X-Message-Number: 30467
Date: Wed, 13 Feb 2008 18:45:48 -0800 (PST)
From: 
Subject: How To Live To 100

How To Live To 100: Remain Independent, Avoid Disability, Research
Suggests

ScienceDaily (Feb. 13, 2008) - Researchers from Boston Medical Center's
(BMC) New England Centenarian Study report that for a substantial
proportion of their centenarian subjects, avoiding age-related diseases
(i.e. stroke, cardiovascular disease, diabetes) may not be the key to
their longevity; rather, the avoidance of disability may be a key feature
in their exceptional survival.

The researchers examined the health histories of 739 centenarians and
found about one third of the subjects had age-related diseases for 15 or
more years (age of onset prior to the age of 85). "We expected to find
that nearly all centenarians have to compress the time they are sick
towards the very end of their lives, otherwise how could they get to such
old age?" asked senior author, Thomas Perls, MD, MPH, director, of BMC's
New England Centenarian Study and associate professor of medicine at
Boston University School of Medicine. "One factor enabling the survival
of these sick centenarians-to-be appears to be a delay or compression of
their disability," he added.

Seventy two percent of the male centenarians and 34 percent of the female
centenarians in this "survivors-of-disease" group (centenarians who
developed age-related diseases prior to age 85) scored in the independent
range on the Barthel Activities of Daily Living Index at the age of 97 or
older. According to the researchers, for a significant proportion of
people surviving to extreme old age, compression of disability, rather
than morbidity is a key feature of their ability to live such long lives.

"The ramifications of our findings are that among older people, morbidity
and disability do not always go hand in hand," said lead author Dellara
Terry, MD, MPH, co-director of the New England Centenarian Study and
assistant professor of medicine at Boston University School of
Medicine. "Eventually being able to understand the underlying mechanisms
for delaying disability in the presence of important age related diseases
could lead to better prognostication and perhaps even therapies," she
added.

The researchers also found that though far fewer in number, male
centenarians tend to have significantly better cognition and physical
function than their female counterparts. One possible explanation for
this may be that women are more resilient compared to men when it comes
to aging. Thus, for a man to live to 100 or older, he must be in truly
fantastic shape as close to the end of his life, whereas, the women can
better handle living with age-related illnesses.

These findings appear in the February 11th issue of Archives of Internal
Medicine.
__________________________________
Arch Intern Med. 2008;168(3):277-283.
Disentangling the Roles of Disability and Morbidity in Survival to
Exceptional Old Age
  Dellara F. Terry, MD, MPH; Paola Sebastiani, PhD; Stacy L. Andersen,
BS; Thomas T. Perls, MD, MPH

Background  Although it is commonly held that survival to age 100 years
entails markedly delaying or escaping age-related morbidities, nearly
one-third of centenarians have age-related morbidities for 15 or more
years. Yet, we have previously observed that many centenarians compress
disability toward the end of their lives. Therefore, we hypothesize that
for some centenarians, compression of disability rather than morbidity is
a key feature for survival to old age.

Methods  This cross-sectional, nationwide study included 523 women and
216 men 97 years or older. The participants were stratified by sex and
age at onset (age <85 years [termed survivors] and age 85 years [termed
delayers]) of chronic obstructive pulmonary disease, dementia, diabetes,
heart disease, hypertension, osteoporosis, Parkinson disease, and
stroke. Dependent variables were the Barthel Activities of Daily Living
Index (Barthel Index) and the Information-Memory-Concentration test of
the Blessed Dementia Scale.

Results  Thirty-two percent of the participants were survivors. For men
with hypertension and/or heart disease for 15 or more years, the median
Barthel Index score was 90 (independence range, 80-100). For female
survivors with hypertension, heart disease, and/or osteoporosis, the
median Barthel Index score was 65 (minimal assistance range,
60-79). Generally, men had better function than women: 60% of male
survivors had Barthel Index scores of 90 or higher compared with 18% of
female survivors (P < .001) and 50% of male delayers had Barthel Index
scores of 90 or higher compared with 27% of females delayers (P < .001).

Conclusions  Whereas the compression of both morbidity and disability are
essential features of survival to old age for some centenarians, for
others, the compression of disability alone may be the key
prerequisite. Though far fewer in number, male centenarians tend to have
significantly better cognition and physical function than their female
counterparts.

Author Affiliations: New England Centenarian Study, Geriatrics Section of
the Department of Medicine, Boston University School of Medicine and
Boston Medical Center (Drs Terry and Perls and Ms Andersen), and
Department of Biostatistics, Boston University School of Public Health
(Dr Sebastiani), Boston, Massachusetts.

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