Who live longer than their age peers: individual predictors of longevity among older individuals.

BACKGROUND: There are a very few studies focusing on the individual-based survival with a long follow-up time. AIM: To identify predictors and determine their joint predictive value for longevity using individual-based outcome measures. METHODS: Data were drawn from Tampere Longitudinal Study on Aging (TamELSA), a study of individuals' age 60-89 years (N = 1450) with a mortality follow-up of up to 35 years. Two measures of longevity were used: the longevity difference (LD) and realized probability of dying (RPD), both of which compare each individual's longevity with their life expectancy as derived from population life tables. Independent variables were categorized into five domains: sociodemographic, health and functioning, subjective experiences, social activities, and living conditions. Linear regression models were used in three steps: bivariate analysis for each variable, multivariate analysis based on backward elimination for each domain, and one final model. RESULTS: The most important predictors of both outcomes were marital status, years smoked regularly, mobility, self-rated health, endocrine and metabolic diseases, respiratory diseases, and unwillingness to do things or lack of energy. The explained variance in longevity was 13.8% for LD and 14.1% for RPD. This demonstrated a large proportion of unexplained error margins for the prediction of individual longevity, even though many known predictors were used. DISCUSSION AND CONCLUSIONS: Several predictors associated with longer life were found. Yet, on an individual level, it remains difficult to predict who will live longer than their age peers. The stochastic element in the process of aging and in death may affect this prediction.

Older individuals' perceptions of a good death: A systematic literature review.

The purpose of this literature review was to describe older individuals' perceptions of a good death. A systematic data search of CINAHL, Medline, PsycINFO, ASSIA, and Medic databases from 2010 to 2020, supplemented with a manual search, resulted in 16 studies that met the inclusion criteria. Study quality was assessed using the JBI critical appraisal criteria. Data were analyzed by inductive content analysis. The core elements of older individuals' perceptions of a good death were a dignified moment of death, factors that enhance the desire to live, an active agency in adapting to death, and equal interpersonal relationships.

Successful Aging as a Predictor of Long-Term Care Among Oldest Old: The Vitality 90+ Study.

AIM: The aim of the study was to investigate whether successful aging (SA) predicts entering long-term care (LTC) among nonagenarians. METHODS: Data originated from the linkage of the Vitality 90+ Study surveys with register data from Finnish Population Register and Care Registers. Altogether 1,966 community-dwelling individuals were followed for 2 years and 1,354 individuals for 5 years. Four models of SA were constructed by varying combinations of physical, psychological, and social components. Competing risk regression analysis was used. FINDINGS: The incidence rate for entering LTC was lower for successful agers. Three models of SA presented a significantly decreased risk for entering LTC in the whole group and in women. The impact of SA was attenuated when living alone, needing help, and the year of participation were adjusted for, but was still significant for Model 3. CONCLUSION: Nonagenarians who meet the multidimensional criteria of SA are less likely to enter LTC than those aging less successfully.

Does use of long-term care differ between occupational classes among the oldest old? Vitality 90 + Study.

Long-term care (LTC) use increases with ageing due to an age-related increase in disability. Both the levels of disability and social resources vary among socioeconomic groups. The association of socioeconomic status with LTC use is largely unexplored for the oldest old. This study examined how occupational class is associated with LTC use among nonagenarians in the context of universal care coverage. A population-based prospective cohort study with 2862 participants who answered the Vitality 90 + Study surveys in 2001, 2003, 2007, or 2010 in Tampere, Finland, was combined with national register data on LTC use. LTC use in total and separately for publicly and privately provided LTC facilities was assessed in a cross-sectional setting and during the 34-month follow-up by using logistic regression and competing-risks regression methods. Functional status, multimorbidity, family relations, and help at home were controlled. In total or public LTC use, only a few differences between occupational classes were found at baseline. However, upper non-manuals used more private LTC than lower non-manuals (OR 0.54, 95% CI 0.35-0.85), skilled manuals (OR 0.40, 95% CI 0.26-0.62), or housewives (OR 0.40, 95% CI 0.22-0.74). There were no statistically significant differences in entering any kind of LTC after adjustments for all independent variables. During the study period, the share of privately provided care out of all LTC increased and the upper non-manuals no more used private care more than other groups. This study underlines the importance of following the structural changes in LTC provision to guarantee that the need for LTC is met equally for all socioeconomic groups.

Perceptions by the oldest old of successful aging, Vitality 90+ Study.

PURPOSE: To discover how 90-91-year-olds see a good old age and identify the dimensions of good and successful aging that appear in their talk. DESIGN AND METHODS: Life-story interviews with 45 community-dwelling nonagenarians (25 women and 20 men), conducted in the context of the Vitality 90+ Study. In the interviews the respondents were asked to give their opinions about a good old age and its constituents. The answers were subjected to thematic analysis with an inductive approach. RESULTS: The dimensions identified in most popular theories of successful aging, such as the physical, the cognitive, the psychological and social functioning, were also found in our study. But we were also able to identify new themes that have rarely been mentioned in previous studies of successful aging. These themes were "living circumstances", emphasizing the importance of having one's own home and living there as long as possible, "independence" in relation to various aspects of life and a "good death". The respondents saw themselves as having a good old age. IMPLICATIONS: Definitions of a good old age provided by the oldest old themselves give new insights into the concept of successful aging. Good health is important, but more in the sense of being pain-free than of being disease-free. Social and cognitive aspects seem to be more important than physical health. The important things for our nonagenarian respondents were to continue living independently, preferably in their own homes, and to have a quick and easy death rather than being institutionalized.

Do successful agers live longer? The Vitality 90+ study.

OBJECTIVE: To discover whether successful aging, understood as a multidimensional concept, predicts further survival in very old people. METHOD: The population sample consisted of 1,370 persons aged 90 or over in the Vitality 90+ study. Four alternative models of successful aging were constructed, each of them consisting of physical, psychological, and social dimensions. Mortality was followed up after 4 and 7 years. RESULTS: Three out of four models significantly predicted survival at both follow-ups for the whole group. Separately, "success" in the physical, psychological, and social components was also associated with higher survival. The associations were stronger in women than in men. DISCUSSION: Successful aging, measured using physical, psychological, and social dimensions, predicts the length of future life in nonagenarians.

Is socioeconomic status a predictor of mortality in nonagenarians? The vitality 90+ study.

BACKGROUND: socioeconomic inequalities in mortality are well-known in middle-aged and younger old adults, but the situation of the oldest old is less clear. The aim of this study was to investigate socioeconomic inequalities for all-cause, cardiovascular and dementia mortality among the people aged 90 or older. METHODS: the data source was a mailed survey in the Vitality 90+ study (n = 1,276) in 2010. The whole cohort of people 90 years or over irrespective of health status or dwelling place in a geographical area was invited to participate. The participation rate was 79%. Socioeconomic status was measured by occupation and education, and health status by functioning and comorbidity. All-cause and cause-specific mortality was followed for 3 years. The Cox regression, with hazard ratios (HR) and 95% confidence intervals (CI), was applied. RESULTS: the all-cause and dementia mortality differed by occupational class. Upper non-manuals had lower all-cause mortality than lower non-manuals (HR: 1.61; 95% CI: 1.11-2.32), skilled manual workers (HR: 1.56 95% CI: 1.09-2.25), unskilled manual workers (HR: 1.88; 95% CI: 1.20-2.94), housewives (HR: 1.77 95% CI: 1.15-2.71) and those with unknown occupation (HR: 2.33; 95% CI: 1.41-3.85). Inequalities in all-cause mortality were largely explained by the differences in functioning. The situation was similar according to education, but inequalities were not statistically significant. Socioeconomic differences in cardiovascular mortality were not significant. CONCLUSIONS: socioeconomic inequalities persist in mortality for 90+-year-olds, but their magnitude varies depending on the cause of death and the indicator of socioeconomic status. Mainly, mortality differences are explained by differences in functional status.

Evidence databases application: comparison of university faculties versus clinical residents in a developing country.

RATIONALE, AIMS AND OBJECTIVES: One of the main barriers against the implementation of evidence-based medicine (EBM) is the lack of search skills, an element that affects the finding of the best available evidence. Faculty staff should be capable of using the best evidence in practice and of teaching students to implement EBM elements. They should be familiar with search strategies and evidence databases. The aim of this study is to compare the application of evidence databases by faculties and by residents with no training in this field. METHODS: Two hundred fifty-seven faculties and first-year residents of the Tabriz University of Medical Sciences filled out a valid self-administered questionnaire on information-seeking behaviour from August 2008 to June 2010. A chi-square test was used to compare the variables. RESULTS: There were 52.1% of the respondents who were faculty members and 47.9% were residents. Only 8.7% used the Internet for their practice mostly. While Google was the most used resource, TRIP and Cochrane were less used. Significantly, the faculties used these resources more than the residents in both cases. Furthermore, two-thirds of the participants were unfamiliar with medical subject headings (MeSH), and only 14.5% consulted a clinical librarian for help. CONCLUSION: Significantly, clinicians used evidence databases and online resources minimally for their practice. Additionally, as the faculties used EBM resources more than the residents, this programme should be considered for inclusion in the curricula of medical schools.

Is there successful aging for nonagenarians? The vitality 90+ study.

Objectives. This study was designed (1) to estimate the prevalence of successful aging among nonagenarians based on six different models and (2) to investigate whether successful aging is associated with socio-demographic factors. Methods. A mailed survey was conducted with people aged 90+ in Tampere in 2010. Responses were received from 1283 people. The prevalence of successful aging was measured by six multidimensional models including physical, social, and psychological components. Age, sex, marital status, level of education, and place of living were studied as factors associated with successful aging. Results. The prevalence of successful aging varied from 1.6% to 18.3% depending on the model applied. Successful aging was more prevalent in men, and also more prevalent among community-living people. In most models, successful aging was also associated with younger age, being married, and a higher level of education. Discussion. Models which emphasize the absence of disease and activity as criteria for successful aging may not be the most relevant and applicable in oldest old. Instead, preference should be given to models that focus more on autonomy, adaptation and sense of purpose. Age-sensitive approaches would help us better understand the potential of successful aging among individuals who already have success in longevity.