Physical multimorbidity and sedentary behavior in older adults: Findings from the Irish longitudinal study on ageing (TILDA)
Introduction
Non-communicable diseases are the leading cause of premature mortality worldwide, accounting for around 70 % of deaths [1]. Research and clinical care tend to focus on managing diseases individually, but between 13 % and 59 % of adults have two or more chronic physical health conditions, or multimorbidity, in community or care settings [[2], [3], [4], [5], [6], [7], [8]]. Multimorbidity is associated with a shorter life expectancy and elevated risk of premature mortality that is greater in older adults, increasing with the number of conditions [[9], [10], [11], [12]]. Multimorbidity involves complex pathways of care and substantial financial costs to the healthcare system [2]. The prevalence of multimorbidity also increases with age and is only partially explained by factors such as access to healthcare or age itself [5,8,13]. Older adults with multimorbidity are also at a greater risk of disability and a lower quality of life [14,15]. Identifying modifiable risk factors that may reduce the prevalence and subsequent burden of multimorbidity may extend life expectancy and promote quality of life in older adults.
Sedentary behavior (SB) refers to any waking behavior in a sitting or reclined position associated with ≤1.5 metabolic equivalents (METs) of energy expenditure [16]. The global prevalence of physical inactivity is high [17] and SBs, such as watching television, have risen in adults and older adults [18,19]. Increasing evidence suggests that SBs are associated with an elevated risk of several chronic physical health conditions and all-cause mortality [20], independent of overall physical activity levels [[21], [22], [23]]. SB is associated with multiple inflammatory processes that may contribute towards the development of multimorbidity in older adults [24,25].
Several population-based studies have found that physical activity is inversely correlated with multimorbidity in older adults [[26], [27], [28], [29], [30], [31], [32]], but few have focused on independent associations with SB and adjusted for physical activity. One cross-sectional study in 34,129 older adults (aged ≥50) using data from six low- and middle-income countries (China, Ghana, India, Mexico, Russia, and South Africa) found that physical multimorbidity was associated with 41 % (OR = 1.41, 95 % CI = 1.19, 1.66) higher odds of high SB (≥8 h per day) [7]. Another cross-sectional study in the US used accelerometer data from 2048 adults (mean age = 42.7) and found that an additional 60 min/day of SB was associated with an 11 % (OR = 1.11, 95 % CI = 1.01, 1.21) increased odds of multimorbidity [3]. Finally, data from 10,186 adults (age 20–69) in the Canadian National Population Healthy Survey suggests that those with sedentary lifestyles had a 14 % (OR = 1.14, 95 % CI = 1.07, 1.14) greater odds of multimorbidity, but not for physical inactivity [13]. While these studies have provided insight into the relationship between SB and multimorbidity, the study including six low- and middle-income countries was limited in terms of the number of chronic conditions assessed, while the other two studies from high-income countries (i.e., the USA and Canada) did not adjust for physical activity. Furthermore, the study from Canada was only on sedentary lifestyles and did not quantify time spent in SB.
Given the paucity of population-based research on the association between SB and multimorbidity in older adults (aged ≥50), and lack of studies that have investigated associations between time spent in SB and multimorbidity independent of low physical activity in high-income countries, we examined the association between SB and physical multimorbidity while adjusting for physical activity levels using a large, nationally representative sample from Ireland. We hypothesized that SB will be higher in people with a greater number of chronic physical conditions.
Section snippets
Participants
We analyzed data from the first wave of the Irish Longitudinal Study on Ageing (TILDA) survey, which is described in detail elsewhere [33,34]. TILDA is a community-based survey of older adults (mostly over 50 years) residing in Ireland between October 2009 and February 2011. Clustered random sampling was used to obtain nationally representative samples. Data was collected using Computer Assisted Personal Interviewing (CAPI) and self-completion questionnaires (SCQs). A total of 8163 people aged
Contributors
A. Kandola drafted the original manuscript and contributed to editing and review of the paper.
B. Stubbs contributed to supervision of the study, and editing and review of the paper.
A. Koyanagi contributed to formal analysis, and editing and review of the paper.
Conflict of interest
The authors declare that they have no conflict of interest.
Funding
Aaron Kandola is supported by the ESRC (ES/P000592/1). Ai Koyanagi's work is supported by the PI15/00862 project, integrated into the National R+D+I and funded by the ISCIII - General Branch Evaluation and Promotion of Health Research - and the European Regional Development Fund (ERDF-FEDER). Brendon Stubbs is supported by a Clinical Lectureship (ICA-CL-2017-03-001) jointly funded by Health Education England (HEE) and the National Institute for Health Research (NIHR). Brendon Stubbs is part
Ethical approval
Ethical approval for TILDA was obtained by the Faculty of Health Sciences Ethics Committee of Trinity College Dublin. Written informed consent was obtained from all participants.
Research data (data sharing and collaboration)
Researchers interested in using TILDA data may access the data for free from the following sites: Irish Social Science Data Archive (ISSDA) at University College Dublin http://www.ucd.ie/issda/data/tilda/; Interuniversity Consortium for Political and Social Research (ICPSR) at the University of Michigan http://www.icpsr.umich.edu/icpsrweb/ICPSR/studies/34315
Provenance and peer review
This article has undergone peer review.
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