Near-Centenarian Roberta McCain in Perfect Health

http://www.style.com/vogue/feature/080108/page2.html

It is a gorgeous spring day in Washington, and I am sitting in a suite at the Hay-Adams Hotel chatting with Roberta McCain while she is having her nails done for Vogue's photo shoot. So far she's been amenable to—and completely delighted with—everything we've suggested: the nails, a change of clothes, a light hair-and-makeup session. "If I leave here and my glass slippers fall off, I won't know what to do," she says, laughing. Next up is a pose in stocking feet on a narrow five-story balcony, which is making everyone but her slightly nervous. "Just call me Barkis," she says, referring to the character in David Copperfield. "I'm willing."

At 96, Roberta (as she insists everyone call her) is not just willing but almost startlingly able and a good example of the resilient genes that her son has been eager to showcase by taking her out on the campaign trail. The daughter of a successful wildcatter, the widow of a highly decorated naval admiral, and now the mother of the Republican nominee for the presidency, she spent her married life in posts ranging from London to Honolulu and has traveled—relentlessly—to pretty much every point in between. At 88, when she was told she was too old to rent a car in Europe, she simply bought one and drove it from Munich to Kazakhstan and Uzbekistan with her twin sister and most constant traveling companion, Rowena. ("I wanted to see Samarkand," she explains, and with that accomplished she continued on to Greece, India, and New Zealand, leaving the car behind in Europe for future jaunts.) Last Christmas she had lunch in Paris at Maxim's and spent New Year's Eve at the Lido before taking off for England and Scotland. A woman of no light convictions, she was rumored, during her son's 2000 presidential bid, to have flown the Taiwanese flag out the window of her apartment in Washington near the Chinese Embassy on the anniversary of the Communist Party's victory in the Chinese Civil War. While her son said, "I would truly not be surprised," his mother wasn't giving anything away. "I'm not saying whether I did or I didn't," she told a reporter. "The less said, the sooner mended. Have you heard that one?"

Despite such uncharacteristic hedging, The Washington Post, in a play on the bus that has become her son's campaign signature, dubbed her "The Even Straighter Talk Express," and it is an apt description. Thoroughly engaging, she is the proverbial open book, albeit a rollicking one that is equal parts history, travelogue, and Who's Who of the twentieth century. In the time it takes for two coats of pale-pink nail polish to dry, the conversation loops from: mutual friends we have in Mississippi (her father grew up there, and the McCain family roots in the state also go deep); the Mae West/W. C. Fields film My Little Chickadee ("the funniest movie I ever saw"); the fate of the shah of Iran ("The way we treated that man was disgraceful.… His problem was he never let anyone beneath him have enough power"); her friendship with J. Paul Getty ("I just loved him—he could tell you about everything"), and the party she has just attended at the Turkish embassy ("It was so glamorous you can't believe it"). She begins almost every sentence with "honey," and when the shoot is over, she tucks, with gusto, into a plate of cold lobster mayonnaise. At her departure, she assures us all that "this was the most fun I've ever had."

She may well have meant it—"I'm happiest wherever I am right this minute," she has told me—but there is no question that she has had a lot more fun than this.

Roberta Wright McCain was born on February 7, 1912, to Myrtle and Archie Wright, who had accumulated lots of land in Oklahoma and Texas just before the oil boom, and subsequently moved the family to Los Angeles. The two youngest of five children, she and Rowena were "always real athletic," she says. "We could run faster and jump higher, and at church suppers or what-have-you, we were always going to win the race. There was no conceit about it or anything; everybody just knew the twins could do it." Her father instilled the travel bug in his children early on, driving them through the Mojave Desert and taking them on trips to see the source of the Mississippi and to learn about the Great Lakes. With their mother the twins went by train to New York. "She always got her linen on sale at B. Altman's in January and June, and she bought our clothes at Best's."

When Roberta eloped at nineteen with Jack McCain, a young Navy ensign ("the lowest of the low," she says of his rank), she took her schoolbooks with her to Tijuana, where they married in a room above Caesar's bar. The event earned the groom a reprimand for going AWOL and merited a headline in the San Francisco Examiner: SOCIETY COED ELOPES WITH NAVAL OFFICER: ROBERTA WRIGHT DEFIES FAMILY. Rowena describes their mother as having a "cat fit" over the nuptials, and looking back, Roberta says she can understand why she "was out of sorts" with her daughter pretty much all the time. "I realize now I was so immature. I just took life as it came—still do."

The latter turned out to be good strategy for a naval wife who occasionally camped out in Quonset huts and moved her three children, Sandy, John III, and Joe, from port to port while her husband was away for long stretches. She insists she loved every place she settled, except maybe Panama, "but that was because it was so hot and there wasn't any air-conditioning." In his memoir, Faith of My Fathers, McCain writes that his mother was obliged to fill the roles of both parents, and that he "became my mother's son," adding that what he lacked of Roberta's "charm and grace," he made up for by "emulating and exaggerating her other characteristics. She was loquacious, and I was boisterous. Her exuberance became rowdiness in me.… She has an irrepressible spirit that yields to no adversity." A touching tribute to be sure, but Roberta will have none of it. "Obviously," she told a reporter when the book was released, "that means all the trouble he got into came from me."

As her husband ascended the ranks, life became a tad more glamorous. Madame Chiang Kai-shek (whom she describes as "misunderstood") gave her presents, and in Hawaii she became close friends with Clare Boothe Luce. While in London she would frequently spend country weekends at the estates of both Getty and Lord Mountbatten. "My eyes were just rolling around in my head like marbles, I was so impressed with the people we were meeting all the time," she tells me. "But they were famous because they'd amounted to something."

It was in London that she learned that "Johnny," as she invariably calls her son, had been shot down in Vietnam. First she waited days to find out if he was alive, and then she waited five and a half years for him to be released. When I ask if she was a nervous wreck through it all, she says, simply, "No. I believe in God's will, I really do. When I pray, I only ever ask for that; I don't ask for things like 'Please help Johnny get into Princeton.' " Besides, she says, "I had talked all that patriotic talk, so in times of fish or cut bait, do I stand up to the claims I've made or not?"

Not only was her husband a decorated admiral, her father-in-law was as well. "I would have been ashamed if my son had not served his country. The ones I feel sorry for are these seventeen- and eighteen-year-olds out there now who lose a leg. But Johnny chose his profession; he was doing his job," she says, adding that I could go down in a plane crash doing mine. "This is life."

"When Johnny was in prison, that woman never made a peep," says Rowena of her twin. "Same thing after Jack died." Still, while Roberta may have been stoic, she never lost her sense of delight in the world. "We were invited everywhere, and I always wanted to go along," Roberta says. When her husband died in 1981, on a flight from Europe to Washington, where they had finally settled, she kept going, traveling with Rowena from the Jordanian desert to Tasmania for two or three months each year. Two years ago, when she could no longer get insurance on the car she had left in Europe, a Mercedes "baby Benz," she had it shipped back to the States and drove it across the country to her nephew in San Francisco—by way of Mississippi, Arkansas ("I couldn't find the Ozarks, or at least I didn't see all the beauty I'd read about"), Louisiana, and Arizona, where she was given a ticket for going 112 miles an hour. "The policeman said, 'Didn't you see me?' and I said, 'Yeah, I saw you,' " she tells me, laughing. "I went straight to the next town and got the money to send to the police. I thought the quicker it was over, the better, so nobody would find out."

"She knows everything that's in every museum in this world," says Rowena. Indeed, when she's not on the road, she avails herself of the offerings of her home city, going to the National Gallery or the Freer (she has a whole room full of the Chinese porcelain she loves, and the Freer has a stunning collection) every Tuesday morning for three hours (as long as she can legally park her car, a red BMW). On occasion, she says, she "hoists herself up to New York," taking the train (with a stop in Philadelphia to visit the Museum of Art there "until my feet fall off") and checking into the New York Yacht Club "because it's cheap." An avid reader, she is currently engrossed in The Odyssey of Chinese Imperial Art Treasures ("It's like a paper chase—it ought to be a movie") and, of course, the newspapers. "I think the treatment they've given Hillary is just awful. She's a human being, and she's certainly worked hard. I mean, anything you say, you can take two ways, even if it's about the weather."


She credits her longevity to good genes (her father remained active until he died of cancer at 98) as well as her California upbringing. Rowena concurs. "We played outside all the time and only ate fresh vegetables and fruits—crates of oranges from California and apples shipped in from Maryland. Our parents had some sense. They never let us drink Coca-Cola or coffee or anything like that, and the only cakes we ever saw were at other children's birthday parties." Both sisters rarely touch alcohol, though Rowena professes to love the occasional glass of champagne and reports seeing Roberta drink beer, but only in Europe.

"I don't do anything I'm supposed to do," Roberta tells me on the phone when I ask her how she manages to maintain her almost astonishing vitality. "I don't exercise, and today I've already eaten half a box of caramel popcorn." The regimen, or lack thereof, seems to be working. Her posture is straight as an arrow, her gait is brisk, and, though a doctor told her once she had arthritis in her hands, she says, "I guess I do, but I've never had an ounce of pain from it.

"Honey, I've had a dream life, and it was all luck," she says. I venture that the impetuosity and appetite her mother so often bemoaned might have had at least a bit to do with it. "I'm glad my mother's not around, because I still don't plan ahead or think things out." She laughs. "Mother told me once, 'If the gardener asked you to go to Chinatown with him, you'd go.' And I thought, Well, of course I would."

"The Firecracker" has been edited for Style.com; the complete story appears in the August 2008 issue of Vogue.

Quality of Life in Italian Centenarians

These aren't true antecedents of longevity, but offer insight into perhaps which aspects of quality of life issues are most highly prevalent in centenarians vs. younger controls. That's about as good a correlation as other observational studies anyhow.


http://ageing.oxfordjournals.org/cgi/reprint/27/2/207.pdf


Age and Ageing 1998; 27: 207-216

Quality of life and longevity: a study of centenarians

MARIROSA DELLO BUONO, ORNELLA URCIUOU, DIEGO DE LEO
Psychogeriatric Service, University of Padua, Via Vendramini 7, 35137 Padua, and Fatebenefratelli Hospital, Brescia, Italy
Address correspondence to M. Dello Buono. Fax: (+39) 49 8216264

Abstract

Objective:

interest in centenarians has focused on two particular aspects: the antecedents of extreme old age and the psychophysical well-being of the very old. Our study deals with the latter aspect and aims to assess the quality of life of Italian centenarians.

Method:

using data collected using two questionnaires designed to investigate quality of life in elderly people, three groups of 38 elderly subjects were compared: centenarians and subjects aged between 75 and 85 years and 86 and 99 years.

Results:

the centenarians complained less spontaneously about their health (maintained in part by medical treatments), but declared having greater functional disability. Their cognitive function appears to be reasonably well preserved and they have lower scores for anxiety and depression than the subjects in the two younger groups. They consider themselves religious, satisfied with their financial situation but no longer interested in sex or involved in recreational activities. They report greater satisfaction with life and with social and family relations than do less elderly individuals.

Conclusions: the centenarians we interviewed seem to be well adapted to their lives and to maintain a more positive attitude than the subjects in the two younger groups.

Keywords: adaptation, centenarians, quality of life, religion, sex

Introduction

The number of Italian centenarians increased from 49 in 1921 to 1660 in 1990 [1]. Census data for 1993 are currently being processed but according to preliminary
data some 6000 centenarians were alive in Italy on 31 December 1993 [2]. Recently, several centres have joined the Italian Multicentre Study on Centenarians,
which aims to assess the clinical and biological condition of centenarians. Preliminary results have highlighted a number of characteristics peculiar to
centenarians: they often have a family history of longevity, live in comfortable, family environments, have been hard workers and possess well-preserved
psychological and cognitive abilities. They are free from certain risk factors (such as hypertension, hypercholesterolaemia and symptomatic hyperglycaemia)
and have always followed a balanced diet, based on natural foods. Their immune systems continue to function well and natural killer cells are particularly
active [2, 3]-

International research into centenarians includes work on demographic and dietary characteristics, in addition to examining genetic/biological, neurological
and neuropathological aspects of this age group and their life style and methods of coping [4-13]. Most research is therefore on the antecedents of extremely
long life [14] and psychophysical well-being in old age[15]. The aim of our study was to investigate the quality of life in centenarians in the Veneto region of Italy, based on the concept that long life should be examined not only quantitatively, but also in qualitative terms. At present we have access only to records from the town
of Padua and some other places coming under local health unit ULSS 13 (S. Maria di Sala, Noale, Spinea, Scorze, Martellago, Mirano) but our research will
become more widespread as we receive data from other local health units.

Materials and methods

The study was conducted between October 1992 and July 1995. Personal records were supplied by the data processing centre of the municipalities of Padua and Pordenone together with other record offices coming under local health unit ULSS 13. With the lists provided, 207 M. Dello Buono et al. we were able to gain access to the names of 57 people aged 100 years or more, 42 of •whom were resident in Padua, six in Pordenone and the remaining nine in the other municipalities of the health unit. Of the 42 residents in Padua who were able to participate in the study, the selected test package on the quality of life was only administered to 27 subjects: two refused to take part, two were too physically disabled, two had transferred to another municipality, one was not to be found at the indicated address and the remaining
subjects (seven women and one man) had died by the time of recruitment. Four of the six subjects from Pordenone were tested. Of the other two, one refused to take part while the other was too physically unfit to undertake the test. Only seven of the remaining nine residents from the other six municipalities were interviewed, as one was in poor physical health and the other could not be contacted. The total
number of subjects tested was therefore 38, including the 11 interviewed subjects who were not resident in Padua.

The questionnaires used were the Profile of Elderly Quality of life (PEQOL), which has been used in other studies [16, 17] and the LEIPAD quality of life
assessment instrument developed to measure self-perceived functioning and well-being in elderly people [18]. (The three universities principally involved in the World Health Organisation European study that developed the LEIPAD instrument were
Leiden, Padua and Helsinki: the instrument's name is a combination of 'Leiden' and 'Padua'.)

The PEQOL questionnaire, which takes the form of a test battery, explores various dimensions of quality of life—physical health, cognitive capacities, psychological
symptoms, basic and instrumental activities of daily living (ADL and IADL), sleeping patterns, social support, religiousness and sexual relations—which form a 'profile' of the quality of life in elderly subjects(see Appendix 1). This questionnaire had previously been administered by means of door-to-door interviews to 462 subjects aged 75 years and older, chosen at random from the electoral rolls (1:10) of Padua and
Brescia [16]. The instrument can be administered by non-specialized personnel after a brief training period and is relatively quick to administer (taking roughly 30
min). The instrument has good psychometric properties, being partly based on scales which have been thoroughly validated.

The LEIPAD questionnaire provides additional self-reported information. Created with a view to studying quality of life in elderly patients in primary health care,
it examines subjective views of physical and mental health, sexual relations, emotional status, level of self-esteem, expectations for the future, ADL, social and
recreational activities and financial situation. It also considers the cognitive status of the subject being tested in order to assess the reliability of the self-evaluation.

The instrument consists of 49 items, 31 of which can be grouped into seven 'core instrument scales'. Other items measure self-perceived personality disorders and social desirability, self-esteem, anger and faith in God. These 18 items can be grouped into a further five scales, referred to as 'moderator scales' (see
Appendix 2). Each item in the instrument assesses responses along a scale of 0 (best condition) to 3(worst condition). Some items of the 'moderator scales' have dichotomic answers so their score is 0 or 1. This paper reports the scores achieved on the core instrument scales and religiousness scale, since the other scales do not contain items comparable with PEQOL ones. The 38 centenarians tested to date were interviewed in their own homes or institution. From the group of elderly people tested in previous studies in Padua, 76 subjects were chosen by random stratification (one in every five, from an alphabetical list), 38 aged between 75 and 85 and 38 between 86 and 99- These constituted the control groups with which we compared our sample of centenarians. The sociodemographic characteristics of the centenarians and
the other two groups included in our study are reported in Table 1. The three groups were comparable with regard to gender and educational level. Of the 38 centenarians, 24 (19 women and five men) lived at home; the remaining 14 lived in institutions (13
women and one man).

The statistical procedures used were Student's West, X2 analysis, ANOVA and ANCOVA variance and Table I. Socio-demographic characteristics of the subjects

No. of subjects
Men
Women
Mean age (years)
Schooling (years)
Age group (years)
75-85 86-99
38
6 (15.79%)
32 (84.21%)
79.24 ± 2.53
5.15 ± 2.30
38
6 (15.79%)
32 (84.21%)
88.44 ± 3.51
4.21 ± 3.07
>100
38
6 (15.79%)
32 (84.21%)
101.13 ± 1.52
4.81 ± 368
All
114
18 (15.79%)
93 (84.21%)
8978 ± 929
4.72 ± 3.07

Differences in mean years of schooling between the three groups: F = 0.92, P = not significant.

208

Quality of life and longevity covariance analysis. The results were processed by
means of SYSTAT statistical software [19].

Results

The package took longer to administer to the centenarians (the mean time taken was 44.0 ± 36.77 min, range 18-70, as opposed to 30± 21.21 min, range 15-30 in younger subjects) and was in no case self-administered, as the subjects frequently
had poor eyesight or their writing skills were not sufficient to allow them to fill in their answers.

Whenever it seemed advisable, relatives were asked to help by explaining the questions and generally creating a more relaxed atmosphere during testing.
Description of the results has been divided into two main sections: the first assesses the data relating to self-sufficiency and the second to psychological well-being and cognitive performance.

Self-sufficiency

Table 2 presents the results obtained after administration of the IADL [20] and ADL [21] scales and those obtained from the PEQOL scale for physical status,
comprising \6ad hoc items to investigate the presence
of pain, discomfort, functional disability (see Appendix
1). Table 3 shows the results from the LELPAD physical
health scale.

Since the subjects aged between 75 and 85 years had
on average 1 year's schooling more than the other two
age groups, we decided to verify whether omitting this
variable would modify the results. By using ANCOVA
covariance analysis we excluded the possibility of such
an effect for the variables considered. Variables which
were not significantly different were also controlled for
schooling; none of the results were significantly
different.

The centenarians reported a mean number of lost
functions on the IADL scale exceeding the numbers
reported by both the 86 - 99-year-old group and the 7 5 -
85-year-old group. Comparison of adjusted values after
ANCOVA did not modify these results. A similar result
was obtained with the ADL scales, even after ANCOVA
for schooling. (Table 2).

On the IADL scales, 50% of the centenarians
interviewed (n = 19) reported eight lost functions,
thus indicating that these subjects depend on others
for basic daily living requisites such as shopping,
money matters, use of medicines and the telephone.
According to the results from the ADL scales on ability
to wash, dress and move about unaided and incontinence,
only 18% (n = 7) were completely dependent.
The centenarians and those in the 86-99-year-old
group spontaneously complained of an average of only
one painful symptom compared with an average of
almost two such symptoms in the youngest group.
After allowing for educational level, the results do not
change (Table 2). The three groups did not, however,
differ significantly in evoked painful symptoms. This
applied even after ANCOVA for schooling (Table 2). On
the question on disability, the centenarians and elderly
people from the intermediate age group had significantly
higher scores than the younger subjects.

The centenarians' mean for spontaneously reported
lost function was not significantly different from those
reported by the subjects from the other two groups;
after ANCOVA the result was similar (Table 2). The
intermediate age group reported a greater mean
number of lost functions evoked by the interviewer
compared with the number reported by the centenarians
and youngest age group; after ANCOVA for
schooling the result did not change (Table 2).

Table 2. Mean points on the Profile of Elderly Quality of life scales scored by the three groups

Scale
IADLa
ADLb
Pain/discomfort lc
Pain/discomfort 2
Function 1
Function 2d
Weakness"
Age group (years)
75-85
0.63 ± 102
5.57 ± 1.150
1.84 ± 1.620
1.50 ± 1.60
1.31 ± 1.47
1.63 ± 1.63
4.81 ± 5.36
86-99
4.10 ± 2.50
7.47 ± 1.78
0.92 ± 1.23
1.47 ± 1.68
1.23 ± 1.26
2.44 ± 1.46
8.97 ± 5.67
>100
6.86 ± 1.51
13.23 ± 3.29
1.13 ± 1.52
1.86 ± 1.85
0.78 ± 1.06
2.36 ± 1.90
10.26 ± 6.43
F
116.12
118.21
3.83
0.98
1.87
2.72
9.02
P
<0.000
<0.000
<0.02
NS
NS
<0.06
<0.000

IADL, instrumental activities of daily living; ADL, activities of daily living; NS, not significant.

"After ANCOVA for schooling: F = 87.33, P < 0.000.
"After ANCOVA for schooling: F= 145.88, P < 0.000.
cAfter ANCOVA for schooling: F= 302, P < 0.05.
"After ANCOVA for schooling: F = 2.70, P < 0.06.
cAfter ANCOVA for schooling: F = 914, P < 0.000.
209
M. Dello Buono et al.

Table 3. Mean points on the LEIPAD scales in the three groups

Scale
Physical function*
Self careb
Cognitive function0
Depression and anxiety
Social function
Sexual functiond
Recreational activities iteme
Economic satisfaction itemf
Life satisfaction8
Faith in Godh
Age group (years)
75-85
6.47 ± 319
2.27 ± 3-71
4.19 ± 2.44
2.19 ± 3.48
4.10 ± 1.76
4.91 ± 1.60
1.32 ± 0.85
1.02 ± 0.63
7.73 ± 3.89
1.43 ± 0.64
86-99
7.05 ± 2.44
7.65 ± 3.87
4.23 ± 2.64
2.18 ± 2.19
368 ± 2.11
5.89 ± 0.64
1.21 ± 0.77
1.49 ± 0.86
5.68 ± 3.05
1.68 ± 0.52
>100
7.27 ± 2.11
14.13 ± 3.75
5.48 ± 2.86
2.34 ± 2.58
3.42 ± 1.61
6.00 ± 0.00
1.91 ± 0.81
0.90 ± 0.52
4.97 ± 2.44
1.75 ± 0.52
F
0.92
89.96
1.90
1.61
1.82
12.37
3.83
5.27
7.20
3.09
P
NS
<0.00
<0.05
NS
NS
<0.00
<0.03
<0.000
<0.000
<0.05
NS, not significant

'After ANCOVA for schooling: F=
"After ANCOVA for schooling: FcAfter
ANCOVA for schooling: F=
"After ANCOVA for schooling: F-
"After ANCOVA for schooling: FfAfter
ANCOVA for schooling: F=
gAfter ANCOVA for schooling: F=

• 88.92, P< 0.000.
= 1.98, P< 0.05.
= 11.37,/>< 0.000.
= 3.90, P< 0.03.
• 4.20, P< 0.02.
5.94, P < 0.000.
= 312, P< 0.05.

The most impaired functions were hearing, eyesight
and walking (especially in institutionalized subjects).
Incontinence was also a common problem, as were
cardiovascular disorders and decreased memory and
cognitive performance. All subjects took at least one
drug and some took as many as 15 different types.
As regards the LEIPAD questionnaire, comparative
analysis of this aspect of the study—which also
confirmed the findings of the PEQOL—can be
performed for the scores obtained by the three
groups for the physical functions and self-care scales.
In the former scale, the scores tend not to differ
significantly, whereas in the latter scale the three
groups differ significantly, with greater impairment
being reported especially by the centenarians (Table 3).

Psychological well-being and cognitive performance

Table 4 presents the scores obtained on the Brief
Symptom Inventory [22] and on the Mini Mental State
Examination (MMSE) [23].

There were no differences between the three groups
in any of the Brief Symptom Inventory subscales for
depression and anxiety of the PEQOL (Table 4) and the
LEIPAD depression and anxiety scales (Table 3).
Comparison of the mean scores obtained in the
MMSE [23] showed that they differed significantly from
group to group, even after covariance for educational
level, with a trend inversely proportional to increasing
age (Table 4).

The LEIPAD cognitive function scale is relatively
coherent with the mean MMSE scores, which are
inversely proportional to increase in age. The three
groups differ and the centenarians appear to be aware
of greater limitations in their function (Table 4).
However, the administration of the MMSE revealed
that some items inappropriately influence the final
overall score, since physical impairment (sight deficits
or arthritis preventing the subject from using a pen)
makes it practically impossible for subjects to complete
the final part of the questionnaire, requiring subjects to
do a reading test, complete an order, write a sentence
and copy a drawing. Consequently, the maximum
score subjects can achieve, even if they are lucid and
oriented but suffer from physical impairment, is 22/30.
On the basis of this rationale, we have admitted to our
study centenarians with a score of between 8 and 27
out of 30, where they are able to answer questions put
to them, with a relation present to confirm the validity
of the answers.

The total score for the items relating to PEQOL sleep
patterns showed that greater problems were experienced
in the intermediate group, who reported more
sleep disorders than those aged 75-85 years and those
aged 100 years or older (Table 4). The same finding
cannot be compared with LEIPAD, as the scales in this
questionnaire do not include specific questions on this
aspect.

The three groups appeared to differ significantly in
Surtees' [24] social support scale included in the
PEQOL, reporting scores between 4 and 7, the lowest
of which (indicating that the subject perceived better
social support) was in centenarians and the 86-99-
year-old group (Table 4). On the LEIPAD social
functions scale, the oldest subjects reported greatest
210

Quality of life and longevity

Table 4. Mean points on the Profile of Elderly Quality of life scales in the three groups
Scale
MMSE*
BSI
Depression
Anxiety
Sleep patterns'5
Social support0
Recreational activities'1
Interest in sexc
Economic statusf
Religiousness8
Age group (years)
75-85
26.07 ± 2.63
0.54 ± 0.44
0.51 ± 0.42
6.31 ± 6.01
7.50 ± 3.63
1.92 ± 1.21
1.81 ± 0.76
6.76 ± 3.21
2.73 ± 1.67
86-99
21.97 ± 2.38
0.75 ± 0.55
0.74 ± 0.64
8.07 ± 5.84
4.68 ± 3.10
0.60 ± 1.79
0.84 ± 1.06
10.42 ± 2.15
3-68 ± 1.64
S100
13-32 ± 6.66
0.64 ± 0.79
0.57 ± 0.78
4.84 ± 4.85
4.89 ± 2.59
0.13 ± 0.34
0.00 ± 0.00
7.94 ± 3.95
5.21 ± 3.04
F
84.86
1.12
1.30
4.01
9.49
20.35
13.52
1308
12.03
P
<0.000
NS
NS
<0.000
<0.000
<0.000
<0.000
<0.000
<0.000
MMSE, Mini Mental State Examination; BSI, Brief Symptom Inventory; NS, not significant.
'After ANCOVA for schooling: F = 79.91, P < 0.000.
bAfter ANCOVA for schooling: F= 4.00, P < 0.000.
cAfter ANCOVA for schooling: F= 929, P < 0.000.
"After ANCOVA for schooling: F= 20.40, P < 0.000.
cAfter ANCOVA for schooling: F= 14.89, P < 0.000.
'After ANCOVA for schooling. F= 13.97, P < 0.000.
"After ANCOVA for schooling: F = 11.09, P < 0.000.
satisfaction with their social relations and friendships,
although the difference in score was not statistically
significant (Table 3)-

Recreational activities were not maintained by the
centenarians, with the exception of four cases. Hence
they differ significantly from the components of the
younger age groups, who reported continuing such
activities, albeit to a diminished extent, even after
ANCOVA for schooling (Table 4). The LEIPAD life
satisfaction scale includes a question on hobbies and
recreational activities. Similar findings emerged for
this item to the PEQOL one on recreational activities
(Table 3). Moreover, on the LEIPAD life satisfaction
scale an interesting difference emerges between the
three age groups: the mean scores are inversely
proportional to increase in age, suggesting that
subjects who report less satisfaction belong to the
youngest age group (75-85 years of age). The
difference appears to be statistically significant, and
even after ANCOVA for educational level the results
remained unchanged (Table 3).
Scores on the scale of economic status differed
significantly from group to group: the subjects in all the
age groups reported scores indicating overall satisfaction
with their financial circumstances, but older
subjects and centenarians generally indicated being
more satisfied than the younger age groups. ANCOVA
for educational level did not modify these findings
(Table 4). The same result was found for the item in
LEIPAD on satisfaction with financial circumstances,
even after ANCOVA for schooling (Table 3).
We investigated the subjects' interest in sex. The
mean scores obtained by the three groups differed
significantly (Table 4): while the subjects in the two
lower age groups reported some interest, albeit
diminished in the case of those aged 86-99 years,
every centenarian affirmed that they had lost all
interest in sex. ANCOVA for educational level did not
modify these findings, showing that this variable had
no influence on the result (Table 4). The same result
was found in relation to the LEIPAD sexual functioning
scale, even after ANCOVA for schooling (Table 3).
Compared with the other two groups, the centenarians
reported finding greater comfort from their faith
and that their interest in religion had increased over the
previous year. The result was confirmed even after
removal of the age and schooling variables by ANCOVA
(Table 4). Similar result for the religious faith of the
centenarians was found on the LEIPAD religiousness
scale, even after ANCOVA (Table 3).

Discussion

People who live to 100 or older represent a select
group, considering that only one person in 7000-
10000 reaches this age [25]. The limited sample of our
study does not permit generalized conclusions,
although we incorporated the entire population of
the town of Padua, the municipality of Pordenone and
six other municipalities in the Veneto region.
Our data confirm Lehr's finding that there is great
variability among extremely old individuals [15], with
varying levels of functional activity, cognitive activity
211 M. Dello Buono et al.
and memory. On MMSE scores, the degree of impairment
in centenarians compared with the lower age
groups confirms data on the increased prevalence of
dementia with advancing age [26, 27]. The centenarians
in our study were able to answer the questions
put to them but had difficulties in performing the
MMSE items requiring ability to read or write.
Consequently, these items have been omitted from
the most recent brief version of the questionnaire.
Furthermore, centenarians' answers were compared
with the opinion of a relative or the principal caregiver,
who was also present during the test, both to help the
interviewee feel more secure and reassured and to
confirm the responses given or report otherwise.
Individuals who reach great age depend almost
entirely upon other people. Only one person we
interviewed was still able to live alone and was selfsufficient
in most ADL. The mean number of functions(ADL and IADL) lost by these subjects is higher than the number lost by the less elderly; moreover, the scores of
the latter indicate a trend which is directly proportional
to increase in age. Despite reporting poorer
functional ability, the centenarians complained less of
pain and discomfort than their younger, functionally
less impaired counterparts. This suggests greater
adaptation to the inevitable loss of functioning which
gradually impedes agility with advancing age. Such
adaptability might be an inborn characteristic of those
who succeed in living very long lives, insofar as they
progressively adjust their lifestyles and accept their
condition as the physiological norm. Furthermore,
these very old people tend to complain less about
their living conditions. On the LEIPAD life satisfaction
scale, they score higher than the less elderly groups.
This supports the hypothesis of the role played by
progressive adjustment and positive attitude to life
[2, 28].
It transpires that the most well-preserved people are
those who remain intellectually stimulated, those who
still maintain satisfactory social relationships and, in
particular, can count on the help of the family or other
caregivers, and those who have spent years working in
crafts requiring creative skills or who have kept their
interests alive. These findings corroborate the results of
other Italian studies [2] and international research
work [29-31].
Most subjects reported poor eyesight and hearing,
which may be one of the reasons why only a few of
them still keep up recreational activities. Some
centenarians complain of motor deficits and urinary
incontinence. Despite this, few subjects presented
symptoms of depression (three subjects) or anxiety
(four subjects) on the Brief Symptom Inventory scale,
in addition to reporting fewer sleep problems than
their younger counterparts.
Very old people attach importance to religious faith
[32]: the centenarians interviewed found greater
solace in faith than the less elderly groups.
Generally speaking, despite their precarious equilibrium,
the old people tested by us had adapted to their
circumstances. They were often aided by their families
or by people in the institutions where they lived.
Predictors of long life include: continuing to play a
role in society, keeping in good physical shape, taking
preventive measures against serious disease, looking
on the bright side of life, being intellectually stimulated,
believing that happiness can be achieved, having
financial security, having a good life expectation and
maintaining satisfactory social relationships [33, 34].
Increasing our sample size might allow us to verify
possible adaptive mechanisms highlighted by this
study. Longitudinal studies will permit assessment of
the adaptations made by extremely old people which
might be useful in revealing the secrets of long life.

Key points

• When 38 centenarians were compared with groups
of subjects aged 75-85 and 86-99 years using two
questionnaires for assessing quality of life in elderly
people, the centenarians were less inclined to
complain about their physical condition and,
despite greater functional disability, were no more
subject to depression or anxiety than the younger
groups.

• The centenarians have well-preserved cognitive
function and a good level of social support, find
solace in religious faith and are satisfied with their
financial situation. They are no longer interested in
sex (in contrast to those aged 86-99 years) and
rarely practice recreational activities, but report
greater satisfaction with life than less elderly
subjects.

• Those who reach 100 years of age adapt to
circumstances and have a positive attitude to life
and good social and family relations.

References

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Received 19 February 1997

Appendix I. Profile of the Elderly Quality of Life
1. Physical symptom scale
System/function Pain/discomfort Functioning11 Impairment15
Hands, arms, shoulders
Feet, legs, hips
Back, neck
Head, face (including persistent headache)
Lungs, respiration
Heart, vessels
Mouth, mastication
Stomach, intestine, digestion
213
M. Dello Buono et al.
Metabolic disorders
Kidneys, urinary tract
Eyes, eyesight
Ears, hearing
Speech disorders
Mental functions
Sexual functions
Other

"Score = 1 for each item for which pain, discomfort or functional difficulty was spontaneously referred or evoked/observed by the interviewer
(range: 0-16).

""Scoring: 1, not at all; 1, a little; 2, somewhat; 3, quite a lot; 4, much.

2. Cognitive symptoms: Mini Mental State Examination (Folstein et al., 1975)
3. Psychological symptoms: Brief Symptom Inventory (Derogatis and Melisaratos, 1983)
4. Instrumental activities of daily living: Index of Instrumental Activities of Daily Living (Lawton and Brody, 1969)
5. Activities of daily living: Index of Activities of Daily Living (Katz, 1970)
6. Sleep disorders
How many days have you had difficulty in sleeping during the last month?
How many days during the last month have you woken up during the night at least twice?
How many days during the last month have you woken up too early and had difficulty going back to sleep?
How many days during the last month have you woken up still tired, even though you had slept as usual?
How many times a week do you have difficulty keeping awake and need to take a nap?
Score: 0, never; 1, 1-3; 2, 4-7; 3, 8-14; 4, 15-21; 5, 22-31.
7. Social support: Social Support Index (Surtees, 1980)
8. Religiousness
Is religious faith a comfort to you in your everyday life?
Has your interest in religion increased over the last year?
Scoring; 0, not at all; 1, at little; 2, somewhat; 3, quite a lot, 4, much.
9. Recreational activities
Over the last year how have your recreational activities been? How does this compare with before?
Include activities from simply playing cards to more complex ways of organizing leisure time. Exclude watching television

Absent
Present
Scoring: 0, decreased compared with before; 1, the same as before; 2, increased compared with before.
10. Economic status
Do you feel that you have sufficient food and clothing for your own personal use?
Are your living conditions adequate, even in the winter?
Do you feel you could cope with an emergency situation with your present financial resources?
Scoring: 0, not at all; 1, at little; 2, somewhat; 3, quite a lot; 4, much.
11. Sexuality

Over the last year (or since the last assessment) what has your interest in sex been? How does this compare with before?
Absent
Present
Scoring: 0, decreased compared with before; 1, the same as before; 2, increased compared with before.
214

Quality of life and longevity

Appendix 2. LEI PAD
The instrument should be administered following the order of the figures indicated for each item
Core instrument (31 items)
Physical functioning scale (theoretical score: 0-15)
1. How would you rate your overall physical health?
6. Do you have sleep problems?
7. Do you get tired, without energy?
9- Are you able to accomplish your usual tasks, either at home, at work or elsewhere?
12. How much do your physical health problems (if any) stand in the way of doing the things you want to do?
Self-care scale (theoretical score: 0-18)
2. Are you able to get up and down the stairs without help?
3- Are you able to dress by yourself?
4. Are you able to eat by yourself?
5. Are you able to bathe or take a shower by yourself?
10. Can you shop by yourself?
11. Can you travel by public transport?
Depression and anxiety scale (theoretical score: 0-12)
17. Taking everything into consideration, how anxious do you feel?
18. How much do your feelings of anxiety (if any) stand in the way of doing the things you want to do?
19. Taking everything into consideration, how depressed (blue) do you feel?
20. How much do your depressed feelings (if any) stand in the way of you doing the things you want to do?
Cognitive functioning scale (theoretical score: 0-15)
8. Do you have difficulties in concentrating?
13- How often does it happen that you are not able to think clearly or that you are confused?
14. How much do your problems with thinking (if any) stand in the way of you doing the things you want to
do?
15. How good is your memory?
16. How much do your memory problems (if any) stand in the way of you doing the things you want to do?
Social functioning scale (theoretical score: 0-9)
21. How satisfied are you with your social ties or relationships?
22. Do you feel emotionally satisfied in your relationships with other people?
23. Is there someone to talk about personal affairs when you want to?
Sexual functioning scale (theoretical score: 0-6)
24. Are you interested in sex?
25. How often do you have sexual contact?
Life satisfaction scale (theoretical score: 0-18)
26. How satisfied are you with your ability to manage your hobbies or recreational activities?
27. How satisfied are you with your financial situation?
28. Do you feel that you cannot afford the standard of living you would need?
29. How satisfied are you in general with your life at present when compared with the past?
30. Taking everything into consideration, how do you expect things will go in the future?
31. How much do your expectations of the future stand in the way of you doing or initiating the things you want
to do?
Moderators (18 items)
The perceived personality disorder scale (theoretical score: 0-6)
39. How often do you feel that most people cannot be trusted?
Do you agree with any of the following statements?
45. "Over the past several years, I have often been troubled by the difficulties I have in dealing with others.'
46. "Over the past several years, I have been bothered by the kind of person I am."
215
M. Dello Buono et a\.
41. "Over the past several years, the way I have behaved has often got me into trouble, either at work, at home or
elsewhere."
48. "Over the past several years, other people have often seemed bothered by the things I do or say."
49. "I haven't got as far as I'd like to because of the kind of person I am."
The anger scale (theoretical score: 0-4)
Do you agree with any of the folio-wing statements?
32. "I feel easily annoyed or irritated."
33- "I have temper outbursts that I cannot control."
34. "I get into arguments with others."
35. "I tend to be resentful."
The social desirability scale (theoretical score: 0-3)
Do you agree with any of the following statements?
42. "I am always ready to go out of my way to help someone else."
43- "I like to gossip at times."
44. "There have been times when I was quite jealous of the good fortune of others."
Self esteem scale (theoretical score: 0-3)
36. Taking everything into consideration, do you feel inferior to other people?
37. How often do you avoid things (refrain from doing things) because you feel inferior?
38. "I tend to have a negative opinion of myself": do you agree with this statement?
Trust in God scale (theoretical score: 0-2)
40. Do you believe in God or some superior being?
41. Do you find comfort or support in such a belief?
216

Interview with 105-Year-Old Mary Sims Elliott

http://www.ovpr.uga.edu/researchnews/95su/eliot_sb.html


Conversations with a Centenarian
by Judy Purdy

It's hard to imagine a lifetime that spans the invention of the automobile to the advent of the electronic superhighway. During her 105 years, though, Mary Sims Elliott has seen everything from the invention of hot dogs, fortune cookies and ice cream cones to the demise of the Boxer revolution, the Iron Curtain and the Berlin Wall.

What's it like to begin a journey in the Gay Nineties and now be heading toward the 21st century? What lifelong lessons would Mrs. Elliott, one of the first participants in the Georgia Centenarian Study, pass along to others?

In addressing the Georgia legislature, which honored her last February during Senior Citizens Week, she emphasized that "it's important to love all people of all sizes, shapes and colors. That's what really matters."

The following excerpts are taken from conversations with Mrs. Elliott that span the past year.

"In September 1894, 101 years ago this fall, I entered kindergarten at Kent Place School for Girls in Summit, N.J. It was the same year the school opened, and my father was one of its founders. Summit was a very safe place for any child to go anywhere in town. Mother taught us to stop at the corner and look both ways to see that no horses or carriages were coming.

"We used to play wonderful outdoor games: cops and robbers, hide and seek, yards off. I also spent lots of time with my dear grandfather, a wonderful, old man and a good companion for a tot. He had eyes like the sky and the purest heart. He was a Scotch-Presbyterian and taught me the favorite old hymns.

"Sprinkle wagons were frequently seen on the streets in summer. They had sprayers, and the wagons would go along the roads and lay down the dust. Then there was the iceman's wagon. You'd put a sign in your kitchen window [with] how many pounds of ice you wanted. He would come and with great big tongs put ice in our ice box. The honey vendor would walk through the streets calling, honey, honey, clover honey.' He would have on his head a round pan with a big oval basin full of honey. He would come to your kitchen, put his big pan on top of your washtub and dish out the honey.

"We were brought up for courtesy in all things -- for people who work for and with us. My father, who was vice president, secretary and treasurer of the New York, Ontario & Western Railroad, was known as the most courteous man in town. Courtesy is very valuable, and I taught my children to look people in the eye and be open and friendly.

"Music has always meant so much to me. My mother was an accomplished pianist. She used to play for the Ladies Fortnightly Club -- which became the Federated Women's Clubs in the new century. She would often play for the family in the evenings. We children would go up to bed and call downstairs for Mama to play so-and-so from Chopin.

"Mother taught me to play simple hymns till I was old enough to learn others. By 1898 or 99, I was playing by ear some of the first ragtime. In 1901, we went to our [summer] cottage in the Catskills for the first time. The little, white Baptist church there had an itinerant minister, and I said Mother, they haven't anybody to play the little bellows organ for services. Can I play for them?' and Mother said, Well certainly, dear.' So I started playing those jiggy little country hymns in the country church that year, and every year till I was 24 and got married.

"When I was 86, my old piano had worn out, so I bought another one. I was at the top of my performance. In 1979, though, I sold it because my dear daughter needed money to have her house painted, and that was the only way I could get it. But I can still harmonize mentally. (With this, she smiles and tilts her head back, closes her eye and fans out her fingers as if playing an imaginary piano.) My hands were very flexible. I used to be able to reach one over an octave, but now I can only span one octave. I played the organ for my grandson's wedding when I was 96, and at 97 I was a substitute organist at the Frederica Church on St. Simon's Island. I was too old to drive, but I had friends who took me.

"My sister Dorothy and I took a ship, the Koening Albrecht, to Europe for the summer in 1905 with a chaperon. I was 15 and Dorothy was 18, and we took the longest sea trip my father could find to rest Dorothy after her [graduation] exams."

[Editor's note: Mrs. Elliott still remembers her French. When Leonard Poon, who directs the UGA centenarian study, traveled to France to work with other centenarian researchers, he invited Mrs. Elliott to write a letter to Madame Jeanne Calment, who at 120 is the oldest documented person in the world. Without assistance, Mrs. Elliott composed her letter in French. When asked how she had remembered French after so many years, she replied, "My dear, I learned it very well as a child."]

"I believe in proper development in mind, body and soul. My parents read to us about Greek myths and Scandinavian legends. In today's society we need to teach mothers and children guiding principles to live by. We need to turn things around; there needs to be a return to the teachings of the Bible.

"Generation after generation of my family has worked on the affairs of the church. When I was 95, I got some friends about 20 years younger than I to help me organize a local chapter of the prayer book society at my church. When I can't work any more, God will know.

"I feel fine except that I don't hear very well and I don't see very well, and at this age it's rather hampering. I am so old I better be glad with what I have. When I get frustrated I pray it off and I laugh it off. If you can't laugh at things, you're in a sad state. I had a cataract operation four years ago and it was a slow recuperative period but afterwards I had a new lease on life because [I am] seeing colors again.

"As a child I learned little sayings that have stayed with me all my life: Good, better, best; never let it rest till your good is better and your better, best. Another is: Do your best in all you do and your best will come back to you. No matter how awful things get sometimes, there's a good side. I have a life filled with love because I have always tried to love others. It's been a wonderful saga, a wonderful life. Just marvelous."



* * *

I just so happen to live near where she grew up (Summit, NJ). If Summit back then was anything like it is now, she very likely came from a relatively wealthy family, so she may have benefited from higher living standards.

Early Observations in Poon's Georgia Centenarian Study

http://www.ovpr.uga.edu/researchnews/95su/centena.html


Hale and Hearty at 100
by Judy Purdy

There's a new notion about old age: Advanced years don't have to be empty years. Even the oldest old can lead productive, fulfilling and independent lives.

As more and more people pass the century mark without a second glance, they are setting examples that are changing our ideas about aging.

At 104, Mary Sims Elliott was working on her autobiography, writing poetry and trying to influence her church's position on social issues. Now she's 105 and her autobiography, titled My First One Hundred Years, was just published.

At 105, Geneva McDaniel taught aerobics daily at her senior citizens center. Now she's 107 and recruiting residents of her retirement community to exercise with her.

At 106, former sharecropper Jessie Champion and his 86-year-old wife, Fronnie, were weeding and harvesting their garden. Recently, Fronnie passed away and now Jessie, now 107, lives and gardens with his daughter.

These vibrant centenarians are among more than 150 who have volunteered for the Georgia Centenarian Study, a decade-long project that explores not just why some people live so long, but how they do it so successfully.

"We want to see what influences longevity and adaptation in old age," said Leonard W. Poon, who directs the UGA Gerontology Center and heads the study. "The primary focus is to understand patterns specific to each age [group] and to individuals in their 60s, 80s and those over 100 years of age who are community dwelling and cognitively intact."

Since 1988, Poon has directed the study that includes nearly a dozen faculty from the University of Georgia, the Medical College of Georgia and Iowa State University, along with dozens of graduate students. Representing many academic fields, the researchers study "expert survivors" -- people who've passed their 100th birthday, live independently or semi-independently, are active in their communities and enjoy relatively good physical and mental health -- and compare them with people in their 60s and 80s.

"We all have stereotypes of what a centenarian should be," Poon said. "But there's no such thing as a typical centenarian."

Nonetheless, the researchers have drawn a composite picture of an expert survivor in the Georgia study. She is a female with a grade school education who:

* lives by herself or with her children;
* has an income of $4,000 - $7,000;
* has vision and hearing problems;
* takes two medications a day;
* wants to avoid institutionalization;
* is feisty and wants to have her way; and
* is generally satisfied with life.

By and large, expert survivors also are focused on the here-and-now and are just as active in mind as in body. Just how these spry individuals got to be so old is a puzzle for centenarians and researchers alike.

Some of the oldest old chalk it up to luck. And some, including Jennie V. Williams, 105, say the "good Lord" isn't through with them yet. Others, like Mary Sims Elliott, say they're just too busy to die.

Clues to Longevity

After intensive analysis of biological, psychological and social factors that may contribute to successful aging, the researchers haven't found any fountain of youth. While they have charted some striking similarities among expert survivors, the researchers also have observed many differences.

"You can't make generalizations about these very exceptional people because each one is different," Poon said. "Centenarians continue to surprise us so that now surprises are the rule."

Among the surprises is that "some centenarians turn us down because they are too busy to participate. They are on college boards or run their own businesses," said Martha Bramlett, an assistant professor of nursing at the Medical College of Georgia who manages data acquisition for the study.

No two centenarians are the same. "For as many optimistic people, we find as many who are grumpy," Poon said. "Successful aging has many, many components."

"Centenarians are far more different than they are alike," said Peter Martin, a former UGA faculty member who co-directs the study and is now a professor of human development and family studies at Iowa State. "There are many paths to longevity, and each situation is very different."

Take a family history of longevity, for instance.

"People aren't likely to live long just because their parents did," Poon said. "It seems the genetic contribution is important for some centenarians who come from a long line of long-lived people. But we have as many people who do not come from long-lived families."

Funded by the National Institute for Mental Health, the study couldn't come at a better time. Post-retirement citizens may be in the minority now, but that trend is changing fast. Senior citizens are already the fastest growing segment of the American population, and the 85-plus group may be the fastest growing among senior citizens, Poon said.

By the year 2025, the number of people under age 20 is expected to equal the number of those 65 and older, according to reports published by the Joint Congressional Committee on Aging.

"People 65 and older are just now becoming a population for us to think about in terms of health care, jobs and the economy," Poon said. "When that of proportion is the same as the young people, this becomes very significant in terms of the work force, health care and retirement."

The research team's findings will have effects that ripple far beyond the families of silver-haired Americans. Their findings will help scientists, medical and social agency personnel, and elected officials better understand the aging process and prepare for the centenarian population explosion that demographers and census takers have predicted.

"The research will help our country provide the services needed as more people survive to be 100," Poon said.

Like centenarians everywhere, those in Poon's study come from all walks of life. Some have doctoral degrees; others never finished grade school. Some live alone in spacious homes; others are so poor they lack even the basics such as a refrigerator. Several have a wealth of family and friends they call on for aid; others rely on their wits to build a support network of friends and neighbors.

Regardless of their lot in life, though, expert survivors face similar challenges unique to their age group. With few road signs to guide them, they have adjusted to diminished physical strength, faced the deaths of numerous -- often much younger -- loved ones and found answers to life's meaning and purpose long after retiring from conventional roles as breadwinners and parents.

The centenarian research project looks specifically at how physical and mental health, intelligence, memory, coping skills, personality traits, attitudes, nutrition, spirituality, family history, support systems and religious beliefs influence a long and independently lived life.

During phase one of the two-phase project, the researchers ask participants a battery of questions and collect bundles of data on everything from what they ate for breakfast to what makes them happy or sad. Then they compare the relative significance of each variable -- both for individuals and for age groups -- to determine which ingredients are important in the recipe for longevity.

Phase One: Many Roads to Longevity

So far, what the researchers have found in phase one is that no one variable stands out as more important for longevity. Moderation, however, "seems to come up frequently and to be practiced over one's lifetime," Poon said.

That may help explain why expert survivors are so hale and hearty.

"We were surprised to find very little depression among the centenarians," said Martin, who directs the project's personality, life events and coping component. "These people have a high degree of self sufficiency and are confident and resourceful in their ability to overcome obstacles and problems.

"They describe themselves as I-can-do people. In fact, overall, their mental health and life satisfaction are very high," he said.

But don't expect them to conform.

"Instead of growing more alike, people become more distinct, more differentiated, more individualized and unique as they grow older," said Philip Holtsberg, one of Poon's doctoral students. "And the longer they live, the more pronounced those differences become."

Even past the age of 100, though, centenarians still conform on some things, like good health. About 50 percent of them try to avoid fats in their diets, said Mary Ann Johnson, who heads the study's diet and nutrition component. They also eat more fruits and vegetables, get slightly more vitamin A and carotene, and consume about the same amount of calories and fat as their younger counterparts.

Among centenarians, age, however, is not the primary predictor of nutritional risk, those factors that may contribute to poor nutrition such as wearing dentures, taking medications that upset the stomach or smoking. Emotions play a bigger role.

"How you feel -- happy or sad, understood or misunderstood -- is more important," said Johnson, a UGA professor of foods and nutrition. "Aspects of mental health and the number of illnesses, more than age, predicted nutritional risk among centenarians."

Expert survivors tend to be healthy and proud of it. Surprisingly, the researchers found no significant differences among people in their seventh, ninth and 11th decades in the number of medications taken, trips to the doctor or hospital, or recent illnesses.

More than 60 percent of the centenarians rated their health as good to excellent; an even higher percentage said it was as good or better than five years ago, said Martha Bramlett of the Medical College of Georgia.

"We know we get a skewed view of the health of centenarians in general because we only look at those who are still community dwelling," Bramlett said. "But our check-ups confirm that they are in remarkably good health. One gentleman, David, who is 105, still reads without glasses and has 20-25 vision. Julia, a retired seamstress still threads her own needles at 100."

Successful agers also know the value of daily activity and mobility, and make an effort to get exercise, Bramlett said.

Take Frank, 101, who drove to his job at the courthouse every day until his recent cataract surgery. Now he often walks to work. Then there's Sara, 101, who works all week keeping her own yard, flower beds and home tidy and neat. On weekends she travels to Atlanta to clean house, do laundry and babysit with her great-grandchildren so her granddaughter, who has health problems, can rest.

The research team also looked at the influence of religious beliefs on physical well-being as well as on other factors. Although all three age groups scored high on the importance of religion in their lives, the researchers found this had no strong correlation with physical or mental health, personality or life satisfaction. This finding may be influenced, in part, by the uniform level of high religious influence in all three age groups, said Bradley C. Courtenay, a UGA professor of adult education who examined the relationship between religion and longevity.

Coping with hardship or loss, though, is another matter, Courtenay said. Expert survivors rely more on spirituality and a deep trust in God and less on non-religious methods than the other groups do.

"Centenarians tend to have a philosophy and keep with it, but they don't tell people about their philosophy," Courtenay said. "They think everybody is supposed to have their own, so they're not imposing."

The Second Time Around

Now that researchers have a "group snapshot" of people in their 60s, 80s and 100s, they want a clearer picture of how each age group as well as each individual within the group changes with the passing of time.

"Because people's life experiences influence the aging process, we don't know whether it's age or peer-influenced differences we are observing," Poon said. Phase two of the study provides a sharper focus on which changes are related to aging and which are peer-influenced, such as having been the same age during the Great Depression or World War II. Researchers re-test 60- and 80-year-olds after five years, 100-year-olds after 18 months.

"There are few longitudinal studies with centenarians because once they reach 100, we're finding that life expectancy is only about 12 to 20 months, and if we wait too long, then we may lose them," Poon said.

Sadly, that already has happened with some, including Elva "Speegie" Spangenberg, a centenarian well-known to Atlantans, who died last December at age 107. At 98, she began a new career as a tour guide at Rhodes Hall, an Atlanta historic site that was seven years her junior--but had to retire her post because of a fall about a year before her death.

"We've had counseling sessions for our testers to make sure they could deal with a centenarian's death. They get very attached to the centenarians. It's like a family member dying," Poon said.

Phase-two testing of the centenarians, which is a repeat of the tests used in phase one is often hard to conduct for other reasons, too -- mainly because of their physical and mental decline. Poon predicts only about half of the original group will be able to participate.

"Those who are still around for the second round of tests are often too frail to be tested for any length of time," he said. "We are finding that 18 months often is too long."

Poon illustrates the point by recalling "one lady who played ragtime piano for the testers on their first visit. Her functional mental state was practically perfect," he said. "Eighteen months later she could not answer many of the same questions. It was heartbreaking to see her go from living an independent life in her own apartment to one in a nursing home."

Poon wants to expand the study to include institutionalized centenarians and compare them to the community-dwelling individuals. He also wants to continue studies of dementia among the oldest old, a project he began last summer with researchers at the University of Lunde, Sweden.

For now, though, those plans are on hold; he and his team of researchers still have plenty of phase-two data to collect, not to mention mountains of data from both phases to analyze. Then there's the monograph on centenarian health issues that he and researchers from France, Hungary, Japan and Sweden plan to publish next spring.

"I think longevity around the world is an important issue," he said. "Researchers from different countries look at it somewhat differently, but we also have common hypotheses and approaches."

In the meantime, Poon et al. have been adding more centenarians to their study. But finding people who meet the study's criteria isn't easy.

"We go to a lot of chicken dinners, talk to a lot of people and pass the word along through churches, senior centers and such," Poon said.

Potential participants must be screened to make sure they're cognitively intact. And that brings up another problem for centenarian researchers: The questionnaires, surveys and other tests they use were designed for and validated on much younger people. They may not hold true for older populations.

"Any time you use a survey, it has to be validated for that particular population," Poon said. "These people are outside of the range of an average life span. Since no one has tested 100-year-olds with these instruments before, we just don't know whether the tests work for the oldest old," Poon said.

Despite the necessary ground-breaking efforts, Poon said he is optimistic that the research will provide useful information. Although it's still too early to draw hard-and-fast conclusions from the phase-two data, a preliminary glance shows "tremendous amounts of individual differences," Poon said. "The changes in our centenarian group are very dramatic over the 18 months of study.

"As centenarians get closer and closer to death, I think a very different picture will emerge in terms of their functioning, but I could be surprised again. Some centenarians may maintain this profile of an independent, functioning person. After all, they've had this pattern for 100 years and 18 months may not change it," he said.

Even among the 80-something-year-olds, the researchers already have seen "a fantastic amount of change," Poon said. "They have already lived beyond the average age, and then we add five years to that."

Learning to Cope

While the researchers are interested in describing centenarians' physical and mental function, they are even more curious about how centenarians have compensated for their diminished abilities.

Poon speculates that the "cohort effect" -- common experiences shared by people born at the same time -- also will have a strong influence on how groups of people change over time.

"The influences of the environment, the context in which you grow up and the value system that holds you up all of these years will be very important," Poon said. "And we know your critical development stage in your 20s and 30s are important."

However, people in their 70s and older are in their last stages of development, which can be the most trying -- and the most rewarding. The longer people live, the more difficulties and losses they face. In addition to losing loved ones -- siblings, children and friends -- centenarians face the loss of career, mobility, respect and attractiveness. They even lose the feeling that they are making a contribution; often they're viewed as "has beens."

"The last stages of life may hold challenges to find ego integrity -- a wisdom or feeling that your life has made sense -- and not to give into despair," Poon said, drawing on ideas proposed by psychologist Erik H. Erikson who is noted for his work on ego integrity and ego development.

Despite the fact people cannot change many traits -- like personality or cognitive ability -- even at 100, people are still able to change some things.

For example, researchers have learned the importance of studying compensatory mechanisms like resourcefulness, which "may be a key ingredient to functioning independently or semi-independently in the community," Poon said.

Although few of us may live long enough to blow out 100 candles, we can still learn pointers from those who have, like the benefits of learning to cope with loss, adopting a positive outlook or finding a central purpose in life. The most important lesson centenarians can teach us may be that we're never too old to learn.

"No matter what your age, the memory is still trainable," Martin said. "You can teach an old dog new tricks. Centenarians can still use their minds, reflections and personality skills to compensate for or overcome problems."

And that's a good take-home message for us all. Especially since today's baby boomers are tomorrow's centenarians.

For more information visit www.thecentenarian.co.uk/home.htm

Britain's Oldest Man, 112, Still 'Full of Life'

Mr Allingham said he felt 'on the crest of a wave' on his 112th birthday


http://news.bbc.co.uk/2/hi/uk_news/england/7439458.stm


Long life secrets of oldest man

Henry Allingham, Britain's oldest man, has joked that his secret to longevity is "cigarettes, whisky and wild women".

Born in Clapton, east London, in 1896, when Queen Victoria was on the throne, the 112-year-old's life has spanned six monarchs and 21 prime ministers.

He has described the current Queen, who he has met on several occasions, as a "lovely lady", and said it was a "great honour" to meet her.

Friends of Mr Allingham have described him as an "incredible man" who remains full of life.

Dennis Goodwin, his friend and chaperone, said: "He is an example to us all. He keeps up with all the events and functions that he is invited to.

"Last year we counted that he had clocked up 47 events which is quite something for a man his age.

"He knows what's going on around him and enjoys the company of people."

Naval battle

But the 112-year-old did not have the easiest start in life.

His father died from tuberculosis in 1898, when Mr Allingham was 18 months old. When he was 19, his mother died.

The teenager then enlisted with the Royal Naval Air Service (RNAS) as a skilled mechanic and a year later, in 1916, he was involved in the greatest naval battle of the World War I, the Battle of Jutland.

A year before the end of the war, he was posted to France to support the Royal Flying Corps, and helped service and rescue aircraft which crashed behind the trenches.

In 1919, after leaving the RNAS, Mr Allingham married 22-year-old Dorothy Cater in Chingford, Essex.

The couple went on to have two daughters, and he now has five grandchildren and 12 great grandchildren.

His wife died 38 years ago, while his daughters both died in their 80s.

Following his armed forces career, Mr Allingham worked in engineering roles, and was in a senior position with car manufacturer Ford by the time of his retirement in 1960.

In 2003, he received France's highest military honour, the Legion D'Honneur, at a ceremony at Eastbourne Town Hall.

In 2004, at the age of 108, he laid a wreath and led the service in the Lord's Prayer at the 90th anniversary of the World War I at the Cenotaph.

To mark Armistice Day in 2005, Mr Allingham travelled to St Omer, near Calais, France, to lay wreaths to fallen comrades.

German greeting

A year later, aged 110, as the oldest British World War I veteran, Mr Allingham met his German counterpart, Robert Meier, 109.

The men greeted each other warmly and laid a wreath at the war memorial near Witten town hall.

Mr Meier said it was "amazing" that both men were still alive and went on to say: "Why did we have to have a war?"

In 2007, Mr Allingham marked his 111th birthday on board the Royal Navy's oldest warship, HMS Victory, at Portsmouth.

A military flypast of aircraft from the Royal Navy's historic flight and the RAF marked the occasion.

Eight of Mr Allingham's grandchildren and great grandchildren and their partners flew from their homes in the United States to join him for his 112th birthday.

On reaching the grand age, Mr Allingham said he felt "on the crest of a wave".

He said: "People ask me how I've done it, and I just say that I look forward to another tomorrow."


* * *

There are videos of Mr. Allingham on the BBC page, if the page is still up, anyway.

Mr. Allingham manages to stay positive and always look forward to the future while enjoying activities and people around him every day. Keeping engaged with life is important.

Okinawan Quick Summary - CNN Transcript

http://www.okinawaprogram.com/news/20041214_cnn.html

This is a transcript from a CNN morning show, courtesy of the above website.


Dr. Craig Willcox on CNN, American Morning

From CNN: American Morning

DEC-14-2004

The following is an edited* transcript from the December 14th broadcast of CNN's American Morning, with comments and corrections added by Dr. Craig Willcox, co-creator of the Okinawa Diet™ and co-authtor of The Okinawa Program and The Okinawa Diet Plan:

HEMMER: Time to page the good doctor. Sanjay Gupta all the way from Tokyo now. On the Japanese island of Okinawa, living longer has become a fact of life.

I will talk to Sanjay in a moment about that. First, though, some background from here in Japan and CNN's Atika Shubert.

(BEGIN VIDEOTAPE)

ATIKA SHUBERT, CNN CORRESPONDENT: Guess how old Makato Nakamatsu (ph) is? Seventy? Eighty? Ninety, maybe? Try 100 years old.

This sprightly great grandmother of 13 is just one of more than 800 centenarians living in Okinawa, the largest verifiable and healthiest concentration of 100 year olds in the world.

On the islands of Okinawa, diseases like cancer, diabetes, and hypertension are rare. Healthy seniors are seen actively at work fishing and farming, seemingly immune to old age.

Okinawa is home to the world's oldest and healthiest people and part of the secret seems to be right on this fishing boat. Elderly fishermen who work late into their lives and of course eat the daily catch. And that turns out to be part of the secret of the Okinawa fountain of youth: staying active and eating well.
That, according to Dr. Craig Willcox, who has studied Okinawa's centenarians for more than a decade.

DR. CRAIG WILLCOX, GERONTOLOGIST: I think they just came up with the right formula, Okinawa. They're doing a lot to either avoid or delay these diseases associated with aging.

SHUBERT: We asked Dr. Willcox to show us how the Okinawans do it. He took us to the market.

WILLCOX: Let's have a look at this. Wow. See that purple color?

(I was pointing out the lycopene content of dragon fruit as well as other Okinawan fruits and vegetables, such as watermelon and sweet potatoes, that are extremely high in carotenoids, anti-oxidants and essential vitamins and minerals - DCW.)

SHUBERT: First, eat lots of colorful fruits and veggies. That means carbs too, but unrefined. Brown rice or whole wheat.

(It is important to eat whole carbohydrates that are high in fiber and that have been refined as little as possible in order to maximize nutritional content as well as minimize the negative effects of unrefined carbs on blood sugar levels. Eating carbs low on the Glycemic Index as well as minimizing quick-release carbs in the diet will keep you healthy and slim throughout life (See pages 33-37 and 89-95 of The Okinawa Diet Plan as well as pages 92-101 of The Okinawa Program for a more in depth explanation of the importance of eating the right carbohydrates) - DCW).

WILLCOX: The traditional diet is very vegetable heavy. Over 70 percent of the daily color intake came from vegetables.
(The staple of the traditional Okinawa Diet was the sweet potato, a nutritional powerhouse and great source of unrefined carbohydrates. Also loaded with beta-carotene, B vitamins, C, E, calcium, potassium, iron and fiber. Over 200 case-control studies have shown that people who consume a diet higher in vegetables suffer from lowers rates of chronic diseases, including cancer, and live longer. - DCW).

SHUBERT: Second, eat moderate portions of protein, especially heart healthy fish and tofu. But also a surprising Okinawan favorite: pork. But just a little.
(The traditional meat in Okinawa was pork but its consumption was limited to ceremonial occasions. Thus, the Okinawan elders have consumed very little meat over the course of their lives. Even now their meat consumption remains less than a quarter of what most people eat in North America. - DCW).

WILLCOX: The way that this is prepared in a traditional Okinawan style would be to boil this down and keep pouring it off until you pour off all the fat.

SHUBERT: Third, follow Okinawan table etiquette. Eat until you are 80 percent full and no more. That keeps calories in check.

Is that the secret to Nakamatsu's exuberant good health? She's certainly happy to share her healthy lunch, but also recommends daily exercises. Apparently when you live past 100 you know some pretty good dance moves. And if you do all that, she says, she'll come visit you when you turn 100.

Atika Shubert, CNN, Okinawa, Japan.

(END VIDEOTAPE)

HEMMER: What a life for her. We're paging the good doctor now. Sanjay Gupta, at the CNN Center.

How are you, Sanjay? Good morning. Tell us about this fountain of youth. How you doing? GUPTA: Good morning. Yes, really interesting, obviously. Okinawa (is) a great place to look at as far as centenarians go. A couple of facts to point out.

First of all, with regards to Okinawa. So they live longer, lower rates of Alzheimer's. If they leave the island, those things go away. Why, is the question? Atika sort of mentioned a couple of these things.

(Okinawans consuming a meat-heavy diet in Brazil live 17 years shorter on average than those who consume the traditional diet in Okinawa. Okinawans who migrate to Hawaii and consume an East-West blend of foods, or East-West fusion diet tend to live almost as long as Okinawans in Okinawa - DCW).

Vigorous physical and mental exercise throughout their lives. A diet low in fat and salt. High in fruits and vegetables.

Also a couple of other interesting things that we found in our research on this -- soy, a significant part of the diet, 60 to 120 grams of soy daily and eat only until you're 80 percent full.

(Soy founds are high in flavonoids and people who consume high amounts of soy products have generally been found to suffer from lower rates of hormone-dependent cancers such as breast and/or prostate. Women who consume more soy have usually been found to have a decreased incidence of menopausal related symptoms such as hot flashes, as well as lower rates of osteoporosis - DCW ).

Atika mentioned this, it's called hara-hachi-bu, Bill, that's the name of it -- it's called eat only until you're 80 percent full. That's going to make you eat fewer calories. Really important.

(As we point out in The Okinawa Diet Plan, eating foods that are low in caloric density has been shown to increase life expectancy - DCW)

Also an important sense of social belonging. Everyone from the youngest in this community to the oldest in this community has a sense of place and is respected as such, Bill. All these things seem to have a factor as well.

(As we pointed out in our first book, The Okinawa Program, strong social support networks are associated with longevity--DCW)

HEMMER: Yes, is this exclusive only to Okinawa, Sanjay, or do you find if you put out the map of the world do you find other areas of the world where you see similar aging rates?

GUPTA: Well, Okinawa is one of the best, certainly, around the world, but there are other places around the world that have high concentrations of centenarians. Take a look: Okinawa topping the list but also Nova Scotia, Canada, for example. Sardinia, Italy as well.

(Okinawa has the highest age-validated centenarian population in the world at 47 per 100,000 population vs about 10 per 100,000 in the US. - DCW)

If you want to look around the world as far as life expectancy Singapore, Hong Kong, Japan all around 81. Japan as a country 81.

Canada 80, France 79. USA 77. China 72 and Botswana only 30. The reason it's so low in Botswana really has to do with high infant mortality rates there, Bill.

(These rates differ according to whose data you use but Japan comes out on top in very case. Of the Japanese, the Okinawans are the longest-lived at 78 years for men and 86 years for women on average. Botswana also is suffering from the AIDS epidemic and has lost approximately 10 years of life expectancy in the past couple of decades - DCW)

HEMMER: What about personality traits, Sanjay? Do you see any common link that would conclude any research as to why some people are living longer than others?

GUPTA: Yes, I mean, there are some significant personality links and this is probably one of the most interesting things about it. If you look at the personalities of people. Strong but flexible characters. They tend to be more dominant in terms of their personality.

Also a bit suspicious. Suspicious of those around them, sometimes. But they're very practical minded. And tend to be more relaxed in general. Another important thing that we found as well, Bill, is that the people who lived longer oftentimes had helpers or people that they associated with who were much younger than them. That was both their -- they got some help from those young people as well as sort of a passageway into being young themselves, perhaps making them live longer, Bill.

(As we pointed out in our first book, personality and longevity experts seem to agree that a positive outlook, as seen in optimistic, emotionally stable, and flexible personalities is a definite advantage for coping with stressful life circumstances. They tend to be emotionally resilient and strong-willed types. Through personality testing we found that Okinawan centenarians tended to score high in “self-determination” and “self-confidence” and low in “tension” and “time-urgency.” See pages 245-251 of The Okinawa Program for further information on personality and longevity. - DCW)

HEMMER: How about that woman in the story that Atika showed -- she was just vibrant -- absolutely.

Hey, thanks, Sanjay. Very interesting stuff. Eighty percent filled and then stop. Talk to you later. Oh, I like that too. We'll talk to you later.

New England Centenarian Study Basic Summary

http://www.sunjournal.com/story/262078-3/LewistonAuburn/Doctors_advice_on_living_to_100/

Doctor's advice on living to 100

- Staff Writer Bonnie Washuk
Tuesday, April 22, 2008

BOSTON - The number of people who live to 100, like Lewiston's Libby Goldman, is low, about 1 out of 8,000, says Dr. Thomas Perls, director of the New England Centenarian Study at Boston University's Medical Center.

Of those who live to be 100, "the larger numbers aren't doing so well," Perls said Monday. Only 20 percent are lucid.

Those in that minority can keep going to 101, 102, 103 and beyond, "as long as their minds are sharp," Perls said.

"Some people say, 'Who would want to live to 100?' I say most of us," if the disabilities associated with old age are compressed to the very end of life, he said.

The vast majority of those who live to 100 have lived independently through their early 90s, Perls said. The world's oldest known person today is Edna Parker of Shelbyville, Ind., who celebrated her 115th birthday April 20. People who live to 110 are "supercentenarians" and are rare, Perls said.

There are three common traits of centenarians, according to research in the New England Centenarian Study:

• Good genes. They have "significant genetic advantages" and lack genes that predispose them to diseases, Perls said. Longevity often runs in families.

• Good health habits. Most don't drink or smoke, and they exercise. They're not overweight.

• They manage stress well. Perls guessed that Libby Goldman was "gregarious and optimistic." People who live to 100 "find humor in their daily lives." They have stress, but "they seem to be able to let go of it easily."

To learn more about the New England Centenarian Study at Boston University's Medical Center, go to: http://www.bumc.bu.edu/Dept/Home.aspx?DepartmentID=361


* * *

Not too helpful, as it's all stuff we knew. I think stress is the biggest problem for most people. The good news is that if you're exercising and eating properly, stress is less likely to be a problem anyway. And what better excuse to block out time for your favorite activities and to hang out with good friends?