Older age underwriting: frisky vs frail.

The speed of the aging process is variable. Some individuals remain exceptionally fit beyond age 90, while others become frail and fragile early. Survival is better predicted by biological age (state of health, status of reserves) rather than chronological age (age in years since date of birth). The frail group shows a higher mortality compared to the robust group. When assessing the elderly in underwriting, it is important to note the usual chronic diseases such as cardiovascular disease, COPD, cancer risk, and so on. But because of its strong impact on prognosis, it is also important to assess frailty. Key features of frailty are social isolation, dependency in managing life activities and self-care, cognitive decline, shrinking of bone and muscle mass, and slow weight loss.