摘要：Objectives . This study investigated the effect of healthy lifestyle behaviors on self-rated health and self-care ability over a 10-year follow-up period in older persons in the SENECA study. Methods . Health status and lifestyle behaviors were examined in 1988/1989, 1993, and 1999 in 216 men and 264 women, born between 1913 and 1918, from 7 European countries. Results . Self-rated health and self-care ability declined in men and women with healthy and unhealthy lifestyle habits over the 10-year follow-up period. Inactive and smoking persons had an increased risk for a decline in health status as compared with active and nonsmoking people. No effect of a healthy, Mediterranean-like diet on the deterioration in health status was observed. Conclusions . Being physically active and nonsmoking delayed deterioration in health status in older participants aged 70 to 75 years in the SENECA study. (Am J Public Health. 2003;93:318–323) A major challenge today is how to improve overall health and quality of life at older ages. In Western societies, the average life expectancy has increased substantially in the past century, resulting in a much greater proportion of people surviving to older ages. 1 Increasing age is associated with comorbidity, cognitive impairments, and disability and loss of independence. 2– 5 If the average age at onset of ill health remained unchanged, an increased life span would mean more years of ill health before death. This is not the intended result of health promotion programs. Ideally, people should survive to an advanced age with their vigor and functional independence maintained, and morbidity and disability should be compressed into a relatively short period before death. 6, 7 In searching for determinants of healthy aging, we investigated whether the lifestyle factors not smoking, being physically active, and having a high-quality diet, which are related to a higher survival rate, 8, 9 are also related to a better health status at older ages. Health status has many dimensions—physical, emotional, and social—and can be operationalized through assessments of these different dimensions or through subjective self-assessments of overall health. In this study, we focused on 2 indicators of health status: self-rated health and functional status (self-care). Functional status is an objective indicator of health status that specifies the degree to which a person depends on others for help in performing activities of daily living. Self-rated health is a subjective health indicator that summarizes individual health aspects, weighed by personal values and preferences. 10, 11 In addition to these individual differences, gender, age, and culture are related to self-rated health. 12– 18 Self-rated health and functional status are good predictors of mortality 13, 19, 20 and are related to morbidity. 15, 21 Because multiple conditions usually occur together in older people, overall health measurements such as self-rated health and functional status are useful indicators with which to examine the effect of lifestyle factors on health status. This study investigated the relation of baseline healthy lifestyle behaviors—being physically active, being a nonsmoker, and having a high-quality diet—to 10-year changes in self-care ability and self-rated health of participants, aged 70 to 75 years, in the Survey in Europe on Nutrition and the Elderly: a Concerted Action (SENECA) study.
