Cognitive function, physical performance, health, and disease: norms from the georgia centenarian study

Profiles of centenarians' functioning: linking functional and cognitive capacity with depressive symptoms

BACKGROUND

Despite most centenarians facing age-related declines in functional and cognitive capacities, the severity of these declines varies among individuals, as does the maintenance of good mental health (e.g., depressive symptoms) despite these declines. This study aims to examine this heterogeneity in centenarians from the Second Heidelberg Centenarian Study, which collected data from 112 centenarians living in Germany. In our study, we focus on a subsample of 73 centenarians who provided self-reports for our measures of interest (M age = 100.4, SD age = 0.55).

METHODS

We examined correlations between functional capacity (i.e., PADL, IADL), cognitive capacity (i.e., MMSE), and depressive symptoms (i.e., GDS), and the existence of different profiles using hierarchical clustering.

RESULTS

Higher functional capacity was related to higher cognitive capacity and to fewer depressive symptoms. Yet, higher cognitive capacity was associated with more depressive symptoms. Hierarchical clustering analysis elucidated this contradiction by identifying three profiles: low-capacity individuals (i.e., 24 individuals had low functional and cognitive capacities, with low depressive symptoms), high-capacity individuals (i.e., 33 individuals with high functional and cognitive capacities, with low depressive symptoms), and low-functional-high-cognitive-capacity individuals (i.e., 16 individuals showed low functional but high cognitive capacity, with high depressive symptoms). Our post-hoc analyses highlighted arthritis and pain as risk factors for functional dependence and depression.

CONCLUSIONS

Our findings emphasize the importance of identifying centenarian subgroups with specific resource- and risk profiles to better address their needs, and of treating pain to improve functional capacity and mental health in centenarians.

Physical Activity in Centenarians beyond Cut-Point-Based Accelerometer Metrics

This study described and compared physical activity (PA) characteristics at the end of the human lifespan using conventional cut-point-based versus cut-point-free accelerometer metrics. Eighteen institutionalized centenarians (101.5 ± 2.1 years, 72.2% female, 89% frail) wore the wrist GENEActiv accelerometer for 7 days. Conventional metrics, such as time spent in light-intensity PA (LiPA) and moderate-to-vigorous intensity PA (MVPA) were calculated according to published cut-points for adults and older adults. The following cut-point-free metrics were evaluated: average acceleration, intensity gradient and Mx metrics. Depending on the cut-point, centenarians accumulated a median of 15-132 min/day of LiPA and 3-15 min/day of MVPA. The average acceleration was 9.2 mg [Q1: 6.7 mg-Q3: 12.6 mg] and the intensity gradient was -3.19 [-3.34--3.12]. The distribution of Z-values revealed positive skew for MVPA, indicating a potential floor effect, whereas the skew magnitude was attenuated for cut-point-free metrics such as intensity gradient or M5. However, both cut-point-based and cut-point-free metrics were similarly positively associated with functional independence, cognitive and physical capacities. This is the first time that PA has been described in centenarians using cut-point-free metrics. Our results suggest that new analytical approaches could overcome cut-point limitations when studying the oldest-old. Future studies using these new cut-point-free PA metrics are warranted to provide more complete and comparable information across groups and populations.

Factor analysis of the Cognitive Abilities Screening Instrument: Kuakini Honolulu-Asia Aging Study

OBJECTIVE

The Cognitive Abilities Screening Instrument (CASI) is a screening test of global cognitive function used in research and clinical settings. However, the CASI was developed using face validity and has not been investigated via empirical tests such as factor analyses. Thus, we aimed to develop and test a parsimonious conceptualization of the CASI rooted in cognitive aging literature reflective of crystallized and fluid abilities.

DESIGN

Secondary data analysis implementing confirmatory factor analyses where we tested the proposed two-factor solution, an alternate one-factor solution, and conducted a χ² difference test to determine which model had a significantly better fit.

SETTING

N/A.

PARTICIPANTS

Data came from 3,491 men from the Kuakini Honolulu-Asia Aging Study.

MEASUREMENTS

The Cognitive Abilities Screening Instrument.

RESULTS

Findings demonstrated that both models fit the data; however, the two-factor model had a significantly better fit than the one-factor model. Criterion validity tests indicated that participant age was negatively associated with both factors and that education was positively associated with both factors. Further tests demonstrated that fluid abilities were significantly and negatively associated with a later-life dementia diagnosis.

CONCLUSIONS

We encourage investigators to use the two-factor model of the CASI as it could shed light on underlying cognitive processes, which may be more informative than using a global measure of cognition.

National Hospitalization Trends and the Role of Preventable Hospitalizations among Centenarians in the United States (2000-2009)

Increases in life expectancy mean that an unprecedented number of individuals are reaching centenarian status, often with complex health concerns. We analyzed nationally representative hospital admissions data (200-2009) from the National Inpatient Study (NIS) for 52,618 centenarians (aged 100-115 years, mean age 101.4). We predicted length of stay (LOS) via negative binomial models and total inflation adjusted costs via fixed effects regression analysis informed by descriptive data. We also identified hospitalizations due to ambulatory care-sensitive conditions defined by AHRQ Prevention Quality Indicators. Mean LOS decreased from 6.1 to 5.1 days, while over the same time period the mean total adjusted charges rose from USD 13,373 to USD 25,026 in 2009 dollars. Black, Hispanic, Asian, or other race centenarians had higher cost stays compared to White, but only Black and Hispanic centenarians had significantly greater mean length of stay. Comorbidities predicted greater length of stay and higher costs. Centenarians admitted on weekends had higher costs but shorter length of stay. In total, 29.4% of total costs were due to potentially preventable hospitalizations for total charges (2000-2009) of USD 341.8M in 2009 dollars. Centenarian hospitalizations cost significantly more than hospitalization for any other group of elderly in the U.S.

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.

Efficacy and safety of a simple home-based resistance exercise program for older adults with low muscle mass: a prospective longitudinal clinical trial

Low muscle mass is a common condition among older adults that adversely affects strength, physical performance and quality of life. This study aimed to investigate the efficacy and safety of a simple home-based resistance exercise program for older adults with low muscle mass, which was defined as appendicular skeletal mass (ASM) measured by bioimpedance analysis lower than 5.7 kg/m2 in females, and lower than 7.0 kg/m2 in males. This home-based resistance exercise program targets 10 muscles with a frequency of 3-5 days/week for 24 weeks. ASM, grip strength, gait speed and functional reach were measured at baseline, 3 and 6 months. The same four outcomes were then remeasured at 9 months to assess long-term effects. A total of 112 participants (average age: 70 years) were recruited. The mean difference between baseline and 6 months was statistically significant for all outcomes, including ASM [0.12 kg/m2: 95% confidence interval (CI), 0.05-0.18; P = 0.001], gait speed (0.19 meter/s: 95% CI, 0.14-0.25; P < 0.001), grip strength (2.06 kg: 95% CI, 1.32-2.80; P < 0.001), and functional reach distance (4.18 cm: 95% CI, 3.18-5.18; P < 0.001). Change over time for all main outcomes from baseline to 9 months also showed statistically significant improvement. The most commonly reported adverse events were muscle pain, joint pain and fatigue. The majority of participants (90-93%) had good exercise compliance, even at the end of the study. In conclusion, this 24-week simple home-based resistance exercise program significantly improved all main outcomes with low adverse events, and most participants continued the program after the end of the intervention.

Walking performance is associated with coronary artery calcification in very old adults

BACKGROUND

Coronary artery calcification (CAC) scores have good predictive value for atherosclerosis-related outcomes in the geriatric population. The low availability of cardiac computed tomography is an obstacle to assess CAC in clinical practice. Thus, clinical signs with a good degree of association with CAC can help to estimate cardiovascular risk, particularly in low-income populations.

OBJECTIVES

To assess whether clinical, biochemical and functional measures explain the CAC scores in older individuals.

METHODS

We characterized 89 non-institutionalized older volunteers (≥ 80 years old) by means of a comprehensive biochemical and anthropometric evaluation along with assessments of CAC scores determined by computerized tomography, and tested their association with walking speed test (WS) and handgrip strength (HS) performance.

RESULTS

Analyses of variance showed that body mass index (BMI) and waist circumference (WC) differed significantly (p ≤ 0.01 and p ≤ 0.03; respectively) across quartiles, so that subsequent tests were adjusted for anthropometry. ANCOVA revealed that the two lower quartiles of CAC had better performance in WS compared to the third and fourth quartiles (p ≤ 0.04). Multinomial logistic regression analysis showed that WS scores exhibit enough power (R² = 0.379, p = 0.05) to explain CAC scores. There were no significant differences for HS between quartiles (p = 0.87).

CONCLUSION

WS is associated and explain CAC scores, and may be useful to stratify atherosclerotic burden in apparently healthy very old individuals regardless of body composition.

Analyzing functional status and its correlates in Chinese centenarians: A cross-sectional study

Factors affecting independence in basic and instrumental activities of daily living have been established in older adults, but not centenarians. The purpose of this study was to examine the state and factors affecting activities of daily living independence in centenarians who resided in Guangxi Province, China. A cross-sectional design was used. Activities of daily living, physical activity, mobility, and physical performance were measured by the Population Study of ChINese Elderly study instruments, and demographics and cognition were assessed. Of the 228 participants, 57% were independent in basic activities of daily living and 5.7% in instrumental activities of daily living. Stepwise regression showed physical activity, cognition, calf circumference, and self-reported health were associated with basic activities of daily living. Physical activity, mobility, cognition, and physical performance were correlated with instrumental activities of daily living. In conclusion, the Chinese centenarians showed impaired instrumental activities of daily living but mostly maintained basic functioning. Physical activity and cognition were associated with activities of daily living independence.

Association of Anemia with Activities of Daily Living in Chinese Female Centenarian

OBJECTIVES

Although anemia and activities of daily living (ADL) disability in female elderly are common conditions and are more likely to occur as people age, little is known about the association of anemia with ADL in female centenarians. The objective of this study was to examine the relationship between anemia and ADL disability in Chinese female centenarians.

DESIGN, SETTING AND PARTICIPANTS

We conducted a population-based cross-sectional study of a sample of 822 Chinese female centenarians from 2014 to 2016.

MEASUREMENTS

Blood analysis, home interview, and physical examination were performed following standard procedures. ADL disability was defined as a Barthel Index total score≤60.

RESULTS

The prevalence of anemia and ADL disability were 66.8% and 29.7% respectively in Chinese female centenarians. Multiple logistic regression analyses revealed that inflammation (OR = 2.280, 95% CI, 1.524-3.410), underweight (OR = 1.653, 95% CI, 1.186-2.303), anemia (OR = 1.775, 95% CI, 1.250-2.521), and living with family (OR = 0.518, 95% CI, 0.302-0.888) were significant factors related to ADL disability. Centenarians with severe anemia had an approximately fourfold greater likelihood of ADL disability than those without anemia (OR =3.747; 95% CI 1.525-9.206). An apparent dose-response relationship was found between anemia and ADL disability.

CONCLUSION

These findings may provide some insights into targeted intervention for maintaining ADL independence in female centenarians, especially encouraging the interventions of anemia to improve ADL.

Prevalence and Correlates of Falls Among Centenarians: Results from the Five-Country Oldest Old Project (5-COOP)

Background

Many studies have been conducted to investigate risk factors of falls in older people, but little is known about falls among centenarians. We analyzed the cross-sectional data from the Five-Country Oldest Old Project (5-COOP) to investigate the prevalence and correlates of falls among centenarians.

Methods

Data collection was carried out in 2011–2014 in Japan, France, Switzerland, Sweden, and Denmark. The sample consisted of 1,165 centenarians who were at least 100 years old in 2011. The outcome variable was falls in the past 6 months. Demographics, chronic conditions, pain, visual impairment, global cognitive function, dizziness and syncope, number of medications, functional limitation (ie, dressing, bathing, toileting, transferring, incontinence, and feeding), mobility difficulty, poor strength, and assistive device usage were included in the analysis.

Results

The prevalence of falls within the last 6 months was 33.7%, ranging from 21.6% (Japan) to 40.9% (France). Being male, experiencing dizziness, syncope, incontinence, and using assistive devices indoors were associated with an increased risk of falls among centenarians. Significant cross-country differences in the relationships between some risk factors (ie, gender, difficulty with bathing, toileting, transferring, and feeding, and using assistive devices for walking indoors and outdoors) and falls were observed. Subsample analysis using data from each country also showed that factors related to falls were different.

Conclusions

The prevalence of falls among centenarians is high and fall-related factors may be different than those for their younger counterparts. Given that centenarians is an emerging population, more studies investigating risk factors are needed to better understand falls among centenarians.

Neuropsychological Test Norms in Cognitively Intact Oldest-Old

OBJECTIVES

Individuals aged 90 or older (oldest-old), the fastest growing segment of the population, are at increased risk of developing cognitive impairment compared with younger old. Neuropsychological evaluation of the oldest-old is important yet challenging in part because of the scarcity of test norms for this group. We provide neuropsychological test norms for cognitively intact oldest-old.

METHODS

Test norms were derived from 403 cognitively intact participants of The 90+ Study, an ongoing study of aging and dementia in the oldest-old. Cognitive status of intact oldest-old was determined at baseline using cross-sectional approach. Individuals with cognitive impairment no dementia or dementia (according to DSM-IV criteria) were excluded. Participants ranged in age from 90 to 102 years (mean=94). The neuropsychological battery included 11 tests (Mini-Mental Status Examination, Modified Mini-Mental State Examination, Boston Naming Test - Short Form, Letter Fluency Test, Animal Fluency Test, California Verbal Learning Test-II Short Form, Trail Making Tests A/B/C, Digit Span Forward and Backwards Test, Clock Drawing Test, CERAD Construction Subtests), and the Geriatric Depression Scale.

RESULTS

Data show significantly lower scores with increasing age on most tests. Education level, sex, and symptoms of depression were associated with performance on several tests after accounting for age.

CONCLUSIONS

Provided test norms will help to distinguish cognitively intact oldest-old from those with cognitive impairment. (JINS, 2019, 25, 530-545).

General intelligence was associated with academic achievement but not fitness in adolescents after one year

AIM

This study investigated whether general intelligence could predict physical fitness and academic achievements one year later.

METHODS

We recruited 129 Spanish adolescents (57.4% boys) with a mean age of 13.6 ± 0.7 years old from a convenience sample of a single public-funded school. The first step was to assess general intelligence during the 2015-2016 school year using the D48 nonverbal test. A year later, we collected data on fitness and academic achievements. Cardiorespiratory fitness was measured with the 20-m endurance shuttle run test, muscular strength with the standing long jump and flexibility with the sit and reach test. Academic achievement was measured using school grades. The findings were assessed using three models with different variables.

RESULTS

One year later, general intelligence at baseline was marginally significantly associated with flexibility (p = 0.079) and mathematics (p = 0.084) in the first model, with mathematics (p = 0.029) and geography and history (p = 0.016) in the second model and with geography and history (p = 0.022) in the third model. All the analyses were controlled by age, sex, fitness and academic achievement.

CONCLUSION

General intelligence may not predict fitness, but it may predict academic achievements in adolescents one year later. Further studies are needed to examine our findings.

Neuropsychological Test Performance of Cognitively Healthy Centenarians: Normative Data From the Dutch 100-Plus Study

OBJECTIVES

The fraction of the population that reaches the age of 100 years is growing. At this age, dementia incidence is high and cognitive functioning is highly variable across individuals. Normative data for neuropsychological tests are lacking in centenarians, which hampers the ability to evaluate their cognitive functioning for both research and clinical practice. Here, we generated norms for neuropsychological tests in a sample of cognitively healthy centenarians while taking sensory impairments into account.

DESIGN

Cross-sectional cohort study.

SETTING

Centenarians who participate in the prospective 100-plus Study.

PARTICIPANTS

A total of 235 centenarians (71.5% female), who self-reported to be cognitively healthy, which was confirmed by an informant and a trained researcher.

MEASUREMENTS

We generated normative data for 15 cognitive tests, measuring global cognition (Mini-Mental State Examination [MMSE]), premorbid intelligence, attention, language, memory, executive function, and visuospatial function by multiple linear regressions and/or by reporting percentiles.

RESULTS

Normative data for global cognition resulted in a mean MMSE score of 25.6 ± 3.1 (range = 17-30; interquartile range = 24-28). Vision problems and fatigue often complicated the ability to complete tests, and these problems explained 41% and 22% of the missing test scores, respectively. In contrast, hearing problems (4%) and task incomprehension (6%) rarely complicated test performance. While educational level was associated with performance on the majority of the tests, sex and age were only weakly associated with test performance.

CONCLUSIONS

We generated normative data for 15 common neuropsychological tests in a large sample of cognitively healthy centenarians, while taking age-related sensory impairments into consideration. These normative data allow the detection of deficits across a wide range of cognitive domains. Our results suggest that, next to education level, vision ability and the level of fatigue should be taken into account when evaluating cognitive functioning in centenarians. J Am Geriatr Soc 67:759-767, 2019.

Health and Disease at Age 100

BACKGROUND

Centenarian studies from around the world have shown that reaching age 100 typically involves substantial health issues. The present study adds to the existing knowledge from other countries by describing health conditions in German centenarians.

METHODS

A total of 112 centenarians or their primary contacts provided information on acute and chronic health conditions and pain in the context of the Second Heidelberg Centenarian Study (mean age = 100.45 years, standard deviation [SD] = 0.47, 89% females).

RESULTS

Participants showed high comorbidity, with an average of five illnesses (mean = 5.3; SD = 2.20). Health conditions with highest prevalence were sensory (vision, hearing; 94%), mobility (72%) and musculoskeletal conditions (60%). Cardiovascular conditions (57%) and urinary system ailments (55%) were also common. Pain was experienced often by 30% of the participants. Of those reporting any pain, 36% indicated pain exceeding bearable levels.

CONCLUSION

German centenarians experienced a substantial number of ill nesses, dominated by sensory and mobility conditions. Cardiovascular diseases were the only potentially lethal illnesses with high prevalence. Evidence of unaddressed pain seems alarming, requiring future research. Emerging health profiles indicate that even in very advanced age, quality of life may be improved by enhanced diagnostics and optimal disease management. Mobility limitations may be addressed with preventive efforts.

Factors Associated with Activities of Daily Life Disability among Centenarians in Rural Chongqing, China: A Cross-Sectional Study

Objective: This study aims to ascertain the health and lifestyle factors associated with the activities of daily living (ADL) disability of centenarians in rural Chongqing, China. Method: 564 centenarians living in rural Chongqing were selected for this cross-sectional study. Demographic characteristics and self-reported lifestyle factors were obtained from face-to-face interviews. ADL disability was measured using the Katz Activities of Daily Living Scale. Result: Among the respondents, 65.7% were considered ADL disability centenarians. Multivariable logistic regression analysis showed that preference for salt, drinking habits, social activities, physical activity, and failure to follow good diet habits were significantly associated with the ADL disability of centenarians. Conclusion: ADL disability of centenarians was associated with certain lifestyle habits. This outcome suggested that target intervention may help maintain ADL independence even among the oldest of the elderly population.

Normative Data for the Cognitively Intact Oldest-Old: The Framingham Heart Study

BACKGROUND/STUDY CONTEXT: The number of individuals who reach extreme age is quickly increasing. Much of the current literature focuses on impaired cognition in extreme age, and debate continues regarding what constitutes "normal" cognition in extreme age. This study aimed to provide oldest-old normative data and to compare cognitive performances of cognitively intact elderly individuals from the Framingham Heart Study.

METHODS

A total of 1302 individuals aged 65+ years from the Framingham Heart Study were separated into 5-year age bands and compared on cognitive tests. Multivariate linear regression analyses were conducted, adjusting for gender, the Wide Range Achievement Test-Third Edition (WRAT-III) Reading score, and cohort. Analyses also included comparisons between 418 individuals aged 80+ and 884 individuals aged 65-79, and comparisons within oldest-old age bands.

RESULTS

Normative data for all participants are presented. Significant differences were found on most tests between age groups in the overall analysis between young-old and oldest-old, and analysis of oldest-old age bands also revealed select significant differences (all ps <.05).

CONCLUSION

As aging increases, significant cognitive differences and increased variability in performances are evident. These results support the use of age-appropriate normative data for oldest-old individuals.

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.

Mildly elevated blood pressure is a marker for better health status in Polish centenarians

The number of centenarians is projected to rise rapidly. However, knowledge of evidence-based health care in this group is still poor. Hypertension is the most common condition that leads to multiple organ complications, disability, and premature death. No guidelines for the management of high blood pressure (BP) in centenarians are available. We have performed a cross-sectional study to characterize clinical and functional state of Polish centenarians, with a special focus on BP. The study comprised 86 consecutive 100.9 ± 1.2 years old (mean ± SD) subjects (70 women and 16 men). The assessment included structured interview, physical examination, geriatric functional assessment, resting electrocardiography, and blood and urine sampling. The subjects were followed-up on the phone. Subjects who survived 180 days (83 %) as compared to non-survivors had higher systolic BP (SBP), diastolic BP (DPB), mean arterial pressure (MAP), pulse pressure (PP), higher mini-mental state examination, Barthel Index of Activities of Daily Living and Lawton Instrumental Activities of Daily Living Scale scores, higher serum albumin and calcium levels, and total iron-binding capacity, while lower serum creatinine, cystatin C, folate, and C-reactive protein levels. SBP ≥140 mm Hg, DBP ≥90 mm Hg, MAP ≥100 mm Hg, and PP ≥40 mm Hg were associated with higher 180-day survival probability. Results suggest that mildly elevated blood pressure is a marker for better health status in Polish centenarians.

Becoming centenarians: disease and functioning trajectories of older US Adults as they survive to 100

BACKGROUND

Little is known about the health and functioning of individuals who become centenarians in the years prior to reaching age 100. We examined long-term trajectories of disease, disability, and cognitive function in a sample of U.S. centenarians to determine how their aging experience differs from their nonsurviving cohort counterparts, and if there is heterogeneity in the aging experience of centenarians.

METHODS

Data are from the 1993-2010 waves of the nationally representative Health and Retirement Study. Among those who had the potential to become centenarians, we identified 1,045 respondents who died before reaching age 100 and 96 who survived to their 100th birthday. Respondents, or their proxies, reported on diagnosis of six major diseases (hypertension, heart disease, lung disease, stroke, cancer, and diabetes), limitations in activities of daily living, and cognitive function.

RESULTS

As they age to 100, centenarians are generally healthier than nonsurviving members of their cohort, and a number of individuals who become centenarians reach 100 with no self-reported diseases or functional impairments. About 23% of centenarians reached age 100 with no major chronic disease and approximately the same number had no disability (18%). Over half (55%) reached 100 without cognitive impairment. Disease and functioning trajectories of centenarians differ by sex, education, and marital status.

CONCLUSIONS

While some centenarians have poor health and functioning upon reaching age 100, others are able to achieve exceptional longevity in relatively good health and without loss of functioning. This study underscores the importance of examining variation in the growing centenarian population.

Profiles of cognitive functioning in a population-based sample of centenarians using factor mixture analysis

BACKGROUND/STUDY CONTEXT: The goal of the study was to identify and characterize latent profiles (clusters) of cognitive functioning in centenarians and the psychometric properties of cognitive measures within them.

METHODS

Data were collected from cross-sectional, population-based sample of 244 centenarians (aged 98 to 108, 15.8% men, 20.5% African American, 38.0% community-dwelling) from 44 counties in northern Georgia participating in the Georgia Centenarian Study (2001-2008). Measures included the Mini-Mental State Examination (MMSE), Severe Impairment Battery (SIB), Wechsler Adult Intelligence Scale-III Similarities subtest (WAIS), Hand Tapping, Behavioral Dyscontrol Scale (BDS), Controlled Oral Word Association Test (COWAT), and Fuld Object Memory Evaluation (FOME). The Global Deterioration Rating Scale (GDRS) was used to independently evaluate criterion-related validity for distinguishing cognitively normal and impaired groups. Relevant covariates included directly assessed functional status for basic and instrumental activities of daily living (DAFS), race, gender, educational attainment, Geriatric Depression Scale Short Form (GDS), and vision and hearing problems.

RESULTS

Results suggest two distinct classes of cognitive performance in this centenarian sample. Approximately one third of the centenarians show a pattern of markedly lower cognitive performance on most measures. Group membership is independently well predicted (area under the curve [AUC] = .83) by GDRS scores (sensitivity 67.7%, specificity 82.4%). Membership in the lower cognitive performance group was more likely for individuals who were older, African Americans, had more depressive symptoms, lower plasma folate, carriers of the apolipoprotein E (APOE) ε4 allele, facility residents, and individuals who died in the 2 years following interview.

CONCLUSIONS

In a population expected to have high prevalence of dementia, latent subtypes can be distinguished via factor mixture analysis that provide normative values for cognitive functioning. The present study allows estimates for normative cognitive performance in this age group.

Sources of variation on the mini-mental state examination in a population-based sample of centenarians

Centenarians represent a rare but rapidly growing segment of the oldest-old. This study presents item-level data from the Mini-Mental State Examination (MMSE) in a cross-sectional, population-based sample of 244 centenarians and near-centenarians (aged 98-108, 16% men, 21% African-American, 38% community dwelling) from the Georgia Centenarian Study (2001-2008) according to age, education, sex, race, and residential status. Multiple-Indicator Multiple-Cause (MIMIC) models were used to identify systematic domain-level differences in MMSE scores according to demographic characteristics in this age group. Indirect effects of age, educational attainment, race, and residential status were found on MMSE scores. Direct effects were limited to concentration for education and race and orientation for residential status. Mean levels of cognitive functioning in centenarians were low, with mean values below most commonly-used cutoffs. Overall scores on the MMSE differed as a function of age, education, race, and residential status, with differences in scale performance limited primarily to concentration and orientation and no evidence of interactions between centenarian characteristics. Adjusting for education was not sufficient to account for differences according to race, and adjusting for residential status was not sufficient to account for differences according to age.

Challenges of diagnosing dementia in the oldest old population

People aged 90 and older are the fastest growing age group in most parts of the world. Since the prevalence of dementia has been shown to increase exponentially after the age of 65, there is an acceptance that the oldest old population has a high burden of dementia; however, there is a lack of consensus on how best to diagnose dementia in this population. This review summarizes the various approaches to diagnosing dementia and the prevalence and incidence rates of dementia that have been reported. We also summarize the literature on cognitive and functional performance and biomarkers for dementia and discuss the limitations to interpretation of these data. Finally, we make recommendations for both researchers and clinicians who intend to diagnose dementia in the oldest old population.

Factors associated with ADL and IADL dependency among Korean centenarians: reaching the 100-year-old life transition

This study aims to examine the functional status of Korean centenarians, who have crossed the relatively rare but increasingly common life transition of living for a century. As functional health is one of the essential components of healthy aging, our primary objective is to identify the correlates of two aspects of functioning, activities of daily living (ADL) and instrumental activities of daily living (IADL). Using a census survey conducted by the Korean National Statistical Office (KNSO) in 2005, we documented ADL and IADL limitations and analyzed their relationship to sociodemographic factors, health behaviors, social connectedness, and presence of diseases. The study participants were 796 adults aged 100 years or older. The mean age was 101.5 +/- 1.8, and females were 89.9% of the sample. Both ADL and IADL dependences were more common among females, those who did less physical activity, those who had more diseases, and those who did not participate in social activities. Intervention programs designed to address life-stage issues such as focusing on initiating healthy behaviors from youth, managing chronic diseases in mid-life, and fostering social participation in later life are recommended ways to improve functional independence and promote healthy aging among current and future generations of Korean centenarians.

The role of exercise capacity in the health and longevity of centenarians

Ageing is a continuum of biological processes characterized by progressive adaptations which can be influenced by both genetic and physiological factors. In terms of human maturation, physically and cognitively functional centenarians certainly represent an impressive example of successful healthy ageing. However, even in these unique individuals, with the passage of time, declining lung function and sarcopenia lead to a progressive fall in maximal strength, maximal oxygen uptake, and therefore reduced exercise capacity. The subsequent mobility limitation can initiate a viscous downward spiral of reduced physical function and health. Emerging literature has shed some light on this multi-factorial decline in function associated with aging and the positive role that exercise and physical capacity can play in the elderly. Recognizing the multiple factors that influence ageing, the aim of this review is to highlight the recently elucidated limitations to physical function of the extremely old and therefore evaluate the role of exercise capacity in the health and longevity of centenarians.

Diabetes mellitus in centenarians

OBJECTIVES

To describe the prevalence of diabetes mellitus (DM) in centenarians.

DESIGN

Cross-sectional, population-based.

SETTING

Forty-four counties in northern Georgia.

PARTICIPANTS

Two hundred forty-four centenarians (aged 98-108, 15.8% male, 20.5% African American, 38.0% community dwelling) from the Georgia Centenarian Study (2001-2009).

MEASUREMENTS

Nonfasting blood samples assessed glycosylated hemoglobin (HbA(1c)) and relevant clinical parameters. Demographic, diagnosis, and DM complication covariates were assessed.

RESULTS

12.5% of centenarians were known to have DM. DM was more prevalent in African Americans (27.7%) than whites (8.6%, P < .001). There were no differences between men (16.7%) and women (11.7%, P = .41) or between centenarians living in the community (10.2%) and in facilities (13.9%, P = .54). DM was more prevalent in overweight and obese (23.1%) than nonoverweight (7.1%, P = .002) centenarians. Anemia (78.6% vs 48.3%, P = .004) and hypertension (79.3% vs 58.6%, P = .04) were more prevalent in centenarians with DM than in those without, and centenarians with DM took more nonhypoglycemic medications (8.6 vs 7.0, P = .02). No centenarians with HbA(1c) of less than 6.5% had random serum glucose levels greater than 200 mg/dL. DM was not associated with 12-month all-cause mortality, visual impairment, amputations, cardiovascular disease, or neuropathy. Thirty-seven percent of centenarians reported onset before age 80 (survivors), 47% between age 80 and 97 (delayers), and 15% aged 98 and older (escapers).

CONCLUSION

Diabetes mellitus is a risk factor for cardiovascular disease and mortality but is seen in persons who live into very old age. Aside from higher rates of anemia and use of more medications, few clinical correlates of DM were observed in centenarians.

Social characteristics and health status of exceptionally long-lived Americans in the Health and Retirement Study

OBJECTIVES

To characterize the social characteristics and physical, functional, mental, and cognitive health of exceptional survivors in the United States and how the experience of exceptional longevity differs according to social status.

DESIGN

Nationally representative longitudinal study of older Americans.

SETTING

United States.

PARTICIPANTS

One thousand six hundred forty-nine men and women born from 1900 to 1911 from the Health and Retirement Study: 1,424 nonsurvivors who died before reaching the age of 97 and 225 exceptional survivors who survived to age 97 and older.

MEASUREMENTS

Self-reported data on sociodemographic characteristics, social environment, physical and mental health, and physical and cognitive function.

RESULTS

At baseline, exceptional survivors were more likely to live independently and had fewer diseases, better mental health, and better physical and cognitive function than those who did not survive to age 97. Exceptional survivors experienced declines from baseline in all health domains upon reaching 97 years of age, but between one-fifth and one-third of exceptional survivors remained disease free, with no functional limitations or depressive symptoms, and one-fifth retained high cognitive function. Of exceptional survivors, men were healthier than women, and whites were generally healthier than nonwhites. Highly educated exceptional survivors had better cognitive function than their less-educated counterparts.

CONCLUSION

On average, exceptional survivors are relatively healthy and high functioning for most of their lives and experience health declines only upon reaching maximum longevity. Heterogeneity in the population of exceptionally old adults indicates that, although many individuals reach maximum longevity in a state of poor health and functioning, a considerable portion of exceptional survivors remain healthy and high-functioning even in very old age.

Body mass index is associated with dietary patterns and health conditions in georgia centenarians

Associations between body mass index (BMI) and dietary patterns and health conditions were explored in a population-based multiethnic sample of centenarians from northern Georgia. BMI ≤20 and ≥25 was prevalent in 30.9% and 25.3% of study participants, respectively. In a series of logistic regression analyses controlled for gender and place of residence, the probability of having BMI ≥25 was increased by being black versus white and having a low citrus fruit, noncitrus fruit, orange/yellow vegetable or total fruit and vegetable intake. The probability of having BMI ≤20 was not associated with dietary intake. When controlled for race, gender, residence, and total fruit and vegetable intake, BMI ≥25 was an independent risk factor for diabetes or having a systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, whereas BMI ≤20 was a risk factor for anemia. Given the many potential adverse consequences of under- and overweight, efforts are needed to maintain a healthy weight, even in the oldest old.

Nutrition in centenarians

The oldest old are among the fastest growing segment of the population and it is important to understand not only the influence of modifiable lifestyle factors such as diet and nutrition on the achievement of exceptional longevity but also the role, if any, of these factors on maintaining optimal cognitive, mental and physical health into advanced age. This review summarizes studies of dietary intake and patterns of long-lived peoples and presents current knowledge of nutritional status of centenarians as determined with nutritionally relevant biomarkers, providing information on comparative levels of the various biomarkers between centenarians and older adult controls and on the prevalence and predictors of nutritional deficiencies in centenarians. The studies indicate that BMI and nutritional status as indicated by circulating levels of antioxidant vitamins, vitamin B12, folate, homocysteine and 25(OH) vitamin D of centenarians are quite heterogeneous and influenced by region of residency and many of the demographic, dietary and lifestyle factors that influence nutritional status in other older adults. While many of the studies have been small, convenience samples of relatively healthy community-dwelling centenarians, a few have population-based or included participants of varying cognitive functioning. These and future studies examining associations between nutritional status and cognitive, mental and physical function should be instrumental in determining the role of nutrition in promoting longevity and improving the quality of life in these exceptional survivors.

Assessing physical performance in centenarians: norms and an extended scale from the georgia centenarian study

Centenarians display a broad variation in physical abilities, from independence to bed-bound immobility. This range of abilities makes it difficult to evaluate functioning using a single instrument. Using data from a population-based sample of 244 centenarians (M_Age = 100.57 years, 84.8% women, 62.7% institutionalized, and 21.3% African American) and 80 octogenarians (M_Age = 84.32 years, 66.3% women, 16.3% institutionalized, and 17.5% African American) we (1) provide norms on the Short Physical Performance Battery and (2) extend the range of this scale using performance on additional tasks and item response theory (IRT) models, reporting information on concurrent and predictive validity of this approach. Using the original SPPB scoring criteria, 73.0% of centenarian men and 86.0% of centenarian women are identified as severely impaired by the scale's original classification scheme. Results suggest that conventional norms for older adults need substantial revision for centenarian populations and that item response theory methods can be helpful to address floor and ceiling effects found with any single measure.