Finding the turning point in aging: a comparison of physical, cognitive, and psychological trajectories among...

Centenarians tend to delay age-related decline until very late life and generally experience slower deterioration across health domains. However, timing and pace of decline across physical, cognitive, and psychological domains among centenarians, compared to other long-lived groups, remain poorly characterized.

Using the nationally representative Health and Retirement Study (1993-2022), we modeled trajectories of disease burden, physical functioning, psychological wellbeing, and cognition among participants born before 1922 (N = 7237), followed up to 29 years. Participants were categorized by survival groups: centenarians (100+), nonagenarians (90-99), octogenarians (80-89), and septuagenarians (73-79). Joinpoint regression identified ages at which decline accelerated and quantified rates of change.

Those who lived to older ages-nonagenarian and centenarian decedents-maintained higher levels of physical/cognitive functioning into later life but showed sharp accelerations thereafter. Across physical functioning and cognition, onset of accelerated decline shifted later among those who survived longer, with centenarians showing the latest age at acceleration. Prior to acceleration, activities of daily living/instrumental activities of daily living limitations increased by approximately 0.04-0.05 points per year, rising to 0.20-0.34 points per year thereafter, while prevalence of cognitive impairment accelerated from roughly 1% to 4%-6% per year. Individuals who survived longer also maintained lower depressive symptoms and disease burden into advanced ages, although cardiovascular conditions continued to rise.

Exceptional longevity is marked by preserved physical and cognitive function followed by rapid late-life declines. Pinpointing when this tipping point occurs offers a quantitative basis for targeting interventions-medical, behavioral, and social-that sustains function and delay deterioration at the population level.