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Specific lifestyle behaviors -- such as sticking to a Mediterranean-like diet and not smoking -- may dictate a person's ability to live without a caregiver into their late 80s. Photo by Sondem/via Adobe

How to stay out of a nursing home and age independently

Want to stay out of a nursing home in your twilight years? Put down that hot dog.

A new study outlines which aspects of a healthy lifestyle predict independent living late in life. While physical activity and living with someone else can factor into reaching old age, specific behaviors — such as sticking to a Mediterranean-like diet and not smoking — may dictate a person’s ability to live without a caregiver into their late 80s, according to research published Friday in the Journal of the American Geriatrics Society. Experts told NewsHour such guidelines for keeping the elderly mobile are invaluable as the geriatric population continues to grow.

“Preserved independence is highly valued by very old individuals,” Kristin Franzon, a geriatrician and the study’s lead author, told NewsHour via email. In the beginning, her team wanted to know if there was anything people could do to maintain independence as they age, or if dependence is an unavoidable part of getting old.

Her 16-year study at Uppsala University followed a cohort of Swedish men as they became octogenarians. Franzon started her investigation in 2011, but relied on data from the the Uppsala Longitudinal Study of Adult Men (ULSAM) — an ongoing project begun in 1970, when its participants were 50 years old.

Approximately 1,100 participants from ULSAM fit the bill for Franzon’s study, though some chose not to participate or didn’t meet the benchmark for independent living at the start. Over the next 16 years, a portion of the men also passed away or dropped out due to severe illness. To qualify as independent, the men had to meet rigorous standards. The men had to be able to bathe, toilet and dress themselves, and walk alone outdoors until the age of 87. They also had to pass a mental state examination, could not be institutionalized or have dementia.

In the end, 369 men completed the final study — 276 counted as independent agers, while 93 lived co-dependent lifestyles.

This cohort underwent a series of tests during medical checkups. The men were queried on their physical activity, education level, smoking habits and whether or not they lived alone. When they could make it to the clinic, nurses gave them a full physical, looking at health indicators like height, weight, waist circumference, blood pressure, blood glucose, insulin and cholesterol.

Participants also kept food diaries. Those records were scored based on how well their diets conformed to a modified Mediterranean diet — meaning it was adapted for a typical Swede. Typically, a Mediterranean diet emphasizes fish, cereals, polyunsaturated fatty acids, fruits and vegetables. For the Swedes in the study, their diets did not contain a lot of olive oil or nuts, while potatoes counted as a grain.

Out of all this information came three traits associated with independent aging: never having smoked, a waistline under 40 inches and a high adherence to the Mediterranean-like diet.

“As far as we know, this is the first study to show an association between high adherence to a Mediterranean-like diet and preserved independence at a very old age,” Franzon said. Other traits, including physical activity and cohabitation, are only associated with longevity.

But these lifestyle recommendations may not translate for everyone. Given that the men are of similar age and ethnicity provides consistency, but at the same time, limits how applicable the findings are to a broader population.

The study is also only in men. Women have more difficulty than men with everyday tasks as they get older, said Anne Newman, an epidemiologist at the University of Pittsburgh and former geriatrician who was not involved in the study.

Newman also noted that some participants didn’t complete every part of the survey — some became too infirm to visit the clinics, for instance — so it’s likely the results are slightly reflective of healthier individuals. Franzon acknowledges this limitation, too. Her team’s report notes that it’s possible the trends they see would be stronger if there had been less bias toward a healthier population.

Even though the study is small, it’s unique in that it looks at how well seniors are living and not just how long, Newman said. It’s also rare and remarkable, she added, for a study to start at a young age and then follow participants over such a long period of time.

As the geriatric population continues to grow, Newman stressed that more work is needed to understand what will keep people active.

People are living longer, but not everyone has a family capable of the emotional and economic burdens of caregiving. For some of the elderly, nursing homes mean boredom and neglect, while other seniors view successful aging as maintaining independence.

Frazon’s research pinpoints the behaviors that might help. So, are you swapping that hot dog for veggies yet?

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