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Background: Despite most centenarians facing age-related declines in functional and cognitive capacities, the severity of these declines varies among individuals, as does the maintenance of good mental health (e.g., depressive symptoms) despite these declines. This study aims to examine this heterogeneity in centenarians from the Second Heidelberg Centenarian Study, which collected data from 112 centenarians living in Germany. In our study, we focus on a subsample of 73 centenarians who provided self-reports for our measures of interest (M age = 100.4, SD age = 0.55)., Methods: We examined correlations between functional capacity (i.e., PADL, IADL), cognitive capacity (i.e., MMSE), and depressive symptoms (i.e., GDS), and the existence of different profiles using hierarchical clustering., Results: Higher functional capacity was related to higher cognitive capacity and to fewer depressive symptoms. Yet, higher cognitive capacity was associated with more depressive symptoms. Hierarchical clustering analysis elucidated this contradiction by identifying three profiles: low-capacity individuals (i.e., 24 individuals had low functional and cognitive capacities, with low depressive symptoms), high-capacity individuals (i.e., 33 individuals with high functional and cognitive capacities, with low depressive symptoms), and low-functional-high-cognitive-capacity individuals (i.e., 16 individuals showed low functional but high cognitive capacity, with high depressive symptoms). Our post-hoc analyses highlighted arthritis and pain as risk factors for functional dependence and depression., Conclusions: Our findings emphasize the importance of identifying centenarian subgroups with specific resource- and risk profiles to better address their needs, and of treating pain to improve functional capacity and mental health in centenarians., (© 2024. The Author(s).)

This study examined how common thinking of and planning for the end of life (EOL) is among German and Portuguese centenarians, and whether patterns of EOL views are shaped by cultural and individual characteristics. A significant portion of centenarians in both countries reported not thinking about the EOL, not believing in the afterlife, and not having made EOL arrangements. Latent class analysis identified three EOL patterns: Class 1 ( EOL thoughts with EOL arrangements and afterlife beliefs ), Class 2 ( EOL arrangements and afterlife beliefs without EOL thoughts ), and Class 3 ( Overall low endorsement of EOL items ). The proportion of Portuguese centenarians was higher in Class 1 and of German centenarians higher in Classes 2 and 3. Centenarians' demographic, social, and health characteristics were significantly different across EOL patterns. As lack of EOL planning can result in poor EOL quality, enhancing communication among centenarians, family, and health-care professionals seems imperative.

Background: Bronchoscopic lung volume reduction (BLVR) using valves and coils has been approved for use since 2003 and 2010, respectively., Objective(s): To study adoption patterns of BLVR in an early-adopting country, and to estimate potential treatment volumes in other European countries., Methods: Therapy- and age-specific volumes for endobronchial valve and coil procedures were obtained from German federal statistics for 2007-2016. Therapy-specific and total BLVR procedure volumes and growth were computed, and patterns in treatment age and device utilization analyzed. Patient volumes for other European countries were predicted using mean German patient volumes of the last 3 data years and age-specific population and emphysema incidences., Results: Over the study period, annual BLVR procedure volumes grew from 91 to 2,053 (+2,256%), reaching a peak of 2,556 procedures in 2013. Coil procedures constituted 36% of the total volume in 2016. Treatment age was stable over time, with highest procedure counts in age group 60-64 years for valves and 65-69 years for coils. A limited increase in device use per procedure was observed. For -Germany, 1,655 newly treated BLVR patients were estimated per year, approximating about 5% of the annual newly diagnosed severe emphysema cases. Predicted volume estimates for other European countries ranged from 1 for Liechtenstein to 1,226 for France., Conclusions: Analysis of -German procedure data show pronounced BLVR therapy uptake in the early years of adoption, with the more recently introduced coil therapy used in about one-third of patients. Estimated patient volumes to date constitute only a small fraction of the severe emphysema population., (© 2018 S. Karger AG, Basel.)

Objectives: To explore how centenarians think about and plan for the end of life (EOL) and to what extent their primary contacts (proxy informants) are aware of these thoughts., Design: Population-based study with semistructured in-person interviews., Setting: Defined geographical region approximately 60 km around Heidelberg, Germany., Participants: Subsample drawn from the larger study of centenarians (N = 78) with data on centenarians' EOL thoughts from the centenarian and the proxy informant., Measurements: Centenarians reported on their thoughts about the EOL, perception of the EOL as threatening, longing for death, engagement in any EOL planning, and type of EOL plan (will, living will, healthcare surrogate) in place. Proxy respondents answered the same set of questions based on what they thought the centenarians' perspective was., Results: In nearly half of cases, proxies misjudged whether the centenarian thought about EOL. Although only few centenarians perceived the EOL as threatening, and approximately one-quarter reported longing for death, proxies overestimated centenarians' reports on the former and underestimated the latter. Proxies reported more centenarian EOL planning than centenarians themselves., Conclusion: Even though enrolled proxies were mostly persons very close to the centenarian, many of them did not seem to be well informed about the centenarians' thoughts and plans regarding the EOL, suggesting a lack of communication between centenarians and social network members in this respect. Healthcare professionals should be aware that, even for very old adults approaching the end of their lives, discussions about EOL and EOL planning may need to be actively encouraged and supported., (© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.)

Demographic change is increasingly determined by development associated with very old age. The reduction of mortality in very old age will continue, so that an age between 80 and 100 years will become common. Present research findings suggest that, with respect to their physical resources, humans are not well equipped for a very long life. Very old individuals are characterized by a high prevalence of chronic diseases and functional limitations that endanger independent living. Centenarians are faced with these restrictions to a large extent. In contrast to increasing physical constraints, old and very old individuals' psyche seems to be rather robust. Well-being and valuation of life reveal only little decline up to the highest ages. Of particular importance are psychological strengths, which include adaptive strategies and self-referent convictions. They remain relatively stable even in very old age and seem to balance the effects of diseases, resource restrictions and loss.

In the present study, we investigated cognitive status, cognitive development and the effect of mortality on cognitive changes in very old age. Analyzing data from the population-based Heidelberg Centenarian Study, results revealed that centenarians differed quite strongly in their cognitive capacities. While about half of the population showed moderate to severe cognitive impairment, one quarter was found to be cognitively intact. Moreover, analyzing cognitive change over a period of 1.5 years, centenarians' cognitive performance was revealed to be rather stable. Finally, only a small effect of mortality on cognitive status and changes was detected, supporting a recent hypothesis that the terminal decline or drop in cognitive functioning decreases in very old age.

In September 1995, the German Center for Research on Aging at the University of Heidelberg had been founded to become a leading national center of excellence with a clear interdisciplinary scope of ageing research activities. So far, three departments have been built up successively: the Department of Social and Environmental Gerontology (established in 1997, chair: Prof. Hans-Werner Wahl), the Department of Adult Development (established in 1998, provisional chair: Prof. Andreas Kruse), and the Department of Epidemiology (established in 2000, chair: Prof. Hermann Brenner). As one of the next steps, the disciplinary spectrum of the Center will be complemented by setting up several junior research groups in molecular ageing research. Within the few years of its existence, the Center has set up multiple large-scale, extramurally funded cross-sectional, case-control and longitudinal studies. These studies provide a unique common basis for interdisciplinary collaboration both within the Center and with the Center's numerous national and international research partners.

The maintenance of autonomy and independence in the oldest old population is at high risk due to the inevitable aging process, which primarily affects functional and cognitive capacities. In this study, we investigate centenarians to assess the extent in which they have lost their ability to live independently. This is done with a classification system for dependency that considers both functional and cognitive limitations and determines the level of functional competence in this population. Based on this system, we evaluate the necessity for nursing care and investigate to which extent their actual needs are covered by the German Long-term Care Insurance. An important and relevant question is whether this system even addresses the evaluation of cognitive impairment. For this reason, 85 centenarians and their proxies were assessed with standardized instruments and the results show a severe loss of independence. The necessity for at least daily contact with nursing care was identified in 91 percent of the centenarians due to their dramatically limited capacities. Forty-four percent of the centenarians need more support than they actually receive from the German Long-term Care Insurance. Therefore, considering cognitive impairment is a crucial component in the evaluation, which would lead to more support by the official system in 20 percent of the centenarians. The considerable differences between the granted and the necessary nursing care demonstrate that co-operation from family members must be heavily relied upon.

Life-span developmental psychology has demonstrated that further cognitive development takes place also in old age. Therefore, this study aims at locating a distinct intellectual structure of older people. Twelve cognitive measured from the "Bonn Longitudinal Study of Aging" are analyzed. Factoranalysis reveals a model with three components: a crystallized, a visual, and a memory component. They represent also different cognitive strategies. Within the aging process the crystallized component is the most stable one. Up to 70 respectively 75 years no decrement can be observed in the development of the other two components. When people are more than 80 years old the number of factors is reduced to two. This is regarded as a process of focusing resources. Verbal and visual strategies are integrated in order to compensate losses.