The same largely modifiable factors that increase the risk of disease and early death -- smoking, high blood pressure, physical inactivity, obesity and diabetes -- also increase the risk of requiring nursing home care later in life, research shows.

This study, Dr. Louise B. Russell told Reuters Health, shows that "the risk of nursing home admission develops in middle age, before most people think of nursing home admission as a possibility, which means that people need to change their habits then if they want to avoid the nursing home."

Russell and colleagues used 20 years of data on a nationally representative sample of "community-dwelling" adults to determine the correlation between nursing home admission and the presence of certain lifestyle-related factors in middle age.

Among 3,526 middle-age adults, who were 45 to 64 years old at the beginning of the study, 230 entered a nursing home over the study period. In another group of 2,936 elderly adults, who were 65 to 74 years old at the start of the study, 728 entered a nursing home.

Even after other health factors were taken into consideration, the presence of modifiable lifestyle factors -- smoking, physical inactivity, obesity, high blood pressure, and diabetes, but not total cholesterol -- substantially increased the risk of nursing home placement.

The risk associated with each lifestyle-related factor was higher for persons in middle-age at the start of the study than for those who were elderly, suggesting that prevention is more effective earlier as opposed to later.

"The risk associated with diabetes is especially large," noted Russell, who is with the Institute for Health at Rutgers University in New Brunswick, New Jersey. "For middle-aged persons (those aged 45-64 at the start of our study), diabetes tripled the risk of admission to a nursing home over the next 20 years."

"This is particularly interesting," Russell added, "because diabetes is increasing rapidly in the U.S. and is associated with obesity and lack of exercise."

Smoking and high blood pressure also substantially raised the risk of nursing home placement in both age groups, but more so in middle-age persons. Inactivity raised the risk of nursing home placement in middle-age, but not elderly persons, while obesity was a risk factor for nursing home admission only in the elderly.

Modifying lifestyle for the better, especially in middle age, may lower the risk of nursing home admission, the authors suggest in their report, published in the Archives of Internal Medicine.

SOURCE: Archives of Internal Medicine, May 8, 2006.