End of Life Events and Causes of Death in Danish Long-Lived Siblings: Reduced Dementia Risk Compared to Sporadic Long-Livers

Article type: Research Article

Authors: Galvin, Angéline^{a; *} | Pedersen, Jacob Krabbe^{a; b} | Arbeev, Konstantin G.^c | Feitosa, Mary F.^d | Ukraintseva, Svetlana^c | Yao, Shanshan^e | Newman, Anne B.^{e; f} | Christensen, Kaare^{a; b}

Affiliations: [a] Epidemiology, Biostatistics, and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark | [b] Department of Public Health, The Danish Aging Research Center, University of Southern Denmark, Odense, Denmark | [c] Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA | [d] Department of Genetics, Division of Statistical Genomics, Washington University School of Medicine, St. Louis, MO, USA | [e] Department of Epidemiology, Center for Aging and Population Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA | [f] Division of Geriatric Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

Correspondence: [*] Correspondence to: Angéline Galvin, Epidemiology, Biostatistics and Biodemography team, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark. Tel.: +45 65 50 30 52; E-mail: [email protected].

Abstract: Background:Better physical robustness and resilience of long-lived siblings compared to sporadic long-livers has been demonstrated in several studies. However, it is unknown whether long-lived siblings also end their lives better. Objective:To investigate end-of-life (EoL) events (dementia diagnosis, medication, hospitalizations in the last 5 years of life), causes of death, and location of death in long-lived siblings compared to matched sporadic long-livers from the Danish population. Methods:Long-lived siblings were identified through three nationwide Danish studies in which the inclusion criteria varied, but 99.5% of the families had at least two siblings surviving to age 90 + . Those who died between 2006 and 2018 were included, and randomly matched with sex, year-of-birth and age-at-death controls (i.e., sporadic long-lived controls) from the Danish population. Results:A total of 5,262 long-lived individuals were included (1,754 long-lived siblings, 3,508 controls; 63% women; median age at death 96.1). Long-lived siblings had a significantly lower risk of being diagnosed with dementia in the last years of life (p = 0.027). There was no significant difference regarding the number of prescribed drugs, hospital stays, days in hospital, and location of death. Compared to controls, long-lived siblings presented a lower risk of dying from dementia (p = 0.020) and ill-defined conditions (p = 0.030). Conclusions:In many aspects long-lived siblings end their lives similar to sporadic long-livers, with the important exception of lower dementia risk during the last 5 years of life. These results suggest that long-lived siblings are excellent candidates for identifying environmental and genetic protective factors of dementia.

Keywords: Aging, Alzheimer’s disease, causes of death, dementia, end of life events, familial longevity

DOI: 10.3233/JAD-231204

Journal: Journal of Alzheimer's Disease, vol. 99, no. 4, pp. 1397-1407, 2024