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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Differentials in Health and Wellbeing in Older Adults with Obesity in England: A Cross-Sectional Analysis Using the English Longitudinal Study of Ageing

The aim of the study is to explore the association of obesity by body mass index (BMI) measurements with subjective health status (SHS), objective health status (OHS) and wellbeing status among older adults in England. The sample of 5640 participants (aged 50 years and over) are considered from the English Longitudinal Study of Ageing Wave 8 dataset. Multivariate logistic regression analysis is performed to explore the cross-sectional relationship of the study variables. The statistical analyses explored those overweight and obese older adults are progressively vulnerable to increasing odds of poor SHS, OHS and poor wellbeing in an adjusted model compared to their normal-weight counterparts. The outcome of the present study would enable policymakers and healthcare providers to have greater insight into the effects of socio-demographic and lifestyle factors and the effect of high BMI on older adults’ health and wellbeing.

Association of Diet Quality With Longevity and Successful Aging in Israeli Adults 65 Years or Older

IMPORTANCE

To our knowledge, the role of overall diet quality in successful aging has not been conclusively demonstrated.

OBJECTIVE

To prospectively examine the association between diet quality and longevity and successful aging in a population-based cohort of older adults.

DESIGN, SETTING, AND PARTICIPANTS

Participants in "Mabat Zahav" (the Israeli National Health and Nutrition Survey of Older Adults), an older adult cohort (aged ≥65 years) consisting of a random sample of 1770 individuals, were recruited from July 2005 to December 2006 (time 1 [T1]). Survivors of T1 were again contacted and asked to participate in a second interview. From May 2017 to June 2019 (time 2 [T2]), an extensive face-to-face interview and a functional assessment were conducted in each participant's home in a subsample of 604 participants from T1, representing 72.7% of 820 surviving individuals who were able to complete interviews and assessments.

EXPOSURES

A 24-hour dietary recall, assessed at T1, was used to calculate scores from the 2015 version of the Healthy Eating Index (HEI-2015) (scores range from 0 [worst diet] to 100 [best diet]).

MAIN OUTCOMES AND MEASURES

Time to death, with follow-up lasting through June 2019, and successful aging. The latter, based on T2 assessment, was defined as (objectively measured) preserved physical and cognitive function and (subjective) mental well-being and favorable self-rated health. Inverse probability weighting was used in the analysis to minimize attrition bias.

RESULTS

At T1, the study included 1770 participants (mean [SD] age, 74.6 [6.2] years; 943 women [53%]). On average, participants with higher HEI-2015 scores had healthier lifestyles and higher socioeconomic status at T1. During a median follow-up duration of 12.6 years (IQR, 7.6-13.2 years), 893 deaths occurred. Among the 596 T2 participants analyzed (mean [SD] age, 84.1 [4.4] years; 334 [56%] women), 242 (40%) met successful aging criteria. After adjustment for sociodemographic and lifestyle risk factors, a higher HEI-2015 score was inversely associated with mortality (hazard ratios, 0.85; 95% CI, 0.72-0.99 in the upper tertile and 0.83; 95% CI, 0.71-0.98 in the middle tertile vs the lower tertile; P = .04 for trend) and was positively associated with successful aging (odds ratios, 1.73; 95% CI, 1.10-2.72 in the upper tertile and 1.30; 95% CI, 0.83-2.03 in the middle tertile vs the lower tertile; P = .03 for trend).

CONCLUSIONS AND RELEVANCE

In this cohort study of older adults in Israel, improved diet quality was associated with increased longevity and successful aging in a dose-dependent manner. These data contribute to the body of literature that suggests diet quality is associated with aging in the older age group.

A systematic review of the associations, mediators and moderators of life satisfaction, positive affect and happiness in near-centenarians and centenarians

OBJECTIVE

Results from studies investigating life satisfaction, positive affect and happiness of near-centenarians (95+) and centenarians are inconsistent. This is the first systematic review to summarise the extant literature on the subjective well-being of this unique age group.

METHOD

Seven electronic databases (PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science and the Cochrane database for systematic reviews) were systematically searched. Subjective well-being was defined as life satisfaction, positive affect and happiness. A narrative synthesis of relevant articles was undertaken.

RESULTS

Of 28 studies eligible for inclusion in this review, 20 predominantly examined life satisfaction, 11 positive affect and 4 happiness. Sex and other demographic variables were not significant predictors of subjective well-being. In contrast, greater perceived health was significantly associated with higher levels of life satisfaction and positive affect. Fatigue and visual impairment were significantly correlated with lower levels of life satisfaction and positive affect. However, there was considerable heterogeneity in the findings on physical, cognitive and social associations, mediators and moderators.

CONCLUSION

The large discrepancy of results in the literature may be explained by methodological differences between studies. Centenarian research needs a clearer definition of life satisfaction, positive affect and happiness as their operationalisation is inconsistent. An international consortium of centenarian studies could facilitate cross-cultural comparisons on subjective well-being. Future research should be directed towards interventions that promote subjective well-being in the oldest-old.

Reaching 80 Years of Age: Clinical, Behavioral, and Psychosocial Related Risk Factors in a Large Cohort of Israeli Working Men

The objective of this study was to estimate the probability of long-term overall survival based on total number of risk factors (RF). We also sought to examine the role of midlife clinical, behavioral, and psychosocial predictors of longevity in a large cohort of Israeli men. This study was based on the Israeli Ischemic Heart Disease (IIHD) cohort that included over 10,000 men who were followed up for mortality over more than four decades. During the 43 years of follow-up, 4634 (46.1%) men survived to 80 years of age or older. We considered cigarette smoking, diabetes mellitus, high systolic blood pressure, hypercholesterolemia, low socioeconomic status, and serious family problems as RF at ages 40–65. Cox proportional hazards regression models, with age as the time scale, were constructed to estimate the hazard ratios (HRs) for failure to survive 80 years of age. Compared with men free of all the above RF, those with one identified RF (HR = 1.58, 95% CI: 1.42–1.75) and counterparts with two identified RF (HR = 2.18, 95% CI: 1.96–2.43) were at a significantly greater risk of death before 80. Additional RF further increased the risk of early mortality (HR = 3.62, 95% CI: 1.50–8.73 for men with 5 RF). The results suggest a role of physiological, behavioral, and psychological risk factors at midlife in predicting longevity.

Factors associated with successful aging in Brazilian community-dwelling older adults: When physical health is not enough

OBJECTIVES

To determine the main factors (physical, psychological, social and spiritual) associated with successful aging in community-dwelling older adults.

METHODS

A cross-sectional study of older adults was conducted evaluating successful aging (Successful Aging Scale-SAS) and its associated factors (sociodemographics, resilience, religiosity/spirituality, meaning in life, quality of life, social support, self-reported diseases, mental health, medications used, among others) using regression models.

RESULTS

A total of 534 older adults were assessed. Linear regression models showed an association of higher SAS score with greater resilience (Beta = 0.371, p < 0.001), spiritual well-being - meaning (Beta = 0.174, p < 0.001) and quality of life - physical (Beta=0.203, p < 0.001), fewer diseases (Beta=-0.128, p < 0.001), greater meaning in life (Beta=0.116, p = 0.001), less loneliness (Beta=-0.133, p = 0.001), lower tobacco use (Beta=0.080, p = 0.013), greater quality of life - environment (Beta=-0.092, p = 0.013) and more frequent religious attendance (Beta=0.068, p = 0.035).

CONCLUSION

The study results suggested that physical factors, although relevant, were not the main factors associated with successful aging.

Caregiving adult children's perceptions of challenges relating to the end of life of their centenarian parents

BACKGROUND

The number of centenarians in Europe is increasing; many face health impairments. Adult children often play a key role in their care, but there is a lack of research into what it means for these caregiving relatives to be confronted for many years with their parents' end of life (EOL), dying and death as well as their own advancing age.

AIM

This study aims to analyse the challenges of caregiving adult children regarding their parents' end of life and the related burdens and barriers they report.

MATERIAL AND METHODS

Semi-structured interviews were conducted with 13 caregivers following a theory-based and tested guideline. The computer-aided coding and evaluation followed the structured content analysis approach.

RESULTS

The analysis showed three main themes: 'Confronting EOL', 'Communicating about death and dying' and 'Assisting in the terminal phase'. The respondents commented on burdensome demands and concerns about the future. Further, a strong underlying presence of intra- and interpersonal conflicts relating to EOL became apparent.

DISCUSSION

The results indicate several potential burdens for centenarians' caregiving offspring. They are confronted with a double challenge resulting from the combination of their own advanced age and experiencing the burdens of their parents' very old age. Further, some participants struggled with their own unclear perspective on the future because of the relative but unclear proximity of the parent's death. Multiple conflicts and overlapping conflict dimensions emphasise the potential of the EOL topic to influence the well-being of family caregivers and care recipients.

LIMITATIONS

The convenience sample used for the study may cause limitations, for example, the fact that persons with a formally lower educational status are not represented.

CONCLUSION

The findings suggest that interventions designed for family-related care situations should include topics like 'Finiteness and grief', 'Communicating about dying and death' and 'Decisions and dispositions at EOL'.

Investigation of healthy living strategies in elderly who achieved to live long and healthy

Objective

To determine the lifestyles, healthy living strategies and socio-cultural characteristics of elderly people who lived long and healthy.

Methods

This study was a cross-sectional study. This study was conducted on 472 elderly patients, aged 80 years and over, selected by random sampling method. The socio-demographic characteristics and daily living activities of the elderly were determined by face to face interview technique using the "Elderly Questionnaire" developed by the researchers in 2018. Chi-square test was used for statistical analysis.

Results

Based on the average age (84) of the elderly in the research group, it was seen that they were able to exceed the average life expectancy of their fathers (72) and mothers (73). It has been found that the participants live 11-12 years longer than their parents. It was also found that more than half (51.9%) of the elderly have the habit of walking regularly every day. It was determined that the elderly mostly consumed vegetables and fruits (88.5%), milk and dairy products and meat, respectively.

Conclusion

The elderly stated that natural and healthy nutrition, working and staying away from stress in the top three places as the reason of their long and healthy life.

Successful Present, Successful Future? Assessment of a Nonbinary Model of Successful Aging

PURPOSE

Though many models of successful aging exist, there is a need for assessments of the empirical validity of these models and their measures. This study tests the validity of the multidimensional model of successful aging presented by Young and colleagues.

DESIGN AND METHODS

Expanding on an earlier validation study, this analysis uses 1,211 respondents from the Americans' Changing Lives (ACL) study to determine predictive and discriminant validity. Respondents were surveyed in 1986, 1989, and 1994, providing an opportunity to assess if a baseline 5-point successful aging scale is associated with present and future outcomes. Validators include self-report items and interviewer recorded observations. In addition, a survival analysis of 24 years of ACL mortality data is conducted to confirm that baseline successful aging decreases risk of all-cause mortality.

RESULTS

Results illustrate that, in some cases as far as 8 years in the future, low successful aging scores correspond with higher risk of future hospitalization and depressive episodes, interviewer observed difficulty moving around, low self-rated health, and decreased life satisfaction. Lowest scorers also had a 356% higher risk of mortality compared to individuals with the highest scores.

IMPLICATIONS

These findings provide further evidence that Young and colleagues' successful aging construct is empirically valid and could be applied in future research and practice. Most respondents had middling scores, suggesting that future analyses should be cautious about concealing heterogeneity by operationalizing successful aging as a binary outcome.

Aging in high functioning elderly persons: study design and analyses of behavioral and psychological factors

This article aims to (a) describe the study design of a 6‐year follow‐up multidisciplinary research project on aging, (b) report the psychosocial characteristics of the sample in detail, and (c) evaluate aging‐related changes of health, physical activity, and psychosocial characteristics in 10 young‐old (age at pre‐test: M ± SD = 63.2 ± 1.5) and 12 old‐old (age at pre‐test: M ± SD = 69 ± 2) individuals. Both age groups consist of individuals displaying a high health status, a high extent of physical activity, high levels of psychosocial properties in the dimensions of well‐being, life satisfaction, self‐concept, body image, self‐esteem, and self‐efficacy, as well as a low general depression index. Psychosocial characteristics demonstrated a stable pattern over a period of nearly 6 years in both age groups with the exceptions of physical activity, satisfaction with children, general depression, and self‐efficacy. Furthermore, physical self‐concept decreased in old‐old adults, whereas the young‐olds showed no change. We assume that a high psychosocial status and a physically active lifestyle play an important role for mastering aging successfully in two life phases, each of which has its own challenges for older individuals. The decline in the physical self‐concept of old‐olds is interpreted as a first sign of subjective aging. Its association with losses in physical performance should be addressed in future studies. Finally, aging‐related changes should be monitored on an individual level in order to capture the complex dynamic of aging that is not considered in analyses of between‐person differences or averages.

The Role of Grandchildren's Own Age-Related Communication and Accommodation From Grandparents in Predicting Grandchildren's Well-Being

This study examined how the accommodative environments experienced from grandparents and grandchildren's own age-related communication are indirectly associated with grandchildren's life satisfaction, depressive symptoms, and loneliness, via grandchildren's self-efficacy with respect to aging. The communication experienced from grandparents was classified as accommodative, ambivalent, and mixed-accommodative chatter. Grandchildren were classified into engaged, disengaged, bantering, and disengaged-joking profiles based on their own age-related communication. Grandchildren who experienced accommodative chatter were likely to be engaged and disengaged communicators about age-related issues; grandchildren who experienced mixed-accommodative chatter were likely to be bantering communicators about age-related issues. Relative to engaged communicators, disengaged-joking communicators demonstrated lower life satisfaction, more depressive symptoms, and greater loneliness, via lower self-efficacy with respect to aging. Patterns of accommodation and nonaccommodation from grandparents may place grandchildren on specific trajectories for communicating about age, and grandchildren's own communication may be consequential for well-being even at relatively young periods of the life span.

Regional differences in morbidity profiles and health care use in the oldest old: Findings from two Centenarian Studies in Portugal

BACKGROUND

The worldwide increase of human life expectancy and the rapid aging of the population will contribute to an increasing prevalence of chronic illness. Even so, individuals who reach very advanced ages often postpone or escape age-related diseases that are common causes of death.

OBJECTIVE

This article aims to examine health-related characteristics of two distinct samples of Portuguese centenarians (one predominantly rural - PR vs. one predominantly urban - PU), and explore potential dissimilarities in their morbidity profiles and use of health care services.

METHODS

A total of 241 centenarians were considered. Sociodemographic characteristics, health status, and use of health care services were assessed by semi-structured interviews with the centenarians and their proxies (family or formal caregiver).

RESULTS

A higher average of 4.80 self-reported illnesses (sd = 2.01) were found in the PU sample (vs. 2.96; sd = 1.77 in the PR sample); in overall the PR sample presented a better health condition with lower levels of physical and mental impairments, and a greater number of centenarians who did not succumb to the three most common lethal diseases (heart disease, non-skin cancer and stroke) in the elderly population (85.4% vs. 60% in the PU sample).

CONCLUSIONS

Portuguese centenarians experienced a substantial number of illnesses, but an overall better health status was found in centenarians from the PR area. By providing distinctive health-related profiles, our findings suggest the importance of contextual factors in shaping how very advanced ages may be achieved.

Of Mice, Whales, Jellyfish and Men: In Pursuit of Increased Longevity

The quest for increased human longevity has been a goal of mankind throughout recorded history. Recent molecular studies are now providing potentially useful insights into the aging process which may help to achieve at least some aspects of this quest. This chapter will summarize the main findings of these studies with a focus on long-lived mutant mice and worms, and the longest living natural species including Galapagos giant tortoises, bowhead whales, Greenland sharks, quahog clams and the immortal jellyfish.

Binary and Nonbinary Measures of Successful Aging: Do They Yield Comparable Conclusions?

Recently, some researchers have employed nonbinary measures of successful aging. Little has been done to determine whether these newer measures yield similar findings compared to traditional binary measures. To test for differences, three measures of successful aging were constructed within five waves of the Americans' Changing Lives data set. A number of demographic, behavioral, and psychosocial predictors were used to predict each outcome, examining whether estimates of effect sizes and statistical significance were similar across measures. Although many effect sizes were similar, conclusions regarding statistical significance were inconsistent. For instance, the binary measure downplayed income gradients, the ordinal measure found more racial disparities, and the continuous measure was most likely to detect effects for stressful life events. These differences may be due to the statistical techniques used to handle each outcome. Results imply that uneven application of operationalization approaches may complicate replication efforts, suggesting a need for consistent measurement standards.

Prevalence and related factors of Active and Healthy Ageing in Europe according to two models: Results from the Survey of Health, Ageing and Retirement in Europe (SHARE)

BACKGROUND

Active and Healthy Ageing (AHA) is the process of optimizing opportunities related to health, participation, and safety in order to improve quality of life. The approach most often used to measure AHA is Rowe and Kahn's Satisfactory Ageing model. Nonetheless, this model has limitations. One of the strategic objectives of the WHO Global Strategy and Action Plan (2016) is to improve Healthy Ageing measurement. Our objectives were to compare two models of assessing AHA and further compare the results by country and sociodemographic variables.

METHODS

This was a cross-sectional, observational analysis of a representative sample of the general population aged 50 years and older in Europe. The data analysed were obtained by the Study of Health, Ageing and Retirement in Europe (SHARE). The dependent variable was AHA and its dimensions, measured using the Rowe and Kahn AHA model (AHA-B) and the authors' model based on the WHO definition (AHA-BPS). A descriptive analysis and multivariate models of binary logistical regression were developed.

RESULTS

The sample consisted of 52,641 participants (mean age 65.24 years [SD = 10.18; Range = 50-104], 53.2% women). Healthy Ageing prevalence in the AHA-B model was 23.5% (95%CI = 23.1%-23.9%). In the AHA-BPS model, this prevalence was 38.9%. In both models, significant variations were observed between countries, and were distributed along a north-western to south-eastern gradient. The sociodemographic variables associated with the absence of AHA were advanced age, female sex, death of spouse, low educational level, lack of employment, and low financial status. Comparing the two models, the strength of association between absence of AHA and advanced age (85 years and older) was four times greater in the AHA-B model.

CONCLUSIONS

Our results showing differences between these two models provide evidence that the AHA-BPS model does not penalize older age and is more likely to characterize AHA from a health promotion perspective.

Sixteen-year predictors of successful aging from a Southern Brazilian cohort The PALA study

Successful aging (SA) is a current positive aging-related perspective and it is important to determine the variables associated with this concept. Most longitudinal population-based studies on predictors of SA were carried out in developed countries.

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

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

Genomic Approach to Understand the Association of DNA Repair with Longevity and Healthy Aging Using Genomic Databases of Oldest-Old Population

Aged population is increasing worldwide due to the aging process that is inevitable. Accordingly, longevity and healthy aging have been spotlighted to promote social contribution of aged population. Many studies in the past few decades have reported the process of aging and longevity, emphasizing the importance of maintaining genomic stability in exceptionally long-lived population. Underlying reason of longevity remains unclear due to its complexity involving multiple factors. With advances in sequencing technology and human genome-associated approaches, studies based on population-based genomic studies are increasing. In this review, we summarize recent longevity and healthy aging studies of human population focusing on DNA repair as a major factor in maintaining genome integrity. To keep pace with recent growth in genomic research, aging- and longevity-associated genomic databases are also briefly introduced. To suggest novel approaches to investigate longevity-associated genetic variants related to DNA repair using genomic databases, gene set analysis was conducted, focusing on DNA repair- and longevity-associated genes. Their biological networks were additionally analyzed to grasp major factors containing genetic variants of human longevity and healthy aging in DNA repair mechanisms. In summary, this review emphasizes DNA repair activity in human longevity and suggests approach to conduct DNA repair-associated genomic study on human healthy aging.

Technology Access and Use, and Their Associations With Social Engagement Among Older Adults: Do Women and Men Differ?

Objectives

To examine how information and communication technology (ICT) access and use are conceptually incorporated in the Successful Aging 2.0 framework.

Method

Using data from the 2011 National Health and Aging Trends Study (N = 6,476), we examined how ICT access and use for different purposes are associated with social engagement (i.e., informal and formal social participation) by gender. Weighted logistic regression analyses were performed.

Results

Findings revealed that men were more likely to access and use ICT than women. ICT access was positively associated with all types of women's social engagement, but only with men's informal social participation. Information technology (IT) use for health matters was positively associated with formal social participation for women and with informal social participation for men. IT use for personal tasks was negatively associated with formal social participation for older adults. Communication technology use was positively associated with formal and informal social participation for women and men.

Discussion

This study supports the expansion of the successful aging model by incorporating ICT access and use. Further, it assists in the identification of specific technologies that promote active engagement in later life for women and men.

Adapting to Aging: Older People Talk About Their Use of Selection, Optimization, and Compensation to Maximize Well-being in the Context of Physical Decline

Objectives:

Selection, Optimization, and Compensation (SOC) may contribute to successful aging by helping older people maximize well-being in the context of physical decline. To explore this hypothesis, and to investigate the potential for narrative analysis to improve understanding of SOC, we analyze interviews conducted with 15 members of the 6-Day Sample, a cohort of Scots born in 1936.

Method:

Interviewees were chosen based on their physical function and well-being scores. Interviews were analyzed to investigate “SOC talk,” that is, older people’s talk about SOC behaviors in everyday life. Types and amounts of SOC talk were quantified, and talk was narratively analyzed. We hypothesized that older people who engaged in more SOC talk would have higher well-being.

Results:

Older people who engaged in high levels of SOC talk had high well-being despite low physical function. Those who engaged in little SOC talk had low well-being despite higher physical function.

Discussion:

The concept of successful aging is valuable in part because of its narrative quality: One must strive to keep one’s life story developing despite physical decline and other losses. We provide evidence, from the perspectives of older people themselves, of the ways in which SOC may play a role in that process.

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

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

[Centenarians preparing for the end of life?]

BACKGROUND

The population of centenarians has grown immensely in Germany but has yet hardly been considered in research on dying and death. Due to their very old age centenarians are especially intensively confronted with the challenge of the end of life.

OBJECTIVE

The aim of this study was to analyze how centenarians handle the existential challenge of the end of life and which aspects are especially significant for them. Conclusions drawn from this analysis were used to identify factors to improve the needs-based provision of care.

MATERIAL AND METHODS

Trained interviewers interrogated 15 centenarians living in Berlin using semi-structured interviews based on theoretically developed and tested guidelines. Subsequently, the interviews were transcribed, computer coded and analyzed following the method of the qualitative content analysis according to Kuckartz.

RESULTS

In the categories "experience with dying and death" and "preparing for the end of life" it was shown to be significant that respondents often referred to the dying of others with respect to their worries and wishes at the end of their life. Additionally, the subcategories "putting things in order", "settling provision of care" and "having conversations" were shown to be highly relevant for the participants in the study.

CONCLUSION

Decisions related to care in the process of dying, for example by advance directives, arrangements for inheritance and funeral as well as communication about dying and death, are central needs of centenarians when preparing for the end of life. There is sometimes considerable need for professional support and protection.

Successful aging among Chinese near-centenarians and centenarians in Hong Kong: a multidimensional and interdisciplinary approach

OBJECTIVES

This study applied a multidimensional model on a continuum to examine successful aging (SA) and investigated whether SA is associated with biomedical and psychosocial-demographic factors among Hong Kong Chinese near-centenarians and centenarians.

METHOD

A cross-sectional data analysis was performed on a geographically representative sample of 120 near-centenarians and centenarians with an age range of 95-108 years. We developed an integrated and cumulative Successful Aging Index (SAI) based on participants' performance in four dimensions: (1) physical and functional health (PF), (2) psychological well-being and cognition (PC), (3) social engagement and family support (SF), (4) economic resources and financial security (EF). To examine the criterion validity of SAI, we conducted a multiple binary logistic regression with interviewer-rated health. A multiple regression model was ran to investigate the independent biomedical and psychosocial-demographic correlates of SAI.

RESULTS

Results show that only 5.8% of participants attained SA in all four dimensions. PF had the least achievers, whereas the proportion was the highest in PC. SAI was significantly associated with interviewer-rated health and a high level of high-density lipoprotein cholesterol. Living with family or friends, high level of optimism, fewer diseases, and barriers to social activities were independent predictors of SAI score.

CONCLUSION

In the light of the lack of consensus on the constituents and assessment of SA especially among very old adults, our findings add to the extant literature by underscoring the importance of the multidimensional nature and the utility of an integrated and cumulative-based assessment of SA at the extreme of longevity.

Successful aging: considering non-biomedical constructs

OBJECTIVES

Successful aging continues to be applied in a variety of contexts and is defined using a number of different constructs. Although previous reviews highlight the multidimensionality of successful aging, a few have focused exclusively on non-biomedical factors, as was done here.

METHODS

This scoping review searched Ovid Medline database for peer-reviewed English-language articles published between 2006 and 2015, offering a model of successful aging and involving research with older adults.

RESULTS

Seventy-two articles were reviewed. Thirty-five articles met the inclusion criteria. Common non-biomedical constructs associated with successful aging included engagement, optimism and/or positive attitude, resilience, spirituality and/or religiosity, self-efficacy and/or self-esteem, and gerotranscendence.

DISCUSSION

Successful aging is a complex process best described using a multidimensional model. Given that the majority of elders will experience illness and/or disease during the life course, public health initiatives that promote successful aging need to employ non-biomedical constructs, facilitating the inclusion of elders living with disease and/or disability.

Happy life expectancy among older adults: differences by sex and functional limitations

OBJECTIVE

To evaluate if the happy life expectancy in older adults differs according to sex and functional limitations.

METHODS

Life expectancy was estimated by Chiang method, and happy life expectancy was estimated by Sullivan method, combining mortality data with the prevalence of happiness. The questions on happiness and limitations came from a health survey, which interviewed 1,514 non-institutionalized older adults living in the city of Campinas, SP, Southeastern Brazil. The happy life expectancy was estimated by sex, age, and functional limitations. Based on the variance and standard error of the happy life expectancy, we estimated 95% confidence intervals, which allowed us to compare the statistical differences of the number of happy years lived among men and women.

RESULTS

Differences by sex in happy life expectancy were significant at ages 60, 65, and 70. In absolute terms, women live more years happily. But, in relative terms, older men could expect to live proportionally more years with happiness. Happy life expectancy decreased significantly with increasing age in both men and women. Among older people living without functional limitation, differences by sex were statistically significant in all age groups, except at age 80. In the group with limitations, no significant differences by sex were found. Significant differences between the group without and with functional limitations were seen in both men and women.

CONCLUSIONS

Older men could expect to live a greater proportion of their lives happily in comparison to same-aged women, but women show more years with happiness than men. Functional limitations have a significant impact on happy life expectancy for both sexes.

Population Health Management for Older Adults: Review of Interventions for Promoting Successful Aging Across the Health Continuum

Background: The older adult population is expanding, living longer, with multiple chronic conditions. Understanding and managing their needs over time is an integral part of defining successful aging. Population health is used to describe the measurement and health outcomes of a population. Objectives: To define population health as applied to older adults, summarize lessons learned from current research, and identify potential interventions designed to promote successful aging and improved health for this population. Method: Online search engines were utilized to identify research on population health and health interventions for older adults. Results: Population health management (PHM) is one strategy to promote the health and well-being of target populations. Interventions promoting health across a continuum tend to be disease, risk, or health behavior specific rather than encompassing a global concept of health. Conclusion: Many existing interventions for older adults are simply research based with limited generalizability; as such, further work in this area is warranted.

Successful aging at 100 years: the relevance of subjectivity and psychological resources

BACKGROUND

Very old individuals seem to present an admirable capacity to overcome adversities and adapt to the challenges of advanced age. However, studies focusing successful pattern of centenarians found that they may easily fail to be categorized as successful agers when objective criteria are applied. The present study examines if centenarians can be considered successful agers. Following Rowe and Kahn's successful aging model, the primary goal was to clarify whether centenarians are able to be successful agers according to objective and subjective criteria of no major disease and disability, high cognitive and physical functioning and engagement with life. The second goal was to investigate whether socio-demographic factors, psychological, social, and economic resources are related to objective and subjective successful aging profiles.

METHODS

We examined different profiles of successful aging in a high selected sample of individuals aged 100 and more years old from the population-based Oporto Centenarian Study.

RESULTS

Main findings reveal that centenarians do not represent the prototype of successful aging, but self-ratings demonstrate that many of them feel successful, despite not being objectively considered as so. Those who were considered successful agers presented higher values of self-efficacy, hope, and purpose in life, as well as few difficulties in covering financial expenses.

CONCLUSIONS

As a basis for strengthening the existing model, the value of subjectivity should be explored and psychological resources promoted in interventions to foster positive adaptation in very old age.

Predicting Successful Aging at One Hundred Years of Age

Objective:

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

Methods:

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

Results:

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

Conclusion:

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

Defining successful aging: a tangible or elusive concept?

PURPOSE OF THE STUDY

Everyone wants to age successfully; however, the definition and criteria of successful aging remain vague for laypersons, researchers, and policymakers in spite of decades of research on the topic. This paper highlights work of scholars who made significant theoretical contributions to the topic.

DESIGN AND METHODS

A thorough review and evaluation of the literature on successful aging was undertaken.

RESULTS

Our review includes early gerontological definitions of successful aging and related concepts. Historical perspectives reach back to philosophical and religious texts, and more recent approaches have focused on both process- and outcome-oriented models of successful aging. We elaborate on Baltes and Baltes' theory of selective optimization with compensation [Baltes, P. B., & Baltes, M. M. (1990a). Psychological perspectives on successful aging: The model of selective optimization with compensation. In P. B. Baltes & M. M. Baltes (Eds.), Successful aging: Perspectives from the behavioral sciences (pp. 1-34). United Kingdom: Cambridge University Press], Kahana and Kahana's preventive and corrective proactivity model [Kahana, E., & Kahana, B. (1996). Conceptual and empirical advances in understanding aging well through proactive adaptation. In V. Bengtson (Ed.), Adulthood and aging: Research on continuities and discontinuities (pp. 18-40). New York: Springer], and Rowe and Kahn's model of successful aging [Rowe, J. W., & Kahn, R. L. (1998). Successful aging. New York: Pantheon Books], outlining their commonalities and differences. Additional views on successful aging emphasize subjective versus objective perceptions of successful aging and relate successful aging to studies on healthy and exceptional longevity.

IMPLICATIONS

Additional theoretical work is needed to better understand successful aging, including the way it can encompass disability and death and dying. The extent of rapid social and technological change influencing views on successful aging also deserves more consideration.

Cross-cultural comparison of successful aging definitions between Chinese and Hmong elders in the United States

The purpose of the study was to elicit the definitions of successful aging according to Chinese and Hmong elders living in Milwaukee, WI. In-depth semi-structured interviews were conducted with 44 elders (Hmong n = 21 and Chinese n = 23). Findings show some similarities in the Chinese and Hmong elders' definitions though specific cultural differences exist. Chinese elders emphasized physical health and mobility, mental health, positive attitudes, shedding responsibilities, positive family relationships, financial stability, social engagement, religious faith, and accomplishments and volunteer work. Hmong elders emphasized physical health and mobility, mental health, harmonious relationships, positive family relationships, tangible family support, financial stability, social engagement, and religious faith. Cross-cultural comparisons of the findings highlight the cultural heterogeneity between these two subgroups. Implications for practice are discussed.

Successful aging and subjective well-being among oldest-old adults

PURPOSE OF THE STUDY

This research integrates successful aging and developmental adaptation models to empirically define the direct and indirect effects of 2 distal (i.e., education and past life experiences) and 5 proximal influences (i.e., physical functioning, cognitive functioning, physical health impairment, social resources, and perceived economic status) on subjective well-being. The proximal influences involved predictors outlined in most extant models of successful aging (e.g., Rowe & Kahn, 1998 [Rowe, J. W., & Kahn, R. L. (1998). Successful aging. New York: Pantheon Books.]). Our model extends such models by including distal impact as well as interactions between distal and proximal impacts.

DESIGN AND METHODS

Data were obtained from 234 centenarians and 72 octogenarians in the Georgia Centenarian Study. Structural equation modeling was conducted with Mplus 6.1.

RESULTS

Results showed significant direct effects of physical health impairment and social resources on positive aspects of subjective well-being among oldest-old adults. We also found significant indirect effects of cognitive functioning and education on positive affect among oldest-old adults. Social resources mediated the relationship between cognitive functioning and positive affect; and cognitive functioning and social resources mediated the relationship between education and positive affect. In addition, physical health impairment mediated the relationship between cognitive functioning and positive affect; and cognitive functioning and physical health impairment mediated the relationship between education and positive affect.

IMPLICATIONS

Integrating 2 different models (i.e., successful aging and developmental adaptation) provided a comprehensive view of adaptation from a developmental perspective.

Tracing the origins of success: implications for successful aging

PURPOSE OF THE STUDY

This paper addresses the debate about the use of the term "successful aging" from a humanistic, rather than behavioral, perspective. It attempts to uncover what success, a term frequently associated with aging, is: how can it be defined and when did it first come into use? In this paper, we draw from a number of humanistic perspectives, including the historical and linguistic, in order to explore the evolution of the term "success." We believe that words and concepts have deep implications for how concepts (such as aging) are culturally and historically perceived.

DESIGN AND METHODS

We take a comparative approach, turning to the etymological roots of this term in British, French, and German literature. According to the earliest entries of the term in the Oxford English Dictionary, events can have good or bad success. Another definition marks success as outcome oriented.

RESULTS

Often used in the context of war, religion, and medicine, the neutral, but often negative, use of "success" in literature of the Renaissance demonstrates the tensions that surround the word, and suggests that success is something to be approached carefully.

IMPLICATIONS

Ignoring the ambiguous origins of success erases the fact that aging in earlier centuries echoes much of the same ambivalence with which many people discuss it today. Attending to the origins of success can help gerontologists understand the humanistic tradition behind their inquiry into what successful aging means today.

Do successful agers live longer? The Vitality 90+ study

OBJECTIVE

To discover whether successful aging, understood as a multidimensional concept, predicts further survival in very old people.

METHOD

The population sample consisted of 1,370 persons aged 90 or over in the Vitality 90+ study. Four alternative models of successful aging were constructed, each of them consisting of physical, psychological, and social dimensions. Mortality was followed up after 4 and 7 years.

RESULTS

Three out of four models significantly predicted survival at both follow-ups for the whole group. Separately, "success" in the physical, psychological, and social components was also associated with higher survival. The associations were stronger in women than in men.

DISCUSSION

Successful aging, measured using physical, psychological, and social dimensions, predicts the length of future life in nonagenarians.

Association between subjective well-being and exceptional longevity in a longevity town in China: a population-based study

To examine the associations of cognitive and emotional facets (measured by life satisfaction [LS], positive affect [PA], negative affect [NA], and affect balance [AB]) of subjective well-being (SWB) with exceptional longevity (EL), we conducted a population-based study with 463 EL individuals (95+, EL group) recruited from a longevity town of Rugao, China (N = 755, with a response rate of 71.6 %), and 926 elderly individuals (60-69, elderly/control group). The population-based controls were sampled from the resident registry according to the gender ratio of the EL group. We found that the EL group had significantly higher levels of LS (30.74 vs. 28.93), PA (3.91 vs. 3.67), and AB (7.89 vs. 7.40) and a lower level of NA (1.02 vs. 1.27) than the elderly group. Multivariate logistic regression analysis revealed that higher levels of LS, PA, AB, and NA were significantly associated with EL, with odds ratios (ORs) of 1.98 (95 % CI, 1.36-2.89), 2.35 (95 % CI, 1.59-3.48), 2.56 (95 % CI, 1.75-3.75), and 0.50 (95 % CI, 0.33-0.74), respectively. Stratification analysis showed that the associations were significant in the healthy subsample, with the following ORs: LS = 2.31, PA = 2.53, AB = 3.05, and NA = 0.39. In conclusion, SWB, with high cognitive and emotional facets, was associated with EL in the healthy Rugao population. The findings imply that interventions that aim to improve elderly individuals' SWB may promote their quality of life and, ultimately, EL.

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

Background

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

Methods

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

Results

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

Conclusions

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

The epidemiology of longevity and exceptional survival

The field of the "epidemiology of longevity" has been expanding rapidly in recent years. Several long-term cohort studies have followed older adults long enough to identify the most long-lived and to define many factors that lead to a long life span. Very long-lived people such as centenarians have been examined using case-control study designs. Both cohort and case-control studies have been the subject of genome-wide association studies that have identified genetic variants associated with longevity. With growing recognition of the importance of rare variations, family studies of longevity will be useful. Most recently, exome and whole-genome sequencing, gene expression, and epigenetic studies have been undertaken to better define functional variation and regulation of the genome. In this review, we consider how these studies are leading to a deeper understanding of the underlying biologic pathways to longevity.