Executive SummarySenior Report SpotlightIntroductionFindingsOverviewState RankingsSuccessesChallengesDisparities in Rural HealthCore MeasuresBehaviorsCommunity & EnvironmentPolicyClinical CareOutcomesSupplemental MeasuresState SummariesAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingUnited StatesAppendixCore Measures TableSupplemental Measures TableThe Team
- In the past year, food insecurity decreased 7 percent from 15.8 percent to 14.7 percent of adults aged 60 and older.
- Since the 2016 edition, dental visits increased 2 percent from 65.7 percent to 66.9 percent of adults aged 65 and older.
- Since the 2014 edition, teeth extractions decreased 10 percent from 16.1 percent to 14.5 percent of adults aged 65 and older.
- Since the 2013 edition, the number of home health care workers per 1,000 adults aged 75+ has increased 19.7 percent from 93.8 to 112.3 workers per 1,000.
- In the past year, four- or five-star rated nursing home beds increased 12 percent from 42.4 percent to 47.4 percent of certified nursing home beds.
- In the past year, hip fractures decreased 2 percent from 5.8 to 5.7 hospitalizations per 1,000 Medicare enrollees.
Food Insecurity Decreases
In the past year, the percentage of adults aged 60 and older who faced the threat of hunger in the past 12 months decreased 7 percent from 15.8 percent to 14.7 percent. Until this year, food insecurity had been increasing steadily since the first America’s Health Rankings Senior Report in 2013.
In the past year, four states decreased by three percentage points or more (Figure 10):
- Arkansas from 24.9 to 19.6 percent
- Missouri from 16.6 to 12.9 percent
- Colorado from 13.7 to 10.2 percent
- Vermont from 15.4 to 12.3 percent
Three states increased by three percentage points or more:
- New Mexico from 10.8 to 18.0 percent
- Alaska from 9.7 to 13.5 percent
- West Virginia from 15.2 to 18.5 percent
The percentage of older adults facing the threat of hunger varies widely depending on where they live (Figure 11). Food insecurity is fourfold higher in Mississippi (24.3 percent) than in North Dakota (6.1 percent), and North Dakota’s food insecurity is 1.5 times lower than the No. 2 ranked state, Wyoming (9.1 percent). Along with Mississippi, food insecurity among adults aged 60 and older is greater than 20 percent in Louisiana (23.4 percent) and North Carolina (20.7 percent).
Oral Health Improving, Large Disparities Exist
Data show national improvements in dental visits and teeth extractions, but wide gaps exist depending on location, socioeconomic factors and race/ethnicity.
Since the 2016 edition, the percentage of adults aged 65 and older who reported visiting a dental health professional in the previous 12 months significantly increased 2 percent from 65.7 percent to 66.9 percent.
Since the 2014 edition, the percentage of adults aged 65 and older who reported having had all teeth removed due to decay or gum disease decreased 10 percent from 16.1 percent to 14.5 percent. In the past year, the prevalence of teeth extractions decreased 3 percent.
Teeth extractions have decreased significantly since the 2014 edition in nine states, with four states decreasing by five percentage points or more (Figure 12):
- Louisiana from 28.7 to 20.5 percent
- Maine from 22.1 to 15.2 percent
- Missouri from 24.9 to 18.3 percent
- Alabama from 23.6 to 18.4 percent
Disparities in Dental Visits
Whether seniors reported a dental visit in the past year varies by race/ethnicity, urbanicity, education and income. The percentage of seniors who reported a dental visit in the past year is significantly higher among:
- Asian (74.1 percent) and white seniors (69.6 percent) compared with black (54.1 percent), Hispanic (54.6 percent), American Indian/Alaskan Native (54.1 percent) and multiracial (52.9 percent) seniors
- Seniors living in suburban (69.5 percent) and urban (69.3 percent) communities compared with seniors living in rural (60.6 percent) communities (see Disparities in Rural Health)
- Seniors with a college degree (84.8 percent) and seniors with $75,000 or more in annual household income (87.4 percent) than seniors with less than a high school education (41.5 percent) and seniors with less than $25,000/year in household income (47.0 percent)
Disparities in Teeth Extractions
Whether seniors reported having had all of their teeth removed depends largely on where they live as well as their education and income. In West Virginia, 30.4 percent of seniors have had all of their teeth removed — 5.4 times higher than the 5.6 percent of seniors in Hawaii (Figure 13). Along with West Virginia, full-mouth teeth extractions are greater than 20 percent in Mississippi (26.1 percent), Arkansas (22.9 percent), Kentucky (22.0 percent), Tennessee (21.6 percent), Oklahoma (21.4 percent) and Louisiana (20.5 percent). Teeth extractions among seniors in Hawaii are 1.7 times lower than in California, the state with the second-lowest prevalence at 9.4 percent.
Teeth extraction prevalence is significantly higher among:
- Rural (19.9 percent) seniors compared with suburban (13.7 percent) and urban (13.6 percent) seniors (see Disparities in Rural Health)
- Seniors with less than a high school education (31.4 percent) and seniors with less than $25,000/year in household income (25.2 percent) than with seniors with a college degree (3.7 percent) and seniors with $75,000 or more in annual household income (3.8 percent)
The lowest education and income groups among seniors have a prevalence of teeth extractions more than sixfold higher than in the highest education and income groups.
Number of Home Health Care Workers Rising
Since the 2013 edition, the number of personal care and home health workers per 1,000 adults aged 75 and older increased 20 percent from 93.8 to 112.3 workers.
In Massachusetts, home health care workers increased by 65.3 workers per 1,000 adults aged 75 and older since the 2013 edition (Figure 14). In New York and North Dakota, the rate increased by more than 50 workers per 1,000 during this same period. Since the 2013 edition, home health care workers decreased by 25 or more workers per 1,000 in North Carolina and Alaska.
In the past year, home health care workers increased by 10 or more workers per 1,000 adults aged 75 and older in six states (Figure 15):
- Massachusetts from 120.6 to 150.0
- North Dakota from 105.7 to 124.9
- New Mexico from 211.2 to 229.7
- New Hampshire from 84.2 to 94.7
- Missouri from 116.9 to 127.2
- Pennsylvania from 127.4 to 137.4
Four states decreased by 10 or more workers per 1,000 adults aged 75 and older since the 2017 edition:
- West Virginia from 122.5 to 104.3
- Alaska from 278.8 to 264.2
- Vermont from 172.3 to 161.8
- Minnesota from 268.3 to 257.9
The number of home health care workers differs widely by state (Figure 16). This number is 9.5 times higher in Alaska (264.2 workers per 1,000 adults aged 75 and older) than in Florida (27.9 workers per 1,000). The District of Columbia has the highest rate at 308.8. Along with Alaska and the District of Columbia, Minnesota (257.9 workers per 1,000), New York (251.3 workers per 1,000) and New Mexico (229.7 workers per 1,000) have more than 200 workers per 1,000 adults aged 75 and older. Florida (27.9 workers per 1,000) has had slightly more than half the number of home health care workers than the state with the second lowest rate, South Dakota (54.5 workers per 1,000).
Nursing Home Quality & Hip Fracture Hospitalization Improving
Nursing Home Quality
In the past year, the percentage of certified nursing home beds rated four- or five-stars over a three-month period increased 12 percent from 42.4 percent to 47.4 percent of certified nursing home beds. Alaska (from 43.9 percent to 64.8 percent), North Dakota (from 50.5 percent to 63.8 percent), West Virginia (from 25.8 percent to 37.2 percent) and Rhode Island (from 54.0 percent to 65.2 percent) all improved by 10 percentage points or more since the 2017 edition (Figure 17).
Hip Fracture Hospitalizations
The number of hospitalizations for hip fracture per 1,000 Medicare enrollees aged 65 and older continues to improve. In the past year, hip fractures decreased 2 percent from 5.8 to 5.7 hospitalizations per 1,000 Medicare enrollees.