Chair: Guro Hanevold Bjørkløf
O6.1.1 How do hundred-year-old people die? Results from a population-level study of
centenarians in Sweden
Lucas Morin, Jonas Wastesson, Stefan Fors, Kristina Johnell
Aging Research Centre, Karolinska Institutet, Stockholm, Sweden
Background: A growing proportion of older adults live beyond the age of 100 years. Little is known about how they die. We aimed to describe the patterns of dying in a large cohort of centenarians, and to investigate their healthcare utilization during the last month of life.
Methods: Nationwide, register-based, longitudinal cohort study in Sweden. All people aged ≥100 years who died in 2013–2015 were included.
Results: 2763 deceased centenarians were included. Mean age was 101.3 years (SD 1.6), 82% were women, and 96.7% had no living spouse. Main reported causes of death were dementia (23.7%), ischaemic diseases (15%), heart failure (10%), stroke (7%), and hypertensive diseases (7%). On average, decedents had 4.5 diagnosed chronic diseases (SD 2.7). 74% died in nursing homes, 14% in hospitals, and 11% at home. During the last 3 months of life, 11% had a fall-related injury, 16% were hospitalized for more than 7 days, and 35% experienced at least one unplanned hospitalization. Centenarians with organ failure were the most likely to be hospitalized in emergency (OR= 1.99, 95%CI 1.65–2.40 compared with dementia patients). Median number of prescribed drugs was 7 (IQR 4–10). Drug utilization was fuelled not only by opioid analgesics (44%), but also by the continuation of antihypertensives (46%), antiplatelet agents (35%), and calcium supplements (8%).
Conclusion: Centenarians have a considerable burden of morbidity near the end of life, and live most often in nursing homes. Healthcare utilization should be optimized to avoid unplanned hospital admissions and reduce the prescription of unnecessary drugs.
O6.1.2 Models for self-rated health among demented and non-demented nonagenarians
Inna Lisko1,Timo Törmäkangas1, Marja Jylhä2
1University of Jyväskylä, Finland, 2 University of Tampere, Finland
Background. No previous studies have explored the model for self-rated health (SRH), a measure holding strong predictive value for future health events, in persons with dementia or in nonagenarians in general. The aim was to construct models for SRH among demented and non-demented nonagenarians and to explore direct and indirect associations between health-related factors and SRH.
Methods. Cross-sectional data from the Vitality 90+ Study, a population-based study conducted in the city of Tampere, Finland, was used. Altogether 408 participants with and 891 participants without self-reported dementia or cognitive decline were included. Structural equation models including mediating effects were constructed for demented and non-demented participants using WLSMV-estimator. Diseases (heart disease, stroke, diabetes, arthritis, hip fracture and cancer), dizziness, hearing and vision were used as independent variables, and mobility, activities of daily living, fatigue, depression and SRH as dependent variables.
Results. In both demented and non-demented participants fatigue (p<0.001), deficits in vision (p=0.004 for poor vision; p=0.023 for moderate vision), depression (p=0.002) and mobility limitations (p=0.002) were directly negatively associated with SRH. Additionally, among non-demented participants dizziness (p<0.001) and heart disease (p=0.002) were directly associated with SRH. Among diseases, arthritis had the most indirect associations with SRH. In both groups, arthritis associated with fatigue (p=0.001), depression (p<0.001) and mobility limitations (p<0.001).
Conclusions. People with and without dementia rate their health differently. Among nonagenarians, the direct contribution of diseases to SRH is either non-existent (demented) or only modest (non-demented) but the indirect contribution of arthritis to SRH is noteworthy.
O6.1.3 Is there a trade-off between mortality selection and disabilities in exceptionally
Stefan Fors1, Bernard Jeune2, Francois Herrmann3, Yasuhiko Saito4, Jean-Marie Robine5,
1 Aging Research Centre, Karolinska Institutet, Stockholm, Sweden, 2 University of Southern Denmark, 3 University of Geneva, Switzerland, 4 Nihon University, Japan, 5 INSERM, France
In high-income countries throughout the world, the oldest old population has grown in numbers as well as in proportions of the total populations. With this development a historically novel demographic segment have emerged: centenarians. While data on the health and living conditions in this segment is sparse, it has been suggested that there may be an adverse association between the level mortality selection and the prevalence of disabilities in exceptionally old age. That is, that the probability of being disability-free during very old age is higher in societies, and during periods, where the likelihood of reaching these ages are relatively low, and vice versa. In this study, we explore the prevalence of ADL disabilities among centenarians from five countries, characterized by different levels of mortality selection (Japan, France, Switzerland, Sweden, and Denmark). Our results suggests that there are substantial variation in the prevalence of ADL disabilities among centenarians from the five countries. The probability of having difficulties with at least one ADL was greatest among women in Switzerland (0.96; 0.93 – 0.99), and lowest among men in Sweden (0.64; 0.52 – 0.75). While our results partly support the ‘trade-off hypothesis’, they also imply that the hypothesis do not provide an exhaustive explanation of the observed cross-country differences in the prevalence of disabilities.
O6.1.4 Centenarian hotspots in Denmark
Laust H Mortensen1, Anne Vinkel Hansen1, Rudi GJ Westendorp2
1 Statistics Denmark, Demark, 2 University of Copenhagen, Denmark
Background: The study of regions with high prevalence of centenarians is motivated by a desire to find determinants of healthy ageing. While existing research has focused on selected candidate regions, we explore the existence of hotspots in the whole the Denmark, which is considered a homogeneous country.
Methods: We performed a Kulldorff spatial scan across the whole of Denmark, searching for regions where a significantly increased percentage of the cohort born 1906-1915 became centenarians. We compared mortality hazards for the hotspot region to the rest of the country by sex and residence at age 70. For the cohorts born 1916-1925 and 1926-1935, we compared post-70 mortality inside and outside the hotspot.
Results: We found a hotspot of 222 centenarians, 1.37 times more than the expected number (p-value 0.04), centered on the island of Langeland. Mortality was lower for those born in the hotspot, and the advantage was strongest in those born and remaining in the hotspot. Post-70 mortality for the hotspot was similar in the primary and the two subsequent cohorts.
Conclusion: We identified a Danish centenarian hotspot that persisted over a period of at least 30 years. Exactly what drives the appearance of this hotspot is unknown, but a range of potential explanations exist.
O6.1.5 Is the decrease in life expectancy in 2015 explained by an excess mortality of the
Jean Marie Robine1, Sarah Cubaynes2, François Herrmann3
1 INSERM, France, 2 CEFE, Montpellier, France, 3 Geneva University Hospitals, Switzerland
According to Eurostat, between 2014 and 2015, life expectancy (LE) at birth decreased in EU28 by 0.3 years for women and 0.2 years for men. Such a decrease at the European level is unexpected. Actually, a sharp increase in the number of deaths, in the order of 300,000 additional deaths for a total of 5.2 million in 2015, occurred between 2014 and 2015 and can explain this development. Decline in LE is observed among women in 29 of the 37 European countries for which Eurostat computes LE. The drop reaches one year in Cyprus, 0.7 years in Italy, 0.5 years in Belgium, Croatia, France, Germany and Luxembourg. Conversely, LE decreases little or not at all in the Nordic countries with the exception of Iceland. Although less marked, a similar decline occured in men. To what extend the excess mortality that followed the influenza epidemic of winter 2014/2015 may be responsible for this decrease in LE? EuroMOMO observed, among the 15 countries participating in this mortality monitoring network, an excess of mortality of 98,903 cases during the winter of 2014/2015 which could be extrapolated to approximately 217,000 cases for the European Union. The detailed statistics now available allow us to show how this excess mortality has been concentrated among people aged 85 and over, particularly among nursing home residents. We thus highlight the impact of the mortality fluctuations among oldest old people on the current trends in LE.
O6.1.6 Quality of life of the very old: A new conceptual framework and representative
Roman Kaspar, Luise Geithner
University of Cologne, Germany
Background: Recent studies on quality of life (QoL) and subjective well-being (SWB) in the very old have emphasized outcomes such as meaning in life and successful aging. Fed from diverse theoretical backgrounds and sub-populations of the very old (e.g. intervention gerontology, developmental psychology, palliative care), however, reliable data on these facets of QoL in the general population of the very old, including those in institutional settings, remains sparse.
Methods: The Challenges and Potentials Model (CHAPO) of Quality of Life in Very Old Age was developed as an interdisciplinary conceptual framework and a grid to operationalize a large-scale representative survey of the very old (80+ years) in Germany’s most populated federal state North-Rhine Westphalia. We used a multivariate approach to responses from the first 1,007 participants to estimate the overlap between long-standing indicators of SWB (i.e. life satisfaction, positive affect and depressive symptoms) and characteristics associated with successful aging (i.e.. valuation of life, meaning, anomia) in age groups 80-84, 85-89, and 90+.
Research results: Conceptually, the proposed CHAPO framework explicitly acknowledges that eudemonic quality of life outcomes are defined in the interplay between idiosyncratic and social-normative criteria and therefore cannot be mapped exhaustively on hedonic well-being outcomes. Our empirical data suggests stronger overlap between eudemonic QoL (e.g., valuation of life) and hedonic well-being (e.g., depressive symptoms) in older compared to younger age groups (-.57, -.50, -.37 resp.).
Conclusions: Our findings are consistent with the idea that existential and relational qualities are factors of well-being particularly prominent in the very old.