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Year : 2013  |  Volume : 27  |  Issue : 1  |  Page : 61-64

Behavior and lifestyle factors among older persons living in a district of North India

1 School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Community Medicine, Indira Gandhi Medical College, Shimla, India

Date of Web Publication17-Aug-2013

Correspondence Address:
Deepak Sharma
School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-4958.116649

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Background: In elderly, healthy lifestyles are critical in reducing disease risk and increased wellness. Among the many top causes of morbidity, chronic lifestyle-related diseases contribute a major chunk. Objectives: The present study examined self-reported frequencies of smoking, alcohol use, physical activity and dietary practices among older persons and the influence of these on functional limitation among older persons. Materials and Methods: The study sample consisted of 400 study subjects of Shimla hills in North India, aged 60 to 92 years. Participants were recruited from urban and rural areas. Behavior and lifestyle factors information was obtained through a structured interview. Results: 12% currently consumed alcohol and 28.0% were current smokers. Less than half engaged in regular physical activity. Only 41% were regularly consuming milk products, fruits and vegetables in their diet. 20.1% of elderly had inadequate functional ability in instrumental activities of daily living. Conclusion: Adoption of healthy lifestyle activities especially a regular nutritious diet can help preventing functional limitation in elderly.

Keywords: Behavior and lifestyle factors, Elderly, Functional status

How to cite this article:
Sharma D, Mazta SR, Parashar A. Behavior and lifestyle factors among older persons living in a district of North India. J Med Soc 2013;27:61-4

How to cite this URL:
Sharma D, Mazta SR, Parashar A. Behavior and lifestyle factors among older persons living in a district of North India. J Med Soc [serial online] 2013 [cited 2020 Oct 21];27:61-4. Available from:

  Introduction Top

Health and wellness are multidimensional. The dimensions include the emotional (mental), intellectual, physical, social and spiritual health. Lifestyle change, more than any other factor, is considered to be the best way of preventing illness and early death in our society. Regular physical activity, sound nutrition and staying away from smoking and alcohol are considered to be priority healthy lifestyles. [1],[2],[3]

Functional status in old age is personal ability of fulfilling different needs. It depends on the person's biological, psychological and social capacities, which synchronically enable all activities. Numerous studies have observed the relation between healthy lifestyle practices (exercise, avoidance of tobacco, alcohol, good dietary practices) and functional ability (i.e., maintenance of health and high quality of life) in old age. [4],[5],[6],[7]

The present paper examined the self-reported frequencies of cigarette smoking, alcohol consumption, regular physical activity, and dietary intake among older persons. We also examine the influence of these practices on functional limitation among older persons.

  Materials and Methods Top

This was an observational study with a cross-sectional design, conducted in the Shimla district of North India during the period 2010-2011.The target population for this study consisted of elderly people aged 60 years or older, living in urban and rural areas of Shimla district. The sample size was calculated based on the formula 4 pq/l. 2 Due to lack of information on the proportion of health practices among elderly in the study area, the calculation was based on the assumption of prevalence to be 50%. Assuming a confidence level of 95 percent and at a precision of 7 percent, the total sample size was 196 elderly (200 elderly from urban areas and 200 elderly from rural areas of district Shimla of Himachal Pradesh). In urban area of Shimla city, 5 wards were selected out of the 25 wards by simple random sampling. 40 older persons were selected from each ward. In rural Mashobra area of Shimla district, out of the 15 sub-center villages, five were selected by simple random sampling. 40 older persons were selected from each selected village. In both urban and rural areas with the help of key informants, sampled areas were geographically divided into four parts with equal population (approximately). For each part, one house was selected randomly. Starting from this house, every nearest next house was surveyed until ten subjects were enrolled for the study. A similar procedure was applied in the remaining parts of the areas. A written informed consent was obtained from all the study participants. Institutional ethics committee approval was obtained before the start of the study.

Questions were phrased in terms of frequency of smoking, alcohol consumption, regular physical activity and dietary intake of some food items. The smoking data was categorized as non-smoker (those who had never tried a cigarette in their lifetime and those who ever smoked, but had stopped now) and current smokers (those who reported smoking during the study both occasionally and daily). Consumption of alcoholic beverages was coded as non-alcoholic (those who had never tried and those who ever took alcohol beverage, but had stopped now) and current alcoholic (those who reported consuming alcohol beverage during the study both occasionally and daily). The food items included in the study were the most commonly eaten food items viz., milk products, green leafy vegetables and fruits. Participants were asked to recall how often they ate these food items. The responses were occasional and regularly.

To evaluate the functional ability, a self-assessment scale namely Lawton and Brody IADL scale was used. In the scale, the following activities were considered: Preparing or cooking food, using the phone, taking a bus, taking medication, managing money, shopping, housekeeping. For the purpose of analysis, functional disability was coded dichotomously (1 = inadequate functional ability and 0 = adequate functional ability) (Lawton and Brody, 1969).

Statistical analyses were carried out using Epi info software for windows (version 6.04). Proportions were calculated for the categorical variables. Relationship of functional disability with the behavior factors was assessed using a multivariate logistic regression analysis, which was adjusted for potential confounders such as age, sex, marital status and education. Ethical clearance was sought from the institute ethics committee of Indira Gandhi Medical College, Shimla.

  Results Top

In this study, a total of 400 subjects were surveyed, out of which, 204 (51%) were females and 196 (49%) were males. Majority of the older population (60.5%) were in the age group 60-69 years. About three-fourth were currently married and half of them were literate. 20.1% of elderly had inadequate functional ability in instrumental activities of daily living (IADL) [Table 1].
Table 1: Socio-demographic characteristics of the study population

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Around 43% were engaged in regular physical activity. A breakdown of the types of exercises done by the study subjects indicates walking to be the most common (87%), followed by power walking (17%), jogging (5%) and others (1%). Among the study subjects, 12% were currently consuming alcohol and 28.0% were current smokers. There were more elderly smokers in rural area (35%) as compared to urban area (21.5%), which was statistically significant. Around two-third were strict vegetarians. Around 41.2% were regularly consuming milk products, fruits and vegetables in their diet [Table 2].
Table 2: Behavior and lifestyle factors by residence among elderly study subjects

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Multiple logistic regression result shows that the odds of inadequate functional ability was more in elderly subjects who were not regularly consuming milk products, green vegetables and fruits [Table 3].
Table 3: Multivariate analysis of behavior and lifestyle factors associated with inadequate functional ability among elderly residents of a district in North India

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  Discussion Top

The findings of this study suggest that 28% of the older study subjects were current smokers. This finding is similar to other studies across India. [8],[9] In our study there were more current smokers in rural area as compared to urban area. The finding is in agreement with the finding of studies done in two states of India. [10],[11] Lack of various facilities for entertainment in the rural areas as compared to the urban areas may contribute to indulgence in smoking. It was observed during this study that smoking was used to extend hospitality to friends and visitors in the rural areas.

In the present study, 12% of the study subjects were currently consuming alcohol. Our finding is similar to a study done by Goswami A. [12] However some studies have reported higher proportion of current elderly alcoholics. [13],[14] We observed that alcohol consuming habit was more prevalent among the urban older persons as compared to their rural counterparts. A study among the older persons in Faridabad district of Haryana [10] made similar observation. Contrary to our finding, a study by Liu et al.[15] observed that rural residents were more likely to have indulged in alcohol drinking as compared to urban older subjects.

A regular exercise program is the best available prescription for independent, active and healthy aging. In our study only 40% study participants were engaged in doing regular physical activity. On the other hand, 60% lived a rather inactive life carrying out no kind of regular physical exercise for their fitness and health. A possible reason may be that many of these older persons would be expected to be suffering from musculoskeletal problems, which interfere with their regular physical activity routine. Previous studies have reported low levels of physical activity among elderly. [16],[17] In our study, among the elderly who did regular physical activity, 87% of the study participants took walks for exercise in the past year. Other popular physical activities included gardening and bicycling. Walking has been documented as the most common forms of physical activity among older adults in various studies. [18],[19]

A good dietary pattern of older persons is important contributors to health of older persons. In the multivariate logistic regression model, regular intake of milk products, fruits and vegetables was inversely associated with functional limitations. This finding is in conformity with the findings of a study done by Houston DK, [20] which concluded that there is an association between high vegetable, fruits, milk products intake and lower odds of functional impairment in the study population. Several other cross-sectional studies have reported an association between the ability to perform instrumental activities of daily living (IADL) and scores of nutrition assessment scales. [21],[22] Contrary to this some studies have found no relation between functional limitation and dietary pattern. [23],[24]

When interpreting and generalizing the study findings, it is important to keep in mind that the present study assessed these behaviors and functional limitation at a point of time (cross-sectional design of the study). We used self-reported frequency of eating some food items, which does not allow accurate calculation of daily nutrient intake and thus be compared with standard recommendations. Also there is possibility of recall bias. Some elderly study subjects may have under or over-reported their smoking status, alcoholic status, physical activity and dietary lifestyle practices. The principal investigator tried his best to keep this bias to the minimum by ensuring confidentiality of the study participants.

In conclusion, our study provides important information on the behavioral practices of older persons. Elderly should be educated regarding quitting smoking and alcohol use. Further they should be encouraged to do regular physical activity and take a regular nutritious diet. Adoption of health lifestyle activities, especially on a regular nutritious diet can help in preventing functional limitation in elderly.

  References Top

1.WHO Review of Best Practice in Interventions to Promote Physical Activity in Developing Countries. Available from: [Last accessed on 2012 5 Feb].  Back to cited text no. 1
2.World Health Organization. Global Age-Friendly Cities: A Guide. Geneva: WHO Press; 2007. Available from: [Last accessed on 2012 5 Feb].  Back to cited text no. 2
3.Shields M, Martel L. Healthy living among seniors. Health Rep 2006;16(Suppl):7-20.  Back to cited text no. 3
4.Stuck AE, Walthert JM, Nikolaus T, Bula CJ, Hohmann C, Beck JC. Risk factors for functional status decline in community-living elderly people: A systematic literature review. Soc Sci Med 1999;48:445-69.  Back to cited text no. 4
5.Carlson JE, Ostir GV, Black SA, Markides KS, Rudkin L, Goodwin JS. Disability in older adults 2: Physical activity as prevention. Behav Med 1999;24:157-68.  Back to cited text no. 5
6.Camacho TC, Strawbridge WJ, Cohen RD, Kaplan GA. Functional ability in the oldest old. Cumulative impact of risk factors from the preceding two decades. J Aging Health 1993;5:439-54  Back to cited text no. 6
7.Kaplan GA. Health and aging in the Alameda County Study. In: Schaie KW, Blazer D, House JS, editors. Aging, health behaviors, and health outcomes. Hillsdale: Lawrence Erlbaum Associates; 1992. p. 69-88.  Back to cited text no. 7
8.Anil JP, Joy B, Malini KA, Vasudevan K, Veliath A, Panda P et al. Morbidity pattern among the Elderly population in the rural area of Tamil Nadu, India. Turk J Med Sci 2006;36:45-50.  Back to cited text no. 8
9.Prakash R, Choudhary SK, Singh US. A study of morbidity pattern among geriatric population in a urban area of Udaipur, Rajasthan. Indian J Community Med 2004;29:35-40.  Back to cited text no. 9
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10.Kaur J, Simon HH. A study of health practices among the elderly in Faridabad district of Haryana. Health and Population-Perspectives and Issues 1998;21:197-204. Available from: [Last accessed on 2013 Mar 23].  Back to cited text no. 10
11.Parwan UC, Ahluwalia SK, Gupta SP, Swami HM, Vaidya NK. Elderly at their homes: A social study. Ind J Prev Soc Med 1983;14:53-9.  Back to cited text no. 11
12.Goswami A, Reddaiah VP, Kapoor SK, Singh B, Dwivedi SN, Kumar G. Tobacco and alcohol use in rural elderly Indian population. Indian J Psychiatry 2005;47:192-7.  Back to cited text no. 12
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13.Anil JP, Joy B, Malini KA, Vasudevan K, Veliath A, Panda P, et al. Morbidity Pattern among the elderly population in the rural area of Tamil Nadu, India. Turk J Med Sci 2006;36:45-50.  Back to cited text no. 13
14.Khokhar A, Mehra M. Lifestyle and morbidity profile of geriatric population in an urban community of Delhi. Indian J Med Sci 2001;55:609-15.  Back to cited text no. 14
[PUBMED]  Medknow Journal  
15.Liu Z, Albanese E, Li S, Huang Y, Ferri CP, Yan F, et al. Chronic disease prevalence and care among the elderly in urban and rural Beijing, China-a 10/66 Dementia Research Group cross-sectional survey. BMC Public Health 2009;9:394.  Back to cited text no. 15
16.Booth ML, Owen N, Bauman A, Clavisi O, Leslie E. Social-cognitive and perceived environment influences associated with physical activity in older Australians. Prev Med 2000;31:15-22.  Back to cited text no. 16
17.Piro FN, Noss O, Claussen B. Physical activity among elderly people in a city population: The influence of neighbourhood violence and self-perceived safety. J Epidemiol Community Health 2006;60:626-32.  Back to cited text no. 17
18.McPhillips JB, Pellettera KM, Barrett-Connor E, Wingard DL, Criqui MH. Exercise patterns in a population of older adults. Am J Prev Med 1989;5:65-72.  Back to cited text no. 18
19.Frandin K, Grimby G, Mellstrom D, Svanborg A. Walking habits and health related factors in a 70 year old population. Gerontology 1991;37:281-8.  Back to cited text no. 19
20.Houston DK, Stevens J, Cai J, Haines PS. Dairy, fruit, and vegetable intakes and functional limitations and disability in a biracial cohort: The Atherosclerosis Risk in Communities Study. Am J Clin Nutr 2005;81:515-22.  Back to cited text no. 20
21.Jensen GL, Kita K, Fish J, Heydt D, Frey C. Nutrition risk screening characteristics of rural older persons: Relation to functional limitations and health care charges. Am J Clin Nutr 1997;66:819-28.  Back to cited text no. 21
22.Sharkey JR, Haines PS, Zohoori N. Community-based screening: Association between nutritional risk status and severe disability among rural home-delivered nutrition participants. J Nutr Elder 2000;20:1-15.  Back to cited text no. 22
23.Sharkey JR, Giuliani C, Haines PS, Branch LG, Busby-Whitehead J, Zohoori N. Summary measure of dietary musculoskeletal nutrient (calcium, vitamin D, magnesium, and phosphorus) intakes is associated with lower-extremity physical performance in homebound elderly men and women. Am J Clin Nutr2003;77:847-56.  Back to cited text no. 23
24.Zamboni M, Zoico E, Tosoni P, Zivelonghi A, Bortolani A, Maggi S, et al. Relation between vitamin D, physical performance, and disability in elderly persons. J Gerontol Med Sci 2002;57:7-11.  Back to cited text no. 24


  [Table 1], [Table 2], [Table 3]


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