The role of lifestyle in socioeconomic inequities in physical limitations in activities daily living among elderly in the Netherlands

Abstract

Background: Physical limitations (PL) in activities daily living (ADL) significantly predict the need for assistance, caregiving, nursing home placement, and health care utilization. Therefore, it is important to reduce the socioeconomic inequities in PL in ADL for elderly. The current study is focused on socioeconomic inequity in PL in ADL and the role of lifestyle behaviours, namely diet, exercise, and smoking.

Methods: The data of a large-scale postal survey, for the longitudinal GLOBE study, among a stratified sample of the adult population (age 25–75 years) of Eindhoven and surrounding cities in October 2004 (N = 4785; response rate 64.4%) is used. In the current study participants above 65 are included. One participant was excluded because there was missing data for gender (N = 1046). A mediation analysis was conducted to see if diet, exercise, and smoking mediate the relationship between PL in ADL and the socioeconomic status (SES) of elderly in the Netherlands.

Results: SES had a significant negative relationship with PL in ADL (b=-.032, 95% CI [-.061, -.002], t= -2.113, p= .035). Exercise had a negative significant relationship with SES as well as PL in ADL. A partial mediation is present. For exercise as mediator the total effect is -.045. Smoking had a significant relation with SES, but no significant relation with PL in ADL. Diet had no significant relation with SES or PL in ADL.

Conclusions: Elderly with a higher SES had fewer PL in ADL than elderly in a lower SES. Elderly in a higher SES exercise more which leads to fewer PL in ADL. More research about lifestyle factors that mediate the relationship between SES and PL in ADL of elderly is needed. There is also a need for more research on the explanations for the differences in lifestyle factors across elderly in different socioeconomic groups.