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
Education fosters health; it enables people to learn about, create, and maintain a healthy lifestyle. Education is a strong predictor of life expectancy as well as overall well-being. Individuals with more education are more likely to have higher incomes, better health insurance coverage, and increased access to preventive health care. Increasing educational attainment has been shown to improve the health status of the population as a whole; each additional year of education is associated with an increase in health-promoting behaviors and decreased mortality risk. Investments in early childhood education can positively influence long-term health and reduce health care expenditures.
Data source: American Community Survey, 2014 For details: www.americashealthrankings.org/ALL/education_sr
Overuse — Mammography
Mammography screening has been widely accepted as an important part of breast cancer detection and mortality reduction, but professional opinions are changing in light of evidence that benefits don’t always outweigh the harms for women at average risk. Despite increased breast cancer risk with advancing age, the US Preventive Services Task Force does not recommend for or against mammography screening in women aged 75 years and older. The predominant risk of mammography screening in women aged 75 and older is over diagnosis. For frail elderly women who have cognitive or functional impairments, over diagnosis and the resulting overtreatment can be especially burdensome, leading to psychological harms and costly follow-up.
Data source: The Dartmouth Atlas of Healthcare, 2012 For details: www.americashealthrankings.org/ALL/ mammography_sr
Overuse — PSA Test
Age is the strongest risk factor for the development of prostate cancer. Men aged 75 years and older account for 70% of deaths due to prostate cancer. Randomized controlled trials of prostate cancer screening and treatment have not shown a significant reduction in prostate cancer mortality among men older than 70. No organizations currently endorse routine prostate cancer screening for men at average risk due to concerns about the high rate of over diagnosis and potential for serious side effects associated with treatment. The US Preventive Services Task Force recommends against prostate-specific antigen (PSA) screening in all age groups stating the benefits do not outweigh the harms to men in the general US population.
Data source: The Dartmouth Atlas of Healthcare, 2012 For details: www.americashealthrankings.org/ALL/ PSA_test_sr
Multiple Chronic Conditions
Chronic conditions negatively impact daily functioning and contribute to increased mortality risk. The prevalence of multiple chronic conditions (MCC) among older adults is much higher than the prevalence in the general population. Adults aged 65 and older with three or more chronic conditions, when compared with those with none, spend an additional $35,000 on medical care over a lifetime and their lives are 5.3 years shorter on average. Many common chronic conditions are largely preventable. Tobacco use, poor diet, insufficient exercise, and alcohol consumption are modifiable behaviors that contribute significantly to multiple chronic conditions.
Data source: Centers for Medicare & Medicaid Services, 2014 For details: www.americashealthrankings.org/ALL/multiple_chronic_conditions_sr
More than 16 million US individuals have cognitive impairment (CI). Mild CI, marked by memory decline, affects nearly 25% of seniors living at home. Alzheimer’s disease, a severe form of CI, affects nearly 5.1 million adults nationwide. Age is the greatest risk factor for CI, and with the growing baby boomer population, demand is soaring for support services related to cognitive issues. Cognitive impairment carries a large cost as individuals with CI have three times as many hospitalizations as those without. Evidence suggests that keeping intellectually engaged and physically active promote healthy cognitive aging.
Data source: American Community Survey, 2014 For details: www.americashealthrankings.org/ALL/cognition_sr
Depression affects an individual’s quality of life and can impair physical, mental, and social functioning. Risk factors include lack of social support, chronic disease, pain, and loss of a loved one. Estimates of the prevalence of depression among seniors vary widely, with higher rates found among those living in long-term care facilities. Seniors with even mild to moderate depression are less likely to seek mental health care and often experience poorer health outcomes than their nondepressed peers. Compared with those who seek treatment, these individuals may use more medications, incur higher outpatient charges, and stay longer in the hospital.
Data source: Behavioral Risk Factor Surveillance System, 2014 For details: www.americashealthrankings.org/ALL/depression_sr
Suicide is the 10th-leading cause of death in the United States. Risk factors in older adults include psychiatric illness, substance abuse, physical illness and disability, cognitive decline, and social isolation. In 2014 the general-population suicide rate was 13.4 deaths per 100,000. That same year, the rate was 15.7 deaths per 100,000 adults aged 65 to 74; 17.7 deaths per 100,000 adults aged 75 to 84; and 19.3 deaths per 100,000 adults aged 85 and older. In 2010, suicide among those 65 and older had an estimated lifetime cost of $1.1 billion.
Data source: National Center for Health Statistics, 2012-2014 For details: www.americashealthrankings.org/ALL/Suicide_sr