Oldest-old Population Research Articles

Assessing palliative care needs in patients with dementia: A cross-sectional analysis of an predominantly oldest-old population from a geriatric memory clinic.

In this cross-sectional study, we assessed palliative care (PC) needs in older adults with dementia. Using the NECPAL CCOMS-ICO© 3.1 tool and comprehensive geriatric assessment, 16.25% of the 554 evaluated patients required PC, which had clinical frailty and a moderate stage of dementia. Advanced frailty was associated with the poorest prognosis, according to the PC-based stratification. Our findings support the use of PC assessment in dementia care, which focuses on a person-centered approach while minimizing unnecessary or ineffective treatments and meeting the real-world patient's needs. PC care may fulfill the multidimensional nature of dementia, shifting towards personalized palliative approaches.

Social isolation and likelihood of becoming centenarians: evidence from the Chinese longitudinal healthy longevity survey

BackgroundSocial isolation, defined as an individual’s lack of social connections, is particularly prevalent among older adults. However, its association with health outcomes among the oldest-old population (aged 80 and above) was understudied.AimsTo examine the association between social isolation and the likelihood of becoming a centenarian among the oldest-old people in China, aiming to provide novel insights into promoting healthy aging and longevity.MethodsUsing data from The Chinese Longitudinal Healthy Longevity Survey, conducted in 22 provinces in mainland China since 1998, we performed a community-based, prospective nested case-control study. The primary outcome was survival to the age of 100 by 2018 (the end of follow-up). Information on social isolation and other covariates was collected via a questionnaire at baseline. The degree of social isolation was categorized as low, moderate, and high. Included (n = 5,716) were 1,584 identified centenarians and 4,132 controls (deceased before reaching 100 years), matched by age, sex, and year of entry. A conditional logistic regression model was used to evaluate the association between social isolation and the likelihood of becoming a centenarian, adjusting for demographic factors, lifestyle factors, chronic disease, potential disability, optimistic attitude, and perceived loneliness.ResultsIndividuals with the highest social isolation score had lower odds of becoming centenarians (adjusted OR:0.82; 95% CI: 0.68, 0.98), relative to those with the least social isolation (P-value < 0.05), and this association persisted in sensitivity analyses. The association was more pronounced among ever smokers, compared to never smokers (P-value = 0.001). We did not observe significant interactions between social isolation and other covariates (P-value > 0.05 for all).ConclusionsThis study highlights the inverse association between social isolation and the likelihood of becoming a centenarian, emphasizing the need for public health initiatives to combat isolation in the older population.

An analysis of in-hospital enoxaparin prescription and bleedingin the predominately middle-, and oldest-old population: insightsfrom a secondary care hospital

An analysis of in-hospital enoxaparin prescription and bleedingin the predominately middle-, and oldest-old population: insightsfrom a secondary care hospital

Independent and combined associations of depression and cognitive impairment with frailty in oldest-old adults

BackgroundFrailty is one of the most significant issues related to human aging. Although studies have confirmed the association of mental and cognitive disorders with frailty, the association might be influenced by age, since oldest-old adults are more likely to have adverse health outcomes. Thus, this study aimed to examine independent and combined associations of mental health and cognitive function with frailty in oldest-old adults using data from the Chinese Longitudinal Healthy Longevity Survey in 2018.MethodsA sum of 6,891 and 3,171 older adults aged 80 and older were included in this study when analyzing the association of depression and cognitive impairment with frailty, respectively. Frailty was measured by the Study of Osteoporotic Fractures frailty index, depression was assessed by the Center for Epidemiologic Studies Depression Scale, and cognitive impairment was evaluated by the Chinese version of modified Mini-Mental State Examination. Independent sample t-test, Chi-square tests, and logistic regression analyses were used to examine the associations of depression and cognitive impairment with frailty.ResultsOlder persons with depression or cognitive impairment had a higher chance of frailty. The adjusted odds ratio (OR) of frailty was 1.27 (95% CI: 1.01, 1.59, p = 0.044) in those with depression, and 1.85 (95% CI: 1.14, 3.01, p = 0.013) in those with cognitive impairment. Compared to adults who had neither depression nor cognitive impairment, those with either depression or cognitive impairment, and those with both depression and cognitive impairment had a significantly higher likelihood of frailty (adjusted OR: 1.61, 95% CI: 1.07, 2.41; and adjusted OR: 4.03, 95% CI: 2.05, 7.94).ConclusionsThe findings suggest that depression and cognitive impairment are associated with frailty. The concurrence of depression and cognitive impairment has an additive effect on frailty in oldest-old population.

TICS-M scores in an oldest-old normative cohort identified by computable phenotype

Objective: To (1) examine the distribution of Telephone Interview for Cognitive Status modified (TICS-m) scores in oldest-old individuals (age 85 and above) identified as cognitively healthy by a previously validated electronic health records-based computable phenotype (CP) and (2) to compare different cutoff scores for cognitive impairment in this population. Method: CP identified 24,024 persons, 470 were contacted and 252 consented and completed the assessment. Associations of TICS-m score with age, sex, and educational categories (<10 years, 11–15 years, and >16 years) were examined. The number of participants perceived as impaired was studied with commonly used cutoff scores (27–31). Results: TICS-m score ranged from 18 to 44 with a mean of 32.6 (SD = 4.7) in older adults aged 85–99 years old. A linear regression model including (range-restricted) age, education, and sex, showed beta estimates comparable to previous findings. Different cutoff scores (27 to 31) generated slightly lower MCI and dementia prevalence rates of participants meeting the criteria for the impairments than studies of younger elderly using traditional recruitment methods. Conclusions: The use of validated computable phenotype to identify a normative cohort generated a normative distribution for the TICS-m consistent with prior findings from more effortful approaches to cohort identification and established expected TICS-m performance in the oldest-old population.

Association between possible sarcopenia and domain-specific cognitive impairment in middle-aged and older adults: Insights from the Gan-Dau Healthy Longevity Plan

BackgroundGiven the established association between sarcopenia and cognitive impairment was mainly in the older and oldest-old population or people with relatively limited education, this study extends the investigation to community-dwelling middle-to-old age adults in urban communities, emphasizing the need for preventive intervention for muscle health and healthy longevity. MethodsData of 712 participants from the Gan-Dau Healthy Longevity Plan were retrieved for analysis, and all participants were stratified by age (50–64, 65–74 and 75+ years old). Possible sarcopenia was defined by 2019 consensus report of the Asian Working Group for Sarcopenia (AWGS). This study used four neuropsychological tests for analysis, i.e., Mini-Mental Status Examination (MMSE), California Verbal Learning Test II (CVLT-SF), Digital Symbol Substitution Test (DSST) and Verbal fluency (VF) for global and domain-specific cognitive function. Multivariate generalized linear models (GLMs) were employed to investigate the associations between possible sarcopenia and cognitive function in each age-specific groups. ResultsThe prevalence of possible sarcopenia increased with age, with 31.8 %, 37.7 %, and 55.6 % in participants aged 5064, 65–74 and, 75+ years, respectively. On the other hand, cognitive performance declined with age. In particular, among participants aged 75+ years with possible sarcopenia, their cognitive performance were poorer than robust counterparts, including MMSE (26.6 [3.4] vs. 27.4 [2.6]), CVTL-SF (total score: 21.5 [5.4] vs. 23.8 [5.5]; 30-second delayed recall: 6.0 [1.7] vs. 6.5 [1.6]), DSST (32.8 [14.3] vs. 41.3 [18.7]), and VF (12.8 [5.1] vs. 14.8 [4.9]). Multivariate generalized linear model indicated that possible sarcopenia was associated with lower MMSE (β: −0.70, p = 0.014) and lower DSST (β: −7.00, p = 0.010) in those aged 50–64 years. Moreover, possible sarcopenia was associated with lower CVLT-SF (total score β:-1.90, p = 0.028), lower DSST (β: −6.45, p < 0.001), and lower VF (β: −1.64, p=0.026) in 75+ years group. ConclusionsAn association exists between possible sarcopenia and cognitive impairment, encompassing global cognition, delayed memory, verbal fluency, and executive function, among community-dwelling adults of mid-to-old age. Future research is warranted to explore the temporal alterations in this association and the potential effects of interventions aimed at fostering healthy longevity.

Metabolic obesity phenotypes and all-cause mortality among the Chinese oldest-old population: a prospective cohort study.

The obesity paradox has been reported among older adults. However, whether the favorable effect of obesity is dependent on metabolic status remains largely unknown. We aimed to explore the association of metabolic obesity phenotypes and their changes with all-cause mortality among the Chinese oldest-old population. This prospective cohort study included 1207 Chinese oldest old (mean age: 91.8 years). Metabolic obesity phenotypes were determined by central obesity and metabolic status, and participants were classified into metabolically healthy obesity (MHO), metabolically unhealthy obesity (MUO), metabolically healthy non-obesity (MHN), and metabolically unhealthy non-obesity (MUN). The hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated by Cox regression models. During 5.3 years of follow-up, 640 deaths were documented. Compared with non-obesity, obesity was associated with a decreased mortality risk among participants with metabolically healthy (HR, 0.75; 95% CI, 0.63-0.91) while this association was insignificant among metabolically unhealthy. Compared to MHO, MHN (HR, 1.27; 95% CI, 1.06-1.53) and MUN (HR, 1.49; 95% CI, 1.10-2.02) were significantly associated with an increased mortality risk. Compared to those with stable MHO, those transited from MHO to MUO demonstrated a higher mortality risk (HR, 1.81; 95% CI, 1.06-3.11). MHO predicts better survival among the Chinese oldest-old population. These findings suggest that ensuring optimal management of metabolic health is beneficial and taking caution in weight loss based on the individual body weight for the metabolically healthy oldest-old adults.

Sedentary patterns and health outcomes in the oldest-old: a latent profile analysis

Background Sedentary behavior is most prevalent among those aged 80 years and above, referred to as the oldest-old. Current literature emphasizes the significance of sedentary behavior patterns, but further evidence is required to understand how these patterns relate to specific health outcomes and to identify at-risk profiles for tailored interventions in the oldest-old. Therefore, the aim of this study was to identify profiles of adults aged 80+ years based on their sedentary patterns and health outcomes, and to examine associations between profiles and socio-demographics. Methods A cross-sectional study was conducted in Flanders (Belgium) from February 2021 to December 2022 recruiting 90 older adults (80+) through convenience sampling, employing word of mouth, social media and local service centers. Latent profile analysis identified device-based sedentary patterns and assessed their associations with physical and cognitive functioning, mental health-related quality of life (QoL), and social isolation. Associations of these profiles with socio-demographic factors were analyzed. Results Three distinct profiles were identified: (1) the ‘cognitively and physically frail’ profile, (2) the ‘healthy’ profile and (3) the ‘lower mental health-related QoL’ profile. Those in the ‘cognitively and physically frail’ profile exhibited the least favorable sedentary pattern, and had a higher likelihood of residing in a nursing home. No significant differences were found for the other socio-demographic variables, being age, sex, educational degree and family situation. Conclusions Three distinct profiles in the oldest-old population, based on cognitive and physical functioning, mental health-related QoL, and sedentary behavior patterns, were identified. Lower physical and cognitive functioning was associated with unhealthy sedentary patterns. Further research with larger samples is crucial to uncover potential links between socio-demographics and at-risk subgroups, enhancing our understanding of sedentary behavior and geriatric health outcomes in this population.

Positive Aspects of Caregiving in Familial Care for Nonagenarians and Centenarians: Findings from Hong Kong Centenarian Study.

Caregiving for the fast-growing but vulnerable oldest-old population may involve distinct challenges but also gratification. We analyzed quantitative and qualitative data from family caregivers of community-dwelling older adults aged 95 or above in Hong Kong. Quantitative analysis of 143 caregivers revealed that higher age, dependence on basic activities of daily living, independence on instrumental activities of daily living, and intact hearing ability of the older adults, and absence of a domestic helper and better self-rated health of the caregivers were associated with more positive aspects of caregiving. Qualitative analysis of the 96 caregivers who mentioned at least a positive aspect from their caregiving identified three themes: acquiring caregiving skills, fulfilling family love and obligation, and preparing for graceful aging. Our findings elaborated the nature and mechanism of caregiving gains against the unique backdrop of exceptional longevity and the Chinese cultural expectations of filial piety.

Trends in prevalence, mortality, and risk factors of dementia among the oldest-old adults in the United States: the role of the obesity epidemic.

The oldest-old population, those aged ≥ 80years, is the fastest-growing group in the United States (US), grappling with an increasingly heavy burden of dementia. We aimed to dissect the trends in dementia prevalence, mortality, and risk factors, and predict future levels among this demographic. Leveraging data from the Global Burden of Disease Study 2019, we examined the trends in dementia prevalence, mortality, and risk factors (with a particular focus on body mass index, BMI) for US oldest-old adults. Through decomposition analysis, we identified key population-level contributors to these trends. Predictive modeling was employed to estimate future prevalence and mortality levels over the next decade. Between 1990 and 2019, the number of dementia cases and deaths among the oldest-old in the US increased by approximately 1.37 million and 60,000 respectively. The population growth and aging were highlighted as the primary drivers of this increase. High BMI emerged as a growing risk factor. Females showed a disproportionately higher dementia burden, characterized by a unique risk factor profile, including BMI. Predictions for 2030 anticipate nearly 4 million dementia cases and 160,000 related deaths, with a marked increase in prevalence and mortality anticipated among those aged 80-89. The past 30years have witnessed a notable rise in both the prevalence and mortality of dementia among the oldest-old in the US, accompanied by a significant shift in risk factors, with obesity taking a forefront position. Targeted age and sex-specific public health strategies that address obesity control are needed to mitigate the dementia burden effectively.

Prevalence and risk factors for isolated systolic hypertension among the oldest-old population in southwestern China: A community-based cross-sectional study.

The prevalence of isolated systolic hypertension (ISH) has doubled between 2002-2005 and 2014 among the oldest-old population in China. However, the prevalence and characteristics of ISH among the oldest-old population in southwestern China remain less known. This study aimed to investigate the prevalence of ISH among the oldest-old population in Chengdu and identify associated factors to provide valuable information for disease etiology and prevention. We recruited 1,312 participants aged over 80 years by using a stratified cluster sampling method between September 2015 and June 2016, from three districts (Jinjiang, Qingyang, and Longquanyi) of Chengdu, the largest city of southwest China. A structured questionnaire, anthropometric data, and blood pressure were collected according to the standard method. Blood pressure was measured three times by using a standardized mercury sphygmomanometer after a 10-minute seated rest. Of 1312 participants, 53.0% (n=695) had ISH. The prevalence of ISH in men and women was 54.7% and 51.3%, respectively, with no significant sex difference (P=.222). The prevalence of ISH increased with advanced age in men (P for trend=0.029), 52.5% for the 80-84 years group, 55.2% for the 85-89 years group, and 70.4% for the 90-98 years group, respectively. Multivariable logistic regression analyses found that drinking (OR=1.85, 95%CI=1.26-2.71), being overweight (OR=1.88, 95%CI=1.19-2.96), and having a higher heart rate (OR=0.66, 95%CI=0.51-0.86) were associated with ISH. Stratified by sex, these three factors remained significant in men. Our work highlights that the burden of ISH is substantial among the oldest-old population in southwestern China.

Role of NT-proBNP and lung ultrasound in diagnosing and classifying heart failure in a hospitalized oldest-old population: a cross-sectional study.

Diagnosing and classifying heart failure (HF) in the oldest-old patients has technical and interpretation issues, especially in the acute setting. We assessed the usefulness of both N-terminal pro-brain natriuretic peptide (NT-proBNP) and lung ultrasound (LUS) for confirming HF diagnosis and predicting, among hospitalized HF patients, those with reduced ejection fraction (HFrEF). We performed a cross-sectional study on 148 consecutive patients aged ≥ 80 years admitted to our Internal Medicine and Geriatrics ward with at least one symptom/sign compatible with HF and NT-proBNP ≥ 125 pg/mL. We measured serum NT-proBNP levels and performed LUS and transthoracic echocardiography (TTE) on admission before diuretic therapy. We divided our cohort into three subgroups according to the left ventricular ejection fraction (LVEF): reduced (LVEF ≤ 40%), mildly-reduced (LVEF = 41-49%) and preserved (LVEF ≥ 50%). The mean age was 88±5 years. Male prevalence was 42%. Patients with HFrEF were 19%. Clinical features and laboratory parameters did not differ between the three subgroups, except for higher NT-proBNP in HFrEF patients, which also had a higher number of total B-lines and intercostal spaces of pleural effusion at LUS. Overall, NT-proBNP showed an inverse correlation with LVEF (r = -0.22, p = 0.007) and a direct correlation with age, total pulmonary B-lines, and intercostal spaces of pleural effusion. According to the ROCs, NT-proBNP levels, pulmonary B-lines and pleural effusion extension were poorly predictive for HFrEF. The best-performing cut-offs were 9531 pg/mL for NT-proBNP (SP 0.70, SE 0.50), 13 for total B-lines (SP 0.69, SE 0.85) and one intercostal space for pleural effusion (SP 0.55, SE 0.89). Patients with admission NT-proBNP ≥ 9531 pg/mL had a 2-fold higher risk for HFrEF (OR 2.5, 95% CI 1.3-4.9), while we did not find any association for total B-lines ≥ 13 or pleural effusion ≥ 1 intercostal space with HFrEF. A significant association with HFrEF emerged for the combination of NT-proBNP ≥ 9531 pg/mL, total B-lines ≥ 13 and intercostal spaces of pleural effusion ≥ 1 (adjusted OR 4.3, 95% CI 1.5-12.9). Although NT-proBNP and LUS help diagnose HF, their accuracy in discriminating HFrEF from non-HFrEF was poor in our real-life clinical study on oldest-old hospitalized patients, making the use of TTE still necessary to distinguish HF phenotypes in this peculiar setting. These data require confirmation in more extensive and longer prospective studies.

Late Life Cognitive Function Trajectory Among the Chinese Oldest-Old Population—A Machine Learning Approach

ABSTRACT Informed by the biopsychosocial framework, our study uses the Chinese Longitudinal Healthy Longevity Survey (CLHLS) dataset to examine cognitive function trajectories among the oldest-old (80+). Employing K-means clustering, we identified two latent groups: High Stability (HS) and Low Stability (LS). The HS group maintained satisfactory cognitive function, while the LS group exhibited consistently low function. Lasso regression revealed predictive factors, including socioeconomic status, biological conditions, mental health, lifestyle, psychological, and behavioral factors. This data-driven approach sheds light on cognitive aging patterns and informs policies for healthy aging. Our study pioneers non-parametric machine learning methods in this context.

Programa de exercícios multicomponentes domiciliar (VIVIFRAIL®) para longevos durante a pandemia da covid-19

Abstract Objective To investigate the acceptability and adequacy of a multicomponent exercise program via videoconferencing for the oldest-old in Porto Alegre, a city in southern Brazil. Method This is a quasi-experimental study. Fourteen participants were enrolled in the multicomponent exercise program Vivifrail® for 12 weeks, 5 days a week, with weekly video calls for assessment of acceptability and adequacy. The acceptability and adequacy questionnaire was based on 6 barriers that older adults face when engaging in physical exercise. Responses were measured using a 5-point Likert scale ranging from 0 to 4 points, with a maximum score of 24 points (maximum acceptability). Results Fourteen participants (89.07±6.30 years) concluded the protocol, with an acceptability rate of 70%. Internal consistency was moderate, with a Cronbach’s coefficient alpha of 0.7. Participants showed an overall increase in acceptability and adequacy (from 17.8±3.51 points in the first week to 22.0±2.94 in the 12th week). Four participants (28.6%) required some modification to the exercise protocol. Conclusion The Vivifrail® protocol, together with weekly follow-up via videoconferencing, was well accepted and adequate. It could be an important tool for promoting quality of life, especially in the oldest-old with difficulty leaving home. The acceptability questionnaire was able to detect exercise barriers and suggest possible modifications to the training program and could be presented as a suggestion for the evaluation of intervention protocols in the oldest-old population. Therefore, the Vivifrail® protocol, with weekly follow-up via videoconferencing, could be a new field of intervention for health professionals.

FACTORS INFLUENCING COGNITIVE FUNCTION AMONG THE US OLDEST-OLDER ADULTS

Abstract Previous studies have identified factors that influence cognition in older adults (aged ≥ 65); however, the findings cannot be generalized to the oldest-old adults (aged ≥ 80), who face different physical and functional challenges. This study aimed to examine the association between potential influencing factors and cognitive function in community-dwelling oldest-older adults using the National Health Aging Trends Study (NHATS) dataset, a nationally representative sample from 2015. We conducted linear multilevel modeling (MLM) to examine the association between participation in physical activity (PA) and social activity, everyday technology use, mental health, and self-reported health with cognitive function (immediate and delayed word recall), adjusting for five sociodemographic characteristics (age, sex, race/ethnicity, and education). A total of 2779 community-dwelling oldest-old adults from the NHATS were included. Most of study participants were 80-84 years old (47%), female (61%), Non-Hispanic White (70%), not married (63%), and did not obtain a college degree (75%). In the MLM, participating in physical and social activities, using technology, and poorer mental health were significantly associated with higher word-recall scores (better cognitive function). Self-reported health was not associated with word recall. Results from our study suggest that interventions aimed at promoting physical and social activities and improving mental health may help maintain cognitive function among the oldest-old population. Our findings also suggest the potential positive impact of technology use on cognition, although further study is needed to support the evidence.

Depressive and anxiety symptoms during the COVID-19 pandemic in the oldest-old population and the role of psychosocial factors: a multivariate and multi-wave analysis.

Since the oldest-old population was identified as a high-risk group for a severe course of the coronavirus disease and higher mortality, it was assumed that they might be particularly psychologically burdened. The aim of the study is to analyze the development of anxiety and depressive symptoms over the course of the pandemic from 2020 to 2022, as well as psychosocial factors associated with these outcomes. We analyzed data of n = 135 participants aged 78 to 97 years old (2020: M = 86.77, SD = 4.54) with three points of measurement from May to June 2020 (t1), March to May 2021 (t2) and November to January 2022 (t3). Besides sociodemographic variables, worries about the Sars-Cov-2 virus, living situation, perceived social support (ESSI), resilience (BRS), anxiety and depressive symptoms (BSI-18) were assessed. We calculated multilevel mixed-effects generalized linear models with a negative binominal distribution to model anxiety and depressive symptoms over time. While there is an increase in depressive and anxiety symptoms in the investigated oldest-old individuals in Germany from 2020 to 2021, there is no further increase in symptomatology from 2021 to 2022. Participants of older age reported higher levels of anxiety symptoms. Higher perceived social support was associated with both less depressive and less anxiety symptoms, while resilience was associated with less depressive symptoms only. More worries about the Sars-Cov-2 virus were associated with higher anxiety levels. Overall, the oldest-old population appeared to show rather stable mental health after a slight increase in symptomatology within the first year of the pandemic. Social support is an important factor to target in mental health prevention programs for oldest-old individuals in times of future crises such as a pandemic.

Real-World Evidence of Multiple Air Pollutants and Mortality: A Prospective Cohort Study in an Oldest-Old Population.

We aimed to report real-world longitudinal ambient air pollutants levels compared to WHO Air Quality Guidelines (AQG) and analyze multiple air pollutants' joint effect on longevity, and the modification and confounding from the climate and urbanization with a focus on the oldest-old. This study included 13,207 old participants with 73.3% aged 80 and beyond, followed up from 2008 to 2018 in 23 Chinese provinces. We used the Cox-proportional hazards model and quantile-based g-computation model to measure separate and joint effects of the multiple pollutants. We adjusted for climate and area economic factors based on a directed acyclic graph. In 2018, no participants met the WHO AQG for PM2.5 and O3, and about one-third met the AQG for NO2. The hazard ratio (HR) for mortality was 1.07 (95% confidence interval-CI: 1.05, 1.09) per decile increase in all three pollutants, with PM2.5 being the dominant contributor according to the quantile-based g-computation model. In the three-pollutant model, the HRs (95% CI) for PM2.5 and NO2 were 1.27 (1.25, 1.3) and 1.08 (1.05, 1.12) per 10 μg/m3 increase, respectively. The oldest-old experienced a much lower mortality risk from air pollution compared to the young-old. The mortality risk of PM2.5 was higher in areas with higher annual average temperatures. The adjustment of road density considerably intensified the association between NO2 and mortality. The ambient PM2.5 and O3 levels in China exceeded the WHO AQG target substantially. Multiple pollutants coexposure, confounding, and modification of the district economic and climate factors should not be ignored in the association between air pollution and mortality.

Over ninety years old: Does high cognitive reserve still help brain efficiency?

Nonagenarians and centenarians, also called oldest-old, are a very heterogeneous population that counts a limited number of individuals as it is a real challenge to reach this goal. Even if it is well known that cognitive reserve can be considered a factor in maintaining good cognitive functioning in ageing, only very few studies have been carried out on the role of cognitive reserve (CR) in the oldest-old people. The aim of this study is to investigate the relationship between cognitive reserve and cognitive functioning in a population living in a specific region of Italy, the Blue Zone in Sardinia. This population is characterised by extreme longevity and distinctive historical, geographic, social, linguistic and nutritional features. The cognitive Reserve Index questionnaire (CRIq) and the short cognitive Esame Neuropsicologico Breve-2 (ENB-2, Brief Neuropsychological Examination) were administered to 67 participants, all aged between 90 and 105 years old. The CRIq was a predictor of neuropsychological performance for the global score of the battery of tests, ENB-2 (ENB-tot) and also for 7 out of 16 of its sub-tests. All except one (Token) tapped executive functions (Interference memory at 10 and 30 s, TMT-B, Overlapping figures, ion, Fluency). Results highlight that also in the oldest-old population CR has a positive effect on cognition, especially on executive functioning.

Prevalence of Outpatient Use of Medicines by the Elderly Population in Portugal: A Cross-Sectional Study

Like in other countries, the age pyramid in Portugal has been changing considerably, with a substantial increase in the size of the older population and a significant reduction in the number of young people. With aging, co-occurrence of several conditions becomes frequent, often leading to the use of multiple medications (polypharmacy). Polypharmacy in the older population is particularly relevant considering the physiological changes of the ageing process, which increase the risk of drug interactions, poor adherence to treatment, and adverse drug reactions, especially in the oldest-old population (85 years or older). As the size of the older population is likely to increase significantly, it is important to characterize the pattern of medicines' use by the elderly while also identifying cases of polypharmacy in order to obtain evidence that can be used to develop specific measures to tackle the high prevalence of use and its associated risks. To this end, the aim of this study was to characterize medication use by older individuals in Portugal. Cross-sectional study with data from the National Health System's Control and Monitoring Center on reimbursed medicines that were prescribed and dispensed to individuals aged 65 years or older in 2019 in all community pharmacies of the Portuguese mainland. We performed a demographic and geographic analysis of the data by international nonproprietary name and therapeutic group. The number of reimbursed packages and the number of reimbursed packages per capita were the metrics used (data from Instituto Nacional de Estatística). A higher consumption of medicines was observed in women, increasing with age, except in the oldest olds, in which the sex difference tended to shrink. Use per capita showed an opposite trend, with the oldest-old men surpassing the oldest-old women (mean reimbursed packages: 55.5 in men versus 55.1 in women). In women, consumption was led by cardiovascular medicines (31%), followed by central nervous system medications (30%) and antidiabetics (13%); in men, 37% of TOP 10 consumption was due to cardiovascular medications, antidiabetics (16%) and drugs for benign prostatic hypertrophy (14%). In the elderly, there were sex differences in the pattern of medicines' use, and there were also significant age-related differences in 2019. To the best of our knowledge, our study is the first nationwide analysis of reimbursed medicines' consumption data in the elderly, which is essential to characterize the use of medicines in this age group in Portugal.

Comparison of functional disabilities, place of death and end-of-life medical expenditures among centenarians and non-centenarians in China: a series of cross-sectional studies

BackgroundLong-term and end-of-life (EOL) care for older adults has become a global concern due to extended longevity, which is generally accompanied by increased rates of disability. However, differences in the rates of disability in activities of daily living (ADLs), place of death and medical expenditures during the last year of life between centenarians and non-centenarians in China remain unknown. This study aims to fill this research gap to inform policy efforts for the capacity-building of long-term and EOL care for the oldest-old, especially for centenarians in China.MethodsData from 20,228 decedents were derived from the 1998–2018 Chinese Longitudinal Healthy Longevity Survey. Weighted logistic and Tobit regression models were used to estimate differences in the prevalence of functional disability, rate of death in hospitals and EOL medical expenditures by age groups among oldest-old individuals.ResultsOf the 20,228 samples, 12,537 oldest-old individuals were female (weighted, 58.6%, hereafter); 3,767 were octogenarians, 8,260 were nonagenarians, and 8,201 were centenarians. After controlling for other covariates, nonagenarians and centenarians experienced a greater prevalence of full dependence (average marginal differences [95% CI]: 2.7% [0%, 5.3%]; 3.8% [0.3%, 7.9%]) and partial dependence (6.9% [3.4%, 10.3%]; 15.1% [10.5%, 19.8%]) but a smaller prevalence of partial independence (-8.9% [-11.6%, -6.2%]; -16.0% [-19.1%, -12.8%]) in ADLs than octogenarians. Nonagenarians and centenarians were less likely to die in hospitals (–3.0% [–4.7%, –1.2%]; –4.3% [–6.3%, –2.2%]). Additionally, nonagenarians and centenarians reported more medical expenditures during the last year of life than octogenarians with no statistically significant differences.ConclusionThe oldest-old experienced an increased prevalence of full and partial dependence in ADLs with increasing age and reported a decline in the prevalence of full independence. Compared with octogenarians, nonagenarians and centenarians were less likely to die in hospitals. Therefore, future policy efforts are warranted to optimise the service provision of long-term and EOL care by age patterns for the oldest-old population in China.