Whether you’re selling long-term care insurance (LTCI), ordinary medical insurance, Medicare supplement insurance, disability insurance, annuities, houses, or dry goods, you face the same challenge: Your clients and prospects are getting older.
Most of us have known our parents, and most of us have known our grandparents. We all think we know something about aging. We all know it’s one of those inevitable things.
Then there’s Bradley Willcox.
He’s a University of Hawaii medical school faculty member who, with his brother, Dr. Craig Willcox, are the co-principal investigators at the Okinawa Centenarian Study. They’re conducting many different aging-related studies based in part on the centerian study findings.
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Genworth Financial Inc. (NYSE:GNW) recently named him to a new National Advisory Center for Long-Term Care Information (NALTCI).
He’s using the tools of science to look aging in a different light, and coming up with interesting ideas. Such as the possibility that improving our cellular machinery could at least slow the aging process for some, and that salmon may be even better for you than you think it is.
For a look at more of his thoughts about what people in the insurance community should know about the science of aging, read on.
1. Scientists are still scrambling some basic questions about aging.
One obvious question is whether people who reach age 100 spend, on average, fewer years with problems the activities of daily living (ADLs) than other people, more years with problems with ADLs, or about the same number of years with ADL problems.
Giving that question a good answer is difficult, because it requires following a large group of people over many years, Willcox said.
Willcox said that his team and others may soon have the data they need to analyze the relationship between extreme longevity and the need for long-term care (LTC) services.
2. The Mediterraneans aren’t the only people in the world who know how to eat.
Researchers like finding relatively isolated, genetically similar groups of people who lead similar lifestyles. Following what those groups of people do over a long period of time can help researchers identify factors that can make a difference in people’s health, even after they adjust as well as they can for factors that could throw off comparisons.
Genetics researchers have been studying the DNA of people in Iceland for years, for example.
Nutrition researchers have looked at people in the Mediterranean region and come up with the concept of the Mediterranean diet: the idea that eating fish, cheese, olive oil, and fresh fruits and vegetables is particularly good for health.
Willcox, who is co-principal investigator of the Okinawa Centenarian Study with his brother, Dr. Craig Willcox, has been using data on Okinawans to investigate many different aging-related matters, such as how diet affects vulnerability to conditions such as lung cancer and colon cancer.
The study leaders have observed that the Okinawans have traditionally eaten a diet that is much different from the Mediterranean diet, and is much lower in fat, but that it is also a low-calorie, moderate-sodium diet made up of high-quality, nutrient-dense foods, and that the diet itself may help promote good health and longevity.
3. Worms get old, too.
Human beings take a long time to age, and they resist living according to the strict rules that could help scientists filter true cause-and-effect relationships from interesting coincidences.
Willcox and colleagues have studied the genes that seem to regulate the lifespans of organisms such as mice and roundworms, then tried to see whether similar versions of the genes that happen to be present in human beings have similar effects on the human lifespan.
The cells in all known creatures on Earth store information in strands of DNA. Each strand is made up of the equivalent of four different kinds of beads: amino acids called adenine, thymine, guanine and cytosine.
Cells use protein mechanisms called transcription factors to lock onto DNA and control whether and how quickly the cells act on the instructions encoded in the DNA. Scientists have discovered a family of transcription factor proteins, the “Forkhead box” (FOXO) proteins, with a V-shaped top.
In the C. elegans roundworm, one protein in the FOXO family, FOXO3A, seems to protect the worms from all sorts of stress, Willcox said.
Some people carry a version of the gene with one little variation: a guanine in place of a cytosine. People could either get the common version of the gene from both parents, the less common version from both parents, or one common version and one less common version.
In the Okinawan study sample, men who inherited one gene with the less common version were twice as likely to live to 100, and men who inherited two copies of the less common version were three times as likely to live to 100.
Proving just what the FOXO3A variant gene really does is complicated. In Denmark, for example, Danish researchers tried looking at how the variant affected longevity in 1,088 very old Danish people. Those researchers found that the variant gene had a slight effect on vulnerability to aging-related bone fractures, no effect on people’s need for help with ADLs, and hints of a small favorable effect on other indicators.
But Willcox thinks the FOXO3A variant, and dietary measures that mimic the effects of the variant, can help protect human cells against a wide range of sources of stress, just as they can protect roundworm cells against stress.
4. Lox might make you live longer.
Willcox made the best-seller lists, and earned the gratitude of soybean farmers, purple yam growers, and fishermen, by suggesting in “The Okinawa Program,” a book that reached the New York Times best-sellers list, that eating those foods could mimic the effects of getting the longevity-promoting version of the FOXO3A gene.
Some of the foods he promotes are humble, but others, including salmon, shrimp and other foods that are red due to the presence of a substance called astaxanthin, have wide appeal.
5. It’s hard to get money to study aging.
FOXO3A is hot, and Willcox can get funded. But, in general, “there’s very little spent on aging,” he said.
In the United States, the National Institutes of Health (NIH) spends only about $1 billion to $2 billion per year on aging-related research. Much of the rest of its research budget goes to pay for studies of specific health conditions, such as cancer and heart disease.
But aging is a major risk factor driving the other conditions, and attacking premature aging itself can get the country much more bang for the research buck than spending money on understanding specific diseases, Willcox said.
Statistical analysis shows that even completely eliminating cancer would only add about three years to the typical American life expectancy, whereas slowing the aging process, and dealing with the factors that keep many people from living to 90 or 100, could add about 10 years to life expectancy, he said.
Image: An illustration showing how part of the FOXO3 protein connects with DNA. (Creative Commons image/“Crystal structure of the human FOXO3a-DBD/DNA complex suggests the effects of post-translational modification,” in Nucleic Acids Research, November 2007)
6. It’s surprisingly hard to get money for any basic medical research.
NIH will spend about $30 billion on medical research this year, which is about what it’s been spending every year since 2010.
In reality, “flat funding” means that the inflation-adjusted amount the country is spending on research has fallen considerably in the past few years,” Willcox said.
“It’s really outrageous,” Willcox said.
Over the past few decades, the odds of getting a medical research proposal funded have fallen to less than 1 in 10, from 1 in 4, Willcox said.
7. The clock is up there, ticking, and we’re not doing much about it.
One of the big secrets of aging research is not much of a secret to anyone in the insurance community who’s been paying attention: The American population is aging rapidly, and public and private support systems for the elderly don’t seem to be keeping pace.
Willcox noted that Japan has at least started to come to terms with the effects of the aging of its population, by creating a mandatory public long-term care insurance program.
In the United States, “we’re a lot less prepared,” Willcox said. “It’s going to be a challenge.”