REVIEW ARTICLE
Year : 2023 | Volume
: 19 | Issue : 1 | Page : 61--66
Characteristics of centenarian studies and variables related to longevity: A narrative review
Shyh Poh Teo
Geriatrics and Palliative Unit, Department of Internal Medicine, RIPAS Hospital, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
Correspondence Address:
Shyh Poh Teo
Department of Internal Medicine, Geriatrics and Palliative Unit, RIPAS Hospital, Jalan Putera Al-Muhtadee Billah, Bandar Seri Begawan BA1710
Brunei Darussalam
Abstract
Studying centenarians requires a “positive biology” approach, where rather than focusing on disease, the research aims to understand the causes of positive phenotypes and explain biological mechanisms of health and longevity. This review outlines the characteristics of the key centenarian studies. Variables that may relate to the longevity of these oldest old are also described, including cardiovascular health, cognitive function, physical ability, mental and cognitive health, personality, and the social circumstances of the centenarian.
How to cite this article:
Teo SP. Characteristics of centenarian studies and variables related to longevity: A narrative review.J Indian Acad Geriatr 2023;19:61-66
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Teo SP. Characteristics of centenarian studies and variables related to longevity: A narrative review. J Indian Acad Geriatr [serial online] 2023 [cited 2023 Jun 3 ];19:61-66
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Full Text
Introduction
Studying centenarians requires a “positive biology” approach, where rather than focusing on disease, the research aims to understand the causes of positive phenotypes and explain biological mechanisms of health and longevity. Healthy aging and longevity are likely due to the interaction between genetics, environment, and social factors, while it is the modifiable factors, such as diet, physical activity and other lifestyle or social changes that can be applied as public health strategies or interventions.[1]
Successful aging encompasses the domains specified in the revised Rowe and Kahn's model: maximize physical and mental abilities, minimize risk and disability, engage in active life, and maximize positive spirituality.[2] It is hoped that centenarian studies will clarify how to achieve successful aging for the general population.
There are several potential challenges in carrying out centenarian studies: first, the ages need to be verified through birth certificates. It may be difficult to arrange assessments due to frailty, illness, or even death of the participants, with a need to consider their physical and mental state during the review. Hearing impairment may also cause difficulties in carrying out interviews. However, there are lessons from other centenarian studies, including protocols from various localities, such as the Sevilla and Castilla y Leon Centenarian Study.[3] In this narrative review, the characteristics of key centenarian studies are outlined, with descriptions of the variables that relate to longevity in the oldest old, including cardiovascular health, cognitive function, physical ability, mental and cognitive health, personality, and the social circumstances of the centenarian.
Findings from the main centenarian studies described are summarized in [Table 1].{Table 1}
Geographical Variation
Different countries have different levels of mortality selection based on a study of nonagenarians and centenarians living in the 5 low mortality countries (Denmark, France, Japan, Switzerland, and Sweden). Mortality selection is an important mechanism behind longevity trends, which suggests that if mortality is higher at younger ages, it should affect patients with frailty and multimorbidity first, leading to a strongly selected, most robust older population with lower mortality. If there is lower mortality at younger ages, there will be an increased proportion of older people who are less healthy (compared to strongly selected areas), leading to a higher rate of morbidity and mortality among older people. Based on the 5-Country Oldest Old Project, there are three levels of mortality selection: milder in Japan, stronger in Denmark and Sweden, and intermediary level in France and Switzerland. There is a need to study if there is a trade-off between the level of mortality selection and functional health status.[4]
Two Centenarian studies in Portugal found regional differences in morbidity profiles and healthcare use based on whether they lived in predominantly rural or predominantly urban areas. Among 241 centenarians, the predominantly urban participants had a higher average of 4.8 self-reported illnesses compared to the rural participants (2.96), who had lower levels of physical and cognitive impairment, and less people who had the three most common diseases leading to mortality (heart disease, nonskin cancer, and stroke).[5] The different health-related profiles between rural and urban areas suggest the importance of the geographical context in how old age can be reached.
Physical, sensory, and cognitive functions were compared between the Tokyo and Georgia centenarian studies (304 and 245 participants respectively) in terms of sensory impairment (vision and hearing) and physical function based on activities of daily living (ADLs) (eating, grooming, dressing, transporting, bathing, and walking). The Georgia cohort had higher levels of functioning in all domains, with the Tokyo cohort showing a strong association between a cognitive and sensory function with physical function.[6] As these differences may be due to environmental variables, comparisons between localities may yield suggestions as to what factors may contribute toward the differences in function.
Genetic Factors
There is a strong genetic component to longevity as shown in the Okinawa Centenarian Study, where their siblings had survival advantages (female siblings 2.58-fold and male siblings 5.43-fold) likelihood of reaching age 90 years and older compared to their birth cohorts. Apolipoprotein E genetic variants have been shown to consistently be associated with longevity, with a need to explore further relevant genetic contributors to this cohort.[22] Four centenarian studies have also suggested that specific FOXO3 single-nucleotide polymorphisms were also associated with longevity.[23]
Key Centenarian Studies, Participant Characteristics, and Comorbidities
The Georgia Centenarian Study was carried out in three phases. Phase 1 (1988–1992) was a cross-sectional review of adaptation characteristics of community-dwelling and cognitively intact older people (60–69, 80–89, 100+). Phase 2 (1992–1998) consisted of a longitudinal follow-up of the three cohorts. Phase 3 (2001–2007) was a comprehensive, population-based study to identify longevity genes, assess neuropsychological and physical functioning, and characterize the resources and adaptations of centenarians. This paper describes methodological concerns and pitfalls, with an emphasis on the need for a multidisciplinary team to work across disciplines to resolve problems and issues.[8]
The New England Centenarian Study evaluated 14 age-associated comorbidities, alcohol and tobacco usage as well as the Blessed Roth Memory-Concentration test for cognitive screening. The following comorbidities were asked: hypertension, congestive heart failure, heart attack, cardiac arrhythmia, diabetes, stroke, nonskin cancer, skin cancer, osteoporosis (including a history of nontraumatic hip, wrist, or spinal fracture after age 50 years), thyroid dysfunction, Parkinson's disease, dementia, chronic obstructive pulmonary disease (emphysema/bronchitis and cigarette smoking 2 pack years or more) and cataracts.
Based on this, the centenarians were classified into three morbidity profiles. Among the 424 respondents in the New England Centenarian Study, 38% were survivors (diagnosis of age-associated illness before age 80 years), 43% were delayers (delayed onset of age-associated illness until at least age 80), while 19% were escapers (attained 100th year of life without age-associated illness).[11] Men were 2.7 times more likely to be escapers compared to women. There may be a need to classify the oldest old into these three different phenotypes to determine contributors to longevity for each group.
The study of Danish centenarians involved an interview (sociodemographic characteristics, ADLs, living conditions, need of assistance from other people, former health and current diseases, current medication) and a clinical examination (dementia screening test, heart and lung auscultation, neurological assessment, height and weight, electrocardiogram (ECG), arm and ankle blood pressure, assessment of hearing and vision capacity, a short physical performance test, bio-impedance, lung function test, and blood test). This study found that among 207 centenarians, there was a high prevalence of diseases and chronic conditions, with 25 autonomous (functioning well physically living at home without dementia) and 182 nonautonomous centenarians.[13]
The China Hainan Centenarian Cohort Study coordinated an interdisciplinary research team to conduct a longitudinal observational study of centenarians from Hainan, China. Among the 1811 centenarians present in their registry, 1002 participated in this study. The comprehensive baseline data collection included socio-demographics, functional capacity, cognitive function, mental health, behaviors, habitual diet (11-item Semi-Quantitative Food Frequency Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), quality of life (EQ-5D), family information, social support/relations, environment, economic status, health service use, and reproductive history. The medical or clinical examination included health conditions, anthropometric measurements, falls, general pain, physical function, physical examination, ECG, ultrasonography, and dental examination. Biological specimens taken included blood analysis, saliva DNA, hair analysis for trace elements, feces examination, and a gynecological check-up. This study aimed to evaluate their physical, mental, and social situations, as well as establish healthy aging indicators that may be used to plan and implement population-wide health interventions.[15]
Cardiovascular Health and Cognitive Functioning
A study of Tokyo centenarians found that 95% had chronic diseases, especially hypertension, heart disease, stroke, fractures, and cataracts. However, diabetes mellitus was relatively uncommon.[6] Among Georgian centenarians, there were 2 discrete clusters identified. The first cluster had predominantly cardiovascular disease, pneumonia, osteoporosis, anemia, and cancer, while the second cluster predominantly had dementia, psychiatric disorders, and neurological disorders.[6],[8] This is in contrast to the Tokyo study showing a strong association between cognitive and sensory function with physical function; this dissociation in Georgia resulted in the two groups with either predominantly physical or neuropsychiatric disorders.
The Danish study identified a relatively high rate of vascular risk factors: hypertension (52%), myocardial infarction (27%), and stroke (22%).[13] However, a study based in Australia identified a low prevalence of osteoporosis, dementia, cardiovascular disease, respiratory illness, cancers, anxiety, and depression.[24]
The Longitudinal Study of Danish Centenarians evaluated participants within 3 months of their 100th birthday. This involved a sociodemographic interview, evaluating the family background, education, occupation, and lifestyle. The assessment of ADLs included Katz's ADL index and Instrumental ADLs (IADLs) (Lawton and Brody). Cognitive function was assessed with the MMSE. A proxy was interviewed regarding short and long-term memory, ability to recognize other people, find their way home, recall time of the year, understand messages, and make decisions. Specific questions regarding health conditions were also asked. Physical examination included the neurological examination, blood pressure, and ECG. This study found that 51% of the centenarians had mild to severe dementia; of which 12% had diseases contributing to dementia (Vitamin B12 or folate deficiency, hypothyroidism, and Parkinson's disease), and 0% had at least one or more cardiovascular and cerebrovascular risk factors.[14]
Physical Abilities
The Georgia Centenarian Study assessed physical performance to identify normative data for the Short Physical Performance Battery (SPPB), which consists of three standing balance measures, five continuous chair stands, and a 2.44 m walk. For those who are physically weak or immobile, the items on the Physical Performance Mobility Exam (PPME) not included in the SPPB were used-this included bed mobility (lying to sitting), transfer from sitting on the edge of the bed to sitting on a chair, and stepping up one step with or without use of a bed handrail. The Glasgow Coma Scale (GCS) Composite Scale, Direct Assessment of Functional Status, grip strength, and knee extensor strength were also assessed. This found that the GCS Composite Scale performed better than SPPB or PPME, correlating with performance on ADLs, IADLs, grip strength, leg extensor strength, and predictive of longer time to mortality.[9]
Mental Health
The Fordham Centenarian Study carried out in New York City assessed the physical, cognitive, social, and mental health of near-centenarians and centenarians. They were interviewed based on physical functioning (number of diagnosis, subjective health, and functional status), cognitive functioning (MMSE, Global Deterioration Scale), social resources (6-item Social Network Scale), and their mental health (Geriatric Depression Scale, 5-item Satisfaction with Life Scale). This study found that despite limited physical function and social resources, they were in good mental health, suggesting high resilience and ability to adapt to age-associated challenges. A large proportion still living in the community highlighted their desire for leading an autonomous life.[16]
In Hong Kong, a quantitative study of 153 near-centenarians and centenarians exploring biopsychosocial correlates of health and “living long” used two validated tools: the Chinese Longitudinal Healthy Longevity Survey and the Elderly Health Centre questionnaire.[25] From this group, they identified six community-dwelling participants, who were physically and cognitively well for a qualitative study. Four themes were identified: positive relations with others, positive events and happiness, hope for the future, and a positive life attitude.[26]
Cognitive Health
In terms of cognitive performance, the Georgia Centenarian Study administered the mini–mental status examination, severe impairment battery (for significantly cognitively impaired individuals or lower levels of performance), and Behavioural Dyscontrol Scale (executive function). There was a greater variation and dispersion in performance, as well as a stronger association between age and performance for centenarians.[10]
In the US New England Centenarian Study, a neuropsychological test battery was used, including the MMSE, Mattis Dementia Rating Scale, Boston Naming Test (CERAD), Trail-Making Test A and B, Clock Drawing, Drilled Word Span Test, Cowboy Story (Boston-Rochester Test), Presidents since Franklin Roosevelt, Geriatric Depression Scale, Telephone Interview for Cognitive Status (for visual impairment), Test for Severe Impairment (if score 10 or less on MMSE), Tactile Naming (for visual impairment, unable to see the Boston Naming Test), Informant Cognition and Health History, Informant Psychiatry history, NEO-Five Factor Inventory (self-report and observer report), and Clinical Dementia Rating Scale and Spiers' Calculations. The Hachinski scale was used to estimate the risk of vascular dementia. Of the 43 centenarians, 64% had some degree of dementia. Clinical Dementia Rating (CDR) scores correlated significantly with Barthel Index scores.[12]
The Sydney Centenarian Study was interested in brain health and sought to identify the cognitive profile of centenarians, relate cognition to brain imaging (magnetic resonance imaging [MRI]) and neuropathology (brain donors), and establish a centenarian phenotype from neuropsychiatric, medical, nutritional and lifestyle perspectives. This was done in several phases, starting with a brief cognitive assessment, including the Addenbrooke Cognitive Examination Revised, an in-depth neuropsychological assessment, informant-based assessments, as well as utilization of health services. MRI brain scans, blood tests, follow-up neuropsychological and medical assessments 6-monthly as well as possible brain donation for neuropathology evaluation.[17]
A study of centenarians correlating the premortem cognitive tests and neuropathology identified on postmortem found a wide range of AD-type neuropathological changes in both dementia and nondementia participants. While AD-type pathology was associated with severe dementia and poor cognition, the heterogeneity of pathophysiological findings suggests the complexity and interaction of other variables for cognitive impairment in centenarians.[27]
The International Centenarian Consortium-dementia is a consortium that aims to harmonize global centenarian studies to describe the cognitive and functional profiles of the oldest-old, the prevalence and incidence of dementia and to identify their trajectories of decline. This should enable pooling of a large, heterogeneous group to understand protective and harmful factors for brain health across diverse ethno-racial and sociocultural populations.[28]
Personality
The Australian Centenarian study applied the NEO Five Factory Inventory (NEO-FFI), Connor-Davidson Resilience Scale, and Life Orientation Test-Revised to evaluate different dimensions of the participant's personalities. They found that centenarians were low in openness and extraversion, high in neuroticism; with cognitively intact participants having higher levels of agreeableness. It is unclear whether these reflect their background personalities or changed due to their advanced age, psychosocial factors, and changes in life circumstances. However, these may facilitate positive health behaviors contributing to their longevity.[18]
The Tokyo Centenarian study similarly applied the NEO-FFI and found that their cohort had higher openness, with females having higher conscientiousness and extraversion. The authors suggested that these personality traits contribute to longevity by having positive effects on health-related behaviors, stress reduction, and improved adaptation to problems.[7]
Social Support
The second Heidelberg Centenarian Study measured socio-demographic characteristics, subjective health, number of health conditions (Health Conditions subscale of the MAI), functional competence (ADL, IADL using modified Older Americans Resources and Services (OARS) Multidimensional Functional Assessment Questionnaire), cognitive impairment (Global Deterioration Scale), core social network, residence, living arrangements, daily help sources, and types. Among the 112 centenarians, children were the main source of support while those without children were more likely to have friends or neighbors involved.[19]
100-plus study (www. 100plus.nl) is a prospective cohort study of cognitively well-Dutch centenarians, their first-degree family members, and respective partners. Demographics, life history, medical history, genealogy, neuropsychological data, and blood samples were collected, in addition to optional PET-MRI scans, feces donation, and postmortem brain donation. This study found that these centenarians had higher levels of education, higher socioeconomic background, higher socioeconomic status, and more children. A third carried the APO-E2 allele.[20]
Quality of Life
An Italian centenarian study compared the quality of life between centenarians with participants aged 75 to 85 years, and 86 to 99 years. The Profile of Elderly Quality of Life and the LEIPAD quality of life assessment instruments was used. This study found that although centenarians had a greater functional disability, they complained less spontaneously about their health, had well-preserved cognitive function, scored lower for anxiety and depression, and had greater satisfaction with their social and family relations and life in general.[21]
Conclusion
This review briefly describes some of the major methodologies and findings of the main centenarian studies. There are many aspects to learn from centenarians, ranging from geographical variation, genetic and lifestyle factors, physical and cognitive function, personality traits, available social support, and quality of life.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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