Impact of lifestyle risk factors on admission to nursing home care: a cohort study of 127 108 people aged 60 years and over.

BACKGROUND: Little is known on how lifestyle factors, individually or in combination, may relate to nursing home admission, an outcome of great societal and economic importance with increased population ageing. The aim of this study was to determine the association of lifestyle risk factors with nursing home admission. METHODS: This prospective cohort study linked data from the 45 and Up Study, Australia, to health records. 127 108 men and women, aged ≥60 years, were recruited between 2006 and 2009. A healthy lifestyle score categorised participants into three risk groups based on five equally contributing risk factors: smoking status, physical activity, sedentary behaviour, sleep duration and diet quality. HRs for incident nursing home admission were estimated using multivariable Cox proportional hazards model. RESULTS: One-quarter of participants were in the low-risk lifestyle group, 62% were in the medium-risk group and 14% in the high-risk (least healthy) group. During a median (IQR) follow-up of 11.3 years, 23 094 (18%) participants were admitted to a nursing home. Compared with those in the low-risk group, risk of nursing home admission was 43% higher among participants in the high-risk group (multivariable adjusted HR (aHR) 1.43; 95% CI 1.36 to 1.50); and participants in the medium-risk group had an intermediate 12% greater risk (aHR 1.12; 95% CI 1.08 to 1.16). Participants aged 60-64 years in the high-risk (aHR 2.15; 95% CI 1.82 to 2.54) lifestyle group had the greatest risk of nursing home admission. CONCLUSION: An unhealthy lifestyle was associated with a marked increased risk of admission to a nursing home in adults aged 60+ years. Interventions focused on lifestyle modifications may prevent or delay nursing home admission.

Effects of divorce and widowhood on subsequent health behaviours and outcomes in a sample of middle-aged and older Australian adults.

Marital disruption is a common life event with potential health implications. We examined the prospective association of divorce/widowhood with subsequent lifestyles, psychological, and overall health outcomes within short and longer terms using three waves of data from the 45 and Up Study in Australia (T1, 2006-09; T2, 2010; T3, 2012-16). Marital status and health-related outcomes were self-reported using validated questionnaires. Nine outcomes were examined including lifestyles (smoking, drinking, diet and physical activity), psychological outcomes (distress, anxiety and depression) and overall health/quality of life. Logistic regression was adjusted for sociodemographic characteristics and baseline health outcomes. Of the 33,184 participants who were married at T1 (mean age 59.5 ± 9.3 years), after 3.4 years, 2.9% became divorced and 2.4% widowed at T2. Recent divorce was positively associated with smoking, poor quality of life, high psychological distress, anxiety and depression at T2. Similar but weaker associations were observed for widowhood. However, these associations were much attenuated at T3 (5 years from T2). Marital disruption in midlife or at an older age can be detrimental to health, particularly psychological health in the short term. Public awareness of the health consequences of spousal loss should be raised. Resources, including professional support, should be allocated to help individuals navigate these difficult life transitions.

Telephone based coaching for adults at risk of diabetes: impact of Australia's Get Healthy Service.

The Get Healthy Information and Coaching Service (GHS), an effective 6-month telephone-based healthy lifestyle coaching service, includes a population-targeted diabetes prevention module (DPM) tailored for adults at risk for type 2 diabetes. This study determined DPM's reach and impact on anthropometric and lifestyle risk factors. Pre-post evaluation design examined self-reported anthropometric (body weight, waist circumference) and lifestyle risk factors (physical activity and dietary behaviors) of DPM participants. Descriptive and chi-square analyses were performed on sociodemographic variables. Behavioral changes were assessed using matched pairs analysis, independent samples analysis, and multivariate analysis. There were 4,222 DPM participants (76.0% female; 75.9% aged ≥ 50; 95.4% spoke English at home). The DPM included higher proportions of older adults (≥50) (75.9% vs. 46.5%; p < .001), retirees (28.7% vs. 18.5%; p < .0001), less educated (33.3% vs. 24.9%; p < .0001), more disadvantaged (41.7% vs. 34.8%; p < .001) and living in regional or rural areas (43.2% vs. 39.8%; p < .001) than the GHS program. DPM participants reported significant improvements at six months for all anthropometric (-3.3 kg weight; -1.2 BMI units; -4.3 cm waist circumference) and behavioral risk factors (+0.2 fruit serves/day; +0.7 vegetables serves/day; -0.2 sweetened drinks/day; -0.2 takeaway meals/week; +1.1 30-min walking sessions/week; +0.7 30-min moderate activity sessions/week; +0.2 20-min vigorous activity sessions/week). Nearly one-third (31.1%) of participants lost ≥5% body weight. The DPM reached priority population groups, those typically underrepresented in diabetes prevention programs and resulted in clinically relevant improvements in anthropometric and lifestyle risk factors in adults at increased risk for type 2 diabetes.

Associations between multiple indicators of socio-economic status and muscle-strengthening activity participation in a nationally representative population sample of Australian adults.

BACKGROUND: Muscle-strengthening activity (MSA) (e.g. weight training), confers unique health benefits. While socioeconomic status (SES) correlates with leisure time physical activity, little is known about its relation with MSA. METHODS: Cross-sectional study of a representative sample of 8993 Australian adults (>18years) who participated in the National Nutrition and Physical Activity Survey 2011-12. Information was collected on SES (income, education, socio-economic disadvantage and remoteness) and MSA participation. RESULTS: 17.9% (CI: 16.8-19.0) met the national guidelines for MSA (≥2 sessions/week). Men and younger adults (<35years) met MSA guidelines more than females (19.7%; CI: 18.3-21.1% vs 16.1%; CI: 14.6-17.6%; p<0.001) and older adults respectively (25.0%; CI: 22.4-27.7% vs 10.4%; CI: 8.9-11.8%; p<0.001). All SES indicators were associated with meeting the guidelines in unadjusted analyses. When adjusting for total physical activity and mutually adjusting for each socioeconomic indicator only remoteness (OR for city vs rural=1.65; CI: 1.17-2.32; p<0.001) was associated with MSA participation (education OR=1.09 for high vs low; CI: 0.80-1.47, p=0.748; income OR=1.31 for Q5 vs Q1, CI: 0.93-1.85, p=0.328; social disadvantage OR=1.04 for v.high vs v.low, CI: 0.76-1.43, p=0.855). These associations were further attenuated when adjusting for BMI, smoking status and self-rated health. CONCLUSION: Remoteness, and to a lesser degree, education, income and social disadvantage, were independently associated with MSA participation. Public health interventions should improve access to strength training facilities, and/or increase home-based muscle-strengthening activity in remote areas.

Who is at risk of chronic disease? Associations between risk profiles of physical activity, sitting and cardio-metabolic disease in Australian adults.

OBJECTIVE: To examine the associations of physical activity (PA) and sitting time (sit) with cardio-metabolic diseases. METHODS: Cross-sectional data from the Australian National Nutrition and Physical Activity Survey 2011-2012 (n=9,435) were used to classify adults into low and high risk groups based on their physical activity and sitting behaviour profiles. Logistic regression models examined associations between low and high risk classifications (high PA-low sit; high PA-high sit; low PA-low sit; low PA-high sit;) and socio-demographic factors, and associations between low and high risk classifications and the prevalence of cardiovascular disease, Type 2 diabetes and metabolic syndrome. RESULTS: These results characterise chronic disease risk based on both physical activity and sitting behaviour. Adults with the highest risk lifestyle behaviour pattern (low PA-high sit) tended to be middle aged, male, at greater social disadvantage, smoke, report fair health, be abdominally obese and employed in administrative and driver occupations. These individuals had a substantially greater risk of cardiovascular disease and metabolic syndrome (OR=1.41, 95% CI 1.13, 1.75; OR= 2.37, 95% CI 1.63, 3.45, respectively). CONCLUSIONS: The findings highlight the importance of both sufficient physical activity and low sitting time for cardio-metabolic health. Implications for public health: Primary prevention focus should consider physical activity and reduced sitting time as well as provision of relevant advice for cardio-metabolic health.

The descriptive epidemiology of total physical activity, muscle-strengthening exercises and sedentary behaviour among Australian adults--results from the National Nutrition and Physical Activity Survey.

BACKGROUND: The current Australia's Physical Activity and Sedentary Behaviour Guidelines recommend that adults engage in regular moderate-to-vigorous-intensity physical activity (MVPA) and strength training (ST), and minimise time spent in sedentary behaviours (SB). However, evidence about the specific individual and concurrent distribution of these behaviours in Australia is scarce. Therefore, the aim of this study was to determine the prevalence and sociodemographic correlates of MVPA, ST and SB in a national-representative sample of Australian adults. METHODS: Data were collected using face-to-face interviews, as part of the National Nutrition and Physical Activity Survey 2011-12. The population-weighted proportions meeting the MVPA (≥ 150 min/week), ST (≥ 2 sessions/week) and combined MVPA-ST guidelines, and proportions classified as having 'low levels of SB' (< 480 min/day) were calculated, and their associations with selected sociodemographic and health-related variables were assessed using multiple logistic regression analyses. This was also done for those at potentially 'high-risk', defined as insufficient MVPA-ST and 'high-sedentary' behaviour. RESULTS: Out of 9345 participants (response rate = 77.0 %), aged 18-85 years, 52.6 % (95 % CI: 51.2 %-54.0 %), 18.6 % (95 % CI: 17.5 %-19.7 %) and 15.0 % (95 % CI: 13.9 %-16.1 %) met the MVPA, ST and combined MVPA-ST guidelines, respectively. Female gender, older age, low/medium education, poorer self-rated health, being classified as underweight or obese, and being a current smoker were independently associated with lower odds of meeting the MVPA, ST and combined MVPA-ST guidelines. A total of 78.9 % (95 % CI: 77.9 %-80.0 %) were classified as having low levels of SB. Females, older adults and those with lower education were more likely to report lower levels of SB, whilst those with poor self-rated health and obese individuals were less likely to report lower levels of SB (i.e. SB = ≥ 480 min/day). A total of 8.9 % (95 % CI: 8.1 %-9.6 %) were categorised as individuals at potentially 'high-risk'. Those with poorer self-rated health, obese individuals, those aged 25-44, and current smokers were more likely to be in the 'high risk' group. CONCLUSIONS: The large majority of Australian adults do not meet the full physical activity guidelines and/or report excessive SB. Our results call for public health interventions to reduce physical inactivity and SB in Australia, particularly among the subgroups at the highest risk of these unhealthy behaviours.

Translational research: are community-based child obesity treatment programs scalable?

BACKGROUND: Community-based obesity treatment programs have become an important response to address child obesity; however the majority of these programs are small, efficacy trials, few are translated into real-world situations (i.e., dissemination trials). Here we report the short-term impact of a scaled-up, community-based obesity treatment program on children's weight and weight-related behaviours disseminated under real world conditions. METHODS: Children age 6-15 years with a body mass index (BMI) ≥ 85th percentile with no co-morbidities, and their parents/carers participated in a twice weekly, 10-week after-school child obesity treatment program between 2009 and 2012. Outcome information included measures of weight and weight-related behaviours. Analyses were adjusted for clustering and socio-demographic variables. RESULTS: Overall, 2,812 children participated (54.2% girls; M(age) 10.1 (2.0) years; M(attaendance) 12.9 (5.9) sessions). Beneficial changes among all children included BMI (-0.65 kg/m(2)), BMI-z-score (-0.11), waist circumference (-1.8 cm), and WtHtr (-0.02); self-esteem (+2.7 units), physical activity (+1.2 days/week), screen time (-4.8 h/week), and unhealthy foods index (-2.4 units) (all p < 0.001). Children who completed ≥ 75% of the program were more likely to have beneficial changes in BMI, self-esteem and diet (sugar sweetened beverages, lollies/chocolate, hot chips and takeaways) compared with children completing <75% of the program. CONCLUSIONS: This is one of the few studies to report outcomes of a government-funded, program at scale in a real-world setting, and shows that investment in a community-based child obesity treatment program holds potential to produce short-term changes in weight and weight-related behaviours. The findings support government investment in this health priority area, and demonstrate that community-based models of child obesity treatment are a promising adjunctive intervention to health service provision at all levels of care.