The Georgia Centenarian Study

Transcription

A Study of Longevity and Survival of the Oldest Old
1988 - 2007
The University of Georgia
In Collaboration with The University of Georgia, Boston University,
Duke University, Emory University, Iowa State University, Louisiana State
University, Rosalind Franklin University of Medicine and Science, University of
Kentucky and University of Michigan.
Funded by the National Institute on Aging
Principal Investigator, Dr. Leonard W. Poon, with Mrs. Inez Wilson, a member of the Georgia
Centenarian Study, on her 106th birthday. Mrs. Wilson survived to 108 years.
Cover Art: The collage of pictures on the cover depicts the diversity of the oldest old population from
around the world.
1
Message from the Principal Investigator
Leonard W. Poon, Ph.D.
The purpose of this brochure is to share information about the Georgia Centenarian Study, a study
that began in 1988 and is currently funded until 2007. The Study evolved from the 1988 National Institute
of Mental Health funded study of “expert survivors” --- those individuals over 100 years who were community-dwelling and cognitively intact --- to our currently National Institute on Aging funded population-based
program project of centenarians in northern Georgia. Since the inception of our research, the study has been
multi-disciplinary and multi-institutional, collaborating with colleagues from different departments and institutions. The combined expertise of colleagues from a variety of research universities made this research
exciting and possible. The following is a table of contents of information contained in this brochure.
Why do we want to study centenarians? An introduction of the Georgia Centenarian Study
The Three Phases of the Georgia Centenarian Study
Phase 3: Our Current Study (2001-2007)
Project 1: Genetic contributions to longevity
Project 2: Neuropathology of dementia in centenarians
Project 3: Neuropsychological correlations of functional capacity
Project 4: Resources and adaptation in centenarians
Core A: Administrative core
Core B: Sampling and subject ascertainment core
Core C: Recruitment and data acquisition core
Core D: Cell, blood, and DNA core
Core E: Data management and statistical analysis core
External Advisory Committee
Publication list from Phases 1 and 2
Left: The principal investigator visited with a village elder.
Right: The principal investigator enjoyed lunch with a 102-year old centenarian (middle) and Dr. Nobuyashi Hirosi (left) of the Tokyo Centenarian
Study in Sunchang County, South Korea.
2
3
6
14
15
16
18
19
20
21
23
24
25
26
2
Why do we want to study centenarians?
An introduction to the Georgia Centenarian Study
Perhaps the most compelling reasons are found in the October 1999 draft of the National Institute
on Aging (NIA) Draft Strategic Plan for Fiscal Years 2001-2005. This document pointed to the remarkable
growth of the older population which poses both opportunities and challenges. One of these opportunities
is that unprecedented numbers of elders in the coming decades will face the risks of disease, frailty, and
dependence. The population at the highest risk is the oldest of the old who are increasing at the fastest rate
among those who are 65 years and older (Jeune, 1995; Kannistof, Lauritsen, Thatcher, & Vaupel, 1994;
Vaupel et al., 1998).
Centenarians by definitions are survivors who have lived to at least 100, which is more than 20 years
longer than the average life span. Contrary to the general picture of a frail individual at the end of life, we
have found that 20 to 25% of centenarians are community-dwelling, cognitively intact, and generally vibrant and full of life (Poon, Clayton, Martin, Johnson, Courtenay, Sweaney, Merriam, Pless, & Thielman,
1992). On the other hand, at least 50% of the centenarians have some form of dementia. As expected, 60 to
70% have a disability and some are completely dependent (Franke, 1977, 1985, 1987) (Hagberg, Poon, &
Homma, 2001). At the extreme longevity of the human species, centenarians represent the ultimate range
of independence and dependence, frailty and strength. The challenge is that there is much to be learned
from centenarians about survival, disease, frailty, and independence to promote health and independence
for all who hope to maintain a successful quality of life in older adulthood.
A fundamental challenge is to understand how centenarians live longer and what specific biological, psychological, and sociological characteristics they possess that would allow them to survive longer
(Lehr, 1991; Poon, Bramlett, Holtsberg, Johnson, & Martin, 1997). Another basic challenge is whether
we could generalize the knowledge gained in our volumes of aging research to individuals of average life
span which is in their 70s (e.g., the MacArthur Study) to individuals who live 20 to 30 years longer (Rowe
& Kahn, 1998). While studies of centenarians and the oldest old remain a rarity within gerontological research, interest in this area has increased steadily over the past 20 years (Vaupel et al., 1998; Lehr, 1991;
Poon et al., 1997). Recently completed studies conducted in the United States (e.g. Poon et al., 1992;
Perls, 1997), Japan (e.g. Chan, Suzuki, & Yamamoto, 1997), Italy (e.g. Capurso et al., 1997), Hungary
(e.g. Regius, Beregi, & Klinger, 1994), France (e.g. Allard et al., 1994), Sweden (e.g. Samuelsson et al.,
1997), Finland and Denmark (e.g. Jeune, 1994b) have provided a foundation for further hypothesis testing. Centenarian studies have identified a number of characteristics associated with extreme longevity.
For example, food preferences (Fischer, Johnson, Poon, & Martin, 1995), marital status (Samuelsson et
al., 1997), personality and coping strategies (Martin et al., 1992), levels of family support (Capurso et al.,
1997), and education (Poon et al., 1992; Ravaglia et al., 1997) have all been linked with successful late-life
aging.
However, the robustness of these findings awaits further research owing to variations from different centenarian studies in samples, subject selection and research methods. For example, the first two
phases of the Georgia Centenarian Study (1988 – 1998) examined community-dwelling and cognitively
intact centenarians whom are estimated to be about 20 to 30% of the centenarian population. The findings
await generalization to the other 70% of centenarians and research on predictors that could differentiate
functional differences among centenarians. This is one of the goals of our current phase III program project
(2001 – 2007).
3
The Three Phases of the Georgia Centenarian Study
We have been most fortunate to have funded three different phases of our research.
Phase 1 (1988-1992) was a cross-sectional study examining unique adaptational characteristics of community-dwelling and cognitively-intact centenarians, octogenarians, and sexagenarians in Georgia. This was
a collaboration among The University of Georgia, Medical College of Georgia, and Iowa State University
and funded by the National Institute of Mental Health (NIMH). Leonard W. Poon, Peter Martin, and Mary
Ann Johnson were in co-principal investigators with collaborations with many colleagues, students, and
staff across the three universities. In this study, we compared “expert survivors” (who are cognitively intact
and community dwelling centenarians) with “master survivors” (who are octogenarians with similar cognitive and community dwelling characteristics) and sexagenarians.
Figure 1. The Georgia Centenarian Study General Conceptual Model shows
the conceptual model of the study. Briefly, we tested hypotheses of the direct
and indirect effects of family longevity, environmental support, individual
characteristics, adaptational abilities, nutrition, mental and physical health on
perceived morale and quality of life of the three age groups.
Phase 2 (1992-1998) was a study to evaluate stability and changes of the three groups over time. This
study was also funded by NIMH.
Phase 3 (2001-2007) is a program project designed to identify and isolate longevity genes, neuropathology,
functional capacity, and adaptational characteristics of a population-based sample of centenarians and controls in 44 counties in Northern Georgia. This program project is a collaboration among The University
of Georgia, Boston University, Duke University, Emory University, Iowa State University, Louisiana State
University, Rosalind Franklin University of Medicine and Science, University of Kentucky and University
of Michigan and is funded by the NIA.
4
Selected Findings of the Georgia Centenarian Study
The following are selected key findings generated from 1988 to the present based on the data collected
in Phases I and II of our study:
(1) Health and Health Habits: Consistent with the findings from the Alameda County Study (Breslow &
Breslow, 1993) and the Harvard College Alumni Study (Paffenbarger et al., 1994), the Georgia centenarians tended to practice health habits that were found to prolong life (Nickols-Richardson, Johnson, Poon,
& Martin, 1996a; Johnson, Houston, Fischer, Poon, & Martin, 1995). That is, few smoked, were obese,
or consumed excessive alcohol. They remained active throughout life and ate breakfast on a regular basis. Compared to cohorts in their 60s and 80s, centenarians tended to escape contracting chronic diseases
during their lifetime.
(2) Dietary Habits: The intake of most nutrients were similar among 60-, 80-, and 100-year old community-dwelling groups with few exceptions (Fischer et al., 1995; Williams, Johnson, Poon, & Martin,
1995; Johnson, Brown, Poon, Martin, & Clayton, 1992). Centenarians consumed about 20 – 30% more
carotenoids and vitamin A from foods. They also consumed breakfast more regularly and avoided weight
loss diets and large fluctuations in body weight. Lastly, centenarians tended to consume more whole milk,
less 2% milk and yogurt, and were less likely to avoid dietary cholesterol.
(3) Cognition and Intelligence: Comparing cognitively-intact centenarians with younger cohorts, centenarians showed poorer performances in most cognitive functions except for everyday problem-solving
tasks (Holtsberg, Poon, Noble, & Martin, 1995; Poon et al., 1992). The magnitudes of age differences
were smaller in crystallized intelligence than in fluid intelligence. Education was shown to have a profound positive effect that mitigated the level of performance differences between subjects, especially
centenarians. It is interesting to note that the performances of centenarians who used their everyday experiences in problem-solving were found to be similar to the younger cohorts (Poon, et al., 1992). Cognition
accounted for about 20% of the variance in IADL for all subjects. When functional and mental health, as
well as social and economic resources, were included in the regression equation, the amount of IADL variance that could be predicted increased to 37%. These findings show that cognition, health, and resources
are all important predictors of everyday functions.
(4) Personality and Coping Styles: Centenarians were more dominant, suspicious, practical, and relaxed
than those in their 60s and 80s (Martin et al., 1992). Centenarians were less likely to use active behavioral
coping but were more likely to use cognitive coping behaviors when compared to octogenarians (Martin
et al., 1992). Centenarians were more likely to acknowledge problems than those in other age groups, and
they were less likely to seek social support as a coping strategy for their problems (Martin, Poon, & Johnson, 1995).
(5) Support Systems: Community-dwelling centenarians reported having fewer potential visitors. They
were less likely to talk on the telephone or have a spouse as a primary caregiver, but more likely to have
their children as caregivers and to receive help with food and meal preparation from family and friends
(Martin, Poon, Kim, & Johnson, 1996). However, they were just as likely as those in their 60s and 80s to
have a confidante, to have daily visitors and to have someone help them if they were sick or disabled.
5
(6) Mental Health: Compared to younger community-dwelling cohorts, centenarians tended to report
more somatic but not emotional symptoms. Although centenarians were found to have a higher level of
depression, measured by the Geriatric Depression Scale (Yesavage, Brink, Rose, & et al., 1983), compared
to younger cohorts, no clinical depression was found among the sample of community-dwelling centenarians. A comment on our findings on race difference is offered here. African-American centenarians had
significantly higher levels of depression and poorer self-perceived health than their Caucasian counterparts.
However, when education and income were taken into account, differences in self-perceived health were
eliminated and differences in mental health decreased but remained significant (Kim, Bramlett, Wright,
& Poon, 1998). This was found for all three age groups. This finding shows that concomitant measures
such as education, socio-economic background, and mental health are very important and could influence
survivorship and quality of life of the oldest old.
(7) Survival Analyses: These analyses were performed to ascertain which variables, if any, could predict
length of survival after an individual attained the age of 100 (Poon et al, 2000). While regression and
modeling analyses are currently being performed, our preliminary analyses have shown that five clusters of
variables show promise. They are: gender, family longevity, income and social support, anthropometrics,
and cognition.
(A) Women, on average, survived 1020 days after attaining 100 years. Men, on the other hand, survived an average of 781 days. The gender difference in survival in the first two years are not significantly different. However, the difference is significant after three years. The gender superiority for
women is quite glaring among centenarians.
(B) Fatherʼs age of death was found to exert a positive effect on the number of days of survival of
centenarians. No effect was found for motherʼs age of death.
(C) Three variables in social support seem to relate to length of survival among centenarians. They
are: talking on the phone, having someone to help, and having a caregiver for the centenarians. These
findings show that the availability of a support system is important to centenariansʼ survival.
(D) Three anthropometric measures were found to correlate positively to survival. They are: tricep
skinfold (an index of body fat), body mass index, and waist to hip ratio. These findings suggest that
once a person attains centenarian status, it is important to have sufficient nourishment to survive longer.
(E) Higher level of cognition after age 100 is positively related to longer length of survival. This was
found in the positive correlation with problem solving, learning and memory, and the WAIS performance measures of picture arrangement and block design.
Please visit http://www.geron.uga.edu for additional or related information.
6
Phase 3
(2001 – 2007)
Phases I and II of our study focused primary on behavioral and social science factors associated
with longevity and survival of cognitively-intact and community-dwelling centenarians, octogenarians,
and sexagenarians. Phase III expands our research to both community-dwelling and institutionalized centenarians in our population. We strive to study a population-based sample of centenarians. Further, we
expand our study to provide a balance of biomedical and psychosocial predictors of longevity and survival.
As this project is currently underway, we do not have results to share. However, we do want to share the
design and methods in the execution of this phase of our study.
The impetus of our current project came from the NIA Strategic Plan which articulated four major
goals that NIA will pursue in the years to come. The four projects being conducted in our current NIAfunded Program Project (2001 -2007) can contribute to the eventual realization of these goals:
Project 1 will test the viability of four homologues of yeast longevity genes. Findings from Project 1 can
contribute to the following NIA goals of (a) understanding healthy aging processes, (b) unlocking the secrets of aging, health, and longevity, and (c) identifying genes associated with aging, longevity, age-related
diseases, and behavior.
Project 2 will test hypotheses on relationships between senile plaque/neurofibrillary tangle counts, brain
infarcts, functional abilities, cognitive measures, the presence of dementia and markers of neurocognitive
reserves in centenarians. Findings from this Project can contribute to the NIA goal of characterizing normal
cognitive and brain function of the oldest-old.
Project 3 will test hypotheses on predictors of functional capacity, which has been shown to be an important determinant of utilization of health care resources, mortality, and institutionalization in the elderly.
This Project has the potential to contribute to a number of NIA goals, including the definition of biological
and environmental factors that maximize cognitive, sensory, and physical functions. This Project also aims
to take advantage of the core physical health information collected on sensory, musculoskeletal, blood
chemistry, mental health, and diseases of centenarians and their impact on functional capacity in comparison to control subjects in their 60s and 80s. This information can contribute to the dissociation of changes
of normal or usual aging from those of diseases and disorders.
Project 4 will test hypotheses of predictors that differentiate centenarians who are independent, healthy,
and experience a sense of well-being from those who are dependent, unhealthy (frail), and do not experience a sense of well-being. This Project can contribute to the NIA goal of identifying social, psychological,
and lifestyle factors that promote health, well-being, and longevity.
7
What This Phase 3 Program Project Will Accomplish:
This Program Project is a multi-disciplinary population-based study of centenarians in North Georgia. Our
long-term goal is to elucidate the roles of biological, psychological, and social factors that are pertinent to
the survival and functioning of this population. We propose to develop and employ probability sampling
frames to select representative samples of centenarians and of younger control populations residing in a set
of designated counties in Georgia.
Projects 1 and 2 will focus on biomedical aging mechanisms among centenarians and Projects 3 and 4 will
concentrate on psychosocial mechanisms. The specific aims are to:
• Assess the underlying genetic structure of our population and test initially the viability of four homologues of yeast longevity genes (LAG1Hs, PHB1Hs, c-H-ras1, and GRP78) to human longevity.
(Project 1)
• Test hypotheses on the relationship between advanced aging and cognitive impairment by evaluating
relationships among plaque/tangle counts, brain infarcts, functional ability, and cognitive measures on
those participants who are willing to donate their brains. (Project 2)
• Test hypotheses on neuropsychological, sensory, neuromuscular, blood chemistry, mental health, and
disease correlates of functional capacity among centenarians. (Project 3)
• Test hypotheses on the impact of distal (life events, past achievements) and proximal (individual,
social, and economic resources) influences on behavioral skills and developmental outcomes (levels
of adaptation) among centenarians. (Project 4)
How We Are Accomplishing the Goals:
The Program Project contains four projects that will focus on the same population of centenarians so that
hypothesis testing on the inter-relationships among biomedical and psychosocial factors could be maximized. Five cores are employed to support the four projects..
Projects
(1) Genetic Contributions to Longevity
(2) Neuropathology
(3) Neuropsychology & Cognition
(4) Developmental Adaptation
Cores
(a) Administrative
(b) Sampling & Subject Ascertainment
(c) Recruitment & Data Acquisition
(d) Cell, Blood, & DNA Bank
(e) Data Management & Analysis
8
The following figure shows the administrative structure of the Program Project and illustrates the synergistic relationships among the projects and cores:
Support Services Provided by the Cores: The cores are designed to sample, ascertain, recruit, collect and analyze data for all four projects. In so doing, we maximize the efficiency and economy in the
conducting of the Program Project.
Core A is the Administrative Core. It is the command and control center for the Program Project.
Core B provides the sampling frame and ascertains subjects for all four projects. Core C recruits and tests
all subjects for the projects. Core D (Cell, Blood, & DNA Bank) processes and distributes the blood for
analysis in Projects 1, 2 and 3. Core E is responsible for the input of data, archive, and analysis for all four
projects.
Basic Data Elements Shared Across Projects: Core elements will be collected by Core C across two
or more projects. These variables are employed to provide basic participant characteristics. Depending on
the project, more detailed information will be obtained beyond the basic profile; the information will be
used as covariates, classifying variables, or as predictor or outcome variables.
These descriptive variables are:
Demographics
Family longevity and history profile
Age, gender, race, education, martial status, county and place of
residence, previous occupations (used by all projects).
Age of death of mother, father, grandparents; number of siblings,
age of death of siblings, causes of death; locations of homes over
their lifetime; military service (used by Projects 1, 4)
9
Cognitive profile
Physical health profile
Mental health profile
Level of dependency profile
MMSE, Severe Impairment Battery, Global Deterioration Scale
(used by all projects)
Physical health profile ; medical history; medications; physical
exam of cardiovascular, respiratory, neurological and musculoskeletal systems; blood assay for status on liver, kidney, glucose
control, and endocrine status (used by all projects)
Medical history; medications; physical exam of cardiovascular,
respiratory, neurological and musculoskeletal systems; blood assay for status on liver, kidney, glucose control, and endocrine
status (used by all projects)
Geriatric Depression Scale, Cornell Scale for Depression in Dementia (used by Projects 3,4)
Physical and instrumental activities of daily living
(used by Projects 3,4)
Synergy Across Projects: Besides the sharing of basic data elements, the projects are designed to
contribute in assisting each other to better understand and account for the variability of mechanisms under
investigation.
Testing Centenarians: From our experience in recruiting and testing centenarians as well as experience reported by other centenarian studies (Franke, 1977; Franke, 1985), we expect about 20 to 30 percent
of the centenarians to be cognitively intact. Fifty percent will probably have dementia in varying levels of
severity, and 20 to 30% will most likely be bedridden and severely demented. This variability in levels of
cognitive abilities has a direct impact on all projects, as all centenarians in our population-based sample
will be tested. Therefore, performance or observational measures will be used whenever possible. To address this issue, the relationships among performance, self and informant report measures are addressed in
Study 1 of Project 3. Further, the relationship between informant and self reports is addressed in Project 4.
Functional capacity is measured by a performance test (Lowenstein et al., 1989) in which a zero (denoting
not able to perform) is a meaningful measure in Project 3. We have piloted the procedures in Project 3 with
either blind, bed-ridden, or demented elders and have adjusted the procedures accordingly. We realize these
measurement issues have not been adequately investigated for centenarians in the literature, and clarification of these issues is an important contribution of this Program Project.
Research Material Obtained
Depending upon a participantʼs level of involvement in the program project, information will be
obtained in each of 6 clusters of information: (1) Demographics; Family and Longevity History; (2) Cognition, Neuropsychology, and Neuropathology; (3) Physical and General Health; (4) Mental Health, Personality, Resources and Adaptation; (5) Functional Capacity and Independence; (6) Genetics, Blood Chemistry
and Nutrient Biomarkers.
A condition to enrollment in the program project for both the younger and centenarian cohorts is
willingness to donate a small blood specimen (20 ml) and consent to its use in genetic and other blood
assays. Centenarians who do not actually provide the blood specimens for the required purposes will not
progress in the data collection process beyond their initial enrollment and limited demographic and
10
cognitive screening. No additional compensation is provided for the blood specimen. All centenarian blood
draws will be conducted by a physician or nurse practitioner trained in geriatric venipuncture. Younger
control subject blood draws will be performed by licensed phlebotomists or nurse-practitioners.
Project 2 of the Program Project requires brain tissue donations from a subset of centenarian participants willing to prospectively consent to the donation of such tissue after their deaths. Willingness to
consent to donation of brain tissue and consent to participation in Project 2 is not a condition to participation in any of the other projects. No additional compensation is offered to centenarians for the brain tissue
donation. Brain tissue is not requested from the younger control subjects.
All data obtained from participants, including blood and tissue specimens, will be recorded by coded ID only; participantsʼ names and ID numbers will be protected, according to the guidelines established
by the Institutional Review Board.
Participant Recruitment and Informed Consent Plans
Recruitment will be performed by Core C, using the methodology and procedures therein described.
Although preliminary contact with centenarians will be attempted by telephone and mail, actual recruitment
will occur only in face-to-face sessions between the interviewers and the centenarian plus their caregivers/
immediate family members. All informed consent procedures will comply with the guidelines, procedures,
and scripts approved by the Institutional Review Board for each Project. This process includes detailed
discussion of the purposes of the study, procedures to be used, confidentiality of data, and videotaping of
test sessions.
For centenarian participants, joint consent procedures will be followed. Informed consents will be
read and executed by the participant as well as the caregiver legally authorized to provide such consent
under Georgia law. This is a sensitive area, legally and ethically. On the one hand there is the need to safeguard the presumption of autonomy and self-determination. On the other hand, there is the need to insure
that the consent is truly informed, and provided by an individual possessing legal capacity. Given the frail
nature of centenarians, and the prevalence of both sensorial impairments as well as cognitive impairments
in this population, we believe that the optimal resolution of this dilemma is through joint consent processes.
If EITHER a centenarian or their legally authorized caregiver objects to participation, at any stage of the
process, the wishes of the objecting party will be strictly honored. All procedures, instruments, and documents requiring execution have been approved by the University of Georgia Institutional Review Board as
well as the Institutional Review Board of each academic institution involved in a given project or core.
Schedule of Participant Testing
Data collection will begin in month 6 of the Program Project and run through month 48. This is the
amount of time required to recruit and test the number of centenarians and control subjects involved in the
projects. Each centenarian will be tested by appointment in their own residence. Five two-hour sessions
will be required to interview a centenarian completely. All five sessions will be completed within a 30 day
interval. In addition, centenarians who have provided consent for brain tissue donation, will be followed
longitudinally every 6 months until death with brief neurological exams performed at each follow-up appointment. Younger controls in the 80-89 age range will require approximately 3.5 hours of testing time,
which will be scheduled in 2 two-hour sessions. They will also be tested in their own residence by appointment. In addition, 400 controls from 20 to 59 years of age will be tested for Project 1.
11
Literature Cited
Allard, M., Lèbre, V., & Robine, J.-M. (1994). Les 120 ans de Jeanne Calment. Doyenne de lʼhumanite. Paris: Le Cherche
Midi Editeur.
Breslow, L., & Breslow, N. (1993). Health practices and disability: some evidence from Alameda County. Prev Med, 22(1),
86-95.
Capurso, A., Resta, F., Damelio, A., Gaddi, A., Daddato, S., Galletti, C., Trabucchi, M., Boffelli, S., Rozzini, R., Motta,
L., Rapisarda, R., Receputo, G., Mattace, R., Motta, M., Pansini, L., Masotti, G., Marchionni, N., Petruzzi, E., Bertolini, S.,
Agretti, M., Costelli, P., Mari, D., Duca, F., Ferrazzi, P., Bosi, E., Manzoni, H., Tomasello, F. B., Salvioli, G., Baldelli, M. V.,
Neri, M., Franceschi, C., Cossarizza, A., Monti, D., Varricchio, M., Gambardella, A., Paolisso, G., Baggio, G., DallaVestra,
M., Donazzan, S., Sangiorgi, G. B., Barbagallo, M., Frada, G., Passeri, M., Fagnoni, F., Sansoni, P., Senin, U., Cherubini, A.,
Polidori, M. C., Marigliano, V., Bauco, C., Cacciafesta, M., Forconi, S., Guerrini, M., Boschi, S., Fabris, F., Cappa, G., Ferrario, E., Giarelli, L., Cavalieri, F., & Stanta, G. (1997). Epidemiological and socioeconomic aspects of Italian centenarians.
Archives of Gerontology and Geriatrics, 25(2), 149-157.
Chan, Y. C., Suzuki, M., & Yamamoto, S. (1997). Nutritional status of centenarians assessed by activity and anthropometric,
hematological and biochemical characteristics. Journal of Nutritional Science and Vitaminology, 43(1), 73-81.
Fischer, J. G., Johnson, M. A., Poon, L. W., & Martin, P. (1995). Dairy product intake of the oldest old. Journal of the American Dietietics Association, 95, 918-921.
Franke, H. (1977). Gesundheitszustand und klinische Beobachtungen bei den Hundertjahrigen der Bundesrepublik Deutschland. (Trans: Centenarians in the Federal Republic of Germany: State of health and clinical observations). Schweizerische
Rundschau fur Medizin Praxis (Revue Suisse de Medicine Praxis), 66(36), 1149-1157.
Franke, H. (1985). Auf den Spuren der Langlebigkeit. Stuttgart: Schatthauer.
Grundy. (1998). The Epidemiology of Aging. In R. Tallis, H. Fillit, & J. Brockleshurst (Eds.), Brocklehurstʼs Textbook of
Geriatric Medicine and Gerontology (5th edition ed., pp. 3-34). Amsterdam: Elsevier Science Publishers.
Holtsberg, P. A., Poon, L. W., Noble, C. A., & Martin, P. (1995). Mini-Mental State Exam status of community-dwelling cognitively intact centenarians. International Psychogeriatrics, 7(3), 417-427.
Jeune, B. (1994b). Morbus centenarius or sanitas longaevorum? Population studies of aging Number 15. Odense, Denmark:
Center for Health and Social Policy. Odense University.
Jeune, B. (1995). In search of the first centenarians. In B. Jeune & J. W. Vaupel (Eds.), Exceptional longevity: From prehistory
to the present. (Odense Monographs on Population Aging 2) . Odense, Denmark: Odense University Press.
Johnson, M. A., Brown, M. A., Poon, L. W., Martin, P., & Clayton, G. M. (1992). Nutritional patterns of centenarians. International Journal of Aging and Human Development, 34(1), 57-76.
Johnson, M. A., Houston, D. I., Fischer, J. G., Poon, L. W., & Martin, P. (1995). Georgia Centenarian Study: Physical health
and functional status. Unpublished manuscript.
Kannisto, V. (1994). Development of oldest-old mortality, 1950-1990: Evidence from 28 developed countries Mongraphs on
population aging. No. 1. Odense, Denmark: Odense University Press.
Kannisto, V., Lauritsen, J., Thatcher, A., R., & Vaupel, J. W. (1994). Reductions in mortality at advanced ages: Several decades of evidence from 27 countries. Population and Development Review, 20(4), 793-810.
Kim, J., Bramlett, M. H., Wright, L. K., & Poon, L. W. (1998). Racial differences in health status and factors that influence
health behaviors in older adults. Nursing Research, 47, 243-250.
Lehr, U. (1991). 100-Years-Old - a Contribution On the Research of Longevity. Zeitschrift Fur Gerontologie, 24(5), 227-232.
Lowenstein, D. A., Amigo, E., Duara, R., Guterman, A., Hurwitz, D., Berkowitz, N., Wilkie, F., Weinberg, G., Black, B., Gittelman, B., & al., e. (1989). A new scale for the assessment of functional status in Alzheimerʼs disease and related disorders.
Journals of Gerontology, 44, 114-121.
Manton, K. G., & Vaupel, J. W. (1995). Survival after the age of 80 in the United States, Sweden, France, England, and Japan.
New England Journal of Medicine, 333, 1232-1235.
Martin, P., Poon, L. W., Clayton, G. M., Lee, H. S., Fulks, J. S., & Johnson, M. A. (1992). Personality, life events and coping
in the oldest-old. International Journal of Aging and Human Development, 34(Special Issue 1), 19-30.
Martin, P., Poon, L. W., & Johnson, M. A. (1995). Predicting autonomy in the oldest-old. Paper presented at the European
Congress of Psychology, Athens, Greece.
Martin, P., Poon, L. W., Kim, E., & Johnson, M. A. (1996). Social and psychological resources of the oldest old. Experimental
Aging Research, 22, 121-139.
Myers, R. J. (1966). Validity of centenarian data in the 1960 census. Demography, 3, 470-476.
Nickols-Richardson, S. M., Johnson, M. A., Poon, L. W., & Martin, P. (1996a). Demographic predictors of nutritional risk in
elderly persons. Journal of Applied Gerontology, 15, 262-276.
Paffenbarger, R. S., Jr., Kampert, J. B., Lee, I. M., Hyde, R. T., Leung, R. W., & Wing, A. L. (1994). Changes in physical
12
activity and other lifeway patterns influencing longevity. Med Sci Sports Exerc, 26(7), 857-865.
Perls, T. T. (1997). Centenarians prove the compression of morbidity hypothesis, but what about the rest of us who are genetically less fortunate? Medical Hypothesis, 49, 405-407.
Poon, L. W., Bramlett, M. A., Holtsberg, P. A., Johnson, M. A., & Martin, P. (Eds.). (1997). Who will survive to 105? Chicago:
Encyclopedia Brittanica, Inc.
Poon, L. W., Clayton, G. M., Martin, P., Johnson, M. A., Courtenay, B. C., Sweaney, A. L., Merriam, S. B., Pless, B. S., &
Thielman, S. B. (1992). The Georgia Centenarian Study. International Journal of Aging & Human Development, 34(1), 1-17.
Ravaglia, G., Morini, P., Forti, P., Maioli, F., Boschi, F., Bernardi, M., & Gasbarrini, G. (1997). Anthropometric characteristics
of healthy Italian nonagenarians and centenarians. British Journal of Nutrition, 77(1), 9-17.
Regius, O., Beregi, E., & Klinger, A. (1994). Verwandten-, angehörigen- und pflegerkontakte der hundertjahrigen in Ungarn
[Extended family, immediate family and caregiver contacts of 100-year-old patients in Hungary]. Zeitschrift für Gerontologie,
27(6), 456-458.
Rodgers, W. L. (1996). Comparisons of two sampling frames for surveys of the oldest old. (DHHS Publication No.(PHS)961013 ed.): Centers for Disease Control, National Center for Health Statistics, Public Health Service, U.S. Department of
Health and Human Services.
Rosenwaike, I. (1985). The extreme aged in America: A Portrait of an Expanding Population. Westport, Conn.: Greenwood
Press.
Rowe, J. W., & Kahn, R. (1998). Successful Aging. (First ed.). New York, NY: Pantheon Books.
Samuelsson, S. M., Alfredson, B. B., Hagberg, B., Samuelsson, G., Nordbeck, B., Brun, A., Gustafson, L., & Risberg, J.
(1997). The Swedish centenarian study: A multidisciplinary study of five consecutive cohorts at the age of 100. International
Journal of Aging & Human Development, 45(3), 223-253.
Vaupel, J. W., Carey, J. R., Christensen, K., Johnson, T. E., Yashin, A. I., Holm, N. V., Iachine, I. A., Kannisto, V., Khazaeli, A.
A., Liedo, P., Longo, V. D., Zeng, Y., Manton, K. G., & Curtsinger, J. W. (1998). Biodemographic Trajectories of Longevity.
Science, 280 (May 8), 855-859.
Williams, L. A., Johnson, M. A., Poon, L. W., & Martin, P. (1995). Oral health and demographic risk factors for poor nutrient
intake in the elderly. Age & Nutrition, in press.
Wilmoth, J., Skytthe, A., Friou, D., & Jeune, B. (1996). The oldest man ever? A case study of exceptional longevity. The Gerontologist, 36(6), 783-788.
Zarit, S. H. (1998). Very Late Life: the Final Frontier. Aging and Mental Health, 2, 85-86.
13
Project 1
Genetic Contributions to Longevity
Abstract
Life maintenance in extreme old age is the problem we address by initiating a genetic analysis of
human aging using a novel approach. Associative genetics constitutes the first tool applied, but the candidate genes that will be analyzed have already passed the muster of causal connection to the aging process
in genetic model organisms. The association of specific alleles of these genes with human longevity will
provide probes for the verification of longevity gene function at the molecular level and clues to the molecular mechanisms of aging. Our focus will initially be the genes LAG1Hs and c-H-ras-1, which have
been validated in yeast longevity studies, and the APOE locus. We will test the hypothesis, for each of
these genes, that certain alleles of a gene are more frequent in centenarians than in younger controls.
The research will be carried out in several steps. First, we will assess the underlying genetic structure of our population by searching for polymorphisms in these genes. Second, we will determine the level
of variation in the centenarian population compared to the control, in our candidate longevity selected (i.e.
replication in other longevous cohorts). We will also supply a panel of ethnic affiliation markers to control
for the confounding effects of population admixture. This analysis, in conjunction with the tests in other
populations, may suggest the existence of longevous haplotypes in the population, a possibility which will
be explored further. Finally, we will examine the functional significance of any allelic variants detected at
higher frequency in centenarians, using the yeast genetic model system. This will involve the determination of the effect on yeast longevity of corresponding mutations in the yeast gene. The embodiment of this
genetic study with its emphasis on metabolic control and stress responses and its accent on nervous system
function in the context of this Program Project with its nutrition, neuropathology, and neuropsychology
components will facilitate identification of genetic correlates, and the elucidation of features important for
maintenance of functional health in old age. Thus, these studies should help to improve the quality of life
in old age.
Project 1 Investigators
S. Michal Jazwinski, Ph.D.
Project Leader
Louisiana State University
Mark Batzer, Ph.D.
Senior Investigator
Louisiana State University
14
Project 2
Neuropathology of Dementia in Centenarians
Abstract
Many questions about the relationship between late-life aging and cognitive impairment are unanswered. It is not known which cognitive changes occur with age alone, and which are due to the presence
of undiagnosed brain diseases, such as Alzheimerʼs disease (AD) and cerebral infarcts (CVAs). Among
persons with the same degrees of neuropathological burden, what factors will influence the clinical expression of dementia? This project will explore these questions by gathering clinical, cognitive and neuropathological data from a sample of centenarians (individuals 100 years old or older).
The overall Program Project will identify and characterize a population-based, stratified sample of
242 centenarians from 44 northern Georgia counties. These subjects and their families will be asked to
agree to brain donation after death. If they agree, they will be recruited into this project and will undergo
standardized physical and cognitive examinations every 6 months thereafter until death. Then, following
death, brain tissue will be removed and examined. Procedures for clinical, cognitive, and neuropathological
evaluations will conform to those currently being used in NIH funded research on other aging populations:
the Nun Study and the Honolulu Asian Aging Study, adding to the diversity of subjects being studied with
these methods. In particular, based upon the racial and ethnic characteristics of the north Georgia centenarian population, the Program Project (and consequently this project) is expected to enroll a high proportion
of African-American subjects. Successful recruitment of African-Americans into this clinicopathological
project would be especially valuable, as this ethnic group has been underrepresented in previous clinicopathological studies.
The overall aim of this project is to explore relationships between the senile plaque/neurofibrillary
tangle counts, brain infarcts, functional abilities, cognitive measures, the presence of dementia and markers
of neurocognitive reserves in a racially and educationally diverse sample of centenarians. Clincopathological data will permit refinements of NIA-Reagan neuropathological criteria for AD in very elderly individuals.
Robert C. Green, M.D., MPH
Project Leader
Boston University
William R. Markesbery, M.D.
Senior Investigator
Univeristy of Kentucky
Marla Gearing, Ph.D.
Project Co-Leader
Emory University
David Snowdon, Ph.D.
Project Consultant
University of Kentucky
15
Project 3
Neuropsychological Correlates of Functional Capacity
Abstract
Two studies are proposed in Project 3 to measure, evaluate, and predict patterns of functional capacity in the oldest old. Study 1 is designed to examine profiles of age differences in functional capacity as
well as to test hypotheses regarding the convergent validity of the functional capacity measures. Study 1
will provide information on profiles of centenariansʼ functional capacity, including those who are visually
and hearing impaired and demented, as well as measurement issues (and problems) relating to functional
capacity. This information will be used in Study 2A on neuropsychological correlates of functional capacity. While global cognitive status (typically using the MMSE) has been investigated in several studies of
centenarians, little is known about the relationship between specific cognitive mechanisms and functional
capacity in centenarians. First, we aim to characterize BADL and IADL capacity in centenarians to identify functional areas that could be targeted for intervention. Second, we aim to examine the relationships
of specific neuropsychological mechanisms, especially motor-dependent and motor-independent executive
functioning, visuospatial abilities, and memory functioning with everyday functional capacities. If central
executive functions, visuospatial skills, and/or memory functioning could account for meaningful amounts
of variance in functional capacity, then this finding could have significance in dealing with remediation and
compensation strategies.
Study 2B will seek to determine whether and to what extent there are age-specific impacts of physical functioning, sensory impairment, depression, and specific cognitive abilities on levels of adaptive functioning. We will rely upon common data, in addition to data collected as part of other projects in our analysis. These include the sections from the physical examination on visual and hearing acuity, tactile acuity,
neuro-musculoskeletal functions, general cognitive functioning, depression and demographic information.
For our exploratory hypothesis testing, specific blood chemistry parameters, medication, and health history
will be employed. These common data will be combined with the data collected for this project. Results
will be analyzed using descriptive analyses and hierarchical multiple regression and structural equation
modeling.
Project Leader
University of Georgia
John L. Woodard, Ph.D.
Project Co-Leader
Rosalind Franklin University of Medicine and Science
Mary Ann Johnson, Ph.D.
Co-Investigator
Dorothy Hausman, Ph.D.
Co-Investigator
16
Project 3 Investigators (continued)
L. Stephen Miller, Ph.D.
Co-Investigator
M. Elaine Cress, Ph.D.
Co-Investigator
Lenette Burrell, R.N., M.S.N., Ed.D.
Co-Investigator
Merrill F. Elias, Ph.D.
Consultant
University of Maine
Ilene C. Siegler, Ph.D., MPH
Co-Investigator
Duke University
Zeb Burrell, M.D.
Co-Investigator
Joyce S. Tenover, M.D., Ph.D.
Co-Investigator
Emory Univesity
17
Project 4
Resources and Adaptation in Centenarians
Abstract
The primary objective of this research is to assess predictors that differentiate centenarians who are
independent, healthy, and experience a sense of wellbeing from those who are dependent, unhealthy (frail),
and do not experience a sense of wellbeing. The study will advance a model of centenarian adaptation that
builds upon and extends traditional stress-and-coping paradigms, emphasizing proximal resources (e.g.,
personality traits, social support, economic assets), as well as distal experiences (e.g., early life events and
past achievements). These proximal resources and distal experiences are hypothesized to influence five
differing levels of adaptation in centenarians: functional capacity, cognitive impairment, mental health,
economic dependency and psychological well-being.
Centenarians and their primary caregivers (“proxies”) will be recruited for this research. They will
participate in structured interviews that will assess the functional capacity and basic physical health, level
of cognitive impairment, mental health, economic costs and burden, psychological well-being, individual,
social, and economic resources, distal and proximal life events and individual achievements, and the behavioral coping skills of each participant.
The overall design includes three separate but interrelated levels. First, a configural frequency design and subsequent analyses are conceptualized to test for specific types and anti-types of adaptation in
centenarians. Second, ANOVA and logistic regression designs are conceived to test for group differences
in high and low functioning centenarian groups and to assess differences between centenarians and their
proxies. Finally, the direct and indirect effects of proximal and distal resources on the five adaptational
outcomes will be tested with LISREL analyses.
Peter Martin, Ph.D.
Project Leader
Iowa State University
Maurice MacDonald
Co-Leader
University of Heidelberg
Christopher Rott
Co-Leader
University of Heidelberg
Ilene Siegler, Ph.D., MPH
Co-Investigator
Duke University
18
Core A
Administrative Core
Abstract
The purpose of the Administrative Core is to ensure the smooth functioning of the Program Project
and to enhance collaboration among the Cores and Projects. This Core has five specific aims: (1) to provide overall scientific leadership; (2) to facilitate and coordinate communication and activities across Cores
and Projects; (3) to provide fiscal management (4) to coordinate the activities of the External Advisory
Board; and (5) to interface with other centenarian studies for research development. The Core Leader of
the Administrative Core and the Principal Investigator of the Program Project is Leonard W. Poon. Joyce
S. Tenover, M.D., Ph.D. serves as Biomedical Director and Dr. Poon serves as the Psychosocial Director
within the Administrative Core. An Executive Committee (Core and Project Leaders) participates in all
administrative and scientific decisions. An External Advisory Board evaluates the extant work and assists
in solutions to design, testing, and analysis issues during the project.
Core A Investigators
Core Leader
Psychosocial Director
Biomedical Director
Emory Univesity
Marie Durden
Project Administrator
Sara Crain
Asst. Project Administrator
19
Core B
Sampling Core
Abstract
The purpose of this core is to develop and direct sampling strategies for the Program Project. The
target population for this project is defined as consisting of all individuals who reach their 100th birthday
by the end of the year 2003 and, who at the time they are first contacted, reside within a geographic area defined by 44 counties of Georgia. The Sampling and Subject Ascertainment Core is responsible for sampling
individuals from both community-dwelling and institutional settings according to census estimates. Four
distinct samples, of sufficient total size to provide 242 centenarians who complete the full complement of
five data collection sessions, will be selected from that population and passed on to the Recruitment and
Data Acquisition Core. In addition, control samples will be developed of individuals in each of six age
groups ranging from 20 to 59 years for Project 1. Samples of those age 65-69 and 80-89 will be obtained
for Projects 3 and 4. A list of telephone numbers will be developed, using random digit dialing procedures,
in sufficient numbers to provide control samples of 100 respondents living within the same geographic area
and in each of the age ranges 20-29, 30-39, 40-49, and 50-59.
Core B Investigator
Willard L. Rodgers, Ph.D.
Core Leader
University of Michigan
20
Core C
Subject Recruitment & Data Acquisition
Abstract
The Subject Recruitment & Data Acquisition Core will recruit all subjects and acquire all data for
the program project. To do so, Core C will provide: (1) subject recruiter and subject tester training, certification and quality control; (2) instrumentation assembly across the projects into one standardized testing
battery; (3) subject recruitment for all individuals to be ascertained by Core B; (4) all stages of data collection for all subjects in procedural compliance with the standardized testing battery (including quality
assurance procedures), from and including informed consents, data collection, debriefings, compensation,
through mortality surveillance; (5) venipunctures and transfer of blood specimens to Core D (for processing and analysis); (6) videographic recordings of session conducted with centenarians and their caregivers,
supplemented by still photographs/slides; and (7) longitudinal follow-up of and data collection from all
centenarian subjects who by virtue of their enrollment in Project 2 have agreed to donate brain tissue after
their deaths. Data will be collected from 242 centenarians, 80 80-year-old controls, and 400 control subjects who are 20-59 years.
Core C Investigators
Core Leader
Sandra Reynolds, Ph.D.
Testing Team Manager
Zeb Burrell, M.D.
Co-Medical Director
Co-Core Leader
Biomedical Director
Emory University
Lenette Burrell, M.S.N., Ed.D.
Co-Medical Director
21
Core C Investigators (continued)
Kathy Shaw
Data Acquisition Team
Kim Grier
Kathy Shaw, R.N., M.S.N.
Molly Burgess
Lisha Strong
Erick McCarthy, Ph.D.
Libby Jackson, M.S.W.
22
Core D
Cell, Blood, & DNA
Abstract
The overall goal of the proposed project is to effectively manage the collection, processing, storage
and distribution of biological materials collected and derived from centenarians and control subjects participating in the program project study. Centralization of blood sample processing, storage and distribution
by this core laboratory will permit standardization of sample handling procedures, coordination of sample
distribution and control of sample inventories. These activities will help maximize the scientific benefit
obtained from the limited amounts of materials available from this unique study population.
Several projects may utilize different blood components from a single tube of blood if processed
properly, e.g., leukocytes for genetics and plasma for blood chemistry. In addition, processing blood samples for specific project needs will generate by-products that can be preserved and used for additional future
studies, e.g., red blood cells for isozome and mitochondrial DNA analyses. This type of efficiency could
not be easily achieved if blood samples were processed by individual project investigators. The laboratory
will also establish lymphoblastoid cell lines (LCLs) from peripheral blood specimens; maintain, expand,
and preserve cell lines; and harvest cells for DNA purification. LCLs will be cryopreserved in liquid N2
and recovered as needed to provide a renewable supply of DNA, RNA, and proteins. In most cases, the
short life expectancy of the centenarian study population will preclude re-sampling of study members beyond one or two years after the first sample is collected. The renewable supply of DNA from LCLs can be
used for follow-up studies of informative genotypes and for typing new candidate genes that may become
of interest during the proposed studies or in future studies related to the present investigations. Since LCLs
remain viable for many years if properly stored, these cells can also be used as living models for in vitro
studies of cellular processes, a feature not available with tissue and blood samples no matter how large.
Core D Investigators
Dorothy Hausman, Ph.D.
Core Leader
Co-Core Leader
23
Core E
Data Management & Statistical Analysis
Abstract
The Data Management and Statistical Analysis Core will provide each component of the Program
Project with expertise and comprehensive support in the areas of data management, study design, and statistical analysis. The proposed Program Project is composed of multiple interrelated studies, each collecting large quantities of information. This Core facility will supply the coordinated resources, services and
consultation essential for effective collaborative research.
This unit will perform data entry and management activities, including maintenance of data quality,
security, and confidentiality, as well as the linkages necessary for the integration of component contributions for collaborative research. It will assist with development of data collection instruments, institute data
verification procedures and participate in instrument validation and assessment of inter-observer variability. The Data Management and Statistical Analysis Core will be responsible for creation and maintenance
of all data files and timely generation of progress reports. Personnel of the Core will provide biostatistical
consultation and support, including assistance with study design, study implementation, planned methods
of analysis, and considerations of power and sample size. They will carry out statistical analyses of the data
from the various components of the Program Project, including both preliminary and exploratory analyses
and multivariate statistical modeling as required. Specific expertise residing within the Core which are
particularly germane to centenarian studies include genetic, survival, multivariate and longitudinal analysis. Unit personnel will thus assist Program Project investigators at every stage of research from the initial
conception through to the final analysis and presentation results.
Core E Investigators
Jonathan Arnold, Ph.D.
Core Leader
Jianliang Dai, Ph.D.
Post-Doctoral Fellow
Tina Savla, Ph.D.
Research Associate
Adam Davey, Ph.D.
Co-Core Leader
Megan Janke, Ph.D.
Research Associate
24
External Advisory Committee
Thomas G. Beach, M.D.,
Ph.D., F.R.C.P.C.
University of Arizona
Richard M. Cawthon, M.D.,
Ph.D.
University of Utah
James L. Fozard, Ph.D.
National Institute on Aging
(Retired)
Rebecca M. Mullis, Ph.D.
Not Pictured
Not Pictured
Gerda G. Fillenhbaum, Ph.D.
Duke University
John. R. Wilmoth, Ph.D.
University of California at
Berkeley
25
Publications of the Georgia Centenarian Study
1. Poon, L.W., Clayton, G., & Martin, P., et al. (1989). Individual similarities and differences of the oldest-old in the Georgia
Centenarian Study. The Gerontologist, 29, 43.
2. DasGupta, M.E., Martin, P., Johnson, M.A., Clayton, G., & Poon, L.W. (1990).
The interactional effects of age, race, and gender on health-seeking behavior: Findings from the Georgia Centenarian Study.
The Gerontologist, 30, 53.
3. Poon, L.W. (1990). Adaptational styles of the oldest old: A report of the Georgia centenarian
Study. The Gerontologist, 30, 274.
4. Brown, M.A., Johnson, M.A., Poon, L.W., Martin, P., Clayton, G., & Pless, B. (1991). Food and
nutrient intakes of the oldest old – the Georgia Centenarian Study. FASEB Journal, 5(5), A1299-A1299.
5. Johnson, M.A., Brown, M., Poon, L.W., Martin, P., Clayton, G., & Pless, B. (1991). Nutritional
Risk Index in the Oldest-Old – Preliminary findings
from the Georgia Centenarian Study. FASEB Journal, 5(5), A1448- A1448.
6. Poon, L.W. (1991). Identifying gender and ethnicity roles in health and adaptation of octogenarians and centenarians. Exp
Aging Res, 17(2), 89.
7. Poon, L.W., Clayton, G.M., & Martin, P. (1991). In her own words: Cecilia Payne Grove, 1989-1990. Generations, 15(1),
67-68.
8. Poon, L.W., Martin, P., Clayton G., & Johnson, M.A. (1991). Health and adaptation styles of centenarians. The Gerontologist, 31 ([Special Issue] II), 14.
9. Bowman, B.A., Rosenberg, I.H., & Johnson, M.A. (1992). Gastrointestinal function in the elderly. In Nestle nutrition workshop series, H. Munro, G. Schlierf (Eds.), Nutrition in the elderly 29, 43-50. NY: Raven Press.
10. DasGupta, M.E., Johnson, M.A., Olsen, S.F., Martin, P., Clayton, G., & Poon, L.W. (1992). A model of nutritional healthseeking behavior in older adults: Findings from the Georgia Centenarian Study. The Gerontologist, 32, 43.
11. Courtenay, B.C., Poon, L.W., Martin, P., Clayton, G.M., & Johnson, M.A. (1992). Religiosity and adaptation in the oldestold. International Journal of Aging and Human Development, 34(1), 47-56.
12. Holtsberg, P.A., Noble, C.A., Poon, L.W., Clayton, G.M., Martin, P., & Johnson, M.A. (1992). The sensitivity/specificity
dilemma: Recruitment of non-demented oldest-old subjects with the MMSE for the Georgia Centenarian Study. The Gerontologist, 32, 42.
13. Johnson, M.A., Brown, M., Poon, L.W., Martin, P., & Clayton, G.M. (1992). Nutritional patterns of centenarians. International Journal of Aging and Human Development, 34(1), 57-76.
14. Poon, L.W., Clayton, G.M., Martin, P., Johnson, M.A., Courtenay, B.C., Sweaney, A.L., Merriam, S.B., Pless, B.S., &
Thielman, S.B. (1992). The Georgia Centenarian Study. International Journal of Aging and Human Development, 34, 1-18.
15. Martin, P., Poon, L.W., Clayton, G.M., Lee, H.S., Fulks, J.S., & Johnson, M.A. (1992). Personality, life events and coping
in the oldest-old. International Journal of Aging &Human Development, 34(1), 19-30.
16. Poon, L.W. (1992). Epilogue – Ode to 3 Wise Men. International Journal of Aging and Human Development, 34(1), 87-89.
17. Poon, L.W., Martin, P., Clayton, G.M., Messner, S., Noble, C.A. (1992). The influences of cognitive resources on adaptation and old age. International Journal of Aging and Human Development, 34(1), 31-46.
18. Poon, L.W., Sweaney, A.L., Clayton, G.M., Merriam, S.B., et al. (1992). The Georgia Centenarian Study. International
Journal of Aging and Human Development, 34(1), 1-18.
19. Siegler, I.C., Longino, C., & Johnson C. (1992). The Georgia centenarian Study: Comments from friends. International
Journal of Aging and Human Development, 34(1), 77-82.
20. Clayton, G.M., Martin, P., Poon, L.W., Lawhorn, L.A., & Avery, K.L. (1993). Survivors of the century. Nursing & Health
Care, 14, 256-260.
21. Holtsberg, P.A., Poon, L.W., Rousseau, G.K., Lee, E.S., & Noble, C.A. (1993). Successful aging– a test of the selective
survival mortality crossover phenomenon hypothesis among Georgiaʼs black/white centenarians. The Gerontologist, 33, 85.
22. Martin, P., Poon, L.W., Johnson, M.A., & Clayton, G. (1993). Psychological changes among the oldest old: Compensating
for physical decline: The role of personality. The Gerontologist, 33, 148.
23. Merriam, S.B. (1993). Butlerʼs life review: How universal is it? International Journal of Aging and Human Development.
37(3), 163-175.
24. Pless, B.S., Clayton, G.M., Martin, P., & Poon, L.W. (1993). Physical health measurement of the older adult: New instrumentation. Journal of the American Academy of Nurse Practitioners, 5(3) 114-118.
25. Poon, L.W. (1993). Centenarians. In R. Kastenbaum (Ed.), The Encyclopedia of Adult Development (pp. 64). Phoenix:
The Oryx Press.
26. Poon, L.W., Johnson, M.A., Martin, P., & Clayton, G. (1993). Psychological changes among the oldest old: Adaptation
and decline. Compensating for instrumental activity of daily living decline: The role of intelligence. The Gerontologist, 33,
148.
26
27. Clayton, G.M., Dudley, W.N., Patterson, W.D., Lawhorn, L.A., Poon, L.W., Johnson, M.A., & Martin, P. (1994). The influence of Rural-Urban
Residence on Health in the Oldest-old. International Journal of Aging & Human Development, 38,
65-89.
28. Fischer, J.G., Johnson, M.A., Poon, L.W., & Martin P. (1994). Nutrient patterns of the oldest old. The Gerontologist, 34,
338.
29. Fischer, J.G., Johnson, M.A., Poon, L.W., & Martin P. & Clayton, G.M. (1994). Dairy product intake of centenarians and
other elderly persons. In P. Holtsberg & K. Pugh (Eds.), Georgiaʼs Centenarians: The quintessential positive models of aging?
The University of Georgia Gerontology CenterTechnical Report (UGAGC-94-01S). Athens, GA: The University of Georgia
Gerontology Center.
30. Fischer, J. G., Johnson, M. A., Poon, L. W., & Martin, P. (1995). Dairy product intake of the oldest old. Journal of the
American Dietetic Association 95, 918-921.
31. Holtsberg, P.A., Poon, L.W., Noble, C.A., Martin, P., & Rousseau, G.K. (1994). Centenarian cognitive performance as measured by the Folstein Mini-Mental State Exam: Is the cup half-full or half empty? In P. Holtsberg & K. Pugh (Eds.), Georgiaʼs
Centenarians: The quintessential positive models of aging? The University of Georgia Gerontology Center Technical Report
(UGAGC-94-01S). Athens, GA: The University of Georgia Gerontology Center.
32. Holtsberg, P.A., Poon, L.W., Noble C.A., Martin, P., & Rousseau, G.K. (1994). Successful aging among centenarians:
Item and percentile analyses of
Mini- Mental State Exams (MMSE) of cognitively intact centenarians and other elders.
The Gerontologist, 34, 216.
33. Houston, D.K., Johnson, M.A., Poon, L.W., Clayton, G.M. (1994). Individual foods and food group patterns of the oldest
old. Journal of Nutrition for the Elderly, 13(4), 5-23.
34. Johnson, M.A., Flor, D., Fischer, J.G., Poon, L.W., & Martin P. (1994). Food patterns of centenarians. The Gerontologist,
34, 338.
35. Mapstone, M.A., Holtsberg, P.A., Poon, L.W., Rousseau, G. K., & Johnson, M. A. (1994).
Height and longevity: Does the reported inverse relationship “measure up” in centenarians? The Gerontologist, 34 (278).
36. Martin, P. (1994). Age related changes in the neurological exam of healthy centenarians.
Journal of Geriatric Psychiatry and Neurology, 7, 1-7.
37. Nichols, M.E., Meador, J.J., Loring, D.W., Poon, L.W., Clayton, G.M., & Martin, P. (1994). Age
related changes in the neurologic examination of healthy sexagenarians, octogenarians, and centenarians. Journal of Geriatric
Psychiatry and Neurology, 7, 1-7.
38. Martin, P., Johnson, M.A., Poon, L.W., Clayton, G, and Olsen, S.F. (1994). Group or individual
testing: Does it make a difference? Educational Gerontology, 20, 171-176.
39. Nickols-Richardson, S.M., Johnson, M.A., Poon, L.W., & Martin, P. (1994). Nutritional risk of
Georgia Centenarians and other elders. The Gerontologist, 34, 338.
40. Noble, C.A., Holtsberg, P.A., Poon, L.W., Johnson, M.A., Martin, P., & Rousseau, G.K. (1994). The Georgia Centenarian
Study: An Introduction to its history, methodology, and hypothetical models of successful aging. In P. Holtsberg & K. Pugh
(Eds.), Georgiaʼs Centenarians: The quintessential positive models of aging? The University of Georgia
Gerontology Center Technical Report (UGAGC-94-01S). Athens, GA: The University of Georgia Gerontology Center.
41. Poon, L.W. (1994). Symposium: Cross-cultural aspects of centenarians: An integration of findings from the American,
French, Hungarian, Japanese, Mexican, and Swedish Centenarian studies. The Gerontologist, 34, 65.
42. Sauter, M.A., Johnson, M.A., Irwin, D., Poon, L.W., Clayton, G.M., & Martin, P. (1994). Physical health and functioning
activity of centenarians: A comparison with younger elderly age groups. In P. Holtsberg & K. Pugh (eds.), Georgiaʼs Centenarians: The quintessential positive models of aging? The University of Georgia Gerontology Center Technical Report
(UGAGC-94-01S). Athens, GA: The University of Georgia Gerontology Center.
43. Williams, L.A., Johnson, M.A., Poon, L.W., Clayton, G.M., & Martin, P. (1994). Oral health of the elderly and its impact
on nutrition. In P. Holtsberg & K. Pugh (Eds.), Georgiaʼs Centenarians: The quintessential positive models of aging? The
University of Georgia Gerontology Center Technical Report (UGAGC-94-01S). Athens, GA: The University of Georgia Gerontology Center.
44. Bramlett, M.A., Poon, L.W., Johnson, M.A., & Nichols, M.E. (1995). Theory versus reality: Neuro-psychological testing
of centenarians. The Gerontologist, 35, 350.
45. Fischer, J.G., Johnson, M.A., Poon, L.W., & Martin, P. (1995). Nutrient Patterns of the oldest-old. FASEB Journal 9,
A174-A-174.
46. Goetting, M.A., Raiser, M.V., Martin, P., Poon, L.W., & Johnson, M.A. (1995). Older womenʼs financial resources and
perception of financial adequacy. Journal of Women and Aging, 7(4), 67-81.
47. Holtsberg, P.A., & Poon, L.W. (1995). Life-span development of everyday problem-solving abilities: Community-dwelling, cognitively intact
centenarians test theoretical limits. The Gerontologist, 35, 100.
27
48. Holtsberg, P.A., Poon, L.W., Noble, C.A., & Martin, P. (1995). Mini-mental State exam status of community-dwelling cognitively
intact centenarians. International Psychogeriatrics., 7 (3), 417-427.
49. Johnson, M.A., Flor, D., Fischer, J.G., Poon, L.W., & Martin, P. (1995). Food Patterns of Centenarians. FASEB Journal 9, A174A174.
50. Merriam, S.B., Martin, P., Adkins, G., & Poon, L.W. (1995). Centenarians: Their memories and future ambitions. International
Journal of Aging & Human Development, 41(2), 117-132.
51. Williams, L.A., Johnson, M.A., Poon, L.W. & Martin P. (1995). Oral health and demographic risk factors for poor nutrient intake
in the elderly. Age and Nutrition, 6, 4-9.
52. Poon, L.W., Bramlett, M.H., Holtzberg, P.A., Johnson, M.A., & Martin, P. (1996). Who will survive to 105? 1997 Medical and
Health Annual (pp. 62-77). Chicago: Encyclopedia Brittanica, Inc.
53. Goetting, M.A., Martin, P., Poon, L.W., & Johnson, M.A. (1996). The economic well-being of community-dwelling centenarians.
Journal of Aging Studies, 10, 43-55.
54. Goetting, M. A., Martin, P., Poon, L. W., & Johnson, M. A. (1996). The economic well-being of community-dwelling centenarians. Journal of Aging Studies 10, 43-56.
55. Adkins, G., Martin, P., & Poon, L.W. (1996). Personality traits and states as predictors of subjective well-being in centenarians/
octogenarians and sexagenarians. Psychology and Aging, 11, 408-416. Martin, P., Poon, L. W., Kim, E., & Johnson, M. A. (1996).
Social and psychological resources in the oldest old. Experimental Aging Research 22, 121-140.
56. Quinn, M.E., Johnson, M.E., Poon, L.W., Martin, P., & Nickols-Richardson, S.M. (1997). Factors of nutritional health-seeking
behaviors: Findings from the Georgia Centenarian Study. Journal of Aging and Health, 9, 90-104.
57. Houston, D.K., Johnson, M.A., Poon, L.W., & Clayton, G.M. (1996). “Individual foods and food group patterns of the oldest old”:
Erratum. Journal of Nutrition for the Elderly, 16(2), 81-88.
58. Martin, P., Poon, L.W., Kim, E., & Johnson, M.A. (1996). Social and psychological resources in the oldest old. Experimental Aging Research, 22(2), 121-139.
59. Nickols-Richardson, S.M., Johnson, M.A., Poon, L.W., & Martin, P. (1996). Demographic predictors of nutritional risk in elderly
persons. Journal of Applied Gerontology, 15(3), 361-375.
60. Nickols-Richardson, S.M., Johnson, M.A., Poon, L.W., & Martin, P. (1996). Mental health and number of illnesses are predictors
of nutritional risk factors in elderly persons. Experimental Aging Research, 22, 141-154.
61. Quinn, M.E., Johnson, M.A., Poon, L.W., & Martin, P. (1996). Intraindividual change and interindividual differences in factors
influencing older womenʼs health-seeking behavior. Health care for Women International, 17, 187-196.
62. Quinn, M.E., Martin, P., Johnson, M.A. (1996). Differences in factors of health orientation of older women. Nursing Connections, 9(1), 63-70.
63. Houston, D.K., Johnson, M.A., Daniel, T., & Poon, L.W. (1997). Health and dietary characteristics of supplement users in an
elderly population. International Journal for Vitamin and Nutrition Research, 67, 183-191.
64. Martin, P., Hagberg, B., & Poon, L.W. (1997). Predictors of loneliness in centenarians: A parallel study. Journal of Cross-Cultural Gerontology, 12(3), 203-224.
65. Martin, P., Raiser, V., Poon, L.W., Bramlett, M.A., & Johnson, M.A. (1997). Personality and activity in the oldest old. In G. Huber (Ed.), Fourth International Congress Physical Activity, Aging and Sports (pp. 243-253). Heidelberg, Germany: Health Promotion
Publications.
66. Poon, L.W., Johnson, M.A., Martin, P., Shibata, H., & Shimonaka, Y. (1997). Commonalties and predictors of activities of daily
living in two community-dwelling older adults samples: The Georgia Centenarian Study, USA and The Koganei Study, Japan. In G.
Huber (Ed.), Proceedings of Fourth International Congress on Healthy Aging, Activity and Sports. (pp. 230-242). Heidelberg, Germany: Health Promotion Publications.
67. Poon L.W., Johnson M.A., Martin P. Looking into the crystal ball: Will we ever be able to accurately predict individual differences in longevity? In: Robine J.M., Vaupel J.W., Jeune B., Allard M. (Eds.). Longevity: To the limits and beyond. Berlin: Springer,1997. (pp. 113-119).
68. Martin, P., Raiser, V., Poon, L.W., Bramlett, M.A., & Johnson, M.A. (1997). Personality and activity in the oldest-old. In G.
Huber (ed.), Healthy aging, activity, and sports (pp. 243-253). Werbach-Gamburg: Health Promotions Publications.
69. Martin, P., Hagberg, B., & Poon, L.W. (1997). Predictors of loneliness in centenarians: A parallel study. Journal of Cross-Cultural Gerontology, 12, 203-224. Martin, P. (1997). Langlebigkeit als Entwicklungsprozeß: Zeitgeschichtliche und individuelle Perspektiven. [Longevity as a developmental process: Historical and individual perspectives]. Zeitschrift für Gerontologie und Geriatrie, 30,
3-9.
70. Quinn, M.E., Johnson, M.A., Poon, L.W., Martin, P., Nickols-Richardson, S.M. (1997). Factors of nutritional health-seeking
behaviors. Journal of Aging and Health, 9(1), 90-104.
71. Houston, D.K., Daniel, T.D., Johnson, M.A., & Poon, L.W. (1998). Demographic characteristics of supplement users in an elderly
population. Journal of Applied Gerontology, 17(1), 79-96.
72. Kim, J., Bramlett, M.H., Wright, L.K., & Poon, L.W. (1998). Racial differences in health status and factors that influence health
behaviors in older adults. Nursing Research, Vol. 47, No. 4, 243-250.
73. Elsner, R.J., Quinn, M.E., Fanning, S.D., Gueldner, S.H., & Poon, L.W. (1999). Ethical and policy considerations for centenarians—the oldest old. Image J Nurs Sch, 31(3), 263-267.
74. Quinn, M.E., Johnson, M.A., Poon, L.W., & Martin, P. (1999). Psychosocial correlates of subjective health in sexagenarians,
28
octogenarians, and centenarians. Issues in Mental Health Nursing, 20(2), 151-171.
75. Martin, P., Raiser, V.M., & Poon, L.W. (1999). Significant events in the lives of centenarians, Gerontology Geriatrics, 2(2), 5-19.
76. Fees, B.S., Martin, P., & Poon, L.W. (1999). A model of loneliness in older adults. Journal of Gerontology: Psychological Sciences, 54B, 231-239.
77. Poon, L.W., Johnson, M.A., Davey, A., Holtsberg, P., Dawson, D., Siegler, I., & Martin, P. (1999). Predictors of Survival after
100. The Gerontologist, 39(Special Issue 1).
78. Poon, L.W., Johnson, M.A., & Martin, P. (1999). Adding life to years and Adding years to life: The Georgia Centenarian Study.
Zeitschrift Fur Gerontologie Und Geriatrie, 32(2), 138.
79. Martin, P., Rott, C., & Poon, L.W. (2000). Predictors of depressive symptoms in centenarians, Autonomy versus dependence in
the oldest old. Auzeville-Tolosane, France: SERDI.
80. Martin, P., Rott, C., Kerns, M.D., Poon, L.W., & Johnson, M.A. (2000). Predictors of depressive symptoms in centenarians. In
P. Martin, C. Rott, B. Hagberg, & K. Morgan (Eds.), Centenarians: Autonomy versus dependence in the oldest old (pp. 91-104). New
York: Springer.
81. Martin, P., Rott, C., Kerns, M.-D., Poon, L. W., Johnson, M.A. (2000) Predictors of depressive symptoms in centenarians. In Centenarians: Automony versus Dependence in the Oldest Old, Martin, P., Rott, C., Hagberg, B., Morgan, K., Eds, Springer Publishing
Company, New York, pgs. 91-104.
82. Poon, L.W., Johnson, M.A., Davey, A., Dawson, D.V., Siegler, I.C., Martin, P. (2000). Psycho-social predictors of survival among
centenarians. In Centenarians: Automony versus Dependence in the Oldest Old, Martin, P., Rott, C., Hagberg, B., Morgan, K., Eds,
Springer Publishing Company, New York, pgs. 77-89.
83. Burrell, L. & Poon, L.W. (2001). Comparison of centenariansʼ physical and functional health from the Georgia, Swedish, and
Hungarian studies. Gerontology, 47(suppl1), 579.
84. Hagberg, B., Bauer Alfredson, B., Poon, L.W., & Homma, A. (2001). Cognitive functioning in centenarians: a coordinated analysis of results from three countries. J Gerontol B. Psychol Sci Soc Sci, 56(3), P141-151.
85. Holtsberg, P.A., & Poon, L.W. (2001). Patters of longitudinal changes in centenariansʼ cognition. Gerontology, 47 (suppl1), 579.
86. Poon, L.W. (2001). Centenarians. In G.L. Maddox, et. al. (Ed.), The Encyclopedia of Aging – Third Edition. New York. Springer.
87. Rott, C., Martin, P., Poon, L.W., & Johnson, M.A. (2001). The nature of subjective well-being and mental health in the oldest old.
Gerontology, 47(suppl 1), 677.
88. Martin, P., Rott, C., Poon, L.W., Courtenay, B., & Lehr, U. (2001). A molecular view of coping behavior in older adults. Journal
of Aging and Health, 13, 72-91.
89. Martin, P., Rott, C., Poon, L.W. (2001) Nur durch Aktivitat gesund und Zufrieden bis ins hochste Alter? Ergebnisse der Langlebigkeitsforschung. [Healthy and satisfying aging into very old age only through activity? Results of longitudinal research]. In R.
Daugs, E. Emrich, C. Igel, & W. Kindermann (eds) Aktivitat Und Altern [Activity And Aging]. Schondorf: Hofmann.
90. Martin, P., Long, M. V., & Poon, L. W. (2002). Age changes and differences in personality traits and states of the old and very old.
Journal of Gerontology: Psychological Sciences, 57B, 144-152.
91. Martin, P. (2002). Individual and social resources predicting well-being and functioning in later years: Conceptual models, research, and practice. Ageing International, 27, 3-29.
92. Jang, Y, Poon, L. W. & Martin, P. (2004). Individual differences in the effects of disease and disability on depressive symptoms:
The role of age and subjective health. International Journal of Aging and Human Development, 59, 127-139.
Links to .pdf files of selected articles can be found at: http://www.geron.uga.edu/multimedia/onlinepublications.php
Gerontology Center
255 E. Hancock Ave.
Athens, GA 30602-5775
Phone: (706) 425-3222
FAX: (706) 425-3221
http://www.geron.uga.edu
Electronic PDF available
RevisedFebruary 2005
Copyright 2005 by The University of Georgia Gerontology Center.
No portion of this booklet may be reproduced without the written consent
of qualified representatives of The University of Georgia Gerontology Center.

The Georgia Centenarian Study

Transcription

Similar documents

Live to 100 and Beyond - Albert Einstein College of Medicine

Brochure 1 - SOWEGA Council on Aging

Martins Office Furniture December 2005

power point José Viña

candice_l_dircks_042213 copy

Early American Life

gcis junior - Georgia Career Information Center

“How to Become a Writer” by Lorrie Moore from Charters, Ann, Ed

Roger C. Wilson Partner

Leap of Faith Leads to New Careers

Living Beyond 100 - International Longevity Centre