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. 2025 Jun 23;9(6):igaf050.
doi: 10.1093/geroni/igaf050. eCollection 2025.

Health Trajectories of Independent and Dependent Centenarians: A Swedish Nationwide Cohort Study

Shunsuke Murata  1 , Yuge Zhang  1 , Marcus Ebeling  1   2 , Katharina Schmidt-Mende  3   4 , Karin Modig  1
Affiliations

Health Trajectories of Independent and Dependent Centenarians: A Swedish Nationwide Cohort Study

Shunsuke Murata et al. Innov Aging. .

Abstract

Background and objectives: Although a large proportion of centenarians depend on assistance, many still live at home, independently or with a little formal long-term care. It is of interest to explore this group further and compare them to dependent centenarians.

Research design and methods: This register-based cohort included the entire Swedish centenarian population between 2020 and 2022. Centenarians were classified into two groups: those independent of formal long-term care and those dependent on such care. Disease trajectories were observed in historical data from age 67 and onwards and described for myocardial infarction, stroke, hip fracture, dementia, diabetes, and different cancer diagnoses, as well as hospitalizations and the number of prescribed drugs.

Results: Of the 4,277 centenarians, 36% were independent. Compared with dependent centenarians, independent centenarians had lower incidences of stroke and dementia after age 85 and a lower incidence of hip fracture from age 75. They were less often hospitalized and had lower levels of polypharmacy. In regression analysis, women, stroke, hip fracture, dementia, and more prescribed drugs were associated with an increased risk of being dependent at age 100, while being married was associated with a reduced risk.

Discussion and implications: The health differences between independent and dependent centenarians appeared mainly after life expectancy was exceeded. After this age, differences in incidences of hip fracture, stroke, and dementia became apparent between the groups. This finding underscores that these diseases affect care needs in very old age and that avoiding them is linked to a more independent life as a centenarian.

Keywords: Exceptional healthy longevity; Health trajectories; Registries.

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Conflict of interest statement

None.

Figures

Figure 1.
Figure 1.
The sex-standardized incidence rates of hospitalization and proportions of drug prescription counts for the two groups of centenarians. Sex-standardized incidence rate of hospitalization from the age of 72 and onwards (upper left panel), incidence rate difference (upper right panel) for independent and dependent centenarians, and the proportion of drugs from the age of 87 (lower panels), respectively. Shaded area represents the 95% confidence interval.
Figure 2.
Figure 2.
The sex-standardized incidence proportions of different diseases and the respective risk differences between the two groups of centenarians. Sex-standardized cumulative incidence of different diseases from the age of 72 and onwards (left panels) and absolute risk difference (right panels) for independent and dependent centenarians, respectively. Shaded area represents the 95% confidence interval.
Figure 3.
Figure 3.
The sex-standardized incidence proportions of different cancers and the respective risk differences between the two groups of centenarians. Sex-standardized cumulative incidence of colorectal-, breast- (women only), and prostate (men only) cancer from the age of 72 and onwards (left panels) and absolute risk difference (right panels) for independent and dependent centenarians, respectively. Shaded area represents the 95% confidence interval.
Figure 4.
Figure 4.
Risk ratios and (95% confidence intervals [CI]) for variables associated with being a dependent centenarian estimated with modified Poisson regression, all estimates mutually adjusted.
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