The natural decline in cardiac function can leave an individual with lower functional capacity than would normally be expected for his/her age. The gradient of decline may become so steep as to result in disability.

The SENECA study demonstrated that a healthy lifestyle is related to stable self-perceived health, and a delay in functional dependence and mortality. The rate of decline of a body’s biological system is largely determined by external factors relating to adult life style.  Inactivity and smoking, and to a lesser extent a low-quality diet, increase mortality risk. A healthy lifestyle at older ages is related to a delay in the deterioration of health status and a reduced mortality risk. The study showed that even at ages 70-75 years, the combined unhealthy lifestyle behaviours of smoking, having a low-quality diet, and being physically inactive were singly related to a three- to four-fold increase in mortality risk. The risk of death was further increased for all combinations of two unhealthy lifestyle behaviors (De Groot et al, 2004). Member States should consider the promotion of programmes which encourage smoking cessation and the reduction of harmful alcohol consumption among older people (European Healthy Ageing, 2007).

Smoking. The acceleration in decline caused by external factors can be reversible at any age. Smoking cessation and small increases in the level of physical fitness, for example, reduce the risk of developing coronary heart disease, including those in later life.

Alcohol. Many chronic diseases which reduce functional capacity are the result of an unhealthy life style. WHO’s 1996 ‘The Global Burden of Disease’ Report states that alcohol use is the leading cause of male disability in industrialised countries (WHO, 1999).

Social factors. Social factors, which the individual can usually do little to change, also affect functional capacity. Poor education, poverty, and harmful living and working conditions all make reduced functional capacity more likely in later life. In some countries, people with poor functional ability are more likely to become institutionalised, which in itself can lead to dependence, particularly for the small minority of older people who suffer from loss of mental function and/or confusion.

Environment. Poverty is clearly linked to a shorter life span and poorer health in older age. Less well-off people tend to live in more harmful environments where they are more likely to be exposed to higher levels of indoor air pollution and to the risk of diseases such as respiratory infections. Poor housing structure and overcrowding increase the risks of accidents and transmission of infectious diseases (WHO, 1999). 

Nutrition. Nutritional status, dietary habits and food pattern, energy and nutrient intake vary widely across Europe. The food pattern in southern countries is characterised by high intakes of grain, vegetables, fruit, lean meat and olive oil, whereas older people in northern countries consumed more milk products and report more frequent use of nutrient supplements. In some towns considerable proportions of older men and women could be at risk of vitamin or mineral deficiency (Volkert, 2005). Obtaining adequate nutrition becomes increasingly difficult with increasing age. Nutrition and lifestyle, however, are important determinants of health and outcome in the elderly (Volkert, 2005). Healthy food and eating habits should be promoted among older people, with an emphasis on low intake of saturated fats and high consumption of fibre-rich foods, green vegetables and fruits (European Healthy Ageing, 2007).

Lack of physical activity. Physical activity usually decreases with age, though great differences exist between countries with respect to physical activity of older people. In a recent pan-European survey physical activity was highest in Sweden and Finland, where more than 85 % of older subjects spent at least 3.5 h per week in physical activity, and lowest in Portugal with only 25 % of active elderly (Volkert, 2005). The level of physical activity among older people needs to be increased in order to reach the international recommendations of 30 minutes or more  at least, of moderate intensity physical activity on most, preferably all, days of the week (European Healthy Ageing, 2007).

Risk factors for falls are muscle weakness, a history of falls, gait deficit, balance deficit, use of assistive devices, visual deficit, arthritis, impaired activities of daily living, depression, cognitive impairment, and being aged over 80. The risk of falling increases exponentially with the number of risk factors. Visual performance, medical problems, slowed neurological response, decreased muscle strength and range of motion, and reduced trunk and neck mobility become significant factors with age. These difficulties can also lead to motor vehicle and pedestrian-related injuries. Although older drivers drive less than younger ones, they succumb to fatal accidents more often. This may be because many medicines can impair driving ability, but a history of falling has also been identified as an important risk factor (WHO/HEN, 2004).

References cited in this table are listed in Chapter 9.4