Journal Article Ahead of print
PubMed: 42090458 DOI: 10.1093/geront/gnag079
Lifestyle, socioeconomic and biological determinants of survival in Nonagenarians and Centenarians: A systematic review and meta-analysis.
Gerontologist
Authors: Óscar Caballero, Antonio García-Hermoso, Juan Hurtado-Amonacid, Rodrigo Yáñez-Sepúlveda, José Francisco López-Gil, Yasmin Ezzatvar
Affiliations
- Department of Nursing, Universitat de València, Valencia, Spain.
- Navarrabiomed, Hospital Universitario de Navarra, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.
- eFidac Grupo de Investigación, Escuela de Educación Física. Pontificia Universidad Católica de Valparaíso, Chile.
- Faculty Education and Social Sciences, Universidad Andres Bello, Viña del Mar, Chile.
- School of Medicine, Universidad Espíritu Santo, Samborondón, Ecuador.
- Faculty of Health Sciences, Universidad Autónoma de Chile, Chile.
- Lifestyle factors with impact on Ageing and overall Health (LAH) Research Group. Department of Nursing, University of València, Valencia, Spain.
- Vicerrectoría de Investigación y Postgrado, Universidad de Los Lagos, Osorno, Chile.
Abstract
BACKGROUND AND OBJECTIVES
Identifying factors associated with survival beyond age 90 is essential for understanding healthy aging trajectories. This study sought to investigate the associations between biological, socioeconomic, and lifestyle factors and survival in individuals aged ≥90 years.
RESEARCH DESIGN AND METHODS
Systematic review with meta-analysis. Cohort studies reporting information on lifestyle, socioeconomic and biological determinants of survival in individuals aged ≥90 years (nonagenarians, centenarians, and supercentenarians) were searched in the MEDLINE, EMBASE, and Web of Science databases up to June 2025. Random effects meta-analyses via the empirical Bayes method generated pooled hazard ratios (HRs). Meta-regression and sensitivity analyses were conducted.
RESULTS
Twenty-three studies were included. Being a woman (HR = 0.83; 95% confidence interval [CI], 0.80-0.86), having normal cognition (HR = 0.55; 95%CI, 0.40-0.76), having activities of daily living (ADL) independence (HR = 0.69; 95%CI, 0.63-0.76), having high handgrip strength (HR = 0.69; 95%CI, 0.48-0.99), not smoking (HR = 0.83; 95%CI, 0.74-0.93), and alcohol abstinence (HR = 0.88; 95%CI, 0.78-0.99) were associated with lower mortality. Education level was not significantly associated with survival. Meta-regression revealed no modifying effect of age or follow-up length. Multivariate meta-analysis confirmed the independent contribution of each factor and ranked ADLs (p < 0.001), cognition (p < 0.001), and handgrip strength (p < 0.001) as the top three survival predictors.
DISCUSSION AND IMPLICATIONS
Survival in the oldest-old is closely linked to female sex, preserved cognitive and physical function, and healthy lifestyle choices. The consistent predictive value of ADLs, cognition, and handgrip strength highlights the relevance of modifiable factors for promoting longevity, even in advanced age.
MeSH
Activities Of Daily Living, Life Style, Aged, Geriatrics, Cognition