Functional Assessment Of Older Age Applicants

    Underwriting older age applicants is certainly difficult from a medical perspective. The effects of aging present difficult and sometimes unique disease entities not present in the everyday population, much less in combination with each other. While no one expects an older age applicant to be in perfect health, an underwriter has to differentiate pathological disease-that will cause premature mortality-from the normal aging process. In addition, a key part of underwriting is functional status of an older age applicant.

    As self-care is so important in any individual, the functional assessment starts with an evaluation of the activities of daily living. The basic activities, or ADLs, which can’t be taken for granted, include bathing, eating, toileting, dressing, transferring from a chair or bed, and bowel and urinary continence. The mortality associated with not being able to do one of these, much less several, is quite significant. Those unable to perform daily life tasks generally are found to have advanced underlying disease and are at risk for prolonged hospitalization, nursing home confinement and earlier death.

    There are additional sets of activities for evaluating older age clients. IADLs, or instrumental activities of daily living, involve housework, managing one’s own finances, using transportation independently, meal preparation and telephoning. One step above is what are called advanced activities of daily living, or AADLs. These are more voluntary and include working, driving, going out socially, participating in a hobby or other recreation, and attending religious services. Those who participate in most AADLs are generally the best insurance risks over time.

    Social involvement is paramount to extended living. Not only does it show an advanced degree of mental and physical capability, it shows a positive attitude toward life. Depression is definitely a risk factor for the worsening of many underlying diseases, and suicide is a reality for many elderly who do not feel life has anything more to offer them. The suicide rate doubles after age 75 and quadruples after 85. In addition, all of us know about mortality of bereavement, where a supposedly healthy partner dies shortly after the loss of a significant other for no obvious reason traceable to overall health. Technology can be a great tool in keeping an elderly person integrated within a society where they would otherwise regress into solitude. The prospect of learning new skills can seem daunting as we grow older, but it can also fulfill us with a sense of purpose. You can read here about alexa skills for elderly and how technology can improve your quality of life.

    Cognition, or the active thought and reasoning process, is another key to extended survival in the elderly. Applicants who have dementia, even a slight amount, put themselves at risk for death. Wandering, falling, behavioral problems, accidents and lapses in good judgment put those at older age at elevated risk for mortality. Most companies require a supplemental part of the insurance exam which checks basics such as memory of a few words (short term memory), orientation to time, place and person, and reasoning processes such as being able to draw a specific time on a clock face. These are not advanced college exam type material questions, but rather just enough to see that there isn’t significant dementia to factor in.

    Exercise capacity is quite important. Those who are physically active have a significantly lowered rate of both cardiovascular disease and all-cause mortality. While older applicants are excused from the treadmill EKG exam as they age, those who can actually perform even to a lower level on one are shown to be better than average long term health risks. Those who swim, dance or walk for extended periods of time in an exercise capacity are shown to have better than average cardiovascular status. A sedentary life is a risk factor for earlier mortality.

    One other factor that is very important to an underwriter is the occurrence of falls in the elderly. Not only are they a marker of poorer health and equilibrium, they are an independent risk factor for death. Falls put the elderly at risk for prolonged disability, fractures and even the inability to summon help when there is a physical injury. Fractures and surgery in these cases are particularly ominous: The mortality post hip fracture, for example, can be more than 700 percent of normal mortality from all sorts of complications such as stroke, pneumonia, heart attack and pulmonary embolus (a blood clot to the lungs).

    Many elderly and older age clients are quite vigorous past the age of 75, continuing well into their eighties. It is important to document these positive attributes and bring them to the underwriter’s attention in a detailed cover letter.

    Remember that there are any number of reasons-physical, medical and cognitive-to decline an insurance application on the elderly because of the complexity of underwriting and the fear of taking on an early claim. The ability to show that an applicant has positive attributes that will lead to extended life is vital to successful case placement. 

    MD, FACE, FLMI, board certified internist and endocrinologist, is medical director for SBLI of Massachusetts. He has extensive brokerage and life insurance experience over 30 years with Pacific Life, MetLife Brokerage and Transamerica Occidental Life.

    Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endocrinology and has written monthly for Broker World from 1991 to September, 2021.

    Goldstone can be reached by ­telephone at 949-943-2310. Emaill: