The older-age market is growing by leaps and bounds as boomers become “gomers.” (“Gomer” is medical slang for “get out of my emergency room”–an expression reflecting the rising incidence of medical complaints by people over age 65.)
Medical screening for life insurance needs to keep pace here by adopting prudent changes to accommodate this insurance-conscious population.
The specialized paramedical, focused on frailty and cognitive issues, is one essential development as underwriting comes to see how these 2 medical factors help pinpoint the most vulnerable elders. Functional testing, along the lines used for years in long term care insurance, is now a major element when screening these over-age-65 applicants for life coverage.
BMI (body mass index) measurements in the “obesity” range (30-35+) are not reflective of the real mortality risk over age 65, especially in females.
Rather than take overly-conservative action on some of these cases, insurers are pressing their examiners to perform waist circumference measurements. This simple step is necessary because excess weight carried in the hips and thighs does not have the mortality implications associated with abdominal obesity.
Prostate-specific antigen (PSA) is the only FDA-approved screening tumor marker (and, one hastens to add, the only routine tumor-related test appropriate in underwriting).
PSA readings in the “gray zone,” between 4 and 10 nanograms, are prevalent in geriatric males. Proactive insurers use a supplement test, known as free-PSA, to pinpoint those individuals with modest PSA elevations who are at greater risk for harboring unsuspected prostate cancer.
Baseline blood screening is being adjusted to reflect the real risks in this age group. For example, a simple calculation known as the estimated glomerular filtration rate (eGFR) affords a valuable indicator of declining kidney function. Thresholds for “abnormal” serum creatinine–a routine test in all profiles–are being scaled back to reflect the fact that what are considered “high normal” readings at younger ages are associated with increased risk of mortality over age 65.
A new kidney marker, cystatin, has been clinically demonstrated to be superior to traditional insurance blood tests for kidney function. At least one insurance laboratory has hinted at offering cystatin as an enhancement in this key aspect of screening.
It is widely appreciated that at older ages, low serum cholesterol is powerfully linked to increased risk of mortality. A new way of testing for high cholesterol when it genuinely is a culprit will soon be available to insurers. Known as skin sterol, it measures actual cholesterol deposition with a pad placed briefly on the palm. Convincing research by cardiologists reveals that “skin cholesterol” (as it will undoubtedly come to be known) is a far better indicator of heart blockage than blood cholesterol.
The majority of those life insurers still retaining treadmill stress tests for screening require that this be done on applicants as old as age 75. Considering that 2 deaths have occurred in this insurance context in South Africa, it is time to revisit this high-risk practice. While this underwriter has not heard of any deaths–yet–in our market, the clock is ticking. This is just one reason why insurers should strive to scrap this slow, expensive, financial-services incongruent relic of the last century and replace its ostensible protective value with more prudent alternatives.
One such alternative, after a decade of careful clinical study, has unprecedented potential as a baseline screening test for the entire spectrum of age-related circulatory diseases.
This is NT-proBNP, a blood test. It is easily done in conjunction with blood profiles, and at 1/20th the cost of a treadmill. Because it reflects a far broader range of CV risks, NT-proBNP will undoubtedly be given priority consideration as a modern alternative to egregiously customer-unfriendly treadmills.
Hopefully, insurers will increase their embrace of these and other enhancements, as the industry strives to transform older-age underwriting into “part of the solution” where insuring older-age risks are concerned.