Although definitions vary, the super-elderly are commonly defined as individuals age 85 years or older.

Tindale LC, Salema D, Brooks-Wilson AR. 10-year follow-up of the Super-Seniors Study: compression of morbidity and genetic factors. BMC Geriatr. 2019;19(1):58.

Special health concerns characterize this group, as highlighted by emerging research.

 

Here is a sampling of such findings on the health issues of the super-elderly.

 

Compression of morbidity

Writing in BMC Geriatrics, Canadian authors found that in a cohort of super-elderly they followed for 9–12 years after the initial study, compression of morbidity was evident at extreme ages—especially among centenarians (100+). The authors pointed to genetics as being a major contributor to living to older age.

The researchers originally assessed a cohort of 480 super-elderly patients, but when following up after nearly a decade, only 13 patients (of whom 54% were still healthy) could be re-interviewed. The vast majority of the original participants had died.

 

Heart issues

Heart failure

In a population-based study published in Circulation Reports in 2020, Japanese researchers assessed the clinical outcomes of super-elderly patients (≥90 years) who were admitted for treatment of heart failure (HF).

Kaneko H, Itoh H, Yotsumoto H, et al. Characteristics and outcomes of superelderly patients (aged ≥90 years) hospitalized for heart failure—analysis of a nationwide inpatient database. Circ Rep. 2020;2(8):393–399.

They found that these patients were less likely to receive advanced procedures, and risk of infection, as well as in-hospital mortality and length of stay, increased with age.

 

Citing a lack of research on the topic, the authors wrote, “An evidence-based approach for super-elderly HF patients should be established in the era of HF pandemic.”

Arrhythmias

In super-elderly patients with arrhythmias, leadless pacemakers may be a good option in those who need them, according to the results of a 2020 study published in Pacing and Clinical Electrophysiology.

Tachibana M, Banba K, Matsumoto K, et al. The feasibility of leadless pacemaker implantation for superelderly patients. Pacing Clin Electrophysiol. 2020;43(4):374–381.

Leadless pacemakers can be used in smaller patients or those with dementia, but “careful procedures and long follow-ups are needed until a greater volume of data is reported,” the authors advised.

 

Aortic stenosis

Authors of a 2022 study published in Medicine compared surgical outcomes for two groups of patients undergoing this procedure: elderly patients (65–79 years) and super-elderly patients (80 years and older).

Oh S, Kim JH, Hwang C-H, et al. Comparison of outcomes after transcatheter aortic valve replacement between elderly (65–79 years) and superelderly (≥80 years) patients. Medicine. 2022;101(26).

In assessing the data for 134 patients, researchers found no age-based differences in safety or clinical outcomes.

 

 

Hip fractures

In a study published in Aging in 2020 that followed a subset of super-elderly patients in China, researchers aimed to assess adverse functional outcomes, perioperative complications, and death rates among those receiving surgery for intertrochanteric fractures.

Guo J, Wang Z, Fu M, et al. Super elderly patients with intertrochanteric fractures do not predict worse outcomes and higher mortality than elderly patients: a propensity score matched analysis. Aging (Albany NY). 2020;12(13):13583–13593.

 

Intriguingly, the researchers noted that the majority of patients could walk on their own after surgery without walking aids, with only a few needing wheelchairs or bed convalescence.

 

Assessing surgical risk is essential

When performing any surgery—especially in the super-elderly—consent based on an objective determination of risk could be key to avoiding bad outcomes.

For this purpose, investigators developed a surgical risk assessment tool for super-elderly people, based on two factors that predominantly affect the quality of postoperative outcomes: (1) skeletal muscle mass index and (2) American Society of Anesthesiologists physical status.

Miura Y, Nishio K, Kitamura Y, et al. Surgical risk assessment for super‐elderly patients. Geriatrics Gerontol Int. 2022;22(4):271–277.

 

As the authors wrote, “Informed consent based on the risk score might be able to reduce the regrettable situation where it would have been better to have had surgery or not to have had surgery.”