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RISK FACTORS FOR CHRONIC DISEASES IN ELDERLY POPULATIONS
Miracelia dos Santos da Silva1
Douglas José Angel2
Samara Santana da Silva Fontenele3
Carlos Renne Silva de Castro4
Abstract: This study aims to review the literature on risk factors associated with the development
of chronic diseases in older populations. The research will address aspects such as lifestyle,
socioeconomic conditions, comorbidities, and the inuence of preventive interventions. Based on
the analysis of recent studies, we hope to identify patterns and correlations that can contribute to
improving the health conditions of this population. The relevance of this study lies in the urgent need
for public health strategies aimed at the prevention and effective management of chronic diseases in
the aging population.
Keywords: Risk Factors, Chronic Diseases, Elderly, Public Health, Prevention
1 Medical Student. Uninorte University Center, AC, Brazil
2 Advisor and Teacher at UNINORTE University Center, Rio Branco, AC, Brazil
3 Graduated in Medicine from Uninorte University Center
4 Graduated in Medicine from Cosmos Private Technical University
INTRODUCTION
Chronic non-communicable diseases (NCDs) represent a growing challenge in elderly
populations, with a signicant impact on morbidity, mortality, and quality of life. Global epidemiology
shows that systolic arterial hypertension, air pollution, and smoking are among the main risk factors
associated with the burden of disease in the elderly aged 70 years or older. With population aging, an
increase in metabolic conditions — such as obesity and high blood glucose — has also been observed
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as relevant determinants in countries with high development rates (Chen, 2025).
In low- and middle-income contexts, behavioral factors such as smoking, excessive alcohol
consumption, sedentary lifestyle, inadequate diet, obesity, and hypertension are common and
modiable, constituting targets for preventive strategies. In addition, biological processes of aging,
such as chronic low-grade inammation — “inammaging” — contribute to susceptibility to chronic
diseases, especially cardiovascular and neurodegenerative diseases. In Brazil, studies in long-lived
elderly people (≥ 80 years old) indicate that polypharmacy, overweight, and gender are determinants
of the prevalence of hypertension and diabetes (Oduro, 2023).
Identifying the main risk factors for chronic diseases in the elderly is critical for a comprehensive
understanding of the health of this population. In recent years, different studies have focused on
the variables that most impact the health of the elderly, revealing a worrying panorama. Behavioral
factors, such as inadequate diet, sedentary lifestyle, and consumption of harmful substances, have
been widely investigated. (Borges et al. 2009).
Inadequate diet is one of the main risk factors, since it can contribute to obesity and its
associated comorbidities. The relevance of this factor is corroborated by Borges et al. (2009), who
state that “the highest mean score was recorded for knowledge about inadequate diet...” (p. 1512).
Another crucial factor is a sedentary lifestyle. The data presented by Borges et al. (2009)
show that “about half of the subjects and two thirds of them, respectively, are aware of the association
of sedentary lifestyle with diabetes mellitus and osteoporosis” (p. 1517). This association is especially
alarming in an elderly population, where lack of physical activity not only contributes to obesity,
but also leads to decreased muscle strength, loss of bone density, and, consequently, a high risk of
falls and fractures. The studies indicate that “more than 80% of the interviewees were aware of the
associations between sedentary lifestyle and acute myocardial infarction...” (Borges et al., 2009, p.
1517), evidencing the population’s awareness of the potential harm of a sedentary lifestyle, but also
signaling the urgency of educational interventions that can translate it into behavioral changes.
In addition, Cruz et al. (2017) corroborate that the presence of risk factors may be prevalent
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in this population, stating that “more than 50% of the elderly had at least two concomitant risk factors”
(p. 6). This nding is alarming, as the coexistence of risk conditions, such as diabetes, hypertension,
and obesity, has a direct relationship with morbidity and mortality in the elderly. The interrelationship
of these factors requires a multifaceted approach in public health policies. Cruz et al. (2017) point
out that “interventions or preventive measures focused on more than one risk factor could be more
efcient than those focused on only one” (p. 8). This suggests that integrated strategies that consider
the multiple determinants of health are needed to effectively address the complexity of aging and
chronic disease, helping to promote active and healthy aging.
Therefore, the identication and understanding of the main risk factors for chronic
diseases in the elderly is more than an academic issue; It is a social imperative that demands urgent
and coordinated action. Understanding this diversity of factors is a critical rst step towards the
development of effective intervention programs and the creation of public policies aimed at promoting
healthy aging and reducing the burden of disease in this growing population.
The objective of this article is to describe the risk factors related to the development of
chronic diseases in elderly populations, with particular emphasis on the interrelationships between
these factors and their implications for public health.
The investigation aims to elucidate not only the individual determinants that contribute to
the manifestation of chronic diseases, such as inadequate eating habits, sedentary lifestyle, smoking,
and excessive alcohol consumption, but also to consider the impact of socioeconomic factors, such as
access to health care, housing conditions, and social support.
The research will aim to identify gaps in current knowledge, critically exploring the available
literature and synthesizing information from different geographical and sociocultural contexts. It is
intended, therefore, to highlight how the simultaneity of risk factors, especially in urban contexts such
as Pelotas, can intensify the development and progression of chronic non-communicable diseases.
In addition, the results of the research will seek to offer subsidies for the formulation of
effective and targeted interventions that can be implemented to promote healthy and equitable aging.
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Finally, the research hopes to contribute to the development of public policies and health programs that
comprehensively address the complexity of the factors that affect the health of the elderly, emphasizing
the importance of a multidisciplinary approach in facing the challenges imposed by population aging
and chronic diseases.
MATERIAL AND METHOD
This is a literature review study that integrates epidemiological evidence and recent population
studies, it is characterized according to its method as deductive, according to its approach it is
qualitative, according to its nature it is a basic research and according to its objective and descriptive.
Data were collected from different sources such as PubMed, BMC Geriatrics, synthesis
articles, ofcial reports (2021–2025). The inclusion criteria were studies published between 2015–
2025, with samples of elderly adults (≥ 60 years old), addressing risk factors for NCDs (hypertension,
diabetes, obesity, dementia, cardiovascular diseases, chronic respiratory diseases), studies with
pediatric populations, isolated clinical cases, or focused on experimental therapy unrelated to risk
factors.
The categories of analysis were behavioral and environmental factors (smoking, alcohol,
sedentary lifestyle, diet, air pollution, sleep). Biological and metabolic factors (hypertension, obesity,
high blood glucose, chronic inammation). Demographic and social factors (polypharmacy, gender,
isolation, education). Specic clinical outcomes (diabetes, hypertension, dementia, osteoporosis,
multimorbidity).
RESULTS AND DISCUSSION
The analysis of the selected studies showed that the main risk factors for chronic diseases in
elderly populations are associated with behavioral, metabolic, environmental and social determinants.
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The most recent data from the Global Burden of Disease Study (GBD 2021) point to systolic
hypertension, air pollution, and smoking as the most relevant risk factors in older adults aged 70
years and older, accounting for a signicant proportion of disability-adjusted life lost years (DALYs)
worldwide (GBD, 2025).
A population-based study conducted by the Study on Global Ageing and Adult Health
(SAGE) analyzed data from six low- and middle-income countries, including China, India, and South
Africa, and revealed that the most prevalent risk factors were smoking, excessive alcohol consumption,
physical inactivity, low fruit and vegetable intake, abdominal obesity, and high blood pressure. The
variability of these factors across countries demonstrates the inuence of sociocultural and economic
context on the health of older adults (Wu et al., 2015).
Smoking, in particular, remains a preponderant risk factor among the elderly, even after
decades of control campaigns. Studies indicate a dose-response relationship between the number
of cigarettes smoked over a lifetime and the risk of developing chronic diseases such as stroke,
chronic obstructive pulmonary disease (COPD), and lung cancer (Ma et al., 2023). Similarly, frequent
alcohol consumption was associated with a 17% increase in the likelihood of at least one chronic non-
communicable disease occurring among the older adults analyzed, suggesting that even moderate
levels of drinking may pose a considerable health risk in this age group (Yang et al., 2023).
Obesity, as measured by body mass index (BMI), was another factor with a major impact.
A study of Chinese older adults demonstrated that a BMI ≥ 28 was strongly associated with the
presence of hypertension (odds ratio [OR] = 1.69), diabetes mellitus (OR = 1.80), COPD (OR = 2.76),
and stroke (OR = 3.54), revealing a signicant association between overweight and chronic disease
in older adults (Wang et al., 2018). These ndings reinforce the need for strategies to control body
weight, even in old age.
In Brazil, a study with long-lived elderly people (≥ 80 years old) showed that polypharmacy,
overweight and female gender were the main factors associated with the presence of hypertension and
diabetes. The prevalence of hypertension was 75.7%, and the use of ve or more daily medications
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increased the risk of developing diabetes mellitus by 2.15 times in this population (Silva et al., 2023;
Silva et al., 2024). These data point to the need for pharmacotherapeutic follow-up in the elderly, as a
way to prevent complications and reduce drug interactions.
In addition, the accumulation of two or more chronic diseases — a condition known as
multimorbidity — has been strongly associated with functional limitation in the elderly. A study
conducted in India revealed that the presence of multimorbidity increased the risk of impairment in
activities of daily living (ADL) by up to six times, which has a direct impact on the autonomy and
quality of life of these individuals (Sharma et al., 2021). The fragility generated by this condition
demands special attention from health services.
In Canada, a national survey showed that the most prevalent chronic diseases among older
adults include hypertension (present in about two-thirds of the elderly population), osteoarthritis,
diabetes (27%), osteoporosis (25%), COPD (20%), stroke (9.5%), and dementia (7%), highlighting
the need for integrated preventive actions (PHAC, 2023). These diseases are often associated with
physiological processes characteristic of aging.
One of these processes is chronic low-grade inammation, known as “inammaging”, which
contributes to the emergence of conditions such as cardiovascular disease, cancer, dementia and
muscle weakness. Inammaging results from the continuous activation of the immune system over
the years, generating an environment conducive to the development of chronic diseases, even in the
absence of active infections (Franceschi et al., 2007).
Finally, irregular sleep patterns were also associated with an increased risk for multiple
chronic diseases in older adults. A recent study indicated that older adults with inconsistent sleep
schedules had a higher incidence of diabetes, hypertension, heart disease, and cognitive disorders,
as well as symptoms of frailty and depression (Li et al., 2025). This reinforces the importance of
promoting regular sleep routines as a preventive measure in geriatric public health.
Thus, the results show that the risk factors for chronic diseases in the elderly are complex,
multifactorial and, for the most part, modiable. Coping with these risks requires integrated strategies
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for health promotion, prevention, clinical follow-up and psychosocial support, with special attention
to the diversity of cultural, social and economic contexts where the elderly live.
The impact of lifestyle and health behaviors on the development of chronic diseases in the
elderly is a topic of vital importance in the context of health sciences, especially with the increase
in the elderly population in many countries. Lifestyle encompasses a variety of behaviors, including
eating habits, physical activity levels, tobacco and alcohol consumption, which play crucial roles
in individuals’ overall health. Studies show that the adoption of healthy behaviors can signicantly
reduce the prevalence of chronic diseases, while unhealthy lifestyles are associated with an increased
risk of conditions such as diabetes, hypertension, and cardiovascular diseases (Borges et al. 2009).
Food is one of the essential pillars for maintaining health, especially in old age. For example,
Borges et al. (2009) state that “the highest mean score was recorded for knowledge about inadequate
diet...” (p. 1512), emphasizing that many older people may be aware of their diet but still do not apply
this knowledge in their daily practices. This may be due to barriers such as limited access to healthy
foods or a lack of proper nutrition education. The relationship between inadequate diet and chronic
diseases is well established, since a diet rich in sugars and fats increases the risk of obesity and,
consequently, associated diseases.
A sedentary lifestyle is another critical factor that affects the health of the elderly. The research
by Borges et al. (2009) reveals that “about half of the subjects and two thirds of them, respectively,
are aware of the association of sedentary lifestyle with diabetes mellitus and osteoporosis” (p. 1517).
Here, awareness is an important step, but not enough. Often, seniors face physical or social limitations
that make it difcult to engage in regular physical activity. More alarmingly, “more than 80% of
the interviewees were aware of the associations between sedentary lifestyle and acute myocardial
infarction...” (Borges et al., 2009, p. 1517), reinforcing the need for interventions that not only inform,
but also empower the elderly to engage in physical activities that are safe and accessible.
In addition, Cruz et al. (2017) highlight that “the presence of two or more risk factors in more
than half of the elderly population indicates the need for public policies aimed at promoting a healthy
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lifestyle” (p. 9). The coexistence of multiple risk factors is a reality in the elderly population, where
“more than 50% of the elderly had at least two concomitant risk factors” (Cruz et al., 2017, p. 6). This
aspect draws attention to the urgency of developing approaches that integrate health promotion and
disease prevention, aiming to reduce the harmful interactions of different risk factors.
The recognition that “interventions or preventive measures focused on more than one risk
factor could be more efcient than those focused on only one” (Cruz et al., 2017, p. 8) is crucial to
improve the quality of life of the elderly. Because of this, multidisciplinary programs that simultaneously
address balanced diets, physical activities, and behavioral changes should be prioritized to positively
impact the health of the senior population. This scenario calls for direct and coordinated actions that
support the construction of a healthy lifestyle, allowing older adults to maintain greater autonomy and
improve their quality of life as they age.
Intervention and prevention strategies aimed at the health of the elderly population are
essential at a time when demographic aging is becoming increasingly prominent in several societies.
Understanding the complexity of the risk factors that contribute to the development of chronic diseases
in this age group is a crucial rst step in designing effective initiatives. The literature highlights that
the presence of two or more risk factors in more than half of the elderly population indicates the need
for public policies aimed at promoting a healthy lifestyle (Cruz et al., 2017, p. 9). This suggests that
interventions should not be one-dimensional, but rather integrate multiple aspects of health and well-
being.
Preventive approaches should consider not only individual but also collective interventions
that promote changes in social and physical environments. Health education, for example, is a powerful
tool that can be used to raise awareness about the importance of healthy habits. In this context,
it is vital that educational programs are adapted to the needs and realities of older people, taking
advantage of opportunities for community interaction and social support. According to Borges et al.
(2009), “the objective of this study was to evaluate the population’s knowledge about the associations
of four behavioral factors...” (p. 1511), emphasizing the need to disseminate relevant information. The
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formation of support groups and workshops that address topics such as nutrition and physical activity
can be extremely benecial.
In addition, proper nutrition and the promotion of regular physical activity are essential
components of any prevention strategy. The literature has indicated that “more than 50% of the elderly
had at least two concomitant risk factors” (Cruz et al., 2017, p. 6), which highlights the interconnection
between health conditions and habits. Interventions that encourage the practice of physical exercise,
adjusted to the capacities and limitations of the elderly, have shown positive results in improving quality
of life. Borges et al. (2009) state that “about half of the subjects and two thirds of them, respectively,
are aware of the association of sedentary lifestyle with diabetes mellitus and osteoporosis” (p. 1517).
This awareness, in itself, reveals a potential to transform behavior, as long as the right conditions are
offered for this change to occur.
In addition, measures that intertwine several dimensions of risk are recommended. Cruz et
al. (2017) argue that “interventions or preventive measures focused on more than one risk factor could
be more efcient than those focused on only one” (p. 8). Therefore, strategies that simultaneously
address nutrition, physical activity, and mental health can result in more effective health promotion.
Integrated programs that offer nutritionists, physical educators, and psychologists working together
can provide holistic care that meets the diverse needs of older adults.
These ndings converge in the identication of mutable risk factors (such as lifestyle habits
and medical control) and non-mutable risk factors (gender, age), which interact with social and
biological determinants, generating a situation of high vulnerability. Health policies should prioritize
integrated interventions: smoking cessation, promotion of physical activity, overweight control,
medication review, sleep monitoring, and environmental measures such as pollution control.
CONCLUSION
Risk factors for chronic disease in older adults are multiple and interrelated, including
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lifestyle, metabolic conditions, polypharmacy, chronic inammation, and social adversities. Recent
evidence reinforces the importance of interventions focused on behavior modication, clinical control
of metabolic factors, improvement of sleep patterns, and reduction of environmental burden. Integrated
approaches segmented by demographic prole and context are essential to promote healthy aging and
reduce the impact of NCDs in geriatric populations.
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