By David Solie, MS, PA
Longevity
in an applicant’s family history is given only minor significance in
underwriting for life and long term care insurance. It is a very small piece of
the morbidity or mortality risk-assessment pie. The fact that the applicant’s
grandma lived to age 103 is impressive but doesn’t turn a standard into a
preferred or make an uninsurable suddenly insurable. Is there another use of
longevity in underwriting beyond documenting an applicant’s family history? The
answer is yes. On closer inspection longevity offers a unique look at the
markers for extended life expectancy and successful aging. These insights
highlight specific physical and mental health traits that lead to a "long-lived
life." This article looks at what I call
centenarian
markersTM
and discusses their usefulness in the underwriting of older applicants.
The Gold Standard of Longevity
The gold standard of longevity is the individual who lives to age 100 and
beyond, the centenarian. Becoming a centenarian is no accident
i
.
In fact, a common theme emerges from the physical and mental lifestyle of these
long-lived individuals, whose profiles provide us with both insights and
guidelines for living long and productive lives. These profiles also provide
clues about who is already on the track to "enhanced" longevity.
Enhanced longevity is not about simply living more years at any cost. Living
longer is of limited value without a satisfactory quality of life. Living well
includes the surprising benefit of a phenomenon called "compressed morbidity."
ii
Contrary to popular belief, centenarians do not experience prolonged periods of
disability and chronic illness. They live long and rather healthy lives with a
"compressed" period of disability near the end. How do they do that?
Many factors tip the morbidity and mortality scales in their favor. All of these
factors have an important bearing not only on living longer, but also on the
risk assessment process itself. With the increased importance of "life style" as
a predictor of morbidity and mortality in older applicants for life and long
term care insurance (i.e., for applicants 75 and up), knowledge of
centenarian
markersTM
becomes essential information for producer and consumer alike.
The first marker is the successful use of heath care.
It is not enough to say that modern medicine and public health measures afford a
greater likelihood of living longer. They do but they are no guarantee. The
operative word is "use" of health care in a timely and systematic manner. On the
most basic level use would include vision and hearing enhancements to make sure
older adults remain safe and connected to their environment. It would also
include vaccines and screening tests. But the question to ask is, has the
applicant taken advantage of them? Is the applicant having age-appropriate
screening tests? Are the applicant’s vaccinations up to date? What about
medications, the most expensive and elusive health care variable. We know
medications save lives and prevent or retard the advancement of disease. The key
question is not their effectiveness, but the applicant’s compliance in taking
prescribed drugs, especially for the so-called silent diseases such as
hypertension that can lead to stroke or heart attack.
|
Underwriting Strategy #1 Make a case for the applicant’s use of
the health care system. Is the applicant getting the appropriate
screening tests for his or her age group? Are the applicant’s
immunizations up to date? Is the applicant compliant with taking
medications as directed and showing up for follow-up visits? |
|
The second marker is genetics.
Centenarians are blessed with "long-lived" family trees. The advantages of this
type of genetic inheritance appear to be both slowed aging and decreased
susceptibility to disease. Who wouldn’t want that?
|
Underwriting Strategy #2 Make a case for the applicant’s family
history of longevity that looks on both sides of the family tree. Who
lived to what age? |
|
The third marker is the immune system.
This is where centenarians with longevity genes really shine. As the body ages,
it starts to build antibodies against itself called autoantibodies. These
autoantibodies are looking more and more like the primary source of heart
disease and cancer. How so? It appears that the end product of these antibodies’
interaction with the body’s various tissues is inflammation, i.e., the
autoantibodies literally attack the body itself and set the individual up for
heart attacks and tumors, among other diseases. Individuals with longevity genes
appear to have a slower buildup of autoantibodies, and may explain, in part, why
they seem to age more slowly than noncentenarians.
But about the centenarians who were not blessed with longevity genes? Recent
research suggests that these immune changes may not be due to aging but to
nutritional deficiencies.
iii
The weakening of the immune system may not be normal part of aging. In fact, it
appears that if the immune system can be enhanced, the inflammation factor is
reduced.
iv
If the inflammation factor is reduced, aging slows down. How? The following
vitamins and minerals have been identified as playing a critical role in
maintaining the immune system:
v
-
Zinc
-
Selenium
-
Iron
-
Copper
-
Folic
Acid
-
Vitamin
A
-
Vitamin
B
-
Vitamin
D
How these
nutrients are taken (i.e. diet or supplement) and at what dosages are issues
still being researched. But this much seems clear. Good nutrition can make up
ground lost to less than optimal genetics.
|
Underwriting Strategy #3 Make a case for the applicant’s
nutritional status. Are they following a healthy diet? If yes, describe
it in detail. Do they take supplements? If so, which ones and how much? |
|
The fourth marker is physical activity and exercise.
The hallmark of centenarians is that they have always lived active lives.
Physical activity and exercise are essential for longevity. As long as it is
constant and of good quality, physical activity and exercise can add years to a
person’s life. As important, it is a major factor in achieving compressed
morbidity.
vi
|
Underwriting Strategy #4 Make a case for the applicant’s physical
activity and exercise status. Does the person exercise on a regular
basis? If yes, what kind? Is it cardiovascular, resistance training, or
both? Be specific about each. How often does he/she exercise and how
long at each session? Is the exercise at a health club or home? If they
exercise at home, do they have their own equipment? If yes, what kind?
In what other activities is the person engaged on a daily and weekly
basis? |
|
The fifth marker is normal weight.
The centenarians as a group maintain a normal weight, which reduces their
chances of getting diabetes and heart disease. Obesity may prove to be the
Achilles heel for baby boomers as they age and want to remain healthy. This is
highlighted in an interesting study of the offspring of the Framingham cohort
(the cohort is the original volunteers who agreed to be part of this landmark
medical study). The offspring (i.e. baby boomers) were found to be healthier
than their parents (the cohorts) in all areas except weight.
vii
The offspring’s weight tends to be greater.
|
Underwriting Strategy #5 Make a case for the applicant’s
successful weight management. Be sure to use the standard height and
weight tables to make your point. Also note if the applicant has
successfully lost extra pounds and maintained a healthy weight over a
period of time. |
|
The sixth marker is not smoking.
Centenarians are almost universally non-smokers. It is common knowledge that
non-smokers do better in every aspect of health and longevity. What isn’t as
well known is that quitting smoking not only increases life expectancy but also
the number of years lived without disability. Quitting smoking has the
additional benefit of compressed morbidity.
viii
|
Underwriting Strategy #6 Make a case for the applicant’s
non-smoking status. Is the applicant a life long non-smoker? If not, how
many years ago did he/she quit? |
|
The seventh marker is social connectedness.
Centenarians are happier and live longer because they are connected to family,
friends, and social groups. Isolation has the opposite effect and can lead to
depression and decreased morbidity and mortality.
ix
Being connected also provides a sense of purpose that is called "productive
engagement." With older adults, productive engagement has a significant impact
on improving longevity.
x
|
Underwriting Strategy #7 Make a case for the applicant’s social
connectedness. Does the person play bridge, volunteer, dance, or serve
at church? How often do social commitments take the person out of the
home? Does the person still drive? If not, who takes the person around
to these events? |
|
The eighth marker is attitude.
Centenarians are good at managing life. No one is immune to life’s unpredictable
events, but viewing life as an unfolding drama with optimism, humor, and
calmness emerges as key traits of the centenarian personality. Centenarians
experience the same stress we all do. They simply use their optimistic attitude
to successfully manage it. Their mental fitness parallels their physical
fitness, and they are consistent in their dedication to both.
|
Underwriting Strategy #8 Make a case for the applicant’s
attitude. Give examples of the optimism, humor, and wisdom. Give
specific examples of how this person’s healthy attitude has benefited
both the person and those to whom he/she is connected. |
|
The ninth marker is spiritual connectedness.
The centenarians do not pretend they know it all or made it all happen on their
own. They possess a sense of spiritual gratitude and connectedness to their
faith. They are as a whole religious people. Their faith is reflected in their
attitude and their sense of personal responsibility. They accept responsibility
for themselves and the world they inhabit. They draw strength, courage, and
peace of mind in their spiritual partnership.
|
Underwriting Strategy #9 Make a case for the applicant’s
spiritual connection. Does the client attend religious services on a
regular basis? If yes, how often and where? Is he/she active in his/her
faith? If yes, provide specific examples. |
|
In the
midst of a national health care crisis and aging population, the
centenarian
markersTM
provide a clear and easy-to-read blueprint on how to live and age successfully.
They provide a collective game plan that can be used at any age to upgrade both
the chances of living longer and living well. The centenarians’ pioneering lives
are resetting the bar on successful aging. We need to be ready and willing to
employ their collective wisdom on a personal and professional basis for our
clients and, as importantly, for ourselves.
i
Perls TT,
Silver MH. Laurerman JF. Living to 100:Lessons in Living to Your Maximum
Potential as Any Age. New York, NY: Basic Books; 1999.
ii
Ferrucci L,
Izmirlian, Leveille S, et al. Smoking, physical activity, and active life
expectancy. Am J Epidemiol. 1999;33:162-179.
iii
Marzi L,
Lesourd BM, Nutritional influences on immune response in healthy aged persons.
Mech Ageing Dev. August 1998;104:25-40.
iv
Heber D, Bowerman S. What Color is Your Diet:The 7 Colors of Health. New York,
NY:Regan Books;2001.
v
Chandra RK.
Nutrition and the immune system from birth to old age. Eur J Clin Nutr 2002
Aug;56 Suppl 3:S73-6
vi
Hubert HB,
Bloch DA, Oehlert JW, Fries JF. Lifestyle habits and compression of morbidity.
J Gerontol A Biol Sci Med Sci. 2002 Jun;57(6):M338-42.
vii
Allaire SH,
LaValley MP, Evans SR, O'Connor GT, Kelly-Hayes M, Meenan RF, Levy D, Felson
DT. Evidence for decline in disability and improved health among persons aged
55 to 70 years: the Framingham Heart Study. Am J Public Health 1999
Nov;89(11):1678-83.
viii
Nusselder
WJ, Looman CW, Marang-van de Mheen PJ, van de Mheen H, Mackenbach JP. Smoking
and the compression of morbidity. J Epidemiol Community Health 2000
Aug;54(8):566-74
ix
Penninx BW,
Leveille S, Ferrucci L, van Eijk JT, Guralnik JM. Exploring the effect of
depression on physical disability: longitudinal evidence from the established
populations for epidemiologic studies of the elderly. Am J Public Health 1999
Sep;89(9):1346-52.
x
Glass TA,
de Leon CM, Marottoli RA, Berkman LF. Population based study of social and
productive activities as predictors of survival among elderly Americans. BMJ
1999 Aug 21;319(7208):478-83.
