IntroductionThe Health of Tomorrow’s SeniorsFindingsTop and Bottom StatesChange in RankFuture PerspectiveCore MeasuresBehaviorsCommunity & Environment: MacroPolicyClinical CareOutcomesSupplemental MeasuresState SummariesAlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDistrict of ColumbiaAppendixDescription of Core MeasuresDescription of Supplemental MeasuresMethodology2016 Model Development2016 Senior Health Advisory GroupThe TeamExecutive SummaryConclusionAmerica’s Health Rankings® Expansion
Overusing the critical care system often goes against the wishes of dying patients and is costly. Research indicates many patients receive care they would not choose in their final days. While not correlated with better outcomes or longer life, intensive care unit (ICU) use is correlated with availability of ICU beds; this could indicate a supply-induced demand. Areas with higher ICU use are high-use areas in other aspects as well, including physician visits and hospitalizations. End-of-life care accounts for a fourth of all Medicare spending, which means that minimizing ICU use offers a chance for meaningful cost savings and better adherence to patient preferences.
Data source: The Dartmouth Atlas of Health Care, 2013 For details: www.americashealthrankings.org/ALL/icu _sr
More than 250,000 adults aged 65 and older are hospitalized each year for hip fractures. Besides hospitalization, hip fractures often lead to surgery and extensive rehabilitation. A hip fracture may signal the end of independence; one in four previously independent seniors remain in a long-term care facility one year after injury. Osteoporosis, physical inactivity, poor vision, certain medications, and general frailty contribute to falls and hip fractures. Common prevention interventions include nutrition supplements, medications, and exercise regimens to maintain mobility, balance, and strength. The estimated lifetime cost of a hip fracture is $81,300, with approximately 44% of that associated with nursing-facility expenses.
Data source: The Dartmouth Atlas of Health Care, 2013 For details: www.americashealthrankings.org/ALL/hip_fractures_sr
Annually, more than 12 million adults aged 65 and older fall. One out of five falls causes serious damage such as head injury or broken bones including costly hip fractures that severely limit mobility for long periods of time. Falls and their resulting injuries may contribute to social isolation and even cause premature death. The risk of falls and injury increases with age, making falls particularly problematic for persons older than age 75. Medicare pays for 78% of fall-related medical expenses which totaled approximately $34 billion in 2013, with each fall costing an average of $9,000 to $13,000.
Data source: Behavioral Risk Factor Surveillance System, 2014 For details: www.americashealthrankings.org/ALL/falls_sr
Self-reported health status is an indicator of the population’s self-perceived health and is an independent predictor of mortality. It is a subjective measure that is not limited to certain health conditions or outcomes. It has been validated as a useful indicator of health for a variety of populations and allows for useful comparisons across different populations. It is influenced by life experience, the health of loved ones, social support, and similar factors that affect overall well-being.
Data source: Behavioral Risk Factor Surveillance System, 2014 For details: www.americashealthrankings.org/ALL/health_status_sr
Nearly 39% of adults aged 65 and older have one or more disabilities. Chronic diseases such as diabetes and congestive heart failure are often precursors to disability. Arthritis is the most common cause of disability in older adults, accounting for more than 20% of cases. Seniors with a disability are more likely to require hospitalization and long-term care than those without a disability, and medical care costs are three times higher for disabled than nondisabled seniors. While some disabilities are largely unavoidable, the extent to which they interfere with a person’s life can be mitigated through exercise, special equipment or aids, and community support programs.
Data source: American Community Survey, 2014 For details: www.americashealthrankings.org/ALL/able_bodied_sr
Premature death is a mortality measure reflecting the rate of death for seniors under age 75 and how those deaths burden the population. According to 2013 mortality data, heart disease, cancer, chronic lower respiratory disease, cerebrovascular disease, and Alzheimer’s disease are the United States’ top five causes of death among adults aged 65 to 74. Many of these premature deaths are preventable through lifestyle changes. Evidence-based smoking interventions can greatly decrease premature deaths attributable to cancer. Heart disease is tied to modifiable risk factors including obesity, diabetes, and physical inactivity. Intervention strategies that encourage healthy lifestyles and preventive care can be effective in decreasing premature death in seniors.
Data source: CDC, National Center for Health Statistics, 2014 For details: www.americashealthrankings.org/ALL/premature_death_sr
Untreated dental caries and periodontal disease are the most common causes of teeth extractions, but other causes include trauma, crowding, and disease. Preventable risk factors include poor diet and tobacco use. Older adults without natural teeth are at increased risk of heart disease and stroke. Absence of natural teeth affects nutrition; dentures are less efficient for chewing than are natural teeth, so people using dentures may choose foods softer than fruits and vegetables. The percentage of older adults without natural teeth is decreasing, likely due to improved access to oral health care, public water-fluoridation programs, and reduced smoking rates.
Data source: Behavioral Risk Factor Surveillance System, 2014 For details: www.americashealthrankings.org/ALL/teeth_extractions_sr
Frequent Mental Distress
Frequent Mental Distress (FMD) emphasizes the burden of chronic and likely severe mental health issues and is an indicator of health-related quality of life, perceived mental distress, and the burden of mental illness on seniors. Older adults with FMD are more likely to have frequent insufficient sleep and are at increased risk of obesity. Depressive symptoms that contribute to frequent mental distress closely relate to impaired cognitive functioning and may reduce seniors’ likelihood of utilizing treatment for their mental health issues. Chronic and severe mental health episodes are treatable and may be preventable through simple, cost-effective and time-efficient screening procedures, early interventions, and quality care.
Data source: Behavioral Risk Factor Surveillance System, 2014 For details: www.americashealthrankings.org/ALL/mental_health_days_sr