Impact of healthy lifestyle on all-cause and cancer mortality
Lifestyle has been a somewhat underrated factor in the contribution, prevention and even treatment of non-communicable diseases. Modifiable lifestyle factors such as nutritional intake, physical activity, body mass index (BMI), and alcohol and tobacco consumption have been identified as important risk factors in heart disease, stroke, pulmonary diseases and cancer, among other conditions. It is also common knowledge that these diseases are associated with mortality and that a healthy lifestyle is associated with extended life expectancy.
Matta et al sought to use longitudinal data to assess the impact of modifying lifestyle behaviours on both all-cause mortality, as well as cancer mortality in particular. From the cohort of an ongoing prospective study, European Prospective Investigation into Cancer and Nutrition, 308 497 adults without cancer, aged 35–70 years across nine countries, were recruited and assessed at baseline with a questionnaire. A follow up was done 7 years later with another questionnaire. A healthy lifestyle index (HLI) was included to assess at the two timepoints, which contained information on physical activity, BMI, smoking status and alcohol intake (ranging from 0–16 units).
Differences in HLI scores between baseline and follow up were classified as change scores and were then assessed in terms of their effect on accelerating mortality rate by modelling with Cox regression and estimating with rate advancement periods. However, even after the follow-up questionnaire that was administered 7 years after baseline, participants were monitored for another 9.9 years on average. In total, 21 696 deaths were recorded (8407 of which were related to cancer).
The authors noted that improved HLI scores were associated with lower all-cause and cancer mortality and delayed risk of death as compared to stable HLI scores. Worsening HLI scores were associated with an increase in all-cause and cancer mortality, and anticipated risk of death. Stable scores were defined as those that remained within one unit, while improved scores are those that improved by more than one unit. Worsening scores were those that decreased by more than one unit.
The opportunity of lifestyle nursing in the UK
While not research, an article by Webster is worth highlighting as it presents an interesting concept that could prove valuable if applied by community nurses. It explores the phenomenon of lifestyle nursing, which has been gaining momentum in the US, but could also be capitalised on within the UK.
Lifestyle nursing brings together the ideas of leadership and health promotion to help nurses take a more proactive and empowering approach to support patients in taking ownership of their health through lifestyle modification. Against the backdrop of non-communicable diseases, lifestyle medicine has an important role to play.
These diseases are responsible for 41 million deaths each year, making up close to three-quarters of global deaths (World Health Organization, 2023). Lifestyle medicine is defined as ‘evidence-based clinical care that supports behaviour change through person-centred techniques to improve mental wellbeing, social connection, healthy eating, physical activity, sleep and minimisation of harmful substances and behaviours' (British Society of Lifestyle Medicine, 2024).
There is consensus regarding the positive impact of lifestyle changes on the prevention of disease and contribution to overall health. Examples of such approaches include engaging in regular physical activity, effectively managing stress, consuming a nutrient-rich diet and eliminating or minimising intake of harmful substances, such as alcohol and tobacco.
One of the main areas emphasised by the author is the role of motivational interviewing in lifestyle nursing, which is based on encouraging people to explore their own feelings around lifestyle changes and following this up with the time and space to facilitate such change and self-motivation.
It was noted that nurses needed the following to effectively engage in motivational interviewing with their patients:
- Asking open-ended questions
- Actively and reflectively listening
- Having the ability to overcome and break through a patient's resistance.
The author pointed to community nursing as one area in particular where evidence shows that health promotion and lifestyle modification opportunities are being missed, despite community nurses being ideally placed at the forefront of these approaches. As emphasised by the International Council of Nurses (2010), nurses also have a role to play in exemplifying such behaviour modifications as role models to their patients in the effort to address chronic disease.
Role of corticosteroids in patients with community-acquired pneumonia
The role of corticosteroids in the treatment of community-acquired pneumonia remains uncertain. Therefore, in a systematic review and meta-analysis, Cheema et al reviewed 15 randomised controlled trials with 3252 patients to investigate the use of adjunctive corticosteroids in patients with community-acquired pneumonia.
Studies from countries around the world were included, with 10 in Europe, two from Egypt, one from Saudi Arabia, one from South Africa, one from Japan and one from the US. Studies covered severe and non-severe community-acquired pneumonia. Some studies included a mix of both types.
While inclusion criteria indicated that participants must be aged 18 years or older, most studies included patients over 60 years of age. However, a handful of studies included patients aged from 30–50 years. The authors found that the use of corticosteroids reduced the risk of all-cause mortality in patients with pneumonia acquired in the community. However, treatment with hydrocorticosteroids only resulted in a significant reduction in mortality in patients with severe pneumonia.
Corticosteroids had no effect on mortality risk in non-severe community-acquired pneumonia. The length of corticosteroid therapy did not modify the mortality effect observed. This effect also remained consistent regardless of the use of a loading dose. The analysis indicated that patients treated with corticosteroids were significantly less likely to need mechanical ventilation or vasopressors. It was also noted that the use of corticosteroids increased patients' risk of developing hyperglycaemia.
Interestingly, the reduction in mortality was greater in younger patients than in older patients. According to Cheema et al, as the age of the patients increased, the mortality benefit gradually decreased. This finding is significant as older people cared for within the community may not benefit from this therapy, while younger patients with severe community-acquired pneumonia are more likely to have their mortality risk reduced using corticosteroids.
Palliative care goals for people with dementia
The role of advance care planning in palliative care is well established. In an international study, 17 researchers from eight countries sought to develop a multidimensional international palliative care goals model for people with dementia nearing the end of life.
The initial model was built by the original 17 researchers and included four central care goals that reflected a person's journey through the progression of dementia, concluding with bereavement support. These were:
- Ensuring the patient's comfort
- Maintaining control over function
- Protecting the patient's comfort and respecting their personhood
- Supporting both the person and their caregiver in terms of coping with their grief and loss.
Following the development of the model, 169 candidate panelists from diverse cultural backgrounds across 33 countries were invited to an international online Delphi study. The initial model did not achieve consensus and was refined, based on panelists' feedback. The panelists managed to achieve consensus on the new multidimensional palliative care model for people with dementia and their families; it included psycho-social-spiritual goals. Consensus was not reached on adding the goal of life prolongation, an area that remains controversial.
The panel also did not achieve a consensus on the use of the model by people with dementia and their families. The authors noted two areas require further research: how the goals may relate to the goal of life prolongation and exactly how to apply the model in practice.