[Nutritional intake by the oldest elderly Japanese. Tokyo Centenarian Study 6]

Dietary patterns in the healthy oldest old in the healthy aging study and the Canadian longitudinal study of aging: a cohort study

Background

Very few people live to eighty-five years and older (the ‘oldest old’), and even fewer live to this age without developing chronic diseases. It is important to understand the relationship, if any, of modifiable factors such as diet on healthy aging. However, there are few studies of diet among healthy oldest old, especially in North American populations. We aimed to characterize dietary patterns among ‘super-seniors’ (SS) within the Canadian Healthy Aging Study.

Methods

122 SS aged 85 years or older and free of cancer, cardiovascular or pulmonary disease, dementia and diabetes were recruited. Comparisons were made to 12,626 participants aged 65–86 in the Canadian Longitudinal Study of Aging who completed the same 36-item food frequency questionnaire that queried consumption over the prior 12 months of nutrients and foods thought to be important for aging. Dietary patterns were identified with principal component analysis. The odds of being a SS were determined for quartiles of each dietary pattern with logistic regression.

Results

Two dietary patterns were identified; a western diet characterized by french fries, red meat, processed meat and a nutrient-rich diet which included fruits, vegetables, whole grains, nuts and seeds among other healthy food choices. Higher scores for both dietary patterns were associated with increased odds of being a SS, however, only the western dietary pattern remained associated with adjustment for covariates (Quartile 4: OR = 3.21, 95% CI 1.91–5.51).

Conclusions

Our finding adds to the limited evidence on dietary intake among the healthiest oldest old but it is unclear whether assocations reflect generational differences between groups or possible contributions to longevity.

Determinant Factors Contributing to Variations in Memory Performance in Centenarians

The role of environmental markers in memory performance among centenarians was examined in a study comparing non-cognitive factors to various aspects of memory performance. The centenarian group participating in the study consisted of 100 individuals (82 females and 18 males). Selected as non-cognitive factors were Quality of Life, Life-Habits, Health, Personality, and Autonomy. These factors were later compared to memory performance in short-term memory, semantic memory, and episodic memory. Using a structural equation model, results showed that performance in short-term memory was best predicted by life-habits and personality, while performance in semantic and episodic memory were best predicted by autonomy and life-habits. Implementation of the result from a life-span perspective includes a closer monitoring of environmental markers in the future. In effect, this could preserve memory function and optimum health through old age, thus making interventions easier to realize.

Successful tongue cancer surgery under general anesthesia in a 99-year-old patient in Okinawa, Japan: A case report and review of the literature

As advances in the medical field have resulted in increased life expectancy, performing surgery under general anesthesia in elderly patients has become an important issue. A 99-year-old Okinawan female was admitted to the hospital presenting with pain in the tongue. Following physical examination, a clinical diagnosis of early stage tongue cancer (T2N0Mx) was confirmed. Early stage tongue cancer is particularly easy to access for surgical resection. By contrast, later stages of tongue cancer are associated with pain, dysphagia and throat obstruction. The patient and their family agreed to surgery due to the worsening pain associated with the tumor and gave informed consent for surgery. Following consultation with a cardiologist and an anesthesiologist, the tongue tumor was surgically resected under general anesthesia. Subsequent to surgery, the patient experienced pain relief and was discharged from the hospital on day 14 post-surgery. The patient was able to maintain the same quality of life, and lived for 5 years and 2 months longer without evidence of disease, surviving to the age of 104 years old. The present case demonstrates that surgery under general anesthesia may be appropriate in patients of an advanced age, with a treatment plan that should ideally be based on careful assessment of the wishes of the patient and their family, medical risks, and benefits and economic costs of alternative treatments, in addition to consideration of the patient's culture.

Successful anesthesia and hip surgery in a 107-year-old patient

PATIENT

Female, 107.

FINAL DIAGNOSIS

Hip fracture.

SYMPTOMS

-.

MEDICATION

-.

CLINICAL PROCEDURE

Hip surgery.

SPECIALTY

Orthopedics and Traumatology.

OBJECTIVE

Rare disease.

BACKGROUND

In modern societies, elderly populations have increased over the last four decades and have become the main clients of medical services. A hip fracture is a significant injury for anyone, but for older people it can be catastrophic.

CASE REPORT

A 107-year-old female was admitted with fracture of the right hip. The patient took a single 200 mL carbohydrate drink orally two hours before surgery. Before induction of spinal anesthesia, routine monitoring was started and an intravenous line was placed. Crystalloids and hydroxyethyl starch in 0.9% sodium chloride solution were administered intravenously during the operation. After sedation with i.v. ketamine and midazolam, spinal puncture was performed with the patient in the sitting position and isobaric bupivacaine were administered. The level of sensory block was observed in T12 and motor blockade (grade 3) of the lower limbs. The surgical procedure lasted 60 minutes without hypotension, bradycardia or decreased oxygen saturation. For safety reason, the patient was transferred to the ICU for monitoring; intravenous hydration was withdrawn and released oral feeding six hours after the end of surgery. The patient was sent to his residence on the morning of the second day.

CONCLUSIONS

This case showed that with suitable techniques and conduits can perform surgery in a patient with 107 years.

Discovery of novel sources of vitamin b(12) in traditional korean foods from nutritional surveys of centenarians

Human longevity can be explained by a variety of factors, among them, nutritional factor would play an important role. In our study of Korean centenarians for their longevity, the apparent nutritional imbalance in the traditional semi-vegetarian diet raised a special attention, especially on vitamin B₁₂ status, supplied by animal foods. Interestingly, we found that the prevalence of vitamin B₁₂ deficient Korean centenarians was not higher compared with those from Western nations with animal-oriented traditional foods. We assumed that there might be some unveiled sources for vitamin B₁₂ in the Korean traditional foods. Screening of vitamin B₁₂ contents has revealed that some traditional soybean-fermented foods, such as Doenjang and Chunggukjang, and seaweeds contain considerable amounts of vitamin B₁₂. Taken together, it can be summarized that the traditional foods, especially of fermentation, might be evaluated for compensation of the nutritional imbalance in the vegetable-oriented dietary pattern by supplying vitamin B₁₂, resulting in maintenance of health status.

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.

Cardiovascular risk factors in centenarians

Several studies have shown that centenarians have better cardiovascular risk profiles compared to younger old people. Some reports have revealed that cardiovascular diseases (i.e. hypertension, diabetes, angina and/or myocardial infarction) are less common in centenarians respect to 70 and 80 years old persons. In order to explain this evidence, there is a growing number of hypothesis that consider a combination of genetic factors and lifestyle aspects to elucidate the exceptional longevity of centenarians, able to overcome the most frequent mortality cause, which is a cardiovascular event. It has been suggested that a role on this better cardiovascular risk profile may be played by the increasing use of pharmacologic treatments in the elderly population (specially for hypertension and dyslipidemia), but the contribution of drug treatments to promote extreme longevity is not confirmed. Furthermore, centenarians in general have needed fewer drugs at younger ages due to a healthy lifestyle. The importance of the genetic contribution is demonstrated by the inheritance of low-risk cardiovascular profiles in centenarian offspring and lower prevalence of cardiovascular diseases in this population as compared with their spouses or with age-matched subjects without centenarian parents. Another advantage in centenarians' offspring seems to be a delay in the onset for cardiovascular diseases, respect to age- and sex-matched controls. Cardiovascular risk factors mirror the factors that contribute to longevity. Hence, it is not surprising that these risk factors are less prevalent in centenarians when compared to younger old individuals.

Intensive Care Unit Outcomes of Surgical Centenarians: The “Oldest Old” of the New Millennium

This study compared the severity of illness and outcomes of surgical intensive care unit (SICU) patients age 100 years or older with those of younger SICU patients. Severity of illness was measured with the Simplified Acute Physiology Score (SAPS) and the Quantified Therapeutic Intervention Scoring System (QTISS). Outcomes were evaluated with SICU length of stay (LOS), hospital LOS, SICU mortality, and hospital mortality. All patients admitted to an urban, tertiary-care SICU from August 1, 1986 to July 31, 1998 (12 years) were included. A total of 24,395 consecutive patients were evaluated of whom nine (0.037%) were age 100 or more. Complete outcome data were available for 13,773 patients who were divided into five groups on the basis of age: <70, 70 to 79, 80 to 89, 90 to 99, and 100 years and above. Nine centenarians were admitted to the SICU of whom one died in the SICU and another died in the hospital after SICU discharge (22.2% overall mortality). Centenarian patients had higher SAPS and QTISS on admission than patients in all other groups, although this difference was not significant because of the small number of centenarians. SICU and hospital LOS were not significantly longer for centenarians. Mortality in the SICU and hospital was significantly different across the age groups and rose with age. However, the modest 11.1 per cent SICU mortality rate in centenarians along with their LOS statistics indicate that these patients fare relatively well in surgical intensive care.