Background/aim: Obesity, diabetes and disability have been identified as the main threats today to healthy ageing. Disability with respect to activities of daily living (ADL) is the most severe disability and a predictor of nursing home placement. We aimed to investigate the relationship between potentially modifiable risk factors in middle age and ADL disability after 14 years using the Framingham Offspring Study (FOS).
Methods: FOS is an ongoing longitudinal cohort study; first examinations occurred between 1971-1975 with follow-up examinations every 4 years. Our study population were adults aged between 45-65 at examination 3 (1983-1987) (baseline) and ‘follow-up’ at examination 7 (1998-2001) (n=1956, mean age 53, 41% men). Predictors of disability considered were age, sex, body mass index (BMI), smoking, hypertension, diabetes and hypercholesterolaemia. Disability was measured at follow-up, defined as at least some limitation to at least one of: dressing, bathing, eating, transferring, toileting or walking 45 metres. Multinomial logistic regression was used to identify predictors of disability or death, as separate outcomes.
Results: Adjusting for age and sex, smoking increased the odds for disability by 64% (OR 1.64, 95% confidence interval (CI; 1.11-2.41), diabetes by 215% (OR 2.15, 95% CI 1.10-4.18) and obesity by 419% (OR 4.19, 95% CI 2.65-6.63). Being female was associated with a 61% increase in the odds for disability (OR 1.61, CI 1.12-2.30). Hypercholesterolaemia and hypertension were not significantly associated with future disability. A 45 year old man free of risk factors has a probability of 96% of surviving free of disability over the next 14 years while a 63 year old female current smoker with hypertension, diabetes and obesity has a 17% probability of surviving free of disability.
Conclusion: Obesity, diabetes and smoking in mid-life are strongly associated with development of future disability. Prevention of obesity, diabetes and cessation of smoking is essential to promote healthy ageing.