Life Expectancy Issues in Life Care Planning

The present paper is a review of life expectancy and life expectancy determination in forensic applications, including life care planning. Part One discusses basic aspects of life expectancy determination and five current approaches to the challenge. Part Two begins with general considerations regarding modification of the standard population life table for individual comorbidities and other influences on mortality, and then provides a stepwise analysis of life expectancy determination by this method, including selection of the baseline life table, identification of relevant medical comorbidities and other conditions, quantification of mortality effects of those factors with information from the medical literature, combination of mortality indices to generate adjusted mortality rates, and construction of a new, modified life table reflecting the effects of mortality influences. Part Three reviews potential future developments in life expectancy determination, and Part Four furnishes a summary. Appendices provide support for the text. This article addresses some of the strengths, weaknesses, and controversies in current practice of life expectancy determination, with the goal of furthering understanding and application of the science (and art) involved in achieving the most scientifically-accurate and valid results in life care planning. Specific aspects discussed include a) selection of the baseline life table; b) identification of relevant influences for the individual under scrutiny, including the multiplicity of elements, both positive and negative; the effects of socioeconomic factors, functional status, and medical care; and potential sources of information; c) accurate quantification of influences, encompassing the proper use of mortality indices; 1. d) combination of baseline mortality rates and comorbidity effects, including overlap in mortality effects of relevant conditions; “double-dipping” by use of standard life tables; and adjustment for secular trends in mortality; and e) generation of a modified life table and adjusted life expectancy. The article ends with a brief discussion of possible future advances in the science and practice of life expectancy determination.