While adapting to disability is an important component of positive ageing, so is preventing disability in the first place. Many common chronic conditions are not life threatening, but can lead to disability, particularly if left untreated. Preventative services therefore play an increasingly important part in primary care for older people. There has been a welcome increase in services such as influenza immunization (Crawford, O’Hanlon, & McGee, 2011) and other preventative interventions among older people such as cancer screening (National Screening Service, 2015).
Lifestyle and behavioural health are also critical for prevention of disease and disability. The behaviours that are associated with healthy or successful ageing are well known: not smoking, being physically active, maintaining weight within moderate ranges and consuming alcohol in moderation (Peel, McClure, & Bartlett, 2005). A recent review of relevant studies indicated that adults who have all four healthy behaviours have a 66% reduced risk of mortality (Loef & Walach, 2012). Even in a cohort of relatively affluent older adult college graduates, the cumulative lifetime disability for those who were obese, smoked and did not exercise was four times as great as in those who were lean, exercised, and did not smoke (Fries, 2003). Physical activity and not smoking have also been found to protect against decline in cognitive function (Allerhand et al., 2014).
While the cumulative effects of behaviour over the life-course is important, the extent to which older adults continue to engage in healthy or unhealthy behaviours also has a critical effect on outcomes. One study of adults aged 65+ reporting that smoking, low consumption of fruit and vegetables and low physical activity were associated with an increased risk of disability over a 12 year period (Artaud et al., 2013). Physical activity was identified as the strongest predictor of disability.
Healthy lifestyle behaviours are also associated with better quality of life outcomes (Perales, Del Pozo-Cruz, Del Pozo-Cruz, & Del Pozo-Cruz, 2014; Schmitz, Ph, Kruse, & Kugler, 2003; Ul-Haq et al., 2014; Ul-Haq, Mackay, Fenwick, & Pell, 2012). Exercise may reduce the risk of depression (Baker et al., 2005) and the chances of developing dementia, although it is difficult to disentangle the benefits of exercise from closely related factors such as social networks (Callaghan 2004). Nevertheless, exercise has been described as the, “best preventive medicine for old age” (World Health Organisation, 2002), significantly reducing the risk of dependency in old age (SNIPH, 2007). There is evidence that a range of activities - even simple types of exercise such as gardening (Ferrer-i-Carbonell & Gowdy, 2007) may be associated with higher life satisfaction, and that this may be especially important for the over 60s (Baker, Cahalin, Gerst, & Burr, 2005).
Despite extensive evidence for the benefits of health behaviours however, many older adults do not have healthy lifestyles - in Ireland, a third of the population aged 50 and over is obese (Leahy, Nolan, O’Connell, & Kenny, 2014), one in five smoke, one in three have low physical activity and one in 20 have problematic alcohol consumption (Barrett, Savva, Timonen, & Kenny, 2011). Between the first (2010/11) and second waves of TILDA (2012/13) rates of smoking declined, while rates of low physical activity and problematic alcohol consumption increased.