Abstract
This study aims to describe the clinical course, drug use, and health services use characteristics during the last year of life of elders who die being centenarians and to identify key aspects differentiating them from elders who die at an earlier age, with a particular focus on sex differences. We conducted an observational, population-based study in the EpiChron Cohort (Aragón, Spain). The population was stratified by sex and into three age sub-populations (80–89, 90–99, and ≥100 years), and their characteristics were described and compared. Multimorbidity was the rule in our elders, affecting up to 3 in 4 centenarians and 9 in 10 octogenarians and nonagenarians. Polypharmacy was also observed in half of the centenarian population and in most of the younger elders. Risk factors for cardiovascular disease (i.e., hypertension, dyslipidaemia, diabetes), cerebrovascular disease and dementia were amongst the most common chronic conditions in all age groups, whereas the gastroprotective drugs and antithrombotic agents were the most dispensed drugs. Centenarians presented in general lower morbidity and treatment burden and lower use of both primary and hospital healthcare services than octogenarians and nonagenarians, suggesting a better health status. Sex-differences in their clinical characteristics were more striking in octogenarians and tended to decrease with age.
Highlights
The extraordinary rise in life expectancy in developed countries during the past decades has resulted in an exponential increase in the centenarian population
Several studies have characterized the burden of diseases and drugs and the use of health services in centenarians with contradictory results [3,4,5,6,7,8,9,10,11,12]
This study aims to describe the demographic, clinical, drug use and healthcare use characteristics during the last year of life of elders who die being centenarians and to identify clinical key aspects differentiating them from elders who die at an early age being nonagenarians or octogenarians, with a specific focus on sex differences
Summary
The extraordinary rise in life expectancy in developed countries during the past decades has resulted in an exponential increase in the centenarian population. The United Nations estimated that there would be more than 25 million centenarians in 2100 [1] This underscores the importance of studying this age group to characterize their biological, genetic, social, clinical, and epidemiological profile. Several studies have characterized the burden of diseases (multimorbidity) and drugs (polypharmacy) and the use of health services in centenarians with contradictory results [3,4,5,6,7,8,9,10,11,12]. The expansion of morbidity hypothesis predicts increased morbidity and an increasing number of years spent in poor health [14,15]. Assessing trends in compression or expansion of morbidity would provide useful epidemiological information with clinical implications [16]
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