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

BACKGROUND: Despite most centenarians facing age-related declines in functional and cognitive capacities, the severity of these declines varies among individuals, as does the maintenance of good mental health (e.g., depressive symptoms) despite these declines. This study aims to examine this heterogeneity in centenarians from the Second Heidelberg Centenarian Study, which collected data from 112 centenarians living in Germany. In our study, we focus on a subsample of 73 centenarians who provided self-reports for our measures of interest (M age = 100.4, SD age = 0.55). METHODS: We examined correlations between functional capacity (i.e., PADL, IADL), cognitive capacity (i.e., MMSE), and depressive symptoms (i.e., GDS), and the existence of different profiles using hierarchical clustering. RESULTS: Higher functional capacity was related to higher cognitive capacity and to fewer depressive symptoms. Yet, higher cognitive capacity was associated with more depressive symptoms. Hierarchical clustering analysis elucidated this contradiction by identifying three profiles: low-capacity individuals (i.e., 24 individuals had low functional and cognitive capacities, with low depressive symptoms), high-capacity individuals (i.e., 33 individuals with high functional and cognitive capacities, with low depressive symptoms), and low-functional-high-cognitive-capacity individuals (i.e., 16 individuals showed low functional but high cognitive capacity, with high depressive symptoms). Our post-hoc analyses highlighted arthritis and pain as risk factors for functional dependence and depression. CONCLUSIONS: Our findings emphasize the importance of identifying centenarian subgroups with specific resource- and risk profiles to better address their needs, and of treating pain to improve functional capacity and mental health in centenarians.

Cognition, function, and prevalent dementia in centenarians and near-centenarians: An individual participant data (IPD) meta-analysis of 18 studies.

INTRODUCTION: There are limited data on prevalence of dementia in centenarians and near-centenarians (C/NC), its determinants, and whether the risk of dementia continues to rise beyond 100. METHODS: Participant-level data were obtained from 18 community-based studies (N = 4427) in 11 countries that included individuals ≥95 years. A harmonization protocol was applied to cognitive and functional impairments, and a meta-analysis was performed. RESULTS: The mean age was 98.3 years (SD = 2.67); 79% were women. After adjusting for age, sex, and education, dementia prevalence was 53.2% in women and 45.5% in men, with risk continuing to increase with age. Education (OR 0.95;0.92-0.98) was protective, as was hypertension (odds ratio [OR] 0.51;0.35-0.74) in five studies. Dementia was not associated with diabetes, vision and hearing impairments, smoking, and body mass index (BMI). DISCUSSION: Among the exceptional old, dementia prevalence remains higher in the older participants. Education was protective against dementia, but other factors for dementia-free survival in C/NC remain to be understood.

Thinking About the End of Life When It Is Near: A Comparison of German and Portuguese Centenarians.

This study examined how common thinking of and planning for the end of life (EOL) is among German and Portuguese centenarians, and whether patterns of EOL views are shaped by cultural and individual characteristics. A significant portion of centenarians in both countries reported not thinking about the EOL, not believing in the afterlife, and not having made EOL arrangements. Latent class analysis identified three EOL patterns: Class 1 (EOL thoughts with EOL arrangements and afterlife beliefs), Class 2 (EOL arrangements and afterlife beliefs without EOL thoughts), and Class 3 (Overall low endorsement of EOL items). The proportion of Portuguese centenarians was higher in Class 1 and of German centenarians higher in Classes 2 and 3. Centenarians' demographic, social, and health characteristics were significantly different across EOL patterns. As lack of EOL planning can result in poor EOL quality, enhancing communication among centenarians, family, and health-care professionals seems imperative.

Valuation of Life Among Old and Very Old Adults: Comparison Between Germany and Japan.

BACKGROUND AND OBJECTIVES: Valuation of life (VOL) represents a construct capturing individuals' active attachment to their life. The majority of studies on VOL were conducted in North America and Europe where personal autonomy and independence are highly valued, leaving open the question about the relevance of this construct in interdependence-oriented cultures. Using a framework of cross-cultural and life-span theories, the present study compared levels and predictors of VOL between the young-old and old-old individuals from Germany and Japan. RESEARCH DESIGN AND METHODS: Two hundred fifty-seven Germans and 248 Japanese, matched by age, gender, education, and IADL, answered a 5-item VOL scale and shared information on sociodemographic, social, and health resources. RESULTS: Germans' VOL levels were higher than in Japanese participants. Both culture- and age-moderated predictions of VOL: education was significant only in the young-old Japanese, and close social partners mattered in the old-old, not in the young-old. Health determined VOL irrespective of culture and age. DISCUSSION AND IMPLICATIONS: The findings suggest that cultural values and aging processes should be considered to better understand how individuals value their life and to help older adults to feel that his/her life is meaningful and worth living.

Centenarians' End-of-Life Thoughts and Plans: Is Their Social Network on the Same Page?

OBJECTIVES: To explore how centenarians think about and plan for the end of life (EOL) and to what extent their primary contacts (proxy informants) are aware of these thoughts. DESIGN: Population-based study with semistructured in-person interviews. SETTING: Defined geographical region approximately 60 km around Heidelberg, Germany. PARTICIPANTS: Subsample drawn from the larger study of centenarians (N = 78) with data on centenarians' EOL thoughts from the centenarian and the proxy informant. MEASUREMENTS: Centenarians reported on their thoughts about the EOL, perception of the EOL as threatening, longing for death, engagement in any EOL planning, and type of EOL plan (will, living will, healthcare surrogate) in place. Proxy respondents answered the same set of questions based on what they thought the centenarians' perspective was. RESULTS: In nearly half of cases, proxies misjudged whether the centenarian thought about EOL. Although only few centenarians perceived the EOL as threatening, and approximately one-quarter reported longing for death, proxies overestimated centenarians' reports on the former and underestimated the latter. Proxies reported more centenarian EOL planning than centenarians themselves. CONCLUSION: Even though enrolled proxies were mostly persons very close to the centenarian, many of them did not seem to be well informed about the centenarians' thoughts and plans regarding the EOL, suggesting a lack of communication between centenarians and social network members in this respect. Healthcare professionals should be aware that, even for very old adults approaching the end of their lives, discussions about EOL and EOL planning may need to be actively encouraged and supported.

Health and Disease at Age 100.

BACKGROUND: Centenarian studies from around the world have shown that reaching age 100 typically involves substantial health issues. The present study adds to the existing knowledge from other countries by describing health conditions in German centenarians. METHODS: A total of 112 centenarians or their primary contacts provided information on acute and chronic health conditions and pain in the context of the Second Heidelberg Centenarian Study (mean age = 100.45 years, standard deviation [SD] = 0.47, 89% females). RESULTS: Participants showed high comorbidity, with an average of five illnesses (mean = 5.3; SD = 2.20). Health conditions with highest prevalence were sensory (vision, hearing; 94%), mobility (72%) and musculoskeletal conditions (60%). Cardiovascular conditions (57%) and urinary system ailments (55%) were also common. Pain was experienced often by 30% of the participants. Of those reporting any pain, 36% indicated pain exceeding bearable levels. CONCLUSION: German centenarians experienced a substantial number of ill nesses, dominated by sensory and mobility conditions. Cardiovascular diseases were the only potentially lethal illnesses with high prevalence. Evidence of unaddressed pain seems alarming, requiring future research. Emerging health profiles indicate that even in very advanced age, quality of life may be improved by enhanced diagnostics and optimal disease management. Mobility limitations may be addressed with preventive efforts.

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.

Whom Do Centenarians Rely on for Support? Findings From the Second Heidelberg Centenarian Study.

This paper provides a detailed picture of the sources and types of informal support available to centenarians, depending on their housing and care arrangements. Participants were 112 centenarians and 96 primary contacts of centenarians enrolled in the population-based Second Heidelberg Centenarian Study. Findings indicate that children of centenarians were their primary source of support in daily life. Those without living children had overall less help. Most frequently reported was help with administrative tasks, regardless of centenarians' residence or living arrangement. All other types of help (e.g., with activities of daily living and housework) were reported by about one-third and were mostly provided by children; centenarians without children were more likely to have friends/neighbors involved in some of these tasks. The one category reported by a third of the centenarians regardless of residence, living arrangements, or presence of a child was help with socializing/companionship. Findings constitute an important step toward identifying and meeting the support needs of centenarians and their families. Policy implications are discussed.

Measuring attachment to life in old age: the Portuguese version of the Positive Valuation of Life Scale (Positive VOL).

PURPOSE: This study aims to present the psychometric properties of the Portuguese version of the Positive Valuation of Life Scale (Lawton et al. in J Aging Ment Healt 13:3-31, 2001). METHOD: Sample included 207 community-dwelling elders (129 women; M Age = 77.2 years, SD = 7.5). The data collection included the translated and adapted Portuguese version of Positive Valuation of Life Scale, Life Satisfaction Index Z, Meaning in Life Questionnaire and Geriatric Depression Scale. RESULTS: From exploratory factor analysis, two factors emerged, existential beliefs and perceived control, explaining 49 % of the total variance. Both factors were positively related with meaning in life and life satisfaction and negatively related with depression (p < 0.05). The values obtained for internal consistency for the total scale and for each subscale were good (α > 0.75). CONCLUSION: The Portuguese version of Positive VOL Scale represents a reliable and valid measure to capture the subjective experience of attachment to one's life. The two-factor structure is an update to Lawton's previous work and in line with findings obtained in the USA (Dennis et al. in What is valuation of life for frail community-dwelling older adults: factor structure and criterion validity of the VOL, Thomas Jefferson University, Center for Applied Research on Aging and Health Research, 2005) and Japan (Nakagawa et al. in Shinrigaku Kenkyu 84:37-46, 2013). Future research is required to investigate VOL predictors and the potential changes toward the end of the life span.

Is aging in place a resource for or risk to life satisfaction?

PURPOSE: Given age-related health restrictions, the importance of the environment for life satisfaction may increase in later life. This study investigated whether objective and perceived physical and social environmental aspects of the home and of the surrounding neighborhood represent resources for or risks to life satisfaction among young-old and old-old individuals. DESIGN AND METHODS: A population-based sample of 381 community-dwelling individuals aged 65-94 years reported on their sociophysical environment and life satisfaction using questionnaires. RESULTS: On average, young-old differ from old-old in indoor physical environmental indicators but not in neighborhood characteristics or social aspects of housing. Regression analyses revealed that apartment size, perceived neighborhood quality, and outdoor place attachment explained life satisfaction independently, whereas social housing aspects played only a minor role. Separate analyses for both age groups revealed age differential explanation patterns. Apartment size was positively related to life satisfaction in the young-old but was negatively related in the old-old. For the old-old, perceived neighborhood quality and outdoor place attachment were more important than for the young-old. Living with others was positively related to life satisfaction only for the young-old. IMPLICATIONS: Environmental characteristics at home and in the neighborhood need to be considered to better understand differential processes of aging in place with respect to well-being.

Valuation of life in old and very old age: the role of sociodemographic, social, and health resources for positive adaptation.

PURPOSE: Valuation of life (VOL) represents a construct capturing active attachment to life put forward by M. P. Lawton (e.g., 1999). As old and very old individuals may differ in terms of endorsement and with respect to what makes a life worth living, the present study investigated whether mean levels and the explanatory value of sociodemographic, social, and health predictors for VOL differ between young-old and old-old individuals. DESIGN AND METHODS: We presented a sample of 356 community-dwelling individuals aged 65 to 94 years with Lawton's Positive Valuation of Life Scale and established measures to assess predictors of VOL. RESULTS: Mean levels of VOL decreased from the third to the fourth age. Zero-order correlations showed significant relations between sociodemographic (i.e., age, gender, marital status, education), social (i.e., social contacts, phone calls, volunteering, contact with youth), and health (i.e., mobility, vision, hearing, activity restrictions, activity of daily living [ADL], instrumental ADL [IADL]) indicators. Regression analyses for the domain-specific predictors reduced the number of significant predictors to age, education, grandchildren, vision, and IADLs. When combining all sets of predictors, health explained twice as much variance in VOL compared to social indicators; sociodemographic indicators including age made no independent contribution. Separate analysis for young-old and old-old participants revealed age-differential prediction patterns. For the young-old, the role of health factors was especially strong, whereas specific social factors became more important in the old-old group. IMPLICATIONS: Age-differential predictive values of the resources seem to indicate positive adaptation to aging. Taking into account such prediction patterns may help to design specific interventions for young-old and old-old individuals.

Age differences and changes of coping behavior in three age groups: findings from the Georgia Centenarian Study.

With increasing age, older adults are more likely to be challenged by an increasing number of physical, functional and social losses. As a result, coping with losses becomes a central theme in very late life. This study investigated age differences and age changes in active behavioral, active cognitive and avoidance coping and related coping to adaptational outcomes, such as physical and mental health. Sixty-one sexagenarians, 46 octogenarians, and 47 centenarians from the Georgia Centenarian Study participated in this longitudinal study to assess coping with health and family events. The results indicated age group differences in active behavioral coping, suggesting that centenarians were less likely to use this mode of coping. Centenarians and octogenarians were also more likely to experience decreases in active behavioral coping over time, while sexagenarians were more likely to experience increases in this coping mode. No significant differences in coping with health versus family events were obtained suggesting that coping is consistent across life domains. Moderate levels of stability were obtained for coping in all age groups. Active behavioral and active cognitive coping predicted functional health, active behavioral coping predicted social relations, and avoidance coping predicted negative affect.

Adaptation in very old age: exploring the role of resources, beliefs, and attitudes for centenarians' happiness.

When individuals reach very old age, accumulating negative conditions represent a serious challenge to their capacity to adapt and are likely to reduce the quality of life. By examining happiness and its determinants in centenarians, this study investigated the proposal that psychological resilience may come to an end in extremely old age. Data from the population-based Heidelberg Centenarian Study indicated high levels of happiness. Basic resources (i.e., job training, cognition, health, social network, extraversion) explained a substantial proportion of variance in happiness, but some resource effects were mediated through self-referent beliefs (e.g., self-efficacy) and attitudes toward life (e.g., optimistic outlook). Results challenge the view that psychological resilience reaches a critical limit or that the self-regulatory adaptation system loses its efficiency in very advanced age.

Cognitive status and development in the oldest old: a longitudinal analysis from the Heidelberg Centenarian Study.

In the present study, we investigated cognitive status, cognitive development and the effect of mortality on cognitive changes in very old age. Analyzing data from the population-based Heidelberg Centenarian Study, results revealed that centenarians differed quite strongly in their cognitive capacities. While about half of the population showed moderate to severe cognitive impairment, one quarter was found to be cognitively intact. Moreover, analyzing cognitive change over a period of 1.5 years, centenarians' cognitive performance was revealed to be rather stable. Finally, only a small effect of mortality on cognitive status and changes was detected, supporting a recent hypothesis that the terminal decline or drop in cognitive functioning decreases in very old age.

The German Center for Research on Aging at the University of Heidelberg: an interdisciplinary approach.

In September 1995, the German Center for Research on Aging at the University of Heidelberg had been founded to become a leading national center of excellence with a clear interdisciplinary scope of ageing research activities. So far, three departments have been built up successively: the Department of Social and Environmental Gerontology (established in 1997, chair: Prof. Hans-Werner Wahl), the Department of Adult Development (established in 1998, provisional chair: Prof. Andreas Kruse), and the Department of Epidemiology (established in 2000, chair: Prof. Hermann Brenner). As one of the next steps, the disciplinary spectrum of the Center will be complemented by setting up several junior research groups in molecular ageing research. Within the few years of its existence, the Center has set up multiple large-scale, extramurally funded cross-sectional, case-control and longitudinal studies. These studies provide a unique common basis for interdisciplinary collaboration both within the Center and with the Center's numerous national and international research partners.