Clinical, functional, mental and social profile of the Nicoya Peninsula centenarians, Costa Rica, 2017

  • Fabian Madrigal-LeerEmail author
  • Alvaro Martìnez-Montandòn
  • Marielos Solìs-Umaña
  • Faridy Helo-Guzmàn
  • Kattia Alfaro-Salas
  • Isabel Barrientos-Calvo
  • Zianne Camacho-Mora
  • Vanessa Jimènez-Porras
  • Susana Estrada-Montero
  • Fernando Morales-Martìnez
Original Article



In Latin America, knowledge about the demography and health status of adults aged 100 years and over is scarce. Insufficient studies of the elderly population in Costa Rica exist despite having a “Blue Zone” (geographical area with a high concentration of centenarians) in the Peninsula of Nicoya, with a high percentage of centenarians in the districts of Santa Cruz, Nicoya, Hojancha, Nandayure and Carrillo.


To describe the clinical, functional, mental and social profile of centenarians residing in the Blue Zone of the Peninsula of Nicoya, Costa Rica.


This is a cross-sectional study using a population base of 43 community-dwelling centenarians. A comprehensive geriatric assessment was performed, including sociodemographic information, health status, electrocardiogram and laboratory tests.


The mean age of centenarians was 101.93 years, of whom 18 (42%) were men and 25 (58%) women. Two (4.6%) resided in nursing homes. Women had worse results than men in the evaluation of dependence on basic and instrumental activities of daily living, and the short physical performance battery performance test. A high prevalence of low Vitamin D levels (87.3%), atrial fibrillation (9.3%) and visual impairment (46.5%) was found.


This is the first study describing the medical, functional, mental and social profile of centenarians in the Peninsula of Nicoya (Blue Zone) in Costa Rica. This population has a high prevalence of malnutrition and hypertension with dependence on the basic activities of daily living, and a low prevalence for diabetes, depression, ischemic heart disease, chronic obstructive pulmonary disease, and polypharmacy.


Centenarians Geriatrics Gerontology Quadri-functional approach Blue zone 



We acknowledge to each of the centenarians for their cooperation, and to their families for their help in the interviews and the warm reception given to the research team; to the national and local health institutions of Costa Rica for their support; to Karen Andersen, MD, for helping in the analysis and interpretation of data, to Tricia Pennycook-Sawyers, MD, former Director of the Center for Strategic Development and Information in Health and Social Security, (CENDEISS), for her support in conducting the field work; Malaquías Monge, MD, for his participation and collaboration in taking laboratory samples; Gendry Diaz-Angulo, MD, Director of the Clinical Laboratory, Hospital “La Anexión”, Nicoya, Costa Rica; Sonia Zeledón for her help in the registry of information.

Compliance with ethical standards

Conflict of interest

The authors have no conflicting or competing interests to declare.

Statement of human and animal rights

All human and animal studies have been approved by the appropiate ethics committe and have therefore been performed in accordance with ethical standars laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Not applicable.


  1. 1.
    Sachdev PS, Levitan C, Crawford J et al (2013) The Sydney Centenarian Study: methodology and profile of centenarians and near-centenarians. Int Psychogeriatr 25:993–1005CrossRefGoogle Scholar
  2. 2.
    Zeng Y et al (2017) Demographics, phenotypic health characteristics and genetic analysis of centenarians in China. Mech Ageing Dev 165:86–97CrossRefGoogle Scholar
  3. 3.
    Teixeira L et al (2017) Centenarians in Europe. Maturitas 104:90–95CrossRefGoogle Scholar
  4. 4.
    Stathakos D et al (2005) Greek centenarians: assessment of functional health status and life-style characteristics. Exp Gerontol 40:512–518CrossRefGoogle Scholar
  5. 5.
    Montesanto A et al (2017) Demographic, genetic and phenotypic characteristics of centenarians in Italy: focus on gender differences. Mech Ageing Dev 165:68–74CrossRefGoogle Scholar
  6. 6.
    Ribeiro O, Teixeira L, Araújo L et al (2016) Health profile of centenarians in Portugal: a census-based approach. Popul Health Metr 14:13CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Ailshire J et al (2014) Becoming centenarians: disease and functioning trajectories of older US Adults as they survive to 100. J Gerontol Ser A Biomed Sci Med Sci 70:193–201CrossRefGoogle Scholar
  8. 8.
    Robine J, Romieu I, Allard M (2003) French centenarians and their functional health status. Presse Medicale (Paris, France: 1983) 32:360–364Google Scholar
  9. 9.
    Rochon PA et al (2014) Demographic characteristics and healthcare use of centenarians: a population-based cohort study. J Am Geriatr Soc 62:86–93CrossRefGoogle Scholar
  10. 10.
    Hazra C et al (2015) Differences in health at age 100 according to sex: population-based cohort study of centenarians using electronic health records. J Am Geriatr Soc 63:1331–1337CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Valdés P, Ruiz A, Pérez A et al (2017) Sociodemographic and clinical characteristics of centenarians in Mexico City. Biomed Res Int 2017:1–7. CrossRefGoogle Scholar
  12. 12.
    Giraldo G (2009) Counting to 100: a first look at Cuba’s National Centenarian Study. MEDICC Rev 11:17–19Google Scholar
  13. 13.
    National Institute of Statistics and Census (INEC) (2013) Estimations and projections of the population by gender and age 1950–2050. San JoseGoogle Scholar
  14. 14.
    OPS (2017) Informe de Salud de las Américas 2017. Accessed 5 May 2017
  15. 15.
    Tribunal Supremo de Elecciones del Gobierno de Costa Rica. Accessed 5 May 2017
  16. 16.
    Rosero L, Dow WH, Rehkopf DH (2013) The Nicoya region of Costa Rica: a high longevity island for elderly males. Vienna Yearb Popul Res Vienna Inst Demogr Austrian Acad Sci 11:109–136CrossRefGoogle Scholar
  17. 17.
    Poulain M, Pes GM, Grasland C et al (2004) Identification of a geographic area characterized by extreme longevity in the Sardinia island: the AKEA study. Exp Gerontol 39:1423–14299CrossRefGoogle Scholar
  18. 18.
    Poulain M, Pes G, Grasland C et al (2004) Identification of a geographic area characterized by extreme longevity in the Sardinia island: the AKEA study. Exp Gerontol 39:1423–1429CrossRefGoogle Scholar
  19. 19. Accessed 5 May 2017
  20. 20.
    Vellas B, Guigoz Y, Gary PJ et al (1999) The mini nutritional assessment (MNA) and its use in grading the nutritional status of elderly patients. Nutrition 15:116–122CrossRefGoogle Scholar
  21. 21.
    Guigoz Y, Laique S, Vellas BJ (2002) Identifying the elderly risk of malnutrition The Mini Nutritional Assessment. Clin Geriatr Med 18:737–757CrossRefGoogle Scholar
  22. 22.
    Chumlea WMC, Guo SS, Steinbaugh ML (1994) Prediction of stature from knee height for black and white adults and children with application to mobility impaired or handicapped persons. J Am Diet Assoc 94:1385–1388CrossRefGoogle Scholar
  23. 23.
    Chumlea WMC, Guo SS, Roche AF et al (1988) Prediction of body weight for the nonambulatory elderly from anthropometry. J Am Diet Assoc 88:564–568Google Scholar
  24. 24.
    Roberts H, Denison NH, Martin H et al (2011) A review of the measure of grip strength in clinical and epidemiological studies: towards standardised approach. Age Ageing 40:423–429CrossRefGoogle Scholar
  25. 25.
    Guralnik J, Simonsick E, Ferrucci L et al (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49:85–94CrossRefGoogle Scholar
  26. 26.
    Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel Index. Md Med J 13:61–65Google Scholar
  27. 27.
    Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186CrossRefGoogle Scholar
  28. 28.
    Downton JH, Andrews K (1991) Prevalence, characteristics and factors associated with falls among the elderly living at home. Aging (Milano) 3:219–228Google Scholar
  29. 29.
    Yesavage JA (1998) Geriatric depression scales. Psychopharmacol Bull 24:709–711Google Scholar
  30. 30.
    Galvin JE, Roe CM, Powlishta KK et al (2005) The AD8 a brief informant interview to detect dementia. Neurology 65:559–564CrossRefGoogle Scholar
  31. 31.
    Gussekloo J, de Craen AJ, Oduber C et al (2005) Sensory impairment and cognitive functioning in oldest-old subjects: the Leiden 85 + Study. Am J Geriatr Psychiatry 13:781–786CrossRefGoogle Scholar
  32. 32.
    Arosio B et al (2017) Cognitive status in the oldest old and centenarians: a condition crucial for quality of life methodologically difficult to assess. Mech Ageing Dev 165B:185–194CrossRefGoogle Scholar
  33. 33.
    Costa Rican University and National Council of the Elder Person (2008) First Report of the current situation of the older adult in Costa Rica, vol 6. National Press, San José, pp 101–106Google Scholar
  34. 34.
    Tettamanti M, Marcon G (2018) Cohort profile: ‘Centenari a Trieste’ (CaT), a study of the health status of centenarians in a small defined area of Italy. BMJ Open 8:e019250. CrossRefPubMedCentralGoogle Scholar
  35. 35.
    Rabuñalr et al (2004) Estado de salud de los muy ancianos: situación clínica y funcional de la población centenaria. An Med Interna (Madrid) 21:543–547Google Scholar
  36. 36.
    World Health Organization (2016) Multimorbidity: technical series on safer primary care. Accessed 18 Aug 2018
  37. 37.
    Michiyo T, Nobuyoshi H, Yasumichi A et al (2007) Morbidity of Tokyo-area centenarians and its relationship to functional status. J Gerontol Med Sci 62ª:774–782Google Scholar
  38. 38.
    Wastesson JW, Parker MG, Fastbom J et al (2012) Drug use in centenarians compared with nonagenarians and octogenarians in Sweden: a nationwide register-based study. Age Ageing 41:218–224CrossRefGoogle Scholar
  39. 39.
    Kannel WB, Wolf PA, Benjamin EJ et al (1998) Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 82:2N–9NCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Fabian Madrigal-Leer
    • 1
    Email author
  • Alvaro Martìnez-Montandòn
    • 1
  • Marielos Solìs-Umaña
    • 1
  • Faridy Helo-Guzmàn
    • 1
  • Kattia Alfaro-Salas
    • 1
  • Isabel Barrientos-Calvo
    • 1
  • Zianne Camacho-Mora
    • 1
  • Vanessa Jimènez-Porras
    • 2
  • Susana Estrada-Montero
    • 1
  • Fernando Morales-Martìnez
    • 3
  1. 1.National Geriatric and Gerontology Hospital CCSSSan JoséCosta Rica
  2. 2.La Anexión Hospital CCSSNicoyaCosta Rica
  3. 3.Faculty of MedicineUniversity of Costa RicaSan JoséCosta Rica

Personalised recommendations