A Healthy Living Index(HLI)and Its Associations With The Health Of Older People In China

BackgroundThe burden of an aging population in China has resulted in big challenges to social and economic development in our country.Healthy Aging has emerged as an important strategy to respond to this situation.Population aging is also a global problem.Many suggestions and viewpoints have been put forward by various national and international academic societies,but the contribution of older people’ s own initiative in responding to this challenge has been underestimated.Our previous study has found that measures of activities in the daily lives of older people--such as doing housework,maintaining a daily routine,and having a hobby--were more strongly associated with a good physical status than were measures of traditional exercise.This finding suggests that the contribution of the older people’s own daily activities to maintaining personal health,which may be termed "active health," needs to be analyzed and evaluated.ObjectivesBy analyzing the association of activities of daily life with the health status of the older people,this study proposes a "healthy living index(HLI)" that can quickly and easily assess the risk of health in older people in their daily activities.This information can also be used to promote the strategy of Healthy Aging.Materials and MethodsThis study was conducted during January to December 2011 and involved investigators in 13 hospitals in six major administrative regions of China with the aims to comprehensively assess the health status of the older people.Participants aged 60 and over were recruited from the community,regular health examination center,outpatient departments and wards.They were interviewed and measured before informed consent was obtained.A variety of data from daily living--,such as smoking,alcohol consumption,exercise,protein intake,amount of normal housework,employment status,level of social interaction,daily life routine,sleep quality and psychological condition(evaluated by the Geriatric Depression Scale,and classified as positive and negative status by binary cluster analysis)--were used to characterize the daily life of the study subjects.A logistic regression model was used to analyze the associations between these variables and the participants’ health status,which was evaluated by their walking speed,cognitive function,and self-evaluation of their health status.Physical performance was measured by walking speed,and walking speed<0.7m/s was defined as reduced physical performance.The mini-mental State Examination(MMSE)was ued to test cognitive function,and MMSE score<27 was defined as cognitive decline.The self-evaluation of health was defined as fair and poor by the older people themselves.Based on these results,a nomogram was generated to verify the associations and assign scores to each variable.These scores were then added together to calculate the HLI.The Receiver Operating Characteristic(ROC)curve was used to determine the cutoff value of the HLI.ResultsA total of 5009 eligible subjects[2,492 males(49.8%)and 2,517 females(50.2%)]were included in this study.Data were collected on the activities of daily life of older people that are associated with health status.The activity of doing housework was most strongly associated with walking speed,and followed by positive psychological status,sufficient protein intake,regular daily routine,and,lastly,exercise.Cognitive function had the strongest association with positive psychological status,followed by doing housework,sleep quality,regular daily routine,sufficient protein intake,and alcohol consumption.Positive psychological status showed the strongest association with selfevaluation of health status,followed by sleep quality,high-level exercise,employment,social interaction and regular daily routine.Based on the information in the nomogram,4.5 points were assigned to positive psychology status,2.5 points each to doing housework and whom aged less than 75,2 points each to good sleep quality,sufficient protein intake and high levels of exercise,1.5 points were assigned to a regular life schedule,1 point each todrinking alcohols and participation in reemployment,as well as 0.5 point was each to non-smoking and social involvement.Therefore,the maximum number of points for HLI was 20,and less than 12.75 was determined by ROC curve as the cutoff value to evaluate the health risk in daily life.ConclusionsThe activities of daily life measured in this study are significantly associated with the health status of the older people.The HLI can be used to semi-quantitatively assess the health risk present in the daily lives of the older people.Therefore,by intentionally pursuing "active health" in daily living of the older peoplewould be a helpful tool in achieving the goal of Healthy Aging.