Missing 90 year olds
An ILC-UK debate supported by Partnership as part of the Population
Patterns Series
Wednesday 5th March 2014
This event is kindly supported by Partnership
#missing90s #populationpatterns
Baroness Sally Greengross
Chief ExecutiveILC-UK
This event is kindly supported by Partnership
#missing90s #populationpatterns
Richard Willets
Director of LongevityPartnership
This event is kindly supported by Partnership
#missing90s #populationpatterns
‘Missing’ 90 year oldsAn Introduction
Richard Willets
International Longevity Centre – 5 March 2014
Introduction
April 8, 2023
5
• Source: Wall Street Journal
• Population estimates for England & Wales based on the 2011 Census were published in July 2012
• Prior to this our population estimates were based on the 2001 Census with adjustments made to allow for subsequent migration and deaths
Impact of the 2011 Census on population estimates
April 8, 2023
6
• Source: own calculations using ONS data
Revision to England & Wales population estimates for mid-year 2011 following 2011 Census, by ageRevision to England & Wales population estimates for mid-year 2011 following 2011 Census, by age
40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99 100+
-20%
-15%
-10%
-5%
0%
5% Females
Impact of the 2011 Census on population estimates
April 8, 2023
7
• Source: own calculations using ONS data
Revision to England & Wales population estimates for mid-year 2011 following 2011 Census, by ageRevision to England & Wales population estimates for mid-year 2011 following 2011 Census, by age
40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99 100+
-20%
-15%
-10%
-5%
0%
5% FemalesMales
Approx 30,000 fewer individuals
More significant revisions in the US
April 8, 2023
8
• Source: Wall Street Journal
• In 2004 the US Census Bureau projected there would be:-• 114,000 Americans aged 100 plus in 2010• 1.1 million centenarians in 2050
• Following the 2010 Census, figures revised to:-• 53,364 Americans aged 100 plus in 2010• 0.59 million centenarians in 2050
Impact on apparent mortality improvement rates
April 8, 2023
9
• Source: own calculations using ONS data
Average annual rate of mortality improvement, males in England & Wales, 2001-2011, by age group, before and after publication of the 2011 Census results
Average annual rate of mortality improvement, males in England & Wales, 2001-2011, by age group, before and after publication of the 2011 Census results
80-84 85-89 90-94 95-990.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0% 2010-based
Impact on apparent mortality improvement rates
April 8, 2023
10
• Source: own calculations using ONS data
Average annual rate of mortality improvement, males in England & Wales, 2001-2011, by age group, before and after publication of the 2011 Census results
Average annual rate of mortality improvement, males in England & Wales, 2001-2011, by age group, before and after publication of the 2011 Census results
80-84 85-89 90-94 95-990.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0% 2010-based
revised
Impact on apparent mortality improvement rates
April 8, 2023
11
• Source: own calculations using ONS data
Average annual rate of mortality improvement, males in England & Wales, 2001-2011, by age group, before and after publication of the 2011 Census results
Average annual rate of mortality improvement, males in England & Wales, 2001-2011, by age group, before and after publication of the 2011 Census results
80-84 85-89 90-94 95-990.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0% 2010-based
revised
2001 to 2013
Impact on projected mortality rates
April 8, 2023
12
• Source: own calculations using ONS data
Average mortality rate for males in the 90-99 age range, England & Wales, actual and projected figures
Average mortality rate for males in the 90-99 age range, England & Wales, actual and projected figures
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2022
2024
2026
2028
2030
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
0.40Actual
Simple extrapo-lation
Impact on projected mortality rates
April 8, 2023
13
• Source: own calculations using ONS data
Average mortality rate for males in the 90-99 age range, England & Wales, actual and projected figures
Average mortality rate for males in the 90-99 age range, England & Wales, actual and projected figures
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2022
2024
2026
2028
2030
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
0.40ActualSimple extrapo-lation2010-based pro-jection
+50%
Consequences
April 8, 2023
14
• *Source: ONS • **Source: own calculation
• Greater appreciation of the challenges in producing accurate data for the highest age groups
• Small but material reductions in the projected lifespans of pensioners/annuitants
• Significant revisions in the projected number of elderly individuals
The ONS publication “What are the chances of reaching age 100?” published in Spring 2012 projected that 9.5% (37,000) of men aged 65 in the UK in 2012 would reach age
100*
Arguably, a more realistic survival probability could be 5-6%**
The equivalent publication in 2013 had a principal projection of 8% (31,000) of men aged 65 in 2013 reaching age 100*
• Raises more fundamental questions (e.g. why is rate of mortality improvement so much lower at high ages?)
Thank you
April 8, 2023
15
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Dave Grimshaw FIA
PartnerBarnett Waddingham LLP
This event is kindly supported by Partnership
#missing90s #populationpatterns
UK Actuarial Advisory Firm of the Year
Understanding mortality at 90+ years
ILC-UK Population Patterns Series event: ‘Missing 90 year olds’
Dave Grimshaw, Partner, Barnett Waddingham LLP
05 March 2014
BACKGROUND
18
Why are actuaries interested in mortality?
19
Where a payment is contingent on survival• Valuing liabilities for pension schemes• Pricing and valuing insurance products:
• Where a benefit is payable on death, and• Where a benefit is payable throughout life
We are interested in current mortality and how it might change in future
Mortality rates and mortality improvements
Mortality rate Deaths ÷ Exposure• Example:
• Age 83 in 2005 9,227 ÷ 92,381 = 9.99%
• Age 83 in 2006 8,779 ÷ 89,958 = 9.76%
Mortality improvement• Percentage reduction in mortality rate compared to
the same age one year earlier• Example:
• Mortality reduction: 0.23%• Mortality improvement: 0.23% ÷ 9.99% = 2.3%
20
What data do actuaries use?
21
• Specific portfolio• Data for the (pension scheme or insurance company)
• Pooled studies• e.g. the CMI produces analyses of pension schemes and
various insurance products
• Population data
Why is population data useful?
22
Preference for similar data i.e. the specific group of pensioners or insured lives but…• Pension schemes can be small and heterogeneous• CMI pensioners dataset is approximately 24% of the
population for Males and only 8% for Females• Population data adds credibility, especially where
data is sparse (e.g. oldest or youngest ages)• Insurance/pensioner data may be unreliable• Mortality tends to converge at older ages• Mortality improvements need especially large
datasets
Unreliability of insured and pensioner data at older ages?
23
Comparison of observed experience with graduations
Source: CMI Working Paper 35 (for S1PML) and CMI Report 23 (for PCML00).
65 70 75 80 85 90 95100
105 65 70 75 80 85 90 95100
1051.00
10.00
S1PML PCML00
Low GateCrude RateHigh GateS1PMLPCML00
Age
Mo
rta
lity
Ra
te
(log
m)
Convergence of mortality rates at older ages?
24
Relative crude mortality rates by age band and socio-economic class for males in England and Wales, 1982-2005.
Source: BW calculations using data from ONS Longitudinal Study 1982-2005 classified by RGSC
40−44 45−49 50−54 55−59 60−64 65−69 70−74 75−79 80−84 85−89 90+0%
20%
40%
60%
80%
100%
120%
140%
160%
180%
200%
I - Professional
II - Managerial
IIIN - Skilled non-manual
IIIM - Skilled manual
IV - Partly skilled
V - Unskilled
All classes combined
Age band
% o
f m
ort
alit
y ra
te f
or
all c
lass
es c
om
bin
ed
UNDERSTANDING POPULATION MORTALITY AT AGES 90+
25
2011 Census and E&W population estimates
26
2011 Census count compared with roll-forward estimateSource: ONS supplemented by BW calculations for ages 90+; estimates as at mid-2011
0-4 5-9 10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90-94
95-99
100+
-20%
-15%
-10%
-5%
0%
5%
10%Males
Females
Age Band
Ch
an
ge
in p
op
ula
tion
est
ima
te (
%)
Population estimates for older ages between Censuses
27
• ONS use Census roll-forward method to estimate population at individual ages to age 89, plus a total for ages 90+
• Use Kannisto-Thatcher survivor ratio method to allocate 90+ total to individual ages
• Extinct cohort method• Reconstruct population working back along cohort’s path, starting
from last survivor and adding back deaths, assuming no migration
• Non-extinct cohorts• Estimate current population using survivor ratio
• Survivor ratio = Survivors ÷ deaths in cohort in last 5 years• Assume stability or predictability of survivor ratio across cohorts
• Then work back along cohort’s path as above
Population estimates for older ages between Censuses
28
• As ONS apply a constraint on the K-T method, the total 90+ estimates are determined by the roll-forward method
• These roll-forward estimates are highly sensitive at older ages to accuracy of initial estimate
• 1% error in estimates for ages 80-89 results in:• 4% error for females at ages 90-99 at next
census; and• 7% error for males at ages 90-99 at next census.
Population estimates for older ages – an alternative approach
29
• ONS use Kannisto-Thatcher method to allocate 90+ total to individual ages (but 90+ total based on roll-forward estimates)
• But can also apply K-T methodology without constraint to 90+ total
• Key assumptions:• Death registration data is accurate• No net migration• Survivor ratio is stable / predictable.
Alternative estimates compared with roll-forward estimate
30
Comparison of estimates of mid-2011 population for E&WSource: BW calculations using population estimates and death registrations data to 2011 published by ONS.
80-84 85-89 90-94 95-99 100+-25%
-20%
-15%
-10%
-5%
0%
2011 Census (M)
BW (M)
2011 Census (F)
BW (F)
Age Band
% r
ed
uct
ion
to th
e r
oll-
forw
ard
es-
tima
te fr
om
the
20
01
Ce
nsu
s
K-T estimate using 2012 deaths compared with roll-forward estimate
31
Comparison of estimates of female population for E&WSource: BW calculations using population estimates and death registrations data to 2012 published by ONS.
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000Females
ONS
Barnett Waddingham (K-T)
K-T estimate using 2012 deaths compared with roll-forward estimate
32
Comparison of estimates of male population for E&WSource: BW calculations using population estimates and death registrations data to 2012 published by ONS.
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
30,000
60,000
90,000
120,000
150,000Males
ONS
Barnett Waddingham (K-T)
Summary
33
• Census estimates at older ages appear reasonably accurate…• But some doubt regarding 2001 for males
• Inter-Censal estimates may become less reliable, as any inaccuracy in the previous Census is amplified in the current approach
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34
Angele Storey
Demographic Analysis UnitONS
This event is kindly supported by Partnership
#missing90s #populationpatterns
How accurate are official high age population estimates?
Angele Storey, Demographic Analysis Unit, Population Statistics Division, Office for National Statistics
Official high age estimates
• Annual mid-year population estimates by single year of age and sex up to age 89 and 90 and over population- component cohort method
• Life tables and population projections require population estimates at single year of age for the 90 and over population- Kannisto-Thatcher method (form of survivor ratio
methodology)
.
Kannisto -Thatcher method
• Age at death data is used to build profiles of the distribution of older people in back years
• Average of the last 5 years ‘age at death’ data for each cohort is used to produce an estimate of the number of survivors for the current year.
• KT estimates constrained to the official 90+ total in final stage of the method
• Back years are recalculated annually as more recent deaths data becomes available
19811983
19851987
19891991
19931995
19971999
20012003
20052007
20092011
75
80
85
90
95
100
105
Males Females
Sum of deaths
KT 90+ totals as percentage of official MYE 90+ totals
19811983
19851987
19891991
19931995
19971999
20012003
20052007
20092011
80
82
84
86
88
90
92
94
96
98
100
2012 based KT estimates 2001 based KT estimates 1991 based KT estimates
1991, 2001 and 2012 based KT 90+ totals as a percentage of official 90+ totals - Males
19811983
19851987
19891991
19931995
19971999
20012003
20052007
20092011
80
85
90
95
100
105
2012 based KT estimates 2001 based KT estimates 1991 based KT estimates
1991, 2001 and 2012 based KT 90+ totals as a percentage of official 90+ totals - Females
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 201270,000
80,000
90,000
100,000
110,000
120,000
130,000
90+ on Patient Register DWP 90+ claimants
Official 90+ MYE 90+ KT estimate (unconstrained)
Comparison of 90+ totals across data sources - Males
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012240,000
260,000
280,000
300,000
320,000
340,000
360,000
90+ on Patient Register DWP 90+ ClaimantsOfficial 90+ MYE 90+ KT estimate (unconstrained)
Comparison of 90+ totals across data sources - Females
Possible sources of error in data sources
• Census estimates:- D.o.b. exaggeration and mis-reporting- Proxy responses - Some incorrect recording of year of birth / processing issues
• Inter-censal estimates: (Annual Mid-Year Estimates)- Any errors in 90+ age group at Census are rolled forward - Any over-count in those in their 80s comprises a larger
proportion as these non-existent people are aged on
• Patient Register and DWP claimants - People not removed / time lag in removing?
- People not on registers
-
1) Deaths data is accurate and complete- No validation of d.o.b on death certificate- Occurrences recorded in the correct year but those not captured
at time are not added back- Registrations capture all deaths but not necessarily in correct year
2) No migration at oldest ages- Internal to E & W (around 2.1% of people aged 90+ in 2005)
- international migration – in and out flows too small to measure
KT method assumptions
2012 BASED MALES
KT estimates constrained to official 90+ total
KT estimates constrained to 92% of official 90+ total
KT estimates unconstrained
Life expectancy at age 0
79.2 79.2 79.1
Life expectancy at age 65
18.4 18.4 18.3
Life expectancy at age 90
4.0 3.8 3.5
What would be the impact of lower estimates of the very old on life expectancy?
2012 BASED FEMALES
KT estimates constrained to official 90+ total
KT estimates constrained to 95% of official 90+ total
KT estimates unconstrained
Life expectancy at age 0
82.9 82.8 82.7
Life expectancy at age 65
20.9 20.8 20.7
Life expectancy at age 90
4.7 4.5 4.1
What would be the impact of lower estimates of the very old on life expectancy?
Review of 90+ totals and age distributions
• Investigate effects of ‘tweaking the method’ - optimum survivor ratios; death registrations v. death occurrences; calendar year to mid-year
• Investigate effect of no allowance being made for improvements to the mortality rate in KT method
• Produce UK set of 90+ estimates on basis of combined constituent countries deaths data (to eliminate any internal migration factor)
• Assess optimum age to ‘join’ KT estimates to official 90+ estimates
Review of 90+ totals and age distributions cont….
• Investigate extent of inaccuracies in reporting of d.o.b. in the Census , - validate a sample of 90+ deaths by matching to birth
certificates
- use ONS LS to trace those aged 90 to 115 back thorough the 5 available Censuses
- quantify imputation rates at oldest ages
• Detailed investigation of comparative data sources- age distributions
• Discussion – Your ideas – what else could we do?
For further information…
For information or queries on…..
- population ageing, contact: [email protected]
- national life expectancy, contact: [email protected];
- sub-national life expectancy ,contact: [email protected]
- population projections ,contact: [email protected]
- 2011 Census, contact: [email protected]
David Sinclair
Assistant Director, Policy and CommunicationsILC-UK
This event is kindly supported by Partnership
#missing90s #populationpatterns
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
The oldest old
David Sinclair, International Longevity
Centre – UK @ilcuk @sinclairda
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Life is pretty tough. (frailty/isolation/health/income)
Dependency is not inevitable
Irrespective on the exact numbers. There will be more.
We don’t actually know a lot about the oldest old.
Today’s oldest old are not necessarily representative of tomorrows (genetics/environment/poor health = withdrawal from longitudinal studies)
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Life is not easy for the oldest old
Three quarters of the oldest old
suffer from limiting longstanding
illnesses, and one out of three
perceive themselves as being in
poor health. (Tomassini C, 2005)
“almost 50% of men and women
aged 80-84 report severe
limitations in activities” (IFS,
2010)
http://www.flickr.com/photos/pondspider/4170990903/sizes/m/in/
photostream/
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Falls
60% of interviewees aged over 90 had had a fall and that of these, 4 in five were unable to get up after at least one fall and almost a third had lain on the ground for an hour or more.
Call alarms were widely available but not used.(Fleming and Brayne, 2008; Cambridge City over 75-Cohor. BMJ)
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
And many find it difficult to do day to day tasks
Sixty per-cent of over 90s
report difficulties shopping for
groceries, almost a quarter
report difficulties making
telephone calls and 35% report
difficulties managing money.
(Sinclair, 2010/ELSA)
http://www.flickr.com/photos/pinkchocolate/3039589789/sizes/m/in/photostream/
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
A relatively high proportion live alone
Of those living in private households, four in ten very old men and seven out of ten very old women live alone. One out of five very old people live in communal establishments. (Tomassini C, 2005). http://www.flickr.com/photos/sbeebe/
5154169795/sizes/m/in/photostream/
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Living together is good for us
Those who moved from living alone to living as part of a couple (with no children) exhibited a 68% fall in the odds of becoming multiply excluded between 2002 and 2008 compared to those who stayed living alone;
Those who moved from being resident in a couple household to living alone were over three times more likely to become multiply excluded. For this age group (50+), becoming a widow is one of the most common reasons for starting to live alone.
http://www.flickr.com/
photos/anabadili/
2963913137/sizes/m/in/
photostream/
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
The oldest old remain the most excluded
Almost 38% of those aged 85 or older faced some kind of social exclusion, an encouraging decline of 10% from the 2002 levels
As people age, they are more likely to become more socially excluded than less
Almost two-fifths (38%) of those aged 85 and older were excluded from two or more domains of exclusion in 2008
http://www.flickr.com/photos/pinkchocolate/3039589789/sizes/m/in/photostream/
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Quality of Life falls with age
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Depression
“23% of those aged 85 and over had levels of depressive symptoms indicative of clinical relevance”
“Almost 13% of men and women aged 80 and over had high levels of depressive symptoms in 2008-09 but not in 2002-03” (IFS, 2010) ELSA http://www.flickr.com/photos/
junglearctic/3002442666/sizes/m/in/photostream/
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Most centenarians consult their GP
98% of centenarians and near centenarians consulted a GP and received prescription medicine during follow up. (Roughead, Kalisch et al, 2010)
http://www.flickr.com/photos/rwjensen/2288339230/sizes/m/in/photostream/
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Centenarians do use drugs heavily
A study of 602 centenarians in Italy found that a very high proportion of this age group were users of drugs.
5% no drugs. 13% one drug a day 16% took 2 drugs per day 65% took three drugs a day 5.5% more than 3 drugs a
day.
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Some evidence of longer hospital stays
Centenarians who had suffered from a hip fracture between 2000 and 2007 compared to a randomly selected control group of 50 hip fracture patients aged between 75 and 85. “the mean stay in acute orthopaedic wards for centenarians was 20.7 days and for the control group was 14.9 days”.
The longer acute hospital stay in the centenarian cohort would amount to a mean extra cost of £ 2511 per patient. (Verma et al)
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Dementia among centenarians
The prevalence of
dementia-free
survival past 100
years of age varied
between 0 and 50
percent.
http://www.flickr.com/photos/thousandshipz/4679235/sizes/m/in/photostream/
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Poverty is a very real challenge
There is evidence that the oldest old (aged 85 and over) are, as a group, at greater risk of poverty than younger older people (aged 65-85)
Up to 10% of the oldest old have total net wealth of £3,000 or less.
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Britons ageing quicker than their parents
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Dependency is not inevitable
Dependency is not inevitable and a ”considerable proportion of the centenarians maintain a good level of auto sufficiency for the basic performance of the everyday life”. (Antonini et al, 2008)
http://www.flickr.com/photos/driever/5525684658/sizes/m/in/photostream/
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Some of the oldest old become more active
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Prevention of ill health
Physical Activity
Smoking and alcohol consumption
Nutrition
Immunisation
A move to prevention is vital
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
We need to get housing right
1. Extra care housing is a home for life
2. Extra care translates into fewer falls
3. Extra care is associated with a lower uptake of inpatient hospital beds
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Many thanks
David Sinclair
Head of Policy and Research
International Longevity Centre
02073400440
Twitter: @ilcuk and @sinclairda
Andrew Latto
Deputy Director, State Pensions DirectorateDepartment for Work and Pensions
This event is kindly supported by Partnership
#missing90s #populationpatterns
Missing 90 year olds
An ILC-UK debate supported by Partnership as part of the Population
Patterns Series
Wednesday 5th March 2014
This event is kindly supported by Partnership
#missing90s #populationpatterns