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The measures and model for America’s Health Rankings® Senior Report were developed by a panel of experts in the field of senior health for the inaugural edition in 2013. The panel was charged with identifying the areas of health and well-being most pertinent to the older adult population and developing a model for assessing population health at a state level.
In March 2016, the panel convened by telephone and reviewed each measure included in the 2015 edition. Panelists recommended that the following items be explored:
  1. Home and Community Based Services (HCBS) waiver waitlists: Waitlists depend heavily on size of state HCBS program and state population, and some states don’t have waivers. This measure is difficult to rank at this time and will be revisited in future years.
  2. Out-of-pocket spending: This measure is lacking data at the state level. Consider exploring bankruptcy, medical impoverishment, and other equivalent measures.
  3. Overuse of clinical care: Consider adding prostate-specific antigen (PSA) testing among men aged 75 and older and mammography among women aged 75 and older.
  4. Wellness visits: Potential issues exist with the definition and data validity. Consider adding as a supplemental measure and explore other possible measures such as the Medicare benefit paid to primary care physicians who counsel seniors with obesity during a 15-minute weight loss visit.
  5. Social support, social isolation, medication adherence, and elder abuse: All areas lack comparable state-level data and will be revisited in future years.
  6. Transportation: Explore potential measures (e.g., lack of reimbursement).
  7. Diet and/or nutrition: Identify improved measure(s).
Changes implemented in 2016:
  • Replaced chronic drinking, a core behaviors measure, with excessive drinking—a combined chronic drinking and binge drinking measure (page 26).
  • Replaced poor mental health days, a core outcomes measure, with frequent mental distress (page 72).
  • Added clinical overuse—PSA among men aged 75 and older and clinical overuse—mammography among women aged 75 and older, supplemental clinical care measures, as proxies for overuse of clinical care services (pages 68–69).
  • The supplemental measure prescription drug plans with a gap is no longer available and was removed.
  • The American Community Survey discontinued 3-year estimates. The measures poverty and able-bodied, as well as the denominators for home-delivered meals, community support, and SNAP reach, are based on a single year of data in this edition.

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