ICC-dementia (International Centenarian Consortium - dementia): an international consortium to determine the prevalence and incidence of dementia in centenarians across diverse ethnoracial and sociocultural groups.

BACKGROUND: Considerable variability exists in international prevalence and incidence estimates of dementia. The accuracy of estimates of dementia in the oldest-old and the controversial question of whether dementia incidence and prevalence decline at very old age will be crucial for better understanding the dynamics between survival to extreme old age and the occurrence and risk for various types of dementia and comorbidities. International Centenarian Consortium - Dementia (ICC-Dementia) seeks to harmonise centenarian and near-centenarian studies internationally to describe the cognitive and functional profiles of exceptionally old individuals, and ascertain the trajectories of decline and thereby the age-standardised prevalence and incidence of dementia in this population. The primary goal of the ICC-Dementia is to establish a large and thorough heterogeneous sample that has the power to answer epidemiological questions that small, separate studies cannot. A secondary aim is to examine cohort-specific effects and differential survivorship into very old age. We hope to lay the foundation for further investigation into risk and protective factors for dementia and healthy exceptional brain ageing in centenarians across diverse ethnoracial and sociocultural groups. METHODS: Studies focusing on individuals aged ≥95 years (approximately the oldest 1 percentile for men, oldest 5th percentile for women), with a minimum sample of 80 individuals, including assessment of cognition and functional status, are invited to participate. There are currently seventeen member or potential member studies from Asia, Europe, the Americas, and Oceania. Initial attempts at harmonising key variables are in progress. DISCUSSION: General challenges facing large, international consortia like ICC-Dementia include timely and effective communication among member studies, ethical and practical issues relating to human subject studies and data sharing, and the challenges related to data harmonisation. A specific challenge for ICC-Dementia relates to the concept and definition of'abnormal' in this exceptional group of individuals who are rarely free of physical, sensory and/or cognitive impairments.

Understanding Very Old Age: Looking Back and Thinking Forward.

Understanding human development among the oldest old is a sequential building process taking into account building-block data, theories, and models from childhood, adulthood, and old age toward a new territory of oldest-old survivors who have lived way beyond the average life-span. A central question is whether the oldest-old survivors have developed specific survival techniques and/or protective environments that nurture survival. Or are the oldest old statistical outliers who by happenstance continue to survive further into old age? This commentary provides a historical framework on the papers in this series that describe challenges confronted by the oldest-old survivors in order to advance our understanding of survival of the oldest old. A clear understanding of the contributors to longevity could guide public policies toward well-being and life satisfaction among our oldest-old citizens.

The realism in older people's confidence judgments of answers to general knowledge questions.

The study investigated 2 aspects of the accuracy (i.e., realism) of confidence judgments of persons age 60-93 years (N = 1,384) regarding their answers to general knowledge questions. These aspects are the level of confidence (calibration) in relation to the proportion of correct answers and the ability to discriminate between correct and incorrect answers by means of confidence judgments. No age differences were found for either of the 2 aspects. Gender differences were found for proportion of correct answers and confidence but not for the realism in the confidence judgments.

Survival after 100 years of age: a multivariate model of exceptional survival in Swedish centenarians.

BACKGROUND: Most survival studies of the elderly population have set their baselines for first examinations between 60 and 80 years. The rapidly increasing numbers of exceptionally old persons call for knowledge about determinants of exceptional survival. METHODS: The Swedish Centenarian Study followed 100 centenarians from the age of 100 to death of the entire cohort, by age 111 years. A biomedical, psychological, and social multivariate survival analysis was performed based on factors identified as important in earlier studies of older adults. Latent Variable Partial Least Square Estimation (LVPLS) Soft Modeling was used to test the hypothesized predictions of survival in centenarians. RESULTS: Fewer predictors for survival were found in centenarians than were observed in studies of younger elderly persons. Survival after age 100 was dependent mainly on better baseline physical reserve, as measured by body mass index and body weight, and better baseline physical and cognitive function, as measured by activities of daily living and verbal ability/spatial orientation, respectively. CONCLUSIONS: Individual characteristics such as physiological reserve, present health and functional status, as well as chance appear important for centenarian survival. Hereditary factors, social relationships, marital status, and personality did not contribute to survival prediction in this exceptional age group. From a theoretical point of view, our data suggest that, in very old age, stochastic determinants may dominate over programmed factors (e.g., family longevity) in determining survival. More research is needed to assess survival factors at exceptional ages.

The relation between personality and the realism in confidence judgements in older adults.

This study investigated the relation between personality factors, as measured by the Swedish version of the NEO-FFI questionnaire, and the realism in older adults' (aged 60-93 years, n = 1,384) probability confidence judgements of their answers to general knowledge questions. The results showed very small effect sizes for the contribution of the personality variables to the fit between the proportion correct answers and the level of one's confidence judgements. Although personality differed somewhat within the age span studied and between the genders no differences were found in the relation between the dimensions of the NEO-FFI and the degree of realism in the confidence judgements as a function of age or gender. In total, the results show a significant but very small effect of personality on the realism in older adults' confidence judgements of their semantic knowledge.

Subjective health and illness, coping and life satisfaction in an 80-year-old Swedish population-implications for mortality.

BACKGROUND: Multimorbidity and illness will become more common due to increased life expectancy. PURPOSE: This study describes various combinations of diseases and symptoms and explores implications for mortality in a sample of 80-year-olds followed up to 95 years of age. Furthermore, reported subjective health, coping, and life satisfaction is explored. METHOD: 212 persons, born in 1908, were classified into four groups based on their number of diseases and reported symptoms according to a health examination at the age of 80. These groups were compared regarding standardized measurements of subjective health, depression, coping, life satisfaction, and mortality. RESULTS: The mortality risks, the hazard ratios, were of the same magnitude, 1.8-2.2, whether the persons experienced several symptoms, had several diseases, or a combination of several symptoms and several diseases when compared to the healthy group of respondents. CONCLUSION: The experience of subjective signs of illness carries the same mortality risks as diseases.

Determinant factors contributing to variations in memory performance in centenarians.

The role of environmental markers in memory performance among centenarians was examined in a study comparing non-cognitive factors to various aspects of memory performance. The centenarian group participating in the study consisted of 100 individuals (82 females and 18 males). Selected as non-cognitive factors were Quality of Life, Life-Habits, Health, Personality, and Autonomy. These factors were later compared to memory performance in short-term memory, semantic memory, and episodic memory. Using a structural equation model, results showed that performance in short-term memory was best predicted by life-habits and personality, while performance in semantic and episodic memory were best predicted by autonomy and life-habits. Implementation of the result from a life-span perspective includes a closer monitoring of environmental markers in the future. In effect, this could preserve memory function and optimum health through old age, thus making interventions easier to realize.

Right temporal lobe activation when listening to emotionally significant music.

The cerebral activation when normal elderly participants (6 women, 6 men, M age = 70 years) listened to self-selected emotionally significant music was investigated. Musical memories and preferences were discussed in an interview, and a piece of music with great emotional significance to the participant was selected and later played during measurement of the regional cerebral blood flow (rCBF). Measurements were made during silence, individually selected emotional music, and standard neutral music. The right temporal lobe showed a significant (p < .01) increase in rCBF when the emotional music was compared to silence. A temporal lobe asymmetry (right > left) during emotional music was also significant (p < .01). A decrease in the left prefrontal areas reached significance (p < .05) when standard music was compared to silence. For the emotional music, the right prefrontal area showed a decrease (p < .05). Emotional music thus activates right temporal and deactivates prefrontal regions in the right hemisphere.

Adaptive behavior in stressful situations in relation to postinfarction mortality results from prospective cohort study "Men Born in 1914" in Malmo, Sweden.

The serial Color Word Test, which is a semi-experimental way to differentiate adaptive behavior in stressful situations, was administered at baseline to men participating in the prospective cohort study "Men born in 1914". During follow-up, from 1982-1983 until December 31, 1996, 133 men experienced a myocardial infarction. Four patterns of adaptive behavior in 2 separate dimensions, the Variability and the Regression, can be discerned during testing. These patterns were compared regarding outcome following the myocardial infarction. The Cumulative-dissociative pattern of the Regression dimension was univariately associated with mortality within 28 days (OR 5.75, CI 1.85-17.88, p = .003). Dissociative (OR 3.87, CI 1.21-12.42, p = .023) and Cumulative-dissociative (OR 5.46, CI 1.66-17.96, p = .005) patterns, of the same dimension, were independently associated with mortality within one year. Specific difficulties in adaptation to stressful situations were associated with increased risk of death following a myocardial infarction. In this male sample, these difficulties could be identified with the serial Color Word Test.

Informal and formal support from a multi-disciplinary perspective: a Swedish follow-up between 80 and 82 years of age.

This longitudinal study used a multi-disciplinary approach and examined the relationship between psychosocial and health characteristics and the pattern of informal and formal support for non-institutionalized very old people. The data were derived from a single cohort of 80-year-old people living in Lund, Sweden who were followed over a 3-year period. In order to account for potential sample bias, an analysis at 80 years measured the differences between the participants who were measured at both test periods, the drop-outs who discontinued from the study prior to 82 years, and the deceased who died prior to 82 years (n = 212). Results revealed that the groups differed significantly according to reported number of children and health measures: the participants were most likely to have children and exhibited the best health. Bivariate analyses examined social, psychological and health variables for survivors (n = 93) at both 80 and 82 years in relationship to independent, informal, and formal support type. Loneliness was significantly and consistently associated with support type at both 80 and 82 years: both frequency and strength of loneliness were most often reported in the formal support group. Depression was significantly related to support type at age 80 only. Looking at change in the psychosocial and health measures and change in support over the 3-year period, no significant relationships were found. Our study concludes that for the very old, in addition to requiring increased support over a 3-year period, loneliness is a significant characteristic that may accompany the receipt of support. Professionals who plan and implement social support programmes for elderly persons should also consider emotional and psychological needs.

A longitudinal study integrating population, care and social services data. The Swedish National study on Aging and Care (SNAC).

BACKGROUND AND AIMS: A large, national, long-term, longitudinal, multi-purpose study has been launched in Sweden--the Swedish National study on Aging and Care (SNAC). The study involves four research centers collecting data in four different areas of Sweden. METHODS: The study consists of two parts: the population part and the care and services part. In the population part, a large, representative panel of elders in different age cohorts is followed over time to record and describe the aging process from different aspects. In the care and services part, a systematic, longitudinal, individually-based collection of data is performed concerning provision of care and services together with functional ability, specific health care problems, and living conditions of the recipients living in the area. RESULTS: The data collection in the population part of the SNAC is not yet completed. In the present article, some preliminary results are reported from the care and services part. These pertain to comparisons between the participating areas with respect to the prevalence of disability among those receiving care and social services in their ordinary homes and those receiving care in special accommodation. A comparison is also presented with regard to the amount of home help provided to subjects with a given disability. CONCLUSIONS: This project has several advantages. It is expected to generate a rich data base relevant for future research on aging and care and to have a direct impact on the future Swedish system of care and services for the elderly.