A 75 year-old man is applying for $2,000,000 of life insurance coverage. His cognitive testing results and lab work are considered acceptable. Should he qualify for coverage? What is known about his physical functioning capacity, and what should you know?
The leading causes of death in the senior population remain heart disease, cancer, cerebrovascular disease, pneumonia/influenza, and chronic obstructive pulmonary disease. While insurers may be able to price for these impairments, it is imperative that, when assessing a mature age applicant, that their ability to function physically is assessed as it impacts how they manage these and other potentially fatal diseases or illnesses.
Frailty is commonly associated with the aging process, but not all seniors become frail. It is an underwriting concern because it is known to be associated with an increased risk of poor outcomes in older adults from both a morbidity and mortality perspective. Older frail individuals tend to be weaker than their peers, and often have complex medical problems. They are less likely to live independently, require assistance with activities of daily living, and, in many instances, may have impaired cognitive abilities. Additionally, most are women, as they tend to live longer than men, are typically age 80 or older, and may be receiving care from an adult child. With the aging of the American population, this group of individuals increases with every passing year.
Gerontologists have classified frailty as a clinical syndrome in which an individual displays three or more of the following symptoms:
- Weight loss (10 pounds or more within the past year)
- Muscle loss and weakness
- Self-reported feeling of fatigue
- Slow walking speed
- Low level of physical activity
The signs of frailty – slow and unsteady gait and perceived diminished size due to loss of muscle mass – are often most obvious to those closest to the individual, prompting, in some cases, an application for life insurance coverage. Frailty can lead to serious health consequences, such as debilitating falls leading to serious fractures which could have varying mortality implications depending upon the type of fracture, difficulty in recovery, hospitalization or assisted living, or death.
Frailty and vulnerability to disease, decline and early mortality
In the insurance application process, information regarding an applicant’s physical functioning capabilities is generally gathered during the examination process. A paramedic or medical examiner typically asks a series of questions to determine the individual’s self-reported ability to perform activities of daily living (ADLs), such as bathing and dressing, and independent activities of daily living (IADLs), including shopping and meal preparation. The examiner then typically conducts a specific test or tests, chosen by the insurer, based upon perceived value in assessing an applicant’s functional capabilities.