Profiles of Ethiopian Centenarians: A Qualitative Inquiry

As global aging advances, the number of centenarians (people aged 100 and over) worldwide i s greatly increasing. Most of what is known about centenarians comes from the Global North, and it is unclear which factors may contribute to the longevity of centenarians in impoverished, mostly rural areas of the Global South that sometimes lack basic amenities. Cultural differences in the profile, lifestyles, and needs of centenarians across Africa have yet to be documented. Using a case study design, this descriptive inquiry investigates the profiles of centenarians in Ethiopia including religion, marriage, education, occupation, income, and living arrangement. Data were generated through in-depth interviews with nine centenarians (1 woman, 8 men) and were analyzed using descriptive narrative analysis. Respondents were between age 100 and 108. All nine were adherents of Orthodox Christianity, had been married, and were great-grandparents. Their adult lives were marked by both residential and marital stability. The Ethiopian centenarians seemed to persevere through many losses and hardships with the help of strong community-based social networks. Unlike studies of centenarians in the Global North, most respondents were male and had strict religious upbringings. Understanding the unique profiles of centenarians in the Global South helps to inform research and practice with this growing population of the oldest-old.


Introduction
The number of centenarians (people aged 100 and over) is increasing globally.In 2000, there were an estimated 180,000 centenarians in the world (Giraldo 2009), and by 2010 there were over 300,000 (Serra et al. 2011).Globally, the number of centenarians is expected to reach over 3 million by 2050 (Sadana et al. 2013) and an incredible 25 million by the end of the 21st century (Robine and Cubaynes 2017).Most of what is known about centenarians stems from studies conducted in the Global North.Thus, studies on centenarians tend to be Western-centric.For example, existing studies often rely on birth certificates and public records to document ages.Ferreira and Kowal (2013) emphasize the inappropriateness of using Western measurements to collect data in African settings.
Centenarians have unique health risks, needs, values, and life goals (Pin and Spini 2016) and yet, the factors contributing to longevity of centenarians in Global South nations have not been delineated (Giraldo 2009;Serra et al. 2011).Despite Giraldo's (2009) acknowledgement over a decade ago of the scarcity of research on centenarians in the Global South, studies of centenarians in Sub-Saharan Africa remain scant.Thus, a full picture of the everyday lived experiences of older people in Africa is lacking (Aboderin 2005;Ferreira and Kowal 2013).Existing gerontology studies in the African context are fragmented, lack comprehensiveness, and focus on certain thematic areas.A clearer understanding of African perspectives and concepts related to old age are necessary to explain the realities of the older population in Africa.In relation to centenarians, research from different perspectives is needed to explain cultural differences in the factors contributing to longevity, the meaning of successful aging, and the socioeconomic and demographic features, health conditions, functionality, and behaviors of centenarians (Afonso et al. 2018).
Documenting the profiles of centenarians can help to understand their geographical distribution, gender differences, occupational backgrounds, and lifestyles as well as how these conditions contribute to longevity, and importantly, can identify health and other care needs of the growing population of centenarians (Giraldo 2009;Serra et al. 2011).While it has been documented that improvements in living conditions including food, hygiene and medical services, education, and income contribute to increases in longevity (UNFPA & Help Age International 2012), it is not clear what factors contribute to longevity of centenarians in impoverished rural areas of Global South nations that lack basic amenities.
In Ethiopia, while just 5% of the population is age 65 and over, it is expected that the country will have 11.5 million older adults by 2050 (Central Statistical Agency of Ethiopia 2007).Despite sub-Saharan Africa having the biggest gains in life expectancy (United Nations 2019), gerontological studies in the region remain sparse (Adamek et al. 2021).In the absence of systematic inquiries in Ethiopia and other Sub-Saharan nations, we have little insight into the lives of scores of undocumented centenarians, including cultural differences in their profile, lifestyles, and needs.Furthermore, in Ethiopia, researchbased data documenting the profiles of centenarians is absent.Empirical literature and statistical reports in Ethiopia do not mention centenarians (Federal Democratic Republic of Ethiopia 2008;Transitional Government of Ethiopia 1991).The age group of 100 and over is not listed as a separate category in government population reports.Thus, there is not even a clear picture of the number of centenarians in Ethiopia.
To address the gap in the knowledge base regarding centenarians in Sub-Saharan Africa in general, and in Ethiopia specifically, we conducted qualitative research in order to introduce profiles of Ethiopian centenarians and give voice to their experiences of aging.With the second largest population and the fastest-growing economy in Africa (World Bank 2021), Ethiopia can reveal the overall patterns of aging that are likely to be evident in other Sub-Saharan nations.
Our study aimed to reveal insights about centenarians in Sub-Saharan Africa with hopes that researchers may undertake further study to build a body of knowledge about this rarely researched minority cohort.Documenting the profiles of centenarians can increase awareness of centenarians among stakeholders including researchers, practitioners, and policymakers.Instead of relying on what is known about centenarians in the Global North, the distinctive features of life as a centenarian in the African context needs to be detailed and thus valued.Understanding the unique factors contributing to the longevity of centenarians in Ethiopia may inform strategies to support the growing population of older adults in the Global South and in Africa in particular.

Methods
We employed a qualitative case-study design to explore the profiles of centenarians living in the rural (five centenarians) and urban areas (four centenarians) of Ethiopia.In the Ethiopian context, areas inhabited by less than 2,000 people and where agriculture is the main source of livelihood are considered rural.We utilized case studies, since they are appropriate to study unique phenomena, issues, individuals or groups, in order to gain a more in-depth and holistic understanding of the centenarians (Creswell 2018;Yin 2003).Purposive sampling, specifically the snowball technique, was used to recruit nine centenarians living in six woredas, a local administrative unit, in the Amhara Regional State.The inclusion criteria for study participants were being age 100 years or over and the willingness and ability to share their stories.Data were collected through in-depth interviews using both structured and unstructured questions.All but one of the centenarians in this study were either bilingual or trilingual.All nine could speak Amharic, the working language in Ethiopia.Altogether, centenarians used four domestic languages (Amharic, Tigrigna, Awign, and Geez) and three foreign languages (Italian, English, and Arabic).
The first author who is a native speaker of Amharic conducted face-to-face interviews in Amharic with centenarians in their homes.The fieldwork was conducted intermittently between December 2015 and January 2019.On average, the interview sessions lasted 142 minutes.Descriptive analysis was used to analyze the data and to create detailed descriptions of centenarians' profiles; such analysis is fitting to reflect a clear picture of cases in their context (Creswell 2018).
Ethical issues were considered throughout the research process including obtaining a letter of permission from the Department of Social Work in the Faculty of Social Sciences at Bahir Dar University to undertake the study; briefing centenarians and their families on the objectives of the study; obtaining oral informed consent from centenarians to take part in the interviews; and getting permission to use a voice recorder during the interviews.Confidentiality of the data was ensured by using pseudonyms and concealing any identifying information.

Temporal contexts and determining age
Among the study participants, eight were men and one was a woman.All nine were born in rural areas of Ethiopia.At the time of the interviews, participants ranged in age from 100 to 108.Three centenarians provided the exact date, month, and year of their births; as we explain in more detail below, the others referred to certain events to specify their year of birth.The eldest centenarian was born on August 11, 1906, and the youngest centenarian was born in September 1918.
These centenarians lived through periods of monarchical and military forms of government in Ethiopia as well as through the more recent unitary and federal systems of government.Many of our study participants stated that the practice of recording birthdays was rare in their rural communities.Sometimes parents (usually fathers), family members, relatives, and priests or religious fathers 1 who could read and write Amharic recorded birthdays and baptismal dates.The centenarians frequently mentioned temporal contexts to communicate, clarify, and strengthen recollections.Our participants mentioned major historical events that happened in Ethiopia or in their localities as a reference to validate their ages, including the period of Lij Iyassu (r.1913Iyassu (r. -1916)), the ascension of Empress Zewditu to the throne in 1916, and the Great Influenza Epidemic of 1918, also known as the Spanish Flu and traditionally as Ye Hidar Beshita (Pankhurst 1989).The Italian invasion of Ethiopia in 1936, the return of Emperor Haile Silassie I from exile, and the end of the Italian occupation in May 1941 were also common events noted by centenarians to confirm their year of birth.One of the respondents, age 104, justified his age using contextual explanations.As he put it, "I was the eighth and the last child of my parents.I was matured and had two children during the Italian invasion.I joined the resistance movement against the Italians in 1936 and received wounds on my hip."According to the table, all nine centenarians followed Orthodox Christianity; six had become monks and a nun in their old age.Becoming a monk or a nun in later life is part of the social and religious expectation among followers of Ethiopian Orthodox Christianity.In this role, they are expected to pray daily for such blessings as peace and security in Ethiopia and in the world, to cure diseases, and to enter paradise.They may perform community services such as helping the poor and giving condolences to the bereaved.

Marriage and family
Our study participants had established families and stable marital lives.Two-thirds of the participants had married only once in their lifetime, with the longest lasting 78 years.Most got married between the ages of 20 to 25.On average, most of the centenarians lived with their spouses for 54 years.Three centenarians explained their late-in-life first marriages as a result of the need to lead a monastic life, inconvenient working conditions, and/or the need to earn a better income.Respondents attributed their successful marriages to the qualities of love, faithfulness, tolerance, mutual respect, forgiveness, and commitment.
Some participants experienced divorce, widowhood, and remarriage.The number of spouses of the centenarians ranged from one to four, and three centenarians had living wives during the interview sessions.Only two centenarians had not experienced widowhood while two centenarians had lost multiple wives.Kebede (104) shared, "I married four wives in my life.All of them passed away.My fourth and last wife died in 2017 without giving birth to a child."Four of the centenarians remained widowers for 31 to 46 years after they had lost their first wives.Being monks and preferring to live without a spouse, four of the centenarians never remarried after the deaths of their first wives; instead, they lived without a spouse for more than 30 years.
The centenarians in this study had a total of 67 children, 37 of whom were still living.Three centenarians had 10 to 15 children each.Deribew (100) had his 15 th child at age 91.He had a strong attachment to his youngest child and praised God for giving him offspring in his later life.He considered her to be "the gift of God."These centenarians could extend the chain of successive generations with both grandchildren and great-grandchildren.They also mourned the loss of 30 children due to disease, murder, and accidents.Abrham (103) had three sons and three daughters; all three sons passed away.As he described: I had three young sons, one of them was a university student; the others were serving as a soldier and a civil servant.My eldest son, a government employee, had four children.He was seriously sick and lost his life.The second son died on the battlefield, and the third one could not recover from his illness and lost his life.Hiruy was shocked and saddened by the assassination of his sons.While the marriage and family lives of the Ethiopian centenarians were marked by stability and long-term commitments, study participants also experienced considerable loss, including outliving some of their children as well as spouses.

Education
Concerning the educational background of these centenarians, four of the nine were illiterate.Bishaw (101), Deribew (100), and Michael (100) attended the traditional education of the Ethiopian Orthodox Church.Hiruy (108) was also well-versed in traditional church education, attended school up to grade eight, and earned a teaching certificate after completing a three-year summer program in 1950.Zekariyas (100) attended grade nine at the General Wingate Secondary School in Addis Ababa.In some cases, parents who attended the traditional church education themselves then sent their children, particularly boys, to church school.Only four of the centenarians' parents had attended church education and could read and write both Amharic and Geez-an ancient liturgical language used in the Ethiopian Orthodox Church.
Deribew's mother grew up in the court of Empress Taytu, wife of Emperor Menelik II, and had the opportunity to learn reading and writing in Amharic 115 or 120 years ago.The Empress herself joined the traditional church education during her childhood and could read and write Amharic and Geez.She encouraged the program to teach daughters, sons, and relatives of the nobility as well as influential personalities in the palace.Deribew's mother was one of those children who was tutored in the palace.
Deribew explained the influence of his parents' church education on their decision to send him and his sisters to church school.Deribew's grandfather also supported church education and made the necessary arrangements.As Deribew explained: My paternal grandfather employed the Geez teacher at home.My older sisters and I learned the Amharic and Geez languages, and could read and write in Amharic and Geez using the Geez alphabet.We learned religious books including Dawit (David), Wudassie Mariyam (Praise of Mary), Teamre Mariyam (The Miracle of Mary), and Melke Mariyam.I attended further traditional church education and was ordained as a deacon in Debre Tabor by Abune Abrham.Then I continued providing religious services in the church for three and a half years.
Among the centenarians, Hiruy had extensive experience in church education.He emphasized how a parent's education could highly influence their children's education.For example, through his father's line, Hiruy's grandfather, great-grandfather, paternal older brothers, and uncle were distinguished in traditional church education and were influential in local religious and administrative matters, inspiring Hiruy to proceed with his own educational career.Hiruy spent three decades attending nine different church schools in various locations.He shared: My father and grandfather were well-educated in church schools, and they obtained the title of Marigeta.They devoted their lives in teaching religious education and providing administrative services in the church holding different positions.My father was appointed as a Marigeta in Dejen, Kosta Teklehaymanot and Wonqa.
In the tradition of the Ethiopian Orthodox Täwahédo Church, Marigeta refers to both a title and an office given to someone who has successfully completed different courses of the traditional church education.
The Marigeta has multiple roles as an administrator of the church or parish, teaching Qene, Zema, liturgical music, singing, and dancing (Sokolinski 2007).

Occupation and source of income
During their working years, each of the centenarians engaged in different occupations.These included being a farmer, teacher, priest, soldier, government employee, shoemaker, and automotive technician.Six of them had farming experience as either their main or secondary occupation.Farming was the permanent occupation for four centenarians until their retirement.
Kebede (104) claimed that he was one of the hardest working and productive farmers in his community until the age of 70.After that point, he occasionally sold grain to subsidize his household income.Zelalem ( 102) was a successful farmer as indicated by the number of oxen, milk cows, sheep, and beehives he had, which supported the production of milk and dairy, honey, meat, and local drinks.He also hosted feasts for neighbors and relatives.Belaynesh (103) was a farmer and a housewife.Over time she had three husbands-two were farmers and one was an Italian soldier.She regularly made charitable contributions to the church.She sold lemons for 15 years and generated about 100,000 Ethiopian Birr, which she gave to the church.Belaynesh described her charitable activity as follows, "I feel strong spiritual satisfaction from presenting gifts to the church used to cover expenses for religious services.I have received recognition in the community." Hiruy (108) and Michael (100) held two or more occupations simultaneously.Hiruy was a schoolteacher, a farmer, and a priest, who actively participated in local church affairs.The combination of his traditional church education and modern education shaped his personality and perspective.He combined priesthood with farming and was employed by the Ethiopian Ministry of Education as a primary-school teacher.Hiruy taught Amharic and Geez for 24 years until his retirement in 1974.
Although he did not identify himself as a merchant, he also traded in grain, sheep, cows, and oxen to subsidize the family income.Hiruy summarized his work experiences: I provided long years of church service from childhood to age 100.I was interested in doing different businesses.Farming was my favorite occupation, and I liked running retail trade selling and buying farming products.If I were not a priest, I would have become a successful merchant.I taught Amharic and Geez in the primary school.
Abrham (103) had diverse occupational experiences as a young man, and later became a well-known shoemaker and business owner.He was born into a poor peasant family in the rural area near Asmera.His father died when he was a child, so his widowed mother took the responsibility of raising him and his siblings as well as managing the family affairs.Being poor and a widow, Abrham's mother faced many challenges.Abrham assisted the family by doing household chores and looking after cattle.The family was desperate and suffered from a hard life due to a shortage of food.As a result, Abrham fled to Asmara and Teseney-larger towns that were centers of manufacturing and agro-processing industries--in search of work.He remembered his childhood as a time of misery, sadness, and hopelessness.
Abrham worked a series of odd jobs in Asmera, Teseney, and Gondar.For a decade, he was employed as a shoemaker in a private business.Over time, Abrham transformed himself economically, built up his confidence, and developed the skills to make leather products.He founded a private shoe-making enterprise, staffed with senior and junior shoemakers.He spent more than 50 years as a shoemaker and was popular, attracting many customers.Abrham shared: My parents were very poor.I led a miserable life in my childhood.I fled to Asmera and engaged in different occupations to earn income.In Asmera, I was working with Italians in an edible-oil factory and gained technical experience.I spent half of my life as a shoemaker.Even now at the age of 103, I have the skills for shoemaking, but I have no capital and physical strength.Currently, I have no occupation.I sit idly.I quit shoemaking for the last fifteen years.
Michael (100), effectively managed dual occupations.He was a farmer and an informal law-enforcement officer (locally in Amharic "Leba Adagn" -which literally means 'hunter of the thieves' or "bounty hunter").He was in charge of maintaining security by hunting criminals in his locality and taking them to court.Michael served as Leba Adagn until his retirement at the age of 55.He continued cultivating his plots of land, employing a sharecropper in his later life.
Deribew (100), began his career as a deacon and served the church for three and a half years.During the Italian invasion from 1936 to 1941, he joined the patriots' resistance movement.In the post-liberation period, Deribew took various positions in government offices at the Woreda (a local administrative unit) as the secretary of senior officials and vice-administrator.After serving in the government for 29 years, he retired in 1974.In retirement, he joined the Ethiopian Patriots Association and took positions as the coordinator, treasurer, and chairperson of the Association.Zekariyas (100) had a career related to automotive mechanics.He was employed by a highway company and government garages.There, he had many positions such as technician, field-chief mechanic, supervisor of junior mechanics, and manager.Zekariyas worked for 60 years as a mechanic until his retirement at age 90.
Seven of the nine study participants had two or three sources of income that they generated themselves or derived from their adult children's support, land rent, rental houses, and pension.Other than Kebede, whose children were very poor, financial support from their children was a primary source of income.Belaynesh had no financial or material resources or assets as a source of income, so she depended on her daughter for financial support.However, a few of the centenarians supported their children and grandchildren.For example, Hiruy, Zelalem, and Kebede shared their limited financial and material assets as well as land with their children and grandchildren.Land rent was a second source of income for five of the centenarians (Bishaw, Hiruy, Kebede, Michael, & Zelalem).They rented plots of farmland for brief periods of time, or they used the system of sharecropping.Kebede relied on income from renting farmland, while Abrham, Deribew, and Zekariyas earned income from rental housing.After serving in government offices for 20 to 30 years, three of the centenarians (Deribew, Hiruy, & Michael) were beneficiaries of state pensions.

Place of residence and living arrangement
All nine centenarians were born and raised in rural areas.Five centenarians-Bishaw, Hiruy, Kebede, Michael, and Zelalem-lived in their birthplaces with their extended families throughout their lives; they aged in place, never changing their place of residence.Four participants--Belaynesh, Deribew, Abrham and Zekariyas--left their rural villages as teenagers or young adults, changing their residence twice or more from one town to another for work-related reasons.
Most of the centenarians lived with family members in households with an average of four family members in each.Family households were composed of spouses, children, grandchildren, in-laws, great-grandchildren, and housemaids.None of the centenarians lived alone.

Discussion
Empirical studies from other nations indicate that the proportion of female centenarians is typically higher than the proportion of males (Ribeiro et al. 2016;Teixeiraa et al. 2017;US Census Bureau 2014).A population-based study in thirty-two European countries indicated that 86% of centenarians were female (Teixeiraa et al. 2017) and in Portugal, the national census revealed that 82% of centenarians were female (Ribeiro et al. 2016).Likewise in the US, the gender ratio of centenarians was found to be 5 to 1, with 100 female centenarians for every 20.7 male centenarians (US Census Bureau 2012).While the current study was based on a non-representative convenience sample of centenarians in Ethiopia, it is remarkable that eight out of the nine centenarians we were able to locate were male.Future studies may help to illuminate and explain whether this gender pattern exists in the larger aging population in Ethiopia as well as in other patriarchal societies.
In 19th and 20th century Ethiopia, when illiteracy was widespread and there was no well-established institution responsible for registering births and deaths, legal birth certificates were not available.As an alternative, people resorted to referencing major events -battles, periods of famine, the enthroning and dethroning of emperors, and so on -in order to specify year of birth and fix their ages.Relying solely on birth certificates to recruit study participants for gerontological research may exclude potential centenarians and other cohorts in the Global South in general and less literate communities in particular.
Compared to studies in other nations, the centenarians in our study had less formal education.Before reaching very advanced old age, four of the nine centenarians were illiterate farmers throughout their working lives.Thus, previous reports of formal education contributing to longevity in Global North populations (e.g., Murtin et al. 2017) may not apply to centenarians in Global South nations.It may be that being closely embedded in a supportive social network makes up for educational differences and other resource disadvantages of centenarians in the Global South.The contributions of spouses, grandchildren, relatives, and neighbors in supporting centenarians should not be overlooked (Pin and Spini 2016).In developing countries such as Ethiopia, family members, mainly adult children who themselves may be in their 70s or 80s, are responsible for providing care and support to older adults (Adamek et al. 2020).
Most of the centenarians in this study were born and continued to live in rural villages throughout their lives.Growing up in the rural Ethiopian countryside, these centenarians had very close relationships with their neighbors, relatives, and the local community.They were deeply embedded in supportive social networks that shared socio-cultural values.Collective life and togetherness are common cultural features in Ethiopia where even unrelated people live together, share social events, and support one another in ways that promote livelihood resilience (Weldegebriel and Amphune 2017) These traditions have persisted with few changes, particularly in rural and semi-urban areas.Typical family structures are extended and may include non-related individuals who are considered family.Similarly, an ethnographic study in South Africa found that non-kin caregivers of elders may be considered part of the family (Bohman et al. 2009) , 2020, personal communication).Thus, nearly all elders, including centenarians, tend to live with family members.Living in a multigenerational household seems to have an impact on longevity that is significant and deserves further examination.
As people get older, especially centenarians, they are likely to experience the loss of spouses and children who are a source of care and support (Kropf and Pugh 1995;Lymbery 2005).The nine centenarians in our study had more children on average than centenarians in other nations including Puerto Rico (Almenas-Velasco and Ortiz-Marin 2013) and the Netherlands (Holstege et al. 2018).Nevertheless, six of the nine centenarians in this study outlived many of their children.

Conclusion
More is known about centenarians in the Global North than in the Global South.Population reports in African tend not to present centenarians in a separate age category.Thus, the number of centenarians in Global South nations remains largely unknown.This study confirms the existence of centenarians in Ethiopia and provides insight into their profiles.Although it may be considered a limitation of this study that centenarians did not have birth certificates, alternative approaches were used to validate their ages such as cross-checking birth years with contemporary events and other official written documents.
Understanding the unique profiles of centenarians in the Global South helps to inform research and practice with this growing population of the oldest-old.In countries where life expectancy is low, particularly in the Global South, much can be learned from the profiles and experiences of those whose lifespans stretch for a century or longer.Further research is needed to compare and confirm the profiles of Ethiopian centenarians with those in other nations around the world.Inclusive longevity studies with diverse racial, ethnic, and sociocultural groups, geographical regions, and climate zones are needed to advance the scientific body of knowledge globally.A systematic census would help to provide an accurate accounting of the number of centenarians in Ethiopia and other developing nations.In Ethiopia and the rest of Africa, centenarian issues have not been the focus of empirical research.Longitudinal studies can be useful to overcome the limitations of this cross-sectional study and may help to inform scholars about the unique factors contributing to elders' longevity in Ethiopia.Researchers from different disciplines and professions including social work, gerontology, sociology, demography, genetics, geriatric medicine and nursing, psychology, history, and anthropology are needed to promote a greater understanding of centenarians in the Global South.

Epilogue
By the end of the data collection period in January 2019, five of the centenarians were still living.Three of them (Kebede, Michael and Hiruy) lived for a year after their interviews.Hiruy, the oldest of all the centenarians who participated in our study, lived for four years after the interview session; he died in November 2019 at the age of 113, reaching the status of super-centenarian.

Notes
1.A "religious father" is not a biological father, but a priest assigned to family members and was responsible for arranging the christening of a newborn, giving them a baptismal name, registering birth dates, teaching them about Christianity, giving blessings during religious festivals and wedding ceremonies, praying, giving condolences to bereaved families, and reconciling conflicts among family members.
Kebede (104) remembered the death of his children sadly, "I fathered 10 children.Unfortunately, I lost seven sons to death; there are only three living daughters in the rural areas leading a destitute life in their old ages."Hiruy (108) and his wife had 11 children but only six were still living.He shared:My eldest daughter died from HIV/AIDS; she was a schoolteacher and had seven children.I lost my little kid at the age of four, and son who was a military officer with the rank of colonel.Two of my young sons were members of the EPRP (Ethiopian People's Revolutionary Party) and were imprisoned and assassinated in 1979 by government forces in Debre Markos prison along with 84 prisoners during the period of red-terror [in the late 1970s].

Table 1 :
Centenarians by Gender, Age, and Religion

Name of Centenarian (pseudonym) Gender (self-identified) Date of Interview Age Religion Year of Birth Age During interview Orthodox Chriristian Monk/Nun Duration of being a monk or nun (in years)
(Holstege et al. 2018;Pin and Spini 2016)he US (US Census Bureau 2012) and 72% in Puerto Rico (Alemenas-Velasco and Ortiz-Marin 2013) lived in urban areas.None of the Ethiopian centenarians in our study lived alone in later life while the living arrangements for older adults in the Global North is largely characterized by living alone, with a spouse (US Census Bureau 2012), or living in congregate settings such as institutional or residential care centers(Holstege et al. 2018;Pin and Spini 2016).In the Global South, older adults tend to live with multigenerational and extended family members (UNFPA & Help Age International 2012; Zimmer 2008).Despite Ethiopia being the third most populous nation in Africa, with over 110 million residents, institutional care for older adults is rare with only ten facilities throughout the country (Dr.Messay Kotecho, Addis Ababa University