Association of Combined Lifestyle Behaviors With Healthspan in Older Adults

BACKGROUND: As populations age, extending healthspan, or years lived in good health, is a global priority. Most evidence on healthy lifestyle and prolonged healthspan comes from middle-aged or comorbid populations, leaving it unclear whether benefits apply to healthy older adults. This study evaluates whether combined lifestyle behaviors are associated with disability-free survival in community-dwelling older adults. METHODS: The study included 11,287 Australian participants (median age 74 [IQR 72-77]) from the ASPirin in Reducing Events in the Elderly (ASPREE) study, with a median follow-up of 6.6 years (IQR 5.5-7.9). Participants received one point for adherence to each of the following lifestyle factors: Mediterranean diet, moderate physical activity, non-smoking, and moderate alcohol consumption and categorized as having low (0-1 factors), moderate (2 factors), or favorable (≥ 3 factors) lifestyle. The primary outcome was a composite endpoint comprised of the first occurrence of either death, dementia, or persistent physical disability. Associations of lifestyle categories with the composite endpoint and the individual components were examined, alongside effect modification by key demographic and health variables. Years gained in disability-free survival and compression of morbidity were calculated. RESULTS: Compared to those with an unfavorable lifestyle, a moderate [HR 0.75 (95% CI 0.65-0.87)] and favorable [HR 0.60 (95% CI 0.52-0.70)] lifestyle were associated with a lower risk of the composite endpoint. Over a median of 6.6 years, a favorable lifestyle was prospectively associated with a 10% gain in years of healthspan and a moderate compression of morbidity. Associations did not differ across groups of age, sex, education, aspirin treatment, BMI, diabetes, and hypertension. CONCLUSION: In healthy older adults, adherence to a healthy lifestyle was associated with a greater likelihood of surviving free from disability and dementia and was prospectively linked with a prolonged healthspan and a compression of morbidity, highlighting its potential importance in promoting healthy aging. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01038583.