Skip to main content

Mixed-methods quantitative–qualitative study of 29 nonagenarians and centenarians in rural Southern Italy: focus on positive psychological traits

  • Anna Scelzo (a1), Salvatore Di Somma (a2), Paola Antonini (a3), Lori P. Montross (a4) (a5), Nicholas Schork (a4) (a5) (a6) (a7), David Brenner (a8) and Dilip V. Jeste (a4) (a9) (a10)...
ABSTRACT Objective:

This was a study of positive psychological traits in a group of rural Italians aged 90 to 101 years, and their children or other family members.


Mixed-methods quantitative (standardized rating scales) and qualitative (semi-structured interviews) study.


Study participants’ homes in nine villages in the Cilento region of southern Italy.


Twenty-nine nonagenarians and centenarians and 51 family members aged 51–75 years, selected by their general practitioners as a part of a larger study called CIAO (Cilento Initiative on Aging Outcomes).


We used published rating scales of mental and physical well-being, resilience, optimism, anxiety, depression, and perceived stress. Qualitative interviews gathered personal narratives of the oldest-old individuals, including migrations, traumatic events, and beliefs. Family members described their impressions about the personality traits of their older relative.


Participants age ≥90 years had worse physical health but better mental well-being than their younger family members. Mental well-being correlated negatively with levels of depression and anxiety in both the groups. The main themes that emerged from qualitative interviews included positivity (resilience and optimism), working hard, and bond with family and religion, as described in previously published studies of the oldest old, but also a need for control and love of the land, which appeared to be unique features of this rural population.


Exceptional longevity was characterized by a balance between acceptance of and grit to overcome adversities along with a positive attitude and close ties to family, religion, and land, providing purpose in life.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Mixed-methods quantitative–qualitative study of 29 nonagenarians and centenarians in rural Southern Italy: focus on positive psychological traits
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Mixed-methods quantitative–qualitative study of 29 nonagenarians and centenarians in rural Southern Italy: focus on positive psychological traits
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Mixed-methods quantitative–qualitative study of 29 nonagenarians and centenarians in rural Southern Italy: focus on positive psychological traits
      Available formats
Corresponding author
Correspondence should be addressed to: Dilip V. Jeste, MD, Senior Associate Dean for Healthy Aging and Senior Care, Distinguished Professor of Psychiatry and Neurosciences, Estelle and Edgar Levi Chair in Aging, Director, Sam and Rose Stein Institute for Research on Aging, University of California San Diego, 9500 Gilman Drive #0664 La Jolla, CA 92023-0664, USA. Phone: +(858) 534-4020; Fax: (858) 534–5475. Email:
Hide All
Andersen-Ranberg K., Christensen K., Jeune B., Skytthe A., Vasegaard L. and Vaupel J. W. (1999). Declining physical abilities with age: a cross-sectional study of older twins and centenarians in Denmark. Age and Ageing, 28, 373377.
Andersen-Ranberg K., Schroll M. and Jeune B. (2001). Healthy centenarians do not exist, but autonomous centenarians do: a population-based study of morbidity among Danish centenarians. Journal of the American Geriatrics Society, 49, 900908.
Archer S., Brathwaite F. and Fraser H. (2005). Centenarians in Barbados: the importance of religiosity in adaptation and coping and life satisfaction in the case of extreme longevity. Journal of Religion, Spirituality & Aging, 18, 319.
Boulet J. and Boss M. W. (1991). Reliability and validity of the Brief Symptom Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 3, 433437.
Campbell-Sills L. and Stein M. B. (2007). Psychometric analysis and refinement of the Connor-Davidson resilience scale (CD-RISC): validation of a 10-item measure of resilience. Journal of Traumatic Stress, 20, 10191028.
Cohen S., Kamarck T. and Mermelstein R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385396.
Connor K. M. and Davidson J. R. (2003). Development of a new resilience scale: the Connor-Davidson resilience scale (CD-RISC). Depression and Anxiety, 18, 7682.
Darviri C. et al. (2009). Psychosocial dimensions of exceptional longevity: a qualitative exploration of centenarians' experiences, personality, and life strategies. The International Journal of Aging and Human Development, 69, 101118.
Derogatis L. R. (1993). BSI, Brief Symptom Inventory: Administration, Scoring, and Procedures Manual. Minneapolis: National Computer Systems.
Engberg H., Christensen K., Andersen-Ranberg K., Vaupel J. W. and Jeune B. (2008). Improving activities of daily living in Danish centenarians–but only in women: a comparative study of two birth cohorts born in 1895 and 1905. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 63, 11861192.
Herzberg P. Y., Glaesmer H. and Hoyer J. (2006). Separating optimism and pessimism: a robust psychometric analysis of the revised Life Orientation Test (LOT-R). Psychological Assessment, 18, 433438.
Hill P. L. and Turiano N. A. (2014). Purpose in life as a predictor of mortality across adulthood. Psychological Science, 25, 14821486. doi:10.1177/0956797614531799.
Hinck S. (2004). The lived experience of oldest-old rural adults. Qualitative Health Research, 14, 779791. doi:10.1177/1049732304265774.
Hutnik N., Smith P. and Koch T. (2016). Using cognitive behaviour therapy to explore resilience in the life-stories of 16 UK centenarians. Nursing Open, 3, 110118.
Hwang K. (2012). Face and morality in Confucian society. In Marsella A. J. (ed.), Foundations of Chinese Psychology. International Cultural Psychology (pp. 265295), vol. 1. New York: Springer.
Jeste D. V. et al. (2013). Association between older age and more successful aging: critical role of resilience and depression. American Journal of Psychiatry, 170, 188196.
Jeste D. V. and Oswald A. J. (2014). Individual and societal wisdom: explaining the paradox of human aging and high well-being. Psychiatry, 77, 317330. doi:10.1521/psyc.2014.77.4.317.
Keys A. and Keys M. (1959). Eat Well and Stay Well. New York: Doubleday.
Kim E. S., Kawachi I., Chen Y. and Kubzansky L. D. (2017). Association between purpose in life and objective measures of physical function in older adults. JAMA Psychiatry, 74, 10391045. doi:10.1001/jamapsychiatry.2017.2145.
Kroenke K., Spitzer R. L. and Williams J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606613.
Lavretsky H. (2014). Resilience and Aging: Research and Practice. Baltimore: Johns Hopkins University Press.
Lin Y. N. (2002). The application of cognitive-behavioral therapy to counseling Chinese. American Journal of Psychotherapy, 56, 4658.
Martin A. S., Distelberg B., Palmer B. W. and Jeste D. V. (2015). Development of a new multidimensional individual and interpersonal resilience measure for older adults. Aging and Mental Health, 19, 3245. doi:10.1080/13607863.2014.909383.
Pascucci M. A. and Loving G. L. (1997). Ingredients of an old and healthy life. A centenarian perspective. Journal of Holistic Nursing, 15, 199213. doi:10.1177/089801019701500209.
Perls T. T., Bochen K., Freeman M., Alpert L. and Silver M. H. (1999). Validity of reported age and centenarian prevalence in New England. Age and Ageing, 28, 193197.
Perls T. and Terry D. (2003). Understanding the determinants of exceptional longevity. Annals of Internal Medicine, 139, 445449.
Poon L. W. et al. (1992). The Georgia centenarian study. International Journal of Aging & Human Development, 34, 117. doi:10.2190/8m7h-cjl7-6k5t-umfv.
Poon L. W. et al. (2007). Methodological considerations in studying centenarians: lessons learned from the Georgia centenarian studies. Annual Review of Gerontology and Geriatrics, 27, 231264.
Poon L. W. et al. (2010). Understanding centenarians' psychosocial dynamics and their contributions to health and quality of life. Current Gerontology and Geriatrics Research, 2010, 113.
Powell J. (ed.) (1988). Cicero: Cato Maior de Senectute. Cambridge: Cambridge University Press.
Read A. E. and Carstensen L. L. (2012). The theory behind the age-related positivity effect. Frontiers in Psychology, 3, 19.
Rius-Ottenheim N. et al. (2012). Parental longevity correlates with offspring's optimism in two cohorts of community-dwelling older subjects. Age, 34, 461468.
Thomas M. L. et al. (2016). Paradoxical trend for improvement in mental health with aging: a community-based study of 1,546 adults aged 21–100 years. Journal of Clinical Psychiatry, 77, e1019–e1025. doi:10.4088/JCP.16m10671.
United Nations (2002). World Population Ageing: 1950–2050. New York, NY: United Nations Publications.
United States Census Bureau World population by age and sex. Available at:; last accessed 6 March 2017.
Von Faber M. et al. (2001). Successful aging in the oldest old: who can be characterized as successfully aged? Archives of Internal Medicine, 161, 26942700.
Ware J. E., Kosinski M. and Keller S. D. (1996). A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220233.
Willcox D. C., Willcox B. J., Hsueh W. C. and Suzuki M. (2006). Genetic determinants of exceptional human longevity: insights from the Okinawa centenarian study. Age (Dordr), 28, 313332. doi:10.1007/s11357-006-9020-x.
Wong W.-C. P. et al. (2014). The well-being of community-dwelling near-centenarians and centenarians in Hong Kong a qualitative study. BMC Geriatrics, 14, 63.
Zeng Y., Poston D. L. Jr, Vlosky D. A. and Gu D. (2008). Healthy Longevity in China: Demographic, Socioeconomic, and Psychological Dimensions. Dordrecht, Netherlands: Springer Science & Business Media.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 2362
Total number of PDF views: 667 *
Loading metrics...

Abstract views

Total abstract views: 5379 *
Loading metrics...

* Views captured on Cambridge Core between 12th December 2017 - 20th January 2018. This data will be updated every 24 hours.