Predicting successful aging in a population-based sample of georgia centenarians

Abstract

Used a population-based sample (Georgia Centenarian Study, GCS), to determine proportions of centenarians reaching 100 years as (1) survivors (43%) of chronic diseases first experienced between 0-80 years of age, (2) delayers (36%) with chronic diseases first experienced between 80-98 years of age, or (3) escapers (17%) with chronic diseases only at 98 years of age or older. Diseases fall into two morbidity profiles of 11 chronic diseases; one including cardiovascular disease, cancer, anemia, and osteoporosis, and another including dementia. Centenarians at risk for cancer in their lifetime tended to be escapers (73%), while those at risk for cardiovascular disease tended to be survivors (24%), delayers (39%), or escapers (32%). Approximately half (43%) of the centenarians did not experience dementia. Psychiatric disorders were positively associated with dementia, but prevalence of depression, anxiety, and psychoses did not differ significantly between centenarians and an octogenarian control group. However, centenarians were higher on the Geriatric Depression Scale (GDS) than octogenarians. Consistent with our model of developmental adaptation in aging, distal life events contribute to predicting survivorship outcome in which health status as survivor, delayer, or escaper appears as adaptation variables late in life.

Figure 1

(a) Exponential growth of Centenarians in England over the last century [2]. (b) Network of morbidity in centenarians in the GCS [3] using lifetime prevalence of 11 most common chronic diseases in the GCS. All pairwise associations that were not significant by an exact test were set to zero, and the remaining significant (with α = 0.05) pairwise correlations (r _xy) between chronic diseases x and y were all positive. These significant pairwise positive associations were graphically rendered using the distance 1-r _xy and multi-dimensional scaling [9] to compute coordinates for the chronic diseases. The coordinates were then graphed as a network [10]. COPD denotes chronic pulmonary obstruction disease. Chronic and acute pneumonia were not distinguished in the medical questionnaire. (c) Average linkage [11] was used to compute a dendrogram independently relating the 11 chronic diseases based on their pairwise correlations {r _xy}. (d) The distribution of GDRS scores [12] in centenarians is compared with the distribution of GDRS scores in 80 octogenarians as a control group. A GDRS score of 4–7 is indicative of dementia, a score of 3, of mild cognitive impairment, and a score of 1-2, as unaffected.

Figure 2

The factors of cardiovascular disease (a), cancer (b), pneumonia (c), psychiatric disorders (d), and living arrangement (e) determine the fraction of survivors, delayers, and escapers [4] among centenarians. The observed (in blue) and expected proportions (in red) track each other in that the logistic multinomial model well predicts the outcome of a being a survivor (S), delayer (D), or escaper (E) [4]. In panels (a)–(e), a square indicates the presence of a disease and a circle, the absence of a disease. (f). Centenarians were higher (with mean of 3.21 and standard deviation of 2.56) on the Geriatric Depression Scale (GDS) [6] than the control group of octogenarians (with mean of 2.13 and standard deviation of 2.62). The proportion (15.5%) of centenarians with GDS from 6–15 is significantly different from that proportion (4.6%) in octogenarians (Z = 3.13, P < .001).

Figure 3

Developmental Adaptation: The influence of distal variables (e.g., cumulative life events, parents' education, education, and childhood health) on adaptational outcomes in very late life.