Lessons from Centenarians: What Patients Who Live Beyond 100 Can Teach Hospice and Palliative Care About Aging, Resilience, and the Hidden Risks of Polypharmacy

As hospice and palliative care clinicians, we spend our careers caring for patients during the final chapter of life. We become intimately familiar with the diseases that ultimately claim our patients—heart failure, dementia, COPD, stroke, cancer, renal failure, and frailty. Yet, every so often we encounter someone who defies expectations: a 100-year-old who still smiles, remembers their grandchildren, walks with a cane instead of remaining bedbound, or proudly tells us they have “never really been sick.”

These remarkable individuals naturally provoke a question: Why do some people live to 100 years of age while others succumb decades earlier?

Although genetics certainly plays a role, modern longevity research suggests that exceptional lifespan is less about avoiding disease altogether and more about maintaining physiologic resilience. Perhaps more importantly for those of us practicing hospice and palliative medicine, these patients teach us an equally valuable lesson about something we encounter every day—the cumulative burden of medications.

Centenarians often demonstrate remarkable physiologic reserve despite advanced age. Ironically, many arrive at age 100 taking remarkably few medications.

There is wisdom in that observation.

Longevity Is More Than Good Genes

Many assume centenarians possess extraordinary genetics that protect them from disease. Genetics certainly contributes to exceptional longevity, particularly after age 85, but hereditary factors account for only a portion of lifespan.

Researchers estimate that genetics explains approximately 20–30% of overall longevity, with lifestyle, environment, healthcare access, nutrition, physical activity, social connectedness, and simple chance accounting for much of the remainder.

Perhaps more fascinating is that many centenarians do not completely escape chronic disease. Rather, they develop illness much later in life than the average individual.

Researchers frequently categorize centenarians into three broad groups:

• Escapers, who reach age 100 with minimal chronic disease.
• Delayers, who develop serious illness only during their ninth or tenth decade.
• Survivors, who live with chronic illness for years yet demonstrate extraordinary resilience.

For hospice clinicians, this distinction is meaningful. Exceptional longevity is often less about the absence of disease and more about delayed physiologic decline.

The Concept of Compression of Morbidity

One of the most compelling findings in geriatric medicine is the concept of compression of morbidity.

Many centenarians remain remarkably functional through their eighth and ninth decades before experiencing a relatively rapid decline near the end of life. Instead of living fifteen years with severe disability, they often live independently until the final one or two years.

Hospice clinicians recognize this pattern frequently.

A patient may remain active, socially engaged, cognitively intact, and relatively independent until a hospitalization, hip fracture, aspiration event, or heart failure exacerbation triggers a steep decline. Rather than experiencing decades of progressive disability, illness becomes compressed into a shorter period.

This phenomenon should remind us that our goal is not simply extending lifespan but preserving healthspan—the years of life spent with independence, purpose, and quality.

The Common Characteristics of People Who Reach 100

Despite differences in geography and culture, longevity studies consistently identify several recurring themes among centenarians.

They continue moving throughout life. Their activity is rarely structured exercise. Instead, they walk, garden, cook, clean, climb stairs, carry groceries, and remain engaged in daily tasks.

They preserve muscle strength.

They maintain healthy body weight.

They avoid tobacco.

They experience lower rates of obesity and diabetes.

They remain socially connected.

They cultivate purpose.

Many demonstrate remarkable optimism and adaptability despite tremendous life adversity.

These observations align closely with what geriatricians increasingly recognize as the strongest predictors of healthy aging—not cholesterol values or isolated laboratory numbers—but functional independence, gait speed, grip strength, cognition, nutrition, and resilience.

The Hidden Threat We See Every Day: Polypharmacy

While studying centenarians teaches us what promotes longevity, hospice and palliative care clinicians are uniquely positioned to witness what often accelerates decline.

One of the most underappreciated contributors is polypharmacy.

Traditionally defined as the use of five or more medications, polypharmacy has become almost routine among older adults. Many nursing home residents take 10–20 scheduled medications, often prescribed by multiple specialists over many years.

Each medication may have been appropriate when initiated.

Collectively, however, they may become harmful.

Older adults experience reduced renal clearance, diminished hepatic metabolism, altered body composition, and increased pharmacodynamic sensitivity. Consequently, medications tolerated well at age 60 may produce profound adverse effects at age 90.

The issue is not merely the number of medications but the accumulation of risk.

Polypharmacy and Mortality

Numerous observational studies have demonstrated that increasing medication burden is associated with higher rates of:

• Falls
• Hip fractures
• Delirium
• Syncope
• Orthostatic hypotension
• Cognitive impairment
• Urinary incontinence
• Malnutrition
• Hospitalization
• Functional decline
• Mortality

While polypharmacy itself may not be the direct cause of death in every patient, inappropriate polypharmacy often initiates a cascade of complications that substantially increases the likelihood of serious adverse outcomes.

A common sequence is familiar to every hospice clinician:

A medication causes dizziness.

The patient falls.

The fall results in a hip fracture.

Hospitalization leads to delirium.

Mobility declines.

Appetite worsens.

Pressure injuries develop.

Aspiration follows.

Within months, the patient who had previously been living independently is hospice eligible.

No single medication caused death.

The cumulative medication burden contributed to physiologic decline.

The Prescribing Cascade

One of the most common consequences of polypharmacy is the prescribing cascade.

A medication causes a side effect.

The side effect is mistaken for a new disease.

Another medication is prescribed to treat the side effect.

The cycle continues.

Examples include:

• Calcium channel blockers leading to peripheral edema, prompting diuretic initiation.
• Cholinesterase inhibitors causing urinary urgency, followed by anticholinergic therapy.
• Opioids causing constipation, then laxatives, dehydration, orthostasis, and falls.
• Antipsychotics causing parkinsonism, treated with antiparkinsonian medications that worsen confusion.

Each prescription appears reasonable in isolation.

Together, they produce increasing complexity and harm.

Deprescribing Is Active Medical Care

One of the greatest misconceptions is that deprescribing represents “doing less.”

In reality, deprescribing is among the most sophisticated interventions physicians perform.

It requires careful consideration of:

• Remaining life expectancy
• Time-to-benefit
• Goals of care
• Risk versus benefit
• Medication interactions
• Patient priorities
• Symptom burden

Hospice physicians perform this every day.

Statins prescribed for primary prevention over the next decade often offer little benefit to a patient expected to live months.

Bisphosphonates intended to prevent fractures years later rarely improve quality of life in advanced illness.

Strict glycemic control may expose frail patients to dangerous hypoglycemia without meaningful long-term benefit.

The question shifts from, “Does this medication work?” to, “Does this medication still help this patient?”

Those are profoundly different questions.

What Centenarians Teach Us About Simplicity

When researchers interview centenarians, they rarely discover elaborate supplement regimens or extensive medication lists.

Instead, they find simple routines.

Daily movement.

Meaningful relationships.

Purpose.

Nutritious meals.

Adequate sleep.

Stress reduction.

Moderation.

It is tempting to search for a longevity pill.

Centenarians repeatedly remind us that longevity rarely comes in a bottle.

A Hospice Perspective on Healthy Aging

Hospice clinicians witness life through a unique lens.

We see what matters at the end.

Few patients tell us they wish they had achieved lower LDL cholesterol.

Almost none regret not taking one more preventive medication.

Instead, they speak about family, independence, meaningful work, friendships, faith, travel, music, grandchildren, laughter, and purpose.

The challenge for modern medicine is not merely helping patients live longer but helping them live well.

Sometimes that means prescribing.

Sometimes it means stopping medications.

Often, it means recognizing that longevity is measured not only in years but also in function, dignity, comfort, and connection.

Final Thoughts

Centenarians remind us that healthy aging is not defined by the absence of disease but by resilience, adaptability, and the preservation of function. For hospice and palliative care clinicians, they reinforce a principle that lies at the heart of our specialty: every intervention should serve the person, not merely the diagnosis.

Polypharmacy deserves ongoing scrutiny because medications that once provided meaningful benefit may become burdensome as patients age and goals of care evolve. Thoughtful deprescribing—guided by prognosis, patient values, and careful risk-benefit assessment—is not withdrawing care; it is delivering care that is individualized, evidence-based, and compassionate.

Perhaps the greatest lesson from those who live beyond 100 years is not that there is a secret to longevity, but that extraordinary lives are often built on simple foundations: purposeful movement, nourishing relationships, good nutrition, emotional resilience, and medical care that remains aligned with what matters most to the individual. As hospice and palliative care providers, we have the privilege and responsibility to help our patients pursue not just a longer life when appropriate, but a life with the greatest possible comfort, function, dignity, and meaning.

Recommended Further Reading

For readers interested in exploring the science of healthy aging, exceptional longevity, deprescribing, and person-centered care in greater depth, the following books are highly recommended. While not all are primary research texts, each has significantly influenced contemporary thinking in geriatrics, longevity medicine, hospice, and palliative care.

• Being Mortal. Atul Gawande (2014). Being Mortal: Medicine and What Matters in the End. New York: Metropolitan Books. A landmark work examining how modern medicine approaches aging, serious illness, and end-of-life care, emphasizing the importance of preserving dignity, autonomy, and quality of life.
• The Challenge of Geriatric Medicine. Bernard Isaacs (1992 reprint). The Challenge of Geriatric Medicine. Oxford: Oxford University Press. A classic text introducing many foundational concepts in geriatric medicine, including frailty, functional decline, and the “geriatric giants,” which continue to influence clinical practice today.
• Outlive. Peter Attia (2023). Outlive: The Science and Art of Longevity. New York: Harmony Books. An evidence-informed exploration of longevity medicine, emphasizing the prevention of chronic disease, preservation of muscle mass, metabolic health, and the extension of healthspan rather than lifespan alone.
• Super Agers. Eric Topol (2025). Super Agers: An Evidence-Based Approach to Longevity. New York: Simon & Schuster. A contemporary review of the emerging science of aging, integrating advances in genomics, artificial intelligence, biomarkers, and precision medicine to better understand why some individuals maintain exceptional health into advanced age.
• Living to 100. Thomas Perls and Margery Hutter Silver (1999). Living to 100: Lessons in Living to Your Maximum Potential at Any Age. New York: Basic Books. Drawing upon the New England Centenarian Study, this book explores the biological, psychological, and lifestyle characteristics commonly shared by individuals who achieve exceptional longevity.

References

American Geriatrics Society Beers Criteria® Update Expert Panel (2023) 'American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults', Journal of the American Geriatrics Society, 71(7), pp. 2052–2081.

Delara, M., Murray, L., Jafari, B., Bahji, A., Goodarzi, Z., Kirkham, J., Chowdhury, M. and Seitz, D.P. (2022) 'Prevalence and factors associated with polypharmacy: a systematic review and meta-analysis', BMC Geriatrics, 22(1), p. 601.

Fried, L.P., Tangen, C.M., Walston, J., Newman, A.B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W.J., Burke, G. and McBurnie, M.A. for the Cardiovascular Health Study Collaborative Research Group (2001) 'Frailty in older adults: evidence for a phenotype', The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(3), pp. M146–M156.

Hung, A., Kim, Y.H. and Pavon, J.M. (2024) 'Deprescribing in older adults with polypharmacy', BMJ, 385, e074892.

Linsky, A.M., Motala, A., Booth, M., Lawson, E. and Shekelle, P.G. (2025) 'Deprescribing in community-dwelling older adults: a systematic review and meta-analysis', JAMA Network Open, 8(5), e259375.

Masnoon, N., Shakib, S., Kalisch-Ellett, L. and Caughey, G.E. (2017) 'What is polypharmacy? A systematic review of definitions', BMC Geriatrics, 17, p. 230.

Perls, T.T. (1997) 'Centenarians prove the compression of morbidity hypothesis, but what about the rest of us who are genetically less fortunate?', Medical Hypotheses, 49(5), pp. 405–407.

Rowe, J.W. and Kahn, R.L. (1997) 'Successful aging', The Gerontologist, 37(4), pp. 433–440.