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ICU Use

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


Measure: ICU Use , 2016 Senior Report
Source:
  • The Dartmouth Atlas of Health Care, 2013



Hip Fracture

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


Measure: Hip Fractures, 2016 Senior Report
Source:
  • The Dartmouth Atlas of Health Care, 2013



Falls

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


Measure: Falls - Ages 65+, 2016 Senior Report
Measure: Falls - Ages 65+, 2016 Senior Report

Why does this matter?

Falls among older adults can lead to serious injuries such as hip fractures and traumatic brain injuries. Other potential consequences of falls include restricted activity, loss of independence and premature death. The fatality rate from falls has been increasing, particularly among those ages 85 and older. As the older adult population grows and lives longer, the number of falls is expected to increase.

Contributing factors for falls — and related injuries such as hip fractures — include poor balance, poor vision, certain medications, alcohol consumption, physical inactivity, osteoporosis, physical disabilities and general frailty.

Falls among older adults result in substantial medical costs. In 2015, the estimated medical costs attributable to fatal and nonfatal falls were approximately $50 billion. The average direct cost of fall injuries is $9,780 per non-fatal fall and $26,340 per fatal fall.

Source:
  • CDC, Behavioral Risk Factor Surveillance System, 2014



Health Status

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


Measure: High Health Status - Ages 65+, 2016 Senior Report
Measure: High Health Status - Ages 65+, 2016 Senior Report

Why does this matter?

Self-reported health status is a measure of how individuals perceive their health. It is a subjective measure of health-related quality of life and is not limited to specific health conditions or outcomes. Instead, it is informed by life experiences, the health of others in one’s life, support from family and friends and other factors affecting well-being. Health status is used to track the health of a population over time and is an independent predictor of mortality. The association between health status and mortality makes this measure a good predictor of future mortality rates and future use of health care. Among adults ages 65 and older, self-reported health status is a good predictor of both short- and long-term mortality.

Source:
  • CDC, Behavioral Risk Factor Surveillance System, 2014



Able-Bodied

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


Measure: Able-bodied, 2016 Senior Report
Measure: Able-bodied, 2016 Senior Report

Why does this matter?

Older adults who are able-bodied are more likely to engage in physical activity and maintain social connectedness than those with disabilities. Compared with able-bodied older adults, those living with disabilities are more likely to smoke and have higher prevalences of obesity, heart disease and diabetes. In addition, older adults with cognitive disabilities such as Alzheimer’s or other forms of dementia are hospitalized twice as often as older adults without cognitive impairment.

In 2019, roughly one-quarter of adults ages 65-74 and nearly half of adults ages 75 and older reported having a disability, including cognitive, visual, auditory, ambulatory, self-care and independent living difficulties.

Source:
  • U.S. Census Bureau, American Community Survey, 2014



Premature Death

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


Measure: Early Death - Ages 65-74, 2016 Senior Report
Measure: Early Death - Ages 65-74, 2016 Senior Report

Why does this matter?

In 2020, life expectancy at age 65 was 18.5 years and yet many older adults do not live to see their 75th birthday. According to the CDC WONDER Online Database, 674,507 adults ages 65-74 died in 2020 and the death rate among adults ages 65-74 increased 17% from 1,764.6 to 2,072.3 deaths per 100,000 between 2019 and 2020.

The leading causes of death in the United States in 2020 were heart disease, cancer, COVID-19, unintentional injuries, stroke, chronic lower respiratory diseases and Alzheimer’s disease, according to the National Center for Health Statistics. Research estimates that 48% of all deaths are due to behavioral and other preventable causes. 

In addition to physiological and behavioral factors, social factors contribute to mortality risk. Based on data from 2010, poverty, low social support, living in areas with high poverty, income inequality and racial segregation were associated with increased risk of death in adults ages 65 and older. Additionally, social isolation increases the risk of premature death.

Source:
  • CDC WONDER, Multiple Cause of Death Files, 2014



Teeth Extractions

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


Measure: Teeth Extractions - Ages 65+, 2016 Senior Report
Measure: Teeth Extractions - Ages 65+, 2016 Senior Report

Why does this matter?

Complete tooth loss, also known as edentulism, is described as the “ultimate marker of disease burden for oral health.” The most common causes of complete tooth loss are tooth decay and gum disease. 

Having all or some permanent teeth missing is associated with an increased risk of disability, mortality and reduced daily function and quality of life, as well as multiple chronic conditions such as:

Missing teeth or having dentures can impair one’s ability to eat and speak and is associated with poor nutrition. Because dentures are less efficient for chewing than natural teeth, people using dentures tend to eat softer foods that are easy to chew and therefore consume fewer fruits and vegetables. Studies find that having an oral health issue that impacts daily life is associated with loneliness among older adults. 

Average annual dental expenditures are highest among adults ages 65 years and older, costing $767 per patient in this age group in 2011.

Source:
  • CDC, Behavioral Risk Factor Surveillance System, 2014



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


Measure: Frequent Mental Distress - Ages 65+, 2016 Senior Report
Measure: Frequent Mental Distress - Ages 65+, 2016 Senior Report

Why does this matter?

Frequent mental distress is an indicator of health-related quality of life and the burden of mental illness in a population. Frequent mental distress is characterized by 14 or more days of self-reported poor mental health in the past month. The cutoff point of 14 or more days is used because a strong relationship has been demonstrated between the 14-day minimum period and clinically diagnosed mental disorders, such as depression and anxiety. This measure aims to capture the population experiencing persistent and likely severe mental health issues.

Frequent mental distress is associated with health conditions and risk factors for poor health, including diabetes, hypertension, smoking, obesity, physical inactivity and insufficient sleep.

Source:
  • CDC, Behavioral Risk Factor Surveillance System, 2014





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