1. Physical and Cognitive Functioning at the Frontier of the Human Life Span: A Longitudinal Analysis from the Heidelberg Centenarian Study Christoph Rott & Dagmara Wozniak REVES 2006, Amsterdam, 29-31 May 2006

2. Christoph Rott Theoretical Background  Compression of morbidity – an accepted paradigm (J. Fries, 1980, 2000; Hubert et al., 2002; Mor, 2005).  Implies that terminal developmental processes superimpose age-related changes in old age.  Very old age – emergence of frail populations combined with a new expansion of morbidity (Robine & Michel, 2004; B. Fries et al., 2000).  There are no studies that have investigated the compression – expansion debate with very old individuals like centenarians.

3. Christoph Rott Aims 1. To describe developmental changes in very old individuals' (centenarians) physical health and cognitive status when approaching death. 2. To examine interindividual differences in intraindividual change at the ultimate end of the human life span. 3. To evaluate whether developmental changes are linear or accelerated ("compressed").

4. Christoph Rott Database  Population-based Heidelberg Centenarian Study  81 women, 10 men (n = 91)  Age at T1: M = 100.2 years (range 99.2 to 101.1)  80% widowed  69% elementary school  48% in institutions  83% received nursing care from the German Long-term Care Insurance.

5. Christoph Rott Design  Face-to-face assessment plus proxy informants and interviewer rating at Time1 and Time2 (1.5 years after Time1)  Proxy evaluation of physical health and cognitive status by phone one year after Time1 and every six months after Time2 until death of centenarian  All assessments after T2 by same researcher, but proxies may have changed.  This study: 84 decedents (74 women, 10 men)  Age at death M = 101.7 years (range 99.6 to 105.3  Mean number of data points 3.5 (range 1 to 10)

6. Christoph Rott Instruments 1. Physical Health Rating Scale (Fillenbaum, 1988): Ranging from "1" (in excellent psychical health) to "6" (totally physically impaired). kappa =.95 based on 20 double coded cases. 2. Global Deterioration Scale (Reisberg et al., 1982): Rating of cognitive status on a scale ranging from "1" (no cognitive impairment) to "7" (very severe cognitive impairment). kappa =.93 based on 20 double coded cases.

7. Christoph Rott Survival Function Estimate

8. Christoph Rott Phenomenology of Death (n = 84) 46 %: death due to frailty (continuous decline in all domains of functioning, no obvious disease) 29 %: death as a consequence of a diagnosed disease (e.g., inflammation of the lungs, tumors, infarction) 23 %: sudden and unexpected death 2 %: no information on death

9. Christoph Rott Physical Health

10. Christoph Rott Physical Health: Age-Related Trajectories

11. Christoph Rott Physical Health: Death-Related Trajectories

12. Christoph Rott Physical Health: Changing Proportions 0 10 20 30 40 50 60 70 -2.0-1.75-1.5-1.25-0.75-0.50-0.25Death Distance to Death in Years Percent Good Health Moderate Health 55% 25% 20% 68% 26% 6% Bad Health

13. Christoph Rott Physical Health: Linear vs. Accelerated Decline 0.41 0.93 0.82 Change point at 1.75 years prior to death

14. Christoph Rott Cognitive Status

15. Christoph Rott Cognitive Status: Age-Related Trajectories

16. Christoph Rott Cognitive Status: Death-Related Trajectories

17. Christoph Rott Cognitive Status: Changing Proportions 0 10 20 30 40 50 60 -2.0-1.75-1.5-1.25-0.75-0.50-0.25Death Distance to Death in Years Percent Good Cognition 40% 32% 28% 21% 24% 55% Bad Cognition Moderate Cognition

18. Christoph Rott Cognitive Status: Linear vs. Accelerated Decline 0.36 1.06 0.60 Change point at 0.75 years prior to death

19. Christoph Rott Summary and Conclusions Compression of morbidity exists for SOME but not all centenarians. A number of centenarians seem to be able to postpone the terminal drop of functioning into the last year of life or even to avoid it. Different patterns exit: very steep decline in the last year of life, moderate decline over 2 or 3 years, and stability on EVERY level. Expansion of morbidity exists too. Decline in health is more pronounced than decline in cognition. Accelerated decline starts earlier and is less pronounced in health compared to cognition.

20. Christoph Rott Next Steps Identify patterns of change for physical health and cogn. status with appropriate methodology (latent class models, Mplus) Identify combined patterns: Do physical health and cognitive status travel together or apart? Find predictors that separate the groups of individuals. Results will be presented at REVES XIX.