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
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).
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