Do You Wish to Live to the Age of 100? A Survey of Older Men

To the Editor: Life expectancy appears to continue to increase, and living to 100 years will be increasingly common.1, 2 It may not necessarily be a desirable goal, but few studies have examined this.3, 4 In a German study, the majority of the respondents (aged 20–92) wished to live into their mid-80s, but fewer than 20% wanted to live longer than 90 years.3 The length of desired lifetime was longer with better subjective health and greater life satisfaction.3 In a U.S. study, no one (aged 70–97, n = 109) wanted to become a centenarian.4 In aging societies, it is important to examine which factors affect people's attitudes toward living an extremely long life. This was investigated in a cohort of older men. These are secondary analyses of the Helsinki Businessmen Study or Finnish men with high socioeconomic status born between 1919 and 1934.5 Analyses included 712 men assessed to be clinically healthy in 1974 who responded to the question about willingness to live to the age of 100 in a mailed questionnaire survey in 2007. This survey also included questions about marital and perceived financial (good, fair, poor) and functional status, chronic diseases, lifestyle (smoking, alcohol), psychological well-being, and current weight (body mass index). Happiness was assessed using a visual analogue scale (0 = poor, 100 = best). According to a psychological well-being scale (PWS) created from the mean points of answers (positive = 1, negative = 0) to six questions (satisfied with life, have zest for life, plans for the future, feel needed, do not feel depressed, do not suffer from loneliness), the men were divided into three PWS groups: good (>0.80), moderate (0.40–0.80) and poor (<0.40).6 There was also a question about having completed a living will (LW). Modified Charlson comorbidity index (CCI) score was dichotomized as 3 or less and more than 3.7 Functional status was considered to be impaired when a participant with a chronic disease, deficit or disability reported deterioration in functional capacity. Dementia was assessed using the Clinical Dementia Rating Scale (CDR), from which sum of boxes (SOB) scores were calculated (a score > 0 implicating cognitive impairment),8 and according to the use of medications for Alzheimer's disease based on the Drug Reimbursement Register of Finland. Mortality over 3 years of follow-up was verified from the national Population Information System. Univariate analyses were used to compare variables and 3-year mortality between men wanting and not wanting to live to age 100. To find independent predictors, age, marital status, and variables found to be different at P < .10 in univariate analyses were further examined separately for younger and older men using logistic regression and using median age (78) as the cut point. The mean age was 78.6 (median 78, range 72–88). The majority reported having good financial status (73.3%) and living at home (98.3%) usually with a spouse (82.3%); 92.7% were satisfied with their lives. The median CDR-SOB score was 0.3, and 6.3% (n = 45) were taking medications for Alzheimer's disease. The median modified CCI was 2.04 (the two most common diseases were coronary artery disease and cancer). Two hundred sixty-five (37.2%) wanted to live to the age of 100. CCI (dichotomized) or chronic diseases, except CDR-SOB scores/use of medications for Alzheimer's disease (related to each other, P < .001), were not significantly associated with this desire. The results of the logistic regression analyses are in Table 1), showing differences between age groups. Through 2010, 65 men (9.0%) had died. Mortality was significantly lower in those wishing to live to the age of 100 (6.0%) than of those not wishing to (11.0%, P = .03). One-third of relatively well-functioning home-dwelling older men wanted to live to aged 100; the willingness predicted lower 3-year mortality. Willingness to live to an extremely old age seemed greater than in prior studies,3, 4 although factors associated with this willingness were age related: the older the men were, the more likely they were to want to be a centenarian. Because poor financial status has generally been associated with worse survival, it was unexpected that, in younger men, fair—rather than good—perceived financial status was related to the desire to live to an extremely old age.9, 10 Reasons are obscure, but other psychological or experiential variables appeared to affect attitudes toward extreme longevity. As expected, worse functional capacity decreased willingness to live to the age of 100, but only in younger men; in older men, current happiness increased this willingness.3, 4 Conflict of Interest: The authors’ work has been supported by the Jahnsson Foundation, the University Central Hospitals of Oulu and Helsinki (EVO funding), and the Konung Gustaf V:s och Drottning Victorias Frimurarestiftelse. Author Contributions: Mr. Huohvanainen and Dr. Strandberg had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Strandberg and Huohvanainen. Acquisition of data: Strandberg, Pitkälä, Tilvis. Analysis and interpretation of data: Huohvanainen, Strandberg. Drafting of the manuscript: Huohvanainen. Critical revision of the manuscript for important intellectual content: Strandberg, Pitkälä, Karppinen, Tilvis. Statistical analysis: Huohvanainen and Strandberg. Sponsor's Role: The funding sources had no role in the design or conduct of the study; in the collection, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript.