Health and Disease at Age 100

Comparing The Mediterranean and The Japanese Dietary Pattern in Relation to Longevity - A Narrative Review

The Mediterranean dietary pattern (MDP) and Japanese dietary pattern (JDP) have received increasing attention from the scientific community and media, predominantly due to their association with increased longevity and health. Although similarities between the two dietary patterns are evident, a detailed comparison between them is still relatively unexplored. This narrative review aimed to explore the similarities and differences between the MDP and JDP in terms of longevity while also reflecting on the adoption of these diets by other populations outside their regions of origin. Both dietary patterns are plant-based, minimally processed, and sustainable for their respective regions and have been shown to significantly prolong life expectancy in different populations. Nevertheless, these dietary patterns also differ in terms of macronutrient ratios, food preparation and consumption and individual cultural characteristics of each population. Additionally, both dietary patterns are part of broader lifestyle patterns, which include other behaviors, such as abstaining from smoking, engaging in regular physical activity, having low stress levels and a sense of community, spirituality/religiousness and purpose. The promotion of these two dietary patterns should be implemented in other regions after considering cultural and socio-economical characteristics.

Coping Patterns in Advanced Old Age: Findings from the Fordham Centenarian Study

INTRODUCTION

Research on coping in advanced old age is scarce. In the present study, we explored coping patterns in near-centenarians and centenarians, and characteristics associated to using a specific coping pattern.

METHODS

We analyzed the frequency with which participants (N = 87, MAge = 99.05; SDage = 2.6; age range 95-107) reported using specific coping strategies (i.e., coping strategy use) and the relative preference for specific strategies (i.e., relative coping preferences) in data from the Fordham Centenarian Study. Moreover, we applied cluster analysis to detect coping patterns, and we compared cluster characteristics.

RESULTS

Very old individuals reported using emotion control and acceptance the most. Cluster analysis further revealed two distinct groups: The high coping group reported significantly higher coping strategy use than the low coping group (p < 0.001). The two groups also favored different strategies (p < 0.001), with the high coping group showing significantly higher relative preferences than the low coping group for active problem-solving, proactive prevention, and strategic planning (all ps < 0.05). The groups furthermore differed significantly in psychological strengths (i.e., personality, self-efficacy, ps < 0.001) and well-being outcomes (i.e., life satisfaction, p = 0.05).

DISCUSSION

This study provides evidence for a general preference for acceptance and emotion control in very old individuals, supporting theories of a developmental coping shift in old age, yet our findings also document the existence of groups with different coping patterns. More frequent coping use, and particularly continued use of active problem-solving and proactive prevention, may enable well-being in very old age.

Geriatric syndromes in a centenarians population

Background

Centenarians develop diseases later than younger populations.

Aims

Assessment of geriatric syndromes in centenarians living in Marseille in 2020.

Methods

Observational preliminary study describing centenarians living in the Marseille area, being part of the patients base of the general practitioners (GPs).

Results

Twenty-two centenarians were enrolled, including seventeen women (77.3%). Thirteen centenarians lived in nursing homes (NH) and nine in private housing (PH). All were dependent for daily living activities and 78.9% used walkers to get around. GPs consultations were exclusively home visits (in NH or PH). Centenarians living in NH presented more cognitive impairments, more comorbidities, and fewer hospitalizations during the past year compared to centenarians living in PH.

Discussion

Although centenarians represent a model of successful aging for society, all were dependent and had at least one geriatric syndrome.

Conclusions

Maintaining centenarians at home requires technical aids and intervention of several professional caregivers relying on family support.

"I'm Getting Older Too": Challenges and Benefits Experienced by Very Old Parents and Their Children

Very old parents and their "old" children are a growing group in industrialized countries worldwide. However, virtually nothing is known about the nature and implications of this relationship constellation. To fill this gap, this study explored the challenges and rewards of the very old parent-child relationship. In-depth interviews were conducted with 114 parent-child dyads (parent age ≥90; child age ≥65). While both challenges and rewards were present, the balance of challenges and rewards was notably less favorable for children with more challenges experienced overall. Challenges reported by children were often characterized by references to children's own advanced age and health problems, and the prolonged caregiving involvement due to their parents' longevity. Health care professionals, policymakers, and families should be made aware of this increasingly common phenomenon, and specific services and policies will be needed to adequately support very old adults and their families.

Trajectories of Pain in Very Old Age: The Role of Eudaimonic Wellbeing and Personality

Pain is common in very old age and in the last years prior to death. However, little is known regarding longitudinal trajectories of pain in very old age and at the end of life. Moreover, whereas medical and morbidity-related factors contributing to pain are established, the role of psychosocial factors, such as eudaimonic wellbeing or personality as potential determinants of late-life pain trajectories has so far not been sufficiently investigated. We used data from the LateLine project. The sample consisted of n = 118 very old adults (M = 90.5 years, SD = 2.8 years) who were living alone at baseline and who had died between 2009 and 2021. They took part in up to 16 measurement occasions (M = 5.2, SD = 4.7, range 1–16) within an observational interval of 7 years. Assessment of pain was based on the SF-36 bodily pain subscale. Key indicators of eudaimonic wellbeing (autonomy, environmental mastery, and purpose in life) as well two of the Big Five personality traits (neuroticism and extraversion) were included as predictors. We controlled in all analyses for gender, education, subjective health, and depressive symptoms. Contrasting pain trajectories over chronological age (time since birth) vs. time to death, a time-to-death-related model resulted in a better model fit and accounted for a larger amount of pain variability than the age-related model. Mean-level change in pain, both over age and time to death, was not significant, but there was substantial interindividual variability in intraindividual trajectories. Age-related change in pain was significantly predicted by autonomy and neuroticism, with increasing pain among those who had lower initial autonomy scores and higher initial neuroticism scores. With regard to time-to-death-related trajectories of pain, higher purpose in life as well as lower extraversion at baseline predicted less increase or even steeper decrease in pain with approaching death. Our findings suggest that, despite overall mean-level stability in pain both over age and time to death, there is a substantial proportion of individuals who reveal deterioration in pain over time. Regarding the role of psychosocial predictors, personality traits and eudaimonic wellbeing are related with late-life pain trajectories both over age and time-to-death.

Association of Dental and Prosthetic Status with Oral Health-Related Quality of Life in Centenarians

To date, there is little evidence on centenarians’ dental and prosthetic status or their oral-health-related quality of life (OHRQoL). Therefore, the aim of this study was to assess possible associations between sociodemographic and oral health factors, including prosthetic needs in this special age group and their potential influence on OHRQoL. Persons born before 1920 were recruited from population registries in south-western Germany. Fifty-five centenarians participated and underwent a comprehensive oral examination. Cognitive capacity was evaluated using the short Mini-Mental State Examination (S-MMSE, max. 21 points). At an S-MMSE > 10, an analysis of OHRQoL by means of the Geriatric Oral Health Assessment Index (max. ADD-GOHAI score 60 points) was performed (n = 43). Bivariate statistics and a linear regression model were used after variable selection to analyze data. Centenarians presented with a mean (SD) of 22 (7.2) missing teeth. Complete (65.5%) or partial dentures (21.8%) in at least one jaw were most common. One-third of the dentures needed repair/replacement; 16% of the centenarians presented with denture sores. In 60% of cases, OHRQoL was rated unsatisfactory (ADD-GOHAI < 57). Trouble biting or chewing resulted in the lowest levels of OHRQoL. Fewer remaining teeth, reduced functional capacity and removable prostheses correlated with an impaired OHRQoL (r_s = −0.36, p = 0.01; r_s = −0.34, p = 0.01; r_s = −0.29, p = 0.03, respectively). After variable selection, the final linear regression model included only the number of missing teeth, the associated ADD-GOHAI score decreasing by 0.3 points per missing tooth. In conclusion, tooth loss and removable prostheses in need of repair or replacement are highly prevalent in centenarians. These factors seem to modulate OHRQoL negatively, assumedly due to impaired chewing function. Larger confirmatory studies are needed to validate these first results.

Oral health and functional capacity of centenarians

The number of very old individuals, namely centenarians, is growing fast. In dentistry, the increasing number of older adults retaining natural teeth present new challenges for preventive and restorative dental care. However, there is a considerable lack of knowledge on the oral health status and needs in this exceptional age group. The aim of this population-based study was to identify the prevalence of oral diseases, therapeutic needs and functional capacity (evaluating centenarians' autonomy and their capabilities regarding treatment and oral hygiene) in centenarians. Subjects born before 1920 were recruited from population registries in South-Western Germany, providing information on dental health experiences, oral health behaviors and undergoing dental examination. 55 centenarians participated in the study (mean age ± SD = 101.2 ± 1.6, 83.6% females). Results were compared to epidemiological data on adults aged 75-100 years examined in the Fifth German Oral Health Study. Adherence to recommended dental behaviors and dental check-ups was lower in the centenarian population. Moreover, with the exception of a lower Root Caries Index, centenarians showed a higher caries experience, and presented with a mean DMFT of 25.2 ± 3.9, a DMFS of 111.0 ± 21.8, a root caries prevalence of 34.5% and a Restorative Index of 54.0%. Centenarians' functional capacity was also considerably lower. Non-existent or greatly reduced treatment capabilities and oral hygiene capabilities were registered in 63.7% and 43.6% of cases, respectively. Centenarians with a lower educational level (p = 0.018), in a care facility (p = 0.045) or in need of nursing care (p = 0.001) were more likely to have a low functional capacity. 98.2% of centenarians received help in their daily activities but only 12.7% in their oral hygiene. In conclusion, although most still have natural teeth, a decline of oral health can be perceived. As compliance with recommended behaviors is limited and most centenarians can no longer undergo dental treatment, the lack of assistance in daily oral health care is problematic.

Lower Prescription Rates in Centenarians with Heart Failure and Heart Failure and Kidney Disease Combined: Findings from a Longitudinal Cohort Study of Very Old Patients

BACKGROUND

Centenarians are considered as models of successful aging and represent a special group of patients. The aim of this study was to analyze heart failure epidemiology and treatment trajectories in centenarians compared to nonagenarians (90-99 years of age) and octogenarians (80-89 years of age) with heart failure and with heart failure and kidney disease combined.

METHODS

This cohort study used quarterly structured routine data from 1398 German insurants over 6 years prior to death (398 centenarians were compared with 500 nonagenarians and 500 octogenarians). Of those, 525 individuals were diagnosed with heart failure before death; 164 had heart failure and kidney disease combined. Generalized estimation equations were used to assess the association of diagnoses of heart failure and other diseases with medication prescriptions.

RESULTS

Across age groups, heart failure was significantly more prevalent in centenarians compared with octogenarians and nonagenarians. Prevalence of heart failure increased over time. Female sex [odds ratio (men) = 0.70, p = 0.024], kidney disease (odds ratio = 1.31, p < 0.001), and hypertension (odds ratio = 1.52, p < 0.001) were all associated with heart failure. Overall, heart failure treatment changed significantly over time with an increased prescription rate of loop diuretics and a decreased rate of renin-angiotensin-system inhibitors. Centenarians were significantly less likely to receive treatment with renin-angiotensin-system inhibitors, loop diuretics, or beta-blockers compared with nonagenarians and octogenarians. Furthermore, aldosterone inhibitors were seldom prescribed; If-channel and neprilysin inhibitors were not routinely used in our sample. For those with heart failure and kidney disease combined, our data revealed that the prevalence of kidney disease was lower in centenarians than in younger patients before death. However, differences in prescription rates across age groups were non-significant, although numerically large. Finally, half of the patients in all three age groups with heart failure and kidney disease received treatment with renin-angiotensin-system inhibitors; about two out of five patients received beta-blockers, while prescription rates of aldosterone inhibitors were low.

CONCLUSIONS

While heart failure prevalence shows a continuous increase with age, prescription rates are lower in centenarians, emphasizing the need for further studies considering the quality of care and outcomes in this patient population. Disease management programs and trials are needed to develop guidelines that address the medically challenging treatment for very old patients with comorbid heart failure and kidney disease.

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.

Geriatric Basics for the Neurohospitalist

Due to the increasing age of the population, neurohospitalists are more frequently caring for old and very old people. Fundamental definitions and topics related to geriatric medicine are therefore of particular importance. In this review, common issues encountered in geriatric patients hospitalized on the neurology service are discussed. Focus is put on the geriatric assessment, multiprofessional diagnostic and therapeutic procedures, geriatric syndromes, pharmacotherapy of the aged, delirium, pain, and palliative management as they are relevant for the neurohospitalist. In addition, ethical questions are addressed.

Multimorbidity Profiles in German Centenarians: A Latent Class Analysis of Health Insurance Data

OBJECTIVES

Multimorbidity in centenarians is common; although investigations of the prevalence of morbidity in centenarians are accumulating, research on profiles of co-occurrence of morbidities is still sparse. Our aim was to explore profiles of comorbidities in centenarians.

METHOD

Health insurance data from 1,121 centenarians comprising inpatient and outpatient diagnoses from the past 5 years (2009-2013) were analyzed using latent class analysis with adjustments for sex, age, hospitalization, and long-term care.

RESULTS

Four distinct comorbidity profiles emerged from the data: 36% of centenarians were categorized as "age-associated"; 18% had a variety of comorbidities but were not diabetic were labeled "multimorbid without diabetes"; 9% were labeled "multimorbid with diabetes"; and 36% "low morbidity."

CONCLUSION

Patterns of comorbidities describe the complexity of geriatric multimorbidity more appropriately than an approach focused on a single disease. The profiles described by this specific research may inform clinicians and health care planners for the oldest old.

Association between handgrip strength, walking, age-related illnesses and cognitive status in a sample of Portuguese centenarians

Background

Centenarians are a growing population in Europe and present significant variability in motor and cognitive functions. The aim of our study was to characterize health status, as well as cognitive and motor functions in a group of Portuguese centenarians. In addition, our study also aimed at analyzing the relationship between cognitive functions and the burden of diseases affecting the elderly.

Methods

Fifty-two centenarians were evaluated using the Mini-Mental State Examination, short version. Walking-related parameters (velocity and time spent in the 3 m walk test), grip strength and number of age-related illnesses were also measured. The relationship between cognitive scores and time spent in the three metre walk test, velocity, grip strength and number of diseases was analysed.

Results

Cognitive scores showed a positive correlation with both handgrip strength and time spent in the three metre walk. In contrast, no association was found between cognitive scores and the presence/absence of disease, walking velocity or number of diseases present.

Conclusions

These results suggest that in centenarians, cognitive functions may be related with motor functions.