Highlights of 2023 Living to 100 Symposium
By Anna Rappaport
Retirement Section News, July 2023
Every three years since 2002, the Society of Actuaries has sponsored a symposium on Living to 100 and Beyond. These symposia bring together a multi-disciplinary group of experts with a range of different viewpoints on high age mortality and life. The series started because of the need to project mortality to high ages, and the difficulty of doing so because of limited data, and questions about the reliability of data. The symposia were designed to balance a variety of different perspectives and have gradually expanded to address many types of information. 2023 included two major innovations in the Living to 100 program. There were two meetings—one in the U.S. and one in the far east. The U.S. meeting included a series of sessions on Elder Tech. These notes reflect my observations. I attended about one-third of the Elder Tech sessions and I focused more heavily on retirement issues. I presented in three sessions. I have attended all of the Living to 100 and Beyond symposia since the beginning, but this year, I attended only the U.S. sessions.
The 2023 symposium included technical and scientific information, evolution of financial products and employee benefits, as well as social and personal actions and decisions.
Technical and scientific information:
- Understanding how life spans are changing and how they are impacted by periods of declining health, mental acuity, or mobility.
- Projecting and quantifying mortality at very high ages.
- Scientific developments that affect mortality and morbidity.
- Climate change and how it relates to aging issues.
Financial product and employee benefit developments:
- How financial service companies/insurance companies/pensions adapt to the aging population and high age issues.
- Social Security issues linked to long life spans.
- How technology fits in and specific examples of technology to support aging.
Focus on social and personal issues:
- Helping individuals live a good life, and helping them age at home as they develop limitations.
- Housing options and choice, and the link of housing options to support systems.
- How society adapts to aging more broadly.
- Helping individuals deal with high age issues and make plans based on better decisions.
- Climate change and how it relates to aging issues.
- The importance and consequences of dementia.
- How technology fits in and specific examples of technology to support aging.
Note that some topics have been included in multiple categories. For example, climate change is a scientific development, but it affects choice of housing. Technology affects the development and administration of financial products and employee benefits.
Throughout the symposium, there was a focus on SOA resources and research. The individuals interested in this topic include those working with retirement, life insurance, health, annuities, and much more.
Mortality and Life Spans
This is a key topic for the symposium. It focused on where we are today and what has changed over the last three years. My summary of what I heard is as follows:
- The scientific research and projects that were underway three years ago are moving forward. There was no discussion of major new projects. The Metformin[1] TAME project is waiting for results of a large-scale trial on humans. It looks promising as an anti-aging drug, but no decisions have been made about what ages should take Metformin, dose, etc. Also, side-effects and contraindications are not known.
- There is no expectation of increases in the maximum life span.
- Average life expectancy could be increased by healthier behaviors—with regard to smoking, diet, exercise, better public health, paying attention to the environment, etc. This is related to paying more attention to the social determinants of health and is not a new issue.
- Healthy life expectancy and a reduction in periods of limitation and disability in the last few years can also be improved by the same factors.
- In addition, some improvements can be achieved by earlier testing for some diseases, which will improve the chance of curing those diseases.
- COVID had a major impact in 2020 and 2021. The U.S. Social Security actuaries are currently projecting that the impact of COVID on changes in mortality will disappear after a five-year period.
- Mortality improvement rates declined several years ago. Deaths of despair[2] are an important factor in this. The U.S. is not the only country affected by this trend.
- However, Long COVID could have a much greater impact over the long run. Up to about 20% of people who had COVID (including some where there was not a diagnosis) could have Long COVID. It is too early to know the impact of Long COVID. (The Woo paper discusses Long COVID and dementia). This may be a major issue for long-term care.
- The Social Security actuaries of the U.S., Canada, and U.K. are projecting about the same changes in year-by-year mortality as they did three years ago. There are several factors that could increase or decrease the rate of change. (Assia Billig laid these out very nicely in a chart).
- Long-term annual rates of improvement in mortality projected by U.S. Social Security actuaries are about 0.7%, for Canada about 0.8%, and for the U.K. about 1.2%. Mortality improvement rates are less at the high ages. These projections do not include the effect of climate change. (Based on a comment by Steve Goss.)
- Shifts in the age distribution of the population and overall population aging are heavily influenced by changes in fertility rates—for the U.S.—changes in number of births by year is a much bigger factor than mortality improvement in overall population aging.
- There are substantial differences in the situation by country and in the U.S. by race and ethnicity and by economic status.
Not discussed much if at all: Life spans in 2022 in the U.S. declined again. The decline is due in part to higher mortality among children. Contributing factors also include access to health care, gun violence, suicide, and drug problems.[3] The U.S. has higher rates of childbirth mortality than many Western nations. These factors are very different from the focus of Living to 100.
Impact of COVID: To Date and Going Forward
COVID had a major shorter-term impact on mortality and it likely has longer-term impacts that will emerge. My observations include the following:
- COVID had a major impact on mortality in the last couple of years, reducing life spans, but the effect will probably be temporary. The U.S. Social Security actuaries are assuming the impact will wear off in five years.
- The impact of Long COVID is not known, and it could be substantial. Long COVID could affect the ability to work, rates of disability, the need for health care, mortality, and more.
- People were home and adapted during the worst part of the pandemic. That created challenges due to social isolation. ZOOM and Facetime offered major support during this period, but they did not totally offset the social isolation.
- There are major links emerging between Long COVID and dementia.
Improving Longer Lives
One of the themes throughout the symposium was that the idea was not just to live longer but to live a good life as long as possible and to improve how we live at higher ages. Some of the topics discussed in this regard included planning for later years in life, staying in your home as long as possible, and social determinants of health, both physical and mental.
A Focus on Planning
The symposium moved from traditional financial planning to facilitate retirement to:
- Focusing on how to support living a good life for as long as possible,
- building an aging plan,
- payment management systems designed to help individuals and their support network keep control of payments.
- using home equity to help support retirement, and
- focusing on planning before there is an emergency.
One of the big issues many people face is how to get support when it is needed. Making a change in response to an emergency usually offers little choice, whereas making a choice earlier often involves much more choice. When a choice is made in response to an emergency, what is immediately available is a critical issue. When a choice is made earlier, what is preferred gets much more consideration.
Helping Individuals Stay at Home Longer
This theme came up repeatedly in different sessions. Some of the ideas that were linked to this theme include:
- Most people say they prefer to stay at home versus moving to an institutional setting.
- Moving to a home that is less demanding to take care of, i.e., from a multi-story home with a lot of maintenance to a condo enables households to be independent for a longer time.
- Adapt housing to make it accessible.
- Technology can help.
- Building an aging plan is important and it will focus on where to live.
- Making long-term care insurance (and Medicaid) more flexible to support services that help people stay at home could help.
- Addressing Social Determinants of Health links to the choice of housing and what is provided.
- Some forms of senior housing help an individual to stay in their own home.
- An individual’s support network is a key issue, and it is linked to where they can safely and comfortably live.
Note that staying in one’s own home does not necessarily mean staying in the same home where one lived for a long period of time. My view is that what is best for someone depends a great deal on their situation. It is also very helpful to build a support network before it is needed so that there is less disruption when one needs the support.
Choosing a Neighborhood or Community That is Age Friendly and Supportive
Location is very important. There are a variety of different approaches to making neighborhoods or living locations more responsive to the needs of seniors. A home may be located in a neighborhood with easy access to many relevant services or it may be in a difficult location to navigate. Considerations include:
- Age friendly initiatives—an international movement focusing on access to food, health care and services, transportation, walkability, etc.
- Village to village networks—neighborhood organizations bringing together seniors in their own homes to help them connect and support each other.
- Senior centers and adult day care—local services for seniors that are accessed during the day. Senior centers offer a variety of activities and socialization. Adult day care offers activities, socialization and care, and is for people with significant limitations.
- Naturally occurring retirement communities—areas with a concentration of seniors who interact and bond in the same way as in a defined community. Could be a neighborhood, an apartment building, etc.
- Continuing care retirement communities (CCRCs)—senior housing offering a range of support within one community.
- Age 55 plus—housing communities to support the age 55 plus population with recreation, food service, gyms, etc., but probably not care.
My view: Senior housing may be a better choice for many people. It all depends on the situation. Independent living in senior housing (CCRC or otherwise) is your home. Note that there are many choices in some geographic areas and not many in others. Urban areas generally offer more choices and services than rural areas.
Housing Issues
I moderated a session that focused on housing and living environments. Housing can integrate with care and support and is an important factor in social determinants of health. Housing choice also determines location, which in turn defines access to transportation, food, medical care, long-term services and support, parks, friends, etc.
- Senior housing offers many options and is a good choice for some people.
- CCRCs provide multiple levels of care within an integrated environment.
- Options are good for higher economic level Americans, there are supports for people at the lowest economic level (but they are limited and have long waiting lists in many places), but people who are above the limit for supports can be in trouble. In general, middle market people have much more limited choices.
- In many communities new housing is focused increasingly on higher economic status. There is a national shortage of modestly priced and affordable housing—both for sale and rent. This is a problem for all generations. Zoning is a contributor to this.
- Most people say they do not want to leave their homes and that they want to age at home, but many also change homes.
- Housing is the largest cost for seniors and can be unaffordable due to rising rents, insurance, taxes, and maintenance costs. Housing is also the largest part of assets for some people. Households should not forget about diversification of assets.
- Barriers to staying in one’s home may be cost, stairs, difficulty of maintenance, other accessibility issues, changes in needs.
- Housing is related to access to transportation, friends and family, activities of interest, food, health care, climate, community centers, etc. It is linked to happiness.
- Many people move during retirement.
- Location is linked to a variety of things that are supportive or not—think about age friendly communities, village to village movement, naturally occurring retirement communities.
- Redlining has contributed to housing problems for some racial and ethnic groups.
- Many late in life issues—can be focused on whether to move and next steps, and also on making the existing step workable.
Climate Change
Several sessions focused on climate change and how it fits into longer life. The range of points covered included building climate change into mortality and other modeling, impact on investments, impact on health, and where to live. An article in the April 2023 Retirement Section newsletter discusses climate change, housing, and retirement. Some key points covered in that article include:
- Climate has both direct and secondary outcomes,
- climate affects decisions about where to live,
- some retirees have high percentage of retirement wealth in their house and may not be insured or well insured—they can lose everything as a result of a catastrophic climate event or other house destroying event,
- reminds us to consider diversification of assets,
- reminds us to be careful about insurance,
- climate events also affect safety of individuals at high ages with limitations.
International Comparisons
There were international comparisons throughout the meeting. There are differences in the speed of aging, life expectancies, expected rates of improvement, impact of climate change, and more. The U.S. is not doing well on life expectancy. At the Social Security session, there was an interesting presentation from Canada with specific international comparisons.
Dementia
The topic of dementia came up repeatedly, and it can be a major barrier to living well. Substantial dementia leads to a need for much greater support. One of the papers offered strategies to slow the onset of dementia.
Technology
The 2023 Living to 100 was combined with the SOA focus on elder tech, which previously had been covered in a separate meeting. There is a close relationship between technology and improving lives. Technology is an important factor enabling people to stay at home.
Technology can improve people’s lives, but it can be too difficult for many people to use. Technology was very important to help people connect during the pandemic. It enabled a wide variety of contacts and also enabled people to order online.
Technology is not all easy. People do not want to give up control or privacy. Cost and the learning curve can also be barriers to use of technology.
At the meeting, there was a focus on a variety of new products/services—but I did not understand the details of how they work and what they do. Some of the technology provides a directory of services/means to connect to various providers.
In my view, it is important not to push too far. We need to be realistic about what people will accept. I did not hear about strategies for dealing with technology in the event of decline but dementia and decline are very important. One of the challenges of technology for older individuals is how long will they be able to use them. Another challenge is lack of access to internet service in some rural areas.
Conclusions
The Living to 100 symposia, papers and presentations offer a wealth of information about late-in-life mortality trends and modeling, and about the implications of longer life. They bring together a variety of different perspectives, on technical and scientific issues, on human issues, and on business issues and opportunities related to aging. The discussions are multi-disciplinary and have over the years included areas of debate and areas of agreement. They have offered professionals the chance to expand their knowledge and think about new issues. These issues are very important to actuaries and other professionals who are developing and managing retirement programs. Thank you to the SOA for its leadership in this important endeavor.
Statements of fact and opinions expressed herein are those of the individual authors and are not necessarily those of the Society of Actuaries, the newsletter editors, or the respective authors’ employers.
Anna Rappaport, FSA, serves as chairperson of the Committee on Post-Retirement Needs and Risks. She can be reached at anna.rappaport@gmail.com.