Disentangling the roles of disability and morbidity in survival to exceptional old age

Factors involved in human healthy aging: insights from longevity individuals

The quest to decipher the determinants of human longevity has intensified with the rise in global life expectancy. Long-lived individuals (LLIs), who exceed the average life expectancy while delaying age-related diseases, serve as a unique model for studying human healthy aging and longevity. Longevity is a complex phenotype influenced by both genetic and non-genetic factors. This review paper delves into the genetic, epigenetic, metabolic, immune, and environmental factors underpinning the phenomenon of human longevity, with a particular focus on LLIs, such as centenarians. By integrating findings from human longevity studies, this review highlights a diverse array of factors influencing longevity, ranging from genetic polymorphisms and epigenetic modifications to the impacts of diet and physical activity. As life expectancy grows, understanding these factors is crucial for developing strategies that promote a healthier and longer life.

Analysis of sex-specific disease patterns associated with human lifespan

Disability and multimorbidity increase with aging and constitute a challenge for the health system. However, different individuals display different aging trajectories, and understanding the underlying relationships between lifespan and disease is fundamental for identifying the different patterns in human lifespan. A previous study explored associations between lifespan and age of onset of diseases of different organ systems, prevalence of escapers, and percentage of life free of disease (health span), comparing them between genders in Catalonian population. In this retrospective study, we analyzed a cohort of 41,063 old individuals (20,722 men, with a mean lifespan of 79 years [50-109], and 20,341 women, with a mean lifespan of 84 years [50-109]) deceased between 2014 and 2019 in Gipuzkoa (Basque Country, Spain) taken from the Basque Health Service electronic health records data lake and analyzed and contrasted the above cited characteristics. Longevity, defined by age above the mean lifespan of the population, showed a protective effect against developing diseases, with higher lifespans delaying the onset of all diseases both at single and multisystemic levels. Furthermore, individuals with the lowest and highest lifespans were the ones presenting the healthier profiles, with fewer systems altered. There were specific differences according to sex, with women exhibiting decreased mortality risk despite having greater multimorbidity and men having less multimorbidity. In addition, men reached the highest lifespans with a smaller number of comorbidities. These results define the aging trajectories of the Basque population, extend the characterization of the human aging, and provide insight into sex-specific differences in multimorbidity and survival risk.

Do people reach 100 by surviving, delaying, or avoiding diseases? A life course comparison of centenarians and non-centenarians from the same birth cohorts

Centenarians are perceived as pioneers of longevity, possessing the secrets to surpassing age 100. It remains unclear whether they achieve this by surviving, delaying, or avoiding diseases to a greater extent than their shorter-lived peers. This register-based study encompassed all individuals aged 60 and older, born between 1912 and 1922 in Stockholm County, Sweden (N = 170,787). Using historical data, individuals were prospectively followed from 1972 to 2022 and stratified by their age at death. Age-specific incidence rates and remaining lifetime risk from age 60 were calculated for stroke, myocardial infarction, hip fracture, and various cancers (including colorectal, breast, and prostate), and compared between those who survived to age 100 and their shorter-lived counterparts. Centenarians had lower age-specific incidence rates for almost all diseases and ages. Despite longer life spans, their lifetime risks for all diseases except hip fracture were lower than those of non-centenarians. This suggests that centenarians delay, and even avoid, many of the major age-related diseases rather than surviving them to a higher extent. The findings that centenarians not only exhibit lower disease rates at younger ages compared to their shorter-lived peers but throughout their lives challenge the notion that longer life span inevitably leads to higher disease rates or a simple shift of diseases to older ages.

Healthy Lifestyle and the Likelihood of Becoming a Centenarian

Importance

Previous studies have reported that lifestyle factors were associated with life expectancy and/or mortality, but most of them studied the middle-aged or older age groups (aged ≥60 years), and few focused on people aged 80 years or older.

Objectives

To examine healthy lifestyle and the likelihood of becoming centenarians among people aged 80 years or older in China.

Design, Settings, and Participants

Using data from the Chinese Longitudinal Healthy Longevity Survey, a nationally representative and one of the largest prospective cohorts targeting people aged 80 years or older established in 1998, a community-based, prospective nested case-control study was performed. Data were analyzed from December 1, 2022, to April 15, 2024.

Exposures

A healthy lifestyle score for 100 (HLS-100, ranging from 0 to 6), including smoking, exercise, and dietary diversity, was constructed, with higher scores indicating potentially better health outcomes.

Main Outcomes and Measures

The primary outcome was survivorship to becoming a centenarian by 2018 (the end of follow-up). Information on sociodemographic characteristics, lifestyle factors, and other covariates was collected.

Results

The sample comprised 5222 individuals (61.7% women, mean [SD] age, 94.3 [3.3] years), including 1454 identified centenarians and 3768 controls (died before becoming centenarians) matched by age, sex, and year of entry. During a median follow-up of 5 (IQR, 3-7) years, 373 of 1486 individuals among the lowest HLS-100 (0-2) group and 276 of 851 individuals among the highest HLS-100 (5-6) group became centenarians. The adjusted odds ratio (AOR) comparing the highest vs the lowest HLS-100 groups was 1.61 (95% CI, 1.32-1.96; P < .001 for trend). An association was noted when we further treated centenarians with relatively healthy status as the outcome, as evaluated by self-reported chronic conditions, physical and cognitive function, and mental wellness (AOR, 1.54; 95% CI, 1.05-2.26). Similar results were observed in other sensitivity analyses.

Conclusions and Relevance

In this case-control study of Chinese older adults, adhering to a healthy lifestyle appears to be important even at late ages, suggesting that constructing strategic plans to improve lifestyle behaviors among all older adults may play a key role in promoting healthy aging and longevity.

The biological age model for evaluating the degree of aging in centenarians

BACKGROUND

Biological age (BA) has been used to assess individuals' aging conditions. However, few studies have evaluated BA models' applicability in centenarians.

METHODS

Important organ function examinations were performed in 1798 cases of the longevity population (80∼115 years old) in Hainan, China. Eighty indicators were selected that responded to nutritional status, cardiovascular function, liver and kidney function, bone metabolic function, endocrine system, hematological system, and immune system. BA models were constructed using multiple linear regression (MLR), principal component analysis (PCA), Klemera and Doubal method (KDM), random forest (RF), support vector machine (SVM), extreme gradient boosting (XGBoost), and light gradient boosting machine (lightGBM) methods. A tenfold crossover validated the efficacy of models.

RESULTS

A total of 1398 participants were enrolled, of whom centenarians accounted for 49.21%. Seven aging markers were obtained, including estimated glomerular filtration rate, albumin, pulse pressure, calf circumference, body surface area, fructosamine, and complement 4. Eight BA models were successfully constructed, namely MLR, PCA, KDM1, KDM2, RF, SVM, XGBoost and lightGBM, which had the worst R2 of 0.45 and the best R2 of 0.92. The best R2 for cross-validation was KDM2 (0.89), followed by PCA (0.62).

CONCLUSION

In this study, we successfully applied eight methods, including traditional methods and machine learning, to construct models of biological age, and the performance varied among the models.

The rosetta stone of successful ageing: does oral health have a role?

Ageing is an inevitable aspect of life and thus successful ageing is an important focus of recent scientific efforts. The biological process of ageing is mediated through the interaction of genes with environmental factors, increasing the body's susceptibility to insults. Elucidating this process will increase our ability to prevent and treat age-related disease and consequently extend life expectancy. Notably, centenarians offer a unique perspective on the phenomenon of ageing. Current research highlights several age-associated alterations on the genetic, epigenetic and proteomic level. Consequently, nutrient sensing and mitochondrial function are altered, resulting in inflammation and exhaustion of regenerative ability.Oral health, an important contributor to overall health, remains underexplored in the context of extreme longevity. Good masticatory function ensures sufficient nutrient uptake, reducing morbidity and mortality in old age. The relationship between periodontal disease and systemic inflammatory pathologies is well established. Diabetes, rheumatoid arthritis and cardiovascular disease are among the most significant disease burdens influenced by inflammatory oral health conditions. Evidence suggests that the interaction is bi-directional, impacting progression, severity and mortality. Current models of ageing and longevity neglect an important factor in overall health and well-being, a gap that this review intends to illustrate and inspire avenues for future research.

Successful aging and its subtypes in centenarians: The Chinese experience

This editorial comments on the article by Lu et al

Multi-modal profiling of peripheral blood cells across the human lifespan reveals distinct immune cell signatures of aging and longevity

BACKGROUND

Age-related changes in immune cell composition and functionality are associated with multimorbidity and mortality. However, many centenarians delay the onset of aging-related disease suggesting the presence of elite immunity that remains highly functional at extreme old age.

METHODS

To identify immune-specific patterns of aging and extreme human longevity, we analyzed novel single cell profiles from the peripheral blood mononuclear cells (PBMCs) of a random sample of 7 centenarians (mean age 106) and publicly available single cell RNA-sequencing (scRNA-seq) datasets that included an additional 7 centenarians as well as 52 people at younger ages (20-89 years).

FINDINGS

The analysis confirmed known shifts in the ratio of lymphocytes to myeloid cells, and noncytotoxic to cytotoxic cell distributions with aging, but also identified significant shifts from CD4+ T cell to B cell populations in centenarians suggesting a history of exposure to natural and environmental immunogens. We validated several of these findings using flow cytometry analysis of the same samples. Our transcriptional analysis identified cell type signatures specific to exceptional longevity that included genes with age-related changes (e.g., increased expression of STK17A, a gene known to be involved in DNA damage response) as well as genes expressed uniquely in centenarians' PBMCs (e.g., S100A4, part of the S100 protein family studied in age-related disease and connected to longevity and metabolic regulation).

INTERPRETATION

Collectively, these data suggest that centenarians harbor unique, highly functional immune systems that have successfully adapted to a history of insults allowing for the achievement of exceptional longevity.

FUNDING

TK, SM, PS, GM, SA, TP are supported by NIH-NIAUH2AG064704 and U19AG023122. MM and PS are supported by NIHNIA Pepper center: P30 AG031679-10. This project is supported by the Flow Cytometry Core Facility at BUSM. FCCF is funded by the NIH Instrumentation grant: S10 OD021587.

Longevity Science and Women's Health and Wellbeing

In most areas of the world women comprise the majority of older persons (especially at the most advanced ages), but the additional longevity (globally it is 4.8 years) women have often comes with poorer health status compared to age-matched men. This article draws attention to four distinct ways an applied gerontological intervention designed to increase the human healthspan via "rate (of ageing) control" could positively impact the health and wellbeing of women in today's ageing world. The four benefits examined are: (1) improving women's health in late life; (2) increasing reproductive longevity and improving maternal health, (3) reducing the financial vulnerability many women experience at advanced ages (especially in the developing world); and (4) reducing the caring burdens which typically fall, at least disproportionately, on daughters to care for their ageing parents. Highlighting these factors is important as is helps focus geroscience advocacy not only on the potential health dividend age retardation could confer on those in late life, but also the distributional effects on health throughout the lifespan (e.g. improving maternal health) and on helping to ameliorate other important inequalities (e.g. reducing the financial vulnerabilities of late life and easing the burdens on the care givers for ageing parents). By making vivid the benefits "rate (of ageing) control" could confer on women, especially in the developing world, the goal of retarding biological ageing can be rightly construed as a pressing public health priority for the 21st century.

NIA Long Life Family Study: Objectives, Design, and Heritability of Cross Sectional and Longitudinal Phenotypes

The NIA Long Life Family Study (LLFS) is a longitudinal, multicenter, multinational, population-based multigenerational family study of the genetic and nongenetic determinants of exceptional longevity and healthy aging. The Visit 1 in-person evaluation (2006–2009) recruited 4 953 individuals from 539 two-generation families, selected from the upper 1% tail of the Family Longevity Selection Score (FLoSS, which quantifies the degree of familial clustering of longevity). Demographic, anthropometric, cognitive, activities of daily living, ankle-brachial index, blood pressure, physical performance, and pulmonary function, along with serum, plasma, lymphocytes, red cells, and DNA, were collected. A Genome Wide Association Scan (GWAS) (Ilumina Omni 2.5M chip) followed by imputation was conducted. Visit 2 (2014–2017) repeated all Visit 1 protocols and added carotid ultrasonography of atherosclerotic plaque and wall thickness, additional cognitive testing, and perceived fatigability. On average, LLFS families show healthier aging profiles than reference populations, such as the Framingham Heart Study, at all age/sex groups, for many critical healthy aging phenotypes. However, participants are not uniformly protected. There is considerable heterogeneity among the pedigrees, with some showing exceptional cognition, others showing exceptional grip strength, others exceptional pulmonary function, etc. with little overlap in these families. There is strong heritability for key healthy aging phenotypes, both cross-sectionally and longitudinally, suggesting that at least some of this protection may be genetic. Little of the variance in these heritable phenotypes is explained by the common genome (GWAS + Imputation), which may indicate that rare protective variants for specific phenotypes may be running in selected families.

Comparison of Japanese Centenarians' and Noncentenarians' Medical Expenditures in the Last Year of Life

IMPORTANCE

Although research has shown that centenarians tend to experience shorter periods of serious illness compared with other age groups, few studies have focused on the medical expenditures of centenarians as a potential indicator of the scale of medical resources used in their last year of life.

OBJECTIVE

To compare Japanese centenarians' and noncentenarians' monthly medical expenditures during the year before death according to age and sex.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cohort study used linked national health and long-term care insurance data collected from April 2013 to March 2018 in Nara Prefecture, Japan, for residents aged 75 years or older who were insured under the Medical Care System for older adults and died between April 2014 and March 2018. Data were analyzed from April 2013 to March 2018.

EXPOSURES

Age of 100 years or older (centenarians) vs 75 to 99 years (noncentenarians).

MAIN OUTCOMES AND MEASURES

The numbers of unique inpatients and outpatients and medical expenditures related to decedents' hospitalization and outpatient care were extracted and analyzed based on sex and age group. The Jonckheere-Terpstra test was used to identify trends in unadjusted medical expenditures by age group, and generalized estimating equations were used to estimate monthly median expenditures by age group with adjustment for comorbidity burden and functional status.

RESULTS

Of 34 317 patients aged 75 to 109 years (16 202 men [47.2%] and 18 115 women [52.8%]) who died between April 2014 and March 2018, 872 (2.5%) were aged 100 to 104 years (131 men [15.0%] and 741 women [85.0%]) and 78 (0.2%) were aged 105 to 109 years (fewer than 10 were men). The analysis of unadjusted medical expenditures in the last year of life showed a significant trend of lower expenditures for the older age groups; the median adjusted total expenditures during the 30 days before death by age group were $6784 (IQR, $4884-$9703) for ages 75 to 79 years, $5894 (IQR, $4292-$8536) for 80 to 84 years, $5069 (IQR, $3676-$7150) for 85 to 89 years, $4205 (IQR, $3085-$5914) for 90 to 94 years, $3522 (IQR, $2626-$4861) for 95 to 99 years, $2898 (IQR, $2241-$3835) for 100 to 104 years, and $2626 (IQR, $1938-$3527) for 105 to 109 years. The proportion of inpatients among all patients in the year before death also decreased with increasing age: 4311 of all 4551 patients aged 75 to 79 years (94.7%); 43 of all 78 patients aged 105 to 109 years (55.1%); 2831 of 2956 men aged 75 to 79 years (95.8%); 50.0% of men aged 105 to 109 years (the number is not reported owing to the small sample size); 1480 of 1595 women aged 75 to 79 years (92.8%); and 55.7% of women aged 105 to 109 years (the number of women is not reported to prevent back-calculation of the number of men). Specifically, 274 of 872 patients aged 100 to 104 years (31.4%) and 35 of 78 patients aged 105 to 109 years (44.9%) had not been admitted to a hospital in the year before death.

CONCLUSIONS AND RELEVANCE

This cohort study found that medical expenditures in the last year of life tended to be lower for centenarians than for noncentenarians aged 75 years or older in Japan. The proportion of inpatients also decreased with increasing age. These findings may inform future health care services coverage and policies for centenarians.

Health Trajectories in Swedish Centenarians

Background

Longitudinal studies describing centenarians’ health trajectories are currently lacking. We compared health trajectories of older adults becoming centenarians and their shorter-living counterparts in terms of chronic diseases, disability, and cognitive decline.

Methods

We identified 3,573 individuals participating in the Kungsholmen Project and the Swedish National Study on Aging and Care in Kungsholmen who lived <100 years and 222 who survived to their 100th birthday. Trajectories of chronic diseases, disability (impaired activities of daily living), and cognitive status were obtained via linear mixed models over 13 years.

Results

Centenarians had fewer chronic diseases than noncentenarians. Before age 85, centenarians showed slower health changes. In centenarians, multimorbidity, disability, and cognitive impairment occurred 4 to 9 years later than in noncentenarians. After age 85, the speed of accumulation of chronic diseases, disabilities, and cognitive decline accelerated in centenarians. At age 100, 39% of the centenarians were cognitively intact and 55% had escaped disability. Only 5% were free of multimorbidity at age 100. When compared with their shorter lived counterparts, in terms of years spent in poor health, centenarians experienced more years with multimorbidity (9.4 vs 6.8 years; p < .001), disability (4.3 vs 3.1 years; p = .005), and cognitive impairment (6.3 vs 4.3 years; p < .001).

Conclusions

Older people who become centenarians present a delay in the onset of morbidity, but spend more years in this condition compared to their shorter lived peers. The observation of older adults’ health trajectories might help to forecast healthier aging, and plan future medical and social care delivery.

A Compendium of Age-Related PheWAS and GWAS Traits for Human Genetic Association Studies, Their Networks and Genetic Correlations

The rich data from the genome-wide association studies (GWAS) and phenome-wide association studies (PheWAS) offer an unprecedented opportunity to identify the biological underpinnings of age-related disease (ARD) risk and multimorbidity. Surprisingly, however, a comprehensive list of ARDs remains unavailable due to the lack of a clear definition and selection criteria. We developed a method to identify ARDs and to provide a compendium of ARDs for genetic association studies. Querying 1,358 electronic medical record-derived traits, we first defined ARDs and age-related traits (ARTs) based on their prevalence profiles, requiring a unimodal distribution that shows an increasing prevalence after the age of 40 years, and which reaches a maximum peak at 60 years of age or later. As a result, we identified a list of 463 ARDs and ARTs in the GWAS and PheWAS catalogs. We next translated the ARDs and ARTs to their respective 276 Medical Subject Headings diseases and 45 anatomy terms. The most abundant disease categories are neoplasms (48 terms), cardiovascular diseases (44 terms), and nervous system diseases (27 terms). Employing data from a human symptoms-disease network, we found 6 symptom-shared disease groups, representing cancers, heart diseases, brain diseases, joint diseases, eye diseases, and mixed diseases. Lastly, by overlaying our ARD and ART list with genetic correlation data from the UK Biobank, we found 54 phenotypes in 2 clusters with high genetic correlations. Our compendium of ARD and ART is a highly useful resource, with broad applicability for studies of the genetics of aging, ARD, and multimorbidity.

Effect of longevity genetic variants on the molecular aging rate

We conducted a genome-wide association study of 1320 centenarians from the New England Centenarian Study (median age = 104 years) and 2899 unrelated controls using >9 M genetic variants imputed to the HRC panel of ~65,000 haplotypes. The genetic variants with the most significant associations were correlated to 4131 proteins that were profiled in the serum of a subset of 224 study participants using a SOMAscan array. The genetic associations were replicated in a genome-wide association study of 480 centenarians and ~800 controls of Ashkenazi Jewish descent. The proteomic associations were replicated in a proteomic scan of approximately 1000 Ashkenazi Jewish participants from a third cohort. The analysis replicated a protein signature associated with APOE genotypes and confirmed strong overexpression of BIRC2 (p < 5E-16) and under-expression of APOB in carriers of the APOE2 allele (p < 0.05). The analysis also discovered and replicated associations between longevity variants and slower changes of protein biomarkers of aging, including a novel protein signature of rs2184061 (CDKN2A/CDKN2B in chromosome 9) that suggests a genetic regulation of GDF15. The analyses showed that longevity variants correlate with proteome signatures that could be manipulated to discover healthy-aging targets.

Longitudinal Implications of Social Integration for Age and Gender Differences in Late-Life Physical Functioning

Social integration has documented benefits for late-life health; yet, little is known about its impacts on trajectories of physical functioning. This study examines age and gender differences in the longitudinal associations between social integration and activities of daily living (ADLs) using a hierarchical linear model with three waves of survey data collected over 4 years from the Social Integration and Aging Study (N = 400; baseline mean age = 80.3). Findings indicated some interaction effects of age, gender, and/or social integration on ADL trajectories. Among those of more advanced age, women showed greater increases in ADL limitations than men, and individuals with lower social integration experienced greater increases in ADL limitations than those with higher social integration. Neither of these patterns were found among younger older adults. This study highlights the benefits of longitudinal research on social integration and the need to explore practical interventions for promoting social integration particularly among the oldest older adults.

New Insights for BPIFB4 in Cardiovascular Therapy

Aging is the most relevant risk factor for cardiovascular diseases which are the main cause of mortality in industrialized countries. In this context, there is a progressive loss of cardiovascular homeostasis that translates in illness and death. The study of long living individuals (LLIs), which show compression of morbidity toward the end of their life, is a valuable approach to find the key to delay aging and postpone associate cardiovascular events. A contribution to the age-related decline of cardiovascular system (CVS) comes from the immune system; indeed, it is dysfunctional during aging, a process described as immunosenescence and comprises the combination of several processes overpowering both innate and adaptative immune system. We have recently discovered a longevity-associated variant (LAV) in bactericidal/permeability-increasing fold-containing family B member 4 (BPIFB4), which is a secreted protein able to enhance endothelial function through endothelial nitric oxide synthase (eNOS) activation and capable to protect from hypertension, atherosclerosis, diabetic cardiopathy, frailty, and inflammaging. Here, we sum up the state of the art of the mechanisms involved in the main pathological processes related to CVD (atherosclerosis, aging, diabetic cardiopathy, and frailty) and shed light on the therapeutic effects of LAV-BPIFB4 in these contexts.

Devising a new dialogue for nutrition science: how life course perspective, U-shaped thinking, whole organism thinking, and language precision contribute to our understanding of biological heterogeneity and forge a fresh advance toward precision medicine

The process of designing and implementing individualized health-promoting interventions, nutritional or otherwise, is fraught with great difficulty owing to the heterogeneity inherent in factors that influence healthy longevity. This article proposes that careful attention to three principles-life course perspective, U-shaped thinking, and whole organism thinking-creates an attitudinal framework that can be used to reframe biological heterogeneity into the clinically relevant question: Who will benefit? The search for tools to cope with the complexity of this heterogeneity has been dominated by technological advances, including state-of-the-art "-omics" approaches and machine-based handling of "big data." Here, it is proposed that language precision and nuanced category usage could provide critical tools for coping with heterogeneity, thereby enabling interventionalists to design and implement strategies to promote healthy longevity with greater precision. The lack of a clear understanding of "Who will benefit?" stands as a major obstacle to the design and implementation of nutritional strategies to optimize healthy longevity. This article opens a new dialogue situating the principles of life course perspective, U-shaped thinking, and whole organism thinking, along with cultivating an attitude of language precision at the very core of accelerating creative discovery and refining practical advance in the field of nutrition science.

The longevity-associated variant of BPIFB4 improves a CXCR4-mediated striatum-microglia crosstalk preventing disease progression in a mouse model of Huntington's disease

The longevity-associated variant (LAV) of the bactericidal/permeability-increasing fold-containing family B member 4 (BPIFB4) has been found significantly enriched in long-living individuals. Neuroinflammation is a key player in Huntington's disease (HD), a neurodegenerative disorder caused by neural death due to expanded CAG repeats encoding a long polyglutamine tract in the huntingtin protein (Htt). Herein, we showed that striatal-derived cell lines with expanded Htt (STHdh Q^111/111) expressed and secreted lower levels of BPIFB4, when compared with Htt expressing cells (STHdh Q^7/7), which correlated with a defective stress response to proteasome inhibition. Overexpression of LAV-BPIFB4 in STHdh Q^111/111 cells was able to rescue both the BPIFB4 secretory profile and the proliferative/survival response. According to a well-established immunomodulatory role of LAV-BPIFB4, conditioned media from LAV-BPIFB4-overexpressing STHdh Q111^/111 cells were able to educate Immortalized Human Microglia-SV40 microglial cells. While STHdh Q^111/111 dying cells were ineffective to induce a CD163 + IL-10^high pro-resolving microglia compared to normal STHdh Q^7/7, LAV-BPIFB4 transduction promptly restored the central immune control through a mechanism involving the stromal cell-derived factor-1. In line with the in vitro results, adeno-associated viral-mediated administration of LAV-BPIFB4 exerted a CXCR4-dependent neuroprotective action in vivo in the R6/2 HD mouse model by preventing important hallmarks of the disease including motor dysfunction, body weight loss, and mutant huntingtin protein aggregation. In this view, LAV-BPIFB4, due to its pleiotropic ability in both immune compartment and cellular homeostasis, may represent a candidate for developing new treatment for HD.

Echocardiographic evaluation of centenarians in Trieste

BACKGROUND

Population aging has increased together with the need for cardiovascular care. Understanding the relevance of cardiovascular conditions in the very old is crucial to developing a specific and rationale therapeutic approach. Centenarians can be considered a model of successful aging, although the impact of cardiovascular disease in this population is still unclear.

AIM

To evaluate the cardiovascular health status of a subset of centenarians enrolled in the Centenari a Trieste study and living in the province of Trieste to describe the prevalence of cardiovascular conditions among them.

METHODS

The current study included 20 individuals born before 1919 and living in the province of Trieste as of 1 May 2019. All centenarians were able to give consent and were subjected to an in-home complete clinical assessment focused on cardiovascular conditions, ECG and echocardiography.

RESULTS

The majority of centenarians were women (85%) and were not taking any chronic cardiovascular medication (55%). No centenarians had a history of ischemic heart disease while about one-third had signs suggestive of heart failure at examination (20%). Atrial fibrillation was present in 20% of individuals and conduction disorders were uncommon. Although the majority of individuals had a preserved left ventricular function, diastolic function was abnormal in 80% of enrolled centenarians that, however, was mild in 73% of cases.

CONCLUSION

This is the second study to perform in-home echocardiography in centenarians and the first to characterize the cardiovascular status of centenarians living in Trieste. The majority of centenarians had asymptomatic diastolic dysfunction and were naïve from cardiovascular therapy. The recruitment of new individuals from the Trieste area is continuing to perform analyses on clinical, genetic and environmental factors that may predict greater longevity in this geographical context and unveil mechanisms that regulate cardiac aging associated with increased lifespan.

Purpose in Life Among Centenarian Offspring

OBJECTIVES

Purpose in life (PIL), a feeling of meaning and direction in life, is associated with favorable health outcomes including lower mortality and reduced risk of disease, disability, and cognitive impairment. Since centenarian offspring have been shown to have long health spans we sought to examine whether they have higher PIL than individuals without familial longevity.

METHOD

We compared PIL scores from the Ryff Scales of Psychological Well-Being in centenarian offspring from the New England Centenarian Study (N = 361, mean age = 82.0 years) with 3 referent groups: spouses, birth cohort-matched referents, and Health and Retirement Study (HRS) participants.

RESULTS

Logistic regression analyses adjusted for age, sex, education, and marital status indicated greater odds of high PIL among centenarian offspring compared with spouse (adjusted odds ratio [aOR] = 1.92, 95% confidence interval [CI] = 1.002-3.68, p = .049) and birth cohort referents (aOR = 2.64, 95% CI = 1.36-5.14, p = .004). Offspring had an almost 3 times greater odds of having high PIL than HRS participants (odds ratio [OR] = 2.93, 95% CI = 2.17-3.96, p < .0001).

DISCUSSION

Higher PIL is associated with being an offspring of a long-lived parent and may play a role in the ability to delay age-associated illnesses and functional decline. Increasing purposefulness may be a target for interventions to promote healthy aging.

Centenarians: An excellent example of resilience for successful ageing

Centenarians are remarkable not only because of their prolonged life, but also because they compress morbidity until the very last moments of their lives, thus being proposed as a model of successful, extraordinary ageing. From the medical viewpoint, centenarians do not escape the physiological decline or the age-related diseases or syndromes (i.e. frailty), but the rate of such processes is slow enough to be counterbalanced by their increased intrinsic capacity to respond to minor stresses of daily life (i.e. resilience). These new concepts are reviewed in this paper. Allostatic stresses lead to a chronic low-grade inflammation that has led to the proposal of the "inflammaging" theory of ageing and frailty. The biology of centenarians, described in this review, provides us with clues for intervention to promote healthy ageing in the general population. One of the major reasons for this healthy ageing has to do with the genetic signature that is specific for centenarians and certainly different from octogenarians who do not enjoy the extraordinary qualities of centenarians.

Functional capacity assessment of long-lived older adults from Amazonas

OBJECTIVE

To evaluate the functional capacity of long-lived older adults from Amazonas.

METHOD

A cross-sectional epidemiological study was carried out with 116 older adults aged 80 years or older, registered in a primary health care unit in Belém, in the state of Pará, Brazil. The Functional Independence Measure (FIM) was used for functional capacity assessment and the Mini-Mental State Examination (MMSE) for cognitive screening. Univariate and bivariate analyses were carried out, in addition to the Pearson's chi-square test.

RESULTS

The older adults presented modified independence in the self-care, sphincter control and locomotion dimensions, and needed supervision for mobility/transfers. In mobility, men presented complete independence. Modified independence was found in the 80-89 age group. It was observed that, the lower the education level, the worse the cognitive performance.

CONCLUSION

In spite of their advanced age, long-lived older adults still present functional capacity for activities of daily living, even though they required supervision for high energy expenditure tasks, such as mobility and transfers.

Physical Activity and Sedentary Behavior at the End of the Human Lifespan

To objectively assess physical activity levels and sedentary behavior in a cohort of Spanish centenarians and their nonagenarian peers. Physical activity and sedentary behavior patterns were objectively measured by an ActiGraph GT3X accelerometer in centenarians (n = 18; 83% women; 100.8 ± 0.8 [100-103] years) and nonagenarians (n = 11; 91% women; 93.3 ± 2.5 [90-98] years). Centenarians showed less counts per minute (17.6 ± 7.1 vs. 46.1 ± 23.7, p = .003, d = 1.851) and steps per day (455 ± 237 vs. 1,249 ± 776, p = .007, d = 1.587) than nonagenarians. The daily number of sedentary breaks was also lower in the former (5.0 ± 1.5 vs. 6.7 ± 2.0, p = .019, d = 0.971). When observing time distribution, the most active day period in both groups was the morning, with a peak between 10:00 and 11:59. This data suggest that the decline in physical activity levels continues to worsen until the end of the human lifespan.

Regional differences in morbidity profiles and health care use in the oldest old: Findings from two Centenarian Studies in Portugal

BACKGROUND

The worldwide increase of human life expectancy and the rapid aging of the population will contribute to an increasing prevalence of chronic illness. Even so, individuals who reach very advanced ages often postpone or escape age-related diseases that are common causes of death.

OBJECTIVE

This article aims to examine health-related characteristics of two distinct samples of Portuguese centenarians (one predominantly rural - PR vs. one predominantly urban - PU), and explore potential dissimilarities in their morbidity profiles and use of health care services.

METHODS

A total of 241 centenarians were considered. Sociodemographic characteristics, health status, and use of health care services were assessed by semi-structured interviews with the centenarians and their proxies (family or formal caregiver).

RESULTS

A higher average of 4.80 self-reported illnesses (sd = 2.01) were found in the PU sample (vs. 2.96; sd = 1.77 in the PR sample); in overall the PR sample presented a better health condition with lower levels of physical and mental impairments, and a greater number of centenarians who did not succumb to the three most common lethal diseases (heart disease, non-skin cancer and stroke) in the elderly population (85.4% vs. 60% in the PU sample).

CONCLUSIONS

Portuguese centenarians experienced a substantial number of illnesses, but an overall better health status was found in centenarians from the PR area. By providing distinctive health-related profiles, our findings suggest the importance of contextual factors in shaping how very advanced ages may be achieved.

Exceptional Human Longevity

Exceptional longevity represents an extreme phenotype. Current centenarians are survivors of a cohort who display delayed onset of age-related diseases and/or resistance to otherwise lethal illnesses occurring earlier in life. Characteristics of aging are heterogeneous, even among long-lived individuals. Associations between specific clinical or genetic biomarkers exist, but there is unlikely to be a single biomarker predictive of long life. Careful observations in the oldest old offer some empirical strategies that favor increased health span and life span, with implications for compression of disability, identification and implementation of lifestyle behaviors that promote independence, identification and measurement of more reliable markers associated with longevity, better guidance for appropriate health screenings, and promotion of anticipatory health discussions in the setting of more accurate prognostication. Comprehensive PubMed literature searches were performed, with an unbiased focus on mechanisms of longevity. Overall, the aggregate literature supports that the basis for exceptional longevity is multifactorial and involves disparate combinations of genes, environment, resiliency, and chance, all of which are influenced by culture and geography.

Prevalence of Morbidity at Extreme Old Age in Germany: An Observational Study Using Health Claims Data

We assessed the prevalence of morbidity in long-lived individuals according to age and age at death and explored the association between dementia and other diseases and surviving to age 90 and 100. Using health claims data from the largest German health insurer from 2004 to 2013, we followed birth cohorts from 1908 to 1913 from age 95 until death or survival to age 100 (n=2,865) and compared them with birth cohorts from 1918 to 1923 and their survival from age 85 to age 90 (n=17,013). We observed their exact date of death and main categories of morbidity based on International Classification of Diseases, Tenth Revision, diagnoses. For all diseases studied, when differentiated according to age at death, prevalence continued to increase with age. Nonagenarians and centenarians had significantly lower disease prevalence at each age. Dementia was associated with the highest risk of dying before becoming a centenarian (hazard ratio (HR)=1.63, 95% confidence interval (CI)=1.50-1.78), followed closely by the residual category other chronic heart disease (HR=1.42, 95% CI=1.30-1.56). Results were even stronger for the younger cohort. Our study shows that exceptionally long-lived individuals are different in terms of good health. Survival at these high ages depends primarily on the absence of dementia and chronic heart disease, with acute heart disease and pneumonia playing important roles as diseases leading directly to death.

Genomic Approach to Understand the Association of DNA Repair with Longevity and Healthy Aging Using Genomic Databases of Oldest-Old Population

Aged population is increasing worldwide due to the aging process that is inevitable. Accordingly, longevity and healthy aging have been spotlighted to promote social contribution of aged population. Many studies in the past few decades have reported the process of aging and longevity, emphasizing the importance of maintaining genomic stability in exceptionally long-lived population. Underlying reason of longevity remains unclear due to its complexity involving multiple factors. With advances in sequencing technology and human genome-associated approaches, studies based on population-based genomic studies are increasing. In this review, we summarize recent longevity and healthy aging studies of human population focusing on DNA repair as a major factor in maintaining genome integrity. To keep pace with recent growth in genomic research, aging- and longevity-associated genomic databases are also briefly introduced. To suggest novel approaches to investigate longevity-associated genetic variants related to DNA repair using genomic databases, gene set analysis was conducted, focusing on DNA repair- and longevity-associated genes. Their biological networks were additionally analyzed to grasp major factors containing genetic variants of human longevity and healthy aging in DNA repair mechanisms. In summary, this review emphasizes DNA repair activity in human longevity and suggests approach to conduct DNA repair-associated genomic study on human healthy aging.

Disability Experience and Measurement

Top themes of international research on disability in the past three decades are discussed: disability dynamics, buffers and barriers for disability, disability trends, and disability among very old persons. Each theme is highlighted by research examples. Turning to measurement, I discuss traditional measures of disability, new longer and shorter ones, and composites like disability-free life expectancy, noting their merits. Contemporary models of disability are presented, ranging from visual images to formal theories. The article ends on how scientists can facilitate movement of disability science into health care practice and policy.

Association of Family History of Exceptional Longevity With Decline in Physical Function in Aging

Background

Although many genetic and nongenetic factors interact to determine an individual's physical phenotype, there has been limited examination of the contribution of family history of exceptional parental longevity on decline in physical function in aging.

Methods

The LonGenity study recruited a relatively genetically homogenous cohort of Ashkenazi Jewish adults age 65 and older, who were defined as either offspring of parents with exceptional longevity ([OPEL]: having at least one parent who lived to age 95 or older) or offspring of parents with usual survival ([OPUS]: neither parent survived to age 95). Decline in performance on objective measures of strength (grip strength), balance (unipedal stance), and mobility (gait speed) as well as a composite physical function measure, the Short physical performance battery (SPPB), were compared between the two groups over a median follow-up of 3.2 years, accounting for age, sex, education, and comorbidities.

Results

Of the 984 LonGenity participants (mean age 76, 55% women), 448 were OPEL and 536 were OPUS. Compared to OPUS, OPEL had slower decline on measures of unipedal stance (-0.03 log-units/year, p = .026), repeated chair rise (0.13 s/year, p = .020) and SPPB (-0.11 points/year, p = .002). OPEL women had slower decline on chair rise and SPPB scores compared to OPUS women, although OPEL men had slower decline on unipedal stance compared to OPUS men.

Conclusion

Our findings provide evidence that variation in late-life decline in physical function is associated with familial longevity, and may vary for men and women.

Epistasis, physical capacity-related genes and exceptional longevity: FNDC5 gene interactions with candidate genes FOXOA3 and APOE

BACKGROUND

Forkhead box O3A (FOXOA3) and apolipoprotein E (APOE) are arguably the strongest gene candidates to influence human exceptional longevity (EL, i.e., being a centenarian), but inconsistency exists among cohorts. Epistasis, defined as the effect of one locus being dependent on the presence of 'modifier genes', may contribute to explain the missing heritability of complex phenotypes such as EL. We assessed the potential association of epistasis among candidate polymorphisms related to physical capacity, as well as antioxidant defense and cardiometabolic traits, and EL in the Japanese population. A total of 1565 individuals were studied, subdivided into 822 middle-aged controls and 743 centenarians.

RESULTS

We found a FOXOA3 rs2802292 T-allele-dependent association of fibronectin type III domain-containing 5 (FDNC5) rs16835198 with EL: the frequency of carriers of the FOXOA3 rs2802292 T-allele among individuals with the rs16835198 GG genotype was significantly higher in cases than in controls (P < 0.05). On the other hand, among non-carriers of the APOE 'risk' ε4-allele, the frequency of the FDNC5 rs16835198 G-allele was higher in cases than in controls (48.4% vs. 43.6%, P < 0.05). Among carriers of the 'non-risk' APOE ε2-allele, the frequency of the rs16835198 G-allele was higher in cases than in controls (49% vs. 37.3%, P < 0.05).

CONCLUSIONS

The association of FDNC5 rs16835198 with EL seems to depend on the presence of the FOXOA3 rs2802292 T-allele and we report a novel association between FNDC5 rs16835198 stratified by the presence of the APOE ε2/ε4-allele and EL. More research on 'gene*gene' and 'gene*environment' effects is needed in the field of EL.

Chronic conditions and use of health care service among German centenarians

Background

there is limited data comparing conditions and health service use across care settings in centenarians. To improve health service delivery in centenarians, the aim of this study was to compare the proportion of centenarians who have chronic conditions, take medication and use health care services across different care settings.

Methods

this cohort study uses routine data from a major health insurance company serving Berlin, Germany and the surrounding region, containing almost complete information on health care transactions. The sample comprised all insured individuals aged 100 years and older (N = 1,121). Community-dwelling and institutionalised individuals were included. Charlson comorbidity index was based on 5 years of recordings. Hospital stays, medical specialist visits and medication prescribed in the previous year were analysed.

Results

while 6% of the centenarians did not receive any support; 45% received family homecare or homecare by professional care services; 49% were in long-term care. The most frequent conditions were dementia and rheumatic disease/arthritis, with the highest prevalence found among long-term care residents. A total of 97% of the centenarians saw a general practitioner in the previous year. Women were more often in long-term care and less often without any care. Centenarians with long-term care showed higher proportions of comorbidities, greater medication use, and more visits to medical specialists compared with centenarians in other care settings.

Conclusions

the higher prevalence of dementia and rheumatic disease/arthritis in long-term care compared to other care settings emphasises the role of these diseases in relation to the loss of physical and cognitive functioning.

The drug burden of anticholinergics and sedatives and influence on outcomes in the community-living oldest old: The Tokyo Oldest Old survey on Total Health (TOOTH) survey

AIM

The objective of this study was to assess the burdens of anticholinergic and sedative drugs in community-living individuals of 85 years of age or older.

METHODS

The Tokyo Oldest Old survey on Total Health (TOOTH) is a cohort study designed to assess the physical, mental, and oral health of the community-living oldest old. We investigated the relationships between the anticholinergic/sedative burden and physical/cognitive outcomes. The drug burden was assessed by the Drug Burden Index (DBI). Relationships between the DBI score and the physical/cognitive outcomes were evaluated by multivariate regression. The age-related changes (baseline to 3-year follow-up) of these outcomes were also investigated.

RESULTS

At baseline, the data of 306 subjects were subjected to a cross-sectional analysis. The Instrumental Activities of Daily Living and Mini Mental State Examination scores were found to be significantly associated with the DBI score. After 3 years, the Activities of Daily Living score was significantly associated with the DBI score in 176 subjects. Changes in these outcome measures were small during the 3-year follow-up period and were not associated with the DBI scores at baseline.

DISCUSSION

DBI in the community-living oldest old were evaluated. Our findings suggest that anticholinergic and sedative drugs may influence the physical and cognitive function in the oldest old. Additional studies should be performed to investigate the relationships between the change of the physical/cognitive functions and the DBI score over a long-term observation period.

Characteristics and Incidence of Chronic Illness in Community-Dwelling Predominantly Male U.S. Veteran Centenarians

OBJECTIVES

To assess the incidence of chronic illness and its effect on veteran centenarians.

DESIGN

Retrospective longitudinal cohort study.

SETTING

United States Veterans Affairs Corporate Data Warehouse (CDW).

PARTICIPANTS

Community-dwelling veterans born between 1910 and 1915 who survived to at least age 80 (N = 86,892; 31,121 octogenarians, 52,420 nonagenarians, 3,351 centenarians).

MEASUREMENTS

The Kaplan-Meier method was used to estimate cumulative incidence of chronic conditions according to age group. Incidence rates were compared using the log-rank test. Cox proportional hazards models were used to estimate unadjusted hazard ratios.

RESULTS

Ninety-seven percent of Centenarians were male, 88.0% were white, 31.8% were widowed, 87.5% served in World War II, and 63.9% did not have a service-related disability. The incidence rates of chronic illnesses were higher in octogenarians than centenarians (atrial fibrillation, 15.0% vs 0.6%, P < .001; heart failure, 19.3% vs 0.4%, P < .001; chronic obstructive pulmonary disease, 17.9% vs 0.6%, P < .001; hypertension, 29.6% vs 3.0%, P < .001; end-stage renal disease, 7.2% vs 0.1%, P < .001; malignancy, 14.1% vs 0.6%, P < .001; diabetes mellitus, 11.1% vs 0.4%, P < .001; stroke, 4.6% vs 0.4%, P < .001) and in nonagenarians than centenarians (atrial fibrillation, 13.2% vs 3.5%, P < .001; heart failure, 15.8% vs 3.3%, P < .001; chronic obstructive pulmonary disease, 11.8% vs 3.5%, P < .001; hypertension, 27.2% vs 12.8%, P < .001; end-stage renal disease, 11.9% vs 4.5%, P < .001; malignancy, 8.6% vs 2.3%, P < .001; diabetes mellitus, 7.5% vs 2.2%, P < .001; and stroke, 3.5% vs 1.3%, P < .001).

CONCLUSION

In a large cohort of predominantly male community-dwelling elderly veterans, centenarians had a lower incidence of chronic illness than those in their 80s and 90s, demonstrating similar compression of morbidity and extension of health span observed in other studies.

Association study of polymorphisms in FOXO3, AKT1 and IGF-2R genes with human longevity in a Han Chinese population

FOXO3, AKT1 and IGF-2R are critical members of the insulin/IGF-1 signaling pathway. Previous studies showed that polymorphisms (SNPs) in FOXO3, AKT1 and IGF-2R were associated with human longevity in Caucasian population. However, the association of these SNPs in different ethnic groups is often inconsistent. Here, we investigated the association of genetic variants in three genes with human longevity in Han Chinese population. Twelve SNPs from FOXO3, AKT1 and IGF-2R were selected and genotyped in 1202 long-lived individuals (nonagenarians and centenarians) and younger individuals. Rs9486902 of FOXO3 was found to be associated with human longevity in both genders combined in this study (allelic P = 0.002, corrected P = 0.024). The other eleven SNPs were not significantly associated with human longevity in Han Chinese population. The haplotypes TTCTT, CCTTC and CTCCT of FOXO3 as well as GGTCGG and GGTCAG of AKT1 were shown to have a significant difference between case and control (P =0.006, 2.78×10-5, 4.68×10-6, 0.003,0.005, respectively). The estimated prevalence of diabetes and prediabetes in long-lived individuals was significantly lower than in common adult populations (P = 0.001, 2.3×10-26) .Therefore, the search for longevity-associated genes provides the identification of new potential targets beneficial for the treatment of diabetes.

Compression of Morbidity Is Observed Across Cohorts with Exceptional Longevity

OBJECTIVES

To determine, in a sample of Ashkenazi Jewish aged 95 and older, whether there is a compression of morbidity similar to what has been reported in other cohorts with exceptional longevity.

DESIGN

Case-control study.

SETTING

Longevity Genes Project (LGP) and New England Centenarian Study (NECS).

PARTICIPANTS

LGP (n = 439, mean age 97.8 ± 2.8) and NECS (n = 1,498, mean age 101.4 ± 4.0) participants with exceptional longevity and their respective younger referent cohorts (LGP, n = 696; NECS, n = 302).

MEASUREMENTS

Self- and proxy reports of age of onset of cancer, cardiovascular disease, diabetes mellitus, hypertension, osteoporosis, and stroke.

RESULTS

Long-lived individuals from LGP and NECS had later age of onset of cancer, cardiovascular disease, diabetes mellitus, hypertension, and osteoporosis than their respective younger reference groups. The risk of overall morbidity was lower in participants with exceptional longevity than in younger participants (NECS men: relative risk (RR) = 0.12, women: RR = 0.20; LGP men: RR = 0.18, women: RR = 0.24). The age at which 20% of each of the groups with exceptional longevity experienced specific diseases was between 18 and 24 years later than in the reference groups, stratified according to sex.

CONCLUSION

The similar extension of health span and compression of morbidity seen in NECS and LGP participants with exceptional longevity further validates the utility of these rare individuals for the study of factors that delay or prevent a broad spectrum of diseases otherwise associated with mortality and disability.

Employing biomarkers of healthy ageing for leveraging genetic studies into human longevity

Genetic studies have thus far identified a limited number of loci associated with human longevity by applying age at death or survival up to advanced ages as phenotype. As an alternative approach, one could first try to identify biomarkers of healthy ageing and the genetic variants associated with these traits and subsequently determine the association of these variants with human longevity. In the present study, we used this approach by testing whether the 35 baseline serum parameters measured in the Leiden Longevity Study (LLS) meet the proposed criteria for a biomarker of healthy ageing. The LLS consists of 421 families with long-lived siblings of European descent, who were recruited together with their offspring and the spouses of the offspring (controls). To test the four criteria for a biomarker of healthy ageing in the LLS, we determined the association of the serum parameters with chronological age, familial longevity, general practitioner-reported general health, and mortality. Out of the 35 serum parameters, we identified glucose, insulin, and triglycerides as biomarkers of healthy ageing, meeting all four criteria in the LLS. We subsequently showed that the genetic variants previously associated with these parameters are significantly enriched in the largest genome-wide association study for human longevity. In conclusion, we showed that biomarkers of healthy ageing can be used to leverage genetic studies into human longevity. We identified several genetic variants influencing the variation in glucose, insulin and triglycerides that contribute to human longevity.

Pilot study of adrenal steroid hormones in hair as an indicator of chronic mental and physical stress

Currently, the quantitative analysis of moderators affecting the function of the hypothalamus-pituitary-adrenal (HPA)-axis in health and sickness is still unreliable. This is, in particular, due to physiological factors such as pulsatile ultradian and circadian glucocorticoid secretion as well as to methodological limitations of the current techniques for steroid hormone determination. Based on this background, the determination of long-term hair steroid concentrations is an important methodological improvement allowing for the quantitative analysis of chronic HPA axis-activation. In order to determine the relationship between chronic mental and physical stress and a chronic activation of the HPA axis, we performed a cross-sectional pilot-study with 40 healthy students and examined the relationships between physical activity, mental burden(s), subjective stress perceptions, depressiveness, anxiety, physical complaints, sense of coherence, resilience, and the long-term integrated steroid hormone levels in hair. The results showed that the concentrations of cortisol, cortisone, and dehydroepiandrosterone in hair were significantly correlated to mental (p = 0.034) and physical stress (p = 0.001) as well as to subjective stress perception (p = 0.006). We conclude that steroid concentrations in hair are decisive predictors for an increase in the long-term-HPA axis activity. Moreover, this biomarker is suitable for capturing the stresslevel after burdening events and physical activity.

Trace elements levels in centenarian 'dodgers'

Trace element bioavailability can play a role in several metabolic and physiological pathways known to be altered during the aging process. We aimed to explore the association of trace elements with increased lifespan by analyzing the circulating levels of seven trace elements (Cr, Cu, Fe, Mn, Mo, Se and Zn) in a cohort of healthy centenarians or 'dodgers' (≥100 years, free of major age-related diseases) in comparison with sex-matched younger elderly controls. Centenarians showed significant lower Cu (783.7 (76.7, 1608.9) vs 962.5 (676.3, 2064.4)μg/mL, P<0.001), but higher Fe (1.3 (0.4, 4.7) vs 1.1 (0.5, 8.4)μg/mL, P=0.003) and Se (85.7 (43.0, 256.7) vs 77.8 (24.3, 143.8)ng/mL, P=0.002) values compared with elderly controls. The logistic regression analysis identified the combination of Cu and Se as significant predictor variables associated with successful aging (P=0.001), while receiver operating characteristic (ROC) analysis confirmed that Cu and Se (either alone or in combination) were independent variables associated with healthy aging. An 'improved' trace element profile (reduced Cu and elevated Se, which are involved in key physiological processes) could play a role in the resistance to disease showed by centenarian 'dodgers', and, therefore, at least partly, be involved in the healthy aging phenotype shown by these subjects. These results should be confirmed in larger cohorts of other geographic/ethnic origin and the potential cause-effect association tested in mechanistic experimental settings.

The ApoE gene is related with exceptional longevity: a systematic review and meta-analysis

The objective of this meta-analysis was to determine the association of the apolipoprotein E (ApoE) gene with exceptional longevity (EL) (i.e., reaching 100+ years) by identifying possible unequal distribution of alleles/genotypes in the common variants ε2, ε3, and ε4 among centenarians and younger population. The association of ApoE with EL was analyzed in a total of 2776 centenarians (cases) and 11,941 younger controls (from 13 case-control studies) using the chi-squared test with the Yates correction. We conducted combined and separate analyses for all ethnic groups studied in the literature (Caucasian and Asian). The main result for all ethnic groups combined was that the likelihood of reaching EL was negatively associated with ε4 allele carriage [pooled odds ratio (OR)=0.43; 95% confidence interval (CI) 0.36, 0.50; p<0.001] and with ε4/ε4 (OR=0.18; 95% CI 0.08, 0.39; p<0.001), ε3/ε4 (OR=0.44; 95% CI 0.37, 0.53; p<0.001) and ε2/ε4 genotypes (OR=0.48; 95% CI 0.31, 0.74; p<0.001). In contrast, the ε2/ε3 genotype was positively associated with EL (OR=1.35; 95% CI 1.06, 1.72; p=0.017). When compared with the ε3 allele, the ε2 allele was not associated with increased odds of EL (OR=1.08; 95% CI 0.77, 1.50, p=0.660). The present meta-analysis confirms that, besides its previously documented influence on Alzheimer's and cardiovascular disease risk, the ApoE gene is associated with the likelihood of reaching EL.

Physical, cognitive, social and mental health in near-centenarians and centenarians living in New York City: findings from the Fordham Centenarian Study

BACKGROUND

Despite their strong increase, the population of the very old, including near-centenarians and centenarians, represent an unstudied and underserved population. Available studies mostly concentrate on predictors of exceptional longevity, but rarely extend their focus to other areas of functioning. Also, little is known about what contributes to experiencing a quality life in very old age. The present population-based study aims at providing a comprehensive picture of key domain of functioning, including physical, cognitive, social and mental function in very old individuals and to determine predictors of mental health indicators.

METHODS

A total of 119 individuals aged 95 to 107 living in private dwellings and residential care facilities were recruited based on the New York City Voters Registry. Participants answered questions regarding their health and activities of daily living. Their cognitive functioning was determined using the Mini-Mental State Examination and the Global Deterioration Scale. Social resources were measured with number of children and the Lubben Scale. Mental health was assessed with the Geriatric Depression Scale and the Satisfaction with Life Scale.

RESULTS

An unexpectedly large proportion of the sample lived in the community. On average, cognitive functioning was high. Although five diseases were reported on average, participants reported good health. Functional status was reduced. Most participants had at least one person for communication/social support. On average, depression was below cut-off, and most participants reported high life satisfaction. Regression analyses indicated that individual differences in depression were associated with subjective health, IADL and relatives support. For life satisfaction, subjective health, ADL and number of children were most important. Demographic characteristics, number of illnesses or cognitive status were not significant.

CONCLUSIONS

Despite reduced levels of physical functioning and social resources, very old participants were in good mental health suggesting high resilience and ability to adapt to age-associated challenges. That a large proportion of them lived in the community further highlights their desire for leading an autonomous life, which may have been facilitated by New York service culture. More research is necessary to provide guidance for the development of well-suited services for this very old population.

Functional measures, inflammatory markers and endothelin-1 as predictors of 360-day survival in centenarians

Centenarians represent a rapidly growing population. To better characterize this specific age group, we have performed a cross-sectional study to observe associations between functional measures and a range of biochemical markers, including inflammatory markers and their significance as predictors of 360-day survival. Medical history and physical and functional assessment (Mini-Mental State Examination (MMSE), Katz Index (activities of daily living, ADL) and Barthel Index (Barthel Index) of Activities of Daily Living, and Lawton Instrumental Activities of Daily Living Scale (Lawton IADL)) were conducted on 86 101.9 ± 1.2-year-old (mean ± SD) subjects (70 women, 16 men). Blood tests were performed on 84 subjects of whom 43 also had extended biomarker assessment. As a reference group 30 51.8 ± 5.0-year old healthy subjects (20 women, 10 men) were recruited. The centenarians received follow-up phone calls. Fifty-two centenarians (60 %) survived ≥360 days. Longer survival was associated with higher MMSE (hazard ratio, HR = 0.934, 95 % confidence interval (CI) 0.896-0.975, P = .002), ADL (HR = 0.840, 95 % CI 0.716-0.985, P = .032), Barthel Index (HR = 0.988, 95 % CI 0.977-0.999, P = .026), and albumin level (HR .926, 95 % CI 0.870-0.986, P .016) and with lower white blood cell (WBC) (HR = 1.161, 95 % CI 1.059-1.273, P = .001), C-reactive protein (CRP) (HR = 1.032, 95 % CI 1.014-1.050, P < .001), IL-6 (HR = 1.182, 95 % CI 1.047-1.335, P = .007), and endothelin-1 (ET-1) level (HR = 3.711, 95 % CI 1.233-11.169, P = .020). Centenarians had higher 360-day survival probability with MMSE ≥13 (P < .001), ADL ≥1 (P < .001), Barthel Index ≥15 (P < .001), Lawton IADL ≥10 points (P = .009), WBC <8.3 G/L (P = .039), CRP <10 mg/L (P < .001), IL-6 <6 pg/mL (P .002), and ET-1 <1.1 pg/mL (P .007). Our results indicate that functional measures, inflammatory markers, and endothelin-1 are predictors of 360-day survival in centenarians.

Differences in Health at Age 100 According to Sex: Population-Based Cohort Study of Centenarians Using Electronic Health Records

OBJECTIVES

To use primary care electronic health records (EHRs) to evaluate the health of men and women at age 100.

DESIGN

Population-based cohort study.

SETTING

Primary care database in the United Kingdom, 1990-2013.

PARTICIPANTS

Individuals reaching the age of 100 between 1990 and 2013 (N = 11,084, n = 8,982 women, n = 2,102 men).

MEASUREMENTS

Main categories of morbidity and an index of multiple morbidities, geriatric syndromes and an index of multiple impairments, cardiovascular risk factors.

RESULTS

The number of new female centenarians per year increased from 16 per 100,000 in 1990-94 to 25 per 100,000 in 2010-13 (P < .001) and of male centenarians from four per 100,000 to six per 100,000 (P = .06). The most prevalent morbidities at the age of 100 were musculoskeletal diseases, disorders of the senses, and digestive diseases. Women had greater multiple morbidity than men (odds ratio (OR) = 1.64, 95% confidence interval (CI) = 1.42-1.89, P < .001). Geriatric syndromes, including falls, fractures, hearing and vision impairment, and dementia, were frequent; 30% of women and 49% of men had no recorded geriatric syndromes. Women had greater likelihood of having multiple geriatric syndromes (OR = 2.14, 95% CI = 1.90-2.41, P < .001).

CONCLUSION

Fewer men than women reach the age of 100, but male centenarians have lower morbidity and fewer geriatric syndromes than women. Research using EHRs offers opportunities to understand the epidemiology of aging and improve care of the oldest old.

PTK2 rs7460 and rs7843014 polymorphisms and exceptional longevity: a functional replication study

Focal adhesion is critical for cell survival. The focal adhesion kinase (FAK, or PTK2) is an important component of the human interactome and thus is a potential longevity-related protein. Here we studied the association between two PTK2 gene single-nucleotide polymorphisms (SNPs) (rs7843014, rs7460) and exceptional longevity (EL). In addition to gaining insight into their functionality by determining luciferase gene reporter activity, we studied the genotype/allele frequency of these two SNPs among three different cohorts: (1) Spanish centenarians (n=175, 100-111 years, 144 women) and healthy controls (n=355, 20-50 years, 284 women); (2) Italian centenarians (n=79, 100-104 years, 40 women) and controls (n=316, 29-50 years, 156 women); and (3) Japanese centenarians (n=742, 100-116 years, 623 women) and healthy controls (n=499, 23-59 years, 356 women). Both SNPs had functional significance, with the A allele up-regulating luciferase activity compared to the other allele (rs7460 T allele and rs7843014 C allele, respectively). The A allele of both SNPs was negatively associated with EL in the Spanish cohort (rs7460, odds ratio [OR] adjusted by sex=0.40, 95% confidence intervals [CI] 0.3, 0.6, p<0.001); rs7843014, OR=0.37, 95% CI 0.3, 0.5, p<0.001). The OR of being a centenarian if having the rs7460-TT genotype was 6.68 (95% CI 4.1, 10.8, p<0.001). The rs7843014 CC genotype was also positively associated with EL (OR=7.58, 95% CI 4.6, 12.3, p<0.001]. No association was, however, found for the Italian or Japanese cohorts. Thus, two genotypes of the FAK gene, rs7460 TT and rs7843014 CC, are possibly associated with lower gene expression and might favor the likelihood of reaching EL in the Spanish population. Further research is needed to unveil the mechanisms by which FAK expression could perhaps influence the rate of aging.

Genetic Analysis Reveals a Longevity-Associated Protein Modulating Endothelial Function and Angiogenesis

RATIONALE

Long living individuals show delay of aging, which is characterized by the progressive loss of cardiovascular homeostasis, along with reduced endothelial nitric oxide synthase activity, endothelial dysfunction, and impairment of tissue repair after ischemic injury.

OBJECTIVE

Exploit genetic analysis of long living individuals to reveal master molecular regulators of physiological aging and new targets for treatment of cardiovascular disease.

METHODS AND RESULTS

We show that the polymorphic variant rs2070325 (Ile229Val) in bactericidal/permeability-increasing fold-containing-family-B-member-4 (BPIFB4) associates with exceptional longevity, under a recessive genetic model, in 3 independent populations. Moreover, the expression of BPIFB4 is instrumental to maintenance of cellular and vascular homeostasis through regulation of protein synthesis. BPIFB4 phosphorylation/activation by protein-kinase-R-like endoplasmic reticulum kinase induces its complexing with 14-3-3 and heat shock protein 90, which is facilitated by the longevity-associated variant. In isolated vessels, BPIFB4 is upregulated by mechanical stress, and its knock-down inhibits endothelium-dependent vasorelaxation. In hypertensive rats and old mice, gene transfer of longevity-associated variant-BPIFB4 restores endothelial nitric oxide synthase signaling, rescues endothelial dysfunction, and reduces blood pressure levels. Furthermore, BPIFB4 is implicated in vascular repair. BPIFB4 is abundantly expressed in circulating CD34(+) cells of long living individuals, and its knock-down in endothelial progenitor cells precludes their capacity to migrate toward the chemoattractant SDF-1. In a murine model of peripheral ischemia, systemic gene therapy with longevity-associated variant-BPIFB4 promotes the recruitment of hematopoietic stem cells, reparative vascularization, and reperfusion of the ischemic muscle.

CONCLUSIONS

Longevity-associated variant-BPIFB4 may represent a novel therapeutic tool to fight endothelial dysfunction and promote vascular reparative processes.

A preliminary candidate approach identifies the combination of chemerin, fetuin-A, and fibroblast growth factors 19 and 21 as a potential biomarker panel of successful aging

Although the number of centenarians is growing worldwide, the potential factors influencing the aging process remain only partially elucidated. Researchers are increasingly focusing toward biomarkers as tools to shed more light on the pathophysiology of complex phenotypes, including the ability to reach successful aging, i.e., free of major chronic diseases. We therefore conducted a case-control study examining the potential associations of multiple candidate biomarkers in healthy centenarians and sex-matched healthy elderly controls. Using a case-control study of 81 centenarians (aged ≥ 100 years) selected based on the fact that they were disease-free and 46 healthy elderly controls (aged 70-80 years), serum levels of 15 different candidate biomarkers involved in the regulation of metabolism, angiogenesis, inflammation, and bone formation were measured. Of the 15 biomarkers tested, four molecules (chemerin, fetuin-A, and fibroblast growth factors [FGF] 19 and 21) were found to be independently associated with successful aging regardless of sex. Logistic regression analysis confirmed that chemerin, fetuin-A, FGF19, and FGF21 were independently associated with successful aging [predicted probability (PP) = 1 / [1 + 1 / exp (11.832 - 0.027 × (chemerin) - 0.009 × (fetuin-A) + 0.014 × (FGF19) - 0.007 × (FGF21)]. The area under the curve (AUC) of predicted probability values for the four-biomarker panel revealed that it can discriminate between centenarians and elderly controls with excellent accuracy (AUC > 0.94, P < 0.001). Although preliminary in essence and limited by the low sample size and lack of replication in other independent cohorts, our data suggest an independent association between successful aging and serum chemerin, fetuin-A, FGF19, and FGF21, which may provide novel information on the mechanisms behind the human aging process. Whether the four-biomarker panel may predict successful aging deserves further scrutiny.

Exceptional longevity and muscle and fitness related genotypes: a functional in vitro analysis and case-control association replication study with SNPs THRH rs7832552, IL6 rs1800795, and ACSL1 rs6552828

There are several gene variants that are candidates to influence functional capacity in long-lived individuals. As such, their potential association with exceptional longevity (EL, i.e., reaching 100+ years) deserves analysis. Among them are rs7832552 in the thyrotropin-releasing hormone receptor (TRHR) gene, rs1800795 in the interleukin-6 (IL6) gene and rs6552828 in the coenzyme A synthetase long-chain 1 (ACSL1) gene. To gain insight into their functionality (which is yet unknown), here we determined for the first time luciferase gene reporter activity at the muscle tissue level in rs7832552 and rs6552828. We then compared allele/genotype frequencies of the 3 abovementioned variants among centenarians [n = 138, age range 100–111 years (114 women)] and healthy controls [n = 334, 20–50 years (141 women)] of the same ethnic and geographic origin (Spain). We also studied healthy centenarians [n = 79, 100–104 years (40 women)] and controls [n = 316, 27–81 years (156 women)] from Italy, and centenarians [n = 742, 100–116 years (623 women)] and healthy controls [n = 499, 23–59 years (356 women)] from Japan. The THRH rs7832552 T-allele and ACSL1 rs6552828 A-allele up-regulated luciferase activity compared to the C and G-allele, respectively (P = 0.001). Yet we found no significant association of EL with rs7832552, rs1800795 or rs6552828 in any of the 3 cohorts. Further research is needed with larger cohorts of centenarians of different origin as well as with younger old people.