Health concerns of the super-elderly to watch out for

By Naveed Saleh, MD, MS | Fact-checked by Barbara Bekiesz
Published August 10, 2022

Key Takeaways

  • An emerging collection of research is exploring healthcare issues surrounding the super-elderly (85+ years). A general theme is the compression of morbidity, in which the time between the presentation of disability and death is shorter in this group.

  • Heart failure incidence increases as patients reach super-elderly age. For arrhythmias and aortic stenosis, leadless pacemakers and transcatheter aortic valve replacement (TAVR), respectively, are good options for those who need them.

  • Surgery should be approached cautiously in super-elderly patients.

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

Compression of morbidity is defined as a decreased time between the manifestation of disability and death.

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).[] 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.”


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.[] 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

TAVR is a common treatment for severe 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).[] 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.[]

After compensating for confounding variables, the researchers found that age didn’t mediate these negative factors, but comorbidities did play a role.

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.[]

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.”

What this means for you

As the number of super-elderly people increases, evidence-based treatment recommendations are needed for this group. It’s a good idea for any physician to check the literature on health concerns specific to the super-elderly. Physicians who treat patients in this group should cautiously approach the use of invasive procedures and make sure that the patient is on board with surgery and its secondary effects.

Related: Health-related quality of life in elderly patients with heart failure
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