Summary of What’s Known
Summary of What’s Known About Supercentenarians
Demographics
Centenarians are rare in the United States, with a prevalence of about 0.7 to 1 per 10,000.[1] Living to age 110 is even less common, although the number of supercentenarians worldwide has increased steadily at least since the 1980s.[2] The exact number of living supercentenarians in the United States is unknown. The 2000 U.S. census listed 1,400 supercentenarians, about 1 per 200,000.[3] This is undoubtedly a gross overestimate of the size of the supercentenarian population in the United States.[13]
Based on age-validated cumulative data on supercentenarians from seven European countries up to 2000, it is estimated that there are roughly 0.8 cumulative supercentenarians per million inhabitants.[2,4] The number of supercentenarians who are alive at any one time is likely to be even smaller. A list of 45 age-validated supercentenarians known to be alive at some point in 2003 in the United States was recently published.[5] Kestenbaum et al. reported, based on Medicare data, that there were 105 supercentenarians in 2000, representing 0.3% of centenarians.[6] In 2002, there were 139 supercentenarian social security recipients of whom a sizable fraction was thought to be less than 110 years old, bringing the true number closer to 75-100.[4]
Age Validation
In accordance with the recommendations of the National Institute on Aging Panel on the Characterization of Participants in Studies of Exceptional Survival in Humans, age verification of centenarians begins with obtaining the subject’s birth certificate.[7]
In the case of rarer and potentially sensationalized ages, such as claims of 110 years old and older, additional forms of proof that indicate ages at different times in the person’s life are obtained. Such forms of proof include census records, school report card with age, military record, marriage license, employment record, old passport, and/or parental age on child’s birth certificate. Dates of death for those subjects who have died are confirmed using death certificates, the Social Security Death Index or, when the latter two are unavailable, cemetery or funeral home records. We also employ the familial reconstitution method to determine if the ages of parents, grandparents, siblings and children are reasonable in relation to that of the supercentenarian.[8] Such stringent requirements for age verification are necessary since, according to our and others’ experiences, the majority of claims of age 115 and older are false.
Health and Function
Centenarians have been found to exhibit marked delays in functional decline and in most cases age-related lethal diseases such as heart disease, cancer and stroke.[9] Compression of functional decline towards the relative end of their very long lives might be a prerequisite or at least a marker of the ability to live to 100. In a sample of 105 centenarians, 88% were functionally independent at a mean age of 92 years.[10] Such compression of disability is even more pronounced among male centenarians.[11] Our early experience with supercentenarians led us to hypothesize that such a delay must be extended at least through age 100 in order for a person to survive to age 110 or older.
The First Published Case Series[12]
The Journal of the American Geriatrics Society recently published our findings of the first ever case series of supercentenarians describing their past medical history and current functional status. In that study of 32 supercentenarians the collected data included sociodemographic, pedigree, activities of daily living (ADL) and medical history variables. The Barthel Index was used to categorize functional status based upon ADL variables.[13] In all cases, data were provided by family and/or nursing home and medical staff. In addition, available medical records were obtained and reviewed. When the cognitive status of the subject allowed, data were also obtained from the subject.
Findings
As revealed in the below table, medical history was remarkable for few subjects having a history of vascular-related diseases including myocardial infarction (n=2, 6%) and stroke (n=4, 13%) despite their extremely long lives. Seven (22%) were taking medication to treat hypertension. Eight subjects (25%) had a history of cancer, all cases of which had been successfully treated and none of which were active. Diabetes and Parkinson’s disease were extremely rare (n=1, 3%). Osteoporosis (n=14, 44%) and cataract history (n=28, 88%) were common.
As shown in the below table, 59% of the subjects had Barthel Index scores in the partially to totally dependent range. Remarkably, however, the remaining 41%, despite their extreme age, required minimal assistance or were independent. The sample of men was too small to make gender-specific observations. We have previously reported that centenarians compress the time they experience disability towards the end of their very long lives, in part, because disability amongst the extreme old is likely a potent predictor of mortality.[10] We suspect that the same would be true for supercentenarians, though this has yet to be demonstrated with longitudinal data.
How Strongly Does Extreme Old Age Run In Families of Supercentenarians?
Given previous evidence of familial predisposition for longevity, we hypothesized that siblings and parents of supercentenarians were predisposed to survival to very old age and that, relative to their birth cohorts, their relative survival probabilities (RSPs) are even higher than what has been observed for the siblings of centenarians.
Working with our demography colleagues Irma Elo and Iliana Kohler at the University of Pennsylvania, we studied the ages of survival for the brothers and sisters of 29 supercentenarians and compared that to the average survival experience of their birth cohort.
Conditional on survival to age 20 years, the mean age at death of supercentenarians’ siblings was 81 years for both men and women. Compared with respective Swedish and U.S. birth cohorts, these estimates were 17%–20% (12–14 years) higher for the brothers and 11%–14% (8–10 years) higher for the sisters. Sisters had a 2.9 times greater probability and brothers had a 4.3 times greater probability of survival from age 20 to age 90. Mothers of supercentenarians had a 5.8 times greater probability of surviving from age 50 to age 90. Fathers also experienced an increased survival probability from age 50 to age 90 of 2.7, but it failed to attain statistical significance.
We concluded that the RSPs of siblings and mothers of supercentenarians revealed a substantial survival advantage and were most pronounced at the oldest ages. Counter to our hypothesis, the RSP to age 90 for siblings of supercentenarians was approximately the same as that reported for siblings of centenarians. It is possible that greater RSPs are observed for reaching even higher ages such as 100 years, but a larger sample of supercentenarians and their siblings and parents is needed to investigate this possibility.
Please go to the PDF of our article published in the Journal of Gerontology, Medical Sciences, for a full description of the study, the findings and our discussion.
Conclusions
Older people are well known for their heterogeneity across a broad spectrum of genetic and environmental variables known to effect longevity. We suspect however that supercentenarians might be more homogeneous with regard to phenotypic presentation and genetic and environmental characteristics that play significant roles in the ability to achieve such exceptional old age.
Reported or clinically significant cardiovascular disease and stroke were rare among the supercentenarians, perhaps because these diseases prevent survival to extreme age. By virtue of their likely ability to markedly delay or escape age-related illnesses and frailty and their probable sharing of traits that enable such exceptional survival, supercentenarians are likely to be an important resource for discovering environmental, behavioral and genetic factors that predispose to longevity and decreased susceptibility to vascular and other lethal diseases associated with aging.
References:
[1] Kestenbaum B, Ferguson BR. . Number of centenarians in the united states 01/01/1990, 01/01/2000, and 01/01/2010 based on improved Medicare data. Society of Actuaries http://cesoaorg/living-to-100/6b_paperspdf Last accessed April 29, 2006, 2002.
[2] Robine JM, Vaupel JW. Emergence of supercentenarians in low-mortality countries. North Amer Actuarial J. 2002;6: 54-63.
[3] Hustead E. Ending the mortality table. Society of Actuaries Living to 100 and Beyond Symposium. 2005;http://library.soa.org/library-pdf/m-li05-1_ix.pdf.
[4] Rosenwaike I, Stone, LF. Verification of Ages of Supercentenarians in the United States: Results of a Matching Study. Demography. 2003;40: 727-739.
[5] Coles L. Demography of human supercentenarians. J Gerontol A Biol Sci Med Sci 2004;59: B579-586.
[6] Kestenbaum B, Feruson RB. Number if Centenarians in the United States Jan. 1, 1990, Jan. 1, 2000 and Jan. 1, 2010 Based on Improved Medicare Data. Society of Actuaries. Orlando, FL http://library.soa.org/library-pdf/m-li05-1_XXVIpdf: N Amer Actuarial J 2005, pp. 1-11.
[7] Cawthon R, Cummings S, Curb JD, et al. National Institute on Aging Panel on the Characterization of Participants in Studies of Exceptional Survival in Humans. Bethesda, MD: National Institute on Aging, 2002, pp. http://www.nia.nih.gov/ResearchInformation/ConferencesAndMeetings/NIAPanel.htm.
[8] DeJardins B. Validation of Extreme Longevity Cases in the Past: The French-Canadian Experience: Odense University Press, 1999.
[9] Evert J, Lawler E, Bogan H, Perls T. Morbidity profiles of centenarians: survivors, delayers, and escapers. J Gerontol A Biol Sci Med Sci. 2003;58: 232-237.
[10] Hitt R, Young-Xu Y, Silver M, Perls T. Centenarians: the older you get, the healthier you have been. Lancet. 1999;354: 652.
[11] Franceschi C, Motta L, Valensin S, Rapisarda R, Franzone A, Berardelli M, Motta M, Monti D, Bonafe M, Ferrucci L, Deiana L, Pes GM, Carru C, Desole MS, Barbi C, Sartoni G, Gemelli C, Lescai F, Olivieri F, Marchegiani F, Cardelli M, Cavallone L, Gueresi P, Cossarizza A, Troiano L, Pini G, Sansoni P, Passeri G, Lisa R, Spazzafumo L, Amadio L, Giunta S, Stecconi R, Morresi R, Viticchi C, Mattace R, De Benedictis G, Baggio G. . Do men and women follow different trajectories to reach extreme longevity? Italian Multicenter Study on Centenarians (IMUSCE). . Aging (Milano). 2000;12: 77-84.
[12] Schoenhofen EA, Wyszynski DF, Andersen S, Pennington J, Young R, Terry DF, Perls TT. Characteristics of 32 supercentenarians. J Am Geriatr Soc. 2006;54: 1237-1240.
[13] Mahoney FL, Barthel DA. Functional evaluation: The Barthel Index. Maryland State Med J. 1965;14: 56-61.
