Introduction: The number of centenarians has increased dramatically in developed countries during the last five decades, which is mainly attributable to a decline of oldest-old mortality. The planning of future health care is highly dependent on whether these subjects are suffering from multiple diseases and chronic conditions, or they are relatively healthy and self-sufficient survivors with only few chronic conditions, as suggested by some previous centenarian researchers. This study aims at describing the health characteristics of an unselected population of Danish centenarians using standardised instruments of assessment and well-known disease definitions.

Material and Methods: A population-based study of a dynamic cohort of all Danes celebrating their 100th anniversary was performed in 1995-96, a total of 276 persons. All participants were visited at their domicile for an interview (incl. proxies), a clinical examination, and a blood test. Further health information was retrieved from GP’s, the National Discharge Register (in existence since 1976), and the Danish Cancer Register (in existence since 1943). Standard assessment scales and definitions were used. All surviving centenarians from the cohort were re-visited a few weeks after their 101½, 103rd, 104th and 105th anniversary. Presently, the surviving 106-year olds are being interviewed. Only health related changes including activities of daily living and cognitive functioning are registered at the follow-ups. A blood test has been drawn as well.

Results: In all, 75% (N=207, F:M ratio: 3.6:1) of the eligible 276 subjects participated in the study. There was no significant difference between participants and non-participants regarding sex and living conditions. About half of the population were nursing home residents. In activities of daily living roughly one third was totally dependent, almost one fourth was relatively dependent and just about two fifth were relatively independent of help. Almost no centenarian could be described as being free from diseases. Cardiovascular disease was the most common disease affecting nearly 3/4 of the centenarians. Objective assessment of blood pressure and standard ECG revealed a substantial proportion of subjects with hypertension and myocardial ischemia, which were previously unrecognised. Disabling chronic conditions such as osteoarthritis, urinary incontinence and dementia were common, each affecting about half of the centenarians. However, at least one third of the centenarians were assessed as being non-demented. The presented disease prevalences can be regarded as minimum prevalences or "best case scenarios". Of major interest is the identification of a group, although small, of autonomous centenarians, who were non-demented, non-institutionalised and relatively independent regarding physical functions, and yet they had the same level of comorbidity as those who could not fulfil all these three criteria. Exemplified by the measurement of thyroid function, centenarians seem to possess some well-preserved physiological functions in spite of organ atrophy. Based on information from previous medical records centenarians were found to have suffered from several different diagnoses in the past, all potentially leading to a state of chronic condition and possible subsequent functional loss or even potentially mortal.

Conclusion: Although today’s centenarians have survived to an extreme age, they neither have been nor presently can be described as healthy. They have a high prevalence of common diseases and chronic conditions, with consequent functional limitations. However, in spite of the presence of several diseases, a minor proportion can be identified as cognitively intact and well-functioning.

Background : healthy aging is associated with preservation of intact cognitive functioning. Cognitive decline and dementia are major determinants of disability and loss of autonomy in older people. Thus preventing or at least postponing the onset of cognitive decline could considerably improve their quality of life.

Objectives: the aim of this paper is to present epidemiological data regarding preventable risk factors of cognitive decline and dementia in older people.

Methods: the data come from the PAQuID (Personnes Agées QuID) study on cognitive and functional aging. A representative sample of 3777 community dwellers aged 65 and over, living in two administrative areas of southwestern France, was visited at home in 1988-89. The data collected by a psychologist included sociodemographic information, living habits, main symptoms, a functional assessment (ADL, IADL and mobility), and a neuropsychological testing. If a diagnosis of dementia was suspected, the subject was visited by a neurologist to confirm the diagnosis and ascertain its etiology. Then the subjects were followed-up in the same manner one, three, five, eight and ten years after baseline assessment. The 3-year interview included a brief food questionnaire. End-points were death, institutionalisation, onset of dementia, and evolution of function.

Results: incidence of dementia increased dramatically with age, in particular in women after age 75. Subjects with higher education had a decreased risk of developing dementia. Regarding food, the risk of incident dementia decreased with increasing consumption of fish or seafood, whereas there was no relationship with meat consumption. Moderate wine consumption was also associated with a decreased risk of developing dementia. People engaged in activities such as traveling, gardening, odd jobs or knitting had a significantly decreased risk of subsequent dementia.

Conclusion: these results suggest that increasing educational level, promoting healthy food habits and engagement in social and leisure activities could contribute to healthy cognitive aging.

Social inequalities in mortality at old ages are poorly documented, mainly due to the lack of accurate data. until now in France, only modelisation has allowed estimation of gaps in life expectancies at old ages regarding occupational classes, and this essentially for men. The present study provides estimates of relative mortality risks at old ages, according to occupational status for men and women (as reported at census, retired persons reporting their previous occupational status), using a longitudinal sample from 1975, mortality being recorded over the period 1975-1980. Being longitudinal, the sample also allowed estimation of relative risks of mortality regarding occupational status at two points in time (1975 and 1968). Such a double estimation shows how old ages occupational mobility is linked to mortality, according to the direction of the moves (upward or downwards moves). It also shows whether or not late life occupational mobility can change the magnitude of estimated differentials in old ages. The data used show that mobility has been small over the study period, due to the fact that most of the sample is already retired at first point; therefore, the impact of mobility on the estimated differentials is negligible. Nevertheless, the study shows that mortality and mobility are correlated in male population while it is not in female population.

Le vieillissement démographique n’est pas seulement caractérisé par une hausse de la proportion des personnes âgées dans une population. étant relié à une baisse de la fécondité et une augmentation de l’espérance de vie, le vieillissement démographique sera aussi caractérisé par des changements dans la structure et l’étendue du réseau potentiel de soutien informel. Les changements au niveau des comportements matrimoniaux - union libre, divorce, etc. - amplifient cette transformation du réseau informel. Celle-ci aura sans doute un impact important sur le recours au réseau de soutien formel pour maintenir à domicile les personnes âgées en perte d’autonomie.

Le Cycle 11 de l’Enquête Sociale Générale de Statistique Canada, réalisée en 1996, permet d’étudier les facteurs associés au recours aux réseaux de soutien formel et informel des personnes âgées faisant face à des besoins d’aide reliés à une perte d’autonomie. La richesse des informations contenues dans l’enquête permet notamment d’identifier les caractéristiques socio-démographiques des bénéficiaires de services favorisant le maintien à domicile, notamment en terme de composition de leur réseau de soutien informel. Le but de cette communication est par conséquent d’identifier les caractéristiques socio-démographiques associées à l’utilisation ou non du réseau de soutien informel et/ou formel tel que mis en place, entre autres, par l’état. Ce faisant, cette étude permet d’étudier la complémentarité des deux systèmes ainsi que de formuler certaines hypothèses quant à la demande future de services formels de maintien à domicile.

Using panel data from the "1989 Survey of Health and Living Status of the Elderly in Taiwan" with follow-up in 1993, 1996, and 1999 (N=4,049, age=60+), this study examines changes in the prevalence of functional difficulties and disability-free life expectancy in each two waves. Individuals are conceptualised to be in a state of independence or disability at time of origin, based on responses to activity of daily living items. The outcome at follow-up is categorized as independent, disabled or dead, allowing for six combinations, one from each state of origin to each outcome. Regardless of the decreased, the prevalence rates of functional limitations had reduced between 1989 and 1993, but increased either between 1993 and 1996 or between 1996 and 1999. Similarly, the disability-free life expectancy from IMaCh (Interpolation of Markov Chains) is longest for the earlier period (1989 to1993), followed by the two later periods (1993 to1996 and 1996 to 1999) in order. The mixed results seem to suggest the Depression of morbidity for the earlier period and the Expansion of morbidity for the later periods. Such a transition is somewhat related to the implementation of health insurance program for all people in 1995, which has provided more access to medical care.

Centenarian studies consistently find that the apolipoprotein 4 allele is less frequently present compared to younger persons in the same population, while the 2 allele is more frequent. The 3 allele is most frequent in younger and older persons. The mortality differentials that result in the observed allelic frequency shifts by age 100 occur late: Life expectancy at ages 85+ varied by two years for a population cohort in Stockholm (the Kungsholmen Project) depending on which combination of inherited alleles was present, i.e. the genotype (e2/3, e3/3, e3/4). No difference was found for relatively younger subjects. The mortality differentials at ages 85+ were not the result of the well known increased risk for Alzheimer’s disease associated with e4 and the lack if e2, nor were they due to more frequent cardiovascular disease for e4+ persons. Instead, they were specifically related to 5-fold difference in prognosis, i.e. 3-month mortality, for cardiovascular disorders: best for e2/3 (5% mortality) < intermediate for e3/3 < and worst for e3/4 (40%). An 8-fold variation was found for subjects who had good cognition at the time of entry into the cohort, ruling out Alzheimer’s disease as the culprit. Atrial fibrillation and congestive heart failure were the most common diagnoses. The APOE-related differences in prognosis suggest that pathologic changes over a lifetime, such as the replacement of vessel wall components with amyloid, lead to accumulated genetically determined vulnerability to vascular accidents at advanced ages.

Latin America is a vast subcontinent composed of 45 countries and domains. This habitat of more than 520 million people, shows a large social and cultural cohesion created by its Hispanic background and the extended use of the Spanish language. The great geographical and socio-economic diversity contibutes to different demographic transitions, which leads to distinct levels and speeds in population ageing. While some Latin American countries exhibit early and late demographic transitions, but the majority are at an intermediate stages, experiencing ageing processes of great rapidity. The related epidemiological transition is polarized, since prevalence of communicable diseases are still significant but existing concurrently with fast shifts towards chronic illness and disabilities. Increases in life expectancies, particularly for older ages, are implying the quest for healthy expectancies. A large part of these phenomena and their characteristics are determined by socio-economic conditions. Variables that have the greatest impacts come from unfair income distribution, big gaps between the rural and the urban; faulty social security systems; pressing needs of the elderly to engage in paid occupations; changing family structures; and new living arrangements.

The increases in life expectancy that have occurred thus far are a triumph for 20th Century PUBLIC health in its widest sense though by many they are still viewed negatively, especially in the light of falling birth rates and the greater consumption of health care in the final years of life. The future demand for care, both formal and informal, will therefore greatly depend on the health of the newer cohorts of older people.

This paper will debate how we can monitor our potential for healthy ageing and how we might live longer, healthier lives in the future. The term ’healthy ageing’ is now used freely in the gerontology literature as a consequence of the growing emphasis on the positive rather than the negative aspects of an ageing population. However, precise definitions are scarce. The definition of ’successful ageing’ of Rowe and Kahn (1997) will be explored as well as the, far from simple, transition from conceptual definition to measurement. Issues include whether current measurement instruments are are up-to-date still applicable to future cohorts and the difficulty in differentiating the border between healthy and normal ageing. Finally the evidence on the determinants of healthy ageing will be reviewed and the potential for increasing both the numbers of older people who age healthily and the length of time they do so.

This study investigates differences in life expectancy, disability free life expectancy, and disabled life expectancy between groups of people with and without diabetes. using united States’ data from the 1984-1990 Longitudinal Study of Aging, we model transitions among functional status states as discrete-time Markov chains (Laditka & Wolf, 1998), and use microsimulation to calculate summary indices of health expectancies for women and men with and without diabetes. Estimates are calculated separately for groups defined by sex, race, education, and the presence or absence of diabetes at age 70, accounting for the initial distribution of disability in each group. We find that the impact of diabetes on health expectancies is substantial. Measuring disability by difficulty performing one or more Activities of Daily Living, both women and men with diabetes live notably shorter, more disabled lives. For example, white highly educated women at age 70 without diabetes can expect to live 13.8 years, 28.0% of which will include some disability. The corresponding group of women with diabetes can expect to live 9.8 years, 39.2% of this time with a disability. White men at age 70 with low education without diabetes can expect to live 8.9 years, 25.3% of which will include a disability. The corresponding group of men with diabetes can expect to live 6.6 years, 35.5% of this time with disability. In addition to summary measures, we show the impact of diabetes on the full distribution of health expectancies within each group, presenting the proportion of each simulated population with each number of remaining total, active, and disabled years. While the distributions of remaining total and unimpaired life are approximately normal for individuals without diabetes, corresponding distributions for those with the disease are notably skewed toward fewer years of both total and unimpaired life. Results highlight the health burden of diabetes throughout the older life course, and the differential impact of the disease both between and within groups. Recent clinical research findings suggest that even modest efforts can substantially postpone, and possibly even prevent, the onset of this disease. Given projections of a global epidemic of diabetes, our findings support policies promoting lifestyle changes that postpone and control this disease.

Growth and ageing constitute a continuing process which involve genetics, economics, environment and culture. Each of these elements is a major determinant of the individual life cycle. More than 70% of human genes contribute to determine longevity. Reduction of telomers length differ considerably between gender. Good and bad genes with early or late expression modify the ageing process from health to disease. Economics intervenes strongly on human longevity. Habitants of Sierra Leone, one of the poorest world country, live half the time of North Europeans. Environment has been changing a lot during the last decades both in developed and developing countries. For example, traffic injuries increase both mortality and disability. Culture also interacts with healthy ageing. For example Mediterranean cooking appears to be protective of cardiovascular diseases.

This fundamental background of life determines the various processes constituting the life itself: Human anatomy and physiological conditions change all along life. The functional capacity of each individual is maximum at approximately 20 years of age. The physiological ageing process itself is extremely variable between individuals. This ageing process is modified by the mental and physical activities performed from the childhood to the late stages of life. Correlation were found between physical early activities and the bone peak mass. Correlation were found between physical and mental activities and cognition performances in advanced age. Positive (good gene, physical activity…) and negative risk factors (overweight, smoke, alcohol…) interfere with the ageing process itself and related diseases. Progressive or acute onset of disease can disrupt the life cycle. Acute diseases are lesser involved in death. Chronic diseases are more and more frequent, difficult to treat and badly tolerated. Chronic diseases are the main causes of the disabling process. Locomotor and mental disabilities are the more frequent, far before cardiovascular or sensory ones. The analysis of this ageing process will not be complete without stressing the major impact of the individual well being. The quality of life is one of the most tricky part of human sciences. Whatever scientists effort, its evaluation stays very approximate.

The tufted complexity of the life process can easily explain how it is difficult to promote primary health prevention. The will, the drive, the anticipation ability change considerably the perception of life… Healthy ageing is perhaps a good thing for the individual and for the society, but the best process, is without any doubt, a successful ageing with a good appreciation of what the individual did during his life, absent of remorse and desire for himself and for his affective surrounding to continue to have projects and enjoy life.

Introduction: As J. Rowe and R. Kahn reported in Science: "Research in aging has emphasized average age-related losses and neglected the substantial heterogeneity of older persons." The effects of diseases, personal habits and social factors have been underestimated and the usual functional decline at advanced age depends on different individual and on environmental characteristics. The objective of this presentation is to analyze the concept of healthy ageing and to identify the associated factors in the elderly.

Materials and methods: In the Italian Longitudinal Study on Aging we have assessed the physical function (ADL, IADL, and Performance test), the cognitive function (MMSE), the emotional status (Geriatric Depression Scale) and socio-demographic characteristics of a cohort of 5,632 individuals, aged 65-84, and followed them for 3 years.

Results: At baseline the percentage of subjects in the high vitality group was of 11.3 (9.7% among women and 12.8% among men) and in the poor vitality group was of 4.5 (5.1% for women and 4% for men). Among subjects aged 65-74, about 18% were in the high vitality group (and 1%in the poor vitality group) versus a 3.8% for individuals aged 75-84 (and 8.3% in the poor vitality group). Considering the transition matrix from the baseline to the first follow up, we see that about 78% of subjects did not change their level of vitality while an about 11% worsened their status. We have also investigated a) the association between socio-demographic, health habits, health conditions with the level of vitality through a multivariate logistic model; b) the association between the above mentioned predictors and mortality through a Cox Proportional Hazard Model; c) the transition from the baseline to the follow-up vitality level through the Stuart-Maxwell test; d) the independent predictors of decline in vitality level through a multivariate logistic model.

Conclusions: The ILSA study allows the analysis of the role of social, physical and psychological factors in the determination and maintenance of a high level of vitality. The multidisciplinary assessment enables investigators to look at determinants and correlates of healthy ageing and should be included in all analytic studies on the elderly.

The Nun Study is a longitudinal study of aging and Alzheimer’s disease in 678, 75- to 106-year-old members of the School Sisters of Notre Dame religious congregation in the united States. The study includes regular cognitive and physical examinations as well as brain donation at death. Prior findings from the Nun Study indicate that the combination of Alzheimer’s neuropathology and brain infarcts is strongly associated with dementia. We thus investigated the role of these two pathologic conditions in healthy aging, the opposite end of the functional continuum.

No generally accepted definition for healthy aging has been developed. In our study, we defined three mutually exclusive levels of healthy aging (Gold, Silver and Bronze) based on measures of global cognitive function (Mini-Mental State Exam [MMSE]), short-term memory (Delayed Word Recall [Recall]), basic activities of daily living (ADLs), instrumental activities of daily living (IADLs), and self-reported function (ability to take care of oneself). The Gold level of healthy aging was the most stringently defined (MMSE=28, maximum=30; Recall=7, maximum=10; all 5 ADLs and 5 IADLs intact; and ’excellent’ self-reported function). These criteria were relaxed incrementally for Silver (MMSE=26; Recall=6; all 5 ADLs intact, at least 4 of the 5 IADLs intact; and ’excellent’ or ’very good’ self-reported function) and Bronze levels (MMSE=24; Recall=5; at least 4 of the 5 ADLs and 3 of the 5 IADLs intact; and ’excellent’, ’very good’, or ’good’ self-reported function).

As a valid definition of healthy aging should reflect overall health status, we investigated the association of healthy aging with all-cause mortality as well as neuropathology. Mortality analyses were based on 541 college-educated participants in the Nun Study; neuropathology analyses were restricted to the subgroup of 178 participants who had died and were autopsied (91% autopsy rate). Significant Alzheimer pathology was indicated if neuropathologic criteria for the disease were met (i.e., presence in the neocortex of both neurofibrillary tangles and neuritic plaques, and abundant senile plaques). Brain infarct(s) were deemed present if at least one infarct was visible to the naked eye.

The level of healthy aging was strongly associated with the risk of all-cause mortality. During the study, only 14% of those who met the Gold level of healthy aging at the start of the study subsequently died, compared with 25% for the Silver level, 40% for the Bronze level, and 59% for the remaining participants. The level of healthy aging was also related to the prevalence of significant Alzheimer’s pathology and brain infarcts. For those at the Gold level of healthy aging at their last exam before death, only 17% had significant Alzheimer’s pathology, brain infarct(s), or both, compared with 40% for the Silver level, 65% for the Bronze level, and 83% for the remaining participants. Alzheimer’s pathology had a stronger inverse association with healthy aging than did brain infarcts. Furthermore, there was no clear evidence of an interaction of both pathologic conditions with healthy aging.

Healthy aging is strongly associated with reduced all-cause mortality. In addition, significant Alzheimer pathology and brain infarcts have a substantial impact on the level of healthy aging.

(This study was funded by the National Institute on Aging.)

Disability questions have proliferated in population surveys. Some surveys have just a few questions, or even only one, while others have many. The reasons lie in a survey’s ultimate goals. Examples of surveys with few and many items are shown. New surveys often choose items from prior surveys, with confidence that past use means good quality and clear meaning. Replication also yields comparisons across different countries and populations. Yet fresh thoughtful care must be given to the wording and placement of items in a new survey’s design, and newly created questions may be very desirable for a survey’s own purposes. Examples of disability questions are given, pointing out fine and troublesome features. Lastly, when a survey has several strong purposes, compromises are necessary in design. Each goal can be achieved adequately but not ideally. An example of a uS survey is stated to demonstrate this. In conclusion, there is always room for new ideas in survey design that fit the circumstances of a given population.

Work on health expectancy in Canada began in the early 1980s, using disability data from the 1978 Canada Health Survey together with administrative data on residential care facilities, and retrospectively, using data from the 1951 Canada Sickness Survey. After cancellation of the Canada Health Survey, health expectancy work for Canada as a whole was based on the 1985 and 1990 General Social Surveys, the 1986 and 1991 Health and Activity Limitation Surveys, the 1994 and 1996 National Population Health Surveys (panel and cross-sectional data), disability data from the 1996 Census of Population, and panel data from the Canadian Survey of Ageing and Dementia. Additional work on provincial and regional subsets of the Canadian population was based on a 1980 replication of the Canada Health Survey for Montreal, the Quebec Health Surveys of 1987, 1993 and 1998, the Quebec Health and Activity Limitation Survey of 1998, the 1990 Ontario Health Survey, and hospital-based cohorts of spinal cord injured adults. In most cases, Canadian studies have been careful to include comprehensive estimates of the institutionalized population in the calculations, and have generally given special attention to results for the elderly population. Numerous indices of health expectancy have been calculated, based on various definitions and levels of disability and dependence. Health-adjusted life expectancies have been calculated based either on simple weights for a small number of disability or dependency-related health states, or on complex multi-attribute measures of health including non-disabling impairments and pain. Sullivan-type prevalence-based estimates have been used in most cases, but more recent work has been based on multi-state life table and monte-carlo simulation methods. Cause-deleted health expectancies have been calculated for several chronic conditions and risk factors. Health expectancies have been disaggregated by income, education, immigrant status, urban and rural residence, province and sub-provincial regions. The discussion will include a critical look at problems with the existing work-including interpretation of the sometimes bewildering array of findings, comments on work in progress and possible future directions for health expectancy indices in Canada.

CONTEXT: uS elderly are living longer and healthier lives. But with the sharp increase of the overall elderly population, the size and the health status of the elderly population who needs long-term care is unclear. According to the 1997 National Nursing Home Survey, there are approximately 1.5 million elderly residents living in nursing homes on an average day in the united States. The characteristics of the nursing home population are heterogeneous in terms of both the specific diseases or impairments they have and the demographic attributes they possess.

OBJECTIVE: Categorizing nursing home residents into five disability groups according to their health and functioning, and analyzing the trend of residents’ health status change across the four waves of study.

MAIN OUTCOME MEASURE: Five health types capture the changing prevalence across gender and age for the nursing home residents.

RESULTS: The prevalence of the most disabled group is increasing dramatically. The health compositions for male and female nursing home residents are very similar.

CONCLUSIONS: The demand for more intensive care and the cost of nursing home services will rise sharply.

Based on the Chinese healthy longevity survey on oldest old persons aged 80+ conducted in 1998 and 2000, we found that female oldest old persons of all age groups are more likely to live with their children because elderly women are more likely to be widowed and economically dependent. The gender differentials in education attainment among Chinese oldest old are enormous: about 78.2, 87.3, and 93.5 percent of female oldest old aged 80-89, 90-99, and 100-105 are illiterate with zero year of schooling, in contrast to 30.2, 38.1, and 48.9 percent for their male counterparts. Based on the cross-sectional data, we are confident in concluding that the female oldest old in China are seriously disadvantaged in ADL, physical performance, MMSE and self-reported health, as compared with their male counterparts; these gender differences are more marked with advancing age. Based on longitudinal data collected in 1998 and 2000, we found that, although women live longer than men do, the oldest old females’ probabilities of healthy survival for those survived and probabilities of non-suffering dying for those died are significantly lower than that of their male counterparts.

The large gender differential among Chinese oldest old is an important issue, which needs serious attention from society and government. Very careful attention should be given to ensure that any old age insurance and service programs to be developed or reformed must benefit older women and men equally.

Based on interviews to 208 centenarians in Beijing, Hangzhou, and Chendu by the author, this study found that Male urban centenarians tend to be more dependent than urban female centenarians are; urban centenarians are more dependent than those in the rural areas are. Male centenarians tend to report better health than females do. Educational attainment is positively and significantly associated with centenarians’ self-reported health and well-being. This finding is confirmed by both univariate and multivariate models. Current economic status is associated with centenarians’ self-reported health. Centenarians who have better current economic conditions tend to self-report better health. Childhood economic condition is positively associated with centenarians’ self-reported health and well being. Speech impairment is significantly associated with centenarians’ well-being; hearing impairment does not significantly associate with an individual’s self-reported health and activities of daily living.