Health lifestyles in old age: Assessing the distribution and mortality risk

Objectives. Although the effects of specific health behaviors – including smoking, physical activity, and alcohol consumption – on health during late life have been widely studied, much less is known about the joint effects of multiple risk and protective behaviors. The aim of this research was to describe the prevalence of various multi-behavior profiles (“health lifestyles”) during old age, and estimate the degree to which specific lifestyle profiles are associated with mortality among the U.S. elderly. Methods. Data came from the Health and Retirement Study, a nationally representative panel study of older Americans. Each respondent's status with respect to smoking, physical activity, and alcohol use status was used to create 12 distinct health lifestyle profiles. The prevalence and compositional characteristics of each lifestyle were described, and the mortality risk associated with each lifestyle was estimated over time. Results. A smoke-free, inactive, and non-drinking profile was most prevalent among older Americans, with close to 50% of the sample maintaining this lifestyle. Other prevalent lifestyles included smoke-free, active, non-drinkers (~20%), smoke-free, active, moderate drinkers (~9%), and smoke-free, inactive, moderate drinkers (~8%). The mortality analyses revealed that although smoking was associated with substantial risk, its effects were moderated by physical activity. Furthermore, alcohol consumption levels contributed to mortality risk, but only among non-smokers. Conclusions. Examining the joint effects of multiple behaviors provides new insight into the risks associated with health behaviors among older adults, and suggests the potential value of tailoring late life health promotion interventions to specific health lifestyles rather than specific behaviors.