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 sociodemogra phic, behavioral, and biomedical variables known to affect functional status in old age. DESIGN: A survey design was used. SETTING: Emilia R omagna, Northern Italy. PARTICIPANTS: Eighty-four healthy community-dw elling subjects aged 90 to 106 years. MEASUREMENTS: Sociodemographic v ariables, health behavior, anthropometric indices, and serum DHEAS lev els were recorded. Functional assessment was performed by instruments currently used in geriatric practice: the Mini-Mental State Examinatio n (MMSE), Geriatric Depression Scale (GDS), and Activities of Daily Li ving (ADL) scale. A stepwise multiple regression analysis was performe d. RESULTS: GDS scores correlated directly with MMSE scores and invers ely with ADL severity scores. Poor education, institutionalization, se nsory impairment, muscular mass loss, and lower DHEAS levels were the variables with the highest correlation to functional impairment. Smoki ng, alcohol consumption, and marital status were relatively unimportan t. An inverse association was found between DHEAS levels and dependenc y scores of single ADLs (continence, mobility). CONCLUSION: Impaired c ognitive and physical ability with no increase in depression prevalenc e 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 indepe ndence, as well as social and cultural factors, strongly affect the co mpliance of long-lived subjects with psychocognitive tests currently u sed in the clinical evaluation of younger old people, suggesting that these instruments are not reliable for screening for cognitive impairm ent and depression in the oldest old subjects.