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Oldest-old is the fastest growing segment of society. A substantial number of these individuals are cognitively impaired or demented. Given the lack of a cure, attention is directed to lifestyle interventions that could help alleviate the stress in patients, their families, and society. The aim of this review was to identify lifestyle factors with important roles in dementia prevention in oldest-old. Searches were conducted in PubMed, EMBASE, Scopus and Web of Science. We identified 27 observational cohort studies that met the inclusion criteria. Results showed that eating a healthy diet with plenty of fruits and vegetables, and participation in leisure and physical activities may protect against cognitive decline and cognitive impairment among oldest-old regardless of the APOE genotype. Combined lifestyles may generate multiplicative effects than individual factors. This is the first review known to systematically examine the association between lifestyle and cognitive health in oldest-old. Lifestyle interventions for diet, leisure, or a combination of lifestyles could be beneficial for cognitive function in oldest-old. Interventional studies are warranted to strengthen the evidence.

Background Though dementia rates vary by racial or ethnic groups, it is unknown if these disparities remain among those aged 90 or older. Aims To test this hypothesis, we used baseline clinical evaluation of 541 ethnically and racially diverse individuals participating in the LifeAfter90 Study to assess how associations between core demographic characteristics and measures of physical and cognitive performance differ across the racial/ethnic groups. Methods Participants in this study were long-term non-demented members of Kaiser Permanente Northern California. They were clinically evaluated and diagnosed with normal or impaired cognition (mild cognitive impairment and dementia) through an in-person comprehensive clinical assessment consisting of a detailed medical history, physical and neurological examination, functional, and cognitive tests. Results The average age at enrollment was 93.0 ± 2.6 years, 62.4% female and 34.2% non-Hispanic White. At initial evaluation 301 participants had normal cognition and 165 had mild cognitive impairment (MCI) and despite screening, 69 participants were determined to have dementia. Age, education, 3MS, FAQ and CDR scores were significantly associated with cognitive impairment (normal versus MCI and dementia), but not gender. There was a significant univariate association between race/ethnicity and cognitive impairment (p Conclusion Our results confirm the ability to reliably assess clinical diagnosis in a diverse sample of very old individuals.

Oldest-old is the fastest growing segment of society. A substantial number of these individuals are cognitively impaired or demented. Given the lack of a cure, attention is directed to lifestyle interventions that could help alleviate the stress in patients, their families, and society. The aim of this review was to identify lifestyle factors with important roles in dementia prevention in oldest-old. Searches were conducted in PubMed, EMBASE, Scopus and Web of Science. We identified 27 observational cohort studies that met the inclusion criteria. Results showed that eating a healthy diet with plenty of fruits and vegetables, and participation in leisure and physical activities may protect against cognitive decline and cognitive impairment among oldest-old regardless of the APOE genotype. Combined lifestyles may generate multiplicative effects than individual factors. This is the first review known to systematically examine the association between lifestyle and cognitive health in oldest-old. Lifestyle interventions for diet, leisure, or a combination of lifestyles could be beneficial for cognitive function in oldest-old. Interventional studies are warranted to strengthen the evidence.

Background: Some oldest-old individuals can maintain superior cognition despite advanced age. Little is known about the neuropathological changes in the brains of oldest-old superior cognitive performers. Objective: Our objective was to examine the associations between Alzheimer’s disease (AD) and non-AD neuropathologic features in relation to superior cognitive performance in oldest-old individuals. Methods: We analyzed brain autopsy data from 102 participants with normal cognition from The 90+ Study. Superior global cognitive performers (SGCP) were defined as having Mini-Mental State Examination (MMSE) score ≥28 in the last visit 12 to 2 months before death. To examine the associations between individual and multiple comorbid neuropathologic features with SGCP status we used multiple logistic regression models adjusting for age, sex, and education. Results: Alzheimer’s disease neuropathological change (ADNC) and low levels of vascular pathologic change were not associated with superior cognition. In contrast, participants with limbic (OR = 8.37; 95% CI: 1.48–47.44) and neocortical (OR = 10.80;95% CI: 1.03–113.82) Lewy body disease (LBD), or with hippocampal sclerosis (HS) (OR = 5.28; 95% CI: 1.10–25.47) were more likely to be non-SGCP. High total burden of multiple comorbid neuropathologic features was associated with a lower likelihood of being SGCP. Conclusion: Oldest-old superior cognitive performers were resilient to ADNC and low levels of vascular pathologic change and were resistant to non-AD neurodegenerative changes and multiple comorbid neuropathologic features. Understanding the factors underlying the ability of superior cognitive performers to resist these changes might provide useful insights on maintenance of superior cognition despite advanced age.

As global aging advances, the number of centenarians worldwide is greatly increasing. Most of what is known about centenarians comes the Global North. It is not clear what factors contribute to longevity of centenarians in impoverished, mostly rural areas of Global South nations that still lack basic amenities. Cultural differences in the profile, lifestyles, and needs of centenarians in Africa have yet to be documented. Using a case study design, this descriptive inquiry investigated the profiles of centenarians in Ethiopia including religion, marriage, education, occupation, income, and living arrangement. Data were generated through in-depth interviews with nine centenarians (1 woman, 8 men) and were analyzed using descriptive narrative analysis. Respondents were between 100 and 108 years old. All nine were adherents of Orthodox Christianity, had been married, and were great-grandparents. Their adult lives were marked by both residential and marital stability. The Ethiopian centenarians persevered through many losses and hardships with the help of strong community-based social networks.. Unlike studies of centenarians in the Global North, most respondents were male and had strict religious upbringings. Understanding the unique profiles of centenarians in the Global South will help to inform research and practice with this growing population of the oldest-old.

The oldest-old subjects represent the fastest growing segment of society and are at high risk for dementia with a prevalence of up to 40%. Lifestyle factors, such as lifelong participation in cognitive and leisure activities, may contribute to individual cognitive reserve and reduce the risk for cognitive impairments. However, the neural bases underlying cognitive functioning and cognitive reserve in this age range are still poorly understood. Here, we investigate spectral and functional connectivity features obtained from resting-state MEG recordings in a cohort of 35 cognitively normal (92.2 ± 1.8 years old, 19 women) and 11 cognitively impaired (90.9 ± 1.9 years old, 1 woman) oldest-old participants, in relation to cognitive traits and cognitive reserve. The latter was approximated with a self-reported scale on lifelong engagement in cognitively demanding activities. Cognitively impaired oldest-old participants had slower cortical rhythms in frontal, parietal and default mode network regions compared to the cognitively normal subjects. These alterations mainly concerned the theta and beta band and partially explained inter-subject variability of episodic memory scores. Moreover, a distinct spectral pattern characterized by higher relative power in the alpha band was specifically associated with higher cognitive reserve while taking into account the effect of age and education level. Finally, stronger functional connectivity in the alpha and beta band were weakly associated with better cognitive performances in the whole group of subjects, although functional connectivity effects were less prominent than the spectral ones. Our results shed new light on the neural underpinnings of cognitive functioning in the oldest-old population and indicate that cognitive performance and cognitive reserve may have distinct spectral electrophysiological substrates.

Background Although it is known that mortality due to COVID-19 increases progressively with age, the probability of dying from this serious infection among the oldest-old population is little known, and controversial data are found in literature. Methods We examine the mortality by year and month of birth of Belgians who had turned 100 during the current COVID-19 pandemic and whose birth fell on the years around the end the First World War and the outbreak of the H1N1 "Spanish flu" pandemic. Findings The COVID-19 mortality of the "older" centenarians is significantly lower than that of "younger" centenarians, and this difference between the two groups reaches a maximum on August 1, 1918 as the discriminating cut-off date of birth. Having excluded the plausible impact of the end of WWI it becomes clear that this date corresponds to the time of reporting the first victims of the Spanish flu pandemic in Belgium. Interpretation In this study, the striking temporal coincidence between the outbreak of the Spanish flu epidemic and the birth of the cohorts characterized by greater fragility towards COVID-19 in 2020 strongly suggests a link between exposure to 1918 H1N1 pandemic influenza and resistance towards 2020 SARS-Cov-2. It can be speculated that the lifetime persistence of cross-reactive immune mechanisms has enabled centenarians exposed to the Spanish flu to overcome the threat of COVID-19 a century later.

With an increase in the number of older adults worldwide, the oldest-old population, defined as individuals over the age of 90, is also growing. Japan is now facing the problem of a “super-aged society” in which over 21% of the population is aged over 65. The oldest-old constituted 1.8% (2.31 million) of the Japanese population in 2019. Such individuals have special health-care needs. In cases of acute or chronic (or both) renal failure in the oldest-old, it becomes difficult to decide whether dialysis should be initiated. The issue is controversial, and there is some debate on whether dialysis should be avoided in elderly people because of their frailty or if it should be initiated to enable them to spend their remaining years with their families by improving their quality of life. Herein, we describe our experience in 4 cases of hemodialysis initiated in patients over the age of 90. In our experience, dialysis enabled them to spend the rest of their lives with their families, which could not have been possible without it. Although further studies are needed, we concluded that oldest-old individuals in good general health could be eligible for and benefit from hemodialysis.

Background Changes in older people’s symptoms across recent decades have not been investigated. Aims We analyzed temporal trends in symptom burden by comparing data from independent, cross-sectional cohorts retrieved in 1989, 1999, 2009, and 2019. Furthermore, we compared the association between symptom burden and psychological wellbeing (PWB) in older men and women. Methods The Helsinki Aging Study recruited a random sample of people aged 75, 80, and 85 in 1989, and random samples aged 75, 80, 85, 90, and 95 in 1999, 2009, and 2019 (four study waves). Altogether, 6263 community-dwelling people answered the questions concerning symptoms in the questionnaire surveys. The symptoms inquired in all study waves were dizziness, back pain, joint pain, chest pain, shortness of breath, and loss of appetite. Symptom burden was calculated according to the number of symptoms and their frequency (score range: 0–6). PWB and the Charlson comorbidity index were calculated. Results Symptom burden decreased in both men and women aged 75 and 80 from 1989 to 2019. Changes in cohorts aged 85 + were nonsignificant. There was a significant difference in symptom burden between men and women in all ages with men having fewer symptoms. PWB decreased with increasing symptom burden. Men had greater PWB than women up to severe levels of symptom burden. Conclusions Symptom burden decreased from 1989 to 2019 in cohorts aged 75–80, whereas changes remained nonsignificant in cohorts aged 85 +. To our knowledge, this is the first study to examine temporal trends in symptom burden.

Background Cognitive screening is important for the oldest-old (age 90 +). This age group is the fastest growing and has the highest risk of dementia. However, norms and score equivalence for screening tests are lacking for this group. Aims To provide norms and score equivalence for commonly used cognitive screening tests for the oldest-old. Methods Data on 157 participants of the Center for Healthy Aging Longevity Study aged 90 + were analyzed. First, we derived norms for (1) subtests and cognitive domains of the in-person Montreal Cognitive Assessment having a maximum score of 30 (MoCA-30) and (2) the total MoCA-22 score, obtained from the in-person MoCA-30 by summing the subtests that do not require visual input to a maximum score of 22. These norms were derived from 124 participants with a Mini-Mental State Examination (MMSE) ≥ 27. Second, we derived score equivalences for MMSE to MoCA-30 and MoCA-22, and MoCA-30 to MoCA-22 using equipercentile equating method with log-linear smoothing, based on all 157 participants. Results MoCA-22 total score norms are: mean = 18.3(standard deviation = 2.2). An MMSE score of 27 is equivalent to a MoCA-30 score of 22 and a MoCA-22 score of 16. Discussion and conclusions Subtest, domain and MoCA-22 norms will aid in evaluation of the oldest-old who cannot complete the MoCA-30 or are tested over the phone. The equivalences of the three cognitive tests (MMSE, MoCA-30, MoCA-22) in the oldest-old will facilitate continuity of cognitive tracking of individuals tested with different tests over time and comparison of the studies that use different cognitive tests.

Backgrounds The oldest-old population is increasing sharply in China, and intergenerational support has been their primary source of caregiving. Although intergenerational support has been found to be associated with wellbeing of older people in previous study, most analysis were from the perspective of children’s characteristics and exchange patterns. This study aims to investigate the impact of different types of intergenerational support on subjective wellbeing among Chinese oldest-old and the variation across groups of different economic status, based on their five-tier of needs (physiological needs, safety needs, love/belonging needs, esteem needs, and self-actualization needs). Methods We included older adults aged ≥ 80 years from the 2018 Chinese longitudinal Healthy Longevity Survey (CLHLS). We assessed older people’s subjective wellbeing by their life satisfaction and psychological health. We evaluated four types of intergenerational support: parents provide financial support, receive financial, instrumental and emotional support. We applied binary logistic regression analysis to analyze the association between different intergenerational support and older people’s subjective wellbeing and the moderating effect of self-rated economic status on this relationship. Results A total of 8.794 participants were included, with a mean age of 91,46 years (standard deviation:7.60). Older adults who provide financial support (OR: 1.37, 95% CI: 1.01, 1.85) and receive emotional support (OR: 1.99, 95% CI: 1.40, 2.83) report better subjective wellbeing. However, receiving instrumental support depressed psychological health (OR: 0.67, 95% CI: 0.56, 0.79) while improved life satisfaction (OR: 1.42, 95% CI: 1.04, 1.55). Receiving emotional support promoted parents’ psychological health among all combinations of support, and receiving all the three types together raised their subjective wellbeing most. Conclusions Our study recognizes that higher level of subjective wellbeing for oldest-old is related to providing financial support, receiving emotional and certain instrumental support. In addition, higher economic status can moderate these associations.

With increasing longevity, the number of individuals reaching and surpassing the age of 100 has risen in the past 20 years. Consequently, this phenomenon has attracted the attention of the scientific community from different disciplines putting centenarians in the spotlight of gerontological research. Prior research includes special articles and systematic reviews that had focused on specific scientific domains (e.g., medical, psychological), often lacking an inter/multi-disciplinary perspective (e.g., Pavlidis et al., 2012; Poon & Cheung, 2012; Cheng et al., 2021). Given the increasing number of studies worldwide, it is of interest to investigate the content of published articles to date, distinguish them from articles that do not offer insights on centenarians and near-centenarians, and highlighting the topics that need further investigation.

Oldest-old patients may have an unusual SARS-COV2 presentation that can jeopardise diagnosis and management. The aim of this study was to compare the clinical characteristics and outcomes of oldest-old (≥85 years) and old patients (75-85 years) admitted with COVID-19 to Belgian hospitals during the first wave of the pandemic. We conducted a multicentre, retrospective, observational study in ten Belgian hospitals. We reviewed the electronic clinical records of patients ≥75 years hospitalised with COVID-19 from March to June 2020. A total of 986 patients were placed on the register (old group: n = 507; oldest-old group: n = 479). Before hospitalisation, the oldest-old (OO) group presented with more geriatric syndromes including comorbidities, frailty, falls, cognitive impairment, and incontinence. At admission, the OO group presented with less cough, less headache, and less fever but significantly more delirium than old (O) group. Members of the OO group were admitted less frequently to intensive care units (ICUs). A geriatrician was consulted to help in the decision-making process more often for the OO group. The global mortality of the cohort was 47%, with no difference between the two groups. Patients in the OO group were more often institutionalised after hospitalisation and less often referred for rehabilitation. The OO patients presented with more geriatric syndromes that make them vulnerable to dependence and institutionalisation after a hospital stay, without having a higher mortality rate than O patients. Geriatrician expertise is necessary in the management of frail older patients.

Refereed/Peer-reviewed Limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) and Alzheimer’s disease neuropathologic change (ADNC) are each associated with substantial cognitive impairment in aging populations. However, the prevalence of LATE-NC across the full range of ADNC remains uncertain. To address this knowledge gap, neuropathologic, genetic, and clinical data were compiled from 13 high-quality community- and population-based longitudinal studies. Participants were recruited from United States (8 cohorts, including one focusing on Japanese–American men), United Kingdom (2 cohorts), Brazil, Austria, and Finland. The total number of participants included was 6196, and the average age of death was 88.1 years. Not all data were available on each individual and there were differences between the cohorts in study designs and the amount of missing data. Among those with known cognitive status before death (n = 5665), 43.0% were cognitively normal, 14.9% had MCI, and 42.4% had dementia—broadly consistent with epidemiologic data in this age group. Approximately 99% of participants (n = 6125) had available CERAD neuritic amyloid plaque score data. In this subsample, 39.4% had autopsy-confirmed LATE-NC of any stage. Among brains with “frequent” neuritic amyloid plaques, 54.9% had comorbid LATE-NC, whereas in brains with no detected neuritic amyloid plaques, 27.0% had LATE-NC. Data on LATE-NC stages were available for 3803 participants, of which 25% had LATE-NC stage > 1 (associated with cognitive impairment). In the subset of individuals with Thal Aβ phase = 0 (lacking detectable Aβ plaques), the brains with LATE-NC had relatively more severe primary age-related tauopathy (PART). A total of 3267 participants had available clinical data relevant to frontotemporal dementia (FTD), and none were given the clinical diagnosis of definite FTD nor the pathological diagnosis of frontotemporal lobar degeneration with TDP-43 inclusions (FTLD-TDP). In the 10 cohorts with detailed neurocognitive assessments proximal to death, cognition tended to be worse with LATE-NC across the full spectrum of ADNC severity. This study provided a credible estimate of the current prevalence of LATE-NC in advanced age. LATE-NC was seen in almost 40% of participants and often, but not always, coexisted with Alzheimer’s disease neuropathology.

Old patients with hepatotoxicity have been scarcely studied in idiosyncratic drug-induced liver injury (DILI) cohorts. We sought for the distinctive characteristics of DILI in older patients across age groups. A total of 882 DILI patients included in the Spanish DILI Registry (33% ≥65 years) were categorized according to age: “young” (

The world’s aging population has been constantly increasing in the last decades, causing the number oldest-old individuals to increase. The present study aims to explore the different variables that contribute to the oldest-old wellbeing using a mixed-methods approach, including self-reports, standardized measures, and semi-structured interviews. Thirty-nine oldest-old (90–103) from southern Italy were involved in the study, together with a control sample of younger individuals (51–71) from the same families. Data suggest that the oldest-old have better mental health, higher resilience, and more optimism than younger individuals. High resilience seems to be the key variable that promotes the overall wellbeing. The oldest-old tend to have better mental health, higher resilience and more optimism than younger individuals. Wellbeing in the oldest-old appeared to be promoted by the sense of belonging and life purpose.

Zijia Liu,1 Guangyan Xu,1 Li Xu,1 Yuelun Zhang,2 Yuguang Huang1 1Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People’s Republic of China; 2Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People’s Republic of ChinaCorrespondence: Li Xu Tel +86 10 6915 2020Fax +86 10 6915 5580Email pumchxuli@163.comPurpose: Ever-increasing noncardiac surgeries are performed in patients aged 80 years or over with coronary artery disease (CAD). The objective of the study was to explore the incidence and risk factors of perioperative cardiac complications (PCCs) for the oldest-old patients with CAD undergoing noncardiac surgery, which have not been evaluated previously.Patients and Methods: A total of 547 patients, aged over 80 years, with a history of CAD who underwent noncardiac surgery were enrolled in this retrospective study. Perioperative clinical variables were extracted from the electronic medical records database. The primary outcome was the occurrence of PCCs intraoperatively or within 30 days postoperatively, defined as any of the following complications: acute coronary syndrome, heart failure, new-onset severe arrhythmia, nonfatal cardiac arrest, and cardiac death. Multivariate logistic regression analysis and multivariate Cox regression model were both performed to estimate the risk factors of PCCs. The incidence of PCCs overtime was illustrated by the Kaplan–Meier curve with a stratified Log-rank test.Results: One hundred six (19.4%) patients developed at least one PCC, and 15 (2.7%) patients developed cardiac death. The independent risk factors contributing to PCCs were age ≧85 years; body mass index ≧30 kg/m2; the history of angina within 6 months; metabolic equivalents < 4; hypertension without regular treatment; preoperative ST-T segment abnormality; anesthesia time > 3 h and drainage ≧200 mL within 24 h postoperatively.Conclusion: The incidence of PCCs in elderly patients over 80 years with CAD who underwent noncardiac surgery was high. Comprehensive preoperative evaluation, skilled surgical technique, and regular postoperative monitoring may help to reduce the occurrence of PCCs in this high-risk population.Keywords: oldest-old, coronary artery disease, noncardiac surgery, perioperative, cardiac complications

Zijia Liu,1 Guangyan Xu,1 Li Xu,1 Yuelun Zhang,2 Yuguang Huang1 1Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People’s Republic of China; 2Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People’s Republic of ChinaCorrespondence: Li Xu Tel +86 10 6915 2020Fax +86 10 6915 5580Email pumchxuli@163.comPurpose: Ever-increasing noncardiac surgeries are performed in patients aged 80 years or over with coronary artery disease (CAD). The objective of the study was to explore the incidence and risk factors of perioperative cardiac complications (PCCs) for the oldest-old patients with CAD undergoing noncardiac surgery, which have not been evaluated previously.Patients and Methods: A total of 547 patients, aged over 80 years, with a history of CAD who underwent noncardiac surgery were enrolled in this retrospective study. Perioperative clinical variables were extracted from the electronic medical records database. The primary outcome was the occurrence of PCCs intraoperatively or within 30 days postoperatively, defined as any of the following complications: acute coronary syndrome, heart failure, new-onset severe arrhythmia, nonfatal cardiac arrest, and cardiac death. Multivariate logistic regression analysis and multivariate Cox regression model were both performed to estimate the risk factors of PCCs. The incidence of PCCs overtime was illustrated by the Kaplan–Meier curve with a stratified Log-rank test.Results: One hundred six (19.4%) patients developed at least one PCC, and 15 (2.7%) patients developed cardiac death. The independent risk factors contributing to PCCs were age ≧85 years; body mass index ≧30 kg/m2; the history of angina within 6 months; metabolic equivalents < 4; hypertension without regular treatment; preoperative ST-T segment abnormality; anesthesia time > 3 h and drainage ≧200 mL within 24 h postoperatively.Conclusion: The incidence of PCCs in elderly patients over 80 years with CAD who underwent noncardiac surgery was high. Comprehensive preoperative evaluation, skilled surgical technique, and regular postoperative monitoring may help to reduce the occurrence of PCCs in this high-risk population.Keywords: oldest-old, coronary artery disease, noncardiac surgery, perioperative, cardiac complications

SARS-CoV-2 dramatically revealed the sudden impact of respiratory viruses in our lives. Influenza and respiratory syncytial virus (RSV) infections are associated with high rates of morbidity, mortality, and an important burden on healthcare systems worldwide, especially in elderly patients. The aim of this study was to identify severity predictors in the oldest-old admitted with influenza and/or RSV infections. This is a multicenter, retrospective study of all oldest-old patients (≥ 85 years old) admitted for laboratory-confirmed influenza and/or RSV infection in three tertiary hospitals in Portugal, Italy, and Cyprus over two consecutive winter seasons. The outcomes included the following: pneumonia on infection presentation, use of non-invasive ventilation (NIV), and in-hospital death (IHD). The association with possible predictors, including clinical features and type of virus infection, was assessed using uni- and multivariable analyses. A total of 251 oldest-old patients were included in the study. Pneumonia was evident in 32.3% (n = 81). NIV was implemented in 8.8% (n = 22), and IHD occurred in 13.9% (n = 35). Multivariable analyses revealed that chronic obstructive pulmonary disease (COPD) or asthma was associated with pneumonia (OR 1.86; 95% CI 1.02–3.43; p = 0.045). COPD or asthma (OR 4.4; 95% CI 1.67–11.6; p = 0.003), RSV (OR 3.12; 95% CI 1.09–8.92; p = 0.023), and influenza B infections (OR 3.77; 95% CI 1.06–13.5; p = 0.041) were associated with NIV use, respectively, while chronic kidney disease was associated with IHD (OR 2.50; 95% CI 1.14–5.51; p = 0.023). Among the oldest-old, chronic organ failure, such as COPD or asthma, and CKD predicted pneumonia and IHD, respectively, beyond the importance of viral virulence itself. These findings could impact on public health policies, such as fostering influenza immunization campaigns, home-based care programs, and end-of-life care. Filling knowledge gaps is crucial to set priorities and advise on transition model of care that best fits the oldest-old.

Objective: This study aimed to examine perioperative complication risks in elderly patients stratified by age. Method: Elderly patients (youngest-old, ages 65 to 74 years; middle-old, 75 to 84 years; and oldest-old, ≥85 years) and controls (20-30 years) who underwent surgical intervention under general anesthesia were included in this prospective observational study. Results: Two-hundred-sixty patients were included. Different age subgroups showed a different course in terms of perioperative complications. For any combined end-point of any perioperative complication, having a body mass index>28 [odds ratio (OR): 2.4; 95% confidence interval (CI): 1.2-4.6; p=0.012] and being on multi-pharmacy regimen at baseline (OR: 1.9; 95% CI: 1.1-3.5; p=0.029) emerged as significant independent predictors. In reference to controls, each elderly age group emerged as a significant independent predictor: youngestolds (OR: 4.9; 95% CI: 2.2-10.8; p28 olması [olasılık oranı (OO): 2,4; %95 güven aralığı (GA): 1,2-4,6; p=0,012] ve başlangıçta çoklu ilaç kullanıyor olmak (OO: 1,9; %95 GA: 1,1-3,5; p=0,029) anlamlı bağımsız belirleyiciler olarak bulunmuştur. Kontrollere göre, her bir yaşlı alt grubunda bulunmak anlamlı bağımsız belirleyici olarak saptanmıştır: Yaşlılar (OO: 4,9; %95 GA: 2,2-10,8; p

China is facing an increasingly contradictory challenge between growing demand for health services for the oldest-old and the unbalanced and inadequate development in the context of rapid population aging. This study sought to evaluate the quality of life of the oldest-old in China under the active aging framework. Health, participation, and security data were sourced from China Statistics/Labor Statistics/Civil Affairs Yearbook 2000–2016 and National 1% Sample Survey Data 2005–2015. Then, we used the current life table, entropy method, coefficient variation, and panel data regression to evaluate the quality of life among the oldest-old and reveal its regional differences and mechanisms. The results show: (1) From 2005 to 2015, the overall quality of life in China steadily improved, and the quality of health, participation, and security of the oldest-old increased by 6.06%, 5.64%, and 47.48%, respectively. (2) Distinct regional disparities exist in the distribution of quality of life for the oldest-old in China; the “east–northeast–middle–west” stepped-declining pattern existed stably. (3) Population and family structure, economic development, and social security were the main reasons for the regional differences in quality of life for the oldest-old. Narrowing the socioeconomic gap between regions, promoting the function of family pension, and improving social old-age service supply will help improve the quality of life of the oldest-old.

BackgroundThe association between high-sensitivity C-reactive protein (hsCRP) levels and all-cause mortality for the oldest-old (aged 80 years or older) remains unclear. We aimed to investigate the associations between hsCRP concentrations and the risks of all-cause mortality, and further identify the potential modifying factors affecting these associations among the oldest-old.MethodsThis prospective, community-based cohort study included 2,206 participants aged 80 years or older (median age 93.0 years) from the Healthy Aging and Biomarkers Cohort Study. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidential intervals (95% CIs) for all-cause mortality according to hsCRP quartiles and recommendation for relative risk categories of hsCRP levels (< 1.0, 1.0–3.0, and > 3.0 mg/L), with adjustment for sociodemographic information, lifestyle, physical examination, medical history, and other potential confounders.ResultsDuring a median follow-up period of 3.1 years (IQR: 1.6–3.9 years), 1,106 deaths were verified. After full adjustment for potential confounders, a higher hsCRP concentration was positively associated with an increased risk of all-cause mortality (P for trend < 0.001). Compared with the lowest quartile, the fully adjusted HRs of the second, third, and fourth quartiles were 1.17 (95% CI: 0.94, 1.46), 1.28 (95% CI: 1.01, 1.61), and 1.49 (95% CI: 1.20, 1.87), respectively. The association of hsCRP with all-cause mortality was modified by smoking status (P for interaction = 0.011), an increased risk of hsCRP with all-cause mortality showed among non-current smokers (HR: 1.17; 95% CI: 1.07, 1.28), but no significance was observed in current smokers (HR: 0.83; 95% CI: 0.66, 1.18).ConclusionsOur study indicated that elevated hsCRP concentrations were associated with a higher risk of all-cause mortality among Chinese oldest-old. Future studies investigating additional factors of disease and aging processes are needed to obtain a better understanding of the mechanisms.

We assessed the impact of malnutrition on 14-day, 28-day, and 3-month mortality risk in oldest-old inpatients aged ≥80 years with COVID-19 in the hospital-based GERIA-COVID cohort. Malnutrition was assessed on hospital admission using the Geriatric Nutritional Risk Index (GNRI). Potential confounders were age, sex, functional abilities, number of acute health issues, CRP level, hypertension, cardiomyopathy, malignancies, use of antibiotics, and respiratory treatments. Seventy-eight participants (88.9 ± 4.3 years old, 55% women) were included. Of these, 82.1% had survived at day 14, 78.2% at day 28, and 70.5% after 3 months. No association between malnutrition according to the GNRI and 14-day (P = 0.324), 28-day (P = 0.166), or 3-month mortality (P = 0.109) was found. Thus, malnutrition according to the GNRI was not associated with mortality within the first 3 months of diagnosis of COVID-19 among oldest-old inpatients.

PurposeSocial isolation is considered a risk factor for dementia. However, less is known about social isolation and dementia with respect to competing risk of death, particularly in the oldest-old, who are at highest risk for social isolation, dementia and mortality. Therefore, we aimed to examine these associations in a sample of oldest-old individuals.MethodsAnalyses were based on follow-up (FU) 5–9 of the longitudinal German study AgeCoDe/AgeQualiDe. Social isolation was assessed using the short form of the Lubben Social Network Scale (LSNS-6), with a score ≤ 12 indicating social isolation. Structured interviews were used to identify dementia cases. Competing risk analysis based on the Fine-Gray model was conducted to test the association between social isolation and incident dementia.ResultsExcluding participants with prevalent dementia, n = 1,161 individuals were included. Their mean age was 86.6 (SD = 3.1) years and 67.0% were female. The prevalence of social isolation was 34.7% at FU 5, 9.7% developed dementia and 36.0% died during a mean FU time of 4.3 (SD = 0.4) years. Adjusting for covariates and cumulative mortality risk, social isolation was not significantly associated with incident dementia; neither in the total sample (sHR: 1.07, 95%CI 0.65-1.76, p = 0.80), nor if stratified by sex (men: sHR: 0.71, 95%CI 0.28-1.83, p = 0.48; women: sHR: 1.39, 95%CI 0.77-2.51, p = 0.27).ConclusionIn contrast to the findings of previous studies, we did not find an association between social isolation and incident dementia in the oldest-old. However, our analysis took into account the competing risk of death and the FU period was rather short. Future studies, especially with longer FU periods and more comprehensive assessment of qualitative social network characteristics (e.g., loneliness and satisfaction with social relationships) may be useful for clarification.

Internationally health and social care policies have increasingly promoted carer selfidentification as the best way to target and support people in caring roles.There has been remarkably little research concerning how people adopt the identity. This paper explores the carer identification practices of older partners providing end-of-life care.A narrative interview study comprising 41 interviews with 20 participants from 17 couples were conducted between in August 2018–August 2019 in the United Kingdom.This paper coins the term carering to denote the co-constructive practices of policy makers, researchers and broader cultural narratives calling forth the carer identity and the unfolding practices of people interacting with the carer identity in relation to their sense of self.Through three narrative case studies, this paper captures the diversity of older partners carering with three categories defined as engaged, ambivalent and disengaged carering.The carer identity was only taken-up when participants felt that the qualities assigned to being a carer, such as experiencing social isolation and providing 24/7 care, reflected their own personal experience. Given that not every older partner wants to, or will, self-identify as a carer, this paper suggests that carer selfidentification should not be the only strategy to identify and support people involved in caring. Qualitative health researchers also need to be reflexive in their use of the carer identity when studying caring-related topics.

This study was conducted to investigate the adherence of Daily Food Guides (DFGs) among older Taiwanese, and the relationship of dietary quality and frailty. 154 functional independent older adults who were retirement home residents or community dwellers involved in congregate meal services were recruited. DFGs adherence was measured using a novel Taiwanese Healthy Index (T-HEI). Dietary quality was further assessed using Dietary Approach to Stop Hypertension (DASH) and Mediterranean Diet Score (MDS). Frailty was defined using modified Fried’s criteria. Of the total participants, 12.3% were considered non-frail individuals, while 77.3% were prefrail, and 10.4% were frail. Compared to non-frail participants, prefrail and frail individuals indicated significantly lower adherence to DFGs (ptrend = 0.025). Intake of dark or orange vegetables (ptrend = 0.010), whole grains (ptrend = 0.007), as well as nuts and seeds (ptrend = 0.029) by non-frail individuals were significantly higher than the levels by prefrail and frail individuals. Linear regression model adjusted for age, gender, and functional ability showed that T-HEI was inversely associated with frailty status (β = −0.16 ± 0, p = 0.047), but additional adjustment for nutritional status attenuated the association (β = −0.14 ± 0, p = 0.103). A similar relationship was observed for DASH but not MDS (DASH: β = −0.18 ± 0.01, p = 0.024; MDS: β = −0.06 ± 0.02, p = 0.465). After adjustment for confounders, the association was not observed. However, the distribution of whole grains component in both DASH and MDS was significantly higher in non-frail than prefrail and frail individuals, indicating the importance of whole grains intake in frailty prevention. In conclusion, higher adherence to DFGs and better dietary quality were associated with a lower prevalence of frailty. Higher nutrient-dense foods intake such as whole grains, dark or orange vegetables, nuts, and seeds mark a watershed in frailty prevention.

Background Blood pressure targets for oldest-old people have been long debated due to the concern that more stringent targets are associated with increased mortality. We aimed to investigate the association between changes of late-life systolic blood pressure (SBP), mean SBP and SBP variability (SBPV), and all-cause mortality in oldest-old. Methods Based on the community-based Chinese Longitudinal Healthy Longevity Survey with follow-up conducted in the 3-year interval, we assembled a retrospective cohort of 6639 participants ≥ 80 years with available blood pressure measurements at baseline and second wave. The primary exposures were mean SBP and SBPV (defined as the annual difference in SBP divided by mean SBP) measured between baseline and second wave. The primary outcome was all-cause mortality assessed from the second wave. Results During 21443.1 person-years of follow-up, 4622 death was recorded. U-shaped associations of mortality with mean SBP and SBPV were identified; the value of 137 mmHg and 4.0 %/year conferred the minimum mortality risk, respectively. The associations of a larger SBPV with an increased mortality risk were observed for both rises and large falls in SBP. The hazard ratio was 1.11 (comparing lowest versus middle quintile; 95 % CI: 1.01, 1.22) with large falls in SBPV and 1.08 (comparing highest versus middle quintile; 95 % CI: 0.98, 1.18) with large rises in SBPV. Conclusions U-shaped associations between late-life SBP and SBPV and all-cause mortality were found. Our study suggests that a stable SBP level in the middle range is related to lower mortality risk in the oldest-old.

Objectives The oldest‐old (aged ≥80 years) are the fastest growing population segment and age is related to cognitive impairment. We aimed to estimate the association between cognitive impairment and all‐cause mortality, in addition to the relationship with different cognitive subdomains among the oldest‐old in China. Methods We analyzed 25,285 participants recruited from 22 out of 30 provinces in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2008, with mortality follow‐up until 2014. Cognitive function was measured by the Chinese‐version 30‐item Mini‐Mental State Examination (MMSE), classified as no (MMSE score: 25–30), mild (18–24), moderate (10–17), and severe (0–9) impairment. We used time‐dependent Cox model to evaluate the relationship between time‐varying cognition and mortality. Results The relationship between cognition and mortality showed a dose–response pattern among the overall population. Compared to those with no impairment, participants with moderate (HR = 1.41, 95% CI 1.28–1.56) and severe (HR = 1.77, 95% CI 1.59–1.96) cognitive impairment showed increased mortality risk. Impairment in the subdomain of orientation was independently associated with increased mortality risk (HR = 1.20, 95% CI 1.05–1.36) among participants without overall cognitive impairment. Urban and rural residents had similar mortality risk. Conclusions A consistent dose–response pattern existed between cognitive impairment and all‐cause mortality. Orientation was associated with mortality in the population without cognitive impairment. Similar mortality regardless of residence areas indicated scarce health care and treatment for cognitive impairment in China from 1998 to 2014., Based on 25,285 Chinese participants 80 years or older, we found a clear negative dose–response relationship between the severity of time‐varying cognitive impairment and the probability of survival for both female and male and the total population. The relationship between cognition and mortality was similar for urban and rural residents, and the dose–response pattern disappeared in the highest educated group. The orientation subscale was associated with mortality risk independent of the overall MMSE score.

Objectives Determinants of cognitive functioning in individuals aged 90 years and older, the oldest-old, remain poorly understood. We aimed to establish the association of risk factors, white matter hyperintensities (WMHs), hippocampal atrophy, and amyloid aggregation with cognition in the oldest-old. Method We included 84 individuals without cognitive impairment and 38 individuals with cognitive impairment from the EMIF-AD 90+ Study (mean age 92.4 years) and tested cross-sectional associations between risk factors (cognitive activity, physical parameters, nutritional status, inflammatory markers, and cardiovascular risk factors), brain pathology biomarkers (WMH and hippocampal volume on magnetic resonance imaging, and amyloid binding measured with positron emission tomography), and cognition. Additionally, we tested whether the brain pathology biomarkers were independently associated with cognition. When applicable, we tested whether the effect of risk factors on cognition was mediated by brain pathology. Results Lower values for handgrip strength, Short Physical Performance Battery (SPPB), nutritional status, HbA1c, and hippocampal volume, and higher values for WMH volume and amyloid binding were associated with worse cognition. Higher past cognitive activity and lower body mass index were associated with increased amyloid binding, lower muscle mass with more WMH, and lower SPPB scores with more WMH and hippocampal atrophy. The brain pathology markers were independently associated with cognition. The association of SPPB with cognition was partially mediated by hippocampal volume. Discussion In the oldest-old, physical parameters, nutritional status, HbA1c, WMH, hippocampal atrophy, and amyloid binding are associated with cognitive impairment. Physical performance may affect cognition through hippocampal atrophy. This study highlights the importance to consider multiple factors when assessing cognition in the oldest-old.

The potential association between medical resources and the proportion of oldest-old (90 years of age and above) in the Chinese population was examined, and we found that the higher proportion of oldest-old was associated with the higher number of beds in hospitals and health centers. Supplementary Information The online version contains supplementary material available at 10.1186/s40779-021-00307-6.

Background Very few population-based studies have investigated self-rated health and related factors in the increasing age group 85 years or older. The aim of this study was to examine self-rated health and its association with living conditions, lifestyle factors, physical and mental health problems and functional ability among the oldest-old in the general population in Sweden. Methods The study is cross-sectional and based on 1360 persons, 85 years of age or older, who answered a survey questionnaire sent to a random population sample in 2012 (participation rate 47%). Multivariate logistic regression was used as the statistical method. Results The prevalence of good self-rated health was 39% in men and 30% in women. Physical inactivity, impaired physical mobility, pain, anxiety/depression and longstanding illness were independently associated with poorer than good self-rated health, while factors such as gender, age, educational level, cash margin, living alone, social support, smoking, alcohol use, obesity, accidents and impaired vision/hearing were not. Conclusions While a considerable part of the oldest-old assess their health as good, not being physically active and having common health problems such as pain and depression as well as impaired physical mobility are associated with poorer than good self-rated health. This should be considered when planning how to improve and maintain health in the growing population of persons 85 years and older.

Tina Mallon,1 Marion Eisele,1 Hans-Helmut König,2 Christian Brettschneider,2 Susanne Röhr,3 Alexander Pabst,3 Siegfried Weyerer,4 Jochen Werle,4 Edelgard Mösch,5 Dagmar Weeg,5 Angela Fuchs,6 Michael Pentzek,6 Kathrin Heser,7 Birgitt Wiese,8 Luca Kleineidam,9 Michael Wagner,9 Steffi Riedel-Heller,3 Wolfgang Maier,7,9 Martin Scherer1 1Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 2Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 3Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany; 4Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany; 5Department of Psychiatry, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; 6Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; 7Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany; 8Work Group Medical Statistics and IT-Infrastructure, Institute for General Practice, Hannover Medical School, Hannover, Germany; 9DZNE, German Center for Neurodegenerative Diseases, Bonn, GermanyCorrespondence: Tina MallonDepartment of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyTel +49-40-741057164Fax +49-40-741053681Email t.mallon@uke.dePurpose: Dealing with the high prevalence of pain among the oldest-old (+75) is becoming a major health issue. Therefore, the aim of the study was to uncover health-related lifestyle behaviors (HLB) and age-related comorbidities which may predict, influence and prevent pain in old age.Patients and methods: In this longitudinal cohort study, data were obtained initially from 3.327 individuals aged 75+ from over 138 general practitioners (GP) during structured clinical interviews in 2003. Nine follow-ups (FU) were assessed until 2017. Available data from 736 individuals scoring in FU3 and FU7 were included in this analysis. Data were assembled in an ambulatory setting at participant’s homes. Associations were tested using a linear regression model (model 1) and ordered logistic regression model (model 2).Results: Statistical analyses revealed increased likelihood to experience pain for participants with comorbidities such as peripheral arterial disease (PAD) (coef. 13.51, P>t = 0.00) or chronic back pain (CBP) (coef. 6.64, P>t = 0.003) or higher body mass index (BMI) (coef. 0.57, P>t = 0.015) and, female gender (coef. 6.00, SE 3.0, t = 2.02, P>t = 0.044). Participants with medium education and former smokers showed significantly lower pain rating (coef. −5.05, P>t = 0.026; coef. −5.27, P>t = 0.026). Suffering from chronic back pain (OR = 2.03), osteoarthritis (OR = 1.49) or depressive symptoms (OR = 1.10) raised the odds to experience impairments in daily living due to pain. Physical activity showed no significant results.Conclusion: Chronic conditions such as PAD, or CBP, female gender and higher BMI may increase the risk of experiencing more pain while successful smoking cessation can lower pain ratings at old age. Early and consistent support through GPs should be given to older patients in order to prevent pain at old age.Keywords: oldest-old, health-related aspects, pain prevention, longitudinal cohort study, chronic conditions

Background Inflammatory markers, such as high sensitivity C-reactive protein (hs-CRP), and cognitive impairment (CI) are associated with mortality; CRP is related to the deterioration of CI. However, it is still unknown whether these two indices predict mortality independent of each other. Furthermore, their joint effect on all-cause mortality has not been well established, especially in oldest-old adults. Methods Based on data from the 2012 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we included 1447 oldest-old adults (mean age 84.7 years and 58.7% were female, weighted) with information on hs-CRP (stratified by a cutoff value of 3.0 mg/L) and cognition (quantified by Mini-Mental Status Examination (MMSE) scored according to the personal educational level) at baseline. Mortality was assessed in followed 2014 and 2017 waves. Cox proportional hazards regression models were used, with adjustment for hs-CRP and cognition (mutually controlled) and several traditional mortality risk factors. Results During a median follow-up period of 32.8 months (Q1-Q3, 9.7–59.0 months), 826 participants died. Hs-CRP [HR > 3.0 mg/L vs ≤ 3.0 mg/L: 1.64 (95% CI, 1.17, 2.30)] and cognition [HR CI vs normal: 2.30 (95% CI, 1.64, 3.21)] each was independent predictor of all-cause mortality, even after accounting for each other and other covariates. Monotonic and positive associations were observed in combined analyses, in which the highest mortality risk was obtained in elders with both high hs-CRP> 3.0 mg/L and CI [HR: 3.56 (95% CI, 2.35, 5.38)].The combined effects were stronger in male and younger oldest-old (aged 80–89 years). Conclusion High hs-CRP and CI, both individually and jointly, were associated with increased all-cause mortality risks in Chinese oldest-old. Intervention strategies for preventing inflammation and maintaining adequate cognitive function may be more important in male and younger oldest-old for reducing mortality risk.

Background The studies on the association of various midlife risk factors with reaching 90 years or more are scarce. We studied this association in a socioeconomically homogenous cohort of businessmen. Methods The study consists of men (n = 970) from the Helsinki Businessmen Study cohort (born 1919–1928). Five major cardiovascular disease (CVD) risk factors (smoking, BMI, blood pressure, serum lipids, fasting glucose), consumption of alcohol and coffee, self-rated health and self-rated fitness, were assessed in 1974, at an average age of 50 years. The number of major risk factors was tested as a risk burden. The Charlson Comorbidity Index and the RAND-36 (SF-36) Physical and Mental health summary scores were calculated from surveys in year 2000, at age of 73 years. Mortality dates were retrieved through 31 March 2018 from the Population Information System of Finland. Results 244 men survived to the age of 90 representing 25.2% of the study cohort. The survivors had less risk factor burden in midlife, and less morbidity and higher physical health summary score in 2000. Of those with five major risk factors only 7% survived up to 90 years, whereas 51% of those without any risk factors reached that age. Single risk factors reducing odds of reaching 90 years were smoking (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.34–0.67), glucose (0.66, 0.49–0.88), BMI (0.63, 0.46–0.86), and cholesterol (0.71, 0.53–0.96). Conclusion Lack of five major CVD risk factors in midlife strongly increased odds of reaching 90 years of age and also predicted factors related to successful ageing in late life.

Rui Chen,1,* Kunhao Bai,2,* Fanghong Lu,3 Yingxin Zhao,3 Yujing Pan,4 Fang Wang,1 Luxia Zhang1,5,6 1Renal Division, Department of Medicine, Peking University First Hospital, Beijing, People’s Republic of China; 2Department of Endoscopy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People’s Republic of China; 3Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, Shandong, People’s Republic of China; 4Renal Division, Department of Medicine, Peking University International Hospital, Beijing, People’s Republic of China; 5National Institute of Health Data Science at Peking University, Beijing, People’s Republic of China; 6Center for Data Science in Health and Medicine, Peking University, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Luxia ZhangPeking University, 8 Xishiku Street, Xicheng District, Beijing 100034, People’s Republic of ChinaTel +86 10 8357 2388Fax +86 10 6655 1055Email zhanglx@bjmu.edu.cnPurpose: Previous studies have identified that electrocardiographic pattern of left ventricular hypertrophy (ECG LVH) is associated with mortality, but studies of its correlation in the oldest-old hypertensive population is extremely limited. We investigated the correlation between ECG LVH and mortality in a hypertensive Chinese population aged 80years and older.Patients and methods: In this study, we included 284 Chinese participants older than 80years. All included participants with hypertension (sitting systolic blood pressure [BP] 160 to 200mmHg; sitting diastolic BP

Rui Chen,1,* Kunhao Bai,2,* Fanghong Lu,3 Yingxin Zhao,3 Yujing Pan,4 Fang Wang,1 Luxia Zhang1,5,6 1Renal Division, Department of Medicine, Peking University First Hospital, Beijing, People’s Republic of China; 2Department of Endoscopy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People’s Republic of China; 3Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, Shandong, People’s Republic of China; 4Renal Division, Department of Medicine, Peking University International Hospital, Beijing, People’s Republic of China; 5National Institute of Health Data Science at Peking University, Beijing, People’s Republic of China; 6Center for Data Science in Health and Medicine, Peking University, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Luxia ZhangPeking University, 8 Xishiku Street, Xicheng District, Beijing 100034, People’s Republic of ChinaTel +86 10 8357 2388Fax +86 10 6655 1055Email zhanglx@bjmu.edu.cnPurpose: Previous studies have identified that electrocardiographic pattern of left ventricular hypertrophy (ECG LVH) is associated with mortality, but studies of its correlation in the oldest-old hypertensive population is extremely limited. We investigated the correlation between ECG LVH and mortality in a hypertensive Chinese population aged 80years and older.Patients and methods: In this study, we included 284 Chinese participants older than 80years. All included participants with hypertension (sitting systolic blood pressure [BP] 160 to 200mmHg; sitting diastolic BP

Miao Liu,1,* Yanhong Yue,2,* Yao He11Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China; 2Medical Service, National Defense Mobilization Department, Central Military Commission, Beijing, People’s Republic of ChinaCorrespondence: Miao LiuInstitute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, State Key Laboratory of Kidney Diseases, Second Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, People’s Republic of ChinaTel +86 106 687 6415Email liumiaolmbxb@163.com*These authors contributed equally to this workAims: This study was designed to investigate the association between COPD and activity of daily living among oldest-old in People’s Republic of China.Patients and methods: The data of Chinese Longitudinal and Health Longevity Study in 2014 was used, and those who were aged more than 80 years old were included. Both basic activity of daily living (BADL) and instrumental activity of daily living (IADL) were measured.Results: A total of 4621 oldest-old (≥80 years old) were included. 32.1% (1482) of the oldest-old had BADL disability and 79.0% (3129) had IADL disability. The BADL disability and IADL disability rates were higher for participants with COPD than those without, and this difference was more robust among male (31.8% vs 25.6%, p=0.018). The IADL disability rate showed similar trends. Multivariate logistic regression analysis showed that the odds ratios of COPD on BADL disability and IADL disability were 1.261 (95% CI: 1.044–1.525) and 2.014 (95% CI: 1.561–2.598), respectively. The odds ratios of COPD on moderate to severe BADL disability and IADL disability were 1.007 (95% CI: 0.790–1.284) and 1.713 (95% CI: 1.397–2.100), respectively.Conclusion: There were independent associations between COPD and disability among oldest-old in People’s Republic of China, and the associations were greater among male population. Besides, COPD had a profound influence on the mild disability of BADL, while had a greater impact on the moderate and severe disability of IADL.Keywords: chronic obstructive pulmonary disease, activity of daily living, oldest-old

Riaan Botes,1 Karin M Vermeulen,1 Anthonie M Gerber,2 Adelita V Ranchor,3 Erik Buskens11Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, 9700 RB, The Netherlands; 2Department of Basic Medical Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, 9300, South Africa; 3Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, 9700 AD, The NetherlandsBackground: Valuing hypothetical health states is a demanding personal process, since it involves the psychological evaluation of hypothetical health states. It seems plausible that elderly individuals will value hypothetical health states differently than the general population. It is, however, important to understand the psychological division that oldest old subgroups construct between acceptable and unacceptable health states. This information can produce important evidence regarding well-being and disability conceptualization.Objective: To investigate how Dutch oldest old, conceptualize health-related quality of life health states when compared to well-being health states. In addition, we aim to compare subgroups, based on dependency classification.Methods: Ninety-nine elderly living in the Groningen, Hoogeveen and Veendam areas of the Netherlands participated in the study. Respondents were classified into three groups based on dependency levels. The respondents were asked to value hypothetical health states, a generic preference-based HRQoL and a well-being instrument, using a visual analog scale.Results: All three groups ranked the same health states, from both questionnaires, below the average across the health states. The health-related quality of life health states was consistently ranked lower than the current well-being health states.Conclusions: Health state valuations performed by the oldest old indicate that conceptually, respondents view below average health-related and well-being health states as undesirable. The results indicated that the oldest old do view deficits in health-related health states as more important than deficits in well-being health states. Since the oldest old performed the valuations, focused interventions to improve below average health-related outcomes might be the most cost-effective way to increase oldest old well-being outcomes.Keywords: oldest old, valuation, health states, health-related quality of life (HRQoL), well-being

Objectives: The fraction of the population that reaches the age of 100 years is growing. At this age, dementia incidence is high and cognitive functioning is highly variable across individuals. Normative data for neuropsychological tests are lacking in centenarians, which hampers the ability to evaluate their cognitive functioning for both research and clinical practice. Here, we generated norms for neuropsychological tests in a sample of cognitively healthy centenarians while taking sensory impairments into account. Design: Cross-sectional cohort study. Setting: Centenarians who participate in the prospective 100-plus Study. Participants: A total of 235 centenarians (71.5% female), who self-reported to be cognitively healthy, which was confirmed by an informant and a trained researcher. Measurements: We generated normative data for 15 cognitive tests, measuring global cognition (Mini-Mental State Examination [MMSE]), premorbid intelligence, attention, language, memory, executive function, and visuospatial function by multiple linear regressions and/or by reporting percentiles. Results: Normative data for global cognition resulted in a mean MMSE score of 25.6 ± 3.1 (range = 17-30; interquartile range = 24-28). Vision problems and fatigue often complicated the ability to complete tests, and these problems explained 41% and 22% of the missing test scores, respectively. In contrast, hearing problems (4%) and task incomprehension (6%) rarely complicated test performance. While educational level was associated with performance on the majority of the tests, sex and age were only weakly associated with test performance. Conclusions: We generated normative data for 15 common neuropsychological tests in a large sample of cognitively healthy centenarians, while taking age-related sensory impairments into consideration. These normative data allow the detection of deficits across a wide range of cognitive domains. Our results suggest that, next to education level, vision ability and the level of fatigue should be taken into account when evaluating cognitive functioning in centenarians. J Am Geriatr Soc 67:759–767, 2019.

While physical performance decline rates accelerate after around the age of 70 years, longitudinal athletic performance trends in athletes older than 95 years are unknown. We hypothesized a further accelerated decline in human performance in athletes who still perform at the age of 100 years. To investigate this, longitudinal data of all athletes with results at or over the age of 100 years were collected from the “World Master Rankings” data base spanning 2006–2019 (138 results from 42 athletes; 5 women, 37 men; maximum 105 years) and compared to previously published longitudinal data from 80- to 96-year-old athletes from Sweden (1,134 results from 374 athletes). Regression statistics were used to compare performance decline rates between disciplines and age groups. On average, the individual decline rate of the centenarian group was 2.53 times as steep (100 m: 8.22x; long jump: 0.82x; shot put: 1.61x; discus throw: 1.04x; javelin throw: 0.98x) as that seen in non-centenarians. The steepest increase in decline was found in the 100-m sprint (t-test: p < 0.05, no sign. difference in the other disciplines). The pooled regression statistics of the centenarians are: 100 m: R = 0.57, p = 0.004; long jump: R = 0.90, p < 0.001; shot put: R = 0.65, p < 0.001; discus throw: R = 0.73, p < 0.001; javelin throw: R = 0.68, p < 0.001. This first longitudinal dataset of performance decline rates of athletes who still compete at 100 years and older in five athletics disciplines shows that there is no performance plateau after the age of 90, but rather a further acceleration of the performance decline.

What is already known on this topic? Little is known about gender differences in health, family, and socioeconomics among oldest-old in China, What is added by this report? This study aims to fill this knowledge gap through analyzing gender differences in familial status, socioeconomics, functional capacities, and self-reported wellbeing using the 1998, 2008–2009, and 2017–2018 waves of the Chinese Longitudinal Healthy Longevity Survey. We found that compared with the male oldest-old, the female oldest-old are seriously disadvantaged in familial status, socioeconomics, and capacities of activities of daily living, physical performances, cognitive function, and self-reported wellbeing. What are the implications for public health practice? We discussed possible contributing reasons for our findings and strongly suggest that the female oldest-old should be prioritized higher.

Until recently, studies of individuals who reached the tenth and eleventh decade of life have been relatively rare, in part because individuals reaching this age group were themselves quite rare. However, with the extension of life expectancy over the past century, individuals over age 90 are now the fastest growing segment of the population in the United States and most of the world. With the risk of dementia profoundly age-related, these individuals have the highest rates of dementia and portend an enormous public health burden in coming decades. While we tend to assume that dementia-related factors identified in younger elderly also apply to the oldest-old, current research suggests otherwise and provides some surprising observations that can contribute insight into dementia occurring at all ages. In addition to investigations of cognitive loss, studies in very old individuals have also promoted the concepts of resilience and resistance. Resilience is most frequently defined as the presence of dementia-related pathological brain changes, most frequently Alzheimer disease (AD), in individuals who are cognitively normal. Paradoxically, this definition also serves to identify people who are presumably in the preclinical phase of their dementing illness [1]. The exceptionally high rate of this occurrence in people over 90, where approximately 40% of people without dementia have intermediate and high levels of AD, provides an ideal platform to investigate and understand these fundamental issues. We briefly summarize some of these issues and recent findings below. Open in a separate window Box 1 no caption available

This study described and compared physical activity (PA) characteristics at the end of the human lifespan using conventional cut-point-based versus cut-point-free accelerometer metrics. Eighteen institutionalized centenarians (101.5 ± 2.1 years, 72.2% female, 89% frail) wore the wrist GENEActiv accelerometer for 7 days. Conventional metrics, such as time spent in light-intensity PA (LiPA) and moderate-to-vigorous intensity PA (MVPA) were calculated according to published cut-points for adults and older adults. The following cut-point-free metrics were evaluated: average acceleration, intensity gradient and Mx metrics. Depending on the cut-point, centenarians accumulated a median of 15–132 min/day of LiPA and 3–15 min/day of MVPA. The average acceleration was 9.2 mg [Q1: 6.7 mg–Q3: 12.6 mg] and the intensity gradient was −3.19 [−3.34–−3.12]. The distribution of Z-values revealed positive skew for MVPA, indicating a potential floor effect, whereas the skew magnitude was attenuated for cut-point-free metrics such as intensity gradient or M5. However, both cut-point-based and cut-point-free metrics were similarly positively associated with functional independence, cognitive and physical capacities. This is the first time that PA has been described in centenarians using cut-point-free metrics. Our results suggest that new analytical approaches could overcome cut-point limitations when studying the oldest-old. Future studies using these new cut-point-free PA metrics are warranted to provide more complete and comparable information across groups and populations.

Background Globally, the population of oldest-old (those aged ≥80 years) is rapidly growing. This change is likely to have a deep impact on societies. Resilience is a key concept related to facilitating adaptation, and can be applied, to aging-related change and losses, as well as promoting health and well-being in this population. However, no existing scales have been developed to measure resilience among oldest-old people. To address this, we developed a resilience scale for oldest-old age (RSO), and examined its reliability and validity. Methods The RSO is a self-administered questionnaire developed via a literature review, interviews with oldest-old individuals, and interviews with experts. The survey included 3000 community-dwelling oldest-old people who were recruited via random sampling in Yokohama city, Japan. Construct validity was determined using confirmatory factor analysis. Internal consistency was calculated using Cronbach’s alpha. The revised Philadelphia Geriatric Center Morale Scale (PGC) and the self-anchoring scale to measure the feeling that life is worth living (SAS-WL) were used to assess the criterion-related validity of the RSO. Results We received 1283 valid participant responses. Confirmatory factor analysis identified nine items from one factor of the RSO with a goodness of fit index of 0.979, adjusted goodness of fit index of 0.963, comparative fit index of 0.973, and root mean square error of approximation of 0.049. Cronbach’s alpha was 0.800. The total RSO score was positively correlated with the PGC (r = .492, p Conclusions The RSO demonstrated adequate reliability and validity for assessing individual resilience among oldest-old people. Thus, the scale is potentially useful for promoting health and well-being in oldest-old age.

Background and objectives: There has been a recent increase in older patients admitted to general hospitals. A significant percentage of hospitalized older patients are ≥75 years old, which differ from the patients aged 65 to 74 years old in terms of functional status at patient discharge. This study aims to compare sociodemographic, clinical features, and factors associated with length of hospital stay in youngest-old and oldest-old populations of inpatients referred to the consultation liaison psychiatry unit. Material and methods: This is an observational, cross-sectional, retrospective, and comparative study. We obtained data from a sample of 1017 patients (≥65 years) admitted to a general hospital and referred from different services (medicine, surgery, etc.) to the consultation liaison psychiatry unit. The sample was divided into two groups of patients: youngest-old (65–74 years) and oldest-old (≥75 years). Psychiatric evaluations were performed while the patients were on wards at the hospital. Psychopharmacs were started as needed. A comparative analysis was carried out and predictive factors related to length of hospital stay were calculated. Results: The reference rate to consultation liaison psychiatry unit was 1.45% of the total older patients hospitalized. Our study demonstrates differences between the groups of older people: the oldest-old group were mainly female (p &lt, 0.001), had more previous psychiatric diagnoses (p &lt, 0.001), physical disabilities (p = 0.02), and neurocognitive disorders (p &lt, 0.001), they used more antipsychotics (p &lt, 0.001), and more frequently had a discharge disposition to a nursing home (p = 0.036). The presence of physical disability (beta = 0.07, p &lt, 0.001) and logtime to referral to consultation liaison psychiatry unit (beta = 0.58, p &lt, 0.001) were associated with increased length of hospital stay. Conclusions: Youngest-old and oldest-old people should be considered as two different types of patients when we consider clinical features. The time to referral to consultation liaison psychiatry unit seems to be a relevant factor associated with length of hospital stay.

Background Sleep duration and vegetable consumption are associated with mortality at old age (termed as sleep-mortality linkage and vegetable-mortality linkage, respectively). Yet, little is known about the interplay of sleep duration and vegetable consumption on mortality. Methods A dataset of nationwide longitudinal survey with 13,441 participants aged 65 years or older recruited in 2008 and followed up till 2014 was used. Sleep duration was classified into five groups (≤5, 6, 7–8, 9, and ≥ 10 h/day). Vegetable consumption was classified as either high frequency (eating vegetables almost daily) or low frequency. We used parametric Weibull hazard regression models to estimate associations of sleep duration and frequency of vegetable consumption with mortality, adjusting for demographics, socioeconomic factors, family/social support, health practice, and health conditions. Results Over the six-year study period, when only demographics were present, participants sleeping ≤5, 6, 9, and ≥ 10 h/day had relative hazard (RH) of mortality 1.18 (p p p > 0.1), and 1.30 (p p p p p p p Conclusions Too short and too long sleep durations were associated with higher mortality risk, and infrequent vegetable consumption could exacerbate the risk, although frequent vegetable intake could offset the risk for short sleep duration. The relationship between these two lifestyles and mortality was complex and varied among subpopulations.

Background/objective With increased life expectancy, the incidence of colorectal cancer in oldest-old patients has been rising. Advanced age is a risk factor for adverse outcomes after surgery. This study aimed to evaluate the short- and long-term outcomes of curative resection for colorectal cancer in nonagenarians. Methods Patients who had undergone curative resection for colorectal cancer (CRC) at Stage I to III from January 2010 to December 2019 were included. Cases of emergent surgery were excluded. The clinical characteristics were documented retrospectively, and factors affecting the long-term outcome were analyzed using multivariate analysis. Results Fifty patients met the selection criteria. Most of them were women (58.0%), and the median age was 92 years. Among these patients, 29 (58.0%) had a poor performance status (ASA-PS≥3). Laparoscopic surgery was performed in 42.0% of the patients, and 50% of the patients had postoperative complications classified as Clavien–Dindo grade 2 or severer, including 3 patients (6.0%) with grade 3 disease. No postoperative mortality occurred. The 30-day, 180-day, 1-year, 3-year and 5-year survival rates were 100%, 80.4%, 71.0%, 46.3%, and 33.8%, respectively. Multivariate analysis showed that a preoperative poor performance status (ASA-PS≥3) (HR: 3.067; 95% CI: 1.220–7.709; p = 0.017) was an independent prognostic factor for OS. Conclusion Curative elective resections for CRC in nonagenarians were performed safely without postoperative mortality. The preoperative performance status was significantly associated with OS after curative elective resection of colorectal cancer in nonagenarians. Our results suggest that excellent long-term outcomes can be achieved in a selected group with a good performance status.

Frontiers in physiology 12, 730995 (2021). doi:10.3389/fphys.2021.730995 special issue: "Exercise as a Countermeasure to Human Aging. - Volume II", Published by Frontiers Research Foundation, Lausanne