Quality of life and longevity: a study of centenarians

Age and Ageing, March, 1998 by Marirosa Dello Buono, Ornella Urciuoli, Diego De Leo

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, ill 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, 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.