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The international extension of life expectancy is resulting in a fast improve within the inhabitants aged 80 and over, and particularly, the proportion of people aged 95 and over, outlined because the “oldest-old,” is rising considerably yearly.1 Statistics relating to this age group are fairly restricted each globally and in Turkey. According to the report by the Turkish Statistical Institute, people aged 65 and over represent 10.6% of the whole inhabitants in Turkey, and seven.8% of the older inhabitants is aged 85 and over.2
Prolonged life expectancy will increase the prevalence of geriatric syndromes comparable to frailty, cognitive decline, melancholy, malnutrition, fall danger, and practical dependence.3 Frailty is a scientific syndrome characterised by decreased physiological reserves and elevated susceptibility to stressors in older people, which might result in irreversible adversarial outcomes. Inflammatory processes, sarcopenia, hormonal modifications, dietary deficiencies, and psychosocial elements play a major function within the pathophysiology of frailty.4
Another essential issue on this age group is the historical past of bodily exercise. Regular train has been proven to delay the event of sarcopenia and frailty, assist cognitive features, and scale back the danger of falling.5 The improve in persistent illness burden with superior age additionally will increase practical dependence. This state of affairs is seen as an element contributing to the event of melancholy. Social and environmental life occasions comparable to ailments, lack of a partner, or placement in a care establishment improve vulnerability in older people; this results in a susceptibility to melancholy and sleep issues.2
It is thought that psychological traits are as determinant on well being outcomes in older people as diet and bodily exercise. Positive have an effect on, optimism, and psychological resilience contribute to the preservation of cognitive features and the upkeep of bodily endurance. Conversely, melancholy and low self-efficacy ranges have been reported to have unfavourable results on each high quality of life and mortality.6 Longevity is usually related to the onset of a number of well being issues or the worsening of current ones.7 Although the World Health Organization (WHO) reviews a rise within the prevalence of melancholy amongst older adults, it’s said that this situation is ceaselessly misinterpreted as a “natural process of aging” in very superior ages, is underdiagnosed, and remedy usually stays insufficient.8
In Turkey, the definition and goal of Healthy Aging Centers (YAŞAM) have been defined within the Regulation on Home Health Services dated June 2, 2023. Accordingly, YAŞAM models have been established by the Ministry of Health to make sure that people, particularly these over the age of 80, have simpler entry to well being companies, to judge and assist medical care wants at dwelling or of their atmosphere, to carry out common medical monitoring, and to supply distant well being companies when vital. Furthermore, it goals to contribute to the availability of holistic and uninterrupted well being companies to older adults by making certain the coordination of in-hospital medical care processes.9
To higher perceive the advanced interaction of things on this distinctive inhabitants, this research is grounded within the biopsychosocial mannequin of growing older, which posits that wholesome growing older will not be merely the absence of illness however the results of interactions between organic, psychological, and social elements.10 Furthermore, we undertake the World Health Organization’s idea of “intrinsic capacity”, outlined because the composite of all bodily and psychological capacities of a person.11 This framework helps clarify how way of life historical past and psychological traits (eg, optimism) contribute to practical preservation even within the presence of multimorbidity within the oldest-old.12
While research on nonagenarians and centenarians are growing globally—such because the Heidelberg Centenarian Study in Germany —knowledge from creating international locations and particularly the Mediterranean area stay restricted.7 Comparing the traits of the Turkish oldest-old with worldwide cohorts, comparable to these from Japan is important to establish culturally particular versus common determinants of longevity.13
This research was deliberate to look at the connection of persona traits, dietary habits, and way of life elements with geriatric syndromes comparable to frailty, malnutrition, melancholy, cognitive standing, fall danger, and sleep high quality in people aged 95 and over who’re adopted up in YAŞAM polyclinics. In this side, this research is among the many uncommon research through which psychosocial and organic elements are evaluated collectively in a really superior age group, with the participation of three facilities, and goals to contribute to the literature.
This research was designed as a descriptive and cross-sectional research. It was carried out between February 1 and October 1, 2025, on the YAŞAM Polyclinics working inside three totally different coaching and analysis hospitals. All contributors have been knowledgeable intimately in regards to the goal and scope of the research, and verbal and written knowledgeable consent was obtained previous to knowledge assortment. The research was carried out in accordance with the ideas of the Declaration of Helsinki.
A complete of 230 people aged 95 years and above have been registered within the YAŞAM polyclinics. The pattern measurement for this research was calculated utilizing the OpenEpi (model 3.0) program, assuming a 95% confidence interval, 5% margin of error, and an anticipated frequency of fifty%. Accordingly, the minimal required pattern measurement was decided as 148 contributors. Individuals aged 95 years and older who have been registered within the YAŞAM polyclinic, had enough cognitive capacity to answer the questionnaire, and voluntarily agreed to take part have been included within the research.Individuals aged 95 years and over registered within the YAŞAM polyclinics, who had enough cognitive competence to reply the survey questions and agreed to take part, have been included within the research.Exclusion standards have been: (1) extreme cognitive impairment that prevented completion of the interview, (2) acute medical circumstances requiring rapid remedy, (3) extreme listening to or speech impairment stopping dependable communication, (4) being bedridden resulting from terminal sickness (CFS = 9), and (5) refusal to take part.
Data have been collected by way of face-to-face interviews carried out by educated researchers. Participants have been knowledgeable in regards to the research procedures, and written and verbal consent was obtained previous to questionnaire administration. The knowledge assortment kind consisted of an 8-item sociodemographic questionnaire (together with age, gender, marital standing, training, earnings supply, dwelling association, and well being notion) and a 10-item way of life questionnaire (bodily exercise, social assist, and so forth).
Functional independence period represented the whole variety of years a person was in a position to carry out fundamental actions of each day dwelling—together with consuming, dressing, bathing, toileting, and mobility—with out help. Based on info obtained from the participant or caregiver, the age at which the person was final absolutely unbiased was famous, and the period was calculated by subtracting this age from the participant’s present age.
This scale assesses fundamental self-care actions comparable to feeding, bathing, dressing, toileting, and transferring. Scores vary from 0 to six, with 6 indicating full independence and scores under 6 indicating dependence.
The CFS evaluates frailty standing on a scale from 1 (very match) to 9 (terminally in poor health), based mostly on comorbidities, practical capability, and total well being.
This software consists of 19 objects (8 main and 11 minor) assessing fall danger in older adults. Scores of 0–4 point out low fall danger, whereas scores ≥5 point out excessive fall danger.
Recommended by ESPEN, MUST evaluates malnutrition danger based mostly on BMI, unintentional weight reduction throughout the final 3–6 months, and the presence of acute illness. Scores are categorized as 0 (low danger), 1 (medium danger), and ≥2 (excessive danger).14
A 15-item sure/no scale used to display screen for melancholy. Scores ≥5 point out a danger of melancholy.
A 19-item self-report scale assessing sleep high quality over the earlier month. Total scores vary from 0 to 21, with ≥5 signifying poor sleep high quality.
Consists of three-word recall and a clock drawing process. Scores vary from 0 to five, with ≤2 indicating potential cognitive impairment.
The CCI assesses comorbidity burden based mostly on 19 persistent circumstances, every scored from 1 to six factors. Total scores of 0–2 point out low danger, whereas ≥3 point out moderate-to-high danger.
Statistical analyses have been carried out utilizing SPSS (Statistical Package for the Social Sciences) model 22.0. Descriptive statistics for steady variables have been reported as imply ± normal deviation for these assembly the conventional distribution assumption, and as median (minimal–most) or median (IQR) for these not assembly it; categorical variables have been reported as quantity (proportion, %). The distribution of steady variables was evaluated with the Kolmogorov–Smirnov check and skewness–kurtosis z-scores (│z│ < 1.96 accepted), and homogeneity of variance between teams was evaluated with the Levene check.
Independent samples t-test was used for comparisons of two teams becoming regular distribution and homogeneity of variance, and the Mann–Whitney U-test was used when assumptions weren’t met. The Pearson chi-square check was utilized within the comparability of categorical variables; Fisher’s actual chi-square check was most well-liked in instances the place the anticipated cell rely was <5. In cross-tabulation analyses, cell percentages and impact sizes (phi [φ] or Cramér’s V) have been additionally reported for vital relationships. Relationships between steady variables have been examined with Pearson correlation when assumptions have been met, and with Spearman rank correlation once they weren’t or for ordinal variables. All checks have been carried out as two-tailed, and the statistical significance stage was decided as p < 0.05.
Effect sizes have been reported as Cohen’s d (for t-tests), r (for Mann–Whitney U), and phi (φ) / Cramér’s V (for chi-square checks) the place acceptable. Approximate threshold values for small, medium, and huge results have been accepted as d = 0.20 / 0.50 / 0.80; r = 0.10 / 0.30 / 0.50; φ or V = 0.10 / 0.30 / 0.50, respectively. Bonferroni correction was made when vital in a number of comparisons. Missing knowledge have been excluded listwise from analyses. Significant p-values have been offered as actual values as much as three decimal locations (eg, p =0.032); inequality notation was used for p < 0.001.
A complete of 148 people have been included within the research. The ages of the contributors ranged from 95 to 109 years, with a imply of 97.09±2.63 years. The variety of people over the age of 100 is 25. Of the contributors, 74.3% (n=110) are ladies, the overwhelming majority are widowed (85.8%), and the speed of those that haven’t modified their place of residence within the final 10 years is 85.1%. Regarding earnings supply, 35.1% reported their very own retirement pension, whereas 49.3% reported a partner/little one/father or mother pension. It was decided that care assist was principally supplied by kids (69.6%). The sociodemographic, well being notion, and persona traits of the contributors are proven in Table 1.
| Table 1 Sociodemographic Data and Health Perception Characteristics of Participants (n=148)
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The mean height was 154.39±8.55 cm, weight 57.93±11.29 kg, BMI 24.18±3.78 kg/m2, and calf circumference was 29.2±3.77 cm.
It was determined that 26.4% of the participants had exercised regularly in earlier periods of their lives. The presence of chronic disease was 91.9%, with hypertension being the most frequent at a rate of 70.3%, followed by cardiovascular diseases at 37.2%, diabetes mellitus at 20.3%, and dementia at 18.9%. Osteoporosis was detected at 7.4%, COPD/asthma at 4.1%, psychiatric disease at 3.4%, Parkinson’s at 2.0%, malignancy at 1.4%, and incontinence complaints at 66.9%.
The participants’ average number of hospitalizations in the last 10 years was 1.81±1.89; the average number of doctor visits in the last 1 year was 8.59±5.33. The average number of prescribed drugs was 4.0±2.3 (min 2–max 6). The duration of functional independence was 86.89±8.43 years, and the life spans of mothers and fathers were 77.99±12.96 and 75.09±14.08 years, respectively.
When participants’ personality traits were queried, they were identified as “calm” 33.1% (n=49), “talkative” 29.7% (n=44), “optimistic” 29.1% (n=43), “extroverted” 23.6% (n=35), “irritable” 20.9% (n=31), “introverted” 14.9% (n=22), and “pessimistic” 12.2% (n=18).
When geriatric scales were evaluated, it was found that Clinical Frailty Scale (CFS) scores ranged from 3–8, with a mean value of 6.11±0.98. Katz ADL varied between 0–6, calculated as an average of 2.95±1.70. Mini-Cog was applied to only 43 participants; scores were found to be in the 0–5 range (mean 2.44±1.47). ITAKI-minor mean score was 5.29±1.77 (1–9), ITAKI-major mean score was 7.64±5.23 (0–20), and ITAKI-total was 12.93±6.01 (1–28). MUST score ranged from 0–4 with a mean of 0.87±1.13. GDS-SF scores ranged from 0–14 with a mean score of 4.87±2.57. Finally, the PSQI total score varied between 2–19, and the mean value was determined as 8.03±3.85.
In comparisons by gender, the Mini-Cog score was higher in men (2.14±1.35 vs 3.75±1.28; p=0.004). In women, doctor visits in the last 1 year (12.51±7.63 vs 6.88±7.99; p=0.010), GDS-SF score (5.51±3.40 vs 3.13±2.47; p=0.002), and hospitalizations in the last 10 years (median 2 [1–3] vs 1 [0–1]; p=0.032) were higher. These data were statistically significant. There was no significant difference in terms of BMI, calf circumference, CFS, ITAKI scores, PSQI, MUST, and number of prescribed drugs (p>0.05).
In those with a history of exercise, functional independence duration (U=1272.5; Z=–3.97; p<0.001), Katz (U=1591.0; Z=–2.36; p=0.018), and Mini-Cog (U=32.0; Z=–2.44; p=0.015) scores were higher. Conversely, ITAKI-major (U=1601.5; p=0.016) and ITAKI-total (U=1608.5; p=0.024) scores were higher in those without an exercise history (Table 2). Additionally, DM (25.6% vs 12.1%; p=0.046) and incontinence (73.3% vs 56.9%; p=0.038) have been extra frequent in these with out an train historical past. In steady variable analyses, hospitalizations within the final 10 years (p=0.015) and GDS-SF (p=0.032) have been increased in these with out an train historical past; CFS tended to be increased (p=0.018) and Katz decrease (p=0.050).
| Table 2 Evaluation of the Relationship of Exercise History with Other Variables
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When the relationship between personality traits and geriatric syndromes was evaluated; in Chi-square analyses, a significant relationship was observed only between optimism and CFS (χ2(1,n=148)=11.04; p=0.001; φ=–0.27); the frailty rate was lower in those who were optimistic. There was no significant relationship between other personality traits and CFS (all p>0.05). No significant relationship was detected between the presence of depression and personality traits (all p>0.05); borderline significance was observed for “talkativeness” (χ2=3.23; p=0.072; φ=–0.15). While there was generally no significant relationship according to Mini-Cog results, optimism was associated with normal cognitive function (χ2(1,n=43)=7.44; p=0.006; φ=0.42).
Significant relationships were observed between CFS categories and perceived health status, CCI, and optimistic/calm personality (all p<0.05). Frailty was more common in CCI moderate–high risk (p=0.023). Frailty was lower in the optimistic/calm group (p=0.018). It was determined that the frail rate was high in the “very good/good” perceived health status group (p<0.001) (Table 3).
| Table 3 Comparison of Demographic and Clinical Variables with CFS (Frailty)
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Functional dependence was associated with perceived health status (p<0.001), CCI (p=0.023), gender (p=0.044), and optimistic/calm personality (p=0.004). The independence rate was higher in poor/very poor health perception; all individuals in the CCI moderate–high risk group were dependent. The independence rate was higher in men compared to women. No significant relationship was observed with other variables.
A relationship was detected between gender (p=0.029) and Mini-Cog categories: the probability of cognitive impairment was higher in women. The relationship with optimistic/calm personality was borderline significant (p=0.050). There was no significance in other variables.
Perceived health status (p=0.002) and exercise history (Fisher p=0.003) were associated with fall risk. It was determined that the rate of low risk for falling was high in those who exercised. No relationship was detected with other variables (Table 4).
| Table 4 Comparison of Demographic and Clinical Variables with ITAKI (Fall Risk)
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Depression was associated with perceived health status (p=0.002) and gender (p=0.010); depression was higher in women. No significant relationship was found with age group, exercise, personality traits, and CCI.
No significant relationship was observed between MUST categories and demographic/clinical variables (all p>0.05); there was a tendency for moderate–high risk in those with poor/very poor health perception (p=0.168). No significant relationship was detected between the type of caregiver and MUST, Mini-Cog, PSQI, ITAKI, GDS, Katz, and CFS (all p>0.05). PSQI was associated only with optimistic/calm personality. Sleep quality was better in those with an optimistic/calm personality (χ2=6.52; p=0.011); there was no significant relationship with other variables.
This study aimed to shed light on the psychosocial determinants of being healthy in advanced age by evaluating the relationships between lifestyle habits, personality traits, and geriatric syndromes in individuals aged 95 and over. Findings show that behavioral and psychological factors such as optimism and physical activity are associated with the preservation of cognitive function and the maintenance of functional independence. These results indicate that psychosocial resilience continues to be effective on clinical outcomes even in individuals aged 95 and over.
Women constituted the vast majority of participants, and the rate of being widowed was found to be quite high. Similarly, female predominance and high rates of widowhood in long-lived individuals have been reported in the literature.15 A good portion of the contributors are depending on their kids for care, and this case demonstrates the significance of social assist networks in superior age. It was decided that the contributors’ lengthy lives didn’t parallel their mother and father’ life spans. This discovering is according to research within the literature suggesting that longevity will not be strongly hereditary or sex-linked.16
In our analysis, it was noticed that amongst persona traits, solely optimism was considerably related to frailty and cognitive standing. Studies have proven that optimism is a protecting issue towards frailty in older adults regardless of unfavourable life occasions.7,17 These outcomes assist that psychological resilience is a vital protecting consider superior age. It means that the impact of persona traits on well being outcomes in outdated age ought to be evaluated inside a biopsychosocial framework. Notably, the consistency of this affiliation throughout a number of outcomes—together with decrease frailty, higher cognitive efficiency, and superior sleep high quality—identifies optimism as a strong and first determinant of wholesome growing older in our pattern. This robust correlation means that psychological property could also be as influential as bodily well being markers on the excessive finish of the human lifespan.
Depression, detected in additional than one-third of the contributors, was discovered to be related to gender and subjective well being standing. The excessive charges noticed in ladies parallel research findings emphasizing that this group is in danger for melancholy within the older inhabitants.18
Moreover, the unexpectedly noticed ranges of melancholy amongst people who understand their well being as “good” assist the “well-being paradox,” indicating that psychological processes unbiased of bodily well being are influential.19
Regarding falls, the overwhelming majority of the pattern was within the high-risk group, and because the most putting discovering, it was noticed that every one contributors over the age of 100 carried a excessive danger of falling with out exception; regardless of this, no statistical distinction was detected between the 95–99 and ≥100 age teams. Finding a relationship between common train historical past and low fall danger in our research is according to the literature emphasizing that bodily exercise is the best technique in stopping falls.20 This protecting impact is defined by train creating resistance towards lack of stability by growing neuromuscular management and physiological reserve (intrinsic capability).21 Indeed, present meta-analyses verify that train considerably reduces fall charges in older adults.22
In our research, widespread sleep problem was detected as an anticipated discovering within the older inhabitants. However, the considerably decrease ranges of sleep problem in optimistic and calm-tempered people are according to present literature emphasizing that persona traits can create a protecting (buffering) impact on sleep physiology.23 Optimistic people perceiving each day stressors as much less threatening and staying away from pre-sleep rumination preserves sleep high quality by balancing autonomic nervous system activation.24 Therefore, our findings assist that psychological well-being features as a protecting barrier towards sleep issues ceaselessly seen in outdated age.
In comparisons made in accordance with gender, it was noticed that males had increased cognitive efficiency, whereas ladies had increased charges of melancholy, hospital admissions, and healthcare visits. This state of affairs is according to the “morbidity–mortality paradox,” which signifies that though ladies have an extended life expectancy, they carry a better morbidity and psychological burden.4 The excessive frequency of melancholy in ladies could also be associated to the speed of dwelling alone in addition to hormonal and psychosocial elements.
In this research, practical independence and cognitive efficiency are increased, and frailty and malnutrition charges are decrease in people with a historical past of train. The function of bodily exercise in lowering frailty might be defined by organic mechanisms comparable to suppression of oxidative stress, preservation of mitochondrial perform, and upkeep of muscle mass.25 Studies have said that bodily exercise balances age-related modifications within the prevention of sarcopenia and frailty.1,4 Furthermore, it has been reported that cardio and resistance workout routines assist cognitive features and neuroplasticity.26,27
Finding practical independence ranges related to perceived well being standing, gender, comorbidity burden, and optimism is an anticipated end result. However, a better fee of frailty in people evaluating themselves as “very good/good” was an sudden discovering. Possible explanations for this case embody the small pattern measurement, the subjective nature of subjective well being notion, and the change within the well being reference body in superior age. Jung et al said that subjective well being evaluation is formed not solely by medical indicators but in addition by psychosocial elements.28 Wuorela et al confirmed that subjective well being notion can strongly predict long-term mortality.29 Therefore, though subjective well being evaluation will not be a marker of geriatric syndromes alone, it’s a useful complementary indicator in understanding the final well-being of older people. Gobbens and van Assen’s mannequin, emphasizing that frailty is a multidimensional idea carefully associated to high quality of life and subjective well-being, helps these outcomes.10 On the opposite hand, sure findings ought to be interpreted as exploratory. For occasion, the connection between “talkativeness” and melancholy confirmed solely borderline significance (p=0.072). Similarly, whereas the Mini-Cog outcomes supplied useful insights into cognitive impairment patterns, they’re based mostly on a diminished subset of the inhabitants (n=43). These outcomes, whereas believable, warrant additional validation in bigger, extra numerous cohorts of nonagenarians to find out their scientific stability.
This research has a number of limitations that ought to be acknowledged. First, the cross-sectional design precludes any inferences relating to causality. Second, using comfort sampling and the give attention to a selected geographic area in Turkey might restrict the generalizability of the findings to the broader international inhabitants of the oldest-old. Third, though we reported vital findings relating to cognitive standing, the diminished pattern measurement for the Mini-Cog evaluation restricts the facility and generalizability of those particular outcomes. Fourth, our evaluation of bodily exercise relied on a self-reported historical past with out detailed metrics on the sort, depth, or period of train, which can be topic to recall bias. Finally, sure potential confounders, comparable to detailed dietary consumption or particular biomarkers of growing older, weren’t included within the present evaluation.
This research supplies essential insights into the primary determinants of longevity amongst people aged 95 years and older in Türkiye. It demonstrates that even at very superior ages, psychological and behavioral elements play a figuring out function in well being and performance. From a scientific perspective, these findings recommend that Healthy Aging Centers (YAŞAM) and related geriatric care fashions ought to transfer past conventional medical monitoring to incorporate routine screenings for psychological property like optimism and social engagement. Furthermore, our outcomes underscore the significance of selling “intrinsic capacity” by way of tailor-made bodily exercise packages, even for the oldest-old, to delay practical dependence. Integrating psychosocial resilience assist into normal geriatric assessments might present a extra holistic method to longevity and enhance the standard of life for people on the excessive finish of the human lifespan.
ADL, Activities of Daily Living; BMI, Body Mass Index; CCI, Charlson Comorbidity Index; CFS, Clinical Frailty Scale; COPD, Chronic Obstructive Pulmonary Disease; DM, Diabetes Mellitus; GDS-SF, Geriatric Depression Scale–Short Form; ITAKI, ITAKI Fall Risk Scale; MUST, Malnutrition Universal Screening Tool; PSQI, Pittsburgh Sleep Quality Index; SPSS, Statistical Package for the Social Sciences; YAŞAM, Healthy Aging Centers (Türkiye Ministry of Health).
This research was reviewed and accepted by the İzmir Katip Çelebi University Health Research Institutional Review Board (Decision Date: February 13, 2025; Decision No: 0043). All procedures involving human contributors have been carried out in accordance with the moral requirements of the institutional analysis committee and with the ideas of the Declaration of Helsinki.
Prior to participation, all contributors have been absolutely knowledgeable in regards to the goal and procedures of the research, and written knowledgeable consent was obtained from all people included within the analysis. Participation was voluntary, and contributors have been assured of the confidentiality and anonymity of their knowledge.
No potential battle of curiosity was reported by the authors.
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