Exceptional Longevity in Men: Modifiable Factors Associated With Survival and Function to Age 90 Years | Geriatrics | JAMA Internal Medicine | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Koenig  R Demography: Sardinia's mysterious male Methuselahs.  Science 2001;291 (5511) 2074- 2076PubMedGoogle ScholarCrossref
Herskind  AMMcGue  MHolm  NVSorensen  TIHarvald  BVaupel  JW The heritability of human longevity: a population-based study of 2872 Danish twin pairs born 1870-1900.  Hum Genet 1996;97 (3) 319- 323PubMedGoogle ScholarCrossref
Menotti  AMulder  INissinen  A  et al.  Cardiovascular risk factors and 10-year all-cause mortality in elderly European male populations; the FINE Study: Finland, Italy, Netherlands, Elderly.  Eur Heart J 2001;22 (7) 573- 579PubMedGoogle ScholarCrossref
Fried  LPKronmal  RANewman  AB  et al.  Risk factors for 5-year mortality in older adults: the Cardiovascular Health Study.  JAMA 1998;279 (8) 585- 592PubMedGoogle ScholarCrossref
Kaplan  GASeeman  TECohen  RDKnudsen  LPGuralnik  J Mortality among the elderly in the Alameda County Study: behavioral and demographic risk factors.  Am J Public Health 1987;77 (3) 307- 312PubMedGoogle ScholarCrossref
Willcox  BJHe  QChen  R  et al.  Midlife risk factors and healthy survival in men.  JAMA 2006;296 (19) 2343- 2350PubMedGoogle ScholarCrossref
Terry  DFPencina  MJVasan  RS  et al.  Cardiovascular risk factors predictive for survival and morbidity-free survival in the oldest-old Framingham Heart Study participants.  J Am Geriatr Soc 2005;53 (11) 1944- 1950PubMedGoogle ScholarCrossref
Benetos  AThomas  FBean  KEPannier  BGuize  L Role of modifiable risk factors in life expectancy in the elderly.  J Hypertens 2005;23 (10) 1803- 1808PubMedGoogle ScholarCrossref
Nybo  HPetersen  HCGaist  D  et al.  Predictors of mortality in 2,249 nonagenarians—the Danish 1905-Cohort Survey.  J Am Geriatr Soc 2003;51 (10) 1365- 1373PubMedGoogle ScholarCrossref
Evert  JLawler  EBogan  HPerls  T Morbidity profiles of centenarians: survivors, delayers, and escapers.  J Gerontol A Biol Sci Med Sci 2003;58 (3) 232- 237PubMedGoogle ScholarCrossref
Nybo  HGaist  DJeune  BMcGue  MVaupel  JWChristensen  K Functional status and self-rated health in 2,262 nonagenarians: the Danish 1905 Cohort Survey.  J Am Geriatr Soc 2001;49 (5) 601- 609PubMedGoogle ScholarCrossref
Andersen-Ranberg  KSchroll  MJeune  B Healthy centenarians do not exist, but autonomous centenarians do: a population-based study of morbidity among Danish centenarians.  J Am Geriatr Soc 2001;49 (7) 900- 908PubMedGoogle ScholarCrossref
Steering Committee of the Physicians' Health Study Research Group, Final report on the aspirin component of the ongoing Physicians' Health Study.  N Engl J Med 1989;321 (3) 129- 135PubMedGoogle ScholarCrossref
Arias  E. United States Life Tables, 2001.  Natl Vital Stat Rep 2004;52 ((14)) 1- 38Google Scholar
Christen  WGGaziano  JMHennekens  CH Design of Physicians' Health Study II—a randomized trial of beta-carotene, vitamins E and C, and multivitamins, in prevention of cancer, cardiovascular disease, and eye disease, and review of results of completed trials.  Ann Epidemiol 2000;10 (2) 125- 134PubMedGoogle ScholarCrossref
Hennekens  CHBuring  JEManson  JE  et al.  Lack of effect of long-term supplementation with beta carotene on the incidence of malignant neoplasms and cardiovascular disease.  N Engl J Med 1996;334 (18) 1145- 1149PubMedGoogle ScholarCrossref
Ware  JE  JrSherbourne  CD The MOS 36-Item Short-Form Health Survey (SF-36), 1: I, conceptual framework and item selection.  Med Care 1992;30 (6) 473- 483PubMedGoogle ScholarCrossref
Sinclair  AJRobert  IECroxson  SC Mortality in older people with diabetes mellitus.  Diabet Med 1997;14 (8) 639- 647PubMedGoogle ScholarCrossref
Harris  TCook  EFGarrison  RHiggins  MKannel  WGoldman  L Body mass index and mortality among nonsmoking older persons: the Framingham Heart Study.  JAMA 1988;259 (10) 1520- 1524PubMedGoogle ScholarCrossref
Psaty  BMFurberg  CDKuller  LH  et al.  Association between blood pressure level and the risk of myocardial infarction, stroke, and total mortality: the Cardiovascular Health Study.  Arch Intern Med 2001;161 (9) 1183- 1192PubMedGoogle ScholarCrossref
Paffenbarger  RS  JrHyde  RTWing  ALHsieh  CC Physical activity, all-cause mortality, and longevity of college alumni.  N Engl J Med 1986;314 (10) 605- 613PubMedGoogle ScholarCrossref
Li  FFisher  KJHarmer  P Prevalence of overweight and obesity in older US adults: estimates from the 2003 Behavioral Risk Factor Surveillance System survey.  J Am Geriatr Soc 2005;53 (4) 737- 739PubMedGoogle ScholarCrossref
Bijnen  FCFeskens  EJCaspersen  CJNagelkerke  NMosterd  WLKromhout  D Baseline and previous physical activity in relation to mortality in elderly men: the Zutphen Elderly Study.  Am J Epidemiol 1999;150 (12) 1289- 1296PubMedGoogle ScholarCrossref
Goldberg  RJBurchfiel  CMReed  DMWergowske  GChiu  D A prospective study of the health effects of alcohol consumption in middle-aged and elderly men: the Honolulu Heart Program.  Circulation 1994;89 (2) 651- 659PubMedGoogle ScholarCrossref
Simons  LAMcCallum  JFriedlander  YOrtiz  MSimons  J Moderate alcohol intake is associated with survival in the elderly: the Dubbo Study.  Med J Aust 2000;173 (3) 121- 124PubMedGoogle Scholar
Hall  KMLuepker  RV Is hypercholesterolemia a risk factor and should it be treated in the elderly?  Am J Health Promot 2000;14 (6) 347- 356PubMedGoogle ScholarCrossref
Barzilai  NAtzmon  GSchechter  C  et al.  Unique lipoprotein phenotype and genotype associated with exceptional longevity.  JAMA 2003;290 (15) 2030- 2040PubMedGoogle ScholarCrossref
Stamler  JStamler  RNeaton  JD  et al.  Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women.  JAMA 1999;282 (21) 2012- 2018PubMedGoogle ScholarCrossref
Fraser  GEShavlik  DJ Ten years of life: is it a matter of choice?  Arch Intern Med 2001;161 (13) 1645- 1652PubMedGoogle ScholarCrossref
Kaplan  GAHaan  MNWallace  RB Understanding changing risk factor associations with increasing age in adults.  Annu Rev Public Health 1999;2089- 108PubMedGoogle ScholarCrossref
Original Investigation
February 11, 2008

Exceptional Longevity in Men: Modifiable Factors Associated With Survival and Function to Age 90 Years

Author Affiliations

Author Affiliations: Divisions of Aging (Drs Yates, Djoussé, Kurth, Buring, and Gaziano) and Preventive Medicine (Drs Kurth, Buring, and Gaziano), Department of Medicine, Brigham and Women's Hospital (Drs Yates, Djoussé, Kurth, Buring, and Gaziano), and Department of Ambulatory Care and Prevention (Dr Buring), Harvard Medical School; Department of Epidemiology, Harvard School of Public Health (Drs Kurth and Buring); and Massachusetts Veterans Epidemiology Research and Information Center, Boston VA Healthcare System (Dr Gaziano); Boston, Massachusetts.

Arch Intern Med. 2008;168(3):284-290. doi:10.1001/archinternmed.2007.77

Background  Prospective data on nongenetic determinants of exceptional longevity are limited, and information on long-lived men and their functional status is particularly sparse. We examined modifiable factors associated with a life span of 90 or more years and late-life function in men.

Methods  In this prospective cohort study of 2357 healthy men (mean age, 72 years) within the Physicians' Health Study (1981-2006), biological and lifestyle factors and comorbid conditions were assessed by self-report with baseline and annual questionnaires. Mortality and incidence of major diseases were confirmed by medical record review. Late-life function was assessed 16 years after baseline by the Medical Outcomes Study 36-Item Short-Form Health Survey.

Results  A total of 970 men (41%) survived to at least age 90 years. Smoking was associated with increased risk of mortality before age 90 years (hazard ratio [HR]; 2.10; 95% confidence interval [CI], 1.75-2.51), and similar associations were observed with diabetes (HR, 1.86; 95% CI, 1.52-2.26), obesity (HR, 1.44; 95% CI, 1.10-1.90), and hypertension (HR, 1.28; 95% CI, 1.15-1.43). Regular exercise was associated with a nearly 30% lower mortality risk (HR, 0.72; 95% CI, 0.62-0.83). The probability of a 90-year life span at age 70 years was 54% in the absence of smoking, diabetes, obesity, hypertension, or sedentary lifestyle. It ranged from 36% to 22% with 2 adverse factors and was negligible (4%) with 5. Compared with nonsurvivors, men with exceptional longevity had a healthier lifestyle (67% vs 53% had ≤1 adverse factor), had a lower incidence of chronic diseases, and were 3 to 5 years older at disease onset. They had better late-life physical function (mean ± SD score [maximum 100], 73 ± 23 vs 62 ± 30; P < .001) and mental well-being (mean score, 84 ± 14 vs 81 ± 17; P = .03). More than 68% (vs 45%) rated their late-life health as excellent or very good, and less than 8% (vs 22%) reported fair or poor health (P < .001 for trend). Regular exercise was associated with significantly better—and smoking and overweight with significantly worse—late-life physical function. Smoking also was associated with a significant decrement in mental function.

Conclusion  Modifiable healthy behaviors during early elderly years, including smoking abstinence, weight management, blood pressure control, and regular exercise, are associated not only with enhanced life span in men but also with good health and function during older age.