Older-Age Underwriting: Its Distinctly Different, And With Good Reason
To determine insurability of clients age 65 and over on the same basis as is done at younger ages all but guarantees a botched job.
This is because factors that the life insurance industry knows contribute to premature death in young and middle-aged adults differ dramatically from those linked to excess geriatric mortality. The following examples give clear evidence of this too often overlooked reality.
Frailty (vs. Vitality): At younger ages, vitality is a given. Not so in the “golden years,” where the capacity “merely” to carry out routine activities of daily living (now known simply as ADLs) has been shown to be a more imposing predictor of survival than diabetes. Regrettably, only a handful of life insurance companies employ a long term care version of the paramedical exam designed to probe physical capacity.
Smoking: A number of studies have shown that tobacco indulgence in the seventh decade and beyond translates to largely insignificant extra risk in males and none whatsoever in females. To overemphasize this risk-taking behavior at the expense of other considerations is to mistake the sapling for the proverbial forest.
Blood Pressure: While definite hypertension impacts longevity at all ages, the reality is that its mortality slope becomes distinctly U-shaped late in life. This is to say, when systolic and/or diastolic readings are too low, the implications are, in fact, more ominous than when the readings fall into modestly debited ranges. It is a frank shame that we do not yet recognize the sinister nature of high “pulse pressure” (the difference between the systolic and diastolic readings) for what it really means.
Cholesterol: At younger ages, lower is better. Not so later on, when a low or, worse, falling cholesterol (in those not on lipid-lowering prescription drugs, of course) is a proven harbinger of early demise.
Heavy Drinking: Abuse of alcohol is worrisome at all ages. However, 3 distinct realities must be borne in mind when assessing the impact of such abuse in those over age 65.
First, the elderly are far less tolerant of alcohols acute effects, so what is generally considered to be “social drinking” at age 40 confers genuine risk 3 decades later.
A second consideration is the synergy of alcohol intake and medication effects. Two beers and the wrong pillwhich may have been correctly prescribed for the right reasoncan beget the fall that begets the hip fracture that begets fearsome short-duration mortality.
Lastly, our elders are quite adept at “hiding the bottle!” Woe betides he who discounts even equivocal laboratory and medical history clues to overindulgence in the geriatric risk population.
Diabetes: One of the most disturbing deviations from good underwriting is the industrys rampant failure to appreciate the implications of diabetes at all ages. It is axiomatic in studies of virtually all impairments that the diabetic will fare far worse than those with normal glucose metabolism. This becomes proportionally more important over age 65, as the incidence of diabetes rises and some other prominent cardiovascular risk factors lose much of their impact.
Alas, the notion of the “preferred diabetic” is one of our most ill-conceived oxymorons!
Build: The mortality of “build” is distinctly U-shaped at older agesso much so that one could make a convincing argument for underweight being the real issue. Nevertheless, we continue to measure this risk solely in terms of weight in relation to height. A 2-inch-thick stack of research studies proves that it isnt “how much you carry” but “where you carry it” that makes all the difference. How many well-heeled, pleasingly plump elderly ladies are unwitting victims of the industrys failure to make use of the waist-to-hip ratios, the best benchmark where obesity is concerned.
Rx Use: Older people take more medications than their offspring. Indeed, this phenomenon has earned the label “polypharmacy.” In some casesuse of benzodiazepine sedatives being a clear examplethe implications of drug effects may translate to risks that are all too often unappreciated.
The preceding are just a few examples of how proper older-age underwriting is more distinctive than many underwriting practices and guidelines recognize. Has the time come for this knowledge to be translated into new geriatric risk paradigms? This underwriter does not hesitate to offer up his emphatic “yes!” in this regard.
, FALU, FLMI, CLU, is president of , Inc., Greendale, Wis. His e-mail address is [email protected].
Reproduced from National Underwriter Edition, July 29, 2004. Copyright 2004 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.