Ninety-seven-year-old people:

Article Outline

• Abstract
• 1. Introduction
• 2. Subjects and methods
  • 2.1. Population
  • 2.2. Methods
• 3. Results
• 4. Discussion
• 5. Conclusions
• Acknowledgements
• References
• Copyright

Abstract 

This study—the first in a series of reports—is a description of some general and medical characteristics of 97-year-olds from the representative longitudinal Gerontological and geriatric population studies in Göteborg, Sweden. The sample comprised 117 females and 15 males, a total of 132 97-year-olds. The probands were examined in their homes, with an interview based on a questionnaire. Blood hemoglobin, blood glucose and serum cobolamines were analyzed with standard methods, as well as a detailed hematological analysis which will be reported separately. An examination by a nurse and a physician was completed, comprising also dental status, visual ability and a simple hearing test. Anthropometric measurements and ECG were performed, and blood pressure was measured. Judged from cross-sectional data from our population studies, many symptoms and conditions seem to have a higher prevalence at age 97 than at age 70 and 85, respectively, especially regarding visual impairment, oral dryness, and hearing and ECG abnormalities. On the other hand the prevalence of edentulousness was surprisingly low. We find this investigation important for several reasons, namely its comprising a total community sample at this very high age in an urban area. Furthermore, the subjects are survivors of a cohort of elderly investigated several times by us since 1971/72 at age 70. In some aspects these survivors seem to be an elite of elderly people.

Keywords:  Population study, Oldest-old, General and medical characteristics

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1. Introduction 

The absolute and relative numbers of elderly are increasing in most parts of the world. It has been calculated that there will be an approximately 100% increase of people aged 80 and over in the developed world, and not less than almost 400% in the developing world between the years 1980 and 2020 (UN Department of International Economic and Social Affairs, 1985).

The proportion of 65-year-olds and older in Sweden is about 18% and increases slowly. However, the relative number of the oldest old is increasing more markedly; 2.2% of the Swedish population are now 85 years of age or older (Statistics Sweden, 1999). The very old are, thus, certainly relatively few, but that part of the Swedish population is increasing in absolute and relative terms. Thus, in 1978, the number of 97-year-olds or older in Sweden (with about 8 million inhabitants) was 1386 and in Göteborg (with about 450 000 inhabitants) 71. Ten years later, those figures were 2594 and 135, respectively. The corresponding figures for 97-year-olds or older are now 4278 and 254 in Sweden and Göteborg, respectively.

Studies of very old people are scarce, and in longitudinal studies virtually absent, but there are some. In a Swedish multidisciplinary study of five consecutive cohorts at age 100 (Samuelsson et al., 1997), the results spoke for multifactorial factors favouring the attainment of 100 years of age. Those people were considered to constitute an elite group. Important personality characteristics in the group were sense of responsibility, capability and emotional stability. Many of these centenarians experienced a good quality of life.

One study (Carlsson-Ågren et al., 1991) described 85-year-olds living in the community, and there are also other reports from the gerontological and geriatric population studies in Göteborg, Sweden-H70 (Rinder et al., 1975, Steen and Djurfeldt, 1993) from the age groups between 85 and 95, e.g. from the psychiatric (Skoog et al., 1993), cognitive (Steen et al., 2001), oral health (Lundgren et al., 1995) and other fields. From those studies, data from 97-year-olds have, however, not yet been reported.

However, it is important to analyze the situation at the age of 97 in this population as more knowledge is needed concerning the globally increasing oldest-old group. This study is cross-sectional, but longitudinal retrospective and prospective analyses are in progress. From this cohort born in 1901/02 also cross-sectional relation analyses will be published subsequently.

It has been demonstrated (Beregi, 1990) that there are endogenous factors relating to survival, e.g. heredity, birth order, and birth season of the year. Furthermore, family conditions, socioeconomic factors, and age-dependent immunological changes played a role in that study. Investigations of hormone levels of Japanese centenarians (Tauchi et al., 1999) suggest factors relating to metabolism and physical activity.

In a Finnish study (Louhija et al., 1994) aging and relation to levels of plasma apolipoproteins was studied. This study showed a relative loss of apolipoprotein E4 phenotype in centenarians. This might explain the lowered mean plasma cholesterol levels in this population.

The aim of the present study—the first in a series of reports—was to describe some general and medical characteristics of 97-year-olds from the representative longitudinal gerontological and geriatric longitudinal population studies in Göteborg, Sweden (Rinder et al., 1975, Steen and Djurfeldt, 1993). Further, this study aims at comparing retrospectively the data at age 97 to the findings at age 70 and 85 in the same cohort.

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2. Subjects and methods 

2.1. Population 

The subjects were all survivors from the first cohort, born in 1901/02, of the gerontological and geriatric population studies in Göteborg, Sweden (Rinder et al., 1975). The original investigation was performed at age 70 in 1971/72, and thereafter reinvestigations were performed at age 75, 79, 81, 82, 83, 85, 88, 90, 92, 95, 97, 99 and 100. The original sample comprised 3/10 of the target population in the city. However, from age 85 all subjects born in 1901/02 and living in Göteborg were invited, and the same type of sampling was used in this study at age 97. The target population for this study comprised all 97-year-olds living in Göteborg and born between July 1, 1901, and June 30, 1902.

The sample and the participation are shown in Table 1. Thus, the sample comprised 117 females and 15 males, a total of 132 97-year-olds. Five subjects died before invitation, leaving 127 subjects to be invited. Non-response was 35 subjects (28% of the females and 21% of the males, 28% for the whole sample). Six probands were investigated by a nurse only, and the remaining 86 probands were examined by a nurse and a physician. Some secondary non-response was present in some subexaminations. Eighteen probands were examined from age 70, 48 from age 85 only, and 20 probands at age 97 only.

Table 1. Sample, non-response, and participation

The reasons for non-response (35 subjects) were: dying before examination (N=7), frailty/severe disease (N=18), refusal (N=6), moving from the Göteborg area (N=2), subjects with whom we were not able to get in touch (N=2). A telephone interview was carried out in those non-responders who we were able to contact.

2.2. Methods 

An introductory letter with an offer to participate was sent to those sampled. The probands were examined in their homes. The history was given by about half of the probands themselves, and by relatives and social service/health care staff for the other subjects, who had hearing or cognitive impairment.

An interview was performed regarding social history, dwelling conditions, social communication, previous migration, educational level, previous professions, dependence/independence, and consumption of health care and drugs. Blood specimens were taken, and hemoglobin, glucose (fasting) and cobolamines were analyzed with standard methods, as well as a detailed hematological analysis which will be reported separately.

Furthermore, also an examination by a nurse and a physician was completed, comprising dental status, visual ability in the proband's ordinary reading situation, and a simple hearing test (whispering from a distance of one metre). Anthropometrical measurements were performed according to methods described earlier (Steen et al., 1977).

Body composition was measured with an electrical impedance method (Presta et al., 1983, Steen et al., 1987). ECG was analyzed according to the Minnesota Code (The Scandinavian Committee on ECG Classification, 1967). Blood pressure was measured in the supine position, laying, after 5 min rest. A diagnosis of hypertension was settled from history and/or antihypertensive treatment. Hypertension was defined as blood pressure more than 140 mmHg systolic and/or 90 mmHg diastolic, respectively. A routine manual sphygmomanometer was used.

Coronary heart disease was defined as the presence of one or more of the following criteria: Pronounced ST-T depressions and/or negative T waves (Minnesota code 4.1, 4.2, 5.1, 5.2); angina pectoris according to Rose (Rose, 1962); myocardial infarction as documented history and/or major Q-waves (Minnesota Code 1.1.1–1.2.8); probable ECG evidence of ischemia according to Rose (Rose, 1962), i.e. left bundle branch block and/or major Q waves. Congestive heart failure was defined as the presence of dyspnoea and peripheral oedema and/or treatment with digitalis and/or diuretics. Chronic bronchitis was defined according to American Thoracic Society as the presence of chronic productive cough for 3 months in each of the two successive years in probands in whom other causes of chronic cough were excluded (American Thoracic Society, 1995).

Furthermore, ophthalmological (N=71), psychological (N=78) and psychiatric (N=75) examinations were performed. These results are not included in this paper, but will be reported subsequently.

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3. Results 

Forty-six percent of the probands (n=92) lived at home (31%) or in sheltered housing (15%), of which 96% were living alone. Fifty-four percent of the probands lived in homes for the elderly or nursing homes. Eighty-eight percent of the probands were not able to use public transportation, and none had driven a car the latest year. Fifty-six percent had permission to use taxi paid by the society for their transportation, but 28% of those probands did not make use of that possibility. Seven out of 10 probands had living children and/or grandchildren. Eighty percent used drugs regularly, prescribed by a doctor. The range of number of drugs was 0–17 daily (average 7.1 drugs). A detailed analysis of drug consumption will be made separately.

Fifty percent of the probands were edentulous, but almost all of them used removable dentures. Thirty percent never visited a dentist any more, but 55% of the probands with own teeth visited a dentist regularly. No significant differences were observed regarding dental state between institutionalized probands and other probands.

Only one proband (a woman) smoked daily. Fifty-five percent (males) and eighteen percent (females) were ex-smokers (formerly daily consumption).

Thirty-nine out of 75 probands in which visual ability was examined were not able to read any line in the Jaeger test, corresponding to a visual acuity less than 0.2. Twenty-two percent of the probands were not able to hear a conversation at a distance of one metre.

Table 2 reports the prevalence of symptoms and conditions. In Table 2 also cross-sectional comparisons are given from the same cohort at age 70 and 85. It can be seen that many conditions show a higher prevalence at age 97 than at age 70 and 85.

Table 2. Prevalence (%) of symptoms and conditions at age 70, 85, and 97

Cross-sectional data.

Fig. 1 gives the systolic and diastolic blood pressure. The average systolic blood pressure was 147±21.7 mmHg (M±SD) and 154±17.6 mmHg in females and males, respectively, and the average diastolic blood pressure was 74±11.8 and 78±14.8 mmHg in females and males, respectively.

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• Fig. 1. 

  Distribution of systolic and diastolic blood pressure.

The ECG findings are presented in Table 3. The most prevalent ECG items were arrhythmias (26 and 67% for females and males, respectively).

Table 3. Prevalence of ECG items, according to the Minnesota code

Average blood hemoglobin in the total material was 124±16.1 g/l (M±SD) and 130±14.3 g/l in females and males, respectively. This is a lower value than in the cross-sectional comparison in the same cohort at age 85 (135±12.7 g/l and 140±15.2 g/l in females and males, respectively). At age 70 the blood hemoglobin value was 139±11.2 g/l (M±SD) in women and 149±13.6 g/l in men, respectively. Average blood glucose was 6.4±3.3 mM/l, which is slightly higher than the corresponding values at age 85 and 70. Average serum cobalamines were 641 pM/l±350, which is about double the corresponding values at age 85 and 70.

A detailed description and analysis regarding drug consumption, activities of daily living, socioeconomic characteristics and cognition will be reported separately, as well as a longitudinal analysis (both prospective from age 70 and retrospective in these 97-year-olds).

Table 4 shows the results of the anthropometric and body composition measurements. Average waist/hip ratio was below 1.0 in males, but above 0.8 in females.

Table 4. Anthropometric and body composition data

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4. Discussion 

This paper deals with 97-year-olds, i.e. very old people, and the study is part of the representative Gerontological and geriatric population studies in Göteborg, Sweden.

In younger groups in those studies, the non-response has been relatively low, and the examined probands were fairly representative of the target population. At the age of 97, however, non-response was found to be 28%. This can, however, be argued to be a surprisingly low proportion of the sample, taking the very high age and the frailty and diseases of the probands into consideration.

Most non-responders suffered from frailty and diseases to a higher degree than the examined subjects, and the results of the study might therefore, be positively biased compared to a totally representative 97-year-olds population. This probably insufficient representativity of the results may be especially obvious regarding some sub-examinations with additional non-response, such as measurements of height and body weight.

A surprisingly low prevalence (50%) of edentulousness was observed in these very old people. That figure can be compared to the 52% of edentulousness in the same cohort at age 70 cross-sectionally in 1971/72 (Österberg et al., 1983). The probable explanation for this approximately similar figure at age 97 is a selective higher mortality in those probands who were edentulous at age 70. It has also in fact been shown in this population earlier (Österberg et al., 1990) that dental status is a strong predictor of survival. Half of the probands lived at home or in sheltered housing and half in institutions. Surprisingly, there were no significant differences regarding dental state between these two groups, in contrast to the fact in younger elderly. Thus, in ‘young elderly’ oral health including dental status seems to be much worse in institutionalized elderly than in those living at home (Lundgren et al., 1995). Furthermore, a marked improvement of oral health in the elderly during the last decades as a cohort effect in free-living elderly, has not coincided with a parallel improvement of the oral health of institutionalized elderly in those studies of younger elderly. An explanation for this discrepancy might be that the reasons for being in institutions at age 97 might be of more socioeconomic nature than depending on the health conditions per se, as compared to the situation in early old life.

Smoking was virtually absent at this age, only one woman being a smoker. In this cohort born in 1901/02 12% of females and 51% of males were smokers at age 70, and 4% of females and 18% of males at age 85. It can also be mentioned that in a cohort comparison perspective during the last decades, 70-year-olds in our population studies showed an increasing trend for females from 12 to 15%, and a decreasing trend for males from 50 to 34% (Steen, 1991). At the high age of 97, smoking seems, thus, at least in Sweden, to be extremely uncommon.

Judged from cross-sectional data from our population studies, many symptoms and conditions seem to have a higher prevalence at age 97 than at age 70 and 85, respectively. For example, atrial fibrillation was present in 2, 11 and 26% in females aged 70, 85, and 97, respectively. The corresponding figures in males were 4, 16, and 67%. However, the prevalence in men at age 97 must be interpreted with caution due to a small sample size. In most of these cases with atrial fibrillation, the condition was unknown to the proband. In a Japanese study (Hashiba, 1989) the incidence of atrial fibrillation was increasing almost lineary from 0.2% in the forties to 2.5% at the end of the eighties. A German study (Dietz et al., 1987) reported atrial fibrillation in 41% of the subjects between age 90 and 102. Regarding hypertension and chronic bronchitis the opposite was true, indicating a possibility of a selection of individuals with lower morbidity at age 97, caused by higher selective mortality in diseased subjects previously and/or non-response at age 97.

Surprisingly high levels of serum cobolamines were obtained in these subjects; in fact the levels doubled in the same cohort at age 70 and 85. The probable main explanation for this is a much higher prevalence of vitamin B12 supplementation at present compared to the situation a couple decades ago. The finding of the high levels of high cobolamines in this 97-year-olds is therefore probably a cohort difference phenomenon.

A common (41 and 30% in females and males, respectively) and serious symptom in these 97-year-olds was oral dryness. This might be related to age dependent factors as well as changes in salivation, but also common use of drugs, such as psychopharmacological and diuretic ones, is a probable explanation. This symptom was usually experienced as very painful by the probands. However, also at age 85 (on a cross-sectional basis) the symptom was rather prevalent, especially in females (Lundgren et al., 1995).

Examples of other conditions with a markedly higher prevalence at age 97 than at age 70 were diabetes (6 and 15% in females, and 6 and 10% in males, respectively) and falls without fractures (1 and 46% in females, and 1 and 50% in males, respectively).

Most probands showed ‘pathological’ electrocardiograms, and the majority of the 97-year-olds women showed T-wave items according to the Minnesota code, and a majority of men showed QRS axis deviation, T-wave items, ventricular conduction defects, and atrial fibrillation according to the Minnesota code. The 97-year-olds subjects had numerous pathological signs in their ECGs, and one reason that they do not seem to suffer from cardiac symptoms, could be a sedentary life style with very low physical demands to the heart.

In this and subsequent papers we will report on specific aspects of this population at age 97, and longitudinally and retrospectively focus on questions such as ‘Which were the characteristics of 70-year-olds of this cohort who reached age 97?’

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5. Conclusions 

This study concerns a total community sample of 97-year-olds in an urban area. The subjects were survivors of a cohort of elderly investigated by us since 1971/72 at age 70. Subjects of this cohort have also been investigated at age 99 and 100, and these results will be reported subsequently.

Many pathological conditions had a higher prevalence than earlier in the same cohort. On the other hand a surprisingly low prevalence of edentulousness was observed. As much as about half of the probands had own teeth. However, oral dryness was prevalent in about 40% in females and 30% in males. In spite of the fact that the prevalence of many diseases like cardiac diseases as well as hearing and visual impairment was higher, a surprisingly high proportion of these 97-year-olds were subjectively functioning relatively well, and as much as 46% lived in their homes.

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Acknowledgements 

This study was supported by grants from the Lions Foundation, the Wilhelm and Martina Lundgren Foundation, the Dr Félix Neubergh Foundation, the Hjalmar Svensson Foundation, the Elsa and Eivind K:son Sylvan Foundation, the Swedish Research Council (11267), the Swedish Council for Working Life and Social Research (2835), and the Alzheimer's Association Stephanie B. Overstreet Scholars (IIRG-00-2159).

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