Modifiable Healthy Behaviors Improves Life Span

Modifiable healthy behaviors during the early elderly years, including smoking abstinence, weight management, blood pressure control, and regular exercise, are linked to enhanced life span in men as well as to good health and function during older age. Laurel B. Yates, MD, MPH, from the Harvard Medical School in Boston, Massachusetts writes, “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."

Within the Physicians’ Health Study (PHS), from 1981 to 2006, a total of 2357 healthy men (mean age, 72 years) completed baseline and annual questionnaires regarding self-reported biologic and lifestyle factors and comorbid conditions. Medical record review was used to confirm mortality and incidence of major diseases.

Of the 2357 men initially evaluated, 970 (41%) survived to at least 90 years of age. Factors associated with an increased risk for mortality before 90 years of age were smoking, diabetes, and hypertension. Regular exercise was associated with a nearly 30% decrease in the risk for mortality.

In the absence of smoking, diabetes, obesity, hypertension, or sedentary lifestyle, the probability of surviving from age 70 to 90 years was 54%. This probability ranged from 36% to 22% with 2 adverse factors and was only 4% in the presence of all 5 risk factors.

Compared with men who did not survive to age 90 years, those who did had a healthier lifestyle (67% vs 53% had at least 1 risk factor), had a lower incidence of chronic diseases, were 3 to 5 years older at disease onset, and had better late-life physical function and mental well-being.

Late-life health was rated as excellent or very good by more than 68% of the survivors (vs 45% of men who did not survive to age 90 years) and as fair or poor by less than 8% (vs 22%; P for trend < .001). Regular exercise was associated with significantly better late-life physical function, whereas smoking and overweight were associated with significantly worse late-life physical function, and smoking was also associated with a significant decline in mental function.

"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," the study authors write.

Practice Pearls:

• Adults aged 85 years or older are the fastest growing segment of the older population in the United States, but overall rates of disability are decreasing. Genetic factors account for a minority of the difference in longevity between adults, and some factors, such as cholesterol levels, might play a stronger role in the longevity of middle-aged vs the oldest adults.
• The current study suggests that smoking is the most significant variable in reducing men’s chances to live to 90 years, but diabetes, obesity, hypertension, and a sedentary lifestyle also have additive negative effects on survival among older men.

Arch Intern Med. 2008;168:262-263, 284-290.