Determinants of functional status in healthy Italian nonagenarians and centenarians: a comprehensive functional assessment by the instruments of geriatric practice.
OBJECTIVE
To evaluate the physical ability and psychocognitive status of a population more than 90 years of age with regard to sociodemographic, behavioral, and biomedical variables known to affect functional status in old age.


METHODS
A survey design was used.


METHODS
Emilia Romagna, Northern Italy.


METHODS
Eighty-four healthy community-dwelling subjects aged 90 to 106 years.


METHODS
Sociodemographic variables, health behavior, anthropometric indices, and serum DHEAS levels were recorded. Functional assessment was performed by instruments currently used in geriatric practice: the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Activities of Daily Living (ADL) scale. A stepwise multiple regression analysis was performed.


RESULTS
GDS scores correlated directly with MMSE scores and inversely with ADL severity scores. Poor education, institutionalization, sensory impairment, muscular mass loss, and lower DHEAS levels were the variables with the highest correlation to functional impairment. Smoking, alcohol consumption, and marital status were relatively unimportant. An inverse association was found between DHEAS levels and dependency scores of single ADLs (continence, mobility).


CONCLUSIONS
Impaired cognitive and physical ability with no increase in depression prevalence was found in a sample of subjects more than 90 years of age free of major age-related disease. Muscular mass and DHEAS levels seem to play a role in maintaining physical independence. In turn, physical independence, as well as social and cultural factors, strongly affect the compliance of long-lived subjects with psychocognitive tests currently used in the clinical evaluation of younger old people, suggesting that these instruments are not reliable for screening for cognitive impairment and depression in the oldest old subjects.
Ravaglia
G
G
Institute of Medical Pathology I, St. Orsola Hospital, Bologna, Italy.
Forti
P
P
Maioli
F
F
Boschi
F
F
Cicognani
A
A
Bernardi
M
M
Pratelli
L
L
Pizzoferrato
A
A
Porcu
S
S
Gasbarrini
G
G
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D003687:Dehydroepiandrosterone / Q000097:blood; D003863:Depression / Q000175:diagnosis; D005260:Female; D015577:Geriatric Assessment; D015438:Health Behavior; D006801:Humans; D007558:Italy; D008297:Male; D008609:Mental Status Schedule; D011237:Predictive Value of Tests; D012044:Regression Analysis; D015203:Reproducibility of Results; D012959:Socioeconomic Factors
D003687:Dehydroepiandrosterone