We all likely would like to live a long period of time, but how? Although it is commonly held that survival to age 100 years entails delaying or escaping age-related morbidities, nearly one-third of centenarians have age-related morbidities for 15 or more years. Many of these centenarians appear to compress disability toward the end of their lives. Terry and coworkers hypothesized that for some centenarians, compression of disability rather than morbidity is a key feature for survival to old age. Their cross-sectional, nationwide study included 523 women and 216 men 97 years or older. The participants were stratified by sex and age at onset (age <85 years [termed survivors] and age >or=85 years [termed delayers]) of chronic obstructive pulmonary disease, dementia, diabetes, heart disease, hypertension, osteoporosis, Parkinson disease, and stroke. Dependent variables were the Barthel Activities of Daily Living Index (Barthel Index) and the Information-Memory-Concentration test of the Blessed Dementia Scale. Thirty-two percent of the participants were survivors. For men with hypertension and/or heart disease for 15 or more years, the median Barthel Index score was 90 (independence range, 80-100). For female survivors with hypertension, heart disease, and/or osteoporosis, the median Barthel Index score was 65 (minimal assistance range, 60-79). Generally, men had better function than women: 60% of male survivors had Barthel Index scores of 90 or higher compared with 18% of female survivors, and 50% of male delayers had Barthel Index scores of 90 or higher compared with 27% of females delayers. Five behaviors in elderly men were associated not only with living into extreme old age, but also with good health and independent functioning. The behaviors are abstaining from smoking, weight management, blood pressure control, regular exercise, and avoiding diabetes. All the behaviors are significantly correlated with healthy survival after 90 years.

WHAT THE STUDY MAY MEAN TO YOU: The authors concluded that whereas the compression of both morbidity and disability are essential features of survival to old age for some centenarians, for others the compression of disability alone may be the key prerequisite. Though far fewer in number, male centenarians tend to have significantly better cognition and physical function than their female counterparts. Equally significant are the findings those five behaviors in old age--all of which depend upon the self-directed performance of the individuals-- so strongly predict survival into extreme old age.

DF Terry et al. Disentangling the roles of disability and morbidity in survival to exceptional old age. Archives of Internal Medicine, 2008;168:277-283.