Behavioural risk factors

Many serious health issues, including some chronic diseases (such as cardiovascular disease, chronic kidney disease, certain types of cancer, type 2 diabetes, influenza and high blood pressure) can relate to lifestyle factors—particularly lack of physical exercise, poor nutrition, obesity, smoking, excessive alcohol consumption, non-vaccination and psychological distress.

Overall, there is a mixed story on the healthy lifestyles of older Australians. In addition, when compared with people aged 18–64, older people do well on some measures, but poorly on others.

Behavioural risk factors, by age group, 2014–15
  Aged 65 and over Aged 18–64

Sufficiently active

35%

48%

Current daily smoker

7%

16%

Vaccinated against influenza

75%

23%

More than 2 standard drinks of alcohol a day

16%

18%

At least 2 fruit + 5 vegetables a day

8%

5%

Overweight or obese

72%

61%

Experienced stress

52%

63%

Source: ABS [1,2].

These factors are now explored in more detail for older Australians.

Physical activity

National guidelines state that older Australians should aim for 30 minutes of moderate exercise (for example, brisk walking, sports, gardening or swimming) on most, if not all, days of the week [6]. Being active can help to maintain a healthy Body Mass Index. Regular physical activity has important benefits for both physical and mental health, including:

  • reducing the risk of many health problems, such as cardiovascular disease, diabetes, anxiety, depression, and musculoskeletal problems
  • enhancing social and community connectedness by providing opportunities for social engagement [7].

In 2014–15, 35% of people aged 65 and over surveyed as part of the Australian Bureau of Statistics (ABS) National Health Survey (NHS) reported being sufficiently active (doing more than 150 minutes of exercise over 5 or more sessions) during the preceding week; 37% reported being insufficiently active (less than 150 minutes of exercise); and 28% reported doing no exercise at all (Figure 1).

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Nutrition

A diet with a wide range of fruit and vegetables protects against conditions such as heart disease, type 2 diabetes and certain eye diseases such as cataracts and macular degeneration [4]. A high intake of fruit and vegetables promotes a healthy lifestyle; the National Health and Medical Research Council (NHMRC) recommends that adults have 2 servings of fruit and 5 servings of vegetables every day [10].

Based on data from the 2014–15 NHS, across all age groups, most Australians (95%) reported not eating enough fruit and vegetables to meet these recommended guidelines. Older Australians, however, tend to consume more fruit and vegetables than younger cohorts, with 8% of people aged 65 and over (8% aged 65–84, and 6% of people aged over 85) meeting the guidelines compared with 5% of people aged 18–64 [2].

Obesity

Obesity is a key health issue for older Australians and can increase the risk of developing heart disease, type 2 diabetes and certain cancers, among other things. Based on data from the 2014–15 NHS, 72% of people aged 65 and over (around 2.4 million) were overweight or obese, compared with an average of 63% for all Australians aged 18 and over and 61% for Australians aged 18–64.

The proportion of people who are overweight or obese increases with age (Figure 2) among both sexes, peaking at ages 55–64 for men and at ages 65–74 for women. Among people aged 65 and over, the proportion who were overweight or obese declined from 80% of men and 69% of women aged 65–74, to 58% of men and 56% of women aged 85 and over [2].

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Smoking

Rates of smoking have dramatically decreased in Australia since the late 1980s. This may be due to an improved awareness of the negative health effects of tobacco, and a range of control measures aimed at reducing smoking rates.

Smoking is the leading risk factor for a number of diseases and conditions, including coronary heart disease and lung disease. As well, smoking is estimated to be responsible for 22% of all cancer deaths per year.

Older Australians tend to have lower rates of smoking than younger cohorts—only 9% of people aged 65–74, and 5% of people aged 75 and over, were daily smokers in 2016, compared with 13% for all people aged 18 and over. However, the proportion of older people who smoked daily did not change between 2001 and 2016, while the rates decreased in all younger age groups during the same time period [5].

Around one-third of older people (35% of those aged 65–74, and 32% of those aged 75 and over) reported being previous smokers. Among those who were current smokers, smoking a pack a day was common: 44% of people aged 65–74 and 41% of those aged 75 and over smoked on average 20 or more cigarettes a day [5].

The most common reasons older people reported for quitting were financial cost (46% of people aged 65–74, and 53% of those aged 75 and over) and health: 57% of people aged 65–74, and 43% of people aged 75 and over, reported that they were motivated by reasons such as “I think it was affecting my health or fitness” and “My doctor advised me to give it up” [5].

Alcohol consumption

Alcohol plays a prominent role in society; most Australians drink at light to moderate levels. However, drinking excessive amounts of alcohol is a health risk, and can contribute to long-term health issues such as liver disease, some cancers, and brain damage [8].

The NHMRC recommends no more than 2 standard drinks daily to reduce one’s lifetime risk, and no more than 4 drinks in one event to reduce single-occasion risk [9]. In 2016, older Australians were less likely to have single-occasion risk than younger people. Around 13% of people aged 65–74 (and just 5% of those aged 75 and over) had drunk more than 4 standard drinks on any one occasion in the last month, compared with 21% of people aged 55–64, and 40% of people aged in their 20s. Older people were also more likely to not have consumed any alcohol in the last 12 months: 24% of people aged 65–74, and 34% of those aged 75 and over were abstainers, compared with around 20% in younger age groups [5].

In terms of lifetime risk—that is, drinking on average more than 2 standard drinks per day—some 16% of people aged 65–74, and 9% of those aged 75 and over drank alcohol above the recommended guidelines. Men were more likely than women to drink more than 2 standard drinks per day (Figure 3) [5].

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Vaccinations

One of the most effective health interventions against preventable health issues is vaccination. Influenza and pneumonia can seriously affect the health of older Australians, and vaccinations are free for people aged 65 and over to ensure a high coverage. The influenza vaccine is available annually; the pneumonia vaccine is administered less often, with only one re-vaccination required every 5 years after the first dose. In 2009, around three-quarters (75%) of people aged 65 and over were vaccinated against seasonal influenza, and more than half (54%) against pneumococcal disease (pneumonia) [3]. Combined, half (51%) of older people were vaccinated against influenza and pneumonia—and conversely, more than 1 in 5 (22%) were not vaccinated for either disease.

Stress

Chronic stress can potentially lead to anxiety and depression, as well as to physical health issues such as high blood pressure. In 2014, stress affected more than half (52%) of people aged 65 and over in the last 12 months, with serious illness and the death of a loved one some of the most common types of stressors older people experienced [1]. Stress management strategies, such as relaxation, physical activity, time management and social connections, can help lower stress levels and reduce the negative impact experienced as a result of chronic stress.

Another factor that has a significant impact on the health outcomes of older Australians is their exposure to abuse. Comprehensive data on elder abuse in Australia– including its prevalence, the type of abuse, the perpetrator and in what context the abuse may be more likely to occur– are not currently collected or reported. The importance of bridging this data gap is widely recognised, with the Elder Abuse–A National Legal Response report by the Australian Law Reform Commission in 2017 calling for a national prevalence study, including the development of standardised measures for consistent data collection [11, 12].

References

  1. Australian Bureau of Statistics (ABS) 2014. General Social Survey: summary results, Australia, 2014. ABS cat. no. 4159.0. Canberra: ABS.
  2. ABS 2015. National Health Survey: first results, 2014–15. ABS cat. no. 4364.0. Canberra: ABS.
  3. Australian Institute of Health and Welfare (AIHW) 2011. 2009 Adult Vaccination Survey: summary report. Cat. no. PHE 135 Canberra: AIHW.
  4. AIHW 2011. Key indicators of progress for chronic disease and associated determinants: data report. Cat. no. PHE 142. Canberra: AIHW.
  5. AIHW 2017.  National Drug Strategy Household Survey 2016: detailed findings. Cat. no PHE 214. Canberra: AIHW.
  6. Department of Health (DoH) 2013. Recommendations on physical activity for health for older Australians. Canberra: Department of Health. Viewed 22 March 2016.
  7. DoH 2012. Development of evidence-based physical activity recommendations for adults (18–64 years) (PDF). Canberra: DoH. Viewed 5 May 2016.
  8. Ministerial Council on Drug Strategy (MCDS) 2011. The National Drug Strategy 2010–2015. Canberra: MCDS.
  9. National Health and Medical Research Council (NHMRC) 2009. Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC.
  10. NHMRC 2013. Australian dietary guidelines. Canberra: NHMRC.
  11. AIHW 2018. Family, domestic and sexual violence in Australia, 2018. Cat.no. FDV 2. Canberra: AIHW.
  12. ALRC (Australian Law Reform Commission) 2017. Elder abuse—a national legal response. Sydney: ALRC.