1. Extreme Longevity in Dominica, West Indies: A Population Study
Noel T. Boaz, Ph.D., M.D.
Gerald A.C. Grell, M.D., FRCP, FACP
Robert Nasiiro, M.D., M.P.H
Paul Ricketts, MB.BS., M.Sc.

2. Was “Ma Pampo” Really 128 Years Old?
Was Mrs. Elizabeth Israel (“Ma Pampo”), possibly the oldest living individual in the world (b. 27 I, 1875; d. 14 X, 2003), an isolated occurrence, or is extreme longevity relatively common on Dominica?
Certificate of Birth fulfills requirements of study, but original Portsmouth Catholic Church records destroyed by Hurricane David in 1979, and original governmental birth records destroyed by fire in 1979
Prior oldest living human being was Jeanne Calment of Arles, France, who died at the age of 122 years (b. 21 II, 1875, d. 4 VIII 1997)

3. Dominica Centenarian Study
Retrospective Cohort Study –
Report on 1st year of 3-year study: 1 Sept, 2001 to 30 Aug, 2004
“a scientific research project aimed at discovering the biological and medical causes of long life. It also seeks to provide ongoing medical surveillance for health maintenance of the elderly, especially centenarians, on Dominica.”
Observance of human rights per Helsinki Accord:
Ross University School of Medicine Human Subjects Review Board
Dominica Council on Ageing
Dominica Ministry of Community Development and Gender Affairs
Dominica Office of the President
Consent of subjects to participate:
Verbal agreement with subjects and care-givers
Signed “Participant Authorization Form”, with options for four levels of participation
Medical history and access to medical records
Physical examination
Laboratory analysis of blood, hair, or skin cells
Laboratory analysis of tissues at autopsy

4. Centenarians are evenly distributed geographically
Dominica
Geography: 290 mi2 island in the Lesser Antilles of eastern
Caribbean; mountainous terrain, largely forested, with numerous
rivers
Population: 72,727 (May, 2001 census); Largest Caribbean enclave
of Carib Amerindians; Large population of African descent; Small
European population; Admixture among all
Life Expectancy: Male - 75 years; Female - 78 to 81 years
Languages: French creole (“patois”), English, pidgin English
(“kokoi”), Carib/Arawak (extinct)
= centenarian
Centenarians are evenly distributed geographically

5. South fork, Layou River, central Dominica, north of Morne Trois Pitons
Physiography
Pointe Daniel, Southeastern Atlantic coast
South fork, Layou River, central Dominica, north of Morne Trois Pitons
Carib Reserve, northeastern Dominica, looking west towards Morne Diablotins (el ft.)

6. Research Design
A “natural history” approach, investigating the phenomenon at a populational level, using the following perspectives:
Ecological - Documenting the environmental, nutritional, demographic, familial, and sociocultural contexts
Evolutionary - Biological, genetic, and adaptive contexts
Comparative - Dominica centenarians compared to studies elsewhere
Results will help define what is “adaptively normal” (Boaz, N.T Evolving Health. NY: Wiley), a fundamentally important concept for medicine

7. Methods: Documenting the Phenomenon
In visits to each centenarian
Photographing of subjects and their birth documents
4-page form recording
Health history
Data for assessment scales (ADL’s)
Weight
Height
Blood pressure
Other information
Van at Vielle Case Health Centre
Chair scale for individuals unable to stand unassisted
U.K. passport accepted as documenting a birth date as April 2, 1898

8. Methods: Tissue Collection
Blood samples are frozen and curated for genetic analysis
Postmortem examination yields organ tissue samples for analysis and to determine cause of death

9. Methods: Lens Pachymetry
For consenting subjects – Ultrasound A-scan immersion biometry using a Kohn shell
Database will relate lens thickness to age

10. Results: Extreme Longevity in Dominica
Dominica has 22 confirmed centenarians (excluding “Ma Pampo”) in a population of 72,727 (May, 2001 census)
Prevalence is 3.02/10,000, over 3 times the incidence of centenarians in Western countries (Perls, T Sci. Am. 272:7-75).
 1/10,000 from Boston, Danish, French, and Italian Centenarian Studies
Prevalence is similar to extreme longevity seen in Okinawa and Sardinia
Centenarian Mrs. FJ with Dr. G.A.C. Grell

11. Population Statistics - Dominica
Population growth rate % (2000 est.)
Birth rate  births/1,000 population (2000 est.)
Death rate  7.3 deaths/1,000 population (2000 est.)
Net migration rate  migrant(s)/1,000 population (2000 est.)
Emigration of young Dominicans results in lower overall population census, thus increasing apparent prevalence of centenarians

12. Dominica Centenarian Statistics
Female
Male
Total
Make-Up by Gender
86% (N=19)
14% (N=3)
100% (N=22)
Mean Age
102.1
102.3
Mean BMI
20.5
17.0
19.0
Married
95% (N=18)
100% (N=3)
96% (N=22)
Children
6.7 (N=18)
4.7 (N=3)
6.1 (N=22)

13. Functional Independence: Mr. WJF
Age 102 years (birth date May 12, 1900) documented by baptismal certificate
Work: fisherman (rowed 30 miles round trip to Roseau weekly)
25 pack-year smoking history
Blood pressure 144/70
Katz rating: A
RDRS-2 Rating: 23

14. Measures of Function – Katz Index
Katz Rankings from
A – independent, to
G – totally dependent
A second index, the Rapid Disability Rating Scale, assess ADL’s without an assumption of ontogenetic order
Average of the Dominican centenarians is 41, compared to for community-dwelling older adults, 32 for hospitalized older adults, and 36 for nursing home residents (Kane and Kane 2000 Assessing Older Persons. Oxford Univ. Press, p. 33).
Mid-
point
Katz Index of Independence in Activities of Daily Living (ADLs)
Loss of ADLs in old age presumed to be in reverse ontological order and due to neurological damage or advancing age (Guttman Scale)
50% of the Dominica centenarian population scored “E” or better

15. Leanness: Mrs. AT
Mean BMI of Dominica centenarians is 19
Mrs. AT, Soufriere, Dominica, b. 6 IX 1900; d. 7 V 2002
BMI = 13.7
Katz rating G
RDRS-2 = 60
Loss of dentition, difficulty in preparing traditional, non-Western foods, or inability/unwillingness/lack of knowledge of caretakers in preparing traditional food may place centenarians at nutritional risk

16. Cardiovascular Fitness and Strength: Mr. WE
Born 15 August, 1898, documented by family Bible and government records; age now 105
Occupation: Sawyer. Used cross-cut saw 10 hours a day in montane forests; week-long stays in the forest, and carried out heavy loads of sawed lumber on head
Blinded when cement mix got into eyes in 1972
Never hospitalized; denies use of tobacco or alcohol
BP 133/69
BMI 16.3
Independent: Katz “Other”, RDRS-2 30
Man, age unknown, carrying 75-pound load of wood in Carib Reserve, Dominica, 12/2001

17. “Diseases of Civilization” are Rare in Dominica Centenarians
Common complaints
Osteoarthritis (OA)/Degenerative Joint Disease - most common
Immobility
Blindness (accident, glaucoma, cataracts, or macular degeneration)
Urinary incontinence (females)
Results of trauma/old injuries – common
Rare complaints:
Hypertension (HTN)
Stroke
Dementia (vascular) – Alzheimer’s not seen
Cardiac arrhythmia
Diabetes mellitis (DM)
Osteoporosis
Cancer
Dominica centenarians resemble a “pre-Second Epidemiologic Transition” population1, i.e. before a shift from acute infectious diseases to chronic noninfectious, degenerative diseases2 except that good public health and access to health care in Dominica reduce infectious and parasitic disease.
Armelagos et al Disease in Human Evolution. In: Selig, R.O. and M.R. London, eds. Anthropology Explored, pp Washington, DC: Smithsonian Institution Press.
Burkitt, D.P Some diseases characteristic of modern western civilization: A possible common causative factor. Clin. Radiol. 24:

18. Dominica Centenarian medical conditions contrast markedly with U. S
Dominica Centenarian medical conditions contrast markedly with U.S. and other Caribbean “diseases of civilization”
Dominica centenarians have a low incidence of HTN, TIA/CVA, and diabetes mellitis, both for their population and in comparison with U.S. geriatric patients, despite being a population at risk (African American); Factors: exercise, diet, fitness
Osteoporosis is rare among Dominica centenarians, but osteoarthritis/DJD is the most common ailment; trend is opposite in U.S. sample; Factors: strength, weight bearing, joint stress
U.S. cancer and hypercholesterolemia prevalences are high compared to Caribbean; Factors: diet, toxins, exercise
Blindness (cataracts, glaucoma, macular degeneration) prevalences similar across samples, where measured
US-Glennan = Glennan Center, EVMS geriatric patients > 85 years of age (N=36); Anonymous data courtesy of Rosanne Newman, M.D.
Dom Elder = Marigot Health District, Dominica; individuals > 65 yo (N=132) (Veen-de Vries, N.R., et al Health Status of the elderly in the Marigot District. In: Luteijn, A.J. (ed.) Primary Health Care in Dominica: Studies in the Marigot Health District, pp , Groningen: Regenboog.)
Barb Elder = Diagnoses of patients at Geriatric Hospital, Barbados from Fraser. (Grell, G.A.C The Elderly in the Caribbean, p. 8. Kingston, Jamaica: University Printery.)

19. Do “canalizing environmental factors” explain Dominica longevity?
1Corruccini, R.S., and S.S. Kaul 1983 The epidemiological transition and anthropology of minor chronic non-infectious diseases. Med. Anthropol. 7:36-50.

20. Possible “Canalization Factors”: Traditional Diet in Dominica
Staples – Tubers/ “ground provisions”: yams (Dioscorea batatas), dasheen/tanya (Clocasia esculenta); also plantains (Musa sp.) and breadfruit (Artocarpus altilis); bread
Fruits/Vegetables - Grown locally: mangoes (Mangifera indica), citrus (Citrus paradisi, Citrus sinensis, Citrus reticulata, Citrus aurantifolia), papaya (Carica papaya), pineapple (Ananas comosus), bananas (Musa acuminata), pomegranate (Punica granatum), soursop (Annona muricata), melons (Citrullus lanatus), squash (Cucurbita pepo) / lettuce, tomatoes, onions, spinach, cress
Fish/Crustaceans - Land crabs (Cardisoma guanhumi), river fish (many species), sea fish (many species), spiny lobster (Panulirus argus), crayfish (Orconectes neglectus)
Land vertebrates – Agouti (Dasyprocta leporina), chicken, frogs (“crapaud” or “mountain chicken”), manicou opossum (Didelphis albiventris), pork, goat; rarely beef
Sweeteners - Molasses; brown (unrefined) sugar; rarely white (refined) sugar
Drinks - Water, coffee, herbal teas, rum; wine and brandy only in some locales

21. Possible “Canalization Factors”: Low Rate of Tobacco Use
70% (14/20) deny any use of tobacco
15% (3 females) habitually smoked a pipe
15% smoked cigarettes – two 8.5 and 15.5 pack/years, and one at 66 pack/years
Cigarette smoking is not generally popular in Dominica

22. Possible “Canalization Factors”: Low Rate of Alcohol Use
65% (N=13) deny any use of alcohol
25% (N=5) drink occasionally, on special occasions, and/or with meals
5% (N=1) drank when young but claims to have stopped at age 40
5% (N=1) admits regular use of alcohol

23. Summary: “Canalizing Factors” Postulated as Important to Longevity Among Dominica Centenarians
Active, athletic life-style: Lifelong cardiovascular fitness, low BMI, muscularity
Diet: High-fiber, low salt, low sugar, high protein, many fresh fruits, root staples; similar to “Paleo-diet” (Eaton et al. 1985)
High environmental quality: Low exposure to toxins, no air pollution, no water pollution, no noise pollution
Low stress: Low population density, no crowding, access to forest, river, and marine resources
Low rates of tobacco and alcohol use
Effective public health and medical care: Present on Dominica and explain low incidence of infectious and parasitic diseases

24. Remaining Questions and Future Research
How to assess age without written records?
Anatomical Assessment of Extreme Longevity – Lens Pachymetry
Cellular Assessment of Extreme Longevity - Telomere Shortening
Genetic Aspects of Dominica’s Centenarians: Are they related? Do they share “anti-aging genes”? Do they lack “aging genes”?
In Dominica Centenarian Study, the following argue against primary genetic effects:
Centenarians are unaware of any kinship with other centenarians
Centenarians were born and live throughout the island
Centenarians come from different populational/racial backgrounds, e.g. Carib Amerindian, African American, Afro-European
Population structure is derived from widespread Carib and African American influx over 400 years, along with European admixture, not conducive to inbreeding