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More than fifty extraordinary Americans, who have all celebrated their one hundredth birthday, share a century of insights. Paul Mobley has taken his camera on the road once again, this time to photograph America's oldest and wisest citizens. Mobley traveled to all fifty states to find these indomitable, extraordinary centenarians. In this inspiring collection of intimate and powerful portraits, direct quotes, and personal stories, we learn that wisdom is the reward for perseverance. The centenarians in Mobley's stunning portfolio are eyewitnesses to a century dominated by world wars and conflicts, space travel, and cultural and digital revolutions. Their stories are inspirational, educational, and deeply touching. In them, we are reminded that love, loss, hope, and grief are essential ingredients in a full life and that humor can get us through the worst of times. Mobley's heartfelt portraits are a beautiful tribute to this unique assemblage of Americans. There are more than 70,000 centenarians in the United States alone. Each of them has touched others with their gift of long lives. This book is a celebration of this generation and an inspiration to the rest of us. -- Amazon.com.

In recent years, there has been a growing interest in the investigation of very old individuals. However, various challenges arise when collecting data from this age group. Given potential health and cognitive impairments and the difficulty of retrieving accurate self-reported data, involving individuals knowledgeable of the target person as proxy respondents are an invaluable solution. The primary goal of this study is to explore the association between proxy-centenarian relationship and item nonresponse, a pivotal data quality measure. We used data from the phone study conducted within SWISS100, a study on centenarians in Switzerland, focusing on a subsample of 94 centenarians and 75 proxy respondents. We compared characteristics of centenarians who provided self-reports with those interviewed through proxy respondents using descriptive analyses, and Firth's regression models to investigate the association of different types of proxies (children, other relatives, and non-relatives) with item nonresponse. We noted differences between centenarians participating themselves in interviews and those represented by proxies, observing higher proportions of men and private home residents in the self-report group. There was a low prevalence of item nonresponse among proxy respondents. Proxy type significantly impacted item nonresponse, particularly with non-relatives showing notably higher unanswered question rates. A robust association between non-relatives as proxies and increased item nonresponse persisted even when controlling for potential confounding factors. This study enhances the understanding of data quality, particularly item nonresponse, and highlights the impact of the proxy-centenarian relationship when studying the oldest-old. The findings stress the importance of carefully choosing proxy respondents, preferably children, to improve data quality and inclusivity for those individuals hard to reach or to interview. Future research should investigate various data quality indicators and rely on larger samples to enhance the representation and methodological rigour in the study of the oldest-old.

Frailty refers to a state of increased vulnerability to mortality and other adverse outcomes as a consequence of age-related decline in physiologic reserve and function. Comparative biomedical scientists are relied upon to innovate approaches to enhance understanding of the similarities and differences between humans and other animal species that can impact healthy aging. The research aim of this study was to develop a clinical frailty index (FI) in the Exceptional Aging in Rottweilers Study (EARS) and test its ability to predict all-cause mortality in elderly dogs. EARS is an ongoing lifetime cohort study of pet dogs with extreme longevity living in North America. Living 30% longer than the breed average, these dogs represent the canine counterpart to human centenarians. A 34-item FI (EARS-FI) was constructed to assess deficit accumulation using clinical data collected by telephone interviews with owners of 93 dogs with extreme longevity. Health deficits across multiple domains, including cognitive and sensory, cardiovascular and endocrine, and mobility, were included. The association between EARS-FI and subsequent mortality was tested in Kaplan-Meier survival analysis and in age-adjusted Cox proportional hazard models. Median (interquartile range) EARS-FI was 0.43 (0.38–0.50), and the estimated frailty limit was 0.68, consistent with data reported in humans with extreme longevity. Frailty index increased with increasing chronological age (p < 0.001). Deficit accumulation was significantly associated with increased mortality risk. Age-adjusted hazard ratio for mortality per 0.01 unit increase in FI was 1.05 (95%CI, 1.02–1.08; p = 0.001). This work provides the first demonstration of a strong association between frailty and mortality risk in pet dogs with extreme longevity. Notably, EARS-FI showed key features observed in the evaluation of frailty in aging human populations: heterogeneity, increase with chronological age, and estimated limit of <0.7. Validated here as a predictor of mortality in aged pet dogs, EARS-FI offers a useful tool for further comparative analyses of the linkages between deficit accumulation, mortality, and other adverse health outcomes.

ABSTRACTObjectiveThis was a study of positive psychological traits in a group of rural Italians aged 90 to 101 years, and their children or other family members. DesignMixed-methods quantitative (standardized rating scales) and qualitative (semi-structured interviews) study. SettingStudy participants’ homes in nine villages in the Cilento region of southern Italy. ParticipantsTwenty-nine nonagenarians and centenarians and 51 family members aged 51–75 years, selected by their general practitioners as a part of a larger study called CIAO (Cilento Initiative on Aging Outcomes). MethodsWe used published rating scales of mental and physical well-being, resilience, optimism, anxiety, depression, and perceived stress. Qualitative interviews gathered personal narratives of the oldest-old individuals, including migrations, traumatic events, and beliefs. Family members described their impressions about the personality traits of their older relative. ResultsParticipants age ≥90 years had worse physical health but better mental well-being than their younger family members. Mental well-being correlated negatively with levels of depression and anxiety in both the groups. The main themes that emerged from qualitative interviews included positivity (resilience and optimism), working hard, and bond with family and religion, as described in previously published studies of the oldest old, but also a need for control and love of the land, which appeared to be unique features of this rural population. ConclusionsExceptional longevity was characterized by a balance between acceptance of and grit to overcome adversities along with a positive attitude and close ties to family, religion, and land, providing purpose in life.

China is facing a dramatic aging of its population. Little is known about the factors that influence the place of death and the trends in the place of death for elderly people in China. The purposes of this study were: (1) to examine the impact of the socioeconomic status (SES) on place of death for elderly Chinese residents; and (2) to assess temporal trends in the place of death over the last 15 years. Data were derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (1998–2012). Place-of-death as an outcome was dichotomized into either death at home or death outside the home. Logistic regression analyses were used to examine the impact of SES on place of death. The results showed that, of the 23,098 deaths during the study period, 87.78% occurred at home. The overall trend in home death has increased since 2005. SES was shown to be an important factor affecting place of death. The elderly with higher SES were more likely to die where health resources were concentrated, i.e., in a hospital or other type of institution. Our finding suggests that the trend towards a greater emphasis on death at home may call for the development of more supportive home care programs in China. Our finding also suggests that the socioeconomic differences in the place of death may be related to the availability of or access to health care services.

Background The number of nonagenarians is growing globally. The promotion of mental wellbeing is increasingly important. The aim of this study was to explore mental wellbeing and psychological experiences of older adults in their early 90 s who were living at home. Methods We conducted a qualitative study using semi-structured face-to-face interviews with 20 older adults in their early 90 s. A thematic analysis, according to Braun and Clarke, was used to analyze data. Results An inner process of older adults in their early 90 s was revealed; its three themes were the “reality of aging,” “seeking emptiness of the mind,” and “still moving on.” Older adults in this study experienced functional decline, regret, and loneliness. They were tired of life and nearly gave up. Emptying their minds helped them reset their attitudes and find a way to move on. After realizing that negative thinking did not help anything, they focused on what they could do and their daily routines. Perceived social usefulness validated participants’ self-worth. However, a few were consistently active without negative perceptions of aging. Conclusion Understanding the psychological process and mental wellbeing in later life aids in the development of practical healthcare policies to assist the growing oldest-old population in cope with age-related challenges and improve their mental wellbeing.

The role of health behaviors in oral health conditions in individuals of extremely old age remains understudied. This study included 185 participants aged 100 years or older from the Nanjing Centenarians Study (NCS) to examine the associations between health behaviors and oral health and investigate the potential moderating role of education and living arrangements in such relationships. The oral health status as an outcome included the self-reported oral health status and edentulous status. Health behavior variables included smoking, eating fruits, eating vegetables, participating in leisure activities, and practicing oral hygiene behaviors. Sociodemographic characteristics and health status were considered as confounders. Descriptive statistics, ordinal regression, and logistic regression models were used to address the research questions. Results showed that better oral health was reported by centenarians who were non-smokers, participated in more leisure activities, and practiced higher frequency of oral hygiene behaviors. Those who ate fruits daily and practiced more frequently oral hygiene behaviors were more likely to be dentate. The positive association of oral hygiene behaviors was stronger for centenarians who were formally educated and co-resided with family members. The results suggest that effective interventions should consider health behaviors and living arrangements in this growing population to improve their oral health status.

Purpose Research focusing on the consequences of sensory impairments for the everyday competence of the oldest-old is emerging. The two main goals of this study were to document the prevalence of self-reported vision, hearing, and dual sensory impairment and to explore associations of these impairments with functional disability in near-centenarians and centenarians. Methods Centenarians and near-centenarians (N = 119; average age = 99) were recruited, with about 80 % living in the community. In-person interviews included self-ratings of vision and hearing impairment and functional disability conceptualized as having difficulties performing personal and instrumental activities of daily livings (PADLs and IADLs). Results Based on self-report ratings, 17 % of participants were classified as having a visual impairment only, 18 % as having a hearing impairment only, and 38 % with both a visual and hearing impairment (dual sensory impairment). Regression analyses demonstrated that having a vision impairment only and being dual sensory impaired were the strongest predictors of functional disability. They were associated with higher levels of functional disability over and above higher levels of depressive symptomatology, interference of health with desired activities, and living in a nursing home. Conclusions Sensory impairments—especially dual sensory impairment—are prevalent in the oldest-old. Having dual sensory impairment or a single visual impairment among other factors are strongly associated with less-optimal everyday functioning in the oldest-old.

Background Frailty indicates accumulated vulnerability of adverse health outcomes in later life. Its robustness in predicting dependent living, falls, comorbidity, disability, health change, mortality, and health care utilization at older ages is well-documented. However, almost no studies have ever attempted to examine its robustness in centenarians, mainly due to data unavailability. This study examines prevalence of frailty in centenarians and its predictive powers on subsequent mortality and health conditions. Methods We use a sample of 4434 centenarians from the 2002, 2005, 2008, and 2011 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with elders in three younger age groups 65–79, 80–89, and 90–99 as comparisons. Frailty is measured by a cumulative deficit index (DI) that is constructed from 39 variables covering physical and cognitive function, disease conditions, psychological well-being, and other health dimensions. Survival analysis is conducted to examine how frailty is associated with subsequent mortality at an average follow-up length of 3.7 years (2.6 years for deceased persons died in 2002–2011 and 7.6 years for survived persons at the 2011 wave). Logistic regressions are applied to examine how frailty is associated with subsequent physical and cognitive functions, disease conditions, and self-rated health with an average follow-up length of 3.0 years. Results The study reveals that centenarians are frailer than younger elders. The DI scores increase from less than 0.1 at ages 65–79 to over 0.30 in centenarians. Women are frailer than men at all ages. However, there is a great variation in frailty among all age groups. We also find that each additional increase of 0.01 score of the DI is associated with 1.6 % higher mortality risk (95 % CI: 1.014–1.018) in female centenarians and 1.4 % higher mortality risk (95 % CI: 1.010–1.018) in male centenarians, although these associations are weaker than those in other three younger age groups. Conclusions Frailty still plays an important role in determining subsequent health outcomes and mortality in centenarians.

Background Despite the well-established power of frailty to predict mortality, and the known associations of socioeconomic status (SES) with mortality, it is largely unknown whether the linkage between frailty and mortality varies across different SES groups. This study aims to investigate whether SES moderates the association between frailty and mortality. Methods We relied on the 2008/2009 and 2011/2012 waves of the Chinese Longitudinal Healthy Longevity Survey, a nationwide sample of 13,731 adults aged 65 or older in China. Frailty was constructed using a cumulative index of 38 items (with 39 deficits) reflecting different dimensions of health; the index or the proportion of deficits ranges from 0 to 1, with greater scores indicating poorer health condition. SES was measured by a socioeconomic vulnerability index (SEVI) also from a similar cumulative approach consisting of 6 deficits; the proportion of deficits ranges from 0 to 1 with higher scores indicating lower SES. Eight Weibull hazard regression models were performed to examine how SES moderates the linkage between frailty and mortality. Results We found that a one percentage point increase in the frailty index was associated with an increased hazard ratio (HR) by 2.7 % (HR = 1.027, 95 % CI: 1.025–1.027); a one percentage point increase in SEVI score was associated with an increased hazard ratio by 0.6 % (HR = 1.006, 95 % CI: 1.004–1.008) controlling for demographics. When interactions between SEVI and frailty index were modeled, the increased mortality risk associated with frailty was weaker among people with lower SES than among people with higher SES (HR = 0.983, 95 % CI: 0.967–0.992). However, the moderating role of SES was diminished when interactions between SES and age and between frailty and age were modeled. With increasing age, the increased mortality risks associated with frailty and socioeconomic vulnerability weakened. Conclusions Frailty was a stronger predictor of mortality among individuals with higher SES than those with lower SES. The increased mortality risks associated with socioeconomic vulnerability and frailty weakened with age. Public health programs aimed at improving SES and promoting healthy longevity should start early in old age, or even earlier, and target poor and frail older adults for maximum impact.