Successful aging in centenarians: myths and reality

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Abstract

The term “successful aging” appeared in the first issue of “The Gerontologist” in 1961. During the successive years, this expression has changed its meaning. Nowadays, successful aging means “absence of diseases and disabilities, maintenance of high levels of physical and cognitive abilities, preservation of the social and productive activities”. It has become a common opinion that the centenarians may represent the prototypes of the successful aging. This motivated our work to study the clinical, psychical, and functional aspects in a centenarian group, verifying the real autonomy, instrumental capacities, and working abilities. Our study pool consisted of 602 centenarians, who were also subjects of then epidemiological studies of the Italian Multicenter Studies on Centenarians (IMUSCE). All subjects underwent a clinical-anamnestic evaluation, cognitive-functional tests by means of the mini mental state examination (MMSE), the independence index in activities of daily living (ADL), the instrumental activities of daily living (IADL) scale. The centenarians were classified in three groups, according to the criteria elaborated previously by us, based on their psychophysical status and autonomy, as follows. Group A: centenarians in good health status; Group B: centenarians in an intermediate health status. Group C: centenarians in bad health status. Group A represented 20.0% of the total pool, Group B amounted to 33.4%, and the Group C was 46.6%. The centenarians of Group A presented normal ADL values, and 47.9% of them were autosufficient in all functions; 5.7% of them were independent in all IADL items. These data confirm that the centenarians of Group A are free of invalidating chronic diseases, are autonomous, maintain good physical and cognitive capacities, however, have not maintained any social or productive activities. Therefore, they cannot be considered as prototypes of successful aging.

Introduction

The increase in life expectancy was the most characteristic demographic process during the second half of the last century, being still in a progressive evolution (Anonymous, 2003). The most important aspect of this phenomenon is that the proportion of groups of advanced ages increased most significantly, as revealed by the epidemiological studies. This results in modifications in the types of existing elderly groups, with considerable socio-economic implications, which are difficult to evaluate, and which will certainly influence the evolution of the human society (IMUSCE, 1995, Golini, 1997). Aging is an irreversible and involutive biological process, which manifests itself progressively at cellular, organ and apparatus levels. Generally aging is characterized by modifications appearing continuously, progressively and in a harmonic way. This cannot be considered as a programmed process determined only by the genetic control. Among the various possible factors, we list here only the most important ones, such as the environmental and socio-sanitary ones (social problems, stress, scarce environmental stimulation, loss of social relations, malnutrition, smoking, and various diseases). All these factors could be able to modify the vulnerability, with consequent loss of adaptability, which is characteristic for the senescence (Motta et al., 2000, Motta et al., 2002, Perls et al., 2002). Therefore, aging can be considered as a “network”, characterized prevalently by genetic and environmental factors, however, a certain activity and efficiency should also be attributed to the immune system and to the endocrine factors (Olsen et al., 1991, Maxson et al., 1997).

The oldest old present a particular behavior characterized by progressive phenomena of adaptation. In this sense, it is interesting to note the theory of “efficient gesture of life”, defined also as the theory of “Selective Optimization with Compensation” (SOC) (Table 1) (Marsiske et al., 1995, Baltes and Smith, 2003). In young ages the sources are utilized for the development of the body, while with advancing age, the individuals select and organize behaviors compensating for the age-dependently-reduced capacities. One can explain this way the possibilities of the elderly to maintain the working ability in an apparently optimal efficiency. At an individual level, it is not surprising nowadays to find an increasing number of elderly subjects who keep their activity as managers, entrepreneurs, professionals, artists, etc. In addition, there are also longevous subjects, even if rarely, who keep performing intense physical activities; we intend to remind her the masters who are subjects able to perform activities in sport with results at the levels of records.

This situation resulted in the need of finding a proper expression for this new mode of living the senescence. The term “successful aging” obtained the widest distribution, having appeared in 1961 in the first issue of the journal “The Gerontologist” (Havighurst, 1961). The great interest justified also an article published in “Science” (Rowe and Kahn, 1987), and various commissioned research projects by the MacArthur Foundation (Berkman et al., 1993, Seeman et al., 1994).

During the successive years, this expression gained different meanings. Today successful aging is defined as “absence of diseases and disabilities, maintenance of high levels of physical and cognitive abilities, preservation of the social and productive activities”, with an addition that an activity is productive, if it creates social values, independently from an eventual financial compensation, or none (Rowe and Kahn, 1998). During the recent years, in connection with the increased medium life span, a new concept has been outlined, called “the centenariety”. This phenomenon becomes more and more frequent, especially in the industrialized countries. For example, in Italy the centenarians were only 49 in 1921, and 1304 in 1981. It reached the number of 4684 by the year 1997, and is predicted to arrive to a number of about 100,000 by the year 2050 (IMUSCE, 1995, IMUSCE, 1998).

There are no specific papers in the literature regarding the physical and working capacities of the centenarians. In spite of this fact, it became a generally accepted view that the centenarians may represent the prototypes of successful aging. We are of the opinion that the increase of the medium life span, accompanied by the consequent progressive phenomena of aging, strongly decreases the probability of the possibilities of a continued, and really efficient activity having practiced in the younger ages. On the contrary, it should be noted that even in the cases when the oldest old subjects keep going on with their activities, this is possible only, as mentioned above, on the basis of a certain remodeling and compensatory phenomena (Marsiske et al., 1995, Baltes and Smith, 2003). This motivated us to extend our studies on the clinical, psychical and functional aspects of 602 centenarians, also to their real autonomy, instrumental and working capacities, in order to verify whether a successful aging is really possible in the centenarians.

Section snippets

Subjects and methods

Our studies involved 602 centenarians from various regions of Italy, taking part also in the epidemiological studies of the Italian Multicentric Studies on Centenarians (IMUSCE, 1995, IMUSCE, 1998), as follows.

We identified first a total of 1173 centenarians from a total population of 14,274,591 persons. Among them we had 202 males and 971 females, i.e., the gender ratio was 1:4.8 in favor of females. From this total number of centenarians 650 subjects were sorted for our studies, keeping

Results

Table 2 contains the distribution of centenarians in various groups described in the methods section, according to their actual clinical, physical and cognitive conditions, with their sex-distribution. As a total pool, Group A contained 20% of the centenarians, 33.4% of them were in discrete health conditions (Group B), and the largest was the Group C with 46.6% of them, i.e., being in deteriorated health conditions.

As a logical consequence of the method of creation of these Groups, clear

Discussion

Our analyses show evidently that the centenarians display extremely variable clinical conditions. On the one hand, there are frail individuals among them with polypathologies, being an expression of the terminal deterioration related to the progressive increase of the medium life span. On the other hand, there are subjects without particular disease conditions, who are called “centenarians in good health conditions” in our studies. These latter do not have cognitive disorders, and do not have

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    For IMUSCE see Appendix A.

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