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3:16 pm
Mon June 9, 2014

Study Looks At What's Killing Centenarians

The population of centenarians — people age 100 and over — is growing across the globe.

People over 100 years are expected to reach 3.2 million by 2050, according to a new study by Kings College in London.

The study, which examined the cause of death among the growing demographic, found that centenarians are less likely to die of cancer or heart disease at that age, and more likely to die from pneumonia or frail health.

Catherine Evans, clinical lecturer on palliative care at King’s College London, lead author on the study joins Here & Now’s Jeremy Hobson to talk about her findings.

Interview Highlights: Dr. Catherine Evans

On the evidence that centenarians outlive death from chronic illness

“We were looking at death registration data in England, so looking at 10 years of death registration, from 2001 to 2010, and we looked at centenarians, so people 100-plus. And then we compared their cause of death and where they died with people aged 80 to 99 in five-year cohort groups, and what we could see from that is what people died from when they are 80 looks quite different from what you die from when you’re 100. So when you’re 100, those dying from cancer, some of the circulatory diseases, goes down, and what was very striking is that 75 percent of the death registration certificates for those aged 100-plus all had somewhere the coding for old age, which is coded as senility or fatigue and malaise. And that was very uncommon to see that in the 80-plus group. So what we felt, from our findings, was if you had lived to a very long age, that you were less likely to be certified as dying from cancer or dementia than you were if you were 80-plus, and you were more likely to have on your death certificate what we called old age

On what this research shows

“It’s very, very striking, the differences by age, and it’s very unusual to have looked at that. I mean, historically, what researchers would have done, they would have just looked at all 80-pluses or 85-pluses altogether. And then what you don’t have is the granularity as to how what we die from changes with extreme longevity. And one of the reasons we can do that is because the numbers of people living to be over 100 has increased, that we can now do this sort of population-based work and compare them with younger-older cohorts.”

On what she’d like to see changed in palliative care for centenarians

“One in four of them died in hospital, and so for most of them, that would have probably meant that they were moved — for most of them, would have been residing in a care home, either in England, with nursing, or without in a residential home. And I suppose what people know we want at the end of life, they want to remain in their usual residence, the place where they feel safe and secure, and you really wonder what was in the best patient interest, to move them to hospital. And I suppose for us in England is that we need to look at the services that we provide to our care homes, to enable people to remain there, in their usual residence, at the end of their life.”

“It’s something that is very pressing for us, as it is in all developed countries, as to how we organize our services, and at the moment, we have a heavy reliance on hospital at the end of life, and we have a tendency that to access health care requires people to attend an acute hospital setting, which often, that’s not what they want, and is not the best environment to manage their last days or weeks of life.

Guest

  • Dr. Catherine Evans, clinical lecturer on palliative care at the Cicely Saunders Institute at King’s College London.
Copyright 2014 WBUR-FM. To see more, visit http://www.wbur.org.

Transcript

JEREMY HOBSON, HOST:

It's HERE AND NOW. And if you're listening, Willard Scott, you better get in assistant because the number of people who are more than 100 years old is going up and expected to reach 3.2 million worldwide in 2050. And some new research from Kings College in London finds that their health needs are very different than those of younger seniors. Joining us from London is Catherine Evans, clinical lecturer on palliative care at King's College and lead researcher on the study. Welcome.

CATHERINE EVANS: Thank you.

HOBSON: You say that centenarians have outlived death from chronic illness. Explain that.

EVANS: So we were looking at death registration data in England. So looking at 10 years of death registration from 2001 to 2010. And we looked at centenarians, so people 100-plus. And then we compared their cause of death and where they died with people aged 80 to 99 in five-year cohort groups.

And what we could see from that is that what people died from when they are 80 looks quite different from what you die from when you're 100. So when you're 100, those dying from things like cancer, some of the circulatory diseases, goes down. And what was very striking is that 75 percent of the death registration certificates for those aged 100-plus all had somewhere on the coding for old age, which is coded as senility or fatigue and malaise. And that was very uncommon to see that in the 80-plus group.

So what we felt from our findings was that if you had lived to a very long age, that you were less likely to be certified as dying from cancer or dementia than you were if you were 80-plus and you were more likely to have on your death certificate what we called old age.

HOBSON: Well, you say that cancer is responsible for the deaths of 25 percent of the people in your studies who were aged 80 to 84 but only 5 percent for centenarians.

EVANS: Yes. So it's very, very striking - the differences by age. And it's very unusual to have looked at that. I mean, historically, what researchers would've done, they would've just looked at all 80-pluses or 85-pluses altogether. And then what you don't have is the granularity as to how what we die from changes with extreme longevity. And one of the reasons we can do that is because the numbers of people living to be over 100 increased - that we can now do this with a population-based work and compare them with younger-older cohorts.

HOBSON: And what you're also finding is that what is killing centenarians, if it's not quote old age, it is often something like pneumonia and infection.

EVANS: That right. And that is - I mean, some people would say that all of us in our last days, hours of life would have bronchial pneumonia. And that is, you know, is very typical for most of us in the dying phase that we would have that.

What we can't say, what we didn't look at from this is whether or not people had, you know, pneumococcal pneumonia or was causing the pneumonia. So we can't differentiate if it was a bronco pneumonia often associated with terminal stage, or if it was a lung infection that might've responded to antibiotics.

So I suppose what we have to be careful about is that it is very typical for people when they are dying that they would have a bronco pneumonia. And often we certify pneumonia on the death certificate because there isn't anything else, so we can't say they have died from, you know, ischemia heart disease with the next commonest cause. And so in the absence of a chronic illness, then often what will be put on the death certificate is pneumonia.

So that's not saying that this is preventable. It's saying this is what was bringing them into hospital and this is what they died from in the absence of an underlying chronic illness.

HOBSON: Catherine Evans, what are people supposed to do with this information? And what would you like to be changed to help the centenarians in their final years of life?

EVANS: I think for me what was that 1 in 4 of them still died in hospital and so for most of them that would've probably meant that they were moved - for most of them would've been residing in a care home either in England with nursing or without, in a residential home. And I suppose what we know that people want at the end-of-life, they want to remain in their usual residence - the place where they feel safe and secure.

And you really wonder what was in the best patient interest to move them to hospital. And I suppose for us in England is that we need to look at the services that we provide to our care homes to enable people to remain there in their usual residence at the end of their life.

HOBSON: And there are going to be a lot more of these centenarians in the years ahead.

EVANS: Exactly. And it's something that is very pressing for us as in all developed countries as to how we organize our services. And at the moment, as in the States, we have a heavy reliance on hospital at the end of life, and that we have a tendency that to access health care requires people to attend an acute hospital setting, which often that's not what they want and is not the best environment to manage their last days or weeks of life.

HOBSON: Catherine Evans is a clinical lecturer on palliative care at Garrett Kings College in London, and she's the lead researcher on the study, which you can find a link to at hereandnow.org. Catherine Evans, thanks so much for joining us.

EVANS: My pleasure. Thank you for inviting me. Transcript provided by NPR, Copyright NPR.

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