The triennial Society of Actuaries ‘Living to 100 Symposium’ was held in Orlando, Florida, (January 16-18, 2023), a unique conference that brings together different communities with a keen interest in longevity and a common concern for aging populations, a key issue for actuaries, demographers, as well as medical professionals.
The symposium has been important to us; the Moody's RMS Infectious Diseases Model was developed in 2006 in response to a client suggestion, and RMS began to explore the prospect of developing a medically-informed longevity model as an alternative to the traditional retrospective actuarial models based on a statistical analysis of the past mortality record.
As an initial step, I attended the 2008 symposium, and the ideas gained there were influential in the launch of the Moody's RMS Longevity Risk Model in 2009.
I have now presented twice at the symposium in 2014 and 2020, with the first presentation in 2014 focused on the cognitive, social, and psychological drivers of longevity.
The Search for Effective Alzheimer’s Disease Treatments
In 2020, my presentation focused on the longevity extension consequences of advances in the treatment of dementia and Alzheimer’s Disease (AD). The number of deaths attributed on death certificates to AD is only a small proportion of the number of people dying with AD, as swallowing disorders, malnutrition, and pneumonia may mask the disease’s impact.
There is no health without cognitive health, and thus, effective treatment of AD would be a significant boost to human longevity. AD treatment initiatives have been disappointing for the past decade, but hopes are rising with the U.S. Food and Drugs Administration (FDA) granting accelerated approval of Leqembi™ on January 6, 2023, which has been demonstrated to reduce cognitive decline.
The 2020 symposium had just preceded the COVID-19 lockdown period of social distancing, which has taken a high toll on AD patients. Furthermore, those with COVID-19 have been at significantly increased risk of a new diagnosis of AD. For this latest 2023 symposium, I presented on the importance of cognitive health for pandemic survival and longevity.
One of the concerns for the future is that Long COVID may give rise to an increased prevalence of dementia among the elderly. Cognitive decline is the biggest factor in determining how long patients with AD will live after being diagnosed.
A Roadmap for Healthy Longevity
A feature of the Living to 100 Symposium is that the process of choosing papers for presentation is highly selective, and each paper is assigned a discussant. My talk was positively received by the discussant, Anna Rappaport, a past president of the Society of Actuaries, who appreciated my focus on the increasingly important topic of cognitive health.
The vital significance of cognitive issues for longevity was also reflected in the assignment of the opening symposium talk to a psychologist, Prof. Neil Charness, director of the Institute for Successful Longevity at Florida State University. He reviewed ways in which modern digital technology can increase the quality of life for aging adults.
Another talk addressing cognitive issues explored the National Academy of Medicine’s Global Roadmap for Healthy Longevity. This roadmap defines healthy longevity in the following terms:
“…when years of good health approach the biological life span, with physical, cognitive, and social functioning that enables well-being.”
The target year to achieve this goal globally is 2050; such population aging developments are on a similar time scale to that of achieving net zero emissions to slow climate change.
Actuaries are obligated to consider climate change effects, and a well-researched presentation on this major topic of global concern was duly given at the symposium by Sam Gutterman, a consulting actuary, who has implored his actuarial colleagues to pay attention to the mortality impact of climate change.
The symposium also provided an excellent opportunity to publicize recent breakthroughs in healthcare. In May 2022, Munich Re announced a partnership to bring the Galleri® multi-cancer early detection test to the U.S. life insurance industry, promoting proactive screening among eligible life insurance policyholders.
In a clinical study, the Galleri® test demonstrated the ability to detect more than 50 types of cancer through a single blood draw. The commercial gain to life insurers of encouraging preventive healthcare, wellness, and a healthy lifestyle among the insured has been the essential vision of the Vitality Group, and a very inspiring and informative talk was given by Francois Millard, its chief actuarial officer.
The Shape of the Mortality Rate
Switching from healthcare to demography and actuarial science is an engaging feature of the symposium, which makes every session so interesting. The shape of mortality at very old ages remains an undecided issue even after decades of research.
The increasing mortality rate perspective was given by Prof. Roland Rau. A towering figure in this debate has been his mentor, James Vaupel, founding director of the Max Planck Institute for Demographic Research. I heard him give a compelling presentation at the 2020 symposium. He might have presented in 2023, but he sadly passed away in March 2022; esteemed demographers have no longevity privileges.
The possibility that the mortality rate might plateau at very old ages was proposed by Kai Kaufhold, with whom I had an interesting discussion. Kai Kaufhold has followed RMS LifeRisks longevity modeling from the outset, including the pioneering 2010 longevity cat bond Kortis Capital for Swiss Re.
Having been involved in longevity swap transactions, Kai was keen to know more about prospects for longevity risk transfer, notably the collaboration between Club Vita and the Longevity Exchange which began in March 2022 to improve the efficiency and transparency of the longevity risk transfer market.
Governments Look to Understand Mortality Risk
Mortality is a fundamental element in the financial projections of social security programs around the world. Prominent actuaries from the U.S. Social Security Administration, Canada's Office of the Superintendent of Financial Institutions, and the U.K. Government Actuary's Department discussed some of the key factors and current issues associated with these projections.
Experience over the past decade has indicated a gradual slowing of mortality improvement, which includes the severe mortality impact of COVID-19. Improving mortality will have a significant effect on the affordability and importance of income through retirement to many population segments in these countries. There were several symposium sessions addressing the challenge of financial planning issues for retirees, including long-term care insurance.
Geroscience and Senolytics
At the outset, Moody's RMS LifeRisks has sought to access the latest research in geroscience: the study of aging and age-related diseases. A key symposium presentation on geroscience was given by Prof. Richard Faragher, a U.K. professor of biological gerontology.
Richard Faragher’s work centers on the mechanisms and consequences of cellular senescence. Senescent cells are the living, but permanently non-dividing forms of cells which are normally capable of division within mammalian tissues.
In recent years, anti-aging research has focused on compounds called senolytics, that remove senescent cells while leaving healthy cells to flourish. Many age-related diseases are associated with an accruing senescent cell burden. These aged, damaged cells accumulate in our tissues, refusing to die off. They instead secrete inflammatory molecules that damage surrounding healthy cells. Removing such cells is not an undertaking without the risk of side effects.
Richard Faragher warned that while removing senescent cells might have some longevity advantages, there are some parts of the body, e.g. eyes, where such removal might have dire consequences. He also expressed caution over potential anti-aging drugs, such as metformin, used to treat type 2 diabetes.
A measure of the international status of the Living to 100 Symposium is that Jay Olshansky, a leading authority on aging demographics, rates this as his favorite conference. His talk was based on his recent September 2022 expert testimony to the U.S. Congress. In this testimony, he explained the goal of geroscience as being to extend healthspan by compressing the frailty and disability that comes with aging, into a shorter duration of time near the end of life.
According to Olshansky, there is a red zone from around age 70 in which the health span can be extended. He recounted a milestone meeting with the FDA, which now recognizes the extension of health span as being a practical geroscience goal with future clinical trials addressing multiple diseases.
There is an opportunity for longevity analysts to develop quantitative models not just for lifespan but for health span as well. The availability of such models might encourage initiatives for additional insurance products. I discussed this with Joseph Lu, director of Longevity Science at Legal & General, who approved of this innovation.
Jay Olshansky, who is a professor in the School of Public Health at the University of Illinois at Chicago, has looked across the Atlantic to the life and death of Queen Elizabeth II as an exemplar of what geroscience is pursuing – a healthy active life with a short period of frailty at life’s end. Queen Elizabeth II died of old age on September 8, 2022, at the age of 96, having carried on with official business when she met with her new Prime Minister just two days before.
I opened my symposium talk on the importance of cognitive health by referring to recent scientific research indicating that the postponement of retirement can have cognitive health benefits. Queen Elizabeth II was the epitome of an individual dedicated to their vocation, who remained in very good cognitive health until death.
She possessed what the long-lived Japanese call ikigai – translated as '...a reason for being.' In her long lifetime of public service, she was an inspiration to all. In her passing, she has become an inspiration for geroscience.