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      Lifestyle predictors of successful aging: A 20-year prospective HUNT study

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          Abstract

          Background

          Lifestyle factors predicting successful aging as a unified concept or as separate components of successful aging are important for understanding healthy aging, interventions and preventions. The main objective was to investigate the effect of midlife predictors on subsequent successful aging 20 years later.

          Materials and methods

          Data were from a population-based health survey, the Nord-Trøndelag Health Study (HUNT), with an average follow-up of 22.6 years. Individuals free of major disease at baseline in 1984–86 with complete datasets for the successful aging components in HUNT3 in 2006–08, were included (n = 4497; mean age at baseline 52.7, range 45–59, years). Successful aging was defined either as a unified category or as three components: being free of nine specified diseases and depression, having no physical or cognitive impairment, and being actively engaged with life. The midlife predictors (smoking, physical activity, alcohol consumption, obesity and social support) were analysed both as separate predictors and combined into a lifestyle index controlling for sociodemographic variables, using multivariable regression analysis.

          Results

          Successful aging as a unified concept was related to all the lifestyle factors in the unadjusted analyses, and all except alcohol consumption in the adjusted analyses. The individual components of successful aging were differently associated with the lifestyle factors; engagement with life was less associated with the lifestyle factors. Non- smoking and good social support were the most powerful predictors for successful aging as a unified concept. When the lifestyle factors were summed into a lifestyle index, there was a trend for more positive lifestyle to be related to higher odds for successful aging.

          Conclusions

          Lifestyle factors predicted an overall measure of SA, as well as the individual components, more than 20 years later. Modifiable risk factors in midlife, exemplified by social support, may be used for interventions to promote overall health and specific aspects of health in aging.

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          Most cited references20

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          Successful aging.

          Substantial increases in the relative and absolute number of older persons in our society pose a challenge for biology, social and behavioral science, and medicine. Successful aging is multidimensional, encompassing the avoidance of disease and disability, the maintenance of high physical and cognitive function, and sustained engagement in social and productive activities. Research has identified factors predictive of success in these critical domains. The stage is set for intervention studies to enhance the proportion of our population aging successfully.
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            The HUNT study: participation is associated with survival and depends on socioeconomic status, diseases and symptoms

            Background Population based studies are important for prevalence, incidence and association studies, but their external validity might be threatened by decreasing participation rates. The 50 807 participants in the third survey of the HUNT Study (HUNT3, 2006-08), represented 54% of the invited, necessitating a nonparticipation study. Methods Questionnaire data from HUNT3 were compared with data collected from several sources: a short questionnaire to nonparticipants, anonymous data on specific diagnoses and prescribed medication extracted from randomly selected general practices, registry data from Statistics Norway on socioeconomic factors and mortality, and from the Norwegian Prescription Database on drug consumption. Results Participation rates for HUNT3 depended on age, sex and type of symptoms and diseases, but only small changes were found in the overall prevalence estimates when including data from 6922 nonparticipants. Among nonparticipants, the prevalences of cardiovascular diseases, diabetes mellitus and psychiatric disorders were higher both in nonparticipant data and data extracted from general practice, compared to that reported by participants, whilst the opposite pattern was found, at least among persons younger than 80 years, for urine incontinence, musculoskeletal pain and headache. Registry data showed that the nonparticipants had lower socioeconomic status and a higher mortality than participants. Conclusion Nonparticipants had lower socioeconomic status, higher mortality and showed higher prevalences of several chronic diseases, whilst opposite patterns were found for common problems like musculoskeletal pain, urine incontinence and headache. The impact on associations should be analyzed for each diagnosis, and data making such analyses possible are provided in the present paper.
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              Behavioral determinants of healthy aging.

              With global trends in population aging, many nations are developing and implementing healthy aging policies to promote quality as well as years of healthy life. To broaden the evidence base for such policy development, a review of the literature was conducted to summarize the existing evidence regarding the behavioral determinants of healthy aging. Such research is needed so that the efficacy of modes of intervention can be better understood. The outcome of "healthy" or "successful" aging was selected for this review since this nomenclature dominates the literature describing a global measure of multidimensional functioning at the positive end of the health continuum in older age. Studies published between 1985 and 2003 that reported statistical associations between baseline determinants and healthy aging outcome were identified from a systematic search of medical, psychological, sociological, and gerontological databases. Eight studies satisfied the search criteria. Modifiable risk factors among the behavioral determinants included smoking status, physical activity level, body mass index, diet, alcohol use, and health practices. On the basis of these findings, effective healthy aging policies need to enhance opportunities across the life span for modification of lifestyle risk factors. Efforts to standardize concepts and terminology will facilitate further research activity in this important area.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: SoftwareRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                11 July 2019
                2019
                : 14
                : 7
                : e0219200
                Affiliations
                [1 ] Clinic for Mental Health and Substance Abuse, Nord-Trøndelag Hospital Trust, Namsos, Norway
                [2 ] Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
                [3 ] Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
                [4 ] Division of Psychiatry, St. Olavs Hospital, Nidaros DPS, Trondheim, Norway
                [5 ] Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
                [6 ] Department of Psychology, Stockholm University, Stockholm, Sweden
                [7 ] Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
                Nathan S Kline Institute, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-8841-3998
                http://orcid.org/0000-0001-9275-646X
                http://orcid.org/0000-0002-2443-7923
                Article
                PONE-D-19-04278
                10.1371/journal.pone.0219200
                6622492
                31295289
                e359ec15-f4cf-4cda-b4a2-dcc81b07d777
                © 2019 Bosnes et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 13 February 2019
                : 18 June 2019
                Page count
                Figures: 0, Tables: 4, Pages: 12
                Funding
                This work is funded by a PhD scholarship from the Liaison Committee between the Central Norway Health Authority and the Norwegian University of Science and Technology (NTNU) to IB. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Nutrition
                Diet
                Alcohol Consumption
                Medicine and Health Sciences
                Nutrition
                Diet
                Alcohol Consumption
                Biology and Life Sciences
                Developmental Biology
                Organism Development
                Aging
                Biology and Life Sciences
                Physiology
                Physiological Processes
                Aging
                Medicine and Health Sciences
                Physiology
                Physiological Processes
                Aging
                Medicine and Health Sciences
                Public and Occupational Health
                Physical Activity
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Obesity
                Medicine and Health Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Obesity
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognitive Neuroscience
                Cognitive Neurology
                Cognitive Impairment
                Biology and Life Sciences
                Neuroscience
                Cognitive Neuroscience
                Cognitive Neurology
                Cognitive Impairment
                Medicine and Health Sciences
                Neurology
                Cognitive Neurology
                Cognitive Impairment
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Medicine and Health Sciences
                Epidemiology
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Body Mass Index
                Medicine and Health Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Body Mass Index
                Custom metadata
                The public sharing of the data set supporting the conclusions of this article has been restricted by the Regional Committees for Medical and Health Research Ethics ( post@ 123456helseforskning.etikkom.no ) in accordance with Norwegian law, as HUNT survey ( www.hunt.no) participants have not given consent to the public sharing of their data. These data are therefore available upon appropriate request to the Data Access Committee at HUNT Research Centre (email: hunt@ 123456medisin.ntnu.no ).

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