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Behaviors

Education, 2018 Senior Report
Measure: College Graduate - Ages 65+, 2018 Senior Report

Why does this matter?

High educational attainment is important to the continuous development of a society. Those who earn a college degree have access to a wide variety of employment opportunities and are compensated more on average than those without a college degree.

College graduates tend to engage in healthier behaviors, which contribute positively to health outcomes such as better quality of life and longevity. College graduates are also more likely to participate in civic engagement activities like voting, community service and community organizing — behaviors associated with better health outcomes.

While older adults cannot change whether or not they received a college education during adulthood, education remains one of the greatest drivers of health inequities.

Source:
  • U.S. Census Bureau, American Community Survey, 2016


Clinical Care

Overuse - Mammography*, 2018 Senior Report
Source:
  • ,



Overuse - PSA Test*, 2018 Senior Report
Source:
  • ,


Outcomes

Cognitive Difficulty, 2018 Senior Report
Measure: Cognitive Difficulty - Seniors, 2018 Senior Report

Why does this matter?

Symptoms of cognitive difficulty that interfere with daily life, like dementia, are not a natural component of the aging process. Family, friends and other unpaid caregivers often bear the responsibility of providing daily assistance and emotional support to older adults with severe cognitive impairments such as Alzheimer's, the most common form of dementia. As the number of people ages 65 and older increases, the prevalence of Alzheimer’s disease is projected to reach 12.7 million in 2050.

The causes of cognitive impairment are not entirely understood, though in many cases it is believed to be caused by brain changes stemming from the early stages of Alzheimer’s disease, injury and stroke. Cognitive impairment can also be caused by treatable health issues like medication side effects, vitamin B12 deficiency and depression. While people of all ages can experience cognitive impairment, age is the greatest risk factor for Alzheimer’s. Modifiable risk factors include smoking, diabetes, obesity, hypertension, high cholesterol and physical, social and mental inactivity. 

Cognitive difficulty places a large burden on health care systems:

  • Older adults with cognitive impairment spend twice as many days hospitalized as older adults without it.
  • Medicare beneficiaries with dementia are more likely to have additional chronic diseases than beneficiaries without dementia.
  • The average total health care costs for Medicare beneficiaries ages 65 and older with dementia in 2020 were over 3 times higher than those of beneficiaries without dementia in the same age group.

The cost of caring for adults with severe cognitive impairment, including Alzheimer’s and other dementias, was estimated at $321 billion in 2022 and is projected to reach nearly $1 trillion by 2050.

Source:
  • U.S. Census Bureau, American Community Survey, 2016



Depression, 2018 Senior Report
Measure: Depression - Ages 65+, 2018 Senior Report

Why does this matter?

Depression is a common mood disorder that can negatively impact health. Risk factors for depression among older adults include loneliness, isolation, loss of loved ones, financial hardship, fear of death or dying, chronic health problems and a reduced sense of purpose brought on by major life changes such as retirement. Depression in older adults may also be a side effect of certain medications. If left untreated, depression may lead to:

Depression is associated with significant direct and indirect societal costs stemming from increased use of health care services, social services and medications, as well as unpaid caregiver costs, lost workplace and household productivity and possibly suicide-related costs. One study estimated that total inpatient and outpatient medical costs were 47% to 51% higher among older adults with major depression than among those without depression — even after adjustment for chronic illness, as late-life depression frequently occurs in the context of chronic disease. 

Estimating the true prevalence of depression among older adults is challenging. For example, older adults may assume depression and depressive symptoms are an inevitable part of aging, while others are isolated with few people around to recognize depressive symptoms.

Source:
  • CDC, Behavioral Risk Factor Surveillance System, 2016



Multiple Chronic Conditions*, 2018 Senior Report
Measure: Multiple Chronic Conditions - Ages 65+, 2018 Senior Report

Why does this matter?

Chronic conditions are conditions that last more than a year, require ongoing medical attention or limit activities of daily living such as eating, bathing and mobility. Twenty-one chronic conditions are included in this measure. Included are physical diseases such as diabetes, heart disease, asthma and arthritis, as well as behavioral conditions such as substance use disorders, depression and dementia. 

Adults with multiple chronic conditions represent one of the highest-need segments of the population, as each chronic condition may require medication and monitoring. Around 85.6% of older adults have one or more chronic condition. As the number of chronic conditions an individual has increases, the risks of the following outcomes also increase: 

  • Physical, social and cognitive limitations, including subjective cognitive decline
  • Unnecessary hospitalizations such as emergency department visits, inpatient stays, prescription medication use and outpatient visits.
  • Adverse drug events.
  • Mortality.

Furthermore, people with certain medical conditions are at increased risk of severe illness from COVID-19 including cancer, chronic kidney disease, chronic obstructive pulmonary disease, heart disease and diabetes. Asthma, hypertension, HIV and dementia may increase the risk of severe illness from COVID-19.

The economic burden from multiple chronic conditions is substantial. In 2018, Medicare beneficiaries with four or more chronic conditions made up 40% of the population but accounted for 78% of total Medicare spending. Among Medicare beneficiaries ages 65 and older, the per capita Medicare spending in 2018 for those with one or no chronic conditions was $1,956 compared with $5,663 for those with two to three conditions, $11,028 for those with four to five conditions and $31,285 for those with six or more conditions.

Source:
  • U.S. HHS, Centers for Medicare & Medicaid Services, Research, Statistics, Data and Systems, 2015



Suicide, 2018 Senior Report
Source:
  • CDC WONDER, Multiple Cause of Death Files, 2014-2016



Poor Mental Health Days, 2018 Senior Report
Source:
  • CDC, Behavioral Risk Factor Surveillance System, 2016



Risk of Social Isolation, 2018 Senior Report
Measure: Risk of Social Isolation - Ages 65+, 2018 Senior Report

Why does this matter?

Approximately 43% of older people report feeling some degree of loneliness. Life events such as retirement, loss of loved ones and age-related physical and mental decline can make it difficult for older adults to maintain social connectedness. Socially isolated older adults may not benefit from the buffering effects of social support when experiencing stressful life events common to aging. Strong social networks have been shown to improve the management of chronic illness and physical and cognitive health

While there are many definitions of social isolation and varying ways to measure it, social isolation is generally described as the absence of meaningful social relationships. Social isolation differs from loneliness in that loneliness is the feeling of lacking meaningful social relationships, while social isolation addresses the objective lack of social relationships. An individual can be socially isolated and not lonely, or feel lonely and not be socially isolated. In the United States, social isolation affects around 24% of older adults ages 65 and older.

Social isolation can complicate health care and negatively impact physical health and mental well-being. It is associated with lower use of health care, increased risk of mortality and other negative health outcomes such as dementia and coronary heart disease or stroke. Social isolation results in an estimated $6.7 billion in annual Medicare spending.

Source:
  • U.S. Census Bureau, American Community Survey, 2012-2016


*The data appearing in this edition are the same that appeared in the 2017 edition. A data update was not available at the time of this publication.

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