Medicina · Apr 9, 2026
The centenarian paradox: Psychological integrity versus biological decline
By Ramírez RAH, Chavarro‐Carvajal DA, Sucerquia-Quintero JA et al.
INTRODUCTION: The global increase in the centenarian population represents one of the greatest successes of human development, but also poses a critical challenge to contemporary medicine: the need to transition from a model focused on survival to one that prioritizes quality of life and psychological integrity. OBJECTIVE AND ANALYSIS: This reflective article analyzes mental health in centenarians as a fundamental pillar of extreme longevity, exploring the so-called “aging paradox,” a phenomenon in which subjective well-being and emotional stability are maintained or increase despite biological decline and accumulated social losses. Through an analysis of socioemotional selectivity theory and the concept of the “psychological immune system,” it is argued that reaching one hundred years of age constitutes a triumph of psychological architecture and ontological resilience. DISCUSSION: The text questions the prevailing “cognitivist bias” in gerontological practice, which erroneously equates mental health with the integrity of executive functions. Instead, it proposes that fulfillment is attainable even in the face of neurocognitive impairment, provided that emotional reserve and a sense of identity are preserved. It also highlights the role of the social environment and purpose in life (ikigai) as essential neurobiological determinants that act as buffers against oxidative stress. CONCLUSIONS: The clinical approach to centenarians must evolve toward person-centered medicine that transcends the normalization of biomarkers and combats systemic ageism. The implications for medical practice suggest a redefinition of therapeutic success, prioritizing the dignity and transcendence of those who have mastered the art of living for a century.