Background: Although increasing emphasis is being placed on strategies for successful aging, few studies have examined the relationship between lifestyle factors and mortality and other health outcomes in the old-old population. Objective: To examine the impact of physical activity, dietary habits, smoking, and alcohol consumption on 3-year mortality and other health outcomes. Methods: 2,032 Chinese subjects aged 70 years and older (mean age 80 years) were recruited territorywide by proportional random sampling and followed for 3 years. Baseline information was obtained by interview on level of physical activity, dietary habits (frequency of consumption per week of major food groups), alcohol consumption, and smoking habits. Outcome measures include mortality, self-perceived health status, frequency of hospitalization, geriatric depression score, and development of new diseases (stroke, heart disease, hypertension, diabetes mellitus, fractures). Logistic regression was used to examine the effects of lifestyle factors on each health outcome, with and without adjustment for age and baseline health status. Results: The mortality risk is reduced with increasing physical activity, daily fish intake and moderate alcohol consumption, and avoidance of smoking; hospitalization is inversely associated with increasing activity; better self-perceived health is associated with moderate alcohol consumption and a non-smoking status, and there is an inverse relationship between depressive symptoms and increasing activity and moderate alcohol consumption. After adjustment for age and baseline health status, higher levels of physical activity are associated with decreased mortality and hospitalization; non-smokers have reduced mortality and a better self-perceived health, and moderate alcohol consumption is also associated with better self-perceived health. Conclusion: Lifestyle factors may influence health outcomes even in the old-old population.