SENIOR REPORT AMERICA’S Through collaboration with community partners, grants, and outreach efforts, HEALTH A CALL TO ACTION FOR INDIVIDUALS United Health Foundation works to improve AND THEIR COMMUNITIES our health system, build a diverse and RANKINGS dynamic health workforce and enhance the wellbeing of local communities. 2014 EDITION SENIOR REPORT 2014 EDITION United Health Foundation 9900 Bren Road East Minnetonka, MN 55343 www.unitedhealthfoundation.org America’s Health Rankings® Senior Report is available in its entirety at www. americashealthrankings.org. Visit the website to request or download additional copies. MAY 2014 Become informed and take action At americashealthrankings.org, you can find Components of Health information about the health of your state compared to other states, build custom reports to fit your The World Health Organization defines health as “a state of complete physical, needs, and download templates and graphs to share mental, and social well-being and not merely the absence of disease or infirmity.” with others. Stay informed throughout the year by signing up In addition to genetic factors, health is the result of: for the newsletter and by reading the blog. Keep • Our behaviors; up with America’s Health Rankings® via Facebook • The environment and the community in which we live, including the larger and Twitter. See how everything is working in real community as well as the smaller, personal space of our home and immediate time to help improve the health of our communities, surroundings; workplaces, states, and nation. • The public and health policies and practices of our health, public, and private systems; • The clinical care we receive. These 4 aspects interact with each other in a complex web of cause and effect, and much of this interaction is just beginning to be understood. Understanding these interactions is vital if we are to create the healthy outcomes we desire, including a long, disease-free, robust life for all individuals regardless of race, gender, or socioeconomic status. This report focuses on these determinants and the overall health outcomes for adults aged 65 and older, a large and expanding portion of the general popula- tion. Optimal health for older adults involves creating a healthy life that allows individuals to flourish to the best of their abilities, maintain their independence and autonomy as long as preferred, and respect their needs and desires as life draws to an end. MACRO / MICRO twitter.com/AHR_Rankings facebook.com/AmericasHealthRankings Americashealthrankings.org/newsletter A CALL TO ACTION FOR INDIVIDUALS AND THEIR COMMUNITIES 2014 EDITION America’s Health Rankings® Senior Report is available in its entirety at www.americashealthrankings.org. Visit the site to request or download additional copies. America’s Health Rankings® Senior Report—2014 Edition is funded entirely by United Health Foundation, a recognized 501(c)(3) organization. Data contained within this document was obtained from and used with permission of: US Department of Health and Human Services Centers for Disease Control and Prevention Administration on Aging National Center for Health Statistics Centers for Medicare and Medicaid Services US Department of Commerce Census Bureau Bureau of Economic Analysis US Department of Labor Bureau of Labor Statistics The Dartmouth Atlas Project National Foundation to End Senior Hunger The Henry J Kaiser Family Foundation LTCFocUS, Alpert Medical School, Brown University American Geriatrics Society The Commonwealth Fund United Health Foundation encourages the distribution of information contained in this publication for non-commercial and charitable, educational, or scientific purposes. Please acknowledge America’s Health Rankings® Senior Report as the source and provide the following notice: ©2014 United Health Foundation. All Rights Reserved. Please acknowledge the original source of specific data as cited. Questions and comments on the report should be directed to United Health Foundation at [email protected]. Copyright ©2014 United Health Foundation Table of Contents Acknowledgment 3 Commentary Measuring Elder Abuse, Neglect, and Exploitation: 4 The Role of the Health Care Community, Kathy Greenlee, Administrator and Assistant Secretary for Aging, Administration for Community Living, US Department of Health and Human Services Introduction 9 Findings 11 Health Disparities within States 17 Methodology 22 Description of Measures 26 State-by-State Snapshots 50 Index of Tables 104 The Team 105 Acknowledgment nited Health Foundation is pleased to doing, and to get information on how you can help present America’s Health Rankings® improve community health, please visit our website: Senior Report: A Call to Action for americashealthrankings.org. Individuals and Their Communities. We also invite you to share proven or innovative UToday, 1 in 8 Americans are aged 65 and older; programs that have made a difference in your com- in the next 2 decades, another 79 million baby munity by emailing unitedhealthfoundationinfo@ boomers will move into this demographic. With uhc.com, posting on our Facebook page at www. this in mind, we believe that to truly understand facebook.com/AmericasHealthRankings, or tweet- and address our health as a nation, we must under- ing to us on Twitter at @AHR_Rankings. A healthy stand and take an in-depth look at senior health. exchange of ideas allows all Now in its second year, the America’s Health of us to share information, Rankings® Senior Report reveals some encouraging learn from one another, and data about senior health. We saw improvements in work together to address In the next 25 quality of nursing home care and end-of-life care. our nation’s — and our We also saw some gains in levels of activity among seniors’ — health chal- years, America’s seniors and some reductions in avoidable hospital- lenges and improve the senior population izations. This news points to the idea that seniors lives of all. are not only managing their health better, but We appreciate the will double. We they’re also engaging more with their health and efforts of our expert panel, need to persist in health care, including planning for the future. listed in the report, in the While we should celebrate these gains, we must design of this model. This tackling unhealthy remember that states face serious challenges and group of practitioners a growing aging population, so it’s important to and public health experts behaviors, not just focus on continuing to improve. In the next 25 reviewed available models in seniors, but in years, America’s senior population will double. We and metrics to select a set need to persist in tackling unhealthy behaviors, that reflects the holistic all Americans. not just in seniors, but in all Americans, in order health of seniors, includ- to make much-needed progress against diabetes, ing behaviors, community, heart disease, and other chronic health conditions. environment, clinical care, policy, and outcomes. United Health Foundation is actively engaged Finally, we once again offer our gratitude and in putting a spotlight on the health of America respect to the dedicated public health, clinical, and as well as the evidence-based ideas and means health policy professionals who serve our nation, to improve it. We have designed this report and as well as all of the people who provide care to its related tools to identify health opportunities seniors. They work tirelessly on behalf of seniors in communities and multi-stakeholder, multi- every day and deserve our appreciation. discipline approaches to improving the health of our populations. To learn more about what we are AMERICA’S HEALTH RANKINGS® SENIOR REPORT 3 Measuring Elder Abuse, Neglect, and Exploitation: The Role of the Health Care Community KATHY GREENLEE Administrator and Assistant Secretary for Aging Administration for Community Living, US Department of Health and Human Services In 2011, the first of more than 70 mil- available on the prevalence of elder abuse sug- lion baby boomers turned 65, marking gests that at least 10 percent of older Americans the beginning of a major demographic — approximately 5 million persons — experience shift in the US population. While this emotional, physical, or sexual abuse and neglect shift will affect the entire country, some each year, and many of them experience it in states will bear the pressure more than multiple forms.1 Older persons are also vulnerable others. In addition, states vary greatly to financial abuse; 5 percent are victims of finan- in how prepared they are to address cial exploitation at the hands of a family member, the needs of these aging boomers. while other data suggest the percentage of seniors Last year, United Health Foundation exploited or defrauded by strangers is even released the inaugural edition of its higher.1,2 The financial loss associated with elder America’s Health Rankings® Senior financial abuse alone was estimated to be at least Report, which focused on select health $2.9 billion in 2010, a figure which will likely grow determinants for individuals aged 65 as the number of Americans aged 65 and older and older and their collective impact increases.2,3 on population health at the state Abuse, both physical and financial, takes a level. That report, as well as the annual America’s sizeable toll on the health and well-being of our Health Rankings®, provides targeted metrics that nation’s seniors. On average, older people have all stakeholders — government, private sector, more chronic diseases and access the health care and nonprofits — should assess when exploring system at higher rates than other age groups. ways to improve the health and well-being of their Older adults who are victims of violence have addi- seniors. tional health care problems and higher premature The increase in the US population aged 65 and mortality rates than non-victims. Older victims of older makes it imperative that current health ser- even modest forms of abuse have dramatically vice delivery systems have the ability to ensure the (300 percent) higher morbidity and mortality rates health of our future older Americans.