Centenarians: An excellent example of resilience for successful ageing

A cross-sectional network analysis of successful aging in a resilience-based framework

Aging inevitably gives rise to many challenges and transitions that can greatly impact our (mental) well-being and quality of life if these are not controlled adequately. Hence, the key to successful aging may not be the absence of these stressors, but the ability to demonstrate resilience against them. The current study set out to explore how resilience and successful aging may intersect by investigating how various resilience capacity-promoting (protective) and resilience capacity-reducing (risk) factors relate to mental well-being and quality of life. Through a large-scale (N = 2000, age 55+, 30 factors) network analysis, we established the interplay between risk/protective factors from various domains, including demographics, (mental) health, (environmental) stress, lifestyle, coping/personality, and ageism. We revealed some unique pathways through which each of these factors contribute to individuals' mental well-being and/or quality of life, and interpreted these findings in terms of a resilience-based framework of successful aging. Our findings emphasize the complexity of factors that can impact quality of life and mental well-being in later life and can steer researchers and practitioners in devising efficacious, multi-pronged interventions that target risk and protective factors simultaneously, thereby maximizing their potential in boosting beneficial outcomes among older individuals.

Aging: Disease or "natural" process? A glimpse from regenerative medicine

We explore aging as a global phenomenon, questioning whether it constitutes a treatable condition or follows a natural course. Acknowledging its multifactorial nature, we delve into the challenges and opportunities inherent in this intricate biological process. The inclusion of old age in the 11th International Classification of Diseases sparks debate, categorizing it as a disease based on mechanistic explanations, blood-based biomarkers, and anti-aging products. Ethical dilemmas arise, emphasizing the difficulty of defining the transition from normal to pathological states during this process. We suggest that aging should be regarded as a treatable condition without necessarily labeling it a 'disease.' While anti-aging research unveils promising interventions like Metformin, Rapamycin, and cellular therapy, achieving biological immortality remains a formidable challenge. The future promises to prolong life and enhance quality by comprehensively understanding aging's implications for human health.

Centenarians of the Basque Country are resilient to cancer

Cancer is one of the leading causes of death and its prevalence increases with age. While centenarians exhibit extreme longevity and potential to avoid or delay aging-related diseases, their response to cancer is still barely explored. Our study took advantage of the Electronic Health Records to retrospectively compare the severity of cancer in centenarians (n = 649) and non-centenarians (n = 62,753) in the Basque Country (province of Gipuzkoa), Spain, through analyzing all the recorded diagnoses throughout their lifetime. Descriptive statistics were applied to discern differences between the two population groups in terms of prevalence of tumor types, number of diagnoses, and treatments. Survival analysis was performed through Kaplan-Meier estimator. We found that centenarians had fewer cancer diagnoses (17.1%, n = 111) than non-centenarians (40.5%, n = 25,405), and notably avoided the most aggressive cancer types and did not develop metastasis. Furthermore, they barely had records of treatments or drugs and had extended survival both since the first and last diagnosis of cancer. These results suggest resilience of the centenarians against malignant cancers explaining, in part, their extended longevity.

Outcome of Centenarians with Hip Fracture: An Analysis of the Registry for Geriatric Trauma (ATR-DGU)

Background/Objectives: Outcomes for hip fracture patients have improved over the years, yet the population of older patients (≥80 years) continues to grow. By 2100, the global centenarian population is projected to exceed 25 million, but data on hip fracture outcomes in this group are rare and often derived from small samples. This study aimed to analyze outcomes for centenarian hip fracture patients in specialized geriatric trauma centers and compare them with those of patients under 80. Methods: We conducted a retrospective analysis of the AltersTraumaRegister DGU® from 2016 to 2022, including all proximal femur fracture data. Patients were categorized into two groups: under 80 years and centenarians. The primary outcome was in-hospital mortality, with secondary outcomes including quality of life, walking ability on postoperative day seven, length of hospital stay, readmission rates, and changes in living situations. Results: Among 14,521 patients, 316 were over 99 years old. In-house mortality was significantly higher in centenarians (15.44% vs. 3.58%; p < 0.001), with more discharged to nursing homes. After matching by the Geriatrics at Risk (GeRi) score, mortality differences diminished. Conclusions: While age is a risk factor for mortality, centenarian hip fracture patients' outcomes do not significantly differ from those aged ≤80 when considering other risk factors.

Intracellular cytokines in peritoneal leukocytes relate to lifespan in aging and long-lived female mice

Peritoneal immune cell function is a reliable indicator of aging and longevity in mice and inflammaging is associated with a shorter lifespan. Nevertheless, it is unknown if the content of cytokines in these immune cells is linked to individual differences in lifespan. Therefore, this work aimed to investigate different peritoneal leukocyte populations and their content in intracellular pro-inflammatory (TNF and IL-6) and anti-inflammatory (IL-10) cytokines by flow cytometry in adult (10 months-old, n = 8) and old (18 months-old, n = 20) female Swiss/ICR mice. In addition, old mice were monitored longitudinally throughout their aging process, and the same markers were analyzed at the very old (24 months-old, n = 8) and long-lived (30 months-old, n = 4) ages. The longitudinal follow-up allowed us to relate the investigated parameters to individual lifespans. The results show that long-lived female mice exhibit an adult-like profile in most parameters investigated but also display specific immune adaptations, such as increased CD4+ and CD8+ T cells containing the pro-inflammatory TNF cytokine and CD4+ T cells and macrophages containing the anti-inflammatory cytokine IL-10. These adaptations may underlie their exceptional longevity. In addition, a negative correlation was obtained between the percentage of cytotoxic T cells, KLRG-1/CD4, large peritoneal macrophages, and the percentage of CD4+ T cells containing IL-6 and macrophages containing IL-10 in old age and lifespan, whereas a positive correlation was found between the CD4/CD8 ratio and the longevity of the animals at the same age. These results highlight the crucial role of peritoneal leukocytes in inflammaging and longevity.

Mosaic loss of Y chromosome and the association to mortality in Danish men aged 56-100 years

Mosaic loss of the Y chromosome (mLOY) is a common somatic mutation in the blood of elderly men and several studies have found mLOY in blood cells to be associated with an increased risk of various diseases and mortality. However, most of these studies have focused on middle-aged and older adults, meaning that mLOY in extremely old individuals like centenarians is understudied. To explore mLOY across a wider age range compared to earlier studies and to specifically focus on centenarians, mLOY was estimated in 917 Danish men aged 56-100 years. We found that the percentage of men with LOY increased with age until age 85, after which it plateaued at around 40 %. Consistently, a longitudinal comparison of mLOY revealed that mLOY predominantly increased with age, although inter-individual variation was seen. Using a twin sub-sample, the broad-sense heritability of mLOY was estimated at 72 %, indicating a substantial genetic influence. Supporting previous findings, mLOY was found to associate with increased mortality across all study participants and in men younger than 80 years. In centenarians, however, a higher level of mLOY associated with better survival, most likely due to selection, although confirmation of our findings in larger studies is needed.

Elective Surgery Trends and Outcomes of Nonagenarians and Centenarians in Otolaryngology-Head and Neck Surgery: A NSQIP Study

OBJECTIVE

To describe types and outcomes of elective otolaryngological surgeries undergone by patients ≥90 years of age and to assess whether very old age is an independent risk factor for postsurgical complications and death.

METHODS

The National Surgical Quality Improvement Program, a validated national prospective surgical outcomes database, was used to identify all patients aged 65 years and older who underwent elective otolaryngological procedures from 2011 to 2020. Study outcomes included minor complications, major life-threatening complications, and 30-day mortality. Predictors of outcomes, including frailty, were identified using univariable analyses and age was added into the final logistic regression models with stepwise selection.

RESULTS

A total of 40,723 patients met inclusion criteria; 629 (1.5%) patients were ≥90 years of age. Of the 63,389 procedures, head and neck (67.6%) and facial plastics and reconstructive (15.0%) procedures were most common. The overall incidence of major life-threatening complications, minor complications, and death was 2.0%, 3.5%, and 0.4%, respectively. Age ≥90 was significantly associated with an increased risk for 30-day mortality, but not with major or minor postoperative complications. A high modified frailty index was significantly associated with an increased risk for major postoperative complications and death amongst patients ≥90 years.

CONCLUSIONS

Elective otolaryngological surgery can be safe in relatively healthy nonagenarians and centenarians, though there is a small increased risk of 30-day mortality. Although older age can predispose patients to other comorbidities, age alone should not deter surgeons and patients from considering elective otolaryngological procedures. Frailty may be a better predictor for surgical outcomes.

LEVEL OF EVIDENCE

IV Laryngoscope, 134:3989-3996, 2024.

Frailty and biological age. Which best describes our aging and longevity?

Frailty and Biological Age are two closely related concepts; however, frailty is a multisystem geriatric syndrome that applies to elderly subjects, whereas biological age is a gerontologic way to describe the rate of aging of each individual, which can be used from the beginning of the aging process, in adulthood. If frailty reaches less consensus on the definition, it is a term much more widely used than this of biological age, which shows a clearer definition but is scarcely employed in social and medical fields. In this review, we suggest that this Biological Age is the best to describe how we are aging and determine our longevity, and several examples support our proposal.

The Global Research Trends on Intrinsic Capacity of Older Adults: A Bibliometric and Visual Analysis of Papers Published During 2015-2023

Objective

The concept of intrinsic capacity (IC) revolves around healthy aging and active aging. Since the Introduction of the concept by the World Health Organization in 2015, a series of studies have been conducted by scholars from multiple fields. However, no bibliometric analysis has systematically investigated this issue. We aim to identify the current landscape and frontier trends of scientific achievements on IC in older adults through bibliometric approaches.

Methods

Quantitative analysis of publications relating to IC in older adults from 2015 to 2023 was interpreted and graphed through the Web of Science Core Collection database on December 5, 2023. A variety of quantitative variables was analyzed, including publication and citation counts, H-index, and journal citation reports. Co-authorship, citation, co-citation, and co-occurrence analyses were performed for countries/regions, institutions, authors, and keywords using the VOSviewer and CiteSpace.

Results

A total of 952 original and review articles in English were identified. The European countries possessed an absolute advantage in this field. The most contributive institution was the University of São Paulo. The most productive author is Cesari Matteo from France, followed by Qaisar Rizwan from the United Arab Emirates. However, a relatively low level of research cooperation existed between institutions and authors. Important topics mainly include the connotations, theoretical framework models, evaluation, screening tools, and application scenarios of IC. Among the promising hotspots, "biological aging", "ICOPE", "Covid-19", "prevention", "inflammation", "caf22", "prevalence", and "randomized controlled trial" displayed relatively latest average appearing year.

Conclusion

Global trends indicate a growing scientific output on IC in older adults, and developed countries are leading the way. There is still room for improvement in research team collaboration. The focus gradually shifts from theoretical research to empirical research. It is recommended to pay attention to the latest hot spots, such as "biological aging", "ICOPE implementation", "post-COVID-19 syndrome", and "biomarkers".

New insights into healthy ageing, inflammageing and frailty using metabolomics

Human ageing is a normal process and does not necessarily result in the development of frailty. A mix of genetic, environmental, dietary, and lifestyle factors can have an impact on ageing, and whether an individual develops frailty. Frailty is defined as the loss of physiological reserve both at the physical and cellular levels, where systemic processes such as oxidative stress and inflammation contribute to physical decline. The newest "omics" technology and systems biology discipline, metabolomics, enables thorough characterisation of small-molecule metabolites in biological systems at a particular time and condition. In a biological system, metabolites-cellular intermediate products of metabolic reactions-reflect the system's final response to genomic, transcriptomic, proteomic, epigenetic, or environmental alterations. As a relatively newer technique to characterise metabolites and biomarkers in ageing and illness, metabolomics has gained popularity and has a wide range of applications. We will give a comprehensive summary of what is currently known about metabolomics in studies of ageing, with a focus on biomarkers for frailty. Metabolites related to amino acids, lipids, carbohydrates, and redox metabolism may function as biomarkers of ageing and/or frailty development, based on data obtained from human studies. However, there is a complexity that underpins biological ageing, due to both genetic and environmental factors that play a role in orchestrating the ageing process. Therefore, there is a critical need to identify pathways that contribute to functional decline in people with frailty.

Autoimmunity in centenarians. A paradox

Autoimmune diseases (ADs) are one of the groups of chronic illnesses that impose a significant burden of disease and health costs worldwide. Age is a crucial risk factor for the onset of ADs. Theoretically, it is inferred that with organic and immune system aging, the loss of immune tolerance and specificity of immune activity becomes more intense, the probability of autoimmunity is increasing. However, there is a group of individuals whose prevalence of ADs is very low or non-existent, despite the biological aging. This paradox in autoimmunity raises questions. Centenarians, individuals who are over 100 years old, are possibly the most successful model of biological aging in humans. Most of these individuals exhibit a favorable health phenotype. To date, primary data evidence and potential hypotheses explaining this phenomenon are lacking globally, even though this paradox could provide valuable, original, and relevant information regarding the understanding of risk or protective factors, biological drivers, and biomarkers related to autoimmunity. Herein we discuss some hypothesis that may explain the absence of ADs in centenarians, including inflammaging, immunosenescence and immune resilience, immune system hyperstimulation, proteodynamics, and genetics.

The CEPH aging cohort and biobank: a valuable collection of biological samples from exceptionally long-lived French individuals and their offspring for longevity studies

The increasing aging of the human population is currently and for the coming decades a major public health issue in many countries, requiring the implementation of global public health policies promoting healthy and successful aging. Individuals are not equal in the face of aging and some can present exceptional healthspan and/or lifespan, which are notably influenced by both genetic and environmental factors. Research and studies on human aging, healthy aging and longevity should rely in particular on cohorts of long-lived individuals, also including biological samples allowing studies on the biology of aging and longevity. In this manuscript, we provide for the first time a complete description of the CEPH (Centre d'Etude du Polymophisme Humain) Aging cohort, an exceptional cohort recruited during the 90s to 2000s, including more than 1700 French long-lived individuals (≥ 90 years old) born between 1875 and 1916 as well as for some of them their siblings and offspring. Among the participants, 1265 were centenarians, including 255 semi-supercentenarians ([105-110] years old) and 25 supercentenarians (≥ 110 years old). The available anthropometric, epidemiologic and clinical data for the cohort participants are described and especially the collection of blood-derived biological samples associated with the cohort which includes DNA, cryopreserved cells and cell lines, plasma, and serum. This biological collection from the first cohort of centenarians in the world is an inestimable resource for ongoing and future molecular, cellular, and functional studies aimed at deciphering the mechanisms of human (successful) aging and longevity.

Demographic transition and hospital admissions in Spanish centenarians, 2004-2020: Geographical variations and sex-related differences

BACKGROUND

This study aims to describe the distribution and temporal trends of the centenarian population and their hospital admissions in Spain over the past two decades, focusing on regional and sex-based differences.

METHODS

A retrospective study was conducted using data from the Spanish National Health System's Hospital Discharge Records-Minimum Basic Data Set. The analysis included all hospitalized patients ≥100 years between January 2004 and December 2020. The crude annual centenarian population and admission rates were calculated. Joinpoint regression analysis and cross-correlation analysis were used to identify trends and associations.

RESULTS

From 2004 to 2020, the centenarian population in Spain increased by 89.0 %, with a larger increase observed in women (86.6 %) than men (32.9 %). Significant geographic variability was found, with rates from 1.1 to 5.2 × 10,000 inhabitants per year across different regions. Joinpoint analysis identified three trends: a decline from 2004 to 2008, an increase from 2008 to 2015, and a slower increase from 2015 to 2020. Hospital admissions of centenarians increased by 121.5 %, with a larger increase in women than men (212.1% vs 90.7 %); women represented 75.4 % of admissions. The proportion of centenarian admissions to total hospitalizations showed an upward trend until 2015 and then stabilized; it also varied among regions.

CONCLUSION

There was a significant increase in the centenarian population and hospital admissions of centenarians in Spain. There are regional disparities in their distribution, with women representing a larger proportion of centenarians and hospital admissions. Understanding these trends and differences is crucial for implementing interventions that ensure adequate healthcare for centenarians.

Abalone peptide increases stress resilience and cost-free longevity via SKN-1-governed transcriptional metabolic reprogramming in C. elegans

A major goal of healthy aging is to prevent declining resilience and increasing frailty, which are associated with many chronic diseases and deterioration of stress response. Here, we propose a loss-or-gain survival model, represented by the ratio of cumulative stress span to life span, to quantify stress resilience at organismal level. As a proof of concept, this is demonstrated by reduced survival resilience in Caenorhabditis elegans exposed to exogenous oxidative stress induced by paraquat or with endogenous proteotoxic stress caused by polyglutamine or amyloid-β aggregation. Based on this, we reveal that a hidden peptide ("cryptide")-AbaPep#07 (SETYELRK)-derived from abalone hemocyanin not only enhances survival resilience against paraquat-induced oxidative stress but also rescues proteotoxicity-mediated behavioral deficits in C. elegans, indicating its capacity against stress and neurodegeneration. Interestingly, AbaPep#07 is also found to increase cost-free longevity and age-related physical fitness in nematodes. We then demonstrate that AbaPep#07 can promote nuclear localization of SKN-1/Nrf, but not DAF-16/FOXO, transcription factor. In contrast to its effects in wild-type nematodes, AbaPep#07 cannot increase oxidative stress survival and physical motility in loss-of-function skn-1 mutant, suggesting an SKN-1/Nrf-dependent fashion of these effects. Further investigation reveals that AbaPep#07 can induce transcriptional activation of immune defense, lipid metabolism, and metabolic detoxification pathways, including many SKN-1/Nrf target genes. Together, our findings demonstrate that AbaPep#07 is able to boost stress resilience and reduce behavioral frailty via SKN-1/Nrf-governed transcriptional reprogramming, and provide an insight into the health-promoting potential of antioxidant cryptides as geroprotectors in aging and associated conditions.

Energy and nutrient intake in older adults with healthy aging during the Corona Virus Disease 19 pandemic- a cohort study

BACKGROUND AND OBJECTIVE

Lockdown measures implemented amid the COVID-19 pandemic promoted changes in lifestyle, particularly engagement in physical activity/exercise and dietary intake. However, few studies are available investigating the healthy older population, particularly in developing countries. Therefore, the objective of this study was to assess the impact of the COVID-19 pandemic on energy and nutrient intake among older adults with successful aging and to evaluate changes in muscle mass, strength and physical performance.

METHODS

A cohort study of 38 healthy older adults from a Brazilian geriatrics referral center were assessed at two time points: baseline - up to 1 year prior to the pandemic; and follow-up - an average of 17 months after the pandemic outbreak. Energy and nutrient intake was determined using food recalls and diary records, while muscle mass was calculated based on anthropometric parameters. Maximum hand-grip strength and Short Physical Performance Battery (SPPB) score were also evaluated.

RESULTS

Median age of participants was 87 years. During the pandemic, intake of protein increased from 52.6 g to 63.9 g (p = 0.013) and micronutrients also increased: vitamin C from 35.4 mg to 76.1 mg (p = 0.027), vitamin B12 from 2.2 mg to 3.1 mg (p = 0.045), calcium from 435.1 mg to 631.5 mg (p < 0.001), magnesium from 186.5 mg to 198.9 mg (p = 0.043), zinc from 5.8 mg to 7.6 mg (p = 0.009), iron from 6.9 mg to 7.2 mg (p = 0.035) and potassium from 1941.6 mg to 2115.5 mg (p = 0.048). No changes in energy intake or other nutrients were evident. No difference in mass, strength or physical performance was observed during the study period. Overall, 84% of participants remained physically active, although engagement in physical exercise decreased by 50% (p < 0.002).

CONCLUSION

The increase in intake of proteins and micronutrients suggests improved diet quality during the pandemic. Engagement in physical exercise decreased significantly, but level of physical activity was maintained. No change in anthropometric parameters, strength or physical performance was evident in the population investigated.

Human lifespan and sex-specific patterns of resilience to disease: a retrospective population-wide cohort study

BACKGROUND

Slower paces of aging are related to lower risk of developing diseases and premature death. Therefore, the greatest challenge of modern societies is to ensure that the increase in lifespan is accompanied by an increase in health span. To better understand the differences in human lifespan, new insight concerning the relationship between lifespan and the age of onset of diseases, and the ability to avoid them is needed. We aimed to comprehensively study, at a population-wide level, the sex-specific disease patterns associated with human lifespan.

METHODS

Observational data from the SIDIAP database of a cohort of 482,058 individuals that died in Catalonia (Spain) at ages over 50 years old between the 1st of January 2006 and the 30th of June 2022 were included. The time to the onset of the first disease in multiple organ systems, the prevalence of escapers, the percentage of life free of disease, and their relationship with lifespan were evaluated considering sex-specific traits.

RESULTS

In the study cohort, 50.4% of the participants were women and the mean lifespan was 83 years. The results show novel relationships between the age of onset of disease, health span, and lifespan. The key findings include: Firstly, the onset of both single and multisystem diseases is progressively delayed as lifespan increases. Secondly, the prevalence of escapers is lower in lifespans around life expectancy. Thirdly, the number of disease-free systems decreases until individuals reach lifespans around 87-88 years old, at which point it starts to increase. Furthermore, long-lived women are less susceptible to multisystem diseases. The associations between health span and lifespan are system-dependent, and disease onset and the percentage of life spent free of disease at the time of death contribute to explaining lifespan variability. Lastly, the study highlights significant system-specific disparities between women and men.

CONCLUSIONS

Health interventions focused on delaying aging and age-related diseases should be the most effective in increasing not only lifespan but also health span. The findings of this research highlight the relevance of Electronic Health Records in studying the aging process and open up new possibilities in age-related disease prevention that should assist primary care professionals in devising individualized care and treatment plans.

HALL: a comprehensive database for human aging and longevity studies

Diverse individuals age at different rates and display variable susceptibilities to tissue aging, functional decline and aging-related diseases. Centenarians, exemplifying extreme longevity, serve as models for healthy aging. The field of human aging and longevity research is rapidly advancing, garnering significant attention and accumulating substantial data in recent years. Omics technologies, encompassing phenomics, genomics, transcriptomics, proteomics, metabolomics and microbiomics, have provided multidimensional insights and revolutionized cohort-based investigations into human aging and longevity. Accumulated data, covering diverse cells, tissues and cohorts across the lifespan necessitates the establishment of an open and integrated database. Addressing this, we established the Human Aging and Longevity Landscape (HALL), a comprehensive multi-omics repository encompassing a diverse spectrum of human cohorts, spanning from young adults to centenarians. The core objective of HALL is to foster healthy aging by offering an extensive repository of information on biomarkers that gauge the trajectory of human aging. Moreover, the database facilitates the development of diagnostic tools for aging-related conditions and empowers targeted interventions to enhance longevity. HALL is publicly available at https://ngdc.cncb.ac.cn/hall/index.

How age and health status impact attitudes towards aging and technologies in care: a quantitative analysis

BACKGROUND

Increasing proportions of geriatric patients pose tremendous challenges for our society. Developments in assistive technologies have the potential to support older and frail people in aging and care. To reach a sustainable adoption of these technologies, the perceptions and wishes of future users must be understood. In particular, the relationships between individual health-related factors, and the perceptions of aging and using assistive technologies in severe health situations must be empirically examined.

METHODS

Addressing this research gap, our quantitative study (N = 570) investigates the impact of diverse future users' age and health status on their a) perceptions of aging, b) perceptions and acceptance of using assistive technologies in aging and care, as well as c) end-of-life decisions regarding technology usage. For this, four groups were segmented for the comparison of younger (< 50 years) healthy, younger chronically ill, older (50 + years) healthy, and older chronically ill participants.

RESULTS

The results revealed that health status is more decisive for age-related perceptions compared to age. The technology-related perceptions were slightly impacted by either chronological age or health status. The end-of-life decisions showed the most striking differences in the willingness to use assistive technologies, revealing older chronically ill participants to have more restrained attitudes towards technology usage than older healthy as well as all younger participants.

CONCLUSIONS

The findings suggest that the benefits of assistive technologies in private or professional care contexts should be communicated and implemented tailored to the respective user group's needs. Moreover, the results allow us to derive practical implications within the geriatric care context.

Scrutiny of genome-wide somatic mutation profiles in centenarians identifies the key genomic regions for human longevity

Somatic mutations accumulate with age and are associated closely with human health, their characterization in longevity cohorts remains largely unknown. Here, by analyzing whole genome somatic mutation profiles in 73 centenarians and 51 younger controls in China, we found that centenarian genomes are characterized by a markedly skewed distribution of somatic mutations, with many genomic regions being specifically conserved but displaying a high function potential. This, together with the observed more efficient DNA repair ability in the long-lived individuals, supports the existence of key genomic regions for human survival during aging, with their integrity being of essential to human longevity.

Relationship between intrinsic capacity and health-related quality of life among community-dwelling older adults: the moderating role of social support

PURPOSE

To examine how social support might moderate the relationship between intrinsic capacity and health-related quality of life (HRQoL) based on the buffering model of social support.

METHODS

This was a cross-sectional study with a sample of 1181 Chinese community-dwelling older adults aged ≥ 60 years in 2016. Social support was assessed using the Social Support Rating Scale. Intrinsic capacity was assessed using the revised integrated care for older people screening tool. HRQoL was measured by the 12-item Short Form Health Survey. Hierarchical linear regression analysis was implemented to test the moderating effect of social support.

RESULTS

Support utilization attenuated the relationship between lower intrinsic capacity and poor physical HRQoL while subjective support attenuated the relationship between lower intrinsic capacity and poor mental HRQoL. However, objective support had no significant moderating effect on the relationship between intrinsic capacity and specific domains of HRQoL.

CONCLUSION

The moderating effects of social support on the association between intrinsic capacity and HRQoL vary by support types. Effective interventions should target the perception and utilization of available support among older adults with lower intrinsic capacity to maintain their physical and mental HRQoL.

The Role of Healthy Diet and Lifestyle in Centenarians

Life expectancy at birth (hereafter, life expectancy) and longevity are established indicators of population health [...].

Autonomic nervous system flexibility for understanding brain aging

A recent call was made for autonomic nervous system (ANS) measures as digital health markers for early detection of Alzheimer's disease and related dementia (AD/ADRD). Nevertheless, contradictory or inconclusive findings exist. To help advance understanding of ANS' role in dementia, we draw upon aging and dementia-related literature, and propose a framework that centers on the role of ANS flexibility to guide future work on application of ANS function to differentiating the degree and type of dementia-related brain pathologies. We first provide a brief review of literature within the past 10 years on ANS and dementia-related brain pathologies. Next, we present an ANS flexibility model, describing how the model can be applied to understand these brain pathologies, as well as differentiate or even be leveraged to modify typical brain aging and dementia. Lastly, we briefly discuss the implication of the model for understanding resilience and vulnerability to dementia-related outcomes.

Longevity, Centenarians and Modified Cellular Proteodynamics

We have shown before that at least one intracellular proteolytic system seems to be at least as abundant in the peripheral blood lymphocytes of centenarians as in the same cells of young individuals (with the cells of the elderly population showing a significant dip compared to both young and centenarian cohorts). Despite scarce published data, in this review, we tried to answer the question how do different types of cells of longevous people-nonagenarians to (semi)supercentenarians-maintain the quality and quantity of their structural and functional proteins? Specifically, we asked if more robust proteodynamics participate in longevity. We hypothesized that at least some factors controlling the maintenance of cellular proteomes in centenarians will remain at the "young" level (just performing better than in the average elderly). In our quest, we considered multiple aspects of cellular protein maintenance (proteodynamics), including the quality of transcribed DNA, its epigenetic changes, fidelity and quantitative features of transcription of both mRNA and noncoding RNAs, the process of translation, posttranslational modifications leading to maturation and functionalization of nascent proteins, and, finally, multiple facets of the process of elimination of misfolded, aggregated, and otherwise dysfunctional proteins (autophagy). We also included the status of mitochondria, especially production of ATP necessary for protein synthesis and maintenance. We found that with the exception of the latter and of chaperone function, practically all of the considered aspects did show better performance in centenarians than in the average elderly, and most of them approached the levels/activities seen in the cells of young individuals.

'I Finally Got Rid of My Shadow!': Psychotherapy with an Oldest Old Woman - A Growth Process for Client and Therapist

OBJECTIVES

The increase in the number of people living beyond age 90 pose challenges to mental health professionals, many of whom still harbor ageist notions concerning the efficacy of psychotherapy for the oldest old. This paper demonstrates how integrated psychotherapy with an oldest old woman can provide opportunities for integration and personal growth.

CLINICAL INTERVENTION

Integrated psychotherapy based on self-psychology psychodynamic approach, was provided to a woman from age 90 to 100 concerning age-related changes and losses and unresolved traumatic experiences in life. which troubled her notwithstanding previous efforts to resolve them.

OUTCOMES

Over the course of almost ten years, the client came to terms with her aging losses, experiences, worked through the therapeutic process, and learned how to express and accept her deepest feelings, thereby achieving psychological well-being and internal peace.

CLINICAL IMPLICATIONS

Psychotherapy for the oldest old may contribute to their well-being by offering significant opportunities to process and understand major events and unresolved issues along the life cycle. This study demonstrates that the older self is flexible and capable of growth, even as physical health wanes. Transference and countertransference reactions between therapists and clients can be instrumental in understanding and improving the well-being of the oldest old.

Are centenarians successful agers? Evidence from China

BACKGROUND

It is unclear to what degree centenarians are successful agers. We assess successful aging (SA) and its subtypes in a large Chinese sample.

METHODS

Based on a large national sample of 18,311 Chinese centenarians, we first estimated the prevalence of SA among centenarians, and then used the Latent Class Analysis to classify centenarians into different types based on the five dimensions of SA. Multinomial regression analysis was used to examine how demographic, socioeconomic, and lifestyle covariates are associated with these identified types.

RESULTS

5.7% of centenarians fulfilled all five criteria of SA, and 1.3% failed all five criteria. The remainder could be classified into six types of SA. The regression analysis further revealed that these SA types were related to various social factors. For example, with timely access to medical care, centenarians were three times more likely to be successful agers.

CONCLUSIONS

Centenarians demonstrate substantial heterogeneity in terms of achieving five SA criteria. Social factors are found to be significantly associated with centenarians' aging performances. Specific subtypes of SA among centenarians may be associated with and help explore different underlying biological-environmental mechanisms of exceptional longevity.

Are Skeletal Muscle Changes during Prolonged Space Flights Similar to Those Experienced by Frail and Sarcopenic Older Adults?

Microgravity exposure causes several physiological and psychosocial alterations that challenge astronauts' health during space flight. Notably, many of these changes are mostly related to physical inactivity influencing different functional systems and organ biology, in particular the musculoskeletal system, dramatically resulting in aging-like phenotypes, such as those occurring in older persons on Earth. In this sense, sarcopenia, a syndrome characterized by the loss in muscle mass and strength due to skeletal muscle unloading, is undoubtedly one of the most critical aging-like adverse effects of microgravity and a prevalent problem in the geriatric population, still awaiting effective countermeasures. Therefore, there is an urgent demand to identify clinically relevant biological markers and to underline molecular mechanisms behind these effects that are still poorly understood. From this perspective, a lesson from Geroscience may help tailor interventions to counteract the adverse effects of microgravity. For instance, decades of studies in the field have demonstrated that in the older people, the clinical picture of sarcopenia remarkably overlaps (from a clinical and biological point of view) with that of frailty, primarily when referred to the physical function domain. Based on this premise, here we provide a deeper understanding of the biological mechanisms of sarcopenia and frailty, which in aging are often considered together, and how these converge with those observed in astronauts after space flight.

Comparative Senescence and Lifespan

The word senescence is derived from the Latin word “senex” (meaning old). In biology, senescence is a process by which a cell ages and permanently stops dividing. Senescence is a natural universal phenomenon affecting all living organisms (e.g., humans, animals, and plants). It is the process of growing old (aging). The underlying mechanisms of senescence and aging at the cellular level are not fully understood. Senescence is a multifactorial process that can be induced by several stimuli including cellular stress, DNA damage, telomere shortening, and oncogene activation. The most popular theory to explain aging is the free radical theory. Senescence plays a role in the development of several age-related chronic diseases in humans (e.g., ischemic heart disease, osteoporosis, and cancer). Lifespan is a biological characteristic of every species. The lifespan of living organisms ranges from few hours (with mayfly) to potential eternity (with jellyfish and hydra). The maximum theoretical lifespan in humans is around 120 years. The lifespan in humans is influenced by multiple factors including genetic, epigenetic, lifestyle, environmental, metabolic, and endocrine factors. There are several ways to potentially extend the lifespan of humans and eventually surpass the maximum theoretical lifespan of 120 years. The tools that can be proposed include lifestyle, reduction of several life-threatening diseases and disabilities, hormonal replacement, antioxidants, autophagy inducers, senolytic drugs, stem cell therapy, and gene therapy.

The possible role of increased consumption of ultra-processed food products in the development of frailty: a threat for healthy ageing?

Frailty, a multifactorial ageing-related syndrome characterised by reduced resistance to stressors and possibly associated with low-grade systemic inflammation, results in negative health outcomes and compromises healthy ageing. There is a growing body of evidence on the relationship between dietary habits, low-grade systemic inflammation and the risk of frailty. Consumption of dietary ultra-processed products (UPP) could negatively contribute to these conditions. In this article, we intend to (i) discuss the role that UPP might have on the development of frailty considering the inflammatory potential of this type of food and (ii) to raise awareness on deleterious effects of excess UPP intake in the development of adverse health outcomes, in particular, frailty and compromised healthy ageing. UPP are industrial formulations whose nutrient profile has been associated with inflammation and altered gut microbiota. Besides, diets with a greater presence of unprocessed foods and antioxidants have been linked to the reduction of oxidative stress and the expression of inflammatory biomarkers. Because inflammation is believed to be a contributing factor in the development of frailty, it is possible that UPP would contribute to the onset or increase of this condition. Importantly, the increasing consumption of UPP in younger populations might pose a greater risk to the development of compromised healthy ageing in the long term.

The Less We Eat, the Longer We Live: Can Caloric Restriction Help Us Become Centenarians?

Striving for longevity is neither a recent human desire nor a novel scientific field. The first article on this topic was published in 1838, when the average human life expectancy was approximately 40 years. Although nowadays people on average live almost as twice as long, we still (and perhaps more than ever) look for new ways to extend our lifespan. During this seemingly endless journey of discovering efficient methods to prolong life, humans were enthusiastic regarding several approaches, one of which is caloric restriction (CR). Where does CR, initially considered universally beneficial for extending both lifespan and health span, stand today? Does a lifelong decrease in food consumption represent one of the secrets of centenarians’ long and healthy life? Do we still believe that if we eat less, we will live longer? This review aims to summarize the current literature on CR as a potential life-prolonging intervention in humans and discusses metabolic pathways that underlie this effect.

Functional transcriptomic analysis of centenarians' offspring reveals a specific genetic footprint that may explain that they are less frail than age-matched non-centenarians' offspring

Centenarians exhibit extreme longevity and compression of morbidity and display a unique genetic signature. Centenarians' offspring seem to inherit centenarians' compression of morbidity, as measured by lower rates of age-related pathologies. We aimed to ascertain whether centenarians' offspring are less frail and whether they are endowed with a "centenarian genetic footprint" in a case-control study, matched 1:1 for gender, age ±5 years, and place of birth and residence. Cases must have a living parent aged 97 years or older, aged 65-80 years, community-dwelling, not suffering from a terminal illness, or less than 6 months of life expectancy. Controls had to meet the same criteria as cases except for the age of death of their parents (not older than 89 years). Centenarians were individuals 97 years or older. Frailty phenotype was determined by Fried's Criteria. We collected plasma and peripheral blood mononuclear cells from 63 centenarians, 88 centenarians' offspring, and 88 non-centenarians' offspring. miRNA expression and mRNA profiles were performed by the GeneChip miRNA 4.0 Array (Thermo Fisher Scientific) and GeneChip Clariom S Human Array (Thermo Fisher Scientific), respectively. We found a lower incidence of frailty among centenarians' offspring when compared to their contemporaries' non- centenarians' offspring (p <0.01). Both miRNA and mRNA expression patterns in centenarians' offspring were more like those of centenarians than those of non-centenarians' offspring (p <0.01). in conclusion, centenarians' offspring are less frail than age-matched non-centenarians' offspring, and this may be explained by their unique genetic endowment.

Subphenotyping of COVID-19 patients at pre-admission towards anticipated severity stratification: an analysis of 778 692 Mexican patients through an age-sex unbiased meta-clustering technique

Background

The COVID-19 pandemic has led to an unprecedented global health care challenge for both medical institutions and researchers. Recognizing different COVID-19 subphenotypes—the division of populations of patients into more meaningful subgroups driven by clinical features—and their severity characterization may assist clinicians during the clinical course, the vaccination process, research efforts, the surveillance system, and the allocation of limited resources.

Objective

We aimed to discover age-sex unbiased COVID-19 patient subphenotypes based on easily available phenotypical data before admission, such as pre-existing comorbidities, lifestyle habits, and demographic features, to study the potential early severity stratification capabilities of the discovered subgroups through characterizing their severity patterns, including prognostic, intensive care unit (ICU), and morbimortality outcomes.

Methods

We used the Mexican Government COVID-19 open data, including 778,692 SARS-CoV-2 population-based patient-level data as of September 2020. We applied a meta-clustering technique that consists of a 2-stage clustering approach combining dimensionality reduction (ie, principal components analysis and multiple correspondence analysis) and hierarchical clustering using the Ward minimum variance method with Euclidean squared distance.

Results

In the independent age-sex clustering analyses, 56 clusters supported 11 clinically distinguishable meta-clusters (MCs). MCs 1-3 showed high recovery rates (90.27%-95.22%), including healthy patients of all ages, children with comorbidities and priority in receiving medical resources (ie, higher rates of hospitalization, intubation, and ICU admission) compared with other adult subgroups that have similar conditions, and young obese smokers. MCs 4-5 showed moderate recovery rates (81.30%-82.81%), including patients with hypertension or diabetes of all ages and obese patients with pneumonia, hypertension, and diabetes. MCs 6-11 showed low recovery rates (53.96%-66.94%), including immunosuppressed patients with high comorbidity rates, patients with chronic kidney disease with a poor survival length and probability of recovery, older smokers with chronic obstructive pulmonary disease, older adults with severe diabetes and hypertension, and the oldest obese smokers with chronic obstructive pulmonary disease and mild cardiovascular disease. Group outcomes conformed to the recent literature on dedicated age-sex groups. Mexican states and several types of clinical institutions showed relevant heterogeneity regarding severity, potentially linked to socioeconomic or health inequalities.

Conclusions

The proposed 2-stage cluster analysis methodology produced a discriminative characterization of the sample and explainability over age and sex. These results can potentially help in understanding the clinical patient and their stratification for automated early triage before further tests and laboratory results are available and even in locations where additional tests are not available or to help decide resource allocation among vulnerable subgroups such as to prioritize vaccination or treatments.

Incidência de fragilidade e fatores associados à piora funcional na pessoa idosa longeva durante pandemia da covid-19: Estudo de Coorte

Resumo Objetivo Avaliar a incidência de fragilidade na pessoa idosa longeva, durante a pandemia da covid–19 e identificar as associações entre os domínios do Índice de Vulnerabilidade Clínico Funcional (IVCF -20) e a fragilização. Métodos Estudo de coorte com 64 pessoas idosas longevas previamente não frágeis, avaliados em dois momentos: na linha de base, até um ano antes do início da pandemia e no seguimento, com uma média de intervalo entre os dois momentos de 15 meses. A fragilidade foi avaliada por meio do VS – Frailty (linha de base) e aplicação remota do IVCF-20 (seguimento). Resultados A idade média foi de 88,7±5 anos e a incidência de fragilidade de 20,6%. As pessoas idosas que fragilizaram apresentaram maior dependência em: deixar de fazer compras (p<0,001), deixar de controlar o próprio dinheiro (p<0,001) e deixar de fazer trabalhos domésticos (p=0,010), assim como em: deixar de tomar banho sozinho (p=0,041). A piora da cognição foi mais presente nos idosos que fragilizaram. A presença de desânimo, tristeza ou desesperança foi elevada (92,3%) e teve associação com a fragilização (p<0,001). Na análise multivariada, a fragilização esteve associada com piora do esquecimento (RR=2,39; IC95% 1,27-4,46), perda de interesse e prazer na realização de atividades (RR=4,94; IC95% 1,98-12,35) e incontinência esfincteriana (RR=2,40; IC95% 2.91-1,53). Conclusões A incidência de fragilização entre as pessoas idosas longevas durante a pandemia foi alta. Identificou-se que mais de um domínio foi afetado o que reforça a necessidade de avaliação da pessoa idosa em sua integralidade, sobretudo em períodos atípicos como o vivenciado.

Frailty and Associated Factors among Chinese Centenarians

OBJECTIVES

The study aimed to apply the frailty index (FI) to assess frailty status among Chinese centenarians and analyse its associated factors.

DESIGN

The study was a cross-sectional study.

SETTING AND PARTICIPANTS

The study included 1043 centenarians (742 females and 301 males) aged ≥100 years from the 2018 wave of the China Longitudinal Healthy Longevity Survey.

MEASUREMENTS

All participants were assessed for frailty by the FI. Basic characteristics, including age, height, weight, calf circumference, waist circumference, hip circumference, sex, years of education, financial status, exercise, fall status, coresidence, smoking, alcohol consumption, number of natural teeth, denture use, toothache, and tooth brushing, were collected. Multivariate logistic regression was used to analyse the associations between risk factors and frailty.

RESULTS

The average age of the participants was 102.06±2.55 years (range: 100-117 years). The FI ranged between 0.00 and 0.63. The mean FI for all participants was 0.27±0.13 (median 0.25; interquartile range 0.20-0.35). Participants were divided into quartiles. The number of natural teeth and denture use, coresidence, sex, exercise, and financial status showed significant associations with frailty classes (all P<0.05). Multivariate logistic regression analysis indicated that having ≤20 natural teeth without dentures (OR, 95% CI= 1.89(0.004-1.246), P<0.05), having ≤20 natural teeth with dentures (OR, 95% CI=2.21(0.158,1.432), P=0.015), living alone or in an institution (OR, 95% CI=1.68(0.182-0.849), P=0.002), lacking exercise (OR, 95% CI=2.54(0.616-1.246), P<0.001), having insufficient financial resources (OR, 95% CI=2.9(0.664-1.468), P<0.001), and being female (OR, 95% CI=1.47(0.137,0.634), P=0.002) were independent risk factors for frailty.

CONCLUSION

Chinese centenarian women are frailer than men. Having fewer natural teeth, living alone or in an institution, lacking exercise, and having insufficient financial resources were the factors associated with frailty among Chinese centenarians. Family conditions and healthy lifestyles may be important for frailty status in centenarians.

Incidence of frailty and factors associated with functional deterioration in oldest old during the covid-19 pandemic: A cohort study

Abstract Objective To assess the incidence of frailty in oldest old during the covid-19 pandemic and to evaluate the associations between the domains of the Clinical-Functional Vulnerability Index (IVCF -20) and frailty. Methods A cohort study of 64 non-frail oldest old was conducted. Participants were evaluated at two timepoints: at baseline up to one year before the onset of the pandemic; and at follow-up, with an average interval between the two timepoints of 15 months. Frailty was assessed using the VS – Frailty (baseline) and remote application of the IVCF-20 (follow-up). Results Mean participant age was 88.7±5 years and the incidence of frailty was 20.6%. Frail participants exhibited greater dependence shopping (p<0.001), controlling their own money (p<0.001) and doing housework (p=0.010), as well as bathing alone (p=0.041). Cognitive decline was more prevalent in the frail individuals. The presence of despondency sadness or hopelessness proved high (92.3%) and was associated with frailty (p<0.001). On the multivariate analysis, frailty was associated with worsening forgetfulness (RR=2.39; 95%CI 1.27-4.46), loss of interest and pleasure in performing activities (RR=4.94; 95%CI 1.98-12.35) and fecal/urinary incontinence (RR=2.40; 95%CI 2.91-1.53). Conclusions

Centenarians as models of healthy aging: Example of REST

Centenarians are a group of individuals exhibiting extreme longevity, who are characterized by a remarkable compression of morbidity. Therefore, centenarians have been postulated as a model of healthy aging. Different approaches have been used to decipher the biology and genetics of centenarians in order to identify key anti-aging pathways. The majority of studies have taken advantage of blood samples to perform their analysis. Besides, a recent study in human brain samples deciphered the transcription factor REST (Repressor Element-1 Silencing Transcription Factor) as an important player of extreme longevity and cognitive activity. This study goes from human to animal models and revealed that REST acts as an epigenetic regulator of neuronal homeostasis, to control aging and longevity. The aim of this view point is to summarize recent literature describing genetic and epigenetic factors, as well as molecular pathways associated with centenarians and the biology of aging. We will pay particular attention to the impact of REST in centenarians and longevity.

Sarcopenia versus cancer cachexia: the muscle wasting continuum in healthy and diseased aging

Muscle wasting is one of the major health problems in older adults and is traditionally associated to sarcopenia. Nonetheless, muscle loss may also occur in older adults in the presence of cancer, and in this case, it is associated to cancer cachexia. The clinical management of these conditions is a challenge due to, at least in part, the difficulties in their differential diagnosis. Thus, efforts have been made to better comprehend the pathogenesis of sarcopenia and cancer cachexia, envisioning the improvement of their clinical discrimination and treatment. To add insights on this topic, this review discusses the current knowledge on key molecular players underlying sarcopenia and cancer cachexia in a comparative perspective. Data retrieved from this analysis highlight that while sarcopenia is characterized by the atrophy of fast-twitch muscle fibers, in cancer cachexia an increase in the proportion of fast-twitch fibers appears to happen. The molecular drivers for these specificmuscle remodeling patterns are still unknown; however, among the predominant contributors to sarcopenia is the age-induced neuromuscular denervation, and in cancer cachexia, the muscle disuse experienced by cancer patients seems to play an important role. Moreover, inflammation appears to be more severe in cancer cachexia. Impairment of nutrition-related mediators may also contribute to sarcopenia and cancer cachexia, being distinctly modulated in each condition.

Physical and mental health in the oldest-old: a mixed-methods study on a southern Italy sample

BACKGROUND

The world's aging population has been constantly increasing in the last decades, causing the number oldest-old individuals to increase.

AIMS

The present study aims to explore the different variables that contribute to the oldest-old wellbeing using a mixed-methods approach, including self-reports, standardized measures, and semi-structured interviews.

METHODS

Thirty-nine oldest-old (90-103) from southern Italy were involved in the study, together with a control sample of younger individuals (51-71) from the same families.

RESULTS

Data suggest that the oldest-old have better mental health, higher resilience, and more optimism than younger individuals. High resilience seems to be the key variable that promotes the overall wellbeing.

DISCUSSION

The oldest-old tend to have better mental health, higher resilience and more optimism than younger individuals.

CONCLUSIONS

Wellbeing in the oldest-old appeared to be promoted by the sense of belonging and life purpose.

The ocular surface immune system through the eyes of aging

Since the last century, advances in healthcare, housing, and education have led to an increase in life expectancy. Longevity is accompanied by a higher prevalence of age-related diseases, such as cancer, autoimmunity, diabetes, and infection, and part of this increase in disease incidence relates to the significant changes that aging brings about in the immune system. The eye is not spared by aging either, presenting with age-related disorders of its own, and interestingly, many of these diseases have immune pathophysiology. Being delicate organs that must be exposed to the environment in order to capture light, the eyes are endowed with a mucosal environment that protects them, the so-called ocular surface. As in other mucosal sites, immune responses at the ocular surface need to be swift and potent to eliminate threats but are at the same time tightly controlled to prevent excessive inflammation and bystander damage. This review will detail how aging affects the mucosal immune response of the ocular surface as a whole and how this process relates to the higher incidence of ocular surface disease in the elderly.

The Great Escape. Centenarians' exceptional health

BACKGROUND

Centenarians escapers are those who reached 100 years of age without the diagnosis of any of the common age-related diseases and exploring their characteristics will inform about successful ageing. No previous study has examined centenarians free of common chronic diseases amongst New Zealand centenarians.

METHODS

Retrospective observational cross-sectional review of a national dataset determining the prevalence of depression, dementia, diabetes and hypertension, smoking, physical activity and social relationships among older adults (aged 60-99 years) and centenarians. Participants were all older New Zealanders living independently in the community who completed the international Residential Assessment Instrument-Home Care (interRAI-HC) assessment during the study's 5-year period (July 2013-June 2018).

RESULTS

The assessments of 292 centenarians (mean age 101.03, SD 1.27 years) and 103,377 elderly (mean age 81.7, SD 5.7 years) were analysed. Compared to the elderly, centenarians were more likely to be female (74.7%, compared with 59.3% elderly, p < 0.001). Centenarians free of common chronic diseases did not differ from other centenarians on any of the analysed variables. Reduction in smoking rates and steady high rates of social engagement were associated with reaching a centenarian status free of common chronic diseases compared with older adults.

CONCLUSIONS

Not smoking and being socially engaged throughout older age were associated with being a centenarian free of common chronic diseases. This study adds to our understanding the complexities of attaining exceptional longevity.

Dysregulation of leukocyte trafficking in ageing: Causal factors and possible corrective therapies

Ageing is a universal biological phenomenon that is accompanied by the development of chronic, low-grade inflammation and remodelling of the immune system resulting in compromised immune function. In this review, we explore how the trafficking of innate and adaptive immune cells under homeostatic and inflammatory conditions is dysregulated in ageing. We particularly highlight the age-related changes in the expression of adhesion molecules and chemokine receptor/ligands, and the accumulation of senescent cells that drive modulated leukocyte trafficking. These age-related changes to leukocyte trafficking are multifactorial and specific to leukocyte subset, tissue, type of vascular bed, and inflammatory status. However, dysregulated leukocyte trafficking ultimately affects immune responses in older adults. We therefore go on to discuss approved drugs, including anti-integrins, anti-chemokines and statins, as well as novel therapeutics that may be used to target dysregulated leukocyte trafficking in ageing, improve immune responses and delay the onset of age-related diseases.

Inflammaging in Endemic Areas for Infectious Diseases

Immunosenescence is marked by a systemic process named inflammaging along with a series of defects in the immunological activity that results in poor responses to infectious agents and to vaccination. Inflammaging, a state of low-grade chronic inflammation, usually leads to chronic inflammatory diseases and frailty in the elderly. However, some elderly escape from frailty and reach advanced age free of the consequences of inflammaging. This process has been called immunological remodeling, and it is the hallmark of healthy aging as described in the studies of centenarians in Italy. The biological markers of healthy aging are still a matter of debate, and the studies on the topic have focused on inflammatory versus remodeling processes and molecules. The sub-clinical inflammatory status associated with aging might be a deleterious event for populations living in countries where chronic infectious diseases are not prevalent. Nevertheless, in other parts of the world where they are, two possibilities may occur. Inflammatory responses may have a protective effect against these infectious agents. At the same time, the long-term consequences of protective immune responses during chronic infections may result in accelerated immunosenescence in these individuals. Therefore, the biological markers of healthy aging can vary according to environmental, cultural, and geographical settings that reflect worldwide, and in a non-biased, non-westernized perspective, the changes that we experience regarding our contacts with microorganisms and the outcomes of such contacts.

Exploring the Role of Endothelial Cell Resilience in Cardiovascular Health and Disease

Traditionally, much research effort has been invested into focusing on disease, understanding pathogenic mechanisms, identifying risk factors, and developing effective treatments. A few recent studies unraveling the basis for absence of disease, including cardiovascular disease, despite existing risk factors, a phenomenon commonly known as resilience, are adding new knowledge and suggesting novel therapeutic approaches. Given the central role of endothelial function in cardiovascular health, we herein provide a number of considerations that warrant future research and considering a paradigm shift toward identifying the molecular underpinnings of endothelial resilience.