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At a time when the use of support services for seniors is increasing, senior still face challenges – especially with mental health, unhealthy behaviors and not visiting a doctor when needed due to cost.

Depression is the percentage of adults aged 65 and older who report being told by a health professional they have a depressive disorder. Depression increased 19 percent in the past year from 13.4 to 16.0 percent, and 23 percent in the past six years from 13.0 percent (Figure 16). This year’s prevalence of 16.0 percent is the highest level reported in the history of America’s Health Rankings Senior Report. Depression among older adults may go undiagnosed or misdiagnosed, sometimes because seniors assume depression and depressive symptoms are an inevitable part of aging. Research shows that unrecognized or untreated depression can lead to decreased physical, cognitive and social functioning; increased suicide rate; and diminished health-related quality of life.
The prevalence of depression in Louisiana, the least healthy state for this measure, is 19.8 percent; the prevalence in the healthiest state, Hawaii, is 10.0 percent.
The 11 states with significant increases in the prevalence of depression among seniors are scattered across the U.S. (Figure 17). Depression among seniors in Texas increased 71 percent in the past year — the most of any state — from 11.0 percent to 18.8 percent (Figure 18). Other states with large increases in the past year include Indiana (66 percent), Idaho (54 percent) and North Dakota (43 percent).

Disparities in the prevalence of reported depression vary by gender (see Health Disparities by Gender), education and income level (Figure 19). Depression is highest among seniors at the lowest income level and lowest among seniors at the highest income level. The prevalence of depression is also higher among those with less than a high school education and some college, compared with high school and college graduates.
Table 7 displays depression alongside four other measures in the America’s Health Rankings Senior Report that studies show are related to depression. These include frequent mental distress, risk of social isolation, suicide and excessive drinking.
Depression among seniors is strongly associated with frequent mental distress, a measure that aims to capture the population experiencing persistent and likely severe mental health issues, and risk of social isolation, a composite measure of six risk factors for social isolation (poverty; living alone; being divorced, separated or widowed; having never married; disability; and independent living difficulty), at the state level. Four states (Alabama, Kentucky, Oklahoma and Louisiana) are in the bottom quintile for depression, frequent mental distress and risk of social isolation. Delaware and Colorado are in the top quintile for depression and risk of social isolation, while North Dakota, South Dakota and Alaska are in the top quintile for depression and frequent mental distress.
Though not significant, states with a higher prevalence of depression have a higher rate of suicide (positive correlation) and also have a lower prevalence of excessive drinking (negative correlation).

Excessive drinking is the percentage of adults who report either binge drinking. Excessive drinking increased 12 percent from 6.6 percent in 2016 to 7.4 percent in 2019 (Figure 20); this was an increase of an estimated 657,700 seniors who reported excessive drinking. According to the Centers for Disease Control and Prevention, an average 23,748 people aged 65 and older died from excessive alcohol use each year between 2006 and 2010. Excessive alcohol consumption is associated with many negative health outcomes such as cardiovascular conditions, cancers and unintentional injuries.
The prevalence of excessive drinking in Wisconsin, the least healthy state for this measure, is 12.0 percent, which is 3.5 times higher than the healthiest state, Utah, at 3.4 percent.
Unlike other unhealthy behaviors, the prevalence of excessive drinking increases with each increase in education or income level (Figure 21).

Obesity is the percentage of adults aged 65 and older with a body mass index of 30.0 or higher based on reported height and weight. Obesity increased 13 percent over six years, from 25.3 percent in 2013 to 28.5 percent in 2019 (Figure 22). Relative to 2014, there are an estimated 2.8 million more seniors with obesity. Differences in obesity prevalence exist by race and ethnicity, education and income. According to the Centers for Disease Control and Prevention, adults with obesity are at an increased risk of developing serious health conditions such as heart disease, stroke and type 2 diabetes. Further, research suggests that the association between obesity and mortality risk increases with age.
The prevalence of obesity among seniors in Alaska, the least healthy state for this measure, is 34.8 percent, compared with the healthiest state, Hawaii at 19.8 percent.
In the past six years, obesity increased significantly in 15 states concentrated in the Midwest and Southern regions of the U.S. (Figure 23).
Figure 24 shows the percent increase for each of the 15 states. Obesity increased most among seniors in Wyoming (by 40 percent from 20.4 to 28.6 percent) and North Dakota (by 32 percent from 24.4 to 32.1 percent).

This year, a new clinical care supplemental measure was added to address affordability of health care services and unmet medical needs among seniors due to cost. Avoided care due to cost is the percentage of adults aged 65 and older who reported that there was a time in the past 12 months when they needed to see a doctor but could not because of cost. Nationally, 5.2 percent of seniors report not seeing a doctor in the past year due to cost, representing an estimated 2.7 million adults aged 65 and older.
The percentage of seniors who avoided care due to cost is 3.2 times higher in Louisiana, the least healthy state for this measure at 7.4 percent, compared with the healthiest state, North Dakota at 2.3 percent (Figure 25).
Large gaps exist by race/ethnicity, education and income. Compared with non-Hispanic white seniors at 4.0 percent, the prevalence of seniors who avoided care due to cost is higher among American Indian/Alaska Native (10.0 percent), non-Hispanic black (9.0 percent) and Hispanic (8.7 percent) seniors (Figure 26). Seniors who report avoiding care due to cost is nearly 3.5 times higher among those with less than a high school education (10.2 percent) compared with college graduates (3.0 percent). Among those in the lowest income group (annual household income less than $25,000), the prevalence of seniors who avoided care due to cost is 10.6 percent; among seniors in the highest income group ($75,000 or more), the prevalence is 2.0 percent.

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