This event discusses centenarians and the oldest old. There are currently 11,800 centenarians in the UK, though fewer than 100 are over 110. While some centenarians remain healthy, many experience physical and cognitive decline. Three quarters have longstanding illnesses and one third perceive themselves as in poor health. Dependency is not inevitable, as some maintain independence, but many find daily tasks difficult. Quality of life tends to fall with increasing age. Recommendations include improving housing, care support, and flexible work to support older family carers.

1. Robert Butler Memorial
Lecture and Debate on
Centenarians and Oldest Old
29 November 2011
This event is kindly supported by JRF
The ILC-UK work on “Centenarians and Oldest Old” is supported by Age UK

2. Centenarians and Oldest Old
David Sinclair
ILC-UK
This event is kindly supported by JRF
The ILC-UK work on “Centenarians and Oldest Old” is supported by Age UK

3. Who wants to live forever.
Centenarians and the oldest old
International Longevity Centre -UK

4. Centenarians and the oldest old
• While advances have
been made in researching
antecedent factors that
predict living to 100, less
attention has been paid to
life as a centenarians
• The body of evidence on http://www.flickr.com/photos/pondspider/4170990903/
sizes/m/in/photostream/
centenarians is far from
consistent or extensive
(hence looking at oldest
old).

5. Limitations
• Panel surveys tend to have a very small sample of
the oldest old (IFS, 2010, p 229).
• “Those who were very ill or frail had higher
dropout rates, and people in worse health were
less likely to be re-contactable”. Chatfield et al
(2005)
• “a strong link between attrition and cognitive
decline…cognitive decline may be underestimated
by epidemiological studies as a result”
• Are the predictions right?

6. How many centenarians are there?
• There are currently 11,800
people in the UK who are
currently at least 100
(DWP)
• There are fewer than 100
people who are aged more
than 110. (DWP)
• In 1911 there were just 100
Centenarians living in
England & Wales
• Growth has been about 7% http://www.flickr.com/photos/un_photo/5
p/a 832685007/sizes/z/in/photostream/

7. Projected number of centenarians in
the UK

8. How likely is it that we will reach 100?
The likelihood of living
from birth to 100 might
have increased from 1
in 20 million to 1 in 50
for females in low-
mortality nations, such
as Japan and Sweden.
(Vaupel and Jeune,
1995) http://www.flickr.com/photos/iain_ritchie/2739823588/
sizes/z/in/photostream/

9. Number of people currently alive
who can expect to see their 100th
birthday, by age in 2010

10. Public policy seems oblivious to the
growth
• Opportunity Age: did not mention
centenarians (2005)
• Lifetime Homes, Lifetime Neigbourhoods:
Mention of centenarians in passing.
• Don’t Stop Me Now, Audit Commission
(2008). Mentioned that services for a 50 year
old may be different to services for an 80
year old
• Building a Society for All Ages (2009) growth
in the number of centenarians as a reason
“why we need to go further”

11. But are the predictions right?
In Population Trends, 1999,
Thatcher projected a rise in
the number of centenarians to
95,000 by 2066 (Thatcher,
1999).
By 2010 the DWP and ONS
were projecting that there
would be at least 507,000
people in the UK aged 100 or
over in 2066.
http://www.flickr.com/photos/drs2biz/71468437/sizes/m/
in/photostream/

12. And are the numbers today right?

13. More than 230,000 Japanese
centenarians missing

14. The majority of centenarians are
female
In 2003, among the oldest old
there were 257 women for
every 100 men.
(Tommassini2005).
Between 2001 and 2006,
the number of men aged
between 90 and 99
increased by 24 per cent
whereas for women the
increase was just over 8%
(Dini and Goldring. 2008).

15. And they live in Southern England
In the UK, a higher
concentration of
the oldest old live
in Southern
England and a
lower proportion in
urban areas and
Northern Ireland. http://www.flickr.com/photos/lawrence_chernin/5716015430/sizes/z/in/phot
(Tomassini C, ostream/
2005)

16. Life is not easy for the oldest old
• Three quarters of the oldest
old suffer from limiting
longstanding illnesses, and
one out of three perceive
themselves as being in poor
health. (Tomassini C, 2005) http://www.flickr.com/photos/pondspider/4170
• “almost 50% of men and
990903/sizes/m/in/photostream/
women aged 80-84 report
severe limitations in
activities” (IFS, 2010)

17. And many find it difficult to do day to
day tasks
Sixty per-cent of over 90s
report difficulties shopping
for groceries, almost a
quarter report difficulties
http://www.flickr.com/photos/pinkchoc
making telephone calls and olate/3039589789/sizes/m/in/photostr
eam/
35% report difficulties
managing money. (Sinclair,
2010/ELSA)

18. But dependency is not inevitable
Dependency is not
inevitable and a
”considerable
proportion of the
centenarians maintain
a good level of auto http://www.flickr.com/photos/driever/5525684658/sizes/m/in/ph
sufficiency for the otostream/
basic performance of
the everyday life”.
(Antonini et al, 2008)

19. And some of the oldest old become
more active

20. Many live independently
• Substantial numbers of centenarians and
nonagenarians continue to live
independently in the community, either
alone or with family members.
• 8% of those aged 90 and over were living
in privately rented accommodation and
30% in socially rented accommodation.
2009 Understanding Society

21. Proportion living in communal
establishments

22. A relatively high proportion live alone
Of those living in private
households, four in ten
very old men and seven
out of ten very old
women live alone. One
out of five very old
people live in communal
establishments.
(Tomassini C, 2005).
http://www.flickr.com/photos/sbeebe/515416979
5/sizes/m/in/photostream/

23. And the proportion living alone is
growing.
Over the last 20 years
there has been a
significant increase in the
proportion of the oldest old
living alone. The likelihood
of the oldest old men living
alone has grown by one-
third for men and one
quarter for women.
http://www.flickr.com/photos/driever/55256846
(Tomassini C, 2006). 58/sizes/m/in/photostream/

24. Many, but not all, have adapted their
homes
Research finds that the oldest old are much
more likely than other ages to have had
made adaptations to their homes. For
example. 40% of over 90s have had hand
rails installed (compared to 16% of all over
50s), 41% had bathroom modifications
(compared to 15% of all over 50s), and 24%
are likely to have an alerting device
(compared to 6% of the over 50s). (Atkinson
and Hayes (2010).

25. Centenarian as a model for healthy
ageing
A substantial number of
centenarians remain physically
healthy and cognitively intact into
the last years of their lives.
Health and functional status of
centenarians shows they are
healthy and independent for most
of their lives and experience a
relatively rapid terminal decline”.
http://www.flickr.com/photos/jess
e55lv/455360558/sizes/m/in/phot
ostream/
(Hitt et al, 1999).

26. Self reported health is pretty
good?
(Just?) One in of three of
the oldest old perceive
themselves as being in
poor health. (Tommassini
C, 2005).
“despite substantial levels http://www.flickr.com/photos/animm/4333568373/sizes/m
/in/photostream/
of disease and
impairment”. Collerton,
Davies and Jagger (2010)

27. Most centenarians consult their GP
98% of
centenarians and
near centenarians
consulted a GP
and received
prescription
medicine during
follow up.
(Roughead,
Kalisch et al, http://www.flickr.com/photos/rwjensen/2288339230/sizes/m/in/photostrea
2010) m/

28. Centenarians do use drugs heavily
A study of 602 centenarians in Italy found that a
very high proportion of this age group were
users of drugs. They identified just 5% of this
group who did not take any drugs. 13% of
participants took one drug a day, 16% took 2
drugs per day, 65% took three drugs a day, and
5.5% took more than 3 drugs a day.

29. Some evidence of longer hospital stays
26 centenarians who had suffered from a hip
fracture between 2000 and 2007 and compared
them to a randomly selected control group of 50
hip fracture patients aged between 75 and 85. “the
mean stay in acute orthopaedic wards for
centenarians was 20.7 days and for the control
group was 14.9 days”. They suggested that the
longer acute hospital stay in our centenarian cohort
would amount to a mean extra cost of £ 2511 per
patient. (Verma et al)

30. Dementia among centenarians
The prevalence
of dementia-free
survival past
100 years of
age varied
between 0 and
50 percent.”
http://www.flickr.com/photos/thousandshipz/4679235/sizes/m/in/photostream/

31. Depression
• “23% of those aged 85 and
over had levels of depressive
symptoms indicative of
clinical relevance”
• “Almost 13% of men and
women aged 80 and over
had high levels of depressive
symptoms in 2008-09 but not
in 2002-03” (IFS, 2010) http://www.flickr.com/photos/junglearctic/
3002442666/sizes/m/in/photostream/
ELSA

32. Falls
• 60% of interviewees aged over 90 had had
a fall and that of these, 4 in five were
unable to get up after at least one fall and
almost a third had lain on the ground for
an hour or more.
• Call alarms were widely available but not
used.
(Fleming and Brayne, 2008; Cambridge City
over 75-Cohor. BMJ)

33. OAP recovering after getting trapped
in bath for 5 days

34. Poverty is a very real challenge
• There is evidence that the oldest old (aged
85 and over) are, as a group, at greater
risk of poverty than younger older people
(aged 65-85) (National Equality Panel,
2010).
• Up to 10% of the oldest old have total net
wealth of £3,000 or less (Banks and Tetlow,
2009).
• Yet, over 61% of over 90s report that they
never have too little money to spend on
their needs. (Sinclair, 2010)

35. Their family carers are likely to be
older
The advanced age of
centenarians means that
family caregivers are also
likely to be relatively old.
Younger cohorts of retired
people (50-74 years) often
provide care for their very
old relatives and, even if
untrained and unmonitored,
have a significant role as
caregivers (Richmond,
2008).

36. Quality of Life falls with age

37. Quality of life for oldest old – getting
worse?
“longitudinal analyses
comparing 2002-03 and
2008-09 show that most
of the oldest old
experienced a substantial
decrease in quality of life
over the period. Just over
10% experienced a
substantial improvement
of 5 or more points” (IFS,
2010) http://www.flickr.com/photos/anabadili
/2963913137/sizes/m/in/photostream/

38. Recommendations
• Energy companies to ensure that their oldest
customers access the best deals
• Employers to ensure that they find ways to
provide flexible working to ensure that caring
responsibilities do not pull people out of the
workforce early.
• The Government should introduce a care
voucher scheme for adults, similar to childcare
vouchers, which would allow people of all ages
to buy care vouchers to support the needs of
older adults. This may help older carers of
centenarians stay in the workplace longer.

39. Recommendations
• Significant development of the evidence base
about centenarians in order to inform current
and future ageing strategies.
• Policy-makers to take a more holistic
approach to designing interventions that
integrate health, care and housing solutions.
• Developers to plan for growing numbers of
centenarians through ensuring that housing
and neighbourhoods are better designed
and/or adequately adapted to meet the needs
of a growing centenarian population

40. David Sinclair
International Longevity Centre UK
davidsinclair@ilcuk.org.uk
@sinclairda
@ilcuk