A memorial lecture and debate on Centenarians and the Oldest Old The ILC-UK was saddened last summer, by the loss of Dr. Robert N. Butler, founder of the first International Longevity Centre in the United States and Pulitzer prize-winning gerontologist. His invaluable contribution has changed the approach and research on ageing and longevity. In tribute to Dr Butler, ILC-UK organised a memorial lecture and debate, in partnership with Age UK and the Joseph Rowntree Foundation, on Centenarians and the Oldest Old. In 1911 there were just 100 Centenarians living in England and Wales, a figure which grew to 9,000 people in 2006 and represented a 90-fold increase over the previous 100 years (Dini and Goldring. 2008). There was a fourteen-fold increase in male centenarians and a 23-fold increase in female centenarians over the last 50 years of the twentieth century (Dini and Goldring. 2008). The number of people aged over 100 is expected to nearly double between 2030 and 2035, when it is projected there will be 97,300 centenarians in the UK. It is then expected to more than double again during the next decade, to stand at 202,100 by 2045. (DWP/ONS December 2010). The ONS estimates that by 2066 there will be at least 507,000 people in the UK aged 100 or over, including 7,700 super centenarians who are aged 110 or over. By 2080, there may be 626,900 people aged over 100. 21,000 of these will be over 110. (DWP/ONS December 2010). Even the conservative estimates for the growth in the number of the oldest old will have a significant impact on services. Yet whilst policy makers seem aware of the growth in the number of people living to 100, there has been little or no explicit exploration about the impact of the growth in numbers of oldest old on public policy. Professor Tom Kirkwood, Associate Dean for Ageing at Newcastle University gave the Lecture. The ILC-UK presented early findings of work for Age UK on the oldest old. Agenda from the event: 16:30 – 16.35 Welcome and introduction from chair Baroness Sally Greengross, Chief Executive, International Longevity Centre – UK 16.35 – 17.20 The Robert Butler Memorial Lecture by Professor Tom Kirkwood, Associate Dean for Ageing at Newcastle University. For a copy of Professor Kirkwood's slides please email events@ilcuk.org.uk 17.20 – 17.30 Centenarians and the Oldest Old, ILC-UK David Sinclair 17.30 - 17.35 A personal contribution on the life of a Centenarian Noreen Siba 17.35 – 17.45 First telegram at 110? The implications of longevity Dr Matthew Norton 17.45 – 17.55 'What older people want and value in life?' Joseph Rowntree Foundation Ilona Haslewood 17.55 – 18.25 Panel and Audience Debate 18.25 - 18.30 Close

1. Robert Butler Memorial
Lecture and Debate on
Centenarians and Oldest Old
29 November 2011
This event is kindly supported by JRF
The ILC-UK work on ―Centenarians and Oldest Old‖ is supported by Age UK

2. Welcome
Baroness Sally Greengross
ILC-UK
This event is kindly supported by JRF
The ILC-UK work on ―Centenarians and Oldest Old‖ is supported by Age UK

3. Robert Butler Memorial
Lecture
Professor Tom Kirkwood
University of Newcastle
This event is kindly supported by JRF
The ILC-UK work on ―Centenarians and Oldest Old‖ is supported by Age UK

4. Please contact us at
events@ilcuk.org.uk
to request a copy of
Professor Kirkwood’s
presentation in PDF format.
This event is kindly supported by JRF
The ILC-UK work on ―Centenarians and Oldest Old‖ is supported by Age UK

5. Centenarians and Oldest Old
David Sinclair
ILC-UK
This event is kindly supported by JRF
The ILC-UK work on ―Centenarians and Oldest Old‖ is supported by Age UK

6. Who wants to live forever.
Centenarians and the oldest old
International Longevity Centre -UK

7. Centenarians and the oldest old
• While advances have
been made in researching
antecedent factors that
predict living to 100, less
attention has been paid to
life as a centenarians
• The body of evidence on http://www.flickr.com/photos/pondspider/4170990903/
sizes/m/in/photostream/
centenarians is far from
consistent or extensive
(hence looking at oldest
old).

8. Limitations
• Panel surveys tend to have a very small sample of
the oldest old (IFS, 2010, p 229).
• ―Those who were very ill or frail had higher
dropout rates, and people in worse health were
less likely to be re-contactable‖. Chatfield et al
(2005)
• ―a strong link between attrition and cognitive
decline…cognitive decline may be underestimated
by epidemiological studies as a result‖
• Are the predictions right?

9. How many centenarians are there?
• There are currently 11,800
people in the UK who are
currently at least 100
(DWP)
• There are fewer than 100
people who are aged more
than 110. (DWP)
• In 1911 there were just 100
Centenarians living in
England & Wales
• Growth has been about 7% http://www.flickr.com/photos/un_photo/5
p/a 832685007/sizes/z/in/photostream/

10. Projected number of centenarians in
the UK

11. How likely is it that we will reach 100?
The likelihood of living
from birth to 100 might
have increased from 1
in 20 million to 1 in 50
for females in low-
mortality nations, such
as Japan and Sweden.
(Vaupel and
Jeune, 1995) http://www.flickr.com/photos/iain_ritchie/2739823588/
sizes/z/in/photostream/

12. Number of people currently alive
who can expect to see their 100th
birthday, by age in 2010

13. Public policy seems oblivious to the
growth
• Opportunity Age: did not mention
centenarians (2005)
• Lifetime Homes, Lifetime Neigbourhoods:
Mention of centenarians in passing.
• Don’t Stop Me Now, Audit Commission
(2008). Mentioned that services for a 50 year
old may be different to services for an 80
year old
• Building a Society for All Ages (2009) growth
in the number of centenarians as a reason
―why we need to go further‖

14. But are the predictions right?
In Population
Trends, 1999, Thatcher
projected a rise in the number
of centenarians to 95,000 by
2066 (Thatcher, 1999).
By 2010 the DWP and ONS
were projecting that there
would be at least 507,000
people in the UK aged 100 or
over in 2066.
http://www.flickr.com/photos/drs2biz/71468437/sizes/m/
in/photostream/

15. And are the numbers today right?

16. More than 230,000 Japanese
centenarians missing

17. The majority of centenarians are
female
In 2003, among the oldest old
there were 257 women for
every 100 men.
(Tommassini2005).
Between 2001 and
2006, the number of men
aged between 90 and 99
increased by 24 per cent
whereas for women the
increase was just over 8%
(Dini and Goldring. 2008).

18. And they live in Southern England
In the UK, a higher
concentration of
the oldest old live
in Southern
England and a
lower proportion in
urban areas and
Northern Ireland. http://www.flickr.com/photos/lawrence_chernin/5716015430/sizes/z/in/phot
(Tomassini ostream/
C, 2005)

19. Life is not easy for the oldest old
• Three quarters of the oldest
old suffer from limiting
longstanding illnesses, and
one out of three perceive
themselves as being in poor
health. (Tomassini C, 2005) http://www.flickr.com/photos/pondspider/4170
• ―almost 50% of men and
990903/sizes/m/in/photostream/
women aged 80-84 report
severe limitations in
activities‖ (IFS, 2010)

20. And many find it difficult to do day to
day tasks
Sixty per-cent of over 90s
report difficulties shopping
for groceries, almost a
quarter report difficulties
http://www.flickr.com/photos/pinkchoc
making telephone calls and olate/3039589789/sizes/m/in/photostr
eam/
35% report difficulties
managing money.
(Sinclair, 2010/ELSA)

21. But dependency is not inevitable
Dependency is not
inevitable and a
”considerable
proportion of the
centenarians maintain
a good level of auto http://www.flickr.com/photos/driever/5525684658/sizes/m/in/ph
sufficiency for the otostream/
basic performance of
the everyday life”.
(Antonini et al, 2008)

22. And some of the oldest old become
more active

23. Many live independently
• Substantial numbers of centenarians and
nonagenarians continue to live
independently in the community, either
alone or with family members.
• 8% of those aged 90 and over were living
in privately rented accommodation and
30% in socially rented accommodation.
2009 Understanding Society

24. Proportion living in communal
establishments

25. A relatively high proportion live alone
Of those living in private
households, four in ten
very old men and seven
out of ten very old
women live alone. One
out of five very old
people live in communal
establishments.
(Tomassini C, 2005).
http://www.flickr.com/photos/sbeebe/515416979
5/sizes/m/in/photostream/

26. And the proportion living alone is
growing.
Over the last 20 years
there has been a
significant increase in the
proportion of the oldest old
living alone. The likelihood
of the oldest old men living
alone has grown by one-
third for men and one
quarter for women.
http://www.flickr.com/photos/driever/55256846
(Tomassini C, 2006). 58/sizes/m/in/photostream/

27. Many, but not all, have adapted their
homes
Research finds that the oldest old are much
more likely than other ages to have had
made adaptations to their homes. For
example. 40% of over 90s have had hand
rails installed (compared to 16% of all over
50s), 41% had bathroom modifications
(compared to 15% of all over 50s), and 24%
are likely to have an alerting device
(compared to 6% of the over 50s). (Atkinson
and Hayes (2010).

28. Centenarian as a model for healthy
ageing
A substantial number of
centenarians remain physically
healthy and cognitively intact into
the last years of their lives.
Health and functional status of
centenarians shows they are
healthy and independent for most
of their lives and experience a
relatively rapid terminal decline‖.
http://www.flickr.com/photos/jess
e55lv/455360558/sizes/m/in/phot
ostream/
(Hitt et al, 1999).

29. Self reported health is pretty good?
(Just?) One in of three of
the oldest old perceive
themselves as being in
poor health. (Tommassini
C, 2005).
―despite substantial levels http://www.flickr.com/photos/animm/4333568373/sizes/m
/in/photostream/
of disease and
impairment‖.
Collerton, Davies and
Jagger (2010)

30. Most centenarians consult their GP
98% of
centenarians and
near centenarians
consulted a GP
and received
prescription
medicine during
follow up.
(Roughead, Kalisc
h et al, 2010) http://www.flickr.com/photos/rwjensen/2288339230/sizes/m/in/photostrea
m/

31. Centenarians do use drugs heavily
A study of 602 centenarians in Italy found that a
very high proportion of this age group were
users of drugs. They identified just 5% of this
group who did not take any drugs. 13% of
participants took one drug a day, 16% took 2
drugs per day, 65% took three drugs a day, and
5.5% took more than 3 drugs a day.

32. Some evidence of longer hospital stays
26 centenarians who had suffered from a hip
fracture between 2000 and 2007 and compared
them to a randomly selected control group of 50
hip fracture patients aged between 75 and 85. “the
mean stay in acute orthopaedic wards for
centenarians was 20.7 days and for the control
group was 14.9 days”. They suggested that the
longer acute hospital stay in our centenarian cohort
would amount to a mean extra cost of £ 2511 per
patient. (Verma et al)

33. Dementia among centenarians
The prevalence
of dementia-free
survival past
100 years of
age varied
between 0 and
50 percent.‖
http://www.flickr.com/photos/thousandshipz/4679235/sizes/m/in/photostream/

34. Depression
• ―23% of those aged 85 and
over had levels of depressive
symptoms indicative of
clinical relevance‖
• ―Almost 13% of men and
women aged 80 and over
had high levels of depressive
symptoms in 2008-09 but not
in 2002-03‖ (IFS, 2010) http://www.flickr.com/photos/junglearctic/
3002442666/sizes/m/in/photostream/
ELSA

35. Falls
• 60% of interviewees aged over 90 had had
a fall and that of these, 4 in five were
unable to get up after at least one fall and
almost a third had lain on the ground for
an hour or more.
• Call alarms were widely available but not
used.
(Fleming and Brayne, 2008; Cambridge City
over 75-Cohor. BMJ)

36. OAP recovering after getting trapped
in bath for 5 days

37. Poverty is a very real challenge
• There is evidence that the oldest old (aged
85 and over) are, as a group, at greater
risk of poverty than younger older people
(aged 65-85) (National Equality
Panel, 2010).
• Up to 10% of the oldest old have total net
wealth of £3,000 or less (Banks and
Tetlow, 2009).
• Yet, over 61% of over 90s report that they
never have too little money to spend on
their needs. (Sinclair, 2010)

38. Their family carers are likely to be
older
The advanced age of
centenarians means that
family caregivers are also
likely to be relatively old.
Younger cohorts of retired
people (50-74 years) often
provide care for their very
old relatives and, even if
untrained and
unmonitored, have a
significant role as
caregivers
(Richmond, 2008).

39. Quality of Life falls with age

40. Quality of life for oldest old – getting
worse?
―longitudinal analyses
comparing 2002-03 and
2008-09 show that most
of the oldest old
experienced a substantial
decrease in quality of life
over the period. Just over
10% experienced a
substantial improvement
of 5 or more points‖
(IFS, 2010) http://www.flickr.com/photos/anabadili
/2963913137/sizes/m/in/photostream/

41. Recommendations
• Energy companies to ensure that their oldest
customers access the best deals
• Employers to ensure that they find ways to
provide flexible working to ensure that caring
responsibilities do not pull people out of the
workforce early.
• The Government should introduce a care
voucher scheme for adults, similar to childcare
vouchers, which would allow people of all ages
to buy care vouchers to support the needs of
older adults. This may help older carers of
centenarians stay in the workplace longer.

42. Recommendations
• Significant development of the evidence base
about centenarians in order to inform current
and future ageing strategies.
• Policy-makers to take a more holistic
approach to designing interventions that
integrate health, care and housing solutions.
• Developers to plan for growing numbers of
centenarians through ensuring that housing
and neighbourhoods are better designed
and/or adequately adapted to meet the needs
of a growing centenarian population

43. David Sinclair
International Longevity Centre UK
davidsinclair@ilcuk.org.uk
@sinclairda
@ilcuk

44. A personal contribution on
the life of a centenarian
Noreen Siba
Managing Director
ILC-UK
This event is kindly supported by JRF
The ILC-UK work on ―Centenarians and Oldest Old‖ is supported by Age UK

45. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.

46. Healthy Ageing
 good health
 mentally strong
 physically robust
 never any sign of dementia
Until broken hip at 90 years old through major fall at
home, typical scenario.
My mother survived two world wars and rationing
but had a good diet with fresh food all her life.
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.

47. Positive Attitude
Especially significant!
 pleasant , sociable, relaxed approach to life
 very independent and always not wanting to be a
trouble to anyone
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.

48. Active Ageing
Very active throughout.
Tennis, Golf, Bowls until mid 90 years
Playing cards and social activities, attending church,
local bridge club, until 101 years
And actively helping in the home until the last months
of her life
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.

49. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.

50. Mobility
Drove car until 90 years
Great mobility until major fall in the home, coupled
with knee weakness after 90 years
Then progressed from walking stick and frame to
wheelchair and then finally electric hoist in the home.
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.

51. Family Support
Crucial element especially after 90 years when
moved from marital home to live next door to
extended family
Grandchildren kept their grandmother daily occupied
and interested in their activities
Elder sister who is unmarried gradually became the
full time carer supported by much social stimulation
and help from all the family until our mother passed
away.
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.

52. Key Workers
Occupational therapist – first significant key worker,
providing invaluable equipment in the home:
ramps, grab rails, electric chair and hospital bed, hoist,
water bed.
OT and GP - also key to arranging physiotherapy,
dentistry, optics, chiropody and the following services:
Carers – 8 a day for the last two years and two district
nurses a week for 4 years to treat a none life
threatening skin cancer. Crossroads respite care once
a fortnight and finally Hospice led homecare and night
time Marie Curies’ nursing through her final days.
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.

53. Neighbours and Friends
A network of support at home came through the
extended family and neighbours and friends especially
gave that 'in between support ' with shopping, short
spells of respite care, hairdressing and social contact
and interaction.
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.

54. The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.

55. Many thanks
Noreen Siba
International Longevity Centre
noreensiba@ilcuk.org.uk
02073400440
Twitter: @ilcuk
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.

56. First telegram at 110. The
implications of longevity
Dr Matthew Norton
Age UK
This event is kindly supported by JRF
The ILC-UK work on ―Centenarians and Oldest Old‖ is supported by Age UK

57. First telegram at 110?
The implications of longevity
Dr Matthew Norton, Age UK

58. Historically difficult to predict life
expectancy

59. Large rise in centenarians
• 1952: 255 centenarians received a birthday
message
• 2007: 8,439 centenarians received a birthday
message
• One in five young people aged under 20 can
expect to become a centenarian
• But unlikely to see dramatic rises in record
life expectancy (UK record115 years)

60. How fast is the population
ageing?
“I’ve turned 60 and I can barely believe
nearly a third of my life is over”
Woody Allen

61. Blue Zones – Dan Buettner
• Okinawa, Japan
• Sardinia, Italy
• Loma Linda, California
• Nicoya, Costa Rica
• Ikaria, Greece

62. How to become a blue zone:
Jeanne Calment - 122
• Came from a long-lived family, did not
allow herself to feel stressed and
(reputedly):
―She used to eat two lbs. of chocolate
per week until her doctor persuaded her
to give up sweets at the age of 119. She
quit smoking only at 119, but her doctor
said her abstinence was due to pride
rather than health — she was too blind to
light up herself, and hated asking
someone to do it for her.‖

63. Power of 9

64. Are we all to become Blue Zones?
• DWP estimates: ~ 500 000 by 2066
• Pale blue?
– Public Health messages
– Health and public policy
• What is required to make the UK a Blue
Zone?
– Modifiable risk factors
• Combination of lifestyle and policy initiatives

65. Challenges
• Proportion and length of stay in institutional care
• Loneliness: Half people aged over 75 live alone
• Mental Health: 13% of those 85+ have depressive symptoms
(IFS 2010)
• Poverty and Material Deprivation
– Material Deprivation peak in 85+ cohort: 12% (DWP)
– Up to10% of 85+ have less than £3000 (Banks and Tetlow)
• Older carers
– Carers of 85+
• Gender
– Australia 1 in 5 centenarian men and 1 in 20 centenarian
women had spouse (Richmond 2008)

66. Policy considerations
• Evidence on centenarians is limited
– Centenarians linked to lower levels of hospitalisation and non-
communicable diseases across the life course
• Important from a biological perspective
• Must learn more from life of centenarians
• In terms of policy considerations are centenarians actually any
different to the oldest old?
– More research with centenarians
– Specific inclusion and consideration of people in 80s and beyond

67. What older people want and
value in life?
IlonaHaslewood
JRF
This event is kindly supported by JRF
The ILC-UK work on ―Centenarians and Oldest Old‖ is supported by Age UK

68. What do older people want and
value in life?
Robert Butler Memorial Lecture
29 November 2011
Ilona Haslewood
Joseph Rowntree Foundation

69. Published today…
New research report by
Jeanne Katz, Caroline Holland,
Sheila Peace and Emily Taylor,
The Open University
(edited by Imogen Blood)
Focus on older people with high
support needs
Other recent Better Life
publications:
http://www.jrf.org.uk/work/workarea/
better-life

70. A model to explore what people want and value
… in life, not only what
services or policies
decide they can have.
Possible uses:
as a prompt
in training
commissioning
research

71. Diverse perspectives on ageing and high support
needs
• What lesbian, gay or bisexual older people want and
value (Sally Knocker)
• An insight into the lives of Gypsy families (Pauline Lane)
• The voices of South East Asian elders (ManjitKaurNijjar)
• The future for people ageing with learning difficulties
(Cally Ward)
• The Scottish Dementia Working Group’s experience of
activism (Dot Weaks)
Expected publication date: 18 January 2012

72. Centenarians
Chris Steele-Perkins
explores what life is like
when you reach 100
“I feel very old
sometimes and other
times I feel I could do
anything when my back’s
all right....”

73. ‘The new old age’ microsite
A digital
platform for
older people’s
words and
images
Launches on
18 January
2012
Accessible from http://www.jrf.org.uk/work/workarea/better-life

74. Joseph Rowntree Foundation
Visit our website www.jrf.org.uk
www.twitter.com/jrf_uk
www.twitter.com/ilonahaslewood
www.facebook.com/JosephRowntreeFoundation

75. Robert Butler Memorial
Lecture and Debate on
Centenarians and Oldest Old
29 November 2011
This event is kindly supported by JRF
The ILC-UK work on ―Centenarians and Oldest Old‖ is supported by Age UK