Falls are difficult under the best of circumstances—painful when we are younger, but often catastrophic when we are seniors. The leading cause of injury-related visits to emergency departments in the United States for people 65 years of age and older, falls are the single largest cause of injury mortality for this group. There is little wonder why an underwriter looks carefully at a history of falls in the senior population applying for insurance.
The mortality rate from falls reported by major studies is frightening. Data from the Major Trauma Outcome Study database suggests an almost 12 percent mortality rate for falls in geriatric patients. In addition, a large Dade County, FL, study showed that almost half of the fall injury events that occurred at home resulted in discharge to a nursing home. Almost 90 percent of hip fractures that occur do so as a result of falls, and the immobility associated with surgery and recovery are striking—according to a major textbook on gerontology, about one-fourth die within six months of occurrence.
What are some of the risk factors for falls? Older age, house-bound status and living alone head the list. Historical factors such as previous falls, acute illness, use of a cane or walker, and chronic conditions that affect the neuromuscular system are prevalent. Medications which decrease awareness or sedatives and medication in combination are also cited as contributors. Physical defects, of course, such as poor vision, difficulty in rising from a chair, neurologic changes (even age-related without a specific etiology) and decline in hearing are also major factors.
Cognitive impairment is also at the top of the list in the absence of a distinct physical cause. Elderly people become more susceptible to falls when presented with difficult physical or mental challenges. Confusion or distraction about a condition that could have been avoided can become an accident. When judgment is impaired, the ability to carry out tasks that were easier when younger becomes much more challenging in older age groups.
Falls in the senior population are much more catastrophic when bones are not strong and balance is impaired. Getting out of bed may cause a fall. Common medications or the use of alcohol—even at previously acceptable social limits—may cause instability. Disturbances of gait, balance or even avoidance of pain from arthritis can tip someone into a fall.
External factors are also quite common—homes where people are unable to make the necessary repairs or when cleaning up and removing hazards become more difficult.
If you think only the very elderly who barely manage on a walker are the typical victims of a fall, you might be surprised to know that this often proves not to be the case.
The age 75-to-85 market has expanded rapidly for life insurance, and many of those who initially are managing daily activities with a maximum amount of effort soon are over the threshold for optimal self-care. For instance, diseases such as Parkinson’s cause tremors, shuffling gait, lack of momentum to propel, and inability to stop an accident or a fall. Causes such as this from chronic disease are virtually endless.
Medical exams for older-aged applicants (sometimes referred to as the “senior med”) may seem inconvenient, yet can be very telling when evaluating insurance applicants. Tests for cognitive awareness are not necessarily ones that require someone to be a genius to pass, but orientation to person, place and time, as well as the ability to have more than basic memory (delayed word recall) are often parts of the exam.
A Get Up and Go test, where an applicant must rise from a chair, navigate a small distance in a reasonable amount of time, and return to the starting point helps measure gait, stability and strength. And of course, attending physician statements are of paramount importance in assessing whether older-age applicants can accomplish the activities of daily life without being unduly subject to accident and trauma.
As individuals age, even into years that are now more commonplace for survival—well into the seventies and eighties—they also accumulate larger numbers of chronic disabilities and conditions. While some of those conditions might be considered benign, when combined they can substantially increase the risk of falls.
Falls are a condition an underwriter looks at very seriously when assessing insurability.
Robert Goldstone, MD, FACE, FLMI
Goldstone, board certified internist and endocrinologist, is vice president and chief medical officer for Pacific Life and Pacific Life and Annuity. He has extensive brokerage and life insurance experience, having been medical director at both 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 since 1990. Goldstone can be reached by telephone at 949-420-8390. Email: firstname.lastname@example.org.