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Surgery in Centenarians

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Principles and Practice of Geriatric Surgery

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Abstract

The 100th anniversary of an individual’s birth still bestows an aura, a mystique, as the centenarian is as close to immortality as a human can be. This special prestige has been afforded the imprimatur of scientific study by Baker [2], who found that centenarians represented a striking exception to the inverted U curve of status across the life-span in Western culture. Baker’s data, derived from factorial survey analysis, fit the postulate that there is an “American arc of life” that gives maximum prestige to middle age and least prestige to young and old persons. Centenarians, however, were given unique status nearly equal to that of middle-aged individuals (Fig. 17.1), because “like four leaf clovers or quintuplets, centenarians are rare.

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References

  1. Beard BB (1991) Centenarians: the new generation. Greenwood, Westport, CT, 3

    Google Scholar 

  2. Baker PM (1985) The status of age: preliminary results. J Gerontol 40(4):506–508

    Article  PubMed  CAS  Google Scholar 

  3. Nishikawa K, Harada Y, Fujimori J et al (2003) Possible model for successful care: burden of caregivers of centenarians. J Am Geriatr Soc 51(4):577–578

    Article  PubMed  Google Scholar 

  4. Webb R, Williams LM (1985) Centenarian hand syndrome. N Engl J Med 313(3):188

    PubMed  CAS  Google Scholar 

  5. Matalon J (1997) World’s oldest person dies. The Times Leader

    Google Scholar 

  6. Cowley G (1997) How to live to 100. Newsweek 30:56–67

    Google Scholar 

  7. Vaupel J, Jeune B (1995) The emergence and proliferation of centenarians. In: Jeune B, Vaupel J (eds) Exceptional longevity: from prehistory to the present. Odense University Press, Odense, Denmark

    Google Scholar 

  8. United States Bureau of the Census (1987) America’s centenarians, vol Series P-23, Current population reports. US Government Printing Office, Washington, DC

    Google Scholar 

  9. Bureau USC. Census 2000: States and puerto rico ranked by population 100 years and over. www.census.gov/population/www/cen2000/briefs/phc-t13/index.html. Accessed 8 Oct 2008

  10. Perls TT (1995) The oldest old. Sci Am 272(1):70–75

    Article  PubMed  CAS  Google Scholar 

  11. Ahlburg DA, Vaupel JW (1990) Alternative projections of the U.S. population. Demography 27(4):639–652

    Article  PubMed  CAS  Google Scholar 

  12. Vaupel JW, Gowan AE (1986) Passage to Methuselah: some demographic consequences of continued progress against mortality. Am J Public Health 76(4):430–433

    Article  PubMed  CAS  Google Scholar 

  13. Smith O (1907) Advanced age as a contraindication to operation. Med Rec (NY) 72:642–644

    Google Scholar 

  14. Ochsner A (1967) Is risk of indicated operation too great in the elderly? Geriatrics 22(11):121–130

    PubMed  CAS  Google Scholar 

  15. Brooks B (1937) Surgery in patients of advanced age. Ann Surg 105(4):481–495

    Article  PubMed  CAS  Google Scholar 

  16. Warner MA, Hosking MP, Lobdell CM, Offord KP, Melton LJ 3rd (1988) Surgical procedures among those greater than or equal to 90 years of age. A population-based study in Olmsted County, Minnesota, 1975–1985. Ann Surg 207(4):380–386

    Article  PubMed  CAS  Google Scholar 

  17. Cohen JR, Johnson H, Eaton S, Sterman H, Wise L (1988) Surgical procedures in patients during the tenth decade of life. Surgery 104(4):646–651

    PubMed  CAS  Google Scholar 

  18. Coyle KA, Smith RB 3rd, Salam AA, Dodson TF, Chaikof EL, Lumsden AB (1994) Carotid endarterectomy in the octogenarian. Ann Vasc Surg 8(5):417–420

    Article  PubMed  CAS  Google Scholar 

  19. Chalmers RT, Stonebridge PA, John TG, Murie JA (1993) Abdominal aortic aneurysm in the elderly. Br J Surg 80(9):1122–1123

    Article  PubMed  CAS  Google Scholar 

  20. Blanche C, Matloff JM, Denton TA et al (1997) Cardiac operations in patients 90 years of age and older. Ann Thorac Surg 63(6):1685–1690

    Article  PubMed  CAS  Google Scholar 

  21. Alexander HR, Turnbull AD, Salamone J, Keefe D, Melendez J (1991) Upper abdominal cancer surgery in the very elderly. J Surg Oncol 47(2):82–86

    Article  PubMed  CAS  Google Scholar 

  22. Welch CE, Whittemore WS (1954) Carcinoma of the rectum in a centenarian. N Engl J Med 250(24):1041–1042

    Article  PubMed  CAS  Google Scholar 

  23. Maycock P, Burns C (1955) Prostatic surgery in centenarians. J Urol 74:546–548

    Google Scholar 

  24. Childress HM (1957) Hip fractures in patients over one hundred years of age. NY State J Med 57(9):1604–1606

    CAS  Google Scholar 

  25. Grayzel J (1971) Pacemaker in a centenarian. JAMA 218(1):95

    Article  PubMed  CAS  Google Scholar 

  26. Milliken RA, Milliken GM (1971) Centenarian surgery. JAMA 218(9):1435–1436

    Article  PubMed  CAS  Google Scholar 

  27. Sapala JA, Sapala MA (1983) Clinical note: excision of a large ovarian leiomyoma in a centenarian. Henry Ford Hosp Med J 31(1):37–39

    PubMed  CAS  Google Scholar 

  28. Cobler JL, Akiyama T, Murphy GW (1989) Permanent pacemakers in centenarians. J Am Geriatr Soc 37(8):753–756

    PubMed  CAS  Google Scholar 

  29. McCann WJ, Smith JW (1990) The surgical care of centenarians. Curr Surg 47(1):2–3

    PubMed  CAS  Google Scholar 

  30. Cogbill TH, Strutt PJ, Landercasper J (1992) Surgical procedures in centenarians. Wis Med J 91(9):527–529

    PubMed  CAS  Google Scholar 

  31. Warner MA, Saletel RA, Schroeder DR, Warner DO, Offord KP, Gray DT (1998) Outcomes of anesthesia and surgery in people 100 years of age and older. J Am Geriatr Soc 46(8):988–993

    PubMed  CAS  Google Scholar 

  32. Grey MA, Keggi KJ (2006) Revision total hip arthroplasty in a centenarian: a case report and review of the literature. J Arthroplasty 21(8):1215–1219

    Article  PubMed  Google Scholar 

  33. Katlic MR (1985) Surgery in centenarians. JAMA 253(21):3139–3141

    Article  PubMed  CAS  Google Scholar 

  34. Silver M, Newell K, Hyman B, Growdon J, Hedley-Whyte ET, Perls T (1998) Unraveling the mystery of cognitive changes in old age: correlation of neuropsychological evaluation with neuropathological findings in the extreme old. Int Psychogeriatr 10(1):25–41

    Article  PubMed  CAS  Google Scholar 

  35. Silver MH, Jilinskaia E, Perls TT (2001) Cognitive functional status of age-confirmed centenarians in a population-based study. J Gerontol B Psychol Sci Soc Sci 56(3):P134–P140

    Article  PubMed  CAS  Google Scholar 

  36. Perls T (2004) Dementia-free centenarians. Exp Gerontol 39(11–12):1587–1593

    Article  PubMed  Google Scholar 

  37. Brody H (1973) Aging of the vertebrate brain. In: Rockstein M, Sussman ML (eds) Development and aging in the nervous system. Academic, San Diego, pp 121–133

    Chapter  Google Scholar 

  38. Hubbard O, Sunde D, Goldensohn ES (1976) The EEG in centenarians. Electroencephalogr Clin Neurophysiol 40(4):407–417

    Article  PubMed  CAS  Google Scholar 

  39. Pavia D, Thomson ML (1970) Unimpaired mucociliary clearance in the lung of a centenarian smoker. Lancet 1(7663):101–102

    Article  PubMed  CAS  Google Scholar 

  40. Mari D, Mannucci PM, Coppola R, Bottasso B, Bauer KA, Rosenberg RD (1995) Hypercoagulability in centenarians: the paradox of successful aging. Blood 85(11):3144–3149

    PubMed  CAS  Google Scholar 

  41. Schacter F, Faure-Delanef L, Guenot F (1994) Genetic associations with human longevity at the APOE and ACE loci. Nat Genet 6:29–32

    Article  Google Scholar 

  42. Mannucci PM, Mari D, Merati G et al (1997) Gene polymorphisms predicting high plasma levels of coagulation and fibrinolysis proteins. A study in centenarians. Arterioscler Thromb Vasc Biol 17(4):755–759

    Article  PubMed  CAS  Google Scholar 

  43. Tietz NW, Shuey DF, Wekstein DR (1992) Laboratory values in fit aging individuals – sexagenarians through centenarians. Clin Chem 38(6):1167–1185

    PubMed  CAS  Google Scholar 

  44. Gondo Y, Hirose N, Arai Y et al (2006) Functional status of centenarians in Tokyo, Japan: developing better phenotypes of exceptional longevity. J Gerontol A Biol Sci Med Sci 61(3):305–310

    Article  PubMed  Google Scholar 

  45. Franceschi C, Monti D, Sansoni P, Cossarizza A (1995) The immunology of exceptional individuals: the lesson of centenarians. Immunol Today 16(1):12–16

    Article  PubMed  CAS  Google Scholar 

  46. Paolisso G, Barbieri M, Bonafe M, Franceschi C (2000) Metabolic age modelling: the lesson from centenarians. Eur J Clin Invest 30(10):888–894

    Article  PubMed  CAS  Google Scholar 

  47. Franceschi C, Monti D, Cossarizza A, Fagnoni F, Passeri G, Sansoni P (1991) Aging, longevity, and cancer: studies in Down’s syndrome and centenarians. Ann NY Acad Sci 621:428–440

    Article  PubMed  CAS  Google Scholar 

  48. Lowbeer L (1987) Autopsy pathology in centenarians. Arch Pathol Lab Med 111(9):784

    PubMed  CAS  Google Scholar 

  49. Chan YC, Suzuki M, Yamamoto S (1997) Dietary, anthropometric, hematological and biochemical assessment of the nutritional status of centenarians and elderly people in Okinawa, Japan. J Am Coll Nutr 16(3):229–235

    PubMed  CAS  Google Scholar 

  50. Ravaglia G, Morini P, Forti P et al (1997) Anthropometric characteristics of healthy Italian nonagenarians and centenarians. Br J Nutr 77(1):9–17

    Article  PubMed  CAS  Google Scholar 

  51. Mellibovsky L, Bustamante M, Lluch P et al (2007) Bone mass of a 113-year-old man. J Gerontol A Biol Sci Med Sci 62(7):794–795

    Article  PubMed  Google Scholar 

  52. Shimonaka Y, Nakazato K, Homma A (1996) Personality, longevity, and successful aging among Tokyo metropolitan centenarians. Int J Aging Hum Dev 42(3):173–187

    Article  PubMed  CAS  Google Scholar 

  53. Ishii T, Sternby NH (1978) Pathology of centerarians. I. The cardiovascular system and lungs. J Am Geriatr Soc 26(3):108–115

    PubMed  CAS  Google Scholar 

  54. Klatt EC, Meyer PR (1987) Geriatric autopsy pathology in centenarians. Arch Pathol Lab Med 111(4):367–369

    PubMed  CAS  Google Scholar 

  55. Lie JT, Hammond PI (1988) Pathology of the senescent heart: anatomic observations on 237 autopsy studies of patients 90 to 105 years old. Mayo Clin Proc 63(6):552–564

    Article  PubMed  CAS  Google Scholar 

  56. Roberts WC (1998) The heart at necropsy in centenarians. Am J Cardiol 81(10):1224–1225

    Article  PubMed  CAS  Google Scholar 

  57. Bernstein AM, Willcox BJ, Tamaki H et al (2004) First autopsy study of an Okinawan centenarian: absence of many age-related diseases. J Gerontol A Biol Sci Med Sci 59(11):1195–1199

    Article  PubMed  Google Scholar 

  58. Ishii T, Sternby NH (1978) Pathology of centenarians. II. Urogenital and digestive systems. J Am Geriatr Soc 26(9):391–396

    PubMed  CAS  Google Scholar 

  59. Ishii T, Sternby NH (1978) Pathology of centenarians. III. Osseous system, malignant lesions, and causes of death. J Am Geriatr Soc 26(12):529–533

    PubMed  CAS  Google Scholar 

  60. Silver MH, Newell K, Brady C, Hedley-White ET, Perls TT (2002) Distinguishing between neurodegenerative disease and disease-free aging: correlating neuropsychological evaluations and neuropathological studies in centenarians. Psychosom Med 64(3):493–501

    PubMed  Google Scholar 

  61. Imhof A, Kovari E, von Gunten A et al (2007) Morphological substrates of cognitive decline in nonagenarians and centenarians: a new paradigm? J Neurol Sci 257(1–2):72–79

    Article  PubMed  Google Scholar 

  62. Stanta G, Campagner L, Cavallieri F, Giarelli L (1997) Cancer of the oldest old. What we have learned from autopsy studies. Clin Geriatr Med 13(1):55–68

    PubMed  CAS  Google Scholar 

  63. Smith DW (1996) Cancer mortality at very old ages. Cancer 77(7):1367–1372

    Article  PubMed  CAS  Google Scholar 

  64. Bonafe M, Barbi C, Storci G et al (2002) What studies on human longevity tell us about the risk for cancer in the oldest old: data and hypotheses on the genetics and immunology of centenarians. Exp Gerontol 37(10–11):1263–1271

    Article  PubMed  CAS  Google Scholar 

  65. Cooley DM, Schlittler DL, Glickman LT, Hayek M, Waters DJ (2003) Exceptional longevity in pet dogs is accompanied by cancer resistance and delayed onset of major diseases. J Gerontol A Biol Sci Med Sci 58(12):B1078–B1084

    Article  PubMed  Google Scholar 

  66. John SM, Koelmeyer TD (2001) The forensic pathology of ­nonagenarians and centenarians: do they die of old age? (The Auckland experience). Am J Forensic Med Pathol 22(2):150–154

    Article  PubMed  CAS  Google Scholar 

  67. Berzlanovich AM, Keil W, Waldhoer T, Sim E, Fasching P, Fazeny-Dorner B (2005) Do centenarians die healthy? An autopsy study. J Gerontol A Biol Sci Med Sci 60(7):862–865

    Article  PubMed  Google Scholar 

  68. Herskind AM, McGue M, Holm NV, Sorensen TI, Harvald B, Vaupel JW (1996) The heritability of human longevity: a population-based study of 2,872 Danish twin pairs born 1870–1900. Hum Genet 97(3):319–323

    Article  PubMed  CAS  Google Scholar 

  69. Wyshak G (1978) Fertility and longevity in twins, sibs, and parents of twins. Soc Biol 25(4):315–330

    PubMed  CAS  Google Scholar 

  70. Willcox BJ, Willcox DC, He Q, Curb JD, Suzuki M (2006) Siblings of Okinawan centenarians share lifelong mortality advantages. J Gerontol A Biol Sci Med Sci 61(4):345–354

    Article  PubMed  Google Scholar 

  71. Terry DF, Wilcox M, McCormick MA, Lawler E, Perls TT (2003) Cardiovascular advantages among the offspring of centenarians. J Gerontol A Biol Sci Med Sci 58(5):M425–M431

    Article  PubMed  Google Scholar 

  72. Terry DF, Wilcox MA, McCormick MA, Perls TT (2004) Cardiovascular disease delay in centenarian offspring. J Gerontol A Biol Sci Med Sci 59(4):385–389

    Article  PubMed  Google Scholar 

  73. Terry DF, Wilcox MA, McCormick MA et al (2004) Lower ­all-cause, cardiovascular, and cancer mortality in centenarians’ offspring. J Am Geriatr Soc 52(12):2074–2076

    Article  PubMed  Google Scholar 

  74. Gonos ES (2000) Genetics of aging: lessons from centenarians. Exp Gerontol 35(1):15–21

    Article  PubMed  CAS  Google Scholar 

  75. Takata H, Suzuki M, Ishii T, Sekiguchi S, Iri H (1987) Influence of major histocompatibility complex region genes on human longevity among Okinawan-Japanese centenarians and nonagenarians. Lancet 2(8563):824–826

    Article  PubMed  CAS  Google Scholar 

  76. Choi YH, Kim JH, Kim DK et al (2003) Distributions of ACE and APOE polymorphisms and their relations with dementia status in Korean centenarians. J Gerontol A Biol Sci Med Sci 58(3):227–231

    Article  PubMed  Google Scholar 

  77. Puca AA, Daly MJ, Brewster SJ et al (2001) A genome-wide scan for linkage to human exceptional longevity identifies a locus on chromosome 4. Proc Natl Acad Sci U S A 98(18):10505–10508

    Article  PubMed  CAS  Google Scholar 

  78. Salvioli S, Capri M, Santoro A et al (2008) The impact of mitochondrial DNA on human lifespan: a view from studies on centenarians. Biotechnol J 3(6):740–749

    Article  PubMed  CAS  Google Scholar 

  79. Cawthon RM, Smith KR, O’Brien E, Sivatchenko A, Kerber RA (2003) Association between telomere length in blood and ­mortality in people aged 60 years or older. Lancet 361(9355):393–395

    Article  PubMed  CAS  Google Scholar 

  80. Martin-Ruiz CM, Gussekloo J, van Heemst D, von Zglinicki T, Westendorp RG (2005) Telomere length in white blood cells is not associated with morbidity or mortality in the oldest old: a population-based study. Aging Cell 4(6):287–290

    Article  PubMed  CAS  Google Scholar 

  81. Bischoff C, Petersen HC, Graakjaer J et al (2006) No association between telomere length and survival among the elderly and oldest old. Epidemiology 17(2):190–194

    Article  PubMed  Google Scholar 

  82. Terry DF, Nolan VG, Andersen SL, Perls TT, Cawthon R (2008) Association of longer telomeres with better health in centenarians. J Gerontol A Biol Sci Med Sci 63(8):809–812

    Article  PubMed  Google Scholar 

  83. Herskind AM, McGue M, Iachine IA et al (1996) Untangling genetic influences on smoking, body mass index and longevity: a multivariate study of 2,464 Danish twins followed for 28 years. Hum Genet 98(4):467–475

    Article  PubMed  CAS  Google Scholar 

  84. Christensen K, Vaupel JW (1996) Determinants of longevity: genetic, environmental and medical factors. J Intern Med 240(6):333–341

    Article  PubMed  CAS  Google Scholar 

  85. McGue M, Vaupel JW, Holm N, Harvald B (1993) Longevity is moderately heritable in a sample of Danish twins born 1870–1880. J Gerontol 48(6):B237–B244

    Article  PubMed  CAS  Google Scholar 

  86. Herbert J (1995) The age of dehydroepiandrosterone. Lancet 345(8959):1193–1194

    Article  PubMed  CAS  Google Scholar 

  87. Nair KS, Rizza RA, O’Brien P et al (2006) DHEA in elderly women and DHEA or testosterone in elderly men. N Engl J Med 355(16):1647–1659

    Article  PubMed  CAS  Google Scholar 

  88. Zhang W (2008) Religious participation and mortality risk among the oldest old in china. J Gerontol B Psychol Sci Soc Sci 63(5):S293–S297

    Article  PubMed  Google Scholar 

  89. Nicita-Mauro V, Lo Balbo C, Mento A, Nicita-Mauro C, Maltese G, Basile G (2008) Smoking, aging and the centenarians. Exp Gerontol 43(2):95–101

    Article  PubMed  CAS  Google Scholar 

  90. Takayama M, Hirose N, Arai Y et al (2007) Morbidity of Tokyo-area centenarians and its relationship to functional status. J Gerontol A Biol Sci Med Sci 62(7):774–782

    Article  PubMed  Google Scholar 

  91. Galioto A, Dominguez LJ, Pineo A et al (2008) Cardiovascular risk factors in centenarians. Exp Gerontol 43(2):106–113

    Article  PubMed  Google Scholar 

  92. Economos AC (1982) Rate of aging, rate of dying and the mechanism of mortality. Arch Gerontol Geriatr 1(1):3–27

    Article  PubMed  CAS  Google Scholar 

  93. Barrett JC (1984) Longevity of selected centenarians. Lancet 2(8410):1032

    Article  PubMed  CAS  Google Scholar 

  94. Barrett JC (1985) The mortality of centenarians in England and Wales. Arch Gerontol Geriatr 4(3):211–218

    Article  PubMed  CAS  Google Scholar 

  95. Franceschi C, Motta L, Valensin S et al (2000) Do men and women follow different trajectories to reach extreme longevity? Italian Multicenter Study on Centenarians (IMUSCE). Aging (Milano) 12(2):77–84

    CAS  Google Scholar 

  96. Carey JR, Liedo P, Orozco D, Vaupel JW (1992) Slowing of ­mortality rates at older ages in large medfly cohorts. Science 258(5081):457–461

    Article  PubMed  CAS  Google Scholar 

  97. Lubitz J, Beebe J, Baker C (1995) Longevity and medicare expenditures. N Engl J Med 332(15):999–1003

    Article  PubMed  CAS  Google Scholar 

  98. Evert J, Lawler E, Bogan H, Perls T (2003) Morbidity profiles of centenarians: survivors, delayers, and escapers. J Gerontol A Biol Sci Med Sci 58(3):232–237

    Article  PubMed  Google Scholar 

  99. Motta M, Bennati E, Ferlito L, Malaguarnera M, Motta L (2005) Successful aging in centenarians: myths and reality. Arch Gerontol Geriatr 40(3):241–251

    Article  PubMed  CAS  Google Scholar 

  100. Franceschi C, Bonafe M (2003) Centenarians as a model for healthy aging. Biochem Soc Trans 31(2):457–461

    Article  PubMed  CAS  Google Scholar 

  101. Robine J, Vaupel JW (2001) Supercentenarians: slower ­ageing individuals or senile elderly? Exp Gerontol 36(4–6):915–930

    Article  PubMed  CAS  Google Scholar 

  102. Schoenhofen EA, Wyszynski DF, Andersen S et al (2006) Characteristics of 32 supercentenarians. J Am Geriatr Soc 54(8):1237–1240

    Article  PubMed  Google Scholar 

  103. Perls T, Kohler IV, Andersen S et al (2007) Survival of parents and siblings of supercentenarians. J Gerontol A Biol Sci Med Sci 62(9):1028–1034

    Article  PubMed  Google Scholar 

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  1. Division of Thoracic Surgery, Regional Ambulatory Campus Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA, USA

    Mark R. Katlic (Director)

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  1. Mark R. Katlic
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  1. School of Medicine, Department of Surgery, Yale University, New Haven, 06520, Connecticut, USA

    Ronnie Ann Rosenthal

  2. Downstate Medical Center, State University of New York, Clarkson Ave. 450, Brooklyn, 11203, New York, USA

    Michael E. Zenilman

  3. , Chairman, Department of Surgery, Sinai Hospital, 2401 West Belvedere Avenue, Baltimore, 21215, Maryland, USA

    Mark R. Katlic

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Katlic, M.R. (2011). Surgery in Centenarians. In: Rosenthal, R., Zenilman, M., Katlic, M. (eds) Principles and Practice of Geriatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-6999-6_17

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