Understanding centenarians' psychosocial dynamics and their contributions to health and quality of life

Healthy aging among centenarians and near-centenarians: Findings from the Georgia Centenarian Study

The Georgia Centenarian Study is one of the earliest comprehensive studies on centenarians. Based on the Georgia model of adaptation, the primary purpose of this study was to assess the health and well-being of our oldest population, with a focus on several primary adaptation areas: genetics and family longevity, environmental support, individual characteristics, cognitive and behavioral skills, health behaviors, and physical and mental health, including overall life satisfaction. The results of the three Georgia Centenarian sub-studies indicate that genetic and environmental variables play an important role in determining different levels of healthy aging, but they also highlight relevant mediating and moderating effects in a network of interrelating adaptation components.

The role of quality of life data as an endpoint for collecting real-world evidence within geroscience clinical trials

With geroscience research evolving at a fast pace, the need arises for human randomized controlled trials to assess the efficacy of geroprotective interventions to prevent age-related adverse outcomes, disease, and mortality in normative aging cohorts. However, to confirm efficacy requires a long-term and costly approach as time to the event of morbidity and mortality can be decades. While this could be circumvented using sensitive biomarkers of aging, current molecular, physiological, and digital endpoints require further validation. In this review, we discuss how collecting real-world evidence (RWE) by obtaining health data that is amenable for collection from large heterogeneous populations in a real-world setting can help speed up validation of geroprotective interventions. Further, we propose inclusion of quality of life (QoL) data as a biomarker of aging and candidate endpoint for geroscience clinical trials to aid in distinguishing healthy from unhealthy aging. We highlight how QoL assays can aid in accelerating data collection in studies gathering RWE on the geroprotective effects of repurposed drugs to support utilization within healthy longevity medicine. Finally, we summarize key metrics to consider when implementing QoL assays in studies, and present the short-form 36 (SF-36) as the most well-suited candidate endpoint.

The relationship between depressive mood and subjective health in centenarians and near-centenarians: a cross-sectional study from Korean centenarian cohort

BACKGROUND

With the rapid increase in population longevity, more clinical attention is being paid to the overall health of long-lived people, especially centenarians. Subjective health, which is the perception of one's health status, predicts both mortality and declining physical function in older adults. The purpose of this study was to investigate the factors related to subjective health among centenarians and near-centenarians (ages ≥95) living in a rural area of South Korea.

METHODS

A total of 101 participants were enrolled from four different regions (Gurye, Gokseong, Sunchang, and Damyang), known as the Longevity Belt in Korea. Variables assessing physical and mental health, including the results of blood tests, were examined. Factors associated with good subjective health were identified with logistic regression analysis.

RESULTS

Fifty-six participants (59.6%) were subjectively healthy among the centenarians and near-centenarians. Logistic regression analysis revealed that depressive mood was the only factor associated with subjective health and was negatively correlated. The regression model explained 39% of the variance in subjective health.

CONCLUSIONS

These findings emphasize the importance of mental health at very advanced ages. Because depressive mood negatively correlates with subjective health, more attention is needed to prevent and manage mood symptoms of people of advanced ages, including centenarians.

Visual word recognition among oldest old people: The effect of age and cognitive load

During the fourth age, a marked physiological deterioration and critical points of dysfunction are observed, during which cognitive performance exhibits a marked decline in certain skills (fluid intelligence) but good performance of others (crystallized intelligence). Experimental evidence describes important constraints on word production during old age, accompanied by a relative stabilization of speech comprehension. However, cognitive changes associated with advanced aging could also affect comprehension, particularly word recognition. The present study examines how the visual recognition of words is affected during the fourth age when tasks involving different cognitive loads are applied. Through linear regression models, performance was compared between two third-age groups and a fourth-age group on reaction time (RT) and accuracy in naming, priming and lexical decision experiments. The fourth-age group showed a significant RT increase in all experiments. In contrast, accuracy was good when the task involved a low cognitive demand (Experiments 1 and 2); however, when a decisional cognitive factor was included (Experiment 3), the fourth-age group performed significantly worse than the younger third-age group. We argue that the behavior observed among fourth-age individuals is consistent with an unbalanced cognitive configuration, in which the fluid intelligence deficit significantly reduces the speed necessary to recognize words, independent of the cognitive load associated with the test. In contrast, the maintenance in crystallized intelligence improves the accuracy of the process, strengthening linguistic functionality in the advanced stages of old age.

Metabolic Rewiring by Human Placenta-Derived Mesenchymal Stem Cell Therapy Promotes Rejuvenation in Aged Female Rats

Aging is a degenerative process involving cell function deterioration, leading to altered metabolic pathways, increased metabolite diversity, and dysregulated metabolism. Previously, we reported that human placenta-derived mesenchymal stem cells (hPD-MSCs) have therapeutic effects on ovarian aging. This study aimed to identify hPD-MSC therapy-induced responses at the metabolite and protein levels and serum biomarker(s) of aging and/or rejuvenation. We observed weight loss after hPD-MSC therapy. Importantly, insulin-like growth factor-I (IGF-I), known prolongs healthy life spans, were markedly elevated in serum. Capillary electrophoresis-time-of-flight mass spectrometry (CE-TOF/MS) analysis identified 176 metabolites, among which the levels of 3-hydroxybutyric acid, glycocholic acid, and taurine, which are associated with health and longevity, were enhanced after hPD-MSC stimulation. Furthermore, after hPD-MSC therapy, the levels of vitamin B6 and its metabolite pyridoxal 5′-phosphate were markedly increased in the serum and liver, respectively. Interestingly, hPD-MSC therapy promoted serotonin production due to increased vitamin B6 metabolism rates. Increased liver serotonin levels after multiple-injection therapy altered the expression of mRNAs and proteins associated with hepatocyte proliferation and mitochondrial biogenesis. Changes in metabolites in circulation after hPD-MSC therapy can be used to identify biomarker(s) of aging and/or rejuvenation. In addition, serotonin is a valuable therapeutic target for reversing aging-associated liver degeneration.

Considering the Relevance of Childhood Religious Experiences Through Centenarian Oral Histories

The current study explored a sub-sample of 57 narrative focused on childhood religious experiences from the Oklahoma Oral History Project. Analyses identified three primary themes connected to childhood religiosity, including transmission, accessibility, and socializing. First, transmission of religiosity during childhood dependent upon a parent or grandparent. A second theme involved accessibility, which highlighted various advantages and disadvantages regarding child and family ability to attend religious services. Such opportunities and barriers were centered upon three subthemes involving rurality, transportation, and infrastructure. Finally, socializing represented a third theme. In particular, church attendance during childhood created unique opportunities for early-life socializing with family, friends, and neighbors. As a whole, key themes indicate that religiosity during childhood may be vital to the early formation of social opportunities and connections that may support positive and adaptive developmental processes in human longevity. Findings have implications relative to advancing conceptual understanding of the impact of childhood religious experience on developmental outcomes among long-lived adults.

Validation of a Self-Perceived Adaptive Behaviors Scale in Older Chilean Women and Percentiles for Evaluation

Healthy ageing means optimizing opportunities that allow older individuals to participate actively in society without discrimination. Learning adaptive behaviors (AB) may be extremely important for individuals for all stages of life. The goal of this study was: (a) to create a scale for self-perceived adaptive behavior, and (b) propose percentiles for evaluating AB in older adult women. A self-perception scale was created to measure adaptive behavior. Anthropometric and physical fitness variables for 192 older Chilean women (ages 60 to 88) were collected and evaluated. Content validity reflected agreement from 0.75 to 1.0. Construct validity carried out with exploratory factor analysis (EFA) resulted in 11 dimensions with 62 items in groups. Saturation oscillated between 0.62 and 0.85 with the explanation of variation as 46.27%. Cronbach’s Alpha was r = 0.83. The results indicated that the scale developed was valid and reliable for the Chilean women studied. This scale may be used to measure self-perception of AB patterns in older women. Furthermore, the percentiles allow for classification of the AB by age and anthropometric indices.

Third follow-up of the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) cohort investigating determinants of cognitive, physical, and psychosocial wellbeing among the oldest old: the CAIDE85+ study protocol

BACKGROUND

The oldest old is the fastest growing age group worldwide and the most prone to severe disability, especially in relation to loss of cognitive function. Improving our understanding of the predictors of cognitive, physical and psychosocial wellbeing among the oldest old can result in substantial benefits for the individuals and for the society as a whole. The Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study investigated risk factors and determinants of cognitive impairment in a population-based longitudinal cohort, which was first examined between 1972 and 1992, when individuals were in their midlife, and re-assessed in 1998 and 2005-2009. Most of the study participants are currently aged 85 years or older. We aim to re-examine the cohort's survivors and gain further insights on the mechanisms underlying both cognitive and overall healthy ageing at old age.

METHODS

CAIDE85+ is the third follow-up of the CAIDE study participants. All individuals still alive and living in the Kuopio and Joensuu areas of Eastern Finland, from the original CAIDE cohort (two random samples, N = 2000 + ~ 900), will be invited to a re-examination. The assessment includes self-reported data related to basic demographics and lifestyle, as well as psychosocial and physical health status. Cognitive and physical evaluations are also conducted. Blood biomarkers relevant for dementia and ageing are assessed. Primary outcomes are the measurements related to cognition and daily life functioning (CERAD, Trail Making Test-A, Letter-Digit Substitution Test, Clinical Dementia Rating and Activities of Daily Living). Secondary endpoints of the study are outcomes related to physical health status, psychosocial wellbeing, as well as age-related health indicators.

DISCUSSION

Through a follow-up of more than 40 years, CAIDE85+ will provide invaluable information on the risk and protective factors that contribute to cognitive and physical health, as well as ageing and longevity.

STUDY REGISTRATION

The present study protocol has been registered at https://clinicaltrials.gov/ (registration nr NCT03938727 , date 03.05.2019).

Identity, civic engagement, and altruism: a phenomenological exploration of activity engagement in older adults

BACKGROUND

Older adults' health and quality of life, proxies for aging well, are tied to activity engagement. Recent research indicates studying the perspective of older adults through their personal stories is key to understanding the phenomenon of occupational engagement as experienced day-to-day.

AIM

To uncover the lived experience of older adults within their natural settings to better understand the phenomenon of activity engagement. This new knowledge informs programming options suited to older adults' wants and needs.

MATERIALS/METHODS

Ten community-dwelling older adults (5 female, 5 male mean 79 years) were studied. Researchers performed phenomenological interpretive analysis (IPA) with multiple coders and member cheques to triangulate findings.

RESULTS

Daily activities revolved around three themes: 1) Perspectives of self-identity are viewed as consistent throughout the lifespan; 2) Civic engagement is beneficial for social support and self-efficacy; and 3) Philosophical outlook influences activity choices and outlooks centred on altruism are critical to continued activity engagement. Seven of the ten participants expressed an overall positive outlook on aging. Three participants described a negative outlook on aging, expressed more difficulty with activity engagement, but reported desire to help others.

CONCLUSIONS AND SIGNIFICANCE

These themes provide a basis for programming to increase activity engagement with older adults in the community.

Mental Health Care Access Using Geographic Information Systems: An Integrative Review

A decade after the Mental Health Parity and Addiction Equity Act was implemented to ensure access to mental health and substance abuse services for U.S. citizens, accessing mental health care still is problematic for many needing services. More than 123 million Americans reside in federally-designated Mental Health Professional Shortage Areas (MHPSA) compared to 84 million living in similarly-designated primary care shortage areas and 62 million in dental health shortage areas. Health professional shortage areas are geographic areas that have a shortage of primary medical, dental, or mental health providers. Geographic Information Systems (GIS) with spatial analysis approaches provide tools to understand the ever-changing distribution of health care, outcomes, and delivery to improve care. The aim of this integrative review is to describe and synthesize the literature on GIS approaches to improve access to mental health care services. GIS Bibliography, PubMed, CINAHL, PsycINFO, Academic Search Premier, Social Sciences Citation Index, and Oalster were searched for articles between January 1, 1998 and January 1, 2018 that met established inclusion/exclusion criteria. Among the 138 articles reviewed, 18 met criteria and were included in the review. GIS approaches to improve access to mental health care can be categorized as (1) type of care (integrated, community), (2) contributions to access (distance, time, cost, perception of traveling, inequalities), and (3) the utilization of services. Results from the literature suggest closer examination of measures used to assess geographic variations in accessibility is needed for ultimately improving quality of care for people in MHPSA.

Inflammation in multimorbidity and disability: An integrative review

OBJECTIVE

Multimorbidity is a robust predictor of disability in aging adults, but the mechanisms by which multimorbidity is disabling are not clear. Most existing research focuses on disease-specific phenomena, such as diminished lung capacity in chronic obstructive pulmonary disease, which can result in functional limitations. This review takes a different approach by highlighting the potential role of a biological process-inflammation-that is common to many chronic medical conditions and thus, from a medical perspective, relatively disease nonspecific.

METHOD

Beginning with a description of inflammation and its measurement, this paper will provide an overview of research on inflammation as a predictor of disease risk in healthy adults and of adverse outcomes (e.g., disability) in those with multimorbidity.

RESULTS

The discussion of inflammation is then situated in the context of biopsychosocial influences on health, as inflammation has been shown to be sensitive to a wide range of social and psychological processes that are thought to contribute to healthy aging, including successful adaptation to multimorbidity and reduced risk of disability.

CONCLUSIONS

Finally, implications of this broader perspective for interventions to improve outcomes in aging adults with multimorbidity are briefly considered. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A comparison of perceived uselessness between centenarians and non-centenarians in China

BACKGROUND

Self-perceived uselessness is associated with poorer health in older adults. However, it is unclear whether there is a difference in self-perceived uselessness between centenarians and non-centenarians, and if so, which factors contributed to the difference.

METHODS

We used four waves of a nationwide longitudinal dataset from 2005 to 2014 in China to investigate these research goals. We first performed multinomial logit regression models to examine the risk of the high or moderate frequency of self-perceived uselessness relative to the low frequency among centenarians (5778 persons) in comparison with non-centenarians aged 65-99 (20,846 persons). We then conducted a cohort analysis for those born in 1906-1913, examining differences in self-perceived uselessness between those centenarians and those died between ages 91 and 99 during 2005-2014.

RESULTS

Compared to persons aged 65-79, centenarians had 84% (relative risk ratio (RRR) = 1.84, 95% CI:1.69-2.01) and 35% (RRR = 1.35, 95% CI: 1.25-1.46) higher risk to have the high frequency and the moderate frequency of feeling useless versus low frequency, respectively, when only demographic factors were controlled for. However, centenarians had 31% (RRR = 0.69, 95% CI: 0.54-0.88), 43% (RRR = 0.57, 95% CI: 0.49-0.68), and 25% (RRR = 0.75, 95% CI: 0.67-0.83) lower risk, respectively, to have the high frequency of self-perceived uselessness relative to the low frequency when a wide set of study covariates were controlled for. In the case of the moderate versus the low frequency of self-perceived uselessness, the corresponding figures were 18% (RRR = 0.82, 95% CI: 0.66-1.02), 22% (RRR = 0.78, 95%CI: 0.67-0.90), and 13% (RRR = 0.87, 95% CI: 0.79-0.96), respectively. The cohort analysis further indicates that those who became centenarians were 36-39% less likely than those died at ages 91-94 to report the high and the moderate frequencies of self-perceived uselessness versus the low frequency; no difference was found between centenarians and those died at ages 95-99. In both period and cohort analyses, behavioral and health-related factors affected the perception substantially.

CONCLUSIONS

Overall, centenarians were less likely to perceive themselves as useless compared to non-centenarians of younger birth cohorts when a wide set of covariates were considered and non-centenarians of the same birth cohort. How centenarians manage to do so remains an open question. Our findings may help improve our understanding about the longevity secrets of centenarians.

Reaching 100 in the Countryside: Health Profile and Living Circumstances of Portuguese Centenarians from the Beira Interior Region

The interest in studying a specific population of centenarians who lives in the country's interior region (PT100-BI) emerged during the first Portuguese systematic study about centenarians (PT100 Oporto Centenarian Study). This region of Portugal is predominantly rural and is one of the regions with the largest number of aged people. The aim of this study is to provide information on the centenarians who live in the Beira Interior region, specifically in terms of their health status and the health services they use. A total of 101 centenarians (mean age: 101.1 years; SD = 1.5 years), 14 males and 87 females, were considered. Most centenarians lived in the community, and 47.6% lived in nursing homes. Nearly half (47.5%) presented cognitive functioning without deficits. A noteworthy percentage presented conditioned mobility and sensory problems. The most common self-reported diseases include urinary incontinence (31.7%), high blood pressure (23.8%), and heart conditions (19.8%). Despite these health and functional characteristics, formal support services and technical assistance were found to be scarcely used. Further research is needed to understand how the role of contextual variables and the countryside environment contribute to the centenarians' adaptation to advanced longevity.

Objective vs. Subjective Health in Very Advanced Ages: Looking for Discordance in Centenarians

Background: Living beyond 100 years of age is associated with several functional and health constraints but their impact depends on one's perception of the situation. Associations between self-rated health (SRH) with sociodemographic and psychosocial variables have been explored in several studies, revealing that one's health appraisal depends of factors beyond the objective health condition. There is a large body of literature concerning SRH in later life but lack of evidence about centenarians' perception of health and its associated factors, which could increase the available knowledge on the strengths and resources individuals in very advanced ages have for facing daily life limitations. Objective and Methods: This study aims to analyse the relationship between subjective and objective health status in a sample of centenarians (n = 127). Subjective health was assessed by a single-item health measure, and objective health by considering the number of reported diseases and a functional capacity scale (BADL and IADL). Main health characteristics are described as well as examined the association between objective and subjective health. Results: 46.5% of the sample has a good, very good, or excellent appraisal of their own health. SRH was associated (p < 0.05) with BADL and IADL scores and with the total number of diagnosis; when analyzing SRH according to the level of functional capacity, results revealed that most individuals with severe and moderate dependence have a reasonable to excellent SRH (p > 0.05). Conclusion: Having diseases and functional dependence at 100 years old may not mean to have a bad SRH. The high variability in SRH and the discordance between objective and subjective measures are a proof of centenarian's capacity of adaptation and the existence of individual resources, which may be decisive for one' perception and handling of health situation at such an advanced age.

Mixed-methods quantitative-qualitative study of 29 nonagenarians and centenarians in rural Southern Italy: focus on positive psychological traits

OBJECTIVE

This was a study of positive psychological traits in a group of rural Italians aged 90 to 101 years, and their children or other family members.

DESIGN

Mixed-methods quantitative (standardized rating scales) and qualitative (semi-structured interviews) study.

SETTING

Study participants' homes in nine villages in the Cilento region of southern Italy.

PARTICIPANTS

Twenty-nine nonagenarians and centenarians and 51 family members aged 51-75 years, selected by their general practitioners as a part of a larger study called CIAO (Cilento Initiative on Aging Outcomes).

METHODS

We used published rating scales of mental and physical well-being, resilience, optimism, anxiety, depression, and perceived stress. Qualitative interviews gathered personal narratives of the oldest-old individuals, including migrations, traumatic events, and beliefs. Family members described their impressions about the personality traits of their older relative.

RESULTS

Participants age ≥90 years had worse physical health but better mental well-being than their younger family members. Mental well-being correlated negatively with levels of depression and anxiety in both the groups. The main themes that emerged from qualitative interviews included positivity (resilience and optimism), working hard, and bond with family and religion, as described in previously published studies of the oldest old, but also a need for control and love of the land, which appeared to be unique features of this rural population.

CONCLUSIONS

Exceptional longevity was characterized by a balance between acceptance of and grit to overcome adversities along with a positive attitude and close ties to family, religion, and land, providing purpose in life.

Life at Age 100: An International Research Agenda for Centenarian Studies

Living a long life is desired by many individuals, and this dream is likely to become reality in more and more industrialized societies. During the past 3 decades, the number of very old individuals has increased significantly, creating a global demographic challenge with consequences at the individual, family, and societal levels. Yet, life in very old age is still poorly understood in terms of its unique characteristics and challenges. Besides specific content areas, very old age represents an understudied field of research. This lack of knowledge may be one reason that the very old also are an underserved population. This special issue introduces an international network of three centenarian studies that describe and compare the life circumstances and characteristics of centenarians across Germany, Portugal, and the United States. Our parallel studies comprehensively assess centenarians' physical, cognitive, social, and psychological functioning to create a knowledge base regarding their capacities and needs. A specific focus lies in the investigation of psychological aspects, social resources, and societal/cultural contexts, factors that may contribute to longevity and successful aging. Determining key characteristics of this very old population and investigating similarities and differences across countries is timely and urgent, both from an applied and a policy standpoint.

Whom Do Centenarians Rely on for Support? Findings From the Second Heidelberg Centenarian Study

This paper provides a detailed picture of the sources and types of informal support available to centenarians, depending on their housing and care arrangements. Participants were 112 centenarians and 96 primary contacts of centenarians enrolled in the population-based Second Heidelberg Centenarian Study. Findings indicate that children of centenarians were their primary source of support in daily life. Those without living children had overall less help. Most frequently reported was help with administrative tasks, regardless of centenarians' residence or living arrangement. All other types of help (e.g., with activities of daily living and housework) were reported by about one-third and were mostly provided by children; centenarians without children were more likely to have friends/neighbors involved in some of these tasks. The one category reported by a third of the centenarians regardless of residence, living arrangements, or presence of a child was help with socializing/companionship. Findings constitute an important step toward identifying and meeting the support needs of centenarians and their families. Policy implications are discussed.

Self-perceived uselessness and associated factors among older adults in China

Background

Self-perceived uselessness is associated with poor health and high mortality among older adults in China. However, it is unclear which demographic, psychosocial, behavioral and health factors are associated with self-perceived uselessness.

Methods

Data came from four waves (2005, 2008, 2011 and 2014) of the largest nationwide longitudinal survey of the population aged 65 and older in China (26,624 individuals contributed 48,476 observations). This study aimed to systematically investigate factors associated with self-perceived uselessness based on the proposed REHAB framework that includes resources (R), environments (E), health (H), fixed attributes (A) and behaviors (B). Self-perceived uselessness was measured by a single item: “with age, do you feel more useless?” and coded by frequency: high (always and often), moderate (sometimes) and low (seldom and never). Multinomial logistic regression models with low frequency as the reference category were employed to identify REHAB risk factors associated with self-perceived uselessness.

Results

Most factors in the REHAB framework were associated with self-perceived uselessness, although some social environmental factors in the full model were not significant. Specifically, more socioeconomic resources were associated with reduced relative risk ratio (RRR) of high or moderate frequency of self-perceived uselessness relative to low frequency. More environmental family/social support was associated with lower RRR of high frequency of self-perceived uselessness. Cultural factors such as coresidence with children and intergenerational transfer were associated with reduced RRR of high frequency of self-perceived uselessness. Indicators of poor health status such as disability and loneliness were associated with greater RRR of high or moderate frequency of self-perceived uselessness. Fixed attributes of older age and Han ethnicity were associated with increased RRR of high frequency of self-perceived uselessness; whereas optimism and self-control were associated with reduced RRR. Behaviors including regular consumption of alcohol, regular exercise, social participation and leisure activities were associated with reduced RRR of high frequency of self-perceived uselessness.

Conclusions

Self-perceived uselessness was associated with a wide range of factors in the REHAB framework. The findings could have important implications for China to develop and target community health programs to improve self-perceived usefulness among older adults.

Demographics, phenotypic health characteristics and genetic analysis of centenarians in China

After a brief introduction to the background, significance and unique features of the centenarian population in China, we describe the Chinese Longitudinal Healthy Longevity Study (CLHLS), which is the world's largest study of centenarians, nonagenarians, octogenarians, and compatible young-old aged 65-79. Based on the CLHLS data and other relevant studies, we summarize demographic and socioeconomic characteristics as well as self-reported and objectively-tested health indicators of centenarians in China, with an emphasis on gender differences and rural/urban disparities. We then compare five-year-age-specific trajectories of physical and cognitive functions, self-reported health, and life satisfactions from ages 65-69 to 100+, concluding that good psychological resilience and optimism are keys to the exceptional longevity enjoyed by centenarians. We discuss recent findings of novel loci and pathways that are significantly associated with longevity based on the genome-wide association study (GWAS) of the CLHLS centenarian sample, which is 2.7 times as large as prior GWAS of longevity. We also highlight colleagues' and our own studies on longevity candidate genes and gene-environment interaction analyses. Finally, we discuss limitations inherent in our studies of centenarians in China and further research perspectives.

Personality Traits and Successful Aging

The current study attempted to describe how personality traits of older adults are associated with components of successful aging (cognition, volunteering, activities of daily living, and subjective health). Three-hundred and six octogenarians and centenarians who participated in the third phase of the Georgia Centenarian Study provided data for this study. Factor analysis was conducted to test the existence of two higher-order factors of the Big Five personality traits, and a two-factor model (alpha and beta) fit the data well. Also, blocked multiple regression analysis was conducted to examine the association between personality traits and four components of successful aging. Results indicated that low scores on neuroticism and high scores on extraversion, openness to experience, agreeableness, and conscientiousness are significantly related to the components of successful aging. After controlling for demographic variables (age, gender, residential type, and race/ethnicity), alpha (i.e., emotional stability, agreeableness, and conscientiousness) was associated with higher levels of cognition, higher likelihood of engaging in volunteer work, higher levels of activities of daily living, and higher levels of subjective health. Beta (i.e., extraversion and openness to experience) was also positively associated with cognition and engaging in volunteer work.

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.

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.

The Fountain of Health: Bringing Seniors' Mental Health Promotion into Clinical Practice

Background

The Fountain of Health (FoH) initiative offers valuable evidence-based mental health knowledge and provides clinicians with evaluated tools for translating knowledge into practice, in order to reduce seniors’ risks of mental disorders, including dementia.

Methods

A presentation on mental health promotion and educational materials were disseminated to mental health clinicians including physicians and other allied health professionals either in-person or via tele-education through a provincial seniors’ mental health network. Measures included: 1) a tele-education quality evaluation form, 2) a knowledge transfer questionnaire, 3) a knowledge translation-to-practice evaluation tool, and 4) a quality assurance questionnaire.

Results

A total of 74 mental health clinicians received the FoH education session. There was a highly significant (p < .0001) difference in clinicians’ knowledge transfer questionnaire scores pre- and post-educational session. At a two-month follow-up, 19 (25.7%) participants completed a quality assurance questionnaire, with all 19 (100%) of respondents stating they would positively recommend the FoH information to colleagues and patients. Eleven (20.4%) translation-to-practice forms were also collected at this interval, tracking clinician use of the educational materials.

Conclusions

The use of a formalized network for knowledge transfer allows for education and evaluation of health-care practitioners in both acquisition of practical knowledge and subsequent clinical behavior change.

Frailty still matters to health and survival in centenarians: the case of China

Background

Frailty indicates accumulated vulnerability of adverse health outcomes in later life. Its robustness in predicting dependent living, falls, comorbidity, disability, health change, mortality, and health care utilization at older ages is well-documented. However, almost no studies have ever attempted to examine its robustness in centenarians, mainly due to data unavailability. This study examines prevalence of frailty in centenarians and its predictive powers on subsequent mortality and health conditions.

Methods

We use a sample of 4434 centenarians from the 2002, 2005, 2008, and 2011 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with elders in three younger age groups 65–79, 80–89, and 90–99 as comparisons. Frailty is measured by a cumulative deficit index (DI) that is constructed from 39 variables covering physical and cognitive function, disease conditions, psychological well-being, and other health dimensions. Survival analysis is conducted to examine how frailty is associated with subsequent mortality at an average follow-up length of 3.7 years (2.6 years for deceased persons died in 2002–2011 and 7.6 years for survived persons at the 2011 wave). Logistic regressions are applied to examine how frailty is associated with subsequent physical and cognitive functions, disease conditions, and self-rated health with an average follow-up length of 3.0 years.

Results

The study reveals that centenarians are frailer than younger elders. The DI scores increase from less than 0.1 at ages 65–79 to over 0.30 in centenarians. Women are frailer than men at all ages. However, there is a great variation in frailty among all age groups. We also find that each additional increase of 0.01 score of the DI is associated with 1.6 % higher mortality risk (95 % CI: 1.014–1.018) in female centenarians and 1.4 % higher mortality risk (95 % CI: 1.010–1.018) in male centenarians, although these associations are weaker than those in other three younger age groups.

Conclusions

Frailty still plays an important role in determining subsequent health outcomes and mortality in centenarians.

Visual impairment, but not hearing impairment, is independently associated with lower subjective well-being among individuals over 95 years of age: A population-based study

BACKGROUND

Sensory impairment affects an increasing number of elderly adults, with a negative psychological impact. Our objective was to examine the associations of visual and hearing impairment with subjective well-being (SWB), an important psychological concept defined by life satisfaction [LS], positive affect [PA], negative affect [NA], and affect balance [AB] among long-lived individuals (LLIs) over 95 years of age.

METHODS

Data on 442 LLIs from the Rugao longevity cohort, a population-based study in Rugao, China, were analyzed. Graded classifications of visual and hearing impairment (none, mild, moderate, and severe) were constructed from self-reported items. Bivariate correlation and multiple regression analysis were performed to test the associations.

RESULTS

Approximately 66.1% and 87.3% of the subjects reported varying degrees of visual and hearing impairment. Following the degree of vision impairment, LS, PA, and AB decreased linearly, whereas NA increased linearly (all p for trend<0.05). Vision was significantly related to LS (r=0.238, p<0.001), PA (r=0.142, p<0.01), NA (r=-0.157, p<0.001), and AB (r=0.206, p<0.001). After adjustment for multiple variables including functional ability, an important factor of SWB, the associations of vision impairment with LS, NA, and AB, while diminished, still existed.

CONCLUSIONS

Visual impairment, but not hearing impairment, was independently associated with low SWB among LLIs, and functional ability may play a mediating role in the observed relationship. The findings indicate that rehabilitation targeted for those with reduced vision and functioning in long-lived populations may be important for promoting well-being and quality of life.

Predicting Successful Aging at One Hundred Years of Age

Objective:

The present study is based upon a multidimensional model of successful aging. It aims to identify subgroups of centenarians sharing communalities in successful aging profiles, and determine the role of sociodemographic factors and psychological, social, and economic resources on successful aging.

Methods:

A total of 80 centenarians were face-to-face interviewed. A cluster analysis was performed to identify distinct groups of successful aging, and logistic regression models were performed considering the cluster membership as dependent covariate.

Results:

Two distinct clusters were grouped, with 40 centenarians in each, one of them presenting better results in all domains. Male sex and better income adequacy were the best predictors of successful aging.

Conclusion:

Results help to identity different patterns of successful aging and provide greater clarity regarding its correlates, increasing current understanding of its modifiable aspects.

The well-being of community-dwelling near-centenarians and centenarians in Hong Kong: a qualitative study

Background

Hong Kong has one of the highest life expectancy rankings in the world. The number of centenarians and near-centenarians has been increasing locally and internationally. The relative growth of this population is a topic of immense importance for population and health policy makers. Living long and living well are two overlapping but distinct research topics. We previously conducted a quantitative study on 153 near-centenarians and centenarians to explore a wide range of biopsychosocial correlates of health and “living long”. This paper reports a follow-up qualitative study examining the potential correlates of “living well” among near-centenarians and centenarians in Hong Kong.

Methods

Six cognitively, physically, and psychologically sound community-dwelling elders were purposively recruited from a previous quantitative study. Semi-structured interviews were conducted.

Results

Four major themes related to living long and well emerged from the responses of the participants: (a) Positive relations with others, (b) Positive events and happiness, (c) Hope for the future, and (d) Positive life attitude. Specifically, we found that having good interpersonal relationships, possessing a collection of positive life events, and maintaining salutary attitudes towards life are considered as important to psychological well-being by long-lived adults in Hong Kong. Most participants perceived their working life as most important to their life history and retired at very old ages.

Conclusions

These findings also shed light on the relationships between health, work, and old age.

Understanding Perceptions of Economic Status among Centenarians

Centenarians are often concerned with outliving their accumulated resources. Yet, research consistently finds that older adults, despite low incomes, are more financially satisfied than younger adults. This “satisfaction paradox” has been attributed to psychological accommodation to poor financial circumstances and lower expectations. As a result, scholars differentiate between objective levels of need and subjective perceptions. Missing is an understanding of whether feeling economically secure is associated with physical, mental, and/or psychological well-being and whether it varies by institutionalization status. This study examined data from 152 centenarians who participated in the first wave of the Iowa Centenarian Study. Analyses examined six perceived economic status variables (sufficiency of financial resources, ability to meet expenses, finances compared to others, meeting needs, ability to purchase extras, and having enough money for the future) and measures derived from activities of daily living, the Short Portable Mental Status Questionnaire (Pfeiffer, 1975) and the Geriatric Depression Scale (Yesavage, Brink, Rose, Lum, Huang, Adey, et al., 1983). Findings indicated that most centenarians do not feel able to handle their finances, yet believe that they are doing relatively well financially. Perceived economic status was positively associated with ability to complete daily living activities, cognitive ability, and psychological well-being with results differing by institutional status. In the end, we agree with other scholars that these relationships are rarely simple and require future exploration.

The older they are, the less successful they become? Findings from the georgia centenarian study

This study examined whether oldest-old adults are successful agers. Three hundred and six octogenarians and centenarians of Phase III of the Georgia Centenarian Study participated in this study. A first model examined Rowe and Kahn's successful aging model (Rowe and Khan (1997 and 1998)) including the probability of disease, physical or cognitive capacity, and engagement with life. All three components were applied to assess how many oldest-old adults satisfied all three criteria. The result showed about 15% of octogenarians (15.1%), and none of centenarians satisfied all three components of successful aging. Consequently, a second alternative model focused on psychosocial aspects including three different components: subjective health, perceived economic status, and happiness. Different from Rowe and Kahn's successful aging model, a total of 62.3% of octogenarians and 47.5% of centenarians satisfied all three components of the alternative model of successful aging. The results suggest that additional criteria of successful aging should be considered thereby expanding the concepts and multidimensional aspects of successful aging among oldest-old adults.

Successful aging: a psychosocial resources model for very old adults

Objectives. Using data from the first two phases of the Georgia Centenarian Study, we proposed a latent factor structure for the Duke OARS domains: Economic Resources, Mental Health, Activities of Daily Living, Physical Health, and Social Resources. Methods. Exploratory and confirmatory factor analyses were conducted on two waves of the Georgia Centenarian Study to test a latent variable measurement model of the five resources; nested model testing was employed to assess the final measurement model for equivalency of factor structure over time. Results. The specified measurement model fit the data well at Time 1. However, at Time 2, Social Resources only had one indicator load significantly and substantively. Supplemental analyses demonstrated that a model without Social Resources adequately fit the data. Factorial invariance over time was confirmed for the remaining four latent variables. Discussion. This study's findings allow researchers and clinicians to reduce the number of OARS questions asked of participants. This has practical implications because increased difficulties with hearing, vision, and fatigue in older adults may require extended time or multiple interviewer sessions to complete the battery of OARS questions.

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.

Gender differences in Greek centenarians. A cross-sectional nation-wide study, examining multiple socio-demographic and personality factors and health locus of control

Background

Centenarians are exceptional ageing paradigms, offering valuable information on achieving longevity. Although, there are several studies examining different biomedical factors as determinants of longevity in centenarians, little is known about gender differences with respect to personality traits and health locus of control.

Methods

Nation -wide study carried out in Greece, between 2007 and 2010. Our final sample of analysis consisted of 400 centenarians who reported on sociodemographic, disease-related and personality factors and health locus of control (HLC). Gender differences were investigated by simple nonparametric comparisons. Bivariate correlations between personality factors and internal and external HLC were obtained.

Results

Women centenarians outnumbered men by a ratio of 1.68 to 1. Significant gender sociodemographic differences were noted, with men reporting less often widowhood, more often centenarian 1st degree relatives and smoking. Higher BMI score was measured in males than females. Concerning personality variables, females were more reward-dependent and adaptable than men, while men were more optimistic than women. No differences were found on health locus of control profile between the genders. Positive correlations between self-directness and spirituality with internal locus of control in men and negative correlations between optimism and external locus of control in women emerged as the main gender disparities in the correlation analyses. Self-directness in men and optimism in women were consistently correlated with the two HLC subscales.

Conclusions

Gender differences should be incorporated in future basic research and epidemiological studies of longevity. Informed policies on ageing and wellbeing programs should also take into account gender issues to increase efficacy by targeting health locus of control.

Age differences and changes in resources essential to aging well: a comparison of sexagenarians, octogenarians, and centenarians

THIS STUDY EXAMINED CHANGE OVER TIME IN FIVE RESOURCES ASSESSED BY THE DUKE OARS MULTIDISCIPLINARY FUNCTIONAL ASSESSMENT QUESTIONNAIRE: social, economic, mental, physical, and functional resources. Two hundred and one participants in the Georgia Centenarian Study provided data for this longitudinal study: 70 sexagenarians, 63 octogenarians, and 68 centenarians. Those in their 60s and 80s were followed up within 60 months; due to mortality attrition, centenarians were followed up within 20 months. Centenarians experienced the lowest levels of resources relative to those in their 80s and 60s. Over time they primarily experienced loss in activities of daily living, highlighting that the ability to maximize gains and mitigate losses over time for older adults is highly associated with various resources essential to well-being. Findings suggest that older adults'-especially the very old-resources should be concurrently assessed in a multidimensional analysis by researchers and practitioners who work with older adults in various settings.

Psychosocial Factors Associated with Longevity in the United States: Age Differences between the Old and Oldest-Old in the Health and Retirement Study

Recent growth in the number of adults surviving to advanced ages raises questions about the quality of life associated with increased longevity. Psychosocial factors have received relatively little attention in research on quality of life among the oldest-old. This study uses nationally representative data on older US adults to examine how social relationships, feelings of loneliness, and satisfaction with life and the aging experience differ between the oldest-old, those who have survived to age 90 or older, and older adults in their 70s. We find that the oldest-old are able to maintain social relationships with family and friends and receive more social support than younger elderly adults. Yet, the oldest-old are more likely to feel lonely due to their greater rates of widowhood. Satisfaction with life was higher among the oldest-old, but the oldest-old had more negative perceptions of the aging experience. Psychosocial dimensions of longevity should be considered in research on quality of life among the oldest-old.

Pathways to aging: the mitochondrion at the intersection of biological and psychosocial sciences

Compelling evidence suggests that both biological and psychosocial factors impact the process of aging. However, our understanding of the dynamic interplay among biological and psychosocial factors across the life course is still fragmentary. For example, it needs to be established how the interaction of individual factors (e.g., genetic and epigenetic endowment and personality), behavioral factors (e.g., physical activity, diet, and stress management), and psychosocial experiences (e.g., social support, well-being, socioeconomic status, and marriage) in perinatal, childhood, and adulthood influence health across the aging continuum. This paper aims to outline potential intersection points serving as an interface between biological and psychosocial factors, with an emphasis on the mitochondrion. Mitochondria are cellular organelles which play a critical role in cellular senescence. Both chronic exposure to psychosocial stress and genetic-based mitochondrial dysfunction have strikingly similar biological consequences; both predispose individuals to adverse age-related health disorders and early mortality. Exploring the interactive nature of the factors resulting in pathways to normal healthy aging, as well as those leading to morbidity and early mortality, will continue to enhance our ability to translate research into effective practices that can be implemented throughout the life course to optimise the aging process.

Exploring Positive and Negative Affect as Key Indicators of Life Satisfaction among Centenarians: Does Cognitive Performance Matter?

The aim of this investigation was to determine how cognitive performance was associated with positive and negative affect and life satisfaction over time. This study involved a secondary longitudinal analysis of cross-section data collected at Phase I (1988-1992) and during an 18-month longitudinal followup at Phase II (1992-1998) of the Georgia Centenarian Study. Participants included N = 137 centenarians at Time 1 and N = 68 survivors at Time 2. Significant stability in cognitive impairment existed at Time 1 and Time 2 for positive (β = .55, P < .01) and negative affect (β = .54, P < .01) models. Negative affect at Time 1 was associated with lower life satisfaction at Time 1 (β = -.42, P < .01 ). In addition, cognitive impairment at Time 2 was associated with decreased positive emotionality at Time 2 (β = -.39, P > .01). Furthermore, greater positive affect at Time 2 was associated with greater satisfaction with life at Time 2 (β = .35, P < .01). It appears that positive emotionality contemporaneously influences the association between cognitive impairment and life satisfaction among centenarians. Implications relative to improving life satisfaction among centenarians are discussed.