Archives of Gerontology and Geriatrics 46 (2008) 67–78
www.elsevier.com/locate/archger
Assessment of the health status of Greek
centenarians
Christina Darviri a,*, Panayotes Demakakos b, Fotini Charizani c,
Xanthi Tigani d, Chrysoula Tsiou e, Alexandros G. Chalamandaris a,
Christina Tsagkari a, Joannnes Chliaoutakis f
a
Department of Health Visiting, Technological Educational Institute (TEI) of Athens,
Thivon Avenue 274, GR-12244 Athens, Greece
b
Department of Epidemiology & Public Health, University College London (UCL),
WC1E 6BT London, UK
c
Department of Public Health, Technological Educational Institute (TEI) of Athens,
Ag. Spyridonos and Pallikaridi Str., GR-12210 Athens, Greece
d
Department of Mother and Child Care, Faculty of Medicine, School of Health Sciences,
University of Athens, Aghia Sophia Children’s Hospital, GR-115 27 Athens, Greece
e
Department of Nursing, Technological Educational Institute (TEI) of Athens,
Ag. Spyridonos and Pallikaridi Str., GR-12210 Athens, Greece
f
Department of Social Work, Technological Educational Institute (TEI) of Crete,
GR-71500 Stavromenos, Heraklion, Greece
Received 29 May 2006; received in revised form 8 February 2007; accepted 21 February 2007
Available online 23 May 2007
Abstract
The present study aims at describing the health status of a sample of relatively functional and
healthy Greek centenarians and at exploring the potential gender differences in health in this sample.
Its objectives are to add to the accumulation of knowledge about the health status of centenarians and
therefore to contribute to the exploration of the mechanisms of healthy longevity. The study employs
a non-representative community sample of Greek centenarians of both sexes (N = 47). It uses
descriptive statistics in order to outline the health status of the participants and non-parametric tests to
assess the statistical significance of the observed sex-differences. The study shows that the
centenarians of our sample are relatively healthy and functional (15% of the sample was free of
any major chronic disease). It also suggests, that the sex-difference in survival is statistical significant
( p 0.013), and that the morbidity and co-morbidity rates of the Greek centenarians are relatively
low (mean value of co-morbidity = 1.4 0.97, S.D.). Moreover, it provides valuable information on
the anthropometric characteristics of the sample, and on health services utilization. These results
* Corresponding author. Tel.: +30 210 5385743; fax: +30 210 5385743.
E-mail address: [email protected] (C. Darviri).
0167-4943/$ – see front matter # 2007 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.archger.2007.02.008
68
C. Darviri et al. / Archives of Gerontology and Geriatrics 46 (2008) 67–78
indicate that exceptional longevity is not necessarily accompanied by disability, disease and total
dependence on others.
# 2007 Elsevier Ireland Ltd. All rights reserved.
Keywords: Centenarians in Greece; Longevity and health; Sex-differences in health status
1. Introduction
Research carried out to explore the causes of the complex and multidimensional nature of
longevity has investigated several determinants of the ageing process such as genetic,
environmental, biomedical and psychosocial (Christensen and Vaupel, 1996; Martin et al.,
1996; Quinn et al., 1999; Perls et al., 2002). Within the limits of exceptional longevity
research, centenarians constitute an important study population for two reasons. First,
because they constitute a unique source of valuable information on longevity as they have
managed to live much longer than the average of their respective generations. Second,
because a certain number of them has managed to escape major chronic diseases and enjoy
relatively satisfactory levels of autonomy (Samuelsson et al., 1997; Dello Buono et al., 1998).
Within this perspective, the present study aims at adding to the accumulation of
scientific knowledge on exceptional longevity by examining a sample of Greek
centenarians. Moreover, it aims at enriching the existing literature and complement the
findings of various recent epidemiological studies on the mental (Selim et al., 2005),
cognitive (Holtsberg et al., 1995; Andersen-Ranberg et al., 2001b; Gondo et al., 2006),
clinical (Andersen-Ranberg et al., 2001a; Evert et al., 2003; Stathakos et al., 2005), and
physical (Andersen-Ranberg et al., 1999, 2001a; Quinn et al., 1999; Evert et al., 2003;
Motta et al., 2005; Selim et al., 2005; Stathakos et al., 2005; Gondo et al., 2006) health
status of centenarians, by providing insights into less known dimensions of Greek
centenarians’ health. Its main objectives are: (a) the description of the health status,
anthropometric characteristics, health services use and morbidity rates of relatively
functional Greek centenarians and (b) the exploration of the potential gender differences in
survival, health status and morbidity among them. A further objective is to show that
exceptional longevity is not necessarily accompanied by disability, disease and total
dependence on others. The rationale of the study is that a thorough examination of the
phenomenon of the centenarians might provide valuable information about the
prolongation of the disability-free lifetime of the general population which expectedly
would support the health and ageing policy-making.
2. Subjects and methods
2.1. Study design and sampling
The study is observational and its design cross-sectional. The sample of the study is
community-based, purposive and consists of 47 (N = 47) relatively healthy centenarians
who were alive in the period 1st October 2004–1st February 2005. The data were collected
C. Darviri et al. / Archives of Gerontology and Geriatrics 46 (2008) 67–78
69
within the prefecture of Attica, Greece through personal face-to-face interviews. All 47
participants were interviewed in their domiciles, by health visitors. The research team
applied the following exclusion criteria in order that the study sample should consist of
relatively healthy and functional centenarians: (a) the respondents should be able to
adequately communicate with the interviewer and grant an interview; (b) not be bedridden; (c) be relatively functional (i.e. be able to move in and out of their houses and be
self-served). No proxy interviews occurred and no institutionalized centenarians were
included in the sample. The lack of a national registry of centenarians in Greece (or any
other similar records) and the difficulty of gaining access to existing registries (i.e.
municipal or voting registries) prompted the researchers to employ a snowball-like
sampling technique in order to identify the subjects of the study. The sampling design
anticipated that the interviewers would employ their family and social networks in order to
identify centenarians or other people who knew centenarians. This snowball technique was
proven effective and led to the creation of a non-representative and non-random
community-based sample of Greek centenarians that this study uses. Prior to the interview,
the interviewers explained the aims of the study to the respondents and provided them with
a consent letter.
2.2. Instrument
The interview included the use of a self-reporting questionnaire along with clinical and
anthropometric measures. The questionnaire covered a range of topics including: the sociodemographic characteristics of the respondents, their living conditions, current and former
diseases, health status, health services and medication utilization, life-style (i.e. smoking,
nutrition, sleep quality, daily activities, and exercise), quality of family relationships and
sociability, spirituality, and questions regarding their willingness to participate in health
promotion programmes. The anthropometric measures included the objective measurement of the height and weight of respondents and the clinical assessment of blood pressure
(measured on the right arm, one time, by a mercury sphygmomanometer and cuff while the
respondent was seated). Hypertension was defined as blood pressure 140/90 mmHg
(World Health Organization, 1999). The co-morbidity was assessed by the use of a list of
twenty diseases from which the participants might suffer at the time of their interview. The
twenty diseases of the list were selected on the basis of their significance for the health and
quality of life of very old people. The list included the following diseases: hypertension;
diabetes mellitus; dyspepsia, gastric ulcer and gall-bladder diseases; dermatitis; epilepsy;
schizophrenia; prostate and kidney-related diseases; asthma; varicose veins, vascular
failure, cardiovascular disease and stroke; Parkinson’s disease; thyroid gland-related
diseases; systematic lupus erythematosus; anaemia. Information on all these diseases was
self-reporting (apart from that for hypertension which was based on the clinical
measurement of blood pressure). All disease-related variables included in the analysis were
used in the form of dichotomies (those suffering from the disease versus all other cases).
The hypertension variable used combines self-reported and objectively measured
hypertension. Respondents who reported being hypertensive along with those who were
found to have raised levels of either systolic or diastolic blood pressure (140/90 mmHg)
were characterized hypertensive while all other cases as non-hypertensive.
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C. Darviri et al. / Archives of Gerontology and Geriatrics 46 (2008) 67–78
It is important for our study to establish that the respondents were indeed 100 years old
or older as in studies of the oldest old there is an observed tendency of age exaggeration
(Perls et al., 1999). The present study addressed the issue of age validation by asking the
respondents to show their identification card (which all Greek citizens are obliged to have)
to the interviewers. The identification card contains, among other things, information about
its holder’s exact date of birth as this is registered in her/his official birth certificate. As
regards the validation of the study instrument, various steps have been taken. First,
information on diseases and visits to any doctor, provided by the respondents, was checked
against their prescription booklet and the drugs they were receiving. Second, the
anthropometric and hypertension data were measured objectively and therefore are less
vulnerable to reporting bias. Moreover, a concurrent assessment of the validity of the
instrument was carried out. The strength of the associations between self-rated health and
diabetes mellitus, hypertension, various pain-related symptoms (musculoskeletal pain, low
back pain and headache) and co-morbidity was assessed through a series of parametric
correlations. The analysis indicated that self-rated health has statistically significant
( p 0.05) relationships to all selected variables, apart from low back pain. All the
aforementioned taken measures ensure that both the instrument used and the data presented
in this study are of acceptable validity and within the margins of statistical error they
provide an accurate account of the participants’ health.
2.3. Statistical analysis
The descriptive analysis of data includes the assessment of the frequency distributions
and the calculation of measures of central tendency and dispersion. Both means and
median are given where appropriate while in cases of categorical variables the results are
presented in the form of percentages. The main break variable employed is sex and its
selection is based on its social and clinical meaningfulness. The assessment of the
statistical significance of the observed sex-differences has been carried out by using nonparametric tests. Cases who reported that they did not know whether they suffer from a
particular disease or condition were excluded from the non-parametric analysis for this
particular disease or condition. The decision to use non-parametric test, provided that the
distributions of the characteristics of the population under investigation are unknown, was
based on the assumption that the distributions studied are not normal. The non-parametric
tests used were: Mann–Whitney (for two independent samples and two-tailed) and chisquare (or alternatively Fisher’s exact test in case a cell in any 2 2 table has an expected
frequency of less than 5 cases). The latter was used in all cases of 2 2 tables and in cases
of categorical variables and the former in all other cases. The level of statistical
significance used was that of p value < 0.05. The statistical analysis was performed using
SPSS 12.
3. Results
The sample consists of 33 women (70% of the sample) and 14 men (30% of the sample).
Twenty-one individuals (45% of the sample) were just 100 years old while the rest of the
C. Darviri et al. / Archives of Gerontology and Geriatrics 46 (2008) 67–78
71
Table 1
The socio-demographic characteristics of the sample broken down by sex
Male
Female
Total
Sex
14 (30%)
33 (70%)
47 (100%)
Age (in years)
Mean (S.D.)
Median
Mode
Range (min/max)
101 1
100
100
100/105
102 2
102
100
100/110
101.7 2.2
101
100
100/110
Education (in years)
Mean (S.D.)
Median
Range (min/max)
66
6
0/21
23
1
0/12
34
2
0/21
Marital Status
Single, never married
Married, partner alive
Widowed
2 (14.3%)
2 (14.3%)
10 (71.4%)
3 (9.1%)
0 (0%)
30 (90.9%)
5 (10.6%)
2 (4.3%)
40 (85.1%)
Household size
Mean (S.D.)
Median
Range (min/max)
21
2
1/5
32
3
1/8
32
3
1/8
p
0.013
0.012
0.067
0.022
sample (26 individuals—55%) was older than 100 years old. Table 1 shows the sociodemographic characteristics of the sample and their break down by sex. The mean age of
the sample is 101.7 years (2.2 years) and the median age is 101 years. The age range is
100–110 years and the mode of the distribution is 100 years. Only one case of a supercentenarian (age 110 years old) is included in the sample. Women reported living more
than men and this difference was statistically significant. As regards their educational
status, men reported significantly higher educational status than women. Eighteen
individuals reported that they had not had any education (three men and 15 women) and
only two male individuals reported having university education. Most of the participants
were widow/ers. Nevertheless, there were nine (19%) participants who reported currently
having a spouse (six men and three women). Fisher’s exact test employed to test the sexdifference in having or not a spouse suggests that this is not statistically significant.
Regarding the size of their household, the majority of the centenarians of the sample (22/
43–51%) reported living in households consisting of two or three people. The analysis
indicates that the difference between men and women, in relation to the size of their
household, is significant. Women tend to live in bigger households than men.
The details of the participants’ anthropometric characteristics and health status are
presented in Table 2. The women were of lower height and weight than men and these
differences are statistically significant. The participants, according to their body mass
index (BMI), could be classified into four distinct categories (National Institute of Heart
Lung and Blood, 1998). Three women (6%) can be characterized as underweight
(BMI 18.5), 27 individuals (60%) (20 women and seven men), as normal
(18.5 BMI 24.9), 13 individuals (29%) (seven women and six men), as overweight
(25 BMI 29.9) while two women (4%) as obese (30 BMI 39.9).
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Table 2
The anthropometric characteristics of the sample broken down by sex
Male
Female
Total
Height (in cm)
Mean (S.D.)
Median
Range (min/max)
167 7
167
155/180
154 8
154
137/170
158 10
157
137/180
Weight (in kg)
Mean (S.D.)
Median
Range (min/max)
69 9
70
50/85
56 11
52
40/81
60 12
59
40/85
Body mass index (BMI)
Mean (S.D.)
Median
Range (min/max)
24.43 2.46
24.57
20.03/27.55
23.59 3.68
23.11
16.80/31.97
23.83 3.37
23.44
16.80/31.97
p
0.001
0.001
0.239
The sex-differences in BMI are not statistically significant. As regards their self-rated
health, the participants reported in general having good health (Table 3). Only 14
centenarians (26%) characterized their health status as fair and just two individuals (4%) as
bad. The analysis shows that there are not any statistically significant sex-differences in
self-rated health. The analysis of the symptom-related variables shows the majority of the
sample does not experience serious pain-related limitations and maintains a relatively good
functional status. Nevertheless, this positive picture of the functional centenarian
attenuates, once hearing ability and vision are taken into account, as only a fraction of the
sample reported seeing well (13 cases—28%) or hearing well (12 cases—26%). No sexdifferences in any of the symptom- or sense-related variables are statistically significant.
Table 4 presents the prevalence of the self-reported diseases. The most prevalent clear
cause of morbidity is hypertension. There were 16 cases (four males and 12 females) who
reported suffering from hypertension. The clinical examination of blood pressure revealed
eight more possible cases of hypertensive centenarians. Thus, in total there were 24 cases
(51%) of centenarians who can be viewed as hypertensive according to the WHO/ISH
classification of hypertension (World Health Organization, 1999). The sex-differences in
hypertension (either self-reported or clinically measured) are not statistically significant.
Only five centenarians (11%) reported being diabetics and seven (15%) having experienced
a stroke. As regards the morbidity and co-morbidity, there are seven cases of centenarians
(15%) who reported that they did not suffer from any of 20 selected diseases, while 23 cases
(49%) reported suffering from only one of these diseases. The mean value of comorbidities for the entire sample is 1.40 (0.97), the median is 1 and the range is 0–3. Men
reported on average 1.36 co-morbidities (1) while the median value is 1 and the range 0–
3. Women reported slightly more co-morbidities than men (mean value = 1.42 0.97,
median = 1 and range 0–3) but this difference is not statistically significant. Moreover,
there were 12 cases (25%) who reported never having had any operation in the past and
three cases (6%) who reported never having been hospitalized. Table 4, also, shows the
current health services usage by the centenarians. A surprisingly high 21% of the sample
(10 cases) reported that they have not visited any medical doctor within the last year. The
C. Darviri et al. / Archives of Gerontology and Geriatrics 46 (2008) 67–78
73
Table 3
The health status and reported symptoms broken down by sex
Male
Female
Total
–
3 (21%)
7 (50%)
4 (29%)
–
1
11
11
8
2
(3%)
(33%)
(33%)
(24%)
(6%)
1
14
18
12
2
(2%)
(30%)
(38%)
(26%)
(4%)
Musculoskeletal pain
Often
Sometimes
Never
D/K
3 (21%)
6 (43%)
5 (36%)
–
11
10
10
2
(34%)
(30%)
(30%)
(6%)
14
16
15
2
(30%)
(34%)
(32%)
(4%)
Back and low back pain
Often
Sometimes
Never
D/K
2 (14%)
7 (50%)
5 (36%)
–
7
11
14
1
(21%)
(33%)
(43%)
(3%)
9
18
19
1
(19%)
(38%)
(41%)
(2%)
Headache
Often
Sometimes
Never
D/K
3 (21%)
5 (36%)
6 (43%)
–
4
11
16
2
(12%)
(33%)
(49%)
(6%)
7
16
22
2
(15%)
(34%)
(47%)
(4%)
Hearing
Good
Restricted
2 (14%)
12 (86%)
10 (30%)
23 (70%)
12 (26%)
35 (74%)
Vision
Good
Restricted
4 (29%)
10 (71%)
9 (27%)
24 (73%)
13 (28%)
34 (72%)
Self-rated health
Excellent
Very good
Good
Fair
Poor
p
0.641
0.621
0.593
0.740
0.302
0.437
Table 4
The reported health problems and diseases and use of health services broken down by sex
Male
Female
Total
p
Age-related health problems and diseases
Hypertensiona
Diabetes mellitus
Stroke
8/14 (57%)
2/14 (14%)
2/14 (11%)
15/33 (46%)
3/33 (9%)
5/33 (15%)
24/47 (51%)
5/47 (11%)
7/47 (15%)
0.534
0.627
0.628
Operations
Operations in the past
13/14 (93%)
22/33 (67%)
35/47 (75%)
0.164
Hospitalizations
Hospitalizations in the past
14/14 (100%)
30/33 (91%)
44/47 (94%)
0.953
Current use of health services
Visits to a doctor within the last year
12/14 (86%)
25/33 (76%)
37/47 (79%)
0.700
a
Variable combining self-reported and clinically measured hypertension.
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C. Darviri et al. / Archives of Gerontology and Geriatrics 46 (2008) 67–78
analysis shows that the difference in self-rated health between these participants who
reported having visited a doctor within the last year and those who did not is statistically
non-significant ( p 0.16).
4. Discussion and conclusions
This study examined a population of 47 centenarians, of both sexes, and describes their
health status in detail. Also, it highlights various interesting dimensions of the exceptional
longevity issue. First, it describes the profile of the Greek centenarian as a relatively
functional and healthy individual. Second, it underscores the importance of female sex for
survival (even within the centenarians group) and brings into the forefront various sexdifferences regarding the social aspects of exceptional longevity. Third, it provides
valuable information on the morbidity and co-morbidity of the Greek centenarians and the
use of health services by them.
As regards the health status and morbidity profile of the centenarians of our sample, the
data described them as relatively healthy and functional individuals who, in general, rated
their health as good (or very good) and whose majority does not experience insurmountable
limitations in everyday life due to pain or other symptoms and diseases. This relatively
good health and function profile of the Greek centenarians, as described by the present
study, should not be considered as an artefact of the sampling process and the exclusion
criteria used to draw the sample, as it coincides with similar results of other recent studies
showing that the relative majority of centenarians are relatively healthy and independent
(Andersen-Ranberg et al., 2001a; Stathakos et al., 2005).
As regards the sex composition of the sample, women outnumber men as the male/
female ratio was 2.4:1 (33 women/14 men). This is a finding in accordance with the male/
female ratio reported by the majority of the recent studies of centenarians (AndersenRanberg et al., 2001a; Passarino et al., 2002; Evert et al., 2003; Stathakos et al., 2005).
Although this finding should not be considered as a major for the present study (as its
sample is neither random nor representative), it constitutes a sign of the validity of the data.
An important finding of the study is that the observed sex-difference in longevity is
statistically significant. This finding is in line with that of the male/female ratio being in
favour of women and points out that the general rule that women are more capable for
survival than men (World Health Organization, 2005) applies even to centenarians who are
a group of extreme longevity. The results highlighted three more statistically significant
sex-differences. Centenarian men and women differ significantly, also, in education
(measured as years of education), in widowhood and the size of the household they live in.
As regards the difference in education between men and women, this is expected and
probably reflects the dominant position of man in the Greek society 100 years ago. The
statistically significant sex-difference in widowhood is also expected and relates to (a) the
disproportional survival of women in older age compared to that of men and (b) the trend in
Greek society for men to marry younger women which reduces drastically the probabilities
of old women to have their spouses alive when they reach the 100th year of age. The sexdifferences in education and widowhood were found statistically significant as well by
Stathakos et al. (2005). A third statistically significant sex-difference in the social
C. Darviri et al. / Archives of Gerontology and Geriatrics 46 (2008) 67–78
75
characteristics of the Greek centenarians concerns the size of household they live in.
Women reported living in households with more members than men. This most probably
should interpret that centenarian men usually live alone or with their wives (in case these
are still alive) and/or with their single children while centenarian women, who in most
cases are widows, live with their offspring and their families. If this is the case, then this
finding should be considered related to man keeping his traditional role of the head of his
household until the end of his life regardless of his age while a woman can more easily live
in the household of her children/relatives, irrespective of her position and roles in it.
Stathakos et al. (2005) complemented this finding by reporting that they also found
statistically significant sex-differences in the size/composition of the households of the
Greek centenarians.
As regards the physical characteristics of the sample, men, as expected, were taller and
heavier than women and these differences were statistically significant. This finding
constitutes a further indication of the validity of the data. As regards body mass index
(BMI), the present study found that 29% of the sample can be characterized overweight
according to the existing guidelines (National Institute of Heart Lung and Blood, 1998)
whereas there were two cases of obese centenarians. These findings (which are of particular
importance as they are based on objective measurement of height and weight) show that, as
Stathakos et al. (2005) have suggested, being a centenarian does not necessarily imply
being above or below a certain limit of body mass. Nevertheless, our study, contrasting
Stathakos et al. (2005), did not find the sex-difference in BMI to be statistically significant.
Moreover, the study highlighted the existence of considerable variations in many
different health- and disease-related characteristics of the sample and provided valuable
information on the prevalence of many age-related diseases. The observed variation in
morbidity is one of the major findings of the study. Seven cases of centenarians (15%)
reported not suffering from any major age-related disease like hypertension, diabetes,
cardiovascular diseases. This is a significant finding which shows that even at the age of
100 years old (or even older age) there might be people who are relatively healthy and do
not suffer from any important chronic disease. Moreover, it is a finding in accordance with
a recent proposition by Evert et al. (2003), that a group of centenarians have achieved
exceptional longevity through escaping all major age-related diseases. Specifically, they
suggest that there are multiple pathways leading to exceptional longevity which can be
grouped into three categories-profiles of centenarians: (a) survivors; (b) delayers; (c)
escapers. The first group consists of individuals who achieved exceptional longevity
although they had been diagnosed with a major age-related disease before the age of 80; the
second of individuals who were diagnosed with a major age-related disease after the age of
80; and the third of individuals who have not been diagnosed with any major age-related
disease up to the age of 100. Obviously, the proportion of Greek centenarians who reported
that they do not suffer from any major chronic disease can be characterized as ‘‘escapers’’
and therefore our finding should be considered as corroborating this three-fold
categorisation (or at least its part referring to ‘‘escapers’’) suggested by Evert et al. In
relation to that, Andersen-Ranberg et al. (2001a) found that only one individual in their
sample of 207 centenarians was disease-free. This finding seemingly contradicts those of
the present study and Evert et al. (2003). But a more thorough examination of AndersenRanberg et al’ results shows that this is not the case as they have examined a much larger
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C. Darviri et al. / Archives of Gerontology and Geriatrics 46 (2008) 67–78
number of diseases than the present study and Evert et al. (2003) some of which are very
common in older age (e.g. musculoskeletal diseases). Thus, the observed differences in
morbidity rates reported by Andersen-Ranberg et al. (2001a) and this study do not contrast
our suggestion that a group of centenarains could be free of major age-related diseases
insofar as they do not reflect measurement differences i.e the difference between objective
measurement and self-reporting. Moreover, Stathakos et al. (2005), in concert with the
present study, found that 24% of the sample was free in their lifetime from any severe
health disorder.
The study highlighted hypertension (either diagnosed or identified through clinical
measurement) as the most important clear cause of morbidity of the Greek centenarians.
Twenty-four cases (51%) of the sample reported suffering from hypertension or identified
as possible hypertensive. The prevalence of hypertension reported in this study is similar to
those reported in Andersen-Ranberg et al. (2001a) who also measured blood pressure
clinically and found that 52% of their sample was hypertensive, and in Selim et al. (2005)
who found that the prevalence in hypertension in a sample of American centenarians is
45%. Another recent Greek study, Stathakos et al. (2005), reported somewhat lower
prevalence of hypertension (38% of their sample reported being hypertensive). The
difference in the prevalence of hypertension reported in the two studies most probably
reflects the difference between objective measurement and self-reporting and indicates the
degree to which studies of centenarians based on self-reporting underestimate the burden of
disease. Significantly lower rates of hypertension than those of the present study are also
reported by Evert et al. (2003).
As regards the prevalence of diabetes mellitus, the analysis shows that 11% of the
sample reported suffering from diabetes. This is a finding in accordance with the majority
of the recent studies of centenarians which have found that the prevalence of diabetes in the
centenarians ranges from 4% (Evert et al., 2003) to 10% (Andersen-Ranberg et al., 2001a).
In the case of diabetes mellitus, notable is that all studies, irrespectively of whether they are
based on self-reporting or objective measuring diabetes, have found that the prevalence of
diabetes is considerable lower in the centenarians than in younger ages, e.g., for Greece see
Pitsavos et al. (2003) and Gikas et al. (2004). A thorough examination of the causes of the
lower rates of prevalence of diabetes in the centenarians compared to the general
population might be proven a potentially important key to explain exceptional longevity.
Our analysis suggests that the centenarians of our sample enjoy a relatively good
functional status, which is a finding, also, in line with what other studies have found.
Stathakos et al. (2005) suggested that 25% of their sample should be considered
autonomous while 6% of their sample can be seen as being in ‘‘optimal position’’
(centenarians who are functional, without any severe health problem and live a relatively
‘‘active’’ social life). Similarly, Andersen-Ranberg et al. (2001a) suggest that using Katz’s
index of ADL 41% of their Danish sample of centenarians were relatively independent. A
comparative study focusing on the health and functional status of very old individuals and
centenarians found that their centenarian subjects were frailer than their younger
counterpartners (aged 85–99 years old) and experienced in their everyday life physical
health limitations disproportionate to their disease prevalence (Selim et al., 2005). Thus,
they suggest that the centenarians are people who suffer from ‘‘decreased functional
reserve’’ although having been diagnosed with less chronic conditions than people aged
C. Darviri et al. / Archives of Gerontology and Geriatrics 46 (2008) 67–78
77
85–99 years old. They, also, found that the centenarians of their sample did not think that
their health had deteriorated compared to the previous year.
The percentage of hospitalizations and operations reported by our sample (94% and
75%, respectively) coincides with that found by Andersen-Ranberg et al. (2001a) (95% and
78%, respectively), adding that way to the validity of our study as Andersen-Ranberg et al.
(2001a) study uses objective data from the national Danish registries or existing medical
records.
The study has important limitations and particular strengths. A first important limitation
is that probably the study underestimates the prevalence of diseases in the Greek
centenarians as its sample consisted of relatively functional centenarians who could grant
an interview and it is based mostly (though not exclusively) on self-reporting. A further
limitation is that the study uses a non-representative and non nation-wide sample which
makes its results not necessarily applicable to all Greek centenarians. Its strengths refer to
the use of objective measures in the case of anthropometric characteristics and
hypertension (to the best of our knowledge this is the first such study in Greece) which
allow comparison to similar studies outside Greece. It also gives the opportunity due to the
breadth and the multidisciplinary nature of the data collected to develop interesting
hypotheses and draw preliminary conclusions on the phenomenon of exceptional
longevity. Furthermore, it complements existing literature and contributes to the
accumulation of important information on a subject about which little is known in Greece.
Acknowledgement
This work is part of a project co-funded by the European Social Fund and National
Resources-EPEAEK II (Archimedes).
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