The Japanese Centenarian Study: autonomy was associated with health practices as well as physical status

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Environmental effects on trace elements in the fingernails of centenarians and their offspring

Bio-monitoring is commonly used to investigate trace elements, and the human nail provides an ideal medium for such testing. Toxic and essential trace metals (Cd, Pb, Fe, and Se) in the fingernails of participants from the Hainan Province were investigated. Samples included 136 centenarians and 197 offspring (101 older adult children and 96 middle-aged grandchildren) who were also sampled for comparison. As a hotspot for longevity, participants in the Hainan Province were found to have high essential nutrients of Fe and Se, and lacked the toxic element Pb. A similar trend was found for trace elements in soil and rice in the Hainan Province. The trace elements preserved in nails revealed dietary and environmental influences that varied among different generations. For the grandchildren's generation, the environment played an important role in elements in their nails, and a significant correlation and linear relationships were found, especially for Fe and Se. As the participants increased in age (from the grandchildren to the centenarians), the correlation between various elements decreased. For centenarians, the influence of beneficial or harmful properties of the elements became more important than their environment. The results also pointed to the important role of trace elements in human health, especially Fe and Se as essential elements. This study can provide information on the factors that influence the existence of trace elements in the human body and demonstrate the advantage of using the human fingernail in bio-monitoring.

Keys to embracing aging: A healthy aging intervention

Keys to Embracing Aging (KTEA) is a community-based educational program that introduces and reinforces health behaviors that promote healthy aging. Data from 12 distinct KTEA lessons delivered by 42 Cooperative Extension educators to 764 unique participants across one year were examined to determine the program's impact on attitude, diet, physical activity, brain health, belonging, staying up-to-date, safety, health, stress, finances, sleep, and self-care. The most frequent immediate behavior changes occurred in practicing self-care, developing a positive attitude, and making safe choices. And longer-term behavior change was reported in the areas of maintaining a positive attitude, brain health, and healthy eating. Participants discussed challenges related to time, commitment, and maintaining a habitual routine of healthy behaviors. KTEA outcomes indicated a promising community-based educational program and supported continued investigation and development in health promotion within Cooperative Extension. Future research is needed to examine the versatility and long-term effects of the KTEA intervention.

Endurance training alleviates MCP-1 and TERRA accumulation at old age in human skeletal muscle

Both oxidative stress and telomere transcription are up-regulated by acute endurance exercise in human skeletal muscle. Whether and how life-long exercise training influences the antioxidant system response at transcriptional level and TERRA expression is unknown, especially during aging. Response to acute endurance exercise was investigated in muscle biopsies of 3 male subjects after 45 min of cycling. MCP-1 and SOD1 mRNA levels increased up to, 15-fold and 63%, respectively, after the cycling session while the mRNA levels of SOD2 were downregulated by 25%. The effects of chronic endurance exercise and aging were tested in the blood and muscle of 34 male subjects divided into four groups: young (YU) or old (OU) untrained, young (YT) or old (OT) trained cyclists. Long-term endurance training limited the age-dependent elevation in SOD1 (OT vs OU, -26%, P = 0.03) and the decline in SOD2 mRNA levels (OU vs YU, -41%, P = 0.04). A high endurance training status alleviated the age-related increase in the aging biological marker MCP-1 in plasma (OU vs YU, +48%, P = 0.005). Similar results were observed for telomeric transcription as the age-associated increase in 16p TERRA levels (OU vs YU, +39%, P = 0.001) was counteracted by a high endurance training status (OT vs OU, -63%, P = 0.0005). In conclusion, as MCP-1, we propose that the age-related TERRA accumulation might represent a novel biological marker of aging. Those aging-related increase expression might be alleviated by a high endurance training status. Whether those biological markers of aging are linked to an elevation of oxidative stress is still an open question. Therefore, whether the positive adaptations provided by endurance training indeed reduce oxidative stress, including at telomeres, and whether TERRA plays any role in this, need to be further investigated.

Protein intake and loss of proteostasis in the eldery

Ageing is a process of declining bodily function and a major risk factor of chronic diseases. The declining bodily function in ageing can cause loss of proteostasis (protein homeostasis), which is a balance between protein synthesis, folding, modification and degradation. For the elderly, adequate protein intake is necessary to prevent sarcopenia, frailty, fracture and osteoporosis as well as reduced resistance to infection. However, increasing the protein intake can enhance the risk of oxidized protein formation, loss of proteostasis and degenerative disorder occurrence. On the other hand, several studies show that protein restriction would increase longevity. The aim of this review was to explain the importance of determining the right amount and composition of protein intake for the elderly. Oxidative stress and molecular mechanism of proteostasis loss in ageing cells as well as its suppression pathway by protein restriction are discussed in this review. Keywords: ageing, dietary proteins, mTOR, oxidative stress, proteostasis loss

Heart Rate Variability and Exceptional Longevity

Centenarians are the paradigm of human extreme longevity and healthy aging, because they have postponed, if not avoided, mayor age-related diseases. The purpose of this study was to investigate potential differences in resting heart rate variability (HRV) between young adults, octogenarians, and centenarians and assess whether HRV variables are predictors of all-cause mortality in centenarians. To this end, three groups of participants: young adults (N = 20; 20.6 ± 2.3 years), octogenarians (N = 18; 84.1 ± 2.6 years), and centenarians (N = 17; 101.9 ± 1.9 years) were monitored for 15 min at rest (seated, without moving or talking) to measure RR intervals, from which HRV was evaluated. Our results showed a clear decrease with age in the main parasympathetic HRV variables, as well as in the standard deviation (SD) of the RR series [SD of normal-to-normal interval (SDNN)] and in low frequency (LF) heart rate (HR) oscillations, although differences between octogenarians and centenarians did not reach statistical significance. In 14 centenarians followed until death, only SDNN showed significant correlation (ρ = 0.536; p = 0.048) with survival prognosis. Additionally, SDNN <19 ms was associated with early mortality (≤1 year) in centenarians (Hazard Ratio = 5.72). In conclusion, HRV indices reflecting parasympathetic outflow as well as SDNN and LF all present an age-related reduction, which could be representative of a natural exhaustion of allostatic systems related to age. Moreover, low SDNN values (<19 ms) could be associated with early mortality in centenarians. HRV seems to play a role in exceptional longevity, which could be accounted for by centenarians' exposome.

Handgrip strength accuracy as discriminator of functional independence in centenarian women

Abstract The aim of this study was to verify and compare handgrip strength (HS) with activities of the daily living (ADL) and to identify the cutoff point of HGS in the prediction of independence in ADL of centenarians. Twenty-four centenarians with mean age of 101.67 ± 2.80 years participated in the study. Subjects were asked about marital status, schooling (years), diseases, hearing difficulties and activities of the daily living (Katz scale), to classify functional independence. Handgrip strength of the right hand (HSR) and left hand (HSL) (mean of the three measures of each hand) was evaluated by means of manual dynamometer. The U Mann Whitney test was applied to compare HSR and HSL with functions of ADL. To identify the cutoff point (sensitivity and specificity) of the right and left HGS of centenarians in the prediction of independence in functions of ADL, the Received Operating Characteristic (ROC) Curves were used. The following cutoff points were used: 11 Kgf for HSR (sensitivity = 66.7%, specificity = 100%, ROC curve = 0.778) and 9 Kgf for HSL (sensitivity = 66.7%, specificity = 77.8%, curve ROC = 0.730) to predict independence in performing the "bathing" function; 11 Kgf for HSR for the "continence" function (sensitivity = 83.3%, specificity = 66.7%, ROC curve = 0.712); and 9 Kgf for HSL for "transfer" function (sensitivity = 80%, specificity = 71.4%, ROC curve = 0.786). For these functions, sensitivity and specificity presented values greater than 66%. On all these functions, sensitivity showed values higher than 46% and specificity 77%. Minimum HSR is required to perform functions of ADL independently. The best HSR cutoff point to predict independence of subjects differs according to functions of activities of the daily living and hand evaluated.

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

OBJECTIVES

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

DESIGN, SETTING AND PARTICIPANTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

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

An Overview of the Beneficial Effects of Exercise on Health and Performance

Life expectancy is steadily increasing in modern societies, and so are noncommunicable diseases such as cardiovascular diseases, diabetes, obesity, and cancer, accounting for more than 70% of all deaths globally. The costs associated with these diseases are enormous, but it has been estimated that the majority of these noncommunicable diseases are preventable. In addition to an unhealthy diet, tobacco use, and harmful use of alcohol, physical inactivity is a key risk factor. Consequently, physical activity is a logical remedy, and in this chapter an overview of the numerous beneficial effects of physical activity on health and performance is given.The chapter is divided into three parts: First, the basics of physical activity and exercise are discussed, for instance exercise classification, exercise intensity operationalization, energy supply, and the acute effects of exercise such as blood flow redistribution and increased cardiac output. In the second part, the effects of exercise on physical performance are summarized. Specifically, it is discussed how endurance, strength, power, and balance can be improved. This discussion includes recommendations regarding the type, intensity, and duration of the exercise leading to improvements in one of these aspects of physical performance, as well as the mechanisms causing these adaptations. In the third part, the beneficial effects of physical activity on physical and mental health are outlined, with particular attention to cardiovascular diseases, the metabolic syndrome, musculoskeletal diseases, mood, anxiety, depression, and dementia.It can be concluded that with adequate programming, regular physical activity is an effective way to improve physical performance, improve physical and mental health, and reduce the risk factors for many noncommunicable diseases such as cardiovascular diseases, metabolic syndrome, sarcopenia, osteoporosis, and depression. In contrast to medication, physical exercise has no negative side effects, costs very little, and targets many health issues at once. If the multitude of beneficial effects of regular exercise were to be combined in a single low-cost drug, it would be prescribed for almost all types of physical and mental health issues.

Assessment of the Health Status of the Oldest Olds Living on the Greek Island of Ikaria: A Population Based-Study in a Blue Zone

Objective

To describe the demographic characteristics, socio-economic status, functional status (autonomy, strength), and health status (cognitive and thymic functions, cardiovascular risk factors, and nutritional status) of the oldest olds living on the Greek island of Ikaria. We also try to explain the longevity observed in this population.

Methods

A cross-sectional observational study of people aged 90 and over living in both municipalities of north-western Ikaria (Evdilos and Raches) was conducted over one year, from October 21, 2012 to October 21, 2013. The participants were interviewed (medical history), had a brief clinical examination, and underwent standardized geriatric assessments including the Geriatric Depression Scale (GDS-15), the Mini-Mental-State Examination (MMSE), the Activities of Daily Living (ADL), the Instrumental ADL (IADL), and an assessment of grip strength.

Results

Seventy-one persons (37 females, 34 males), aged 94.1 years on average, were interviewed at their homes. Seven percent were current smokers (females 5.4%, males 8.8%). Hypertension was diagnosed in 70.4% of participants, diabetes in 19.7%, hypercholesterolemia in 12.7%, and obesity in 17.2%; 66.0% of the population had one chronic disease or more. The mean score for the GDS-15 scale was 3.7/15.0, 23.7/30.0 for the MMSE, 4.0/6.0 for the ADL, and 4.2/8.0 in females and 3.6/5.0 in males for the IADL. Grip strength was 17.0 kg in females and 26.5 kg in males.

Conclusions

This study provides an overview of the socio-demographic and medical characteristics of the oldest olds living in a longevity Blue Zone.

Machine Learning Enhances the Efficiency of Cognitive Screenings for Primary Care

BACKGROUND

Incorporation of cognitive screening into the busy primary care will require the development of highly efficient screening tools. We report the convergence validity of a very brief, self-administered, computerized assessment protocol against one of the most extensively used, clinician-administered instruments-the Montreal Cognitive Assessment (MoCA).

METHOD

Two hundred six participants (mean age = 67.44, standard deviation [SD] = 11.63) completed the MoCA and the computerized test. Three machine learning algorithms (ie, Support Vector Machine, Random Forest, and Gradient Boosting Trees) were trained to classify participants according to the clinical cutoff score of the MoCA (ie, < 26) from participant performance on 25 features of the computerized test. Analysis employed Synthetic Minority Oversampling TEchnic to correct the sample for class imbalance.

RESULTS

Gradient Boosting Trees achieved the highest performance (accuracy = 0.81, specificity = 0.88, sensitivity = 0.74, F1 score = 0.79, and area under the curve = 0.81). A subsequent K-means clustering of the prediction features yielded 3 categories that corresponded to the unimpaired (mean = 26.98, SD = 2.35), mildly impaired (mean = 23.58, SD = 3.19), and moderately impaired (mean = 17.24, SD = 4.23) ranges of MoCA score ( F = 222.36, P < .00). In addition, compared to the MoCA, the computerized test correlated more strongly with age in unimpaired participants (ie, MoCA ≥26, n = 165), suggesting greater sensitivity to age-related changes in cognitive functioning.

CONCLUSION

Future studies should examine ways to improve the sensitivity of the computerized test by expanding the cognitive domains it measures without compromising its efficiency.

Characteristics of centenarians' lifestyles and their contribution to life satisfaction: A case study conducted on Hainan Island

BACKGROUND

Centenarians represent an intriguing model for healthy aging. They appear to have adapted well to their lives and are likely to be influenced by previous lifestyle habits, and their life satisfaction is influenced by mental and psychological health.

OBJECTIVE

The aim of this study is to explore centenarians' lifestyles by sex and their potential contribution to life satisfaction.

METHOD

In order to examine the common characteristics of centenarians in Hainan and the potential differences between men and women, a cross-sectional survey was conducted with 223 cognitively-intact Chinese centenarians. We also explored the association between life satisfaction and other physical factors using binary logistic regression and principal component analysis.

RESULTS

The results provided supplementary evidence indicating that women tended to live longer than men. However, the difference in life satisfaction observed between the sexes was not obvious (p = 0.659). The proportion of physical factors between each sex showed a similar trend in distribution. Most centenarians' lifestyles were similar, in that they followed a light diet and did not smoke or drink alcohol. Centenarians in better physical condition and with higher self-assessment, as well as those with "alcohol and tobacco habits," were more satisfied with their life. Of the factors examined in the binary logistic regression, sleep satisfaction was the only factor significantly positively correlated with life satisfaction (p < .01).

CONCLUSION

The research findings elucidated physiological and psychological health in centenarians and provided a model of healthy aging strategies for reference purposes.

Effects of exercise and nutrition education programs on motor function and eating habit in mild dementia patients

The purpose of this study was to investigate the effects of physical ac-tivity and nutrition education programs on mild dementia patients with changes in exercise function and eating habits. We examined the effects of pre and post program on 23 old patients with dementia who were diagnosed with menarche or mild dementia with the permission of the dementia center in Incheon city and visited from April to July 2017. The Mini-Mental State Examination score of the subjects in this study was 19.68±3.25, consisting of mild dementia patients. After performing the program for 16 weeks, the senior fitness test showed a significant change in the arm curl test, chair sit-and-reach test, and 2-min step test, and a total score of mini nutrition assessment increased from 19.16 to 21.0. In particular, in a level 2 evaluation, which contains more details such as the condition of taking drugs, number of daily meals, protein food intake condition, intake of vegetables, fruit, and water, whether one can eat alone, and evaluation of nutritive condition, a significant increase from 9.78 to 11.28 was verified. There is a significant increase in nutrition condition recovery as a result of nutrition education. In comparing pre and post program, a significant result was confirmed, and there was significance to provide the basic empirical data for the exercise and dietary life nutritional education of mild dementia patients.

Elevated Inflammatory Status and Increased Risk of Chronic Disease in Chronological Aging: Inflamm-aging or Inflamm-inactivity?

Age-associated hyper-inflammation or "inflamm-aging" has been linked to the development of chronic diseases and characterized as an unavoidable aspect of aging. However, the inflamm-aging model does not adequately address the potential anti-inflammatory effects of exercise training and the potential for exercise to ameliorate several age-related diseases. In this brief review, we introduce a new paradigm-inflamm-inactivity-that describes a potent counter-measure to age-associated inflammatory illness.

Prevalence of functional dependence in Chinese centenarians and its relationship with serum vitamin D status

Background

Functional dependence (FD) and vitamin D deficiency are common conditions in older adults. However, little is known about the relationship between FD and serum vitamin D status in centenarians. The current study was designed to evaluate the prevalence of FD and examine its relationship with serum vitamin D status among centenarians in China.

Subjects and methods

A cross-sectional study of a large sample of Chinese centenarians including 180 men and 822 women was conducted from June 2014 to December 2016. Home interviews, physical examinations, and blood analyses were performed in 958 centenarians following standard procedures. FD was evaluated using the Barthel index of activities of daily living (ADL). Serum 25-hydroxyvitamin D (25OHD) concentrations were measured as a marker of vitamin D status.

Results

The prevalence of centenarians with FD was 71.2%. Vitamin D deficiency, lack of tea consumption, lack of outdoor activities, visual impairment, and fracture were predictors of FD. Centenarians in the lowest quartile of serum 25OHD concentration had an approximately threefold greater likelihood of FD than those in the highest quartile in multiple logistic regression models (OR =2.88; 95% CI 1.75–4.73; P<0.001). The multivariable OR with a 1 ng/mL decrease in serum 25OHD concentration was 1.06 (95% CI 1.04–1.08; P<0.001) for FD.

Conclusion

Serum 25OHD levels have important associations with FD in Chinese centenarians. Future research could focus on the value of intervening in the case of low serum 25OHD levels through vitamin D supplementation and improving ADL in the older population.

Dietary Protein, Muscle and Physical Function in the Very Old

There is an ongoing debate as to the optimal protein intake in older adults. An increasing body of experimental studies on skeletal muscle protein metabolism as well as epidemiological data suggest that protein requirements with ageing might be greater than many current dietary recommendations. Importantly, none of the intervention studies in this context specifically investigated very old individuals. Data on the fastest growing age group of the oldest old (aged 85 years and older) is very limited. In this review, we examine the current evidence on protein intake for preserving muscle mass, strength and function in older individuals, with emphasis on data in the very old. Available observational data suggest beneficial effects of a higher protein intake with physical function in the oldest old. Whilst, studies estimating protein requirements in old and very old individuals based on whole-body measurements, show no differences between these sub-populations of elderly. However, small sample sizes preclude drawing firm conclusions. Experimental studies that compared muscle protein synthetic (MPS) responses to protein ingestion in young and old adults suggest that a higher relative protein intake is required to maximally stimulate skeletal muscle MPS in the aged. Although, data on MPS responses to protein ingestion in the oldest old are currently lacking. Collectively, the data reviewed for this article support the concept that there is a close interaction of physical activity, diet, function and ageing. An attractive hypothesis is that regular physical activity may preserve and even enhance the responsiveness of ageing skeletal muscle to protein intake, until very advanced age. More research involving study participants particularly aged ≥85 years is warranted to better investigate and determine protein requirements in this specific growing population group.

The relationship between vision impairment and well-being among centenarians: findings from the Georgia Centenarian Study

OBJECTIVE

The current study evaluated the visual function among centenarians and assessed the relationship between vision, social support, and well-being.

METHODS

This study used the data set of the Georgia Centenarian Study including 106 centenarians (18 men and 88 women). We used scores of the Snellen chart for objective vision and self-reports for subjective vision. Social support, depression, and loneliness were also assessed.

RESULTS

Approximately 75% of the centenarians showed some level of objective visual impairment, and 56% of them reported that they had visual impairment. Objective vision impairment was significantly related to depression. Multiple regression analysis revealed that both variables of visual function were significantly associated with depression, but not loneliness. In the model including depression, a significant interaction was obtained for social support and objective vision. Centenarians reported lower level of depression when they had social support. However, centenarians who had low level of visual function tended to report higher depression even if they had social support.

IMPLICATIONS

These results indicated that vision function was related to centenarians' well-being, especially depression. Copyright © 2017 John Wiley & Sons, Ltd.

Developing Cognitive Markers of Alzheimer's Disease for Primary Care: Implications for Behavioral and Global Prevention

A comprehensive approach to the prevention of Alzheimer's disease (AD) warrants a synergy across multiple domains and procedures. Whereas the study of biological markers has mobilized major activity in the field, the development of cognitive markers is largely ignored, despite the unique advantages they may offer. Cognitive markers essentially assess the core clinical feature that biological markers intend to predict. In this respect, cognitive markers expand the foundation of preclinical diagnostics and disease staging in a manner that integrates both physiological and psychological factors. In addition, the cost-effective implementation of cognitive markers makes them remarkably conducive to community-wide screenings, and thereby a vital component of any global blueprint for prevention. Specifically, in the primary care setting, cognitive markers may provide effective gate keeping for more invasive, labor intensive, and expensive procedures. From this perspective, cognitive markers may provide the first step for identifying preclinical treatment recipients in general public. Moreover, the detection of preclinical decline via cognitive markers can increase awareness of AD risk and the motivation for making protective lifestyle changes. The behavioral approach might be expedient for prevention in light of the compelling evidence of lifestyle amelioration of AD risk. In an integrative view, incorporating cognitive markers to primary care may facilitate a synergetic development in preventive interventions that carries epidemiological significance. This paper addresses the theoretical, methodological, and pragmatic aspects of this prospect.

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

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

Limited compensation at the following meal for protein and energy intake at a lunch meal in healthy free-living older adults

Various interventions have previously been found to increase protein intakes in older adults, but in free-living individuals, compensation for increased intakes at one meal may easily negate these effects resulting in limited long term benefit. This study investigated the impact of adding sauce to an older person's lunch meal on intakes at that meal, at the following meal and overall (lunch + evening meal). Using a repeated measures design, 52 participants consumed both a lunch meal with sauce and the same lunch meal without sauce on two separate occasions, and intake at this meal and at the following meal were measured. In all participants analysed together, the addition of sauce resulted in increased protein intakes at the lunch meal. Individual differences were also found, where for some individuals (n = 26), the addition of sauce resulted in significantly higher protein and energy intakes at the lunch meal (12.3 g protein, 381 kJ) and overall (11 g protein, 420 kJ), compared to the no-sauce condition, while for some individuals (n = 19), the sauce manipulation resulted in lower protein and energy intakes (lunch: 7 g protein, 297 kJ; overall: 7 g protein, 350 kJ). Compensation for earlier intakes was low (0-17%) for both groups. These findings demonstrate the possible value of adding sauce to an older person's meal for increasing intakes, and demonstrate a need for attention to individual differences. This study also confirms previous findings of limited compensation in older adults, but extends earlier studies to demonstrate limited compensation for the protein consumed in a complete meal in healthy older adults.

Hair elements and healthy aging: a cross-sectional study in Hainan Island, China

Healthy aging is considered as the core issue of aging population. Centenarians are a symbol of healthy aging. Concentration of elements in hair is an indicator of micronutrient status, which can affect the human health. In the present study, we investigated element concentrations in the scalp hair of 255 healthy centenarians from Hainan Island, China. The pattern of intergenerational transmission of elements and the effects of confounders such as sex, age, education level, smoking habits, alcohol intake, and frequency of hospitalization on hair element concentrations were assessed. For most elements, the load in hair increased significantly through intergenerational transmission (i.e., centenarians < children < grandchildren). Our results also demonstrated that female centenarians had significantly higher concentrations of Ca, Mg, Mn, Se, and Sr but lower levels of Cr and P. The Mn level was statistically significantly lower in the primary studies group. Alcohol intake was positively associated with Cd and Na levels, whereas smoking habits showed no significant effect on all the elements. Furthermore, the frequency of hospitalization was significantly positively associated with Cd, Cu, and Pb concentration. Moreover, our analysis suggested that adequate concentrations of Fe and Se might increase the life span of centenarians, whereas excessive concentrations of P and Pb were harmful to health and reduced life span. These results imply that element concentrations could be manipulated as a therapeutic modality in geriatric disease. They might also provide reference values for diseased subjects, allowing improved diagnoses and more effective therapies, which might support effective policies on health and aging.

Barriers to and Facilitators of the Consumption of Animal-Based Protein-Rich Foods in Older Adults

Protein intakes in the older population can be lower than recommended for good health, and while reasons for low protein intakes can be provided, little work has attempted to investigate these reasons in relation to actual intakes, and so identify those of likely greatest impact when designing interventions. Questionnaires assessing: usual consumption of meat, fish, eggs and dairy products; agreement/disagreement with reasons for the consumption/non-consumption of these foods; and several demographic and lifestyle characteristics; were sent to 1000 UK community-dwelling adults aged 65 years and over. In total, 351 returned questionnaires, representative of the UK older population for gender and age, were suitable for analysis. Different factors were important for consumption of the four food groups, but similarities were also found. These similarities likely reflect issues of particular concern to both the consumption of animal-based protein-rich foods and the consumption of these foods by older adults. Taken together, these findings suggest intakes to be explained by, and thus that strategies for increasing consumption should focus on: increasing liking/tastiness; improving convenience and the effort required for food preparation and consumption; minimizing spoilage and wastage; and improving perceptions of affordability or value for money; freshness; and the healthiness of protein-rich foods.

Association between Longevity and Element Levels in Food and Drinking Water of Typical Chinese Longevity Area

OBJECTIVES

To carrying out an integrated analysis on regional environment and human health in China and to detect the association between longevity and daily element intake from food and drinking water.

DESIGN

Cross-sectional study.

SETTING

All the 18 cities and counties in Hainan Province.

MEASUREMENTS

The distribution of elderly population and longevity indexes at a county level in Hainan Province were investigated. Quality of food and drinking water in Hainan was evaluated by comparing the chemical elements with National Standards. In addition, the association between element concentrations in food and water and longevity was examined using spearman's rank correlation.

RESULTS

The proportion of elderly people is higher in the northern part of the province compared with southern counties. Food contributes a greater proportion of daily element intake than drinking water. Compared with the National Standards, reaching rates for elements were over 85% for both food and drinking water. There was a positive correlation between daily intake of Cu, Se, and Zn from food and water and aging and longevity indexes, and a negative correlation between Pb intake and these indexes.

CONCLUSION

The quality of food and water in Hainan Province are good and that, compared with water, food is a more important source of trace elements. An appropriate supply of Cu, Se, and Zn is important, whereas excessive intake of Pb should be avoided. The findings also provide basic data to support further studies on regional variations in longevity and their relationship to diet and drinking water.

Exercise Modulates Oxidative Stress and Inflammation in Aging and Cardiovascular Diseases

Despite the wealth of epidemiological and experimental studies indicating the protective role of regular physical activity/exercise training against the sequels of aging and cardiovascular diseases, the molecular transducers of exercise/physical activity benefits are not fully identified but should be further investigated in more integrative and innovative approaches, as they bear the potential for transformative discoveries of novel therapeutic targets. As aging and cardiovascular diseases are associated with a chronic state of oxidative stress and inflammation mediated via complex and interconnected pathways, we will focus in this review on the antioxidant and anti-inflammatory actions of exercise, mainly exerted on adipose tissue, skeletal muscles, immune system, and cardiovascular system by modulating anti-inflammatory/proinflammatory cytokines profile, redox-sensitive transcription factors such as nuclear factor kappa B, activator protein-1, and peroxisome proliferator-activated receptor gamma coactivator 1-alpha, antioxidant and prooxidant enzymes, and repair proteins such as heat shock proteins, proteasome complex, oxoguanine DNA glycosylase, uracil DNA glycosylase, and telomerase. It is important to note that the effects of exercise vary depending on the type, intensity, frequency, and duration of exercise as well as on the individual's characteristics; therefore, the development of personalized exercise programs is essential.

‘Old but not that old’: Finnish community-dwelling people aged 90+ negotiating their autonomy

Autonomy is a pervasive concept in Western lifestyles today. However, people in the fourth age are assumed not to be autonomous but dependent on other people. The data of this study consisted of interviews with Finnish community-dwelling 90–91-year-old people. The study aim was to examine how these people see their own autonomy in their everyday lives. The analysis was based on membership categorisation analysis. Our respondents considered their autonomy through three distinct themes. Functional ability was considered in terms of being physically capable of managing daily tasks. Independence in decision making was based on material and financial self-sufficiency and on the respondents' supposition that they were capable of making decisions due to an absence of memory disorders. Additionally, autonomy was considered as contesting norms of age-appropriateness. Among respondents, chronological age seemed to have been replaced by functional and cognitive ability as a definer of categorisations; age-others became ability-others. Our study revealed that the perceptions of autonomy also included gendered features as they were linked with differing gendered ideals, roles and life domains of women and men. The results highlight the internal diversity among the oldest old and challenge the third/fourth age division. Instead, they suggest the existence of a certain ‘grey area’ within old age, and urge an analysis on the subtle meaning making involved in older people's constructions of age-categorisations.

Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group

The aging process is associated with gradual and progressive loss of muscle mass along with lowered strength and physical endurance. This condition, sarcopenia, has been widely observed with aging in sedentary adults. Regular aerobic and resistance exercise programs have been shown to counteract most aspects of sarcopenia. In addition, good nutrition, especially adequate protein and energy intake, can help limit and treat age-related declines in muscle mass, strength, and functional abilities. Protein nutrition in combination with exercise is considered optimal for maintaining muscle function. With the goal of providing recommendations for health care professionals to help older adults sustain muscle strength and function into older age, the European Society for Clinical Nutrition and Metabolism (ESPEN) hosted a Workshop on Protein Requirements in the Elderly, held in Dubrovnik on November 24 and 25, 2013. Based on the evidence presented and discussed, the following recommendations are made (a) for healthy older people, the diet should provide at least 1.0-1.2 g protein/kg body weight/day, (b) for older people who are malnourished or at risk of malnutrition because they have acute or chronic illness, the diet should provide 1.2-1.5 g protein/kg body weight/day, with even higher intake for individuals with severe illness or injury, and (c) daily physical activity or exercise (resistance training, aerobic exercise) should be undertaken by all older people, for as long as possible.

Regional distribution of longevity population and chemical characteristics of natural water in Xinjiang, China

Xinjiang Province, China is recognized for the longevity of its inhabitants. To study the temporal and spatial variation of longevity region and chemical characteristics of natural water of longevity region in Xinjiang, three population censuses on county-level and 51 natural water samples from Hotan Prefecture, Xinjiang were collected and analyzed. 103 natural water samples were collected from the public papers. Population statistics on county-level showed that the number of centenarians per 100,000 inhabitants (OC) in Southern Xinjiang was 7.4(year 1990), 4.9(year 2000) and 2.1 times (year 2010) more than that of Northern Xinjiang, respectively. And distribution of the longevity index (LI%), centenarity index (CI%) and number of centenarians per 10,000 over 65 year-old subjects (UC) on county-level decreased from south to north. Natural water in Northern Xinjiang was mainly fresh soft water, and it was mainly fresh hard water and brackish hard water in Southern Xinjiang. Water quality of natural water in Northern Xinjiang was superior compare to that of Southern Xinjiang, while number of centenarians 65 year-old & over per 10,000 subjects in Northern Xinjiang were less than that of Southern Xinjiang before 2010. The research indicates that keeping on drinking water with high total hardness (TH) and Mg/Ca ratio might be good for the health.

Anemia and functional capacity in elderly Brazilian hospitalized patients

This study evaluated the association between anemia and physical functional capacity in a cross-sectional population-based sample of 709 hospitalized elderly patients aged 60 years and over admitted to the Madre Teresa Hospital, Belo Horizonte, State of Minas Gerais, Brazil. The Mann-Whitney or "t" test, and chi-square or Fisher exact test were used for quantitative and categorical variables, respectively, and hierarchical binary logistic regression was used to identify significant predictors. The presence of anemia was found in 30% of participants and was significantly associated with decreased functionality according to the two measures which were used - ADL (activities of daily living) and IADL (instrumental activities of daily living). Anemia was also independently associated with older age. The results of this study demonstrate a strong association between the presence of anemia and lower levels of functional capacity. Further investigations are needed to assess the impact of anemia treatment on the functionality and independence of older people.

Social factors associated with centenarian rate (CR) in 32 OECD countries

BACKGROUND

Over the last fifty years, the number of centenarians has dramatically increased. The centenarian rate (CR) is representative of the general longevity prevalent in a nation; it indicates the number of individuals aged 100 years or above at a given date divided by the size of the corresponding cohort of a given age. Two important attributes of the CR (50-54) are that it reflects both unchanged age-specific fertility and the absence of migration in populations. It can generally be used in longevity-based evaluations of the broader concept of successful ageing. As such, this retrospective analysis of the social factors that contribute to the CR (50-54) may help to identify the factors associated with successful ageing.This study estimates the CR (50-54) and elucidates the influence of social factors on successful ageing and the CR (50-54), examining 32 member countries of the Organization for Economic Co-operation and Development (OECD).

METHODS

The social indicators for this study were obtained from the United Nations database. The data for the analysis of centenarians in the 32 OECD countries were obtained from the world population prospects conducted by the United Nations. Associations between social factors and CR (50-54) were assessed using Pearson correlation coefficients and regression models.

RESULTS

Significant positive correlations were found between the CR (50-54) and the social factors of expenditure on health as a percentage of gross domestic product (HEGDP: r = 0.411, p < 0.021), general government expenditure on health as a percentage of total government expenditure (GGEH: r = 0.474, p < 0.006), the proportion of fixed-telephone subscriptions in the population (FTS: r = 0.489, p < 0.005), and the human development index (HDI: r = 0.486, p < 0.005). Finally, these CR (50-54) predictors were used to form a model of successful ageing, with higher HEGDP and GGEH as health expenditure, higher FTS as standard of living, and higher HDI as social well-being (R2 = 0.573, P < 0.025).

CONCLUSIONS

The findings suggest that an increased CR (50-54) is affected by multiple social factors involved in successful ageing. Therefore, if they wish to improve their country's CR (50-54), governments must strengthen their existing support services for the elderly through making improvements to standards of living, social well-being and through increased financing of the health sector.

Impact of Geriatric Conditions Versus Medical Diagnoses on ADL Disability Among Nonagenarians and Centenarians

Objective: The authors investigated the relationship of activities of daily living (ADL) disability with medical diseases and geriatric conditions among nonagenarians and centenarians. Method: Cross-sectional, n = 870 Chinese (age range: 90-108 years). Self-reported medical diseases and geriatric-specific conditions were obtained by face-to-face interviews. Biomedical measurements included systolic/diastolic blood pressure, BMI (body mass index), albumin, fasting glucose, creatinine clearance, hemoglobin, and lipid panel. Results: In bivariate analyses, 4 of 7 geriatric conditions (hearing problems, falls, cognitive impairment, fracture), and 6 of 11 biomedical measurements (fasting glucose, cholesterol, LDL, creatinine clearance, hemoglobin, albumin), but none of 10 medical diseases and no degree of comorbidities, were associated with ADL disability. In four different multivariate logistic regression models, two geriatric conditions (impaired cognition, fracture) were significant in three models, respiratory disease in one model, and fasting glucose in two models. Discussion: This study emphasizes the importance of geriatric conditions and their association with ADL disability among the oldest-old adult population.

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

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

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

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

The Relationship between Physical Health and Psychological Well-Being among Oldest-Old Adults

The purpose of this study was to evaluate the relationship between physical health and psychological well-being among oldest-old adults. Structural equation modeling was performed to examine health influences on psychological well-being among 306 octogenarians and centenarians from the Georgia Centenarian Study. Latent variables were created to reflect subjective health, as measured by self-ratings of health and objective health, as measured by physical health impairment (i.e., health problems, past and present diseases, hospitalization) and biomarkers (i.e., hemoglobin and albumin). Psychological well-being was measured by positive and negative affect. There were significant direct effects of subjective health on affect and significant indirect effects of objective health through subjective health on positive affect and negative affect. Subjective health took the role of a mediator between objective health and psychological well-being. These results highlight the status and perceptions of health as a critical indicator for well-being in extreme old age.

In home or at home? How collective decision making in a new care facility enhances social interaction and wellbeing amongst older adults

Benevolent, long-term care can threaten older adults' sense of autonomy in a residential home environment. Increasing reliance on a hotel style of living has been seen to erode social identity, life satisfaction and even survival or lifespan. Drawing on evidence from both gerontological and social psychological literature, this paper examines the links between the empowerment of residents and their subsequent quality of life in the context of a move into a new care facility in a medium-sized town in South-West England. A longitudinal experiment was conducted during which 27 residents on one floor of a new facility were involved in decisions surrounding its décor, while those on another floor were not. The residents' attitudes and behaviour were monitored at three points over five months (four weeks pre-move, four weeks post-move, and four months post-move). Consistent with the social identity literature, members of the empowered group reported increased identification with staff and fellow residents in the new home, displayed enhanced citizenship, reported improved wellbeing, and made more use of the communal space. Moreover the staff found the empowered residents to be more engaged with their environment and the people around them, to be generally happier and to have better health. These patterns were observed one month after the move and remained four months later. Some implications for theory and practice are discussed.

Correspondence of perceptions about centenarians' mental health

OBJECTIVES

The goals of this study were to uncover the criteria by which centenarians, proxy/caregivers, and interviewers rated centenarians' mental health. Often proxy and interviewer reports are obtained in studies of the oldest-old and become a primary source of information.

METHODS

Data were from a population-based sample of mentally competent US centenarians in northern Georgia. The dependent variables were based on alternative reports for the centenarians' mental or emotional health. Regression analysis was used to predict each source's rating of mental health separately with the same set of variables. These variables included information obtained from the centenarians and proxies about their distal experiences, demographics, and proximal resources including Mini-Mental Status Examination (MMSE), health, personality, socioeconomic resources, and coping behaviors.

RESULTS

Examination of mean-level differences between sources revealed similarity across mental health ratings. For centenarians and proxies, perceived economic status was a very important predictor of mental health. For centenarians and interviewers, personality (neuroticism and extraversion) was an important common predictor. The interviewer and proxy mental health ratings were strongly associated with MMSE, but that was not the case for centenarians.

CONCLUSION

Mean-level findings and the comparative regression results provide corroborating evidence that centenarians' self-reports of mental health are similar based on average ratings and presence of common associations with other raters (i.e., perceived economic status and personality). Implications of differences across rater pairs are discussed as guidance about the comparative value of substitution of proxies as informants for addressing specific influences on mental health.

Centenarians--a useful model for healthy aging? A 29-year follow-up of hospitalizations among 40,000 Danes born in 1905

Centenarians surpass the current human life expectancy with about 20-25 years. However, whether centenarians represent healthy aging still remains an open question. Previous studies have been hampered by a number of methodological shortcomings such as a cross-sectional design and lack of an appropriate control group. In a longitudinal population-based cohort, it was examined whether the centenarian phenotype may be a useful model for healthy aging. The study was based on a complete follow up of 39,945 individuals alive in the Danish 1905 birth cohort on January 1, 1977 identified through the Danish Civil Registration System (DCRS). Data from the Danish Demographic Database and The Danish National Patient Register (in existence since 1977) were used. The 1905 cohort was followed up from 1977 through 2004 with respect to hospitalizations and number of hospital days. Survival status was available until December 2006. Danish centenarians from the 1905 cohort were hospitalized substantially less than their shorter-lived contemporaries at the same point in time during the years 1977 through 2004. For example, at age 71-74, the proportion of nonhospitalized centenarians was 80.5% compared with 68.4% among individuals who died in their early 80s. This trend was evident in both sexes. As a result of their lower hospitalization rates and length of stay in hospital compared with their contemporaries, who died at younger ages, Danish centenarians represent healthy agers. Centenarians constitute a useful study population in the search for fixed traits associated with exceptional longevity, such as genotype.