Newspaper and television reports frequently remind us that the National Health Service (NHS) is under pressure in the face of our ageing population. Older people account for the majority of hospital admissions in England, rates of admission are increasing in this age group, and older people experience longer hospital stays and higher rates of readmission than younger people.
Improved understanding of the risk factors that lead to hospital admission in older people would help to forecast demand on the NHS and would assist in the design of interventions that aim to promote healthy ageing and to reduce the need for hospitalisation in future generations of older people.
It is well known that smoking, excessive alcohol use, low levels of physical activity and poor diet are major risk factors for ill health and early death. These poor health behaviours tend to occur in combination, or ‘cluster’, within people; for example, estimates suggest that 20% of men and 15% of women aged 65 years and older in the UK engage in three or more poor health behaviours. However, few research studies have explored the combined effect of poor health behaviours on illness and mortality in later life. We have addressed this gap in knowledge using data from HCS.
First, we used HCS baseline data to explore the links between the number of poor health behaviours that a person reports and their level of physical function; a high level of physical function is important if people are to remain independent and to maintain their quality of life in older age. We identified a strong increase in the proportion of men and women who reported having poor physical function with increasing number of poor health behaviours (1).
Next, with the consent of the study participants, we linked the baseline HCS database with information on the hospital admissions experienced by the cohort during the following decade. This meant we could explore whether rates of admission to hospital differed according to the number of poor health behaviours reported by HCS participants at baseline. We found that clustered poor health behaviours were very strongly associated with increased risk of hospital admission among men and women. In particular, increased number of poor health behaviours was associated with greater risk of complex types of admission such as long stays (more than 7 days), emergency admissions, and 30-day emergency readmissions (2).
These results are fascinating because they suggest that health promotion strategies designed to reduce the number of poor health behaviours that people engage in across the lifecourse could have a substantial beneficial impact on health and use of healthcare in later life.
Details of the published papers describing these studies are provided below.
- Robinson, S.M., Jameson, K.A., Syddall, H.E., Dennison, E.M., Cooper, C. and Aihie, S.A. (2013) Clustering of lifestyle risk factors and poor physical function in older adults: the Hertfordshire cohort study. J.Am.Geriatr.Soc., 61, 1684-1691.
- Syddall, H.E., Westbury, L.D., Simmonds, S.J., Robinson, S., Cooper, C. and Sayer, A.A. (2016) Understanding poor health behaviours as predictors of different types of hospital admission in older people: findings from the Hertfordshire Cohort Study. Journal of Epidemiology & Community Health, 70 (3), 292-298.