The latest annual report on America’s seniors finds older adults showed improvement on clinical measures like access to quality health care and preventive services, especially flu vaccination rates. But these improvements are tempered with some serious challenges: those over 65 also had several worsening behavioral health outcomes, including increases in drug deaths, suicides and frequent mental distress.
And, despite successes in certain clinical measures, health improvements for older adults were not felt equally across the country. For example, populations in rural states and certain racial and ethnic groups faced more significant hurdles than their urban, white counterparts, according to America’s Health Rankings, who published the analysis in May. (Don’t miss our AHCJ panel on rural aging on Wednesday, June 23, 2021, at 12:10 pm ET.
The pandemic “has highlighted the social impact challenges seniors face from increased isolation, underscoring the impact it has on overall health,” said the report’s authors.
This report is a treasure trove of information about the health of older adults nationally, as well as on a state-by-state basis (pdf). The rankings model includes four drivers, or determinants of health: social and economic factors, physical environment, clinical care and behaviors, all of which influence the fifth driver, health outcomes. Rankings are based on the World Health Organization definition of health: “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity,” according to AHR. (Note that data for the Senior Report 2021 was primarily gathered and analyzed before the pandemic.)
Key highlights include:
- A 16% decrease was seen nationally in food insecurity between 2014 and 2018, from 15.8% to 13.3% of adults ages 60 and older. Arizona decreased its proportion of food insecure older adults from 18.9% to 12.5% between 2015-16 and 2017-18. New Hampshire’s food insecurity decreased 5.2 percentage points from 13.6% to 8.4% between 2015-16 and 2017-18
- A 10% increase in high-speed internet took place between 2016 and 2019, from 71.1% to 78.0% of households with adults ages 65 and older
- A 13% increase in geriatric providers was seen between 2018 and 2020, from 26.7 to 30.1 per 100,000 adults ages 65 and older.
- Preventable hospitalizations decreased 6% from 2017 to 2018, from 2,504 to 2,358 per 100,000 Medicare beneficiaries ages 65-74.
- More people are exercising: physical activity increased 31% between 2017 and 2019 among those 65 and older.
However, there are still numerous challenges to address:
- Nearly 1 in 3 older adult households had severe housing problems in 2013-17.
- In 2019, nearly 1 in 10 (9.4%) adults 65, nearly 5 million people, were living in poverty.
- The poverty rate was 2.7 times higher among adults who identified as “other race” (the group with the highest rate) than white adults (the group with the lowest rate).
- Poverty was also more than two times higher among Hispanic (2.4), Black (2.4) and American Indian/Alaska Native (2.2) older adults than those who identified as white.
- Connecticut had the largest racial disparity ratio at 7.3, followed by Rhode Island (6.5) and Pennsylvania (5.8)
- Behavioral health issues are on the rise: Among those 65 and older, drug-related deaths increased 39% between 2014-16 and 2017–19, from 7.4 to 10.3 deaths per 100,000;
- Suicides rose 3% between 2014–16 and 2017–19, from 16.6 to 17.1 deaths per 100,000; and
- Frequent mental distress increased 11% between 2016 and 2019, from 7.3% to 8.1%
- During 2015-19, states throughout the West and Midwest had the lowest risk of social isolation among older adults, while states in the South had the highest risk.
- Risk of social isolation was highest in Mississippi (97) and lowest in Utah (1).
- Older adults in the District of Columbia, New Mexico, New York and Rhode Island also had higher risk of social isolation.
- Elders experiencing social isolation are at increased risk of dementia, depression, acute and chronic illnesses, poor health status and premature death, according to the National Academies of Science, Engineering and Medicine. This issue was vastly exacerbated by the pandemic.
The majority of the measures in the report use data from 2019 and can serve as a baseline for the health of older Americans before the COVID-19 pandemic. It included 49 measures of population health from 22 unique data sources, such as the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System, the Administration on Aging’s State Program Reports and the U.S. Census Bureau’s American Community Survey. The report also drills down to expose differences by gender, race/ethnicity, education and income. This analysis often reveals differences among groups that can be masked by national or state aggregate data, according to the report’s authors.
Older adults now account for about 16.5% of the nation’s population, with the largest numbers of those 65+ living in Florida, Maine and West Virginia. Some 450,000 seniors died from COVID in the U.S. as of May 5, 2021, according to CDC data. The pandemic has disproportionately affected certain racial and ethnic groups, further reinforcing many longstanding disparities noted in the report.
The report was developed by the United Health Foundation in partnership with the Gerontological Advanced Practice Nurses Association (GAPNA). Unlike prior years, the 2021 edition did not include an overall list of state rankings, due to the challenges COVID-19 presented. Instead, the organization said detailed information will go to the states to help them better manage their area’s specific public health needs.
However, journalists can use the information provided about the highest and lowest category rankings to compare states on their own. You may want to explore public health officials’ reaction to the rankings, which indicators are priorities in the coming year or years, and what achievements or gains of which they are most proud.. How will (or has) COVID-19 affected their plans to improve determinants of health?