyle factors.

RESULTS

A total of 19,893 participants aged ≥30 (mean age 48.8, SD 13.4) years were included, with 3815 deaths recorded during a median follow-up period of 15.6 years. The life expectancy and per capita estimated lifetime health care expenditures for the overall study population were 35.32 years and US $58,560, respectively. Multivariable-adjusted hazard ratios for all-cause mortality in participants adhering to all 5 healthy lifestyle factors, compared with those adhering to none, were 0.37 (95% CI 0.27-0.49). We found significant increases in life expectancy for nonsmokers (2.31 years; 95% CI 0.04-5.13; P=.03), those with sufficient physical activity (1.85 years; 95% CI 0.25-4.34; P=.02), and those with adequate fruit and vegetable intake (3.25 years; 95% CI 1.29-6.81; P=.01). In addition, nonsmokers experienced a significant reduction in annual health care expenditure (-9.78%; 95% CI -46.53% to -1.45%; P=.03), as did individuals maintaining optimal body weight (-18.36%; 95% CI -29.66% to -8.57%; P=.01). Overall, participants adhering to all 5 healthy lifestyle behaviors exhibited a life gain of 7.13 years (95% CI 1.33-11.11; P=.02) compared with those adhering to one or none, with a life expectancy of 29.19 years (95% CI 25.45-33.62). Furthermore, individuals adopting all 5 healthy lifestyle factors experienced an average annual health care expenditure reduction of 28.12% (95% CI 4.43%-57.61%; P=.02) compared with those adopting one or none.

CONCLUSIONS

Adopting a healthy lifestyle is associated with a longer life expectancy and a reduction of health care expenditure in Taiwanese adults. This contributes to a more comprehensive understanding of the impact of healthy lifestyle factors on the overall health and economic burden.

Effects of lifestyle-related risk factors on life expectancy: A comprehensive model for use in early prevention of premature mortality from noncommunicable diseases

Morbidity and premature mortality from noncommunicable diseases can be largely prevented by adopting a healthy lifestyle at the earliest possible age. However, tools designed for the early identification of those at risk among young adults are lacking. We developed and validated a multivariable model for the prediction of life expectancy, allowing the early identification of apparently healthy adults at risk of lifestyle-related diseases. We used a cross-sectional approach to calculate life expectancy using data from 38,481 participants of the National Health and Nutrition Examination Survey (1999-2014), aged ≥20 years. A multivariable logistic model was used to quantify the impact of risk factors on mortality. The model included the following lifestyle-related mortality risk factors as predictors: smoking, diet, physical activity, and body mass index. The presence of the following chronic diseases was considered: diabetes, arrhythmia, coronary artery disease, myocardial infarction, stroke, and malignant neoplasms. The model showed a good predictive ability; the area under the receiver operating characteristic curve measure was 0.846 (95% uncertainty interval 0.838-0.859). Life expectancy was determined using the life table method and the period life tables for the US population as the baseline. The results of this model underscore the importance of lifestyle-related risk factors in life expectancy. The difference between life expectancy for 30-year-old individuals with lifestyle characteristics ranked in 90% and 10% of their gender and age groups was 23 years for males and 18 years for females, whereas in 75% and 25%, it was 14 years for males and 10 years for females. In addition to early risk identification, the model estimates the deferred effect of lifestyle and the impact of lifestyle changes on life expectancy. Thus, it can be used in early prevention to demonstrate the potential risks and benefits of complex lifestyle modifications for educational purposes or to motivate behavioral changes.

Association of healthy lifestyle with life expectancy free of five major disabilities in Chinese older adults

Background

Whether and to what extent multiple healthy lifestyles affect the longevity of people with disabilities, including those in basic activities of daily living, mobility, vision, hearing and cognition, is crucial to policymakers. We aimed to determine the impact of combined lifestyles on life expectancy (LE) lived with and without five disabilities.

Methods

We recruited participants (n = 15 121 from the China Longitudinal Healthy Longevity Survey between 2008 and 2018. Healthy lifestyle levels were estimated from six factors: smoking, drinking, physical exercise, diet, cognitive activity, and sleep, which we categorised as favourable and unfavourable using the latent class growth mixture model throughout the follow-up period. We used Multi-state Markov models to assess the different disability stages of LE.

Results

Of the total LE at age 65, older adults with a favourable lifestyle spent 59.60% (disability-free LE (DFLE) = 10.24 years) without five disabilities in combination, whereas those with unfavourable lifestyle spent 56.74% (DFLE = 7.28 years). Furthermore, the percentage of DFLE was 64.98 (7.71 years) and 68.38 (9.91 years) in males with unfavourable and favourable lifestyle levels, respectively, and 47.92 (6.62 years) and 55.12 (10.30 years) for females. Compared to older adults with low socioeconomic status (SES) and unfavourable lifestyle level, those with lower SES and favourable lifestyle level had more 3.77 years of DFLE, those with higher SES and unfavourable lifestyle level had more 1.94 years, as well as those with higher SES and favourable lifestyle level had more 5.10 years at age 65. Corresponding associations were found separately for each of the five individual disabilities.

Conclusions

A favourable lifestyle level was associated with longer total LE along with a higher proportion of DFLE and may contribute to narrowing socioeconomic health inequalities. Policymakers should develop lifestyle interventions and scale up rehabilitation services in primary care, thereby delaying disabilities to later ages, especially in low- and middle-income countries.

Maintaining healthy lifestyle through fitness app use: A parallel mediation model from a nationwide survey

Objective

Adolescents face various health challenges due to academic pressures and sedentary lifestyles. Establishing healthy habits during this critical period is essential for long-term well-being. With the widespread use of fitness apps, understanding their impact on adolescent health behaviors and the underlying mechanisms is crucial. Guided by social support theory and social comparison theory, this study examined the influence of WeRun, a fitness app within WeChat, on adolescents' adoption of healthy lifestyles. It investigated the correlation between WeRun usage and healthy behaviors, as well as the underlying mechanisms driving this relationship.

Methods

A cross-sectional survey was conducted across 31 provinces and metropolitans in China, utilizing a random cluster sampling approach targeting high school and freshman students aged 15-24 (N = 1312). A parallel mediation model was employed to test the hypotheses.

Results

The analysis showed that WeRun use positively predicted both social support and social comparison. Meanwhile, both social support and social comparison were positively associated with healthy lifestyles. Additionally, WeRun use could not directly predict healthy lifestyles. However, WeRun use indirectly predicted healthy lifestyles via social support and social comparison.

Conclusions

The study's findings revealed the pivotal roles of social support and social comparison as mediating variables in the relationship between adolescents' WeRun usage and adoption of healthy lifestyles. The results contributed to the current comprehension of the mechanisms linking app utilization to health-promoting behaviors. Furthermore, it provided valuable insights for promoting adolescent health and informed improved design strategies for fitness apps.

Lifestyle parameters of Japanese agricultural and non-agricultural workers aged 60 years or older and less than 60 years: A cross-sectional observational study

OBJECTIVES

Improving the lifestyle of occupational workers is essential for extending healthy life expectancy. We investigated various lifestyle-related items in a rural Japanese population and compared them between agricultural and non-agricultural workers.

METHODS

This cross-sectional study was conducted as a part of the "Iwaki Health Promotion Project." Lifestyle-related items such as sleep, work hours, nutrition, health-related quality of life, and proportion of time spent performing each daily activity were compared between agricultural and non-agricultural workers in the ≥60 years (n = 251) and <60 years (n = 560) age groups.

RESULTS

Agricultural workers had significantly lower Pittsburgh Sleep Quality Index total scores than non-agricultural workers in the <60 years group. The proportion of participants with more than 5 weekly working days was high among agricultural workers in both groups. Additionally, the proportion of people who worked more than 8 h per day was high among agricultural workers in both age groups. Energy intake per day was high among agricultural workers in the <60 years group. In both age groups, agricultural workers slept and woke up approximately 40 min earlier than did non-agricultural workers.

CONCLUSIONS

Agricultural workers have better sleep habits but work longer than non-agricultural workers, with some differences in energy intake and proportion of time spent on each daily activity. These differences should be considered when planning lifestyle intervention programs for agricultural workers.

Racial, Ethnic, Nativity, and Educational Disparities in Cognitive Impairment and Activity Limitations in the United States, 1998-2016

Despite extensive research on cognitive impairment and limitations in basic activities of daily living, no study has investigated the burden of their co-occurrence (co-impairment). Using the Health and Retirement Study data and incidence-based multistate models, we study the population burden of co-impairment using three key indicators: mean age at onset, lifetime risk, and health expectancy. We examine patterns by gender, race, ethnicity, nativity, education, and their interactions for U.S. residents aged 50-100. Furthermore, we analyze what fractions of racial, ethnic, and nativity disparities in co-impairment are attributable to inequalities in educational attainment. Results reveal that an estimated 56% of women and 41% of men aged 50 will experience co-impairment in their remaining life expectancy. Men experience an earlier onset of co-impairment than women (74 vs. 77 years), and women live longer in co-impairment than men (3.4 vs. 1.9 years). Individuals who are Black, Latinx, and lower educated, especially those experiencing intersecting disadvantages, have substantially higher lifetime risk of co-impairment, earlier co-impairment onset, and longer life in co-impairment than their counterparts. Up to 75% of racial, ethnic, and nativity disparity is attributable to inequality in educational attainment. This study provides novel insights into the burden of co-impairment and offers evidence of dramatic disparities in the older U.S. population.

Healthy Lifestyle Behaviors and Biological Aging in the U.S. National Health and Nutrition Examination Surveys 1999-2018

People who have a balanced diet and engage in more physical activity live longer, healthier lives. This study aimed to test the hypothesis that these associations reflect a slowing of biological processes of aging. We analyzed data from 42 625 participants (aged 20-84 years, 51% female participants) from the National Health and Nutrition Examination Surveys (NHANES), 1999-2018. We calculated adherence to a Mediterranean diet (MeDi) and level of leisure time physical activity (LTPA) using standard methods. We measured biological aging by applying the PhenoAge algorithm, developed using clinical and mortality data from NHANES-III (1988-94), to clinical chemistries measured from a blood draw at the time of the survey. We tested the associations of diet and physical activity measures with biological aging, explored synergies between these health behaviors, and tested heterogeneity in their associations across strata of age, sex, and body mass index. Participants who adhered to the MeDi and who did more LTPA had younger biological ages compared with those who had less-healthy lifestyles (high vs low MeDi tertiles: β = 0.14 standard deviation [SD] [95% confidence interval {CI}: -0.18, -0.11]; high vs sedentary LTPA, β = 0.12 SD [-0.15, -0.09]), in models controlled for demographic and socioeconomic characteristics. Healthy diet and regular physical activity were independently associated with lower clinically defined biological aging, regardless of age, sex, and BMI category.

Nutritional and lifestyle management of the aging journey: A narrative review

With age, the physiological responses to occasional or regular stressors from a broad range of functions tend to change and adjust at a different pace and restoring these functions in the normal healthy range becomes increasingly challenging. Even if this natural decline is somehow unavoidable, opportunities exist to slow down and attenuate the impact of advancing age on major physiological processes which, when weakened, constitute the hallmarks of aging. This narrative review revisits the current knowledge related to the aging process and its impact on key metabolic functions including immune, digestive, nervous, musculoskeletal, and cardiovascular functions; and revisits insights into the important biological targets that could inspire effective strategies to promote healthy aging.

School Menu Review Programme (PReME): evaluation of compliance with dietary recommendations during the period 2006-2020 in Catalonia

BACKGROUND

The School Menu Review Programme (PReME) has been offering complimentary revisions of meal plans to all schools in Catalonia since 2006. This study aims to assess the evolution of compliance with PReME's recommendations in the meals provided by school cafeterias in Catalonia during the period 2006-2020.

METHODS

Pre-post study with a sample of 6,387 meal plans from 2221 schools assessed during the period. The information was collected mainly by public health specialists within the annual technical and sanitary inspection of school kitchens and cafeterias. Meal plans were evaluated by Dietitian-Nutritionists team according to the criteria of the National Health System's "Consensus document on nutrition in schools" and the Public Health Agency of Catalonia's current guide "Healthy eating at school". Reports were sent to each participating school. A few months later, a new meal plan and another questionnaire were collected and evaluated in comparison with the first meal plan. Compliance with the recommendations was analysed based on the type of canteen management and the school category.

RESULTS

Compliance improved during the study period. The percentage of schools that complied with dietary recommendations in relation to the five PReME indicators (fresh fruit, pulses, daily vegetables, fresh food and olive oil for dressing) has steadily increased since PReME began, (over 70% in all indictors; p =  < 0.001), with variations depending on school category and cafeteria management. Furthermore, an improvement in the levels of compliance with de recommended food frequencies was observed. with statistically significant differences for all items (p < 0.001), except for pulses whose compliance had been high since the beginning of the study (p = 0.216).

CONCLUSIONS

The positive evolution in compliance with PReME's recommendations provides evidence of the programme's effectiveness, with an improvement in the quality of school meals delivered in Catalonia.

Health-adjusted life expectancy according to lifestyle classified by the Yonsei Lifestyle Profile-BREF

OBJECTIVES

This study aimed to investigate health-adjusted life expectancy (HALE) by demographic characteristics (sex, educational achievement, and residential area) according to the lifestyle classifications of the Yonsei Lifestyle Profile-BREF (YLP-BREF).

METHODS

This study included 569 participants aged 55 years or older living in Korea. The YLP-BREF domains were physical activity, activity participation, and nutrition.

RESULTS

Females had a longer HALE (mean±standard deviation, 8.90±5.06 years) in the physical activity domain, while males had a longer HALE in the nutrition domain (9.44±5.91 years). People living in rural areas had longer HALE in physical activity (12.02±5.60 years), activity participation (8.58±4.21 years), and nutrition (11.33±6.43 years). There were no significant differences according to sex or residential area. High school graduates showed the longest HALE (physical activity: 10.38± 6.89; activity participation: 7.64±4.29; nutrition: 9.59±6.40 years). There was a significant difference in educational achievement.

CONCLUSIONS

As people age, the demand for a healthy lifestyle increases. This study attempted to calculate HALE by demographic characteristics according to lifestyle. The results of this study will help inform future research directions for providing a healthy lifestyle.

Trends and biopsychosocial correlates of physical disabilities among older men and women in Taiwan: examination based on ADL, IADL, mobility, and frailty

Background

This study examines correlates of disabilities related to ADL, IADL, mobility, and frailty in men and women with a nationally representative sample of older adults living in the community.

Methods

A total of 10,898 noninstitutionalized Taiwanese nationals aged 65 years and older enrolled in the 2001 (N = 2,064), 2005 (N = 2,727), 2009 (N = 2,904), and 2013 (N = 3,203) National Health Interview Survey (NHIS) were analyzed.

Results

The prevalence of mobility disabilities and frailty in older adults in Taiwan decreased during the past decade (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\chi }_{Mobility}^{2}= -5.4$$\end{document}χMobility2=-5.4, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\chi }_{Frailty}^{2}= -6.2$$\end{document}χFrailty2=-6.2). Exercise, social engagement, and tea and coffee intake were found to be associated with lower levels of all types of disabilities in both men and women. In addition, a diet based on carbohydrates, falls, depressive symptomatology, lung and metabolic diseases were risks for most of the disabilities under consideration. Gender-specific independent correlates included: being married (OR = 0.63, 95%CI: 0.40–0.98), eggs/beans/fish/meat consumption (OR = 0.35, 95% CI = 0.16–0.80); depressive symptoms, obesity and cataracts, which were associated with higher IADL (OR = 3.61, 1.63, and 1.18, respectively) and frailty limitations (OR = 10.89, 1.27, and 1.20, respectively) in women. Cognitive impairment was found to be an important correlate for ADL limitations in men (OR = 3.64, 95%CI: 2.38–5.57).

Conclusions

Exercise, social participation and diet (more tea and coffee intake and lower carbohydrates) were correlates for lower levels of disability. Some gender-specific correlates were also identified, including associations of disability with depressive symptoms, obesity, and cataracts that were more distinct in women, and lower levels of disability which were especially significant in men who were married, eat more eggs, beans, fish, and meat, and those free from cognitive impairment.

Mixed evidence for the compression of morbidity hypothesis for smoking elimination-a systematic literature review

BACKGROUND

There is debate around the composition of life years gained from smoking elimination. The aim of this study was to conduct a systematic review of the literature to synthesize existing evidence on the effect of smoking status on health expectancy and to examine whether smoking elimination leads to compression of morbidity.

METHODS

Five databases were systematically searched for peer-reviewed articles. Studies that presented quantitative estimates of health expectancy for smokers and non-/never-smokers were eligible for inclusion. Studies were searched, selected and reviewed by two reviewers who extracted the relevant data and assessed the risk of bias of the included articles independently.

RESULTS

The search identified 2491 unique records, whereof 20 articles were eligible for inclusion (including 26 cohorts). The indicators used to measure health included disability/activity limitations (n=9), health-related quality of life (EQ-5D) (n=2), weighted disabilities (n=1), self-rated health (n=9), chronic diseases (n=6), cardiovascular diseases (n=4) and cognitive impairment (n=1). Available evidence showed consistently that non-/never-smokers experience more healthy life years throughout their lives than smokers. Findings were inconsistent on the effect of smoking on the absolute number of unhealthy life years. Findings concerning the time proportionally spent unhealthy were less heterogeneous: nearly all included articles reported that non-/never-smokers experience relatively less unhealthy life years (e.g. relative compression of morbidity).

CONCLUSIONS

Support for the relative compression of morbidity due to smoking elimination was evident. Further research is needed into the absolute compression of morbidity hypothesis since current evidence is mixed, and methodology of studies needs to be harmonized.

Exploring the effort-reward structure of university work focusing on perceived overall stress, self-reported health, and musculoskeletal disorders

Background: The effort-reward imbalance (ERI) model by Siegrist encouraged numerous scientific investigations that reported particular ties between psychosocial risks and poor self-reported health (SRH), while psychosocial work-related stress has also been linked to musculoskeletal disorders (MSDs). The aim of this study was to examine the health status and the perceived levels of occupational stress of university employees and to analyse the findings according to the employees’ effort and reward structure of work, perceived overall stress, SRH and the presence of MSDs.

Design and methods: 398 employees – including healthcare professionals, academic personnel and workers with administrative or other jobs – employed at the University of Szeged, Faculty of Medicine were investigated with a self-administered questionnaire including the Effort-Reward Imbalance Questionnaire (ERIQ) and Perceived Stress Scale 4 (PSS-4).

Results: More than half of the investigated subjects (54.8%) reported some forms of MSDs. Low self-reported health (P<0.001) and presence of MSDs (P=0.015) were significantly associated with the level of perceived stress and effort-reward imbalance (ERI), moreover increased level of perceived stress was independently associated with the likelihood of MSDs (AOR=1.13) and low self-reported health (AOR=1.30). ERI well predicted low self-reported health (AOR=2.05) as well. Increased level of perceived stress positively correlated with high workrelated effort (r=0.247, P<0.001) and over-commitment (r=0.387, P<0.001) while with work-related reward (r=−0.181, P=0.011) perceived stress showed a negative connection.

Conclusion: Our results suggest that addressing the burden of effort-reward imbalance and MSDs would likely lessen employees’ perceived level of overall stress and affect their self-reported overall state of health.

Protocol for The International Cohort on Lifestyle Determinants of Health Study: A Longitudinal Investigation of Complementary and Integrative Health Utilization in Postsecondary Education Students

Objectives: The specific aims are: 1) To characterize the health, wellness, and lifestyle of graduate and undergraduate students, and how these characteristics change over time; 2) To evaluate associations between lifestyle factors and gut microbiota populations and diversity; and 3) To evaluate associations between stress and stress management practices with sleep habits, quality of life, and overall health. Design: The International Cohort on Lifestyle Determinants of Health (INCLD Health) longitudinal cohort study is designed to assess health behaviors and lifestyle practices amongst adults studying complementary and integrative health (CIH) and higher-education students more generally after at least one to six years of exposure to CIH education. INCLD Health will adhere to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. Settings/Location: Colleges and universities with a CIH focus or interest with the flagship site being the National University of Natural Medicine. Participants: Adults currently enrolled in a college or university with a CIH focus or interest. Outcome Measures: Study visits will be conducted at baseline, 6 months, then every 12 months until the end of each participants' degree program. Measures include anthropometrics; serum and salivary biomarkers of cardiovascular risk, reproductive hormones, and cortisol; nutritional intake measured by a digital food frequency questionnaire; sequencing of fecal microbiota; plus validated questionnaires investigating mood, perceived stress, stress management practices, physical activity, sleep, and wellness. Conclusions: The INCLD Health Study, approved by the NUNM IRB in late 2018, will enroll a unique cohort of adults to characterize the use of CIH practices in relation to short- and long-term health. Our study design provides a breadth of information that could be implemented at multiple sites internationally allowing for comparisons across diverse student cohorts with relatively low cost and personnel.

Contributions of obesity and cigarette smoking to incident disability: A longitudinal analysis

Downward trends in U.S. disability levels are stagnating. Assessing the key contributors to U.S. disability incidence is critical to improving the functional status of the U.S. population. Using longitudinal, nationally representative data from waves 2003-2015 of the Panel Study of Income Dynamics (PSID), we estimated age-specific U.S. disability incidence and quantified the individual and joint contributions of obesity (contemporaneous and earlier-life; BMI ≥ 30) and cigarette smoking to disability incidence. Participants were adults ages 33-96 who participated in PSID in 1986 and at least two consecutive waves 2003-2015 (N = 3247). We conducted age-stratified logistic regressions to predict incident disability at middle and older ages (33-69 years, 70-96 years). Next, counterfactual scenarios were used to estimate the contributions of each risk factor to incident disability. Disability incidence was greater in women than men (5.8 and 4.5 cases per 100 person-years, respectively) and increased with age. Obesity and cigarette smoking jointly explained 17-38% of disability incidence; each factor contributed roughly equal amounts in all groups but older men, for whom smoking history appeared more important. Obesity and smoking appeared to explain more of disability at younger ages (women: 33.1%, 95% CI: 25.1 to 41.0%; men: 37.6%, 95% CI: 28.8 to 46.5%) than at older ages (women: 16.5%, 95% CI: 8.2 to 24.9%; men: 24.5.%, 95% CI: 12.7 to 36.3%). This study provides a benchmark for monitoring trends in U.S. disability incidence. Obesity and smoking are key contributors to disability, accounting for 17-38% of incident disability in U.S. adults.

The Impact of Smoking and Obesity on Disability-Free Life Expectancy in Older Australians

BACKGROUND

Smoking and obesity are 2 modifiable risk factors for disability. We examine the impact of smoking and obesity on disability-free life expectancy (DFLE) at older ages, using 2 levels of disability.

METHOD

We used the DYNOPTA dataset, derived by harmonizing and pooling risk factors and disability outcomes from 5 Australian longitudinal aging studies. We defined mobility disability as inability to walk 1 km, and more severe (activities of daily living [ADL]) disability by the inability to dress or bathe. Mortality data for the analytic sample (N = 20 401; 81.2% women) were obtained from Government Records via data linkage. We estimated sex-specific total life expectancy, DFLE, and years spent with disability by Interpolated Markov Chain (IMaCh) software for each combination of smoking (never vs ever), obesity (body mass index ≥30 vs 18.5 to <30), and education (left school age 14 or younger vs age 15 or older).

RESULTS

Compared to those without either risk factor, high educated nonobese smokers at age 65 lived shorter lives (men and women: 2.5 years) and fewer years free of mobility disability (men: 2.1 years; women: 2.0 years), with similar results for ADL disability. Obesity had the largest effect on mobility disability in women; high educated obese nonsmoking women lived 1.3 years less than nonsmoking, not obese women but had 5.1 years fewer free of mobility disability and 3.2 fewer free of ADL disability. Differences between risk factor groups were similar for the low educated.

CONCLUSIONS

Our findings suggest eliminating obesity would lead to an absolute reduction of disability, particularly in women.

Safety huddle in a community nursing setting

A safety huddle is a meeting held among district nurses, allied health professionals, specialist nurses, administrative staff, community matrons and healthcare assistants, also known as the wider multidisciplinary team. This article aims to identify and discuss the importance of safety huddles within a community nursing team. The author, a Specialist Community Practitioner District Nurse (SCPDN), explores why safety huddles were introduced and the implications of staff and patient safety if a safety huddle is not performed. The article also discusses the role of the SCPDN, how patient harm is sustained when communication failures occur within a team, new technologies implemented into practice and the implementation of safety huddles electronically.

Are We Living Longer and Healthier?

Objective: To examine whether we live healthier as we live longer in Hong Kong, which has one of the highest life expectancies in the world. Methods: Sullivan's method was used to evaluate the chronic disease-free life expectancy (CDFLE), life expectancy in good self-perceived health (GPHLE), and impairment-free life expectancy (IFLE) among population aged 50 years and older in Hong Kong in 2007-2016. Results: In spite of the marked improvement in life expectancy in Hong Kong, the increase in GPHLE was much smaller, while CDFLE and IFLE even declined for both genders. The situation was more severe among older population. Discussion: People in Hong Kong live longer but with worsening health. The expansion of chronic diseases, self-perceived poor health, and impairments among older adults calls for more fiscal investments, government attention, and public health policies.

Cognitive impairment in the U.S.: Lifetime risk, age at onset, and years impaired

Prior studies have analyzed the burden of cognitive impairment, but often use potentially biased prevalence-based methods or measure only years lived with impairment, without estimating other relevant metrics. We use the Health and Retirement Study (1998-2014; n = 29,304) and the preferred incidence-based Markov-chain models to assess three key measures of the burden of cognitive impairment: lifetime risk, mean age at onset, and number of years lived impaired. We analyze both mild and severe cognitive impairment (dementia) and gender, racial/ethnic, and educational variation in impairment. Our results paint a multi-dimensional picture of cognitive health, presenting the first comprehensive analysis of the burden of cognitive impairment for the U.S. population age 50 and older. Approximately two out of three Americans experience some level of cognitive impairment at an average age of approximately 70 years. For dementia, lifetime risk for women (men) is 37% (24%) and mean age at onset 83 (79) years. Women can expect to live 4.2 years with mild impairment and 3.2 with dementia, men 3.5 and 1.8 years. A critical finding is that for the most advantaged groups (i.e., White and/or higher educated), cognitive impairment is both delayed and compressed toward the very end of life. In contrast, despite the shorter lives of disadvantaged subgroups (Black and/or lower educated), they experience a younger age of onset, higher lifetime risk, and more years cognitively impaired. For example, men with at least an Associate degree have 21% lifetime dementia risk, compared to 35% among men with less than high school education. White women have 6 years of cognitively-impaired life expectancy, compared to 12 and 13 years among Black women and Latinas. These educational and racial/ethnic gradients highlight the very uneven burden of cognitive impairment. Further research is required to identify the mechanisms driving these disparities in cognitive impairment.

Impact of Low Cardiovascular Risk Profiles on Geriatric Outcomes: Evidence From 421,000 Participants in Two Cohorts

BACKGROUND

Individuals with low cardiovascular risk factor profiles experience lower rates of cardiovascular diseases, but associations with geriatric syndromes are unclear. We tested whether individuals with low cardiovascular disease risk, aged 60-69 years old at baseline in two large cohorts, were less likely to develop aging-related adverse health outcomes.

METHODS

Data were from population representative medical records (Clinical Practice Research Datalink [CPRD] England, n = 239,591) and healthy volunteers (UK Biobank [UKB], n = 181,820), followed for ≤10 years. A cardiovascular disease risk score (CRS) summarized smoking status, LDL-cholesterol, blood pressure, body mass index, fasting glucose and physical activity, grouping individuals as low (ie, all factors near ideal), moderate, or high CRS. Logistic regression, Cox models, and Fine and Grey risk models tested the associations between the CRS and health outcomes.

RESULTS

Low CRS individuals had less chronic pain (UKB: baseline odds ratio = 0.52, confidence interval [CI] = 0.50-0.54), lower incidence of incontinence (CPRD: subhazard ratio [sub-HR] = 0.75, 0.63-0.91), falls (sub-HR = 0.82, CI = 0.73-0.91), fragility fractures (sub-HR = 0.78, CI = 0.65-0.93), and dementia (vs. high risks; UKB: sub-HR = 0.67, CI = 0.50-0.89; CPRD: sub-HR = 0.79, CI = 0.56-1.12). Only 5.4% in CPRD with low CRS became frail (Rockwood index) versus 24.2% with high CRS. All-cause mortality was markedly lower in the low CRS group (vs. high CRS; HR = 0.40, 95% CI = 0.35-0.47). All associations showed dose-response relationships, and results were similar in both cohorts.

CONCLUSIONS

Persons aged 60-69 years with near-ideal cardiovascular risk factor profiles have substantially lower incidence of geriatric conditions and frailty. Optimizing cardiovascular disease risk factors may substantially reduce the burden of morbidity in later life.

Parity and Mortality: An Examination of Different Explanatory Mechanisms Using Data on Biological and Adoptive Parents

A growing literature has demonstrated a relationship between parity and mortality, but the explanation for that relationship remains unclear. This study aims to pick apart physiological and social explanations for the parity-mortality relationship by examining the mortality of parents who adopt children, but who have no biological children, in comparison with the mortality of parents with biological children. Using Swedish register data, we study post-reproductive mortality amongst women and men from cohorts born between 1915 and 1960, over ages 45-97. Our results show the relative risks of mortality for adoptive parents are always lower than those of parents with biological children. Mortality amongst adoptive parents is lower for those who adopt more than one child, while for parents with biological children we observe a U-shaped relationship, where parity-two parents have the lowest mortality. Our discussion considers the relative importance of physiological and social depletion effects, and selection processes.