Falls and fear of falling in a sample of centenarians: the role of multimorbidity, pain and anxiety.

BACKGROUND: To explore the recent history of falls and the existence of fear of falling in a sample of centenarians, and to identify factors associated with both conditions. METHODS: The sample included 109 centenarians from two Portuguese studies. The two main outcomes of this study are fear of falling and history of fall(s). RESULTS: Results revealed that more than a half (51.4%) of the participants had fallen in the last 5 years and that the percentage of fear of falling was 78.9%. No association was found between the two conditions. The factors associated with each one were found to be different: number of health conditions for history of falls, and pain frequency and anxiety for fear of falling. CONCLUSIONS: The relationship between anxiety and fear of falling reinforces the importance of screening both conditions as it can improve their detection and treatment. The established relationship between a high number of health conditions (common at very advanced ages) and falls demands greater attention in fall prevention initiatives specifically targeted to the extremely elderly.

The Role of Existential Beliefs Within the Relation of Centenarians' Health and Well-Being.

The purpose of this study was to explore the role of existential beliefs in mediating the influence of health on centenarians' well-being. A total of 80 centenarians (mean age 101.1; SD = 1.3; 81.3 % women) with no/minor cognitive impairment were included. The OARS questionnaire for diseases and functional capacity (ADL, IADL), the Satisfaction with Life Scale, and the existential beliefs subscale were used for data collection. The findings suggest that existential resources are a crucial element for mitigating the impact of health constraints in subjective well-being in this population. Appropriate models of intervention for very old age that recognize the importance of religion, spirituality, and meaning of life are to be considered.

Health profile of centenarians in Portugal: a census-based approach.

BACKGROUND: The number of centenarians is rapidly increasing in Europe. In Portugal, it has almost tripled over the last 10 years and constitutes one of the fastest-growing segments of the population. This paper aims to describe the health and sociodemographic characteristics of Portuguese centenarians as given in the 2011 census and to identify sex differences. METHODS: All persons living in Portugal mainland and Madeira and Azores islands aged 100 years old at the time of the 2011 census (N = 1,526) were considered. Measures include sociodemographic characteristics and perceived difficulties in six functional domains of basic actions (seeing, hearing, walking, cognition, self-care, and communication) as assessed by the Portuguese census official questionnaires. RESULTS: Most centenarians are women (82.1 %), widowed (82 %), never attended school (51 %), and live in private households (71 %). The majority show major constraints in seeing (67.4 %), hearing (72.3 %), and particularly in their mobility (83.7 % cannot/have great difficulties in walking/climbing stairs and 80.7 % in bathing/dressing). In general, a better outcome was found for reported memory/concentration and understanding, with 39.1 % and 42.5 % presenting no or mild difficulty, respectively. Top-level functioning (no/mild difficulties in all dimensions concurrently) was observed in a minority of cases (5.96 %). Women outnumber men by a ratio of 4.6, and statistically significant differences were found between men and women for all health-related variables, with women presenting a higher percentage of difficulties. CONCLUSION: Portuguese centenarians experience great difficulties in sensory domains and basic daily living activities, and to a lesser extent in cognition and communication. The obtained profile, though self-reported, is important in considering the potential of social and family participation of this population regardless of their functional and sensory limitations. Based on the observed differences between men and women, gender-specific and gender-sensitive interventions are recommended in order to acknowledge women's worse overall condition.

Successful aging at 100 years: the relevance of subjectivity and psychological resources.

BACKGROUND: Very old individuals seem to present an admirable capacity to overcome adversities and adapt to the challenges of advanced age. However, studies focusing successful pattern of centenarians found that they may easily fail to be categorized as successful agers when objective criteria are applied. The present study examines if centenarians can be considered successful agers. Following Rowe and Kahn's successful aging model, the primary goal was to clarify whether centenarians are able to be successful agers according to objective and subjective criteria of no major disease and disability, high cognitive and physical functioning and engagement with life. The second goal was to investigate whether socio-demographic factors, psychological, social, and economic resources are related to objective and subjective successful aging profiles. METHODS: We examined different profiles of successful aging in a high selected sample of individuals aged 100 and more years old from the population-based Oporto Centenarian Study. RESULTS: Main findings reveal that centenarians do not represent the prototype of successful aging, but self-ratings demonstrate that many of them feel successful, despite not being objectively considered as so. Those who were considered successful agers presented higher values of self-efficacy, hope, and purpose in life, as well as few difficulties in covering financial expenses. CONCLUSIONS: As a basis for strengthening the existing model, the value of subjectivity should be explored and psychological resources promoted in interventions to foster positive adaptation in very old age.

Coinfection with influenza A(H1N1)pdm09 and dengue virus in fatal cases.

We report on four patients with fatal influenza A(H1N1)pdm09 and dengue virus coinfections. Clinical, necropsy and histopathologic findings presented in all cases were characteristic of influenza-dengue coinfections, and all were laboratory-confirmed for both infections. The possibility of influenza and dengue coinfection should be considered in locations where these two viruses' epidemic periods coincide to avoid fatal outcomes. Dengue is a mosquito-borne viral infection caused by one of the four dengue viruses (DENV-1 to 4). Each of these viruses is capable of causing nonspecific febrile illnesses, classic dengue fever and dengue haemorrhagic fever (Gubler 1998). As a result, dengue is often difficult to diagnose clinically, especially because peak dengue season often coincides with that of other common febrile illnesses in tropical regions (Chacon et al. 2015). In April 2009, a new virus, influenza A/H1N1/pandemic (FluA/H1N1/09pdm), caused a severe outbreak in Mexico. The virus quickly spread throughout the world, and in June 2009, the World Health Organization declared a pandemic (WHO 2010). In Brazil, the first laboratory confirmed case of FluA/H1N1/09pdm was in July 2009 (Pires Neto et al. 2013). The state of Ceará, in Northeast Brazil, is a dengue endemic area. In this state, the virus influenza A(H1N1)pdm09 has circulated since 2009, and through the first half of 2012, 11 deaths caused by the virus were confirmed (Pires Neto et al. 2013). The influenza and dengue seasons in Ceará overlap, which led to diagnostic difficulties. We report four cases of laboratory-confirmed coinfection of deadly influenza A(H1N1)pdm09 with DENV, which occurred during the dengue and influenza season in 2012 and 2013 in Ceará.

Health Status, Living Arrangements, and Service Use at 100: Findings From the Oporto Centenarian Study.

This paper describes the sociodemographic characteristics, health status, and service use of centenarians living in the community and centenarians residing in an elder care facility/nursing home and examines their main differences. Participants were 140 centenarians from the population-based Oporto Centenarian Study (Mage = 101.2; SD = 1.6). Main findings revealed that the majority of the centenarians lived at home with their family members (57.9%). Increased health care needs, living alone, and family caregiving constraints were the most common reasons for entering a nursing home. Community-dwelling centenarians were cared for mostly by their children and were less dependent and in better cognitive health than those who resided in a nursing home. Differences were found in the pattern of health service use according to the centenarians' residence, ability to pay medical expenses, and dependency level. Findings highlight the need for an accurate assessment of caregiving support systems, particularly family intergenerational duties, and of the factors constraining the access and use of health and social services. Policy makers may be guided by the insights gained from this research and work toward improvement of support options and removal of barriers to service access.

Measuring attachment to life in old age: the Portuguese version of the Positive Valuation of Life Scale (Positive VOL).

PURPOSE: This study aims to present the psychometric properties of the Portuguese version of the Positive Valuation of Life Scale (Lawton et al. in J Aging Ment Healt 13:3-31, 2001). METHOD: Sample included 207 community-dwelling elders (129 women; M Age = 77.2 years, SD = 7.5). The data collection included the translated and adapted Portuguese version of Positive Valuation of Life Scale, Life Satisfaction Index Z, Meaning in Life Questionnaire and Geriatric Depression Scale. RESULTS: From exploratory factor analysis, two factors emerged, existential beliefs and perceived control, explaining 49 % of the total variance. Both factors were positively related with meaning in life and life satisfaction and negatively related with depression (p < 0.05). The values obtained for internal consistency for the total scale and for each subscale were good (α > 0.75). CONCLUSION: The Portuguese version of Positive VOL Scale represents a reliable and valid measure to capture the subjective experience of attachment to one's life. The two-factor structure is an update to Lawton's previous work and in line with findings obtained in the USA (Dennis et al. in What is valuation of life for frail community-dwelling older adults: factor structure and criterion validity of the VOL, Thomas Jefferson University, Center for Applied Research on Aging and Health Research, 2005) and Japan (Nakagawa et al. in Shinrigaku Kenkyu 84:37-46, 2013). Future research is required to investigate VOL predictors and the potential changes toward the end of the life span.

Predictors of anxiety in centenarians: health, economic factors, and loneliness.

BACKGROUND: Centenarians' psychological well-being is presently of great interest in psychogeriatric research but little is known about factors that specifically account for the presence of clinically relevant anxiety symptoms in this age group. This study examined the presence of anxiety and its predictors in a sample of centenarians and aims to contribute to a better understanding of anxiety determinants in extreme old age. METHODS: We examined how socio-demographic, health, functional, and social factors contribute to the presence of clinically significant anxiety symptoms in centenarians recruited from two Portuguese centenarian studies. The Geriatric Anxiety Inventory - Short Form (GAI-SF) was used to assess anxiety symptoms. RESULTS: A total of 97 centenarians (mean age 101.1 years; SD = 1.5 years; range = 100-108) with no/minor cognitive impairment were included. Clinically significant anxiety symptoms (GAI-SF ≥3) were present in 45.4% (n = 44) of the sample. Main predictive factors included worse health perception, higher number of medical conditions, financial concerns related to medical expenses (income inadequacy) and loneliness. CONCLUSIONS: Results suggest that along with health status (subjective and objective), income inadequacy related to medical expenses and feeling lonely may predispose centenarians to clinically significant anxiety and be important to their overall well-being. Further research is needed on the repercussions of clinical anxiety in centenarians' quality of life and on co-morbid conditions (e.g. depression) at such advanced ages.

How to Promote Gerotranscendence in Older Adults? A Scoping Review of Interventions.

Gerotranscendence is a psychosocial theory that proposes older adults experience a mindset shift in multiple dimensions (cosmic, coherence, solitude), associated with different constructs, such as life satisfaction and well-being. Increasing studies are employing gerotranscendence, but the practical aspects of how gerotranscendence can be developed are still underexplored. This review involved an assessment of the size and scope of the existing literature on interventions related to gerotranscendence and their effect on participants' well-being. Six databases were searched, and eight studies were selected: five were observational, while three were randomized control trials. Findings showed that gerotranscendence can be developed through weekly thematic encounters. Moreover, the interventions examined in the selected studies were described as having positively impacted participants' mental health and life satisfaction. Future studies should explore gerotranscendence interventions using a rigorous methodology and long-term follow-up data to add consistency to these findings.

Gerontological social workers' perspectives about the future at the start of a COVID-19 vaccination program: A photovoice study.

Summary: The COVID-19 pandemic is a continuing public health crisis, although it has lessened in its intensity since the start of worldwide vaccination programs. In aged care facilities, gerontological social workers have become frontline professionals facing multiple challenges and demands. One year after the first COVID-19 case in Portugal, during the second major lockdown in the country, and with vaccination starting in these facilities, a photovoice program to identify the experiences of these professionals was developed. This study aimed to understand how gerontological social workers foresee the future of practice and intervention with older adults. A thematic analysis was conducted based on the photographs and associated narratives from 10 participants, all female, aged between 22 and 35 years, who attended a program's session. Findings: Three themes were identified with the thematic analysis: (1) personal and professional growth (with renewed life perspectives and increased resilience), (2) reinvention of intervention (with improved management of emotions, teamwork, and alternative ways of intervening), and (3) hope to use the lessons learned (hope that vaccination will bring conditions to recover the older adults' well-being and opportunities to use the good lessons learned). Applications: These findings are relevant to inform policymakers and governments about practices in aged care facilities and to improve the training of gerontological social workers in acute action management and intervention. We stress alternative ways of intervening that came up in the response to the pandemic such as emotional management, digital technology, communication strategies, self-care, or the families' involvement.

Post-Mortem Diagnosis of Pediatric Dengue Using Minimally Invasive Autopsy during the COVID-19 Pandemic in Brazil.

We report the first pediatric disease in which the use of minimally invasive autopsy (MIA) confirmed severe dengue as the cause of death. During the COVID-19 pandemic, a previously healthy 10-year-old girl living in north-eastern Brazil presented fever, headache, diffuse abdominal pain, diarrhoea, and vomiting. On the fourth day, the clinical symptoms worsened and the patient died. An MIA was performed, and cores of brain, lungs, heart, liver, kidneys, and spleen were collected with 14G biopsy needles. Microscopic examination showed diffuse oedema and congestion, pulmonary intra-alveolar haemorrhage, small foci of midzonal necrosis in the liver, and tubular cell necrosis in the kidneys. Dengue virus RNA and NS1 antigen were detected in blood and cerebrospinal fluid samples. Clinical, pathological, and laboratory findings, in combination with the absence of other lesions and microorganisms, allowed concluding that the patient had died from complications of severe dengue.

To Live or Die: What to Wish at 100 Years and Older.

Previous research has shown that will to live is a strong predictor for survival among older people, irrespective of age, gender, and comorbidities. However, research on whether life at age 100 is perceived as worth living is limited. The available literature has presented evidence for good levels of positive attitudes and life satisfaction at such an advanced age, but it has also suggested that a longing for death is common. This study aimed to add to the existing data on this matter by exploring centenarians' will to live and the associated factors. The sample comprised 121 centenarians (mean age, 101 years; SD, 1.63 years), 19 (15.7%) of whom were males, from two centenarian studies (PT100). Answers to open questions were analyzed to identify the centenarians' will to live and the reasons behind it. Three groups were created (willing to live longer, not willing to live longer, no clear positioning) and further analyzed in terms of sociodemographic characteristics, health status, social functioning, and well-being. Of the total sample, 31.4% expressed willingness to live longer, 30.6% did not, and 38% presented no clear positioning. The presence of the Catholic religion (God) was referred for centenarians in all three groups. Annoyance, uselessness, loss of meaning, disconnection, and loneliness were the most common justifications for being reluctant to live longer. Positive valuation of life and good self-rated health, followed by having a confidant and reduced pain frequency, were the factors associated with being willing to live longer. The results of the study contribute to the understanding of the psychological functioning of individuals with exceptional longevity, particularly concerning the factors behind willingness to live at such an advanced age.

The Caregiver Support Ratio in Europe: Estimating the Future of Potentially (Un)Available Caregivers.

The caregiver support ratio (CSR) is defined as the number of potential caregivers aged 45-64 years, the most common caregiving age range, for each person aged 80+, the subgroup of older adults most at risk of needing long-term services and support. This study uses data from the CENSUS HUB database and from the UN database to calculate the current (last year available: 2011) and projected (2020, 2030, 2040 and 2050) CSR for a group of European countries. Mediterranean countries, France, Belgium, and Sweden presented the lowest CSR (5:1) in 2011. The countries with the highest CSR were Slovakia (9:1) and Ireland, Poland, Cyprus, and Malta (8:1). The estimated CSR is expected to progressively decline from 6:1 (2011) to 2:1 (2050) for all countries. Although differences in the CSR exist between countries, the number of people aged 45-64 who are available to care for each person aged 80+ will decrease uniformly in the coming decades. Cross-national challenges for gerontological social policies and healthcare provision are expected due to the increasing demand for long-term care among the oldest population.

Influence of Active and Healthy Ageing on Quality of Life Changes: Insights from the Comparison of Three European Countries.

This study aimed to analyze the determinants of quality of life (QoL) in older people in three European countries (Portugal, Spain and Sweden). A sample of 7589 participants in waves 4 (2011) and 6 (2015) of the Survey on Health, Aging, and Retirement in Europe (SHARE) project, aged 50 and over and living in Portugal, Spain and Sweden, was included. The CASP-12 scale was used to measure QoL. A principal component analysis was performed to group preselected variables related to active and healthy ageing into the dimensions of health, social participation, and lifelong learning. A linear regression model was built using the change in CASP-12 scores over the 4-year follow-up as the dependent variable, including the interactions between country and each independent variable in the model. After four years, the average QoL increased in Portugal (difference = 0.8, p < 0.001), decreased in Spain (-0.8, p < 0.001), and remained constant in Sweden (0.1, p = 0.408). A significant country-participation component interaction (p = 0.039) was found. In Spain, a higher participation (ß = 0.031, p = 0.002) was related to a higher QoL improvement at 4 years, but not in Sweden or Portugal. Physical health and emotional components (ß = 0.099, p < 0.001), functional ability (ß = 0.044, p = 0.023), and cognitive and sensory ability (ß = 0.021, p = 0.026) were associated with QoL changes over time in all countries. The country-specific associations between health, social participation and QoL should be taken into account when developing public health policies to promote QoL among European older people.

Further survival at age 100: Findings from the Oporto Centenarian study.

BACKGROUND: This paper aims to identify the health-related predictors of survival in centenarians. METHODS: A population-based study conducted in North Portugal (PT100) followed 140 individuals from the age of 100+ years. A detailed questionnaire at baseline was completed including information on sociodemographic characteristics, physical health, functional, cognitive, and nutritional status and life-style. Survival of study participants was checked every six months over the period of December 2013 until June 2019. RESULTS: In the univariate Cox proportional hazards model, longer survival was associated with the absence of acute disease, better functional status, absence of physical fatigue and better cognition. Multivariate analysis revealed that acute disease, functional status and physical fatigue remained significant. CONCLUSIONS: Acute disease, functional status and physical fatigue are predictors of survival in the PT100 centenarians.

Psychometric Properties of the CASP-12 Scale in Portugal: An Analysis Using SHARE Data.

The purpose of this study is to assess the psychometric properties of the Portuguese version of the Control, Autonomy, Self-realization, and Pleasure (CASP)-12 scale used in the Survey of Health, Aging and Retirement in Europe (SHARE) project. Data were obtained from a representative sample of 1666 people aged ≥50 years living in Portugal and participating in the SHARE wave 6. In addition to the CASP-12 scale, sociodemographic data and health status, activity limitation (GALI), depression (Euro-D) and satisfaction with life scores were collected. Data quality and acceptability, construct and structural validity and internal consistency of the CASP-12 scale were analyzed. A Rasch analysis was also performed. CASP-12 total score (mean: 33.3; standard deviation: 5.8, range: 12-48) correlated with Euro-D (-0.57) and with life satisfaction (0.52). Mean scores were significantly lower for women, people aged ≥75 years and those with activity limitations and worse health status (p < 0.001). The confirmatory factor analysis showed good fit to the 4-factor model (root mean squared error of approximation (RMSEA): 0.07; comparative fit index (CFI): 0.90, χ2 (48) = 444.59, p < 0.001), which was confirmed by Rasch analysis (χ2 (36) = 10.089, p = 0.745, person separation index (PSI) = 0.722 for the 4-factor model). For domains, person separation index ranged 0.31-0.79 and Cronbach's alpha, 0.37-0.73. In conclusion, the Portuguese version of the CASP-12 scale presents some inadequacies in acceptability, internal consistency and structural validity.

Self-medication in older European adults: Prevalence and predictive factors.

BACKGROUND/OBJECTIVES: Self-medication, despite some benefits, carries many risks, especially when practiced by older adults who are polymedicated. Information addressing the prevalence and associated factors of self-medication in older age in a European context is scarce and sometimes contradictory. This paper aims to estimate the prevalence of self-medication among older adults across Europe and to identify its predictive factors. DESIGN: Cross-sectional study. SETTING: Micro-data from the European Health Interview Survey (2006-2009) was used. PARTICIPANTS: The sample comprised 31,672 community-dwelling individuals aged 65 and over living in private households in 14 European countries. MEASUREMENTS: The analyses explored the use, over the last two weeks, of any medicines, supplements, or vitamins that were not prescribed by a doctor. RESULTS: The mean self-medication prevalence was 26.3 %, being the highest in Poland (49.4 %) and the lowest in Spain (7.8 %). Greater odds of self-medication were found for women and for participants who were younger, divorced, or presented a higher educational degree. The presence of long-standing illness and physical pain or not using prescribed medication also significantly increased the possibility of self-medication. A wide variation in the odds of self-medication between countries was also observed (up to 8 times more for Poland, compared to Spain). CONCLUSION: Self-medication is a prevalent problem among older Europeans, and even though some think it is risk-free, dangers tend to be greater with advancing age. This study will help identify the groups most likely to have this behavior so that we can focus on targeted educative and preventive initiatives.

Anxiety, Depression and Quality of Life in Older Adults: Trajectories of Influence across Age.

This study focuses on the influence of anxiety and depression on individual trajectories of quality of life in old age through a longitudinal approach. A representative sample of adults aged 50+ living in Portugal and participating in wave 4 (W4) and wave 6 (W6) of the Survey of Health, Ageing and Retirement in Europe (SHARE) project was considered. Participants, 1765 at baseline (W4) and 1201 at follow up (W6), were asked about their quality of life (CASP-12) and emotional status (Euro-D scale; five items from the Beck Anxiety Inventory). Linear Mixed Effects models were performed to identify factors associated with changes in quality of life across age. Increasing age was found to have a significant negative effect on quality of life. Lower education and higher levels of depression and anxiety at baseline were also associated with worse quality of life; 42.1% of the variation of CASP-12 across age was explained by fixed and random effects, being depression followed by anxiety as the factors that presented with the highest relative importance. Both depression and anxiety play an important role in quality of life in older adults and must be acknowledged as important intervention domains to foster healthy and active aging.

Thinking About the End of Life When It Is Near: A Comparison of German and Portuguese Centenarians.

This study examined how common thinking of and planning for the end of life (EOL) is among German and Portuguese centenarians, and whether patterns of EOL views are shaped by cultural and individual characteristics. A significant portion of centenarians in both countries reported not thinking about the EOL, not believing in the afterlife, and not having made EOL arrangements. Latent class analysis identified three EOL patterns: Class 1 (EOL thoughts with EOL arrangements and afterlife beliefs), Class 2 (EOL arrangements and afterlife beliefs without EOL thoughts), and Class 3 (Overall low endorsement of EOL items). The proportion of Portuguese centenarians was higher in Class 1 and of German centenarians higher in Classes 2 and 3. Centenarians' demographic, social, and health characteristics were significantly different across EOL patterns. As lack of EOL planning can result in poor EOL quality, enhancing communication among centenarians, family, and health-care professionals seems imperative.

Objective vs. Subjective Health in Very Advanced Ages: Looking for Discordance in Centenarians.

Background: Living beyond 100 years of age is associated with several functional and health constraints but their impact depends on one's perception of the situation. Associations between self-rated health (SRH) with sociodemographic and psychosocial variables have been explored in several studies, revealing that one's health appraisal depends of factors beyond the objective health condition. There is a large body of literature concerning SRH in later life but lack of evidence about centenarians' perception of health and its associated factors, which could increase the available knowledge on the strengths and resources individuals in very advanced ages have for facing daily life limitations. Objective and Methods: This study aims to analyse the relationship between subjective and objective health status in a sample of centenarians (n = 127). Subjective health was assessed by a single-item health measure, and objective health by considering the number of reported diseases and a functional capacity scale (BADL and IADL). Main health characteristics are described as well as examined the association between objective and subjective health. Results: 46.5% of the sample has a good, very good, or excellent appraisal of their own health. SRH was associated (p < 0.05) with BADL and IADL scores and with the total number of diagnosis; when analyzing SRH according to the level of functional capacity, results revealed that most individuals with severe and moderate dependence have a reasonable to excellent SRH (p > 0.05). Conclusion: Having diseases and functional dependence at 100 years old may not mean to have a bad SRH. The high variability in SRH and the discordance between objective and subjective measures are a proof of centenarian's capacity of adaptation and the existence of individual resources, which may be decisive for one' perception and handling of health situation at such an advanced age.