Successful Aging Beyond 90 years. The case of Southern Azerbaijan

This study examines social determinants of healthy aging and resilience among adults aged 90 years and older in southern Azerbaijan, a post-Soviet, family-centered cultural context. While global aging research increasingly emphasizes healthy lifespan and functional ability, less is known about how extreme longevity is shaped in non-Western settings where intergenerational co-residence and family integration remain central to daily life. A population-based, cross-sectional mixed-methods study was conducted with 137 participants identified through regional health authority records. Data were collected through in-home structured and semi-structured interviews assessing social engagement, family structure, functional independence, and self-perceived health. Quantitative measures were analyzed descriptively and through group comparisons by sex. Findings show exceptionally high levels of family integration, with nearly all participants maintaining daily interactions with relatives and actively participating in household and advisory roles, even among respondents aged 100+. Co-residence with family was associated with higher ADL and IADL scores, better cognitive functioning, and fewer depressive symptoms. Women reported particularly large family and social networks linked to sustained engagement and quality of life. Qualitative observations further highlighted the presence of social authority, purpose, and emotional connectedness of the elderly within multigenerational households. Overall, results suggest that in this context, exceptional longevity is strongly associated with strong social involvement and family connections. These findings underscore the importance of culturally grounded models of aging, where social structure and multigenerational family support may play a central role in maintaining function and well-being into extreme old age.