Wk 1 – Field of Gerontology Paper
Using this week’s readings, write a 700- to 1,050-word paper on the field of gerontology in which you:
- Describe the study and field of gerontology.
- Identify the different disciplines involved in the field of gerontology.
- Discuss how Baby Boomers will influence our views about aging.
- Identify major myths and stereotypes associated with aging.
- Discuss how living in an age-irrelevant society would impact the concept of optimistic aging.
Include the two 2 peer-reviewed, scholarly sources that have been provided below.
Format your paper according to APA guidelines. This includes an introduction, conclusion and reference page.
Are you ready? What you need to know about ageing
World Health Day 2012 – Toolkit for event organizers
Our world is changing
Key facts
· The number of people today aged 60 and over has doubled since 1980.
· The number of people aged 80 years will almost quadruple to 395 million between now and 2050.
· Within the next five years, the number of adults aged 65 and over will outnumber children under the age of 5.
· By 2050, these older adults will outnumber all children under the age of 14.
· The majority of older people live in low- or middle-income countries. By, 2050, this number will have increased to 80%.
In the 21st century, health is determined by and contributes to broad social trends. Economies are globalizing, more and more people live and work in cities, family patterns are changing and technology is evolving rapidly. One of the biggest social transformations is population ageing. Soon, the world will have more older people than children and more people of very old age than ever before.
1. The world will have more people who live to see their 80s or 90s than ever before
The number of people aged 80 years or older, for example, will have almost quadrupled to 395 million between 2000 and 2050. There is no historical precedent for a majority of middle-aged and older adults having living parents, as is already the case today. More children will know their grandparents and even their great-grandparents, especially their great-grandmothers. On average, women live six to eight years longer than men.
2. The past century has seen remarkable improvements in life expectancy
In 1910, the life expectancy for a Chilean female was 33 years; today, a mere century later, it is 82 years. This represents a remarkable gain of almost 50 years of life in one century, and is largely due to improvements in public health.
3. Soon, the world will have more older people than children
Within the next five years, for the first time in human history, the number of adults aged 65 and over will outnumber children under the age of 5. By 2050, these older adults will outnumber children under the age of 14.
4. The world population is rapidly ageing
Between 2000 and 2050, the proportion of the world’s population over 60 years will double from about 11% to 22%. The absolute number of people aged 60 years and over is expected to increase from 605 million to 2 billion over the same period.
5. Low- and middle-income countries will experience the most rapid and dramatic demographic change
For example, it took more than 100 years for the share of France’s population aged 65 or older to double from 7 to 14%. In contrast, it will take countries like Brazil and China less than 25 years to reach the same growth.
Determinants of healthy ageing
1. Healthy ageing is linked to health in earlier stages of life
Undernutrition in the womb, for example, may increase the risk of disease in adult life, such as circulatory diseases and diabetes. Respiratory infections in childhood may increase the risk of chronic bronchitis in adult life. Obese, or overweight, adolescents run the risk of developing chronic diseases, such as diabetes, circulatory disease, cancer, respiratory and musculo-skeletal disorders, in adult life.
2. Yet, how well we age depends on many factors
The functional capacity of an individual’s biological system increases during the first years of life, reaches its peak in early adulthood and naturally declines thereafter. The rate of decline is determined, at least in part, by our behaviours and exposures across the whole life course. These include what we eat, how physically active we are and our exposure to health risks such as those caused by smoking, harmful consumption of alcohol, or exposure to toxic substances.
Demographic changes are accompanied by new challenges
1. Even in poor countries, most older people die of noncommunicable diseases
Even in poor countries, most older people die of noncommunicable diseases such as heart disease, cancer and diabetes, rather than from infectious and parasitic diseases. In addition, older people often have several health problems at the same time, such as diabetes and heart disease.
2. The number of people living with disability is increasing due to population ageing and because of the greater risk of chronic health problems in older age
For example, about 65% of all people who are visually impaired are aged 50 and older, with this age group comprising about 20% of the world’s population. With an increasing elderly population in many countries, more people will be at risk of age-related visual impairment.
3. Globally, many older people are at risk of maltreatment
Around 4-6% of older people in developed countries have experienced some form of maltreatment at home. Abusive acts in institutions include physically restraining patients, depriving them of dignity (by for instance leaving them in soiled clothes) and intentionally providing insufficient care (such as allowing them to develop pressure sores). The maltreatment of older people can lead to serious physical injuries and long-term psychological consequences.
4. The need for long-term care is rising
The number of older people who are no longer able to look after themselves in developing countries is forecast to quadruple by 2050. Many of the very old lose their ability to live independently because of limited mobility, frailty or other physical or mental health problems. Many require some form of long-term care, which can include home nursing, community care and assisted living, residential care and long stays in hospitals.
5. Worldwide, there will be a dramatic increase in the number of people with dementias such as Alzheimer’s disease, as people live longer
The risk of dementia rises sharply with age with an estimated 25-30% of people aged 85 or older having some degree of cognitive decline. Older people with dementia in low- and middle-income countries generally do not have access to the affordable long-term care their condition may warrant. Often their families do not often have publicly funded support to help with care at home.
6. In emergency situations, older people can be especially vulnerable
When communities are displaced by natural disasters or armed conflict, older people may be unable to flee or travel long distances and may be left behind. Yet, in many situations they can also be a valuable resource for their communities as well as for the humanitarian aid process when they are involved as community leaders.
Fighting stereotypes
We all generally value and respect the older people we love or know well. But our attitudes to other older people within the broader community can be different. In many traditional societies, older people are respected as “elders”. However, in other societies, older women and men may be less respected. The marginalization can be structural, for example enforced retirement ages, or informal, such as older people being viewed as less energetic and less valuable to a potential employer. These attitudes are examples of “ageism” — the stereotyping of, and discrimination against, individuals or groups because of their age. Ageist attitudes can portray older people as frail, “past their sell-by date”, unable to work, physically weak, mentally slow, disabled or helpless. Ageism serves as a social divider between young and old.
These stereotypes can prevent older men and women from fully participating in social, political, economic, cultural, spiritual, civic and other activities. Younger people may also influence these decisions in the attitudes they convey to older people, or even by building barriers to their participation.
We can escape this vicious cycle by breaking down stereotypes and change our attitudes about older people. Here are a few examples.
Stereotype 1: Older people are “past their sell-by date”
While older workers are often presumed to be less productive than younger workers and studies show slight declines in information processing and attention with age, most individuals maintain mental competence and learning abilities well into older age. They also have the advantage of possessing experience and institutional memory. Deterioration in physical abilities may be much less than presumed. On 16 October 2011, British national Fauja Singh became the first 100 year-old to complete a marathon by running the Toronto Waterfront Marathon in Canada.
Stereotype 2: Older people are helpless
The fact that older people are particularly vulnerable in emergencies does not mean that older people in general are helpless. After the 2007 Cyclone Sidr in Bangladesh, older people’s committees took an active role, disseminating early warning messages to people and families most at risk, identifying those who were worst hit, compiling beneficiary lists and notifying them when and where to receive relief goods. After the 2011 earthquake and Tsunami in Japan, older people and retirees came forward to volunteer at the nuclear disaster sites, saying they were not afraid of becoming contaminated with radiation. Advanced in years, they were less worried about the long term impacts of the exposure.
Stereotype 3: Older people will eventually become senile
Occasional memory lapses are common at any age. And although the risk of developing dementia symptoms rises steeply with age in people over 60, possible signs of dementia (a loss of intellectual abilities), such as uncertainty about how to perform simple tasks, difficulty in completing sentences and confusion about the month or season, are not normal signs of ageing. Most older people are able to manage their financial affairs and their day-to-day lives. They can give informed consent for treatment or medical interventions they may need. In fact, some types of our memory stay the same or even continue to improve with age, as for example our semantic memory, which is the ability to recall concepts and general facts that are not related to specific experiences.
Stereotype 4: Older women have less value than younger women
People often equate women’s worth with beauty, youth and the ability to have children. The role older women play in their families and communities, caring for their partners, parents, children and grandchildren is often overlooked. In most countries, women tend to be the family caregivers. Many take care of more than one generation. These women are often themselves at advanced ages. For example, in sub-Saharan Africa, 20% of rural women aged 60 and older are the main carers for their grandchildren.
Stereotype 5: Older people don’t deserve health care
Treatable conditions and illnesses in older people are often overlooked or dismissed as being a “normal part of ageing”. Age does not necessarily cause pain, and only extreme old age is associated with limitation of bodily function. The right to the best possible health does not diminish as we age: It is mainly society that sets age limits for access to complex treatments or proper rehabilitation and secondary prevention of disease and disability.
It is not age that limits the health and participation of older people. Rather, it is individual and societal misconceptions, discrimination and abuse that prevent active and dignified ageing.
Are you ready? What you need to know about ageing
World
Health
Day
2012
–
Toolkit
for
event
organizers
Our world is changing
Key facts
·
The number of people today aged 60 and over has doubled since 1980.
·
The number of people aged 80 years will almost quadruple to 395 million between now and 2050.
·
Within the next five years, the number of adults aged 65 an
d over will outnumber children under the age of 5.
·
By 2050, these older adults will outnumber all children under the age of 14.
·
The majority of older people live in low
–
or middle
–
income countries. By, 2050, this number will have
increased to 80%.
In
the
2
1st
century,
health
is
determined
by
and
contributes
to
broad
social
trends.
Economies
are
globalizing,
more
and
more
people
live
and
work
in
cities,
family
patterns
are
changing
and
technology
is
evolving
rapidly.
One
of
the
biggest
social
transformations
is
population
ageing.
Soon,
the
world
will
have
more
older
people
than
children
and
more
people
of
very
old
age
than
ever
before.
1. The world will have more people who live to see their 80s or 90s than ever before
The
number
of
people
aged
80
years
or
older,
for
example,
will
have
almost
quadrupled
to
395
million
between
2000
and
2050.
There
is
no
historical
precedent
for
a
majority
of
middle
–
aged
and
older
adults
having
living
parents,
as
is
already
the
case
today.
More
children
will
know
their
grandparents
and
even
their
great
–
grandparents,
especially
their
great
–
grandmothers.
On
average,
women
live
six
to
eight
years
longer
than
men.
2. The past century has seen remarkable improvements in life expectancy
In
1910,
the
life
expectancy
for
a
Chilean
female
was
33
years;
today,
a
mere
century
later,
it
is
82
years.
This
represents
a
remarkable
gain
of
almost
50
years
of
life
in
one
century,
and
is
largely
due
to
improvements
in
public
health.
3. Soon, the world will ha
ve more older people than children
Within
the
next
five
years,
for
the
first
time
in
human
history,
the
number
of
adults
aged
65
and
over
will
outnumber
children
under
the
age
of
5.
By
2050,
these
older
adults
will
outnumber
children
under
the
age
of
14.
4
. The world population is rapidly ageing
Between
2000
and
2050,
the
proportion
of
the
world’s
population
over
60
years
will
double
from
about
11%
to
22%.
The
absolute
number
of
people
aged
60
years
and
over
is
expected
to
increase
from
605
million
to
2
bil
lion
over
the
same
period.
5. Low
–
and middle
–
income countries will experience the most rapid and dramatic demographic
change
For
example,
it
took
more
than
100
years
for
the
share
of
France’s
population
aged
65
or
older
to
double
from
7
to
14%.
In
contras
t,
it
will
take
countries
like
Brazil
and
China
less
than
25
years
to
reach
the
same
growth.
Are you ready? What you need to know about ageing
World Health Day 2012 – Toolkit for event organizers
Our world is changing
Key facts
The number of people today aged 60 and over has doubled since 1980.
The number of people aged 80 years will almost quadruple to 395 million between now and 2050.
Within the next five years, the number of adults aged 65 and over will outnumber children under the age of 5.
By 2050, these older adults will outnumber all children under the age of 14.
The majority of older people live in low- or middle-income countries. By, 2050, this number will have
increased to 80%.
In the 21st century, health is determined by and contributes to broad social trends. Economies are
globalizing, more and more people live and work in cities, family patterns are changing and technology is
evolving rapidly. One of the biggest social transformations is population ageing. Soon, the world will have
more older people than children and more people of very old age than ever before.
1. The world will have more people who live to see their 80s or 90s than ever before
The number of people aged 80 years or older, for example, will have almost quadrupled to 395 million
between 2000 and 2050. There is no historical precedent for a majority of middle-aged and older adults
having living parents, as is already the case today. More children will know their grandparents and even
their great-grandparents, especially their great-grandmothers. On average, women live six to eight years
longer than men.
2. The past century has seen remarkable improvements in life expectancy
In 1910, the life expectancy for a Chilean female was 33 years; today, a mere century later, it is 82 years.
This represents a remarkable gain of almost 50 years of life in one century, and is largely due to
improvements in public health.
3. Soon, the world will have more older people than children
Within the next five years, for the first time in human history, the number of adults aged 65 and over will
outnumber children under the age of 5. By 2050, these older adults will outnumber children under the age
of 14.
4. The world population is rapidly ageing
Between 2000 and 2050, the proportion of the world’s population over 60 years will double from about
11% to 22%. The absolute number of people aged 60 years and over is expected to increase from 605
million to 2 billion over the same period.
5. Low- and middle-income countries will experience the most rapid and dramatic demographic
change
For example, it took more than 100 years for the share of France’s population aged 65 or older to double
from 7 to 14%. In contrast, it will take countries like Brazil and China less than 25 years to reach the same
growth.
National Center for Chronic Disease Prevention and Health Promotion
Division of Population Health
The State of Aging and Health in America 2013 is the sixth volume of a series that presents a
snapshot of the health and aging landscape in the United States or another region of the
world. This series presents the most current information and statistics, often specifically
commissioned for the report, on the health of older adults. The State of Aging and Health
in America 2013 focuses on the health of adults aged 65 years or older in the United States
and was supported by the Centers for Disease Control and Prevention.
Suggested Citation:
Centers for Disease Control and Prevention. The State of Aging and Health in America 2013. Atlanta,
GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013.
PDF and interactive version available at
www.cdc.gov/aging
.
Web site addresses of nonfederal organizations are provided solely as a service to our readers.
Provision of an address does not constitute an endorsement by the Centers for Disease Control and
Prevention (CDC) or the federal government, and none should be inferred. CDC is not responsible
for the content of other organizations’ Web pages.
www.cdc.gov/aging
Foreword
“The State of Aging and Health in America 2013 is a
valuable tool for states and communities to meet the
health challenges of our aging population. There are
proven tools to help prevent and limit the impact of
both infectious and noninfectious diseases, and this
report serves as a report card on how we are doing
addressing health threats.”
—Thomas R. Frieden, MD, MPH, Director
Centers for Disease Control and Prevention,
U.S. Department of Health and Human Services
PAGE ii The State of Aging and Health in America 2013
Executive Summary
Twentieth-century advances in protecting and promoting health among older adults have provided
many opportunities for overcoming the challenges of an aging society. The health indicators presented
in The State of Aging and Health in America 2013 highlight these opportunities. By working to meet
the goals for each of these key indicators, our nation can help to ensure that all of its citizens can look
forward to living longer and living well.
The State of Aging and Health in America 2013 provides a snapshot of our nation’s progress in
promoting prevention, improving the health and well-being of older adults, and reducing behaviors
that contribute to premature death and disability. In addition, the report highlights mobility (referring to
movement in all of its forms) and how optimal mobility is fundamental to healthy aging.
Demographic changes create an urgent need
The growth in the number and proportion of older adults is unprecedented in the history of the
United States. Two factors—longer life spans and aging baby boomers—will combine to double the
population of Americans aged 65 years or older during the next 25 years to about 72 million. By 2030,
older adults will account for roughly 20% of the U.S. population.
Chronic conditions present a strong economic incentive for action
During the past century, a major shift occurred in the leading causes of death for all age groups,
including older adults, from infectious diseases and acute illnesses to chronic diseases and degenerative
illnesses. More than a quarter of all Americans and two out of every three older Americans have
multiple chronic conditions, and treatment for this population accounts for 66% of the country’s health
care budget.
The Report Cards
The National Report Card on Healthy Aging reports on 15 indicators of older adult health, 8 of which
are identified in Healthy People 2020, the national health agenda of the U.S. Department of Health
and Human Services. These 15 indicators are grouped into 4 areas: Health Status, Health Behaviors,
Preventive Care and Screening, and Injuries. In addition, the report assigns a “met” or “not met” score
to states on the basis of their attainment of Healthy People 2020 targets.
For most indicators, the Behavioral Risk Factor Surveillance System (BRFSS) is not the official data
source for tracking Healthy People 2020 targets. Some of these targets are for all adults aged 18 or
older, not just those aged 65 years or older. For this report, we use BRFSS data to report how well
states are doing in meeting Healthy People 2020 targets for their older adult populations. Taken
together, these indicators present a comprehensive picture of older adult health in the United States.
The United States has met six of the Healthy People 2020 targets in this report
�� No leisure time physical activity in past month (31.4% vs. goal of 32.6%).
�� Obesity (24.5% vs. goal of 30.6%).
�� Current smoking (8.4% vs. goal of 12%).
�� Taking medications for high blood pressure (94.1% vs. goal of 77.4%).
�� Mammograms within past 2 years (81.9% vs. goal of 70%).
�� Colorectal cancer screenings (72.2 % vs. goal of 70%).
The State of Aging and Health in America 2013 PAGE iii
But improvement on the remaining Healthy People 2020 targets is needed
�� Flu vaccine in past year (66.9% vs. goal of 90%).
�� Ever had pneumonia vaccine (68.1% vs. goal of 90%).
�� Up to date on select preventive services (49.0% vs. goal of 50.9% for men; 49.0% vs. goal of
52.7% for women).
The State-by-State Report Card on Healthy Aging ranks all 50 states and the District of Columbia
(DC) for each health indicator. Variation among states can be significant. For example, in Utah and
Connecticut, 70.9% of older adults have retained most of their natural teeth (i.e., lost five or fewer
teeth), whereas in West Virginia, this is true for only 33.4% of older adults.
Most states are well ahead of schedule on four health indicators for older adults.
�� Obesity 50 states and DC met the 2020 target.
�� Taking medications for high blood pressure 50 states and DC met the 2020 target.
�� Mammography within past 2 years 50 states and DC met the 2020 target.
�� Current smoking 49 states and DC met the 2020 target.
However, all states have significant work to do on other indicators for older adults.
�� Flu vaccine in past year 0 states met the 2020 target.
�� Ever had pneumonia vaccine 0 states met the 2020 target.
Opportunities for Enhancing Quality of Lif
e
The State of Aging and Health in America 2013 focuses on several areas of concern that, if effectively
addressed, will significantly improve the quality of life for older adults.
Mobility
Mobility is fundamental to everyday life and central to an understanding of health and well-being among
older populations. Impaired mobility is associated with a variety of adverse health outcomes. As the age
of the U.S. population continues to increase, aging and public health professionals have a role to play
in improving mobility for older adults. There are critical gaps in the assessment and measurement of
mobility among older adults who live in the community, particularly those who have physical disabilities
or cognitive impairments. By changing physical environments and creating unique integrated interventions
across various disciplines, we can improve mobility for older adults.
Innovative Approaches
Many states and communities have developed innovative ways to ensure that key information about the
health of older adults is available to those who need it to plan programs, set priorities, and track trends. In
response to the growing need for supportive communities that enhance mobility, this report highlights the
efforts of the Atlanta Regional Commission’s (ARC’s) Area Agency on Aging and Hendersonville, N.C. ARC
is creating a broad plan to transform neighborhoods, cities, and counties into places where people of all
ages can live and Hendersonville has implemented the Walk Wise, Drive Smart program.
The State of Aging and Health in America 2013 highlights the need to maintain the progress made on
several health indicators and increase our efforts to address other important health issues. This report
shows that the key to improving the health and quality of life for all older adults living in the United
States will be collaboration between multiple and diverse groups on national, state, and local levels. These
groups will include the public, health care providers, government agencies, and community organizations.
PAGE iv The State of Aging and Health in America 2013
Calls to Action
The State of Aging and Health in America 2013 presents several calls to action intended to
encourage individuals, professionals, and communities to take specific steps to improve the health
and well-being of older adults. They include the following:
�� Developing a new Healthy Brain Initiative Road Map.
�� Addressing lesbian, gay, bisexual, and transgender (LGBT) aging and health issues.
�� Using data on physically unhealthy days to guide interventions.
�� Addressing mental distress among older adults.
�� Monitoring vaccination rates for shingles.
The State of Aging and Health in America 2013 PAGE v
An Introduction to the Health of Older Americans …………………………………………………………………………………………………………………………………………..1
CALL TO ACTION » Developing a New Healthy Brain Initiative Road Map ……………………………………………………………………………..
7
CALL TO ACTION » Addressing Lesbian, Gay, Bisexual, and Transgender Aging
and Health Issues ……………………………………………………………………………………………………………………………………………………………………………………………………………………….11
The National Report Card on Healthy Aging …………………………………………………………………………………………………………………………………………………………
1
5
CALL TO ACTION » Using Physically Unhealthy Days Data to Guide Interventions …………………………………………………..1
6
CALL TO ACTION » Addressing Mental Distress in Older Adults………………………………………………………………………………………………………17
CALL TO ACTION » Monitoring Vaccination Rates for Shingles………………………………………………………………………………………………………….
23
The State-by-State Report Card on Healthy Aging ……………………………………………………………………………………………………………………………………………27
Spotlight: Mobility………………………………………………………………………………………………………………………………………………………………………………………………………………………………..
35
Appendix ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………47
Acknowledgements………………………………………………………………………………………………………………………………………………………………………………….. Inside back cov
er
Contents
PAGE vi The State of Aging and Health in America 2013
The State of Aging and Health in America 2013 PAGE 1
An Introduction
to the Health of Older Americans
U.S. Population Is Aging
The current growth in the number and proportion of older adults in the United States is unprecedented
in our nation’s history. By 2050, it is anticipated that Americans aged 65 or older will number nearly 89
million people, or more than double the number of older adults in the United States in 2010.1
The rapid aging of the U.S. population is being driven by two realities: Americans are living longer
lives than in previous decades and, given the post-World War II baby boom, there are proportionately
more older adults than in previous generations. Many Americans are now living into their 70s, 80s, and
beyond. The leading edge of the baby boomers reached age 65 in 2011, launching an unparalleled
phenomenon in the United States. Since January 1, 2011, and each and every day for the next 20 years,
roughly 10,000 Americans will celebrate their 65th birthdays.2 In 2030, when the last baby boomer
turns 65, the demographic landscape of our nation will have changed significantly. One of every five
Americans—about 72 million people—will be an older adult.3
The aging of our population has wide-ranging implications for virtually every facet of American society.
At each point in the lifespan of baby boomers, the United States has felt and been changed by the impact
of their numbers and needs—from booming sales in commercial baby food during the late 1940s, to the
construction of thousands of new schools during the 1950s, to the housing construction boom of the
1970s and 1980s. The significant proportion of Americans represented by the baby boomers continues
to exert its influence. In large measure, this influence will have its most profound effects on our nation’s
public health, social services, and health care systems. Public health plays a key role in advocating for
those in need, linking individuals and communities to available services, and promoting healthy aging
because of its effects on personal, societal, cultural, economic, and environmental factors. The public
health sector is ideally positioned to meet the growing needs and demands of a rapidly aging nation.4
U.S. Population Is Becoming More Racially and Ethnically Diverse
Along with the dramatic aging of the U.S. population during the next several decades will be significant
increases in racial and ethnic diversity. Although young people in the United States currently reflect
diversity more strikingly than their older counterparts, the racial and ethnic makeup of older adults is
changing as well.
In 2010, 80% of adults aged 65 years or older in the United States were non-Hispanic white. By 2030, that
percentage will have declined, and older non-Hispanic white adults will make up 71.2% of the population,
whereas Hispanics will make up 12%, non-Hispanic blacks nearly 10.3%, and Asians 5.4%.5
By 2050, the racial and ethnic diversity of older U.S. adults will have changed even more profoundly.
Older non-Hispanic white adults, long deemed the “majority population,” will account for only about
58% of the total population aged 65 or older, a decline of more than 20% from 2010. During the same
PAGE 2 The State of Aging and Health in America 2013
period, the proportion of older Hispanics will almost triple—from
7% in 2010 to nearly 20% in 2050. The proportion of older Asian-Americans will more than double
during 2010–2050, from 3.3% to 8.5%, and the proportion of older African-Americans will increase
from 8.3% to 11.2%.5
At all ages, the health status of Hispanics, Asian-Americans, African-Americans, and other minority
population groups, such as American Indians/Alaska Natives and Native Hawaiians/Other Pacific
Islanders, has long lagged behind that of non-Hispanic whites. For a variety of reasons, older
adults in these groups may experience the effects of health disparities more than younger people.
Language barriers, reduced access to health care, low socioeconomic status, and differing cultural
norms can be major challenges to promoting health in an increasingly diverse older population.
Figure 1. U.S. population aged 65 years or older and diversity, 2010–2050
87%
9%
4%
1%
7%
83%
11%
6%
1%
1
2%
78%
12%
9%
2%
2
0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Non-Hispanic White Non-Hispanic Black Asian Americ an Indian
or Alaska Native
Hispanic (any race)
Source: U.S. Census Bureau, 2008.
P
o
p
u
la
ti
o
n
A
g
e
d
6
5
o
r
O
ld
er
2010 2030 2050
The State of Aging and Health in America 2013 PAGE 3
The Burden of Chronic Disease for Older Adults
Leading Causes of Death
During the twentieth century, effective public health strategies
and advances in medical treatment contributed to a dramatic
increase in average life expectancy in the United States. The
30-year gain in life expectancy within the span of a century had
never before been achieved. Many of the diseases that claimed
our ancestors—including tuberculosis, diarrhea and enteritis,
and syphilis—are no longer the threats they once were.
Although they may still present significant health challenges
in the United States, these diseases are no longer the leading
killers of American adults.
However, other diseases have continued to be leading causes of
death every year since 1900. By 1910, heart disease became the
leading cause of death every year except 1918–1920, when the
influenza epidemic took its disastrous toll. Since 1938, cancer
has held the second position every year.6
Heart disease and cancer pose their greatest risks as people age, as do other chronic diseases and
conditions, such as stroke, chronic lower respiratory diseases, Alzheimer’s disease, and diabetes
(Figure 2). Influenza and pneumonia also continue to contribute to deaths among older adults,
despite the availability of effective vaccines.
Figure 2. Chronic conditions were the leading causes of death among U.S. adults aged 65 or older
in 2007–2009
2
7
.7
%
2
2
.1
%
6
.5
%
6
.
4
%
4
.4
%
2
.8
%
2
.6
%
2
7
.6
%
2
1
.9
%
7
.
0
%
6
.3
%
4
.6
%
2
.5
%
2
.6
%
2
8
.2
%
2
3
.1
%
3
.7
%
7
.0
%
3
.1
% 4
.7
%
2
.3
%
2
7
.6
%
2
1
.6
%
4
.2
% 6
.6
%
2
.9
% 5
.6
%
3
.0
%
0%
5%
10%
15%
20%
25%
30%
Heart D isease Can cer Chronic Lower
Respiratory D iseases
Stroke Alzheimer’s
Disease
Diabetes Influ enza &
Pneumonia
Source: CDC, National Center for Health Statistics. National Vital Statistics System, 2007−2009.
All races/ ethinicities
White, non-Hispani c
Black, non-
Hispanic
Hispanic
P
o
p
u
la
ti
o
n
A
g
ed
6
5
o
r
O
ld
er
PAGE 4 The State of Aging and Health in America 2013
Diminished Quality of Life and Loss of Independence
The burden of chronic diseases encompasses a much broader spectrum of negative health
consequences than death alone. People living with one or more chronic diseases often experience
diminished quality of life, generally reflected by a long period of decline and disability associated
with their disease.
Chronic diseases can affect a person’s ability to perform important and essential activities, both
inside and outside the home. Initially, they may have trouble with the instrumental activities of
daily living (IADLs), such as managing money, shopping, preparing meals, and taking medications
as prescribed. As functional ability—physical, mental, or both—further declines, people may lose
the ability to perform more basic activities, called activities of daily living (ADLs), such as taking
care of personal hygiene, feeding themselves, getting dressed, and toileting.
The inability to perform daily activities can restrict people’s engagement in life and their enjoyment
of family and friends. Lack of mobility in the community or at home significantly narrows an older
person’s world and ability to do the things that bring enjoyment and meaning to life. Loss of the
ability to care for oneself safely and appropriately means further loss of independence and can
often lead to the need for care in an institutional setting.
The need for caregiving for older adults by formal, professional caregivers or by family members—
and the need for long-term care services and supports—will increase sharply during the next
several decades, given the effects of chronic diseases on an aging population.
The State of Aging and Health in America 2013 PAGE 5
Major Contributor to Health Care Costs
The nation’s expenditures for health care, already the highest among developed countries, are
expected to rise considerably as chronic diseases affect growing numbers of older adults. Today,
more than two-thirds of all health care costs are for treating chronic illnesses. Among health care
costs for older Americans, 95% are for chronic diseases. The cost of providing health care for one
person aged 65 or older is three to five times higher than the cost for someone younger than 65.7
By 2030, health care spending will increase by 25%,8 largely because the population will be older.
This estimate does not take into account inflation and the higher costs of new technologies.
Medicare spending is projected to increase from $555 billion in 2011 to $903 billion in 2020.9
Ways to Promote and Preserve the Health of Older Adults and Reduce Costs
Death and decline associated with the leading chronic diseases are often preventable or can be
delayed. Multiple opportunities exist to promote and preserve the health of older adults. The
challenge is to more broadly apply what we already know about reducing the risk of chronic
disease. Death is unavoidable, but the prevalence of chronic illnesses and the decline and
disability commonly associated with them can be reduced.
Although the risk of developing chronic diseases increases as a person ages, the root causes of
many of these diseases often begin early in life. Practicing healthy behaviors from an early age and
getting recommended screenings can substantially reduce a person’s risk of developing chronic
diseases and associated disabilities. Research has shown that people who do not use tobacco,
who get regular physical activity, and who eat a healthy diet significantly decrease their risk of
developing heart disease, cancer, diabetes, and other chronic conditions.
10
Unfortunately, current data on health-related behaviors among people aged 55–64 years do not
indicate a positive future for the health of older Americans. If a meaningful decline in chronic
diseases among older adults is to occur, adults at younger ages, as well as our nation’s children and
adolescents, need to pursue health-promoting behaviors and get recommended preventive services.
Communities can play a pivotal role in achieving this goal by making healthy choices easier and
making changes to policies, systems, and environments that help Americans of all ages take charge
of their health.
The risk of chronic disease increases with age, but growing
older does not have to mean becoming disabled. Effective
programs, such as disease self-management programs, help
people manage chronic diseases better and prevent or
delay associated conditions.
PAGE 6 The State of Aging and Health in America 2013
Addressing Challenges for People with Multiple Chronic Conditions
More than a quarter of all Americans and two of three older Americans have multiple chronic
conditions, and treatment for this population accounts for 66% of the country’s health care
budget11 The nation’s health care system is largely designed to treat one disease or condition
at a time, but many Americans have more than one, and often several, chronic conditions. For
example, just 9.3% of adults with diabetes have only diabetes. Other common conditions include
arthritis, asthma, chronic respiratory disease, heart disease, and high blood pressure.
People with chronic diseases may also have other health problems, such as substance use or
addiction disorders, mental illness, dementia or other cognitive impairments, and developmental
disabilities.11 The varied nature of these conditions leads to the need for multiple health care
specialists, a variety of treatment regimens, and prescription medications that may not be
compatible. People with multiple chronic conditions face an increased risk of conflicting medical
advice, adverse drug effects, unnecessary and duplicative tests, and avoidable hospitalizations,
all of which can further endanger their health. Figure 3 shows the rates of multiple chronic
conditions among Medicare fee-for-service beneficiaries.
Figure 3. Multiple chronic conditions among Medicare fee-for-service beneficiaries, 2010
To address these risks, the U.S. Department of Health and Human Services developed a strategic
framework11 to improve health outcomes for people with multiple chronic conditions. Federal
agencies and key partners will use this framework to improve and coordinate care for people with
multiple chronic conditions, make the best use of effective self-care strategies, and support research
to fill knowledge gaps.
The State of Aging and Health in America 2013 PAGE 7
Call to Action
Developing a New Healthy Brain Initiative Road Map
In 2005, CDC established the Healthy Brain Initiative in the Healthy Aging Program with funding
from Congress. In 2007, hundreds of stakeholders worked with the program to create a 5-year
framework to guide a coordinated public health response across organizations and agencies.
This effort is outlined in The Healthy Brain Initiative: A National Public Health Road Map to
Maintaining Cognitive Health (available at www.cdc.gov/aging/healthybrain/roadmap.htm).
On January 4, 2011, the National Alzheimer’s Project Act (NAPA) was signed into law by
President Barack Obama. The law established the Advisory Council on Alzheimer’s Research,
Care, and Services and requires the Secretary of the U.S. Department of Health and Human
Services (HHS), in collaboration with the Advisory Council, to create and maintain a national
plan to address and overcome the rapidly escalating crisis of Alzheimer’s disease and related
dementias. In May 2012, The National Plan to Address Alzheimer’s Disease was released by
HHS, and refers to Alzheimer’s disease as, “a major public health issue.” NAPA provided an
opportunity for CDC to renew its commitment to incorporate cognitive health as an essential
component of public health, and to highlight CDC’s accomplishments related to the Healthy
Brain Initiative (see the Healthy Brain Initiative Progress report at (www.cdc.gov/aging/pdf/
HBIBook_508 ).
CDC is developing a second Road Map, The Healthy Brain Initiative: The Public Health Road
Map for State and National Partnerships, 2013–2018. This document outlines how state and
local public health agencies and their partners can promote cognitive functioning, address
cognitive impairment for individuals living in the community, and help meet the needs of care
partners. The Road Map provides actions under four areas: monitor and evaluate, educate
and empower the nation, develop policy and mobilize partnerships, and assure a competent
workforce. Public health agencies and private, nonprofit, and governmental partners at the
national, state, and local levels are encouraged to work together on actions in the Road Map
that best fit their missions, needs, interests, and capabilities. For more information, go to
www.cdc.gov/aging/healthybrain.
www.cdc.gov/aging/healthybrain/roadmap.htm
www.cdc.gov/aging/pdf/HBIBook_508
www.cdc.gov/aging/pdf/HBIBook_508
www.cdc.gov/aging/healthybrain
PAGE 8 The State of Aging and Health in America 2013
New Directions in Public Health for Older Americans
As more and more Americans reach the age of 65, society is increasingly challenged to help them grow
older with dignity and comfort. Meeting these challenges is critical to ensuring that baby boomers can
look forward to their later years. Three key areas that public health professionals are beginning to
address among older adults are binge drinking, emergency preparedness, and health literacy. These
areas have long been the target of health care and aging services professionals.
Older Adults and Excessive Alcohol Use
Excessive alcohol use, including binge drinking, accounts for more than 21,000 deaths among adults
65 or older each year in the United States.12 Binge drinking is defined as women consuming four
or more drinks and men consuming five or more drinks on a single occasion. In 2006, excessive
drinking cost the U.S. economy $223.5 billion, or $1.90 a drink.13 Excessive drinking increases a
person’s risk of developing high blood pressure, liver disease, certain cancers, heart disease, stroke,
and many other chronic health problems, as well as a person’s risk of car crashes, falls, and violence.14
Excessive alcohol use can also interact with prescription and over-the-counter medications and
affect compliance with treatment protocols for chronic conditions, thus undermining the effective
management of chronic diseases.15,16
In 2010, binge drinking was reported by one of six (38 million) U.S. adults. The prevalence of binge
drinking was higher among adults aged 18–24 years (28.2%) and aged 25–34 years (27.9%) and
decreased with increasing age to 3.8% among adults aged 65 or older (Figure 4). However, older adults
who binge drank reported engaging in this behavior more frequently than their younger counterparts—
an average of five to six times a month. They also reported consuming an average of about six drinks
when they did, thereby increasing their risk of developing many health and social problems.17
CDC is assessing the public health effect of excessive drinking, including binge drinking. We are
also working with states and communities to translate strategies for preventing excessive alcohol
consumption recommended in The Guide to Community Preventive Services (Community Guide) into
public health practice. These recommendations include increasing the price of alcohol, regulating the
number and concentration of alcohol retailers in a community, holding alcohol retailers liable for harms
resulting from illegal sales to underage or intoxicated persons, maintaining government controls of
alcohol sales (avoiding privatization), using electronic screening and brief intervention for excessive
alcohol use, and limiting the days and hours when alcohol is sold.18
CDC is also helping to increase screening and counseling for excessive alcohol use in clinical settings,
as recommended for adults by the U.S. Preventive Services Task Force.19 Taken together, these
prevention measures can help reduce excessive alcohol use and the many health and social harms
related to it. They can also help the United States meet the Healthy People 2020 leading health indicator
of reducing binge drinking among all U.S. adults.20
The State of Aging and Health in America 2013 PAGE 9
Figure 4. Binge Drinking Among U.S. Adults, 2010
4.2 4.2 4.1
4.7
5.5
0
2
4
6
A
ve
ra
g
e
N
o
. o
f
B
in
g
e
Ep
is
o
d
es
p
er
M
o
n
th
28.2 27.9
19.2
13.3
3.8
0
10
20
30
18–24
25–34
35–44
45–64
65+
18–24
25–34
35–44
45–64
65+
P
er
ce
n
ta
g
e
Age groups (years)
Frequency of Binge Drinking
Among Binge Drinkers Only
Prevalence of Binge Drinking
Among All Adults
*Data from states (except South Dakota and Tennessee) and the District of Columbia.
Source: MMWR 2012;61:14-19.
www.cdc.gov/mmwr/preview/mmwrhtml/mm6101a4.htm?s_cid=mm6101a4_e%0d%0a.
Using Data to Better Protect Vulnerable Older Adults in Emergencies
Some older adults may have difficulty keeping themselves safe and healthy during an emergency
or natural disaster. Conditions such as impaired mobility, multiple chronic health conditions, or
difficulty with memory may cause some older adults to need extra help planning for and dealing
with situations such as hurricanes or floods. Emergencies and disasters can also disrupt the help
that many older adults rely on for independent living, such as help from friends, family, and
home-based medical care.21
To help states, communities, and partner organizations plan for the needs of older adults,
CDC released Identifying Vulnerable Older Adults and Legal Preparedness Options for
Increasing Their Protection During All-Hazards Emergencies: A Cross-Sector Guide for States
and Communities. This guide presents practical strategies and legal options for protecting
older adults during all-hazards emergencies. A key strategy in this guide is “characterizing the
population.” This phrase means using community and state data about demographics, health
status, medical conditions, service requirements, and other needs to paint a picture of the older
adult population so their needs are properly considered in planning. Some of the key indicators
in this report, such as disability, oral health, taking medicine for high blood pressure, and
influenza and pneumococcal vaccinations, are particularly important when trying to understand
the medical needs and health status of a community. This knowledge helps to ensure that
appropriate medical equipment, pharmaceuticals, and preventive measures can be taken in a
shelter environment, evacuation, or shelter-in-place event.21
To supplement this guide, CDC created a Web portal for both professionals and the public that
includes resources, tools, and information related to all-hazards preparedness for older adults. For
more information, go to www.cdc.gov/aging/emergency.
www.cdc.gov/aging/emergency
PAGE 10 The State of Aging and Health in America 2013
Improving Health Literacy Among Older Adults
Why Does Health Literacy Matter?
Every day, people confront situations that involve life-changing decisions about their health. These
decisions are made in places such as grocery and drug stores, workplaces, playgrounds, doctors’
offices, clinics and hospitals, and around the kitchen table. Obtaining, communicating, processing,
and understanding health information and services are essential steps in making appropriate health
decisions. However, research indicates that today’s health information is presented in ways that are
not usable by most adults. Limited health literacy occurs when people cannot find and use the health
information and services they need.
�� Nearly 9 of 10 adults have trouble using the everyday health information that is routinely available
in our health care facilities, retail outlets, media, and communities.22
�� Among adult age groups, those aged 65 or older have the smallest percentage of people with proficient
health literacy skills and the largest percentage with “below basic” health literacy skills.22
�� Without clear information and an understanding of the information’s importance, people are more
likely to skip necessary medical tests, end up in the emergency room more often, and have a
harder time managing chronic diseases such as diabetes or high blood pressure.23
What Is Health Literacy?
Health literacy was defined by Healthy People 2010 as, “the degree to which individuals have the capacity
to obtain, process, and understand basic health information and services needed to make appropriate
health decisions.”24 Healthy People 2020 is tracking health literacy improvement, which is defined as how
many health care providers make sure their instructions are easy for patients to understand.
How Can We Improve Health Literacy?
Recent federal policy initiatives have brought health literacy to a tipping point.25 We are also more
aware that the skills of individual patients are not the only important part of health literacy. This
concept includes what health systems and professionals do to make health information and services
understandable for everyone, regardless of their literacy skills.26 We can do much better in designing and
presenting health information and services that people can use effectively. We can build our own health
literacy skills and help others—such as community members, health professionals, and anyone who
communicates about health—build their skills. Every organization involved in health information and
services needs its own health literacy plan to improve its organizational practices.
To support this effort, CDC created new resources on its Health Literacy Web site to help health and other
professionals communicate health messages more effectively with older adults and their caregivers. This
Web site includes self-assessments, background information on health literacy, ways to improve materials,
and links to resources about older adults and caregivers. The resources on this site will help you learn
about health literacy issues, develop skills, create an action plan, and apply what you learn to create
health information and services that truly make a positive difference in people’s lives. www.cdc.gov/
healthliteracy/DevelopMaterials/Audiences/OlderAdults/index.html.
www.cdc.gov/healthliteracy/DevelopMaterials/Audiences/OlderAdults/index.html
www.cdc.gov/healthliteracy/DevelopMaterials/Audiences/OlderAdults/index.html
The State of Aging and Health in America 2013 PAGE 11
Call to Action
Addressing Lesbian, Gay, Bisexual, and Transgender (LGBT) Aging and Health Issues
The federal Administration on Aging has historically served racial and ethnic minorities as
populations of need, and it directs resources to organizations that serve these populations.
Tremendous gains have been made in the health of Americans during the past century.
Unfortunately, historically disadvantaged groups—including lesbian, gay, bisexual, and
transgender (LGBT) adults—within the older adult population continue to have higher levels of
illness, disability, and premature death.27 Aging services and health needs of LGBT older adults
are often not addressed in policies, research, or services,28 even though diversity is a defining
feature of the aging population. The Aging Services and Public Health Networks can address the
unique needs of LGBT older adults by working in the areas where services are most needed—
senior housing, transportation, legal services, and chronic disease prevention.
The landmark report, The Aging and Health Report: Disparities and Resilience among Lesbian,
Gay, Bisexual, and Transgender Older Adults, found that, among older LGBT adults,
�� Most (91%) engage in wellness activities.
�� 13% have been denied health care or received inferior care.
�� About 50% have a disability, and 33% report depression.
�� More than 20% do not disclose their sexual or gender identity to their doctor.
�� About 33% do not have a will or durable power of attorney for health care.29
In 2010, the Administration on Aging created a national resource center for LGBT older adults.
This clearinghouse was designed to educate professionals within aging services organizations
about the special needs and existence of LGBT older adults. It is also intended to provide
organizations and individuals with information on the importance of planning ahead for future
long-term care needs. For more information, go to http://lgbtagingcenter.org.
http://lgbtagingcenter.org.
PAGE 12 The State of Aging and Health in America 2013
References
1. US Census Bureau. National population projections. US Census Web site.
http://www.census.gov/population/www/projections/summarytables.html.
2. Pew Research Center. Baby boomers retire. Pew Research Center Web site.
http://pewresearch.org/databank/dailynumber/?NumberID=1150.
3. Wan H, Sengupta M, Velkoff VA, DeBarrow KA. 65+ in the United States: 2005 Current Population Reports.
P23-209.Washington, DC: US Census Bureau; 2005. http://www.census/gov/prod/2006pubs/p23-209 .
4. Holtzman D, Anderson LA. Aging and health in America: a tale from two boomers. Am J Public Health.
2012;102(3):392.
5. US Census Bureau. US Population Projections. US Census Bureau Web site. http://www.census.gov/
population/www/projections/summarytables.html.
6. Centers for Disease Control and Prevention. Leading causes of death, 1900–1998. Centers for Disease Control
and Prevention Web site. http://www.cdc.gov/nchs/data/dvs/lead1900_98 .
7. Hoffman C, Rice D, Sung HY. Persons with chronic conditions: their prevalence and costs. JAMA.
1996;276(18):1473-1479.
8. Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention. Physical activity
and older Americans: benefits and strategies; Agency for Healthcare Research and Quality Web site.
http://www.ahrq.gov/ppip/activity.htm.
9. Kaiser Family Foundation. Medicare spending and financing fact sheet. 2011. Kaiser Family Foundation
Web site. http://www.kff.org/medicare/upload/7305-06 .
10. Fries JD. Measuring and monitoring success in compressing morbidity. Ann Intern Med. 2003;139:455–459.
11. US Department of Health and Human Services. Multiple Chronic Conditions: A Strategic Framework—
Optimum Health and Quality of Life for Individuals with Multiple Chronic Conditions. Washington, DC:
US Dept of Health and Human Services; 2010. http://www.hhs.gov/ash/initiatives/mcc/mcc_framework .
12. Centers for Disease Control and Prevention. Alcohol-related disease impact (ARDI) software. Alcohol and
Public Health Web site. http://www.cdc.gov/alcohol/ardi.htm.
13. Bouchery EE, Harwood HJ, Sacks JJ, Simon CJ, Brewer RD. Economic costs of excessive alcohol consumption
in the United States, 2006. Am J Prev Med. 2011;41:516–524.
14. National Institute of Alcohol Abuse and Alcoholism. Tenth Special Report to the US Congress on Alcohol and
Health. Bethesda, MD: National Institute of Health; 2000. http://pubs.niaaa.nih.gov/publications/10report/
intro .
15. National Institute on Aging. Alcohol Use in Older People. Bethesda, MD: National Institute of Health; 2009.
http://www.nia.nih.gov/health/publication/alcohol-use-older-people.
16. US Department of Agriculture, US Department of Health and Human Services. Chapter 3-foods and food
components to reduce. In: Dietary Guidelines for Americans, 2010. 7th ed. Washington, DC: US Government
Printing Office; 2010; 30–32. http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/
Chapter3 .
17. Kanny D, Liu Y, Brewer RD, Garvin WS, Balluz L. Vital signs: binge drinking prevalence, frequency, and
intensity among adults—United States, 2010. MMWR Morb Mortal Wkly Rep. 2012;61:14–19.
18. Task Force on Community Prevention Services. Preventing excessive alcohol consumption. The Guide to
Community Preventive Services Web site. http://www.thecommunityguide.org/alcohol/index.html.
http://www.census.gov/population/www/projections/summarytables.html
http://pewresearch.org/databank/dailynumber/?NumberID=1150
P23-209.Washington
http://www.census/gov/prod/2006pubs/p23-209
http://www.census.gov/population/www/projections/summarytables.html
http://www.census.gov/population/www/projections/summarytables.html
http://www.cdc.gov/nchs/data/dvs/lead1900_98
http://www.ahrq.gov/ppip/activity.htm
http://www.kff.org/medicare/upload/7305-06
http://www.hhs.gov/ash/initiatives/mcc/mcc_framework
http://www.cdc.gov/alcohol/ardi.htm
http://pubs.niaaa.nih.gov/publications/10report/intro
http://pubs.niaaa.nih.gov/publications/10report/intro
http://www.nia.nih.gov/health/publication/alcohol-use-older-people
http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/Chapter3
http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/Chapter3
http://www.thecommunityguide.org/alcohol/index.html
The State of Aging and Health in America 2013 PAGE 13
19. US Preventive Services Task Force. Screening and behavioral counseling interventions in
primary care to reduce alcohol misuse: recommendation statement. US Preventive Services Task
Force Web site.
http://www.uspreventiveservicestaskforce.org/3rduspstf/alcohol/alcomisrs.htm.
20. US Department of Health and Human Services. Substance abuse. Healthy People 2020 Web site.
http://healthypeople.gov/2020/LHI/substanceAbuse.aspx.
21. Centers for Disease Control and Prevention. Identifying Vulnerable Older Adults and Legal Options
for Increasing Their Protection During All-Hazards Emergencies: A Cross-Sector Guide for States and
Communities. Atlanta, GA: Centers for Disease Control and Prevention. US Dept of Health and Human
Services; 2012.
22. Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America’s Adults: Results from the 2003
National Assessment of Adult Literacy. Washington, DC: National Center for Education Statistics, US Dept
of Education, 2006. NCES publication 2006-483.
23. Rudd RE, Anderson JE, Oppenheimer S, Nath C. Health literacy: an update of public health and medical
literature. In: Comings JP, Garner B, Smith C, eds. Review of Adult Learning and Literacy. Vol 7.
Mahwah, NJ: Lawrence Erlbaum Associates; 2007.
24. US Department of Health and Human Services. Healthy People 2010. Washington, DC: US Government
Printing Office; 2000.
25. Koh HK, Berwick DM, Clancy CM, et al. New federal policy Initiatives to boost health literacy can help the
nation move beyond the cycle of costly ‘Crisis Care.’ Health Affairs. 2012;3(2):434-443.
26. US Department of Health and Human Services. National Action Plan to Improve Health Literacy. Washington,
DC: Office of Disease Prevention and Health Promotion. US Dept of Health and Human Services; 2010.
27. Fredriksen-Goldsen K, Muraco A. Aging and sexual orientation: a 25-year review of the literature. Research on
Aging. 2010;32(3):372–413.
28. Institute of Medicine. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation
for Better Understanding. Washington, DC: The National Academies Press; 2011.
29. Fredriksen-Goldsen KI, Kim HJ, Emlet CA, et al. The Aging and Health Report: Disparities and Resilience among
Lesbian, Gay, Bisexual, and Transgender Older Adults. Seattle, WA: Institute for Multigenerational Health; 2011.
http://www.uspreventiveservicestaskforce.org/3rduspstf/alcohol/alcomisrs.htm
http://healthypeople.gov/2020/LHI/substanceAbuse.aspx
PAGE 14 The State of Aging and Health in America 2013
This section reports on 15 indicators related to the health status of adults aged 65 years or older, health
behaviors, preventive care and screening, and injuries. These indicators were chosen because they can be
modified and they present a comprehensive picture of older adult health. Table 1 shows the most current
data for the United States for each indicator and indicates whether the Healthy People 2020 target was
met, if applicable. For most indicators, the Behavioral Risk Factor Surveillance System (BRFSS) is not the
official data source for tracking the Healthy People 2020 targets. Some of these targets are for all adults
aged 18 or older, not just those aged 65 or older. For this report, we use BRFSS data to report how well
states are doing in meeting Healthy People 2020 targets for their older adult population. Some targets
have been met, but there is always room for improvement. A detailed description of each indicator
follows the report card, and a full description of Healthy People 2020 targets is in the Appendix.
Summary of Findings
The United States has met six of the eight Healthy People 2020 targets for indicators in this report:
no leisure time physical activity, obesity, current smoking, medication for high blood pressure,
mammogram within past 2 years, and colorectal cancer screening.
The State of Aging and Health in America 2013 PAGE 15
The National Report Card
on Healthy Aging
Table 1. The National Report Card on Healthy Aging: How Healthy Are Older Adults in the United States?
Indicator
Data for Adults
Aged 65 or Older*
Data Year
Healthy People
2020 Target
Score Target
Met or Not Met†
Health Status
1. Physically unhealthy days (mean number
of days in past month)
5.4 2010 ‡ ‡
2. Frequent mental distress (%)§ 6.9 2010 ‡ ‡
3. Oral health: tooth retention (%)|| 59.6 2010 ‡ ‡
4. Disability (%)¶ 37.9 2010 ‡ ‡
Health Behaviors
5. No leisure-time physical activity in past
month (%)
31.4 2010 32.6 Met
6. Eating fruits and
vegetables daily: 2009 # #
Eating ≥2 fruits daily (%)
Eating ≥3 vegetables daily (%)
41.8
29.6
7. Obesity (%) 24.3 2010 30.6 Met
8. Current smoking (%) 8.3 2010 12.0 Met
9. Medication for
high blood pressure (%)**
94.0 2009 77.4 Met
Preventive Care and Screening
10. Flu vaccine in past year (%) 66.9 2010 90.0
Not Met
11. Ever had pneumonia
vaccine (%)
68.1 2010 90.0 Not Met
12. Mammogram within past
2 years (%)
82.9 2010 70.0 Met
13. Colorectal cancer screening (%) 73.1 2010 70.5 Met
14. Up-to-date on select preventive
services (%)††
Men
Women
48.5
48.5
2010
2010
50.9
52.7
Not Met
Not Met
Injuries
15. Fall with injury within
past year (%)
31.7 2010 ‡ ‡
Source: CDC, Behavioral Risk Factor Surveillance System, 2009–2010.
* Data for all Indicators were collected by CDC’s Behavioral Risk Factor Surveillance System (BRFSS) and depict the mean for all 50 states
and the District of Columbia. See Appendix for a full description of the BRFSS.
† Score is based on attainment of Healthy People 2020 targets among the older adult population. Some targets are for all adults aged 18 or older,
not just those aged 65 or older. This table only reports data for older adults. See Appendix for a full description of Healthy People 2020.
‡ Indicators 1, 2, 4, and 15 do not have Healthy People 2020 targets.
§ Frequent mental distress is defined as having had 14 or more mentally unhealthy days in the previous month.
|| Tooth retention is defined as the percentage of older adults who have lost 5 or fewer of their natural teeth.
¶ Disability is defined on the basis of an affirmative response to either of the following two questions on the 2010 BRFSS Survey: “Are you limited
in any way in any activities because of physical, mental, or emotional problems?” or “Do you now have any health problem that requires you to
use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?”
# Healthy People 2020 divides the nutrition targets into multiple categories of fruits and vegetables. See Appendix for a full description.
** This indicator describes the percentage of people with diagnosed high blood pressure who are taking prescribed medication. The National
Health and Nutrition Examination Survey (NHANES) is used to officially track this indicator at the national level for adults aged 18 or older. For
2005–2008, NHANES data indicate that 70.4% of adults aged 18 or older and 79.4% adults aged 65 or older had high blood pressure
and took prescribed medications.
†† For men, three services are included: flu vaccine in past year, ever had a pneumonia vaccine, and colorectal cancer screening. For women,
these
same three services are included, plus a mammogram within past 2 years.
PAGE 16 The State of Aging and Health in America 2013
Health Status Indicators
Indicator 1. Physically unhealthy days
�� CDC collects data on adults’ physically unhealthy days through the BRFSS. Respondents are
asked how many of the previous 30 days they felt that their physical health (including physical
illness and injury) was “not good.”
�� Older adults have the highest rates of poor physical health and activity limitation compared with
other age groups.1
Call to Action
Using Data on Physically Unhealthy Days to Guide Interventions
Older adults report many more physically unhealthy days than younger adults. Many of these
unhealthy days are from pain, discomfort, and impairments associated with common chronic
diseases and conditions that increase with age—such as arthritis, back and neck pain, diabetes,
cardiovascular disease, and cancer.2,3 Older adults who meet physical activity guidelines are
less likely to experience frequent physical distress, which is defined as 14 or more physically
unhealthy days.4
By monitoring physically unhealthy days regularly, we can identify whether older
adults are declining in physical functioning. This information can be used to develop
effective community interventions for older adults with arthritis. Proven programs include
EnhanceFitness (www.projectenhance.org), an exercise program that can increase strength,
boost activity levels, and elevate mood5 and Walk with Ease (www.arthritis.org/walk-
with-ease.php), a group walking program that can improve health outcomes and boost
confidence in managing symptoms and being physically active.6
In addition, Active Living Every Day (ALED) (www.activeliving.info) is a group-based
program developed to help people who are sedentary become and stay physically active.7
Programs such as these may help older adults maintain or improve their physical health
status. For a description of system-based interventions, please see the “Spotlight: Mobility”
section of this report (page 35).
Indicator 2. Frequent mental distress
�� The BRFSS also assesses general mental health status. Respondents are asked to report how
many of the previous 30 days their mental health was not good because of stress, depression, or
problems with emotions. Frequent mental distress is defined as having 14 or more days of poor
mental health in the previous 30 days. This definition uses a 14-day minimum period because
many health care providers and researchers use a similar duration of mental distress as a marker
for clinical depression and anxiety disorders.
�� Older adults tend to have lower rates of frequent mental distress compared with other age groups
(Figure 5).8
www.projectenhance.org
www.arthritis.org/walk-with-ease.php
www.arthritis.org/walk-with-ease.php
www.activeliving.info
The State of Aging and Health in America 2013 PAGE 17
Call to Action
Addressing Mental Distress in Older Adults
Some aspects of mental health improve with age. But many older adults still suffer with
mental distress associated with limitations in daily activities, physical impairments, grief
following loss of loved ones, caregiving or challenging living situations, or untreated
mental illness such as depression or substance abuse. About 25% of adults aged 65
years or older have some type of mental health problem, such as a mood disorder not
associated with normal aging.9 Although social ties are one of the strongest predictors
of well-being, about 12% of adults aged 65 or older report that they “rarely” or “never”
receive the social and emotional support they needed.10 Mental distress is a problem
by itself, and it has been associated with unhealthy behaviors than can interfere with
self-management and inhibit recovery from an illness. For example, older adults with
frequent mental distress are less likely than those without frequent mental distress to be
nonsmokers, to eat at least five fruits or vegetables daily, and to participate in moderate-to-
vigorous physical activity during the average week.11
Health care providers and other service providers who have contact with older adults can
help identify those with mental distress by regularly asking them if they have any stress,
depression, or problems with their emotions. Health care providers can also help older
adults recognize unusual increases in stress or sadness and help them understand that
these symptoms may not be simply a “normal part of aging.”
On a population level, self-reports of mental distress should be monitored as an indicator
of mental health problems among older populations. Evidence-based programs are
available to help improve mental health among older adults. One example is IMPACT, a
collaborative care program for older adults with major depression or dysthymic disorder.
IMPACT resulted in at least a 50% reduction in depressive symptoms, less functional
impairment, and better quality of life in older adults who participated in the program.12
Another intervention program, PEARLS, targets older adults with minor depression
or dysthymia who are receiving social services from community agencies. PEARLS
participants were three times more likely than those receiving usual care to report a
significant reduction in their symptoms (43% vs. 15%) or complete elimination of their
depression (36% vs. 12%).13 Participants also reported greater health-related quality of life
improvements in functional and emotional well-being. Interventions such as these, as well
as programs delivered by local area agencies that increase social support, may be effective
in reducing symptoms of frequent mental distress in older adults.
PAGE 18 The State of Aging and Health in America 2013
Figure 5. Prevalence of frequent mental distress, by age, among U.S. adults, 2006–2010
U
.S
. A
d
u
lt
s
Age groups (years)
Source: CDC. Health Related Quality of Life Web Site. Behavioral Risk Factor Surveillance System, 2006–2010.
11.5%
11.0% 10.7%
11.7%
11.0%
6.9%
6.3%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
18 –24 25– 34 35 –44 45 –54 55 –64 65 –74 75+
Indicator 3. Oral health: tooth retention
�� The percentage of older adults who have retained their natural teeth (i.e., lost 5 or fewer
teeth) has increased steadily over the past few decades. This trend is significant because the
mouth reflects a person’s health and well-being throughout life.
�� Poor oral health may limit food choices and diminish the pleasure of eating, impair chewing
efficiency, limit social contacts and intimacy, affect speech, cause pain, and detract from
physical appearance. All of these problems can negatively affect a person’s health and well-
being. Oral diseases can affect many aspects of general health, and some health conditions
can, in turn, have an effect on oral health.
�� Older adults may have more difficulty accessing effective interventions to prevent and control
oral disease than younger adults. Barriers include lack of insurance, physical limitations that
make brushing teeth difficult, and lack of perceived need for oral health care.
14
Indicator 4. Disability
�� In this report, disability is defined on the basis of an affirmative response to either of the
following two questions on the 2010 BRFSS Survey: “Are you limited in any way in any
activities because of physical, mental, or emotional problems?” or “Do you now have any
health problem that requires you to use special equipment, such as a cane, a wheelchair, a
special bed, or a special telephone?”
�� The chance of having a disability goes up with age, from less than 10% for people aged 15
years or younger to almost 75% for people aged 80 or older.
�� People with disabilities face many challenges related to mobility and accessibility.15
The State of Aging and Health in America 2013 PAGE 19
New Resource for Data on Disabilities
CDC created the Disability and Health Data System (DHDS) to help partners, researchers,
advocates, and the public assess the health and wellness of people with disabilities. The
DHDS provides access to state health and demographic data by disability status and level
of psychological distress. The DHDS also provides data on disability-associated health
care expenditures.
The data are available in several formats, including standard contrast and high-contrast
interactive maps and data tables that can be customized or downloaded. Users can easily
identify location-specific data for a single year, for multiple years, and by state, territorial,
division, regional, and national levels. For more information, go to http://dhds.cdc.gov.
Indicator 5. Physical activity
�� Regular physical activity is one of the most important things older adults can do for
their health. Physical activity can prevent many of the health problems that may come
with age. According to the 2008 Physical Activity Guidelines for Americans, older adults
need to do two types of physical activity each week to improve health—aerobic and
muscle-strengthening.16
�� Strong evidence shows that regular physical activity is safe and reduces the risk of falls
among older adults. Older adults at risk of falling should do exercises that maintain or
improve their balance. For best results, they should do these exercises at least 3 days a
week from a program shown to reduce falls.
How Much Activity Do Older Adults Need?
2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (i.e., brisk
walking) every week and muscle-strengthening activities on 2 or more days a week that
work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms).
OR
1 hour and 15 minutes (75 minutes) of vigorous-intensity aerobic activity (i.e., jogging
or running) every week and muscle-strengthening activities on 2 or more days a week
that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and
arms).
OR
An equivalent mix of moderate- and vigorous-intensity aerobic activity and muscle-
strengthening activities on 2 or more days a week that work all major muscle groups
(legs, hips, back, abdomen, chest, shoulders, and arms).
Source: CDC, Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and
Health Promotion, 2011. www.cdc.gov/physicalactivity/everyone/guidelines/olderadults.html.
http://dhds.cdc.gov
www.cdc.gov/physicalactivity/everyone/guidelines/olderadults.html
PAGE 20 The State of Aging and Health in America 2013
Indicator 6. Eating fruits and vegetables daily
�� Diets rich in fruits and vegetables may reduce the risk of some cancers and chronic diseases,
such as diabetes and cardiovascular disease. Fruits and vegetables provide essential vitamins and
minerals, fiber, and other substances that are important for good health.
�� A greater proportion of adults aged 65 years or older eat 5 or more fruits and vegetables daily
compared with other age groups.17
Indicator 7. Obesity
�� Obesity is defined as having a body mass index (BMI) of 30 or higher. BMI is calculated by
dividing a person’s weight in kilograms by his or her height in meters squared (kg/m2).
�� The BRFSS uses self-reported data about height and weight, which may lead to under estimating
obesity in the United States. The National Health and Nutrition Examination Survey (NHANES),
which takes body measurements, estimates the prevalence of obesity among older adults at 34.6%.18
�� Older adults can benefit from maintaining a healthy body weight. Obesity is a risk factor for many
chronic conditions, including stroke, heart disease, cancer, and arthritis.19
�� The environment plays a role in helping to fight obesity. People may make decisions on the basis
of their environment or community. For example, a person may choose not to walk to the store
or to work because of a lack of sidewalks. Communities, homes, and workplaces can all influence
people’s health decisions. Because of this influence, it is important to create environments in these
locations that make it easier to be physically active and eat a healthy diet.
Indicator 8. Current smoking
�� Tobacco use remains the single largest preventable cause of disease, disability, and death in
the United States.20
�� Although most older adults who were once regular smokers have quit, about 8.4% of adults
aged 65 or older were still smoking cigarettes in 2010 (Table 1).
Monitoring State and Community Environmental Policies
CDC’s Division of Nutrition, Physical Activity, and Obesity has a policy monitoring
system accessible through an online database that allows users to search for state-
level legislation and regulations related to obesity, physical activity, and nutrition.
Topics such as access to healthy foods, farmers’ markets, fruits and vegetables, active
transit, parks and recreation, transportation, pedestrians, and walking in community
and medical settings can be researched by state and year. The database allows users
to track policies over time, as well as between states. To access the database, go to
http://apps.nccd.cdc.gov/DNPAOLeg.
http://apps.nccd.cdc.gov/DNPAOLeg
The State of Aging and Health in America 2013 PAGE 21
Indicator 9. Taking medications for high blood pressure
�� This indicator describes the percentage of older adults with diagnosed high blood pressure who are
taking medication to control this condition.
�� High blood pressure is a major risk factor for cardiovascular disease, the leading cause of illness and
death among older adults.21 Of the almost 67 million Americans with high blood pressure, more than
half do not have it under control.22
�� About 90% of Americans eat more sodium than is recommended, which can increase a person’s risk
of high blood pressure. Places that produce, sell, or serve food can limit the amount of sodium in
food products, provide information about sodium in foods, and stock lower sodium foods. People
can choose to buy healthy food products, limit processed foods, and ask for lower sodium options.23
�� A team-based approach to health care can also help address high blood pressure. Health care systems
can use electronic health records, encourage the use of 90-day refills, and consider having low or no
co-pays for services. Health care providers, such as doctors, nurses, and pharmacists, can track their
patients’ blood pressure, prescribe once-a-day medications, and give clear instructions on how to
take blood pressure medications. Patients should take the initiative to monitor their blood pressure
between medical visits, take medications as prescribed, tell their doctor about any side effects, and
make lifestyle changes, such as eating a low-sodium diet, exercising, and stopping smoking.21
Indicator 10. Flu vaccine in past year
Indicator 11. Ever had pneumonia vaccine
�� Although both are largely preventable through vaccination, flu and pneumonia represent the 7th
leading cause of death among U.S. adults aged 65 years or older.24
�� About 90% of seasonal flu-related deaths and more than 60% of seasonal, flu-related hospitalizations
in the United States each year occur among people aged 65 years or older. This is because human
immune defenses become weaker with age.
25
�� Previous experience is the best predictor of whether an older adult receives these vaccinations.
People are more likely to get a flu shot if they have gotten it in previous years. Older adults are more
likely to get the pneumonia vaccine if they have gotten a flu shot in the past.26
Indicator 12. Mammogram within past 2 years
�� Almost half of all new cases and nearly two-thirds of deaths from breast cancer occur among women
aged 65 years or older.30
�� Mammography is the best available method to detect breast cancer in its earliest, most treatable
stage before it is big enough to feel or cause symptoms.31 Mammography screening every 2 years for
women aged 65–74 has been shown to reduce deaths.
32
�� Mammograms for women aged 65 or older are covered by Medicare, but BRFSS data show that many
women are still not getting this preventive service.
PAGE 22 The State of Aging and Health in America 2013
Million Hearts: Prevention at Work
In 2011, HHS, the Centers for Medicare & Medicaid Services (CMS), and CDC launched
the Million Hearts campaign. This initiative seeks to prevent one million heart attacks and
strokes among Americans during the next 5 years. It also seeks to improve clinical care
by helping patients learn and follow their ABCS:
�
�
�
�
�
Appropriate Aspirin use for people at risk.
�Blood pressure control.
�Cholesterol management.�
�Smoking cessation.
The Million Hearts campaign is also designed to reduce the number of people who need
cardiovascular treatment. To support this initiative, state, county, and local health officials
are encouraged to
�� PROMOTE smoke-free air policies, effective tobacco packaging labels,
restricted tobacco advertising, and higher tobacco prices.
�� SUPPORT education programs, tobacco prevention incentives, wellness
programs, recognition programs, and efforts to reduce sodium and eliminate
trans fats in the food supply.
�� INCREASE awareness of heart disease and stroke and their risk factors.
�� BUILD local partnerships to enhance the effectiveness and efficiency of efforts
to prevent heart attack and stroke.
For more information, go to http://millionhearts.hhs.gov/index.html.
http://millionhearts.hhs.gov/index.html.
The State of Aging and Health in America 2013 PAGE 23
Call to Action
Monitoring Vaccination Rates for Shingles
Shingles, also known as herpes zoster, is a disease that causes a painful skin rash. It
can also lead to severe pain that can last for months or even years after the rash goes
away, a condition known as post-herpetic neuralgia. Pain from shingles has been
described as excruciating, aching, burning, stabbing, and shock-like. It can cause
depression, anxiety, difficulty concentrating, loss of appetite, and weight loss. Shingles
may interfere with activities of daily living, such as dressing, bathing, eating, cooking,
shopping, and travel. To prevent shingles, CDC recommends that people aged 60
years or older receive a onetime vaccination.27
To date, only national data have been available to monitor the use of the shingles
vaccine. In 2010, 14.4% of adults aged 60 or older reported receiving the vaccine, an
increase from the 10% reported in 2009.28 Recognizing the need for state and selected
MMSA (metropolitan and micropolitan statistical area) data, CDC created a question
about shingles vaccination for the BRFSS survey. Since 2009, this question has been
available as an optional module that states can use to ask about the receipt of shingles
vaccination among adults aged 50 years or older. Five states used the question in 2009
and six states used it in 2010.29
Starting in 2014, the shingles vaccination question will be part of the BRFSS “core”
questionnaire that all states use every 3 years. These data will allow states and MMSAs
to monitor trends in vaccination rates and identify disparities. Program planners can
use this information to identify problems so they can adopt corrective strategies.
Indicator 13. Colorectal cancer screening
�� This report identifies the percentage of older adults who have been screened for
colorectal cancer by having a fecal occult blood test (FOBT) during the past year, a
flexible sigmoidoscopy within 5 years and FOBT within 3 years, or a colonoscopy
within 10 years.
�� Colorectal cancer almost always develops from precancerous polyps (abnormal
growths) in the colon or rectum. Screening tests can find precancerous polyps so that
they can be removed before they turn into cancer. They can also detect colorectal
cancer early, when treatment works best.33
�� Two-thirds of all new cases of colorectal cancer are in people aged 65 or older.34
PAGE 24 The State of Aging and Health in America 2013
Indicator 14. Up-to-date on select preventive services
�� The “up-to-date” indicator presents a composite picture of the vaccination and screening behaviors
of older adults. Indicators 10 through 13 measure the use of selected clinical preventive services
that are covered by Medicare 35 and recommended for adults aged 65 years or older. Although each
is essential independently, older adults need to access all of these services to protect their health.
�� For men, three services are included: flu vaccine in past year, ever had pneumonia vaccine,
and colorectal cancer screening. For women, these same three services are included, plus a
mammogram within the past 2 years..
�� This indicator is intended to provide a more meaningful and practical measure of the delivery of
clinical preventive services in communities. This comprehensive measure could also enhance the
ability of health departments and community groups to assess disparities in delivering preventive
services, better assess progress toward measurable objectives, and identify best practices.36
Indicator 15. Falls resulting in injury
�� Each year, one of three adults aged 65 years or older falls. Falls can cause moderate to severe
injuries, such as hip fractures and head traumas, and increase the risk of early death.37
�� Among older adults, falls are the leading cause of injury death. They are also the most common
cause of nonfatal injuries and hospital admissions due to trauma.37
�� Many people who fall, even if they are not injured, develop a fear of falling. This fear may cause
them to limit their activities—leading to reduced mobility and loss of physical fitness, which in turn
increases their actual risk of falling.38
The State of Aging and Health in America 2013 PAGE 25
1. Centers for Disease Control and Prevention. Health related quality of life: nationwide trends. Centers for Disease
Control and Prevention Web site. http://apps.nccd.cdc.gov/HRQOL/TrendV.asp?State=1&Category=3&Measure=2.
2. Centers for Disease Control and Prevention. Measuring healthy days. Atlanta, Georgia: 2000. Table 2.
www.cdc.gov/hrgol/pdfs/mhd .
3. Centers for Disease Control and Prevention. Health-related quality of life surveillance—United States, 1993–2002.
MMWR. 2005:54(No. SS-4).
4. Brown DW, Balluz LS, Heath GW. Associations between recommended levels of physical activity and
health-related quality of life—findings from the 2001 Behavioral Risk Factor Surveillance System. Prev Med.
2003;37:520-528.
5. Wallace JI, Buchner DM, Grothus L. Implementation and effectiveness of a community-based health promotion
program for older adults. J Gerontol. 1998;53A:M301-M306.
6. Callahan LF, Shreffler JH, Altpeter M, et al. Evaluation of group and self-directed formats of the Arthritis
Foundation’s Walk With Ease program. Arthritis Care Res (Hoboken). 2001;63(8):1098-1107.
7. Dunn AL, Marcus BH, Kampert JB, Garcia ME, Kohl HW, Blair SN. Comparison of lifestyle and structured
interventions to increase physical activity and cardiorespiratory fitness, a randomized trial. JAMA.
1999;281(4):327-334.
8. Centers for Disease Control and Prevention. Health Related Quality of Life Web site. http://apps.nccd.cdc.gov/
HRQOL/TrendV.asp?State=1&Category=3&Measure=7.
9. Centers for Disease Control and Prevention, National Association of Chronic Disease Directors. The State of
Mental Health and Aging in America Issue Brief 1: What Do the Data Tell Us? Atlanta, GA: National Association
of Chronic Disease Directors; 2008.
10. McGuire LC, Strine TW, Okoro CA, Ahluwalia IB, Ford ES. Modifiable characteristics of a healthy lifestyle in U.S.
older adults with or without frequent mental distress: 2003 Behavioral Risk Factor Surveillance System. Am J
Geriatr Psychiatry. 2007;15:754-761.
11. Unützer J, Katon W, Callahan CM, et al. Collaborative care management of late-life depression in the primary
care setting. JAMA. 2002;288:2836-2845.
12. Ciechanowski O, Wagner E, Schmaling K, et al. Community-integrated home-based depression treatment in
older adults: a randomized controlled trial. JAMA. 2004;291:1569-1577.
13. Griffin SO, Jones JA, Brunson D, Griffin PM, Bailey WD. Burden of oral disease among older adults and
implications for public health priorities. Am J Public Health. 2012;102(3):411-418.
14. US Department of Health and Human Services. The 2005 Surgeon General’s Call to Action to Improve the Health
and Wellness of Persons with Disabilities: Calling You to Action. US Dept of Health and Human Services, Office
of the Surgeon General; 2005.
15. Centers for Disease Control and Prevention. 2008 Physical Activity Guidelines for Americans: fact sheet for
health professionals on physical activity guidelines for Americans. Centers for Disease Control and Prevention
Web site. http://www.cdc.gov/nccdphp/dnpa/physical/pdf/PA_Fact_Sheet_OlderAdults .
16. Centers for Disease Control and Prevention. State-specific trends in fruit and vegetable consumption among
adults—United States, 2000-2009. MMWR. 2010;59(35):1125-1130. http://www.cdc.gov/mmwr/preview/
mmwrhtml/mm5935a1.htm?s_cid=mm5935a1_w#tab2.
17. Centers for Disease Control and Prevention. Health Data Interactive Web site. http://205.207.175.93/HDI/
TableViewer/tableView.aspx?ReportId=76.
18. National Heart, Lung, and Blood Institute. Calculate your body mass index National Heart, Lung, and Blood
Institute Web site. http://www.nhlbisupport.com/bmi.
References
http://apps.nccd.cdc.gov/HRQOL/TrendV.asp?State=1&Category=3&Measure=2
www.cdc.gov/hrgol/pdfs/mhd .
http://apps.nccd.cdc.gov/HRQOL/TrendV.asp?State=1&Category=3&Measure=7
http://apps.nccd.cdc.gov/HRQOL/TrendV.asp?State=1&Category=3&Measure=7
http://www.cdc.gov/nccdphp/dnpa/physical/pdf/PA_Fact_Sheet_OlderAdults
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5935a1.htm?s_cid=mm5935a1_w#tab2
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5935a1.htm?s_cid=mm5935a1_w#tab2
http://205.207.175.93/HDI/TableViewer/tableView.aspx?ReportId=76
http://205.207.175.93/HDI/TableViewer/tableView.aspx?ReportId=76
http://www.nhlbisupport.com/bmi
PAGE 26 The State of Aging and Health in America 2013
20. Centers for Disease Control and Prevention. Current cigarette smoking among adults aged ≥18 Years United
States, 2005–2010. Vital Signs. 2011;60(35).
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of contol for too many Americans. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/
features/vitalsigns/hypertension.
23. Centers for Disease Control and Prevention. Where’s the sodium? There’s too much sodium in many common
foods. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/vitalsigns/Sodium/index.html.
24. Centers for Disease Control and Prevention. National Vital Statistics System, 2007–2009. Centers for Disease
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http://www.cdc.gov/flu/about/disease/65over.htm.
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27. Centers for Disease Control and Prevention. Protect yourself against shingles: get vaccinated. Centers for
Disease Control and Prevention Web site. http://www.chronicdisease.org/resource/resmgr/healthy_aging_
critical_issues_brief/ha_cib_shingles . Accessed January 10, 2013.
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Task Force. Ann Intern Med. 2009;151:727-737.
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Medicaid Services Web site. https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/index.html.
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http://www.cdc.gov/nchs/hdi.htm
http://www.cdc.gov/flu/about/disease/65over.htm
http://www.chronicdisease.org/resource/resmgr/healthy_aging_critical_issues_brief/ha_cib_shingles
http://www.chronicdisease.org/resource/resmgr/healthy_aging_critical_issues_brief/ha_cib_shingles
http://apps.nccd.cdc.gov/BRFSSModules/ModByCat.asp?Yr=2010
http://www.cdc.gov/cancer/breast/basic_info/screening.htm
http://www.cdc.gov/cancer/colorectal/basic_info/screening
http://www.uspreventiveservicestaskforce.org/uspstf08/colocancer/colors.htm
https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/index.html
http://www.cdc.gov/pcd/issues/2005/jul/05_0021.htm
http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html
The State of Aging and Health in America 2013 PAGE 27
The State-by-State Report Card
on Healthy Aging
This section presents the State-by-State Report Card on Healthy Aging, which includes data on adults
aged 65 years or older for all 50 states and D.C. Table 2 presents data for the highest and lowest
ranked states and the number of states that met the Healthy People 2020 targets for older adults, where
appropriate. For most indicators, the BRFSS is not the official data source for tracking Healthy People 2020
targets. Some of these targets are for all adults aged 18 years or older, not just those aged 65 or older. For
this report, we use BRFSS data to report how well states are doing in meeting Healthy People 2020 targets
for their older adult populations. A detailed description of each indicator follows the report card, and a
full description of the Healthy People 2020 targets is in the Appendix.
Table 3 presents the most current data for each indicator by state and assigns a score to each state
according to its performance relative to the other states.
SUMMARY OF FINDINGS:
There is considerable variation among the states for each indicator, and mixed progress has been made
since The State of Aging and Health in America 2007 was released. For example,
��
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No states have met all targets.
All states met the targets for obesity, taking medications for high blood pressure, and mammography
within past 2 years.
No states met the targets for flu or pneumonia vaccinations.
Variation among states can be significant. For example, in Utah and Connecticut, 70.9% of older adults have
retained most of their natural teeth, whereas in West Virginia, this is true for only 33.4% of older adults.
PAGE 28 The State of Aging and Health in America 2013
Table 2. State-by-State Report Card on Healthy Aging
Indicator Data Year*
Healthy
People 2020
Target
No. of States
Meeting Target†
Range
Health Status
1. Physically unhealthy days (mean number of days
in past month)
2010 ‡ ‡ 4.0 6.9
2. Frequent mental distress (%)§ 2010 ‡ ‡ 3.9 10.5
3. Oral health: tooth retention (%)|| 2010 ‡ ‡ 33.4 70.9
4. Disability (%)¶ 2010 ‡ ‡ 30.2 46.5
Health Behaviors
5. No leisure-time physical activity in past month (%) 2010 32.6 25 23.2 39.8
6. Eating fruits and vegetables daily: # #
Eating ≥2 fruits daily (%)
Eating ≥3 vegetables daily (%)
2010 25.8 51.3
21.2 39.1
7. Obesity (%) 2010 30.6 51 15.7 29.2
8. Current smoking (%) 2010 12.0 50 4.6 14.6
9. Medication for high blood pressure (%)** 2009 77.4 51 90.1 98.0
Preventive Care and Screening
10. Flu vaccine in past year (%) 2010 90.0 0 59.3 73.4
11. Ever had pneumonia vaccine (%) 2010 90.0 0 61.9 74.0
12. Mammogram within past 2 years (%) 2010 70.0 51 71.8 89.8
13. Colorectal cancer screening (%) 2010 70.5 18 57.1 77.8
14. Up-to-date on select preventive services (%)††
Men
Women
2010 50.9
52.7
15
12
37.0 55.1
37.9 56.1
Injuries
15. Fall with injury within past year (%) 2010 ‡ ‡ 22.8 42.2
Source: CDC, Behavioral Risk Factor Surveillance System, 2009–2010.
* Data for all indicators were collected for adults aged 65 years or older by CDC’s Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is not the
main data source for tracking Healthy People 2020 targets, but it is the source for the state data used in this report. See Appendix for a full description of
the BRFSS.
† Includes all 50 states and the District of Columbia. Some targets are for all adults aged 18 or older, not just those aged 65 or older. This table only reports
data for older adults. See Appendix for a full description of Healthy People 2020.
‡ Indicators 1, 2, 4, and 15 do not have Healthy People 2020 targets.
§ Frequent mental distress is defined as having had 14 or more mentally unhealthy days in the previous month.
|| Tooth retention is defined as having lost 5 or fewer natural teeth.
¶ Disability is defined on the basis of an affirmative response to either of the following two questions on the 2010 BRFSS survey: “Are you limited in any
way in any activities because of physical, mental, or emotional problems?” or “Do you now have any health problem that requires you to use special
equipment, such as a cane, a wheelchair, a special bed, or a special telephone?”
# Healthy People 2020 divides the nutrition target into multiple categories of fruits and vegetables. See Appendix for a full description.
** Indicator 9 describes the percentage of people with diagnosed high blood pressure who are taking prescribed medication.
††For men, three services are included: influenza vaccine in past year, ever had a pneumonia vaccine, and colorectal cancer screening. For women, these
same three services are included, plus a mammogram within past 2 years.
The State of Aging and Health in America 2013 PAGE 29
Table 3. State-by-State Report Card on Healthy Aging
Physically Unhealthy Days
(Mean number of days in past month) 2010
Frequent Mental
Distress*
(%) 2010
Oral Health: Tooth
Retention* (%) 2010
Data† L CI‡ U CI Score§ Data† L CI‡ U CI Score§ Data† L CI‡ U CI Score§
Alabama 6.1 5.6 6.6 3 8.1 6.8 9.4 3 48.0 45.5 50.5 3
Alaska 5.9 4.0 7.9 3 6.7 2.9 10.6 2 59.0 50.7 67.2 2
Arizona 5.2 4.5 5.8 2 6.9 5.4 8.5 2 65.2 62.2 68.3 1
Arkansas 6.0 5.4 6.6 3 8.1 6.5 9.7 3 49.8 46.9 52.7 3
California 5.5 5.1 5.8 2 9.0 7.9 10.1 4 67.7 66.0 69.4 1
Colorado 4.9 4.5 5.3 2 5.2 4.4 6.1 1 67.0 65.0 69.0 1
Connecticut 4.9 4.4 5.4 2 5.6 4.5 6.7 2 70.9 68.5 73.3 1
Delaware 5.3 4.7 5.9 2 6.3 4.8 7.8 2 56.1 53.1 59.2 2
District of Columbia 4.7 4.1 5.4 1 6.4 4.7 8.0 2 63.7 60.4 67.0 1
Florida 5.1 4.8 5.4 2 7.4 6.3 8.4 3 62.7 61.1 64.3 1
Georgia 6.0 5.4 6.6 3 9.0 7.3 10.6 4 55.2 52.4 58.0 2
Hawaii 4.0 3.5 4.4 1 4.0 2.8 5.3 1 69.2 66.6 71.9 1
Idaho 5.6 5.2 6.1 3 6.2 5.1 7.3 2 63.3 61.1 65.5 1
Illinois 5.4 4.9 6.0 2 6.0 4.4 7.5 2 59.2 56.2 62.1 2
Indiana 5.4 5.0 5.9 2 6.6 5.6 7.5 2 55.6 53.5 57.7 2
Iowa 4.7 4.3 5.1 1 3.9 3.1 4.7 1 62.1 59.8 64.4 1
Kansas 4.6 4.2 5.0 1 5.9 4.9 6.8 2 59.7 57.7 61.6 2
Kentucky 6.9 6.3 7.5 4 6.8 5.7 8.0 2 45.3 42.6 48.1 3
Louisiana 6.5 5.9 7.0 4 9.1 7.6 10.6 4 48.5 46.1 51.0 3
Maine 4.5 4.1 4.9 1 5.8 4.8 6.9 2 54.2 52.1 56.4 2
Maryland 4.7 4.2 5.1 1 6.5 5.2 7.8 2 61.7 59.1 64.2 1
Massachusetts 4.9 4.5 5.2 2 5.8 4.9 6.7 2 61.6 59.6 63.6 1
Michigan 5.0 4.6 5.4 2 6.5 5.6 7.5 2 63.8 61.8 65.7 1
Minnesota 4.8 4.3 5.4 2 4.2 3.2 5.3 1 68.4 65.9 71.0 1
Mississippi 6.2 5.7 6.7 3 8.8 7.6 10.0 3 44.3 42.1 46.5 3
Missouri 5.9 5.2 6.5 3 6.3 4.9 7.6 2 52.6 49.7 55.6 2
Montana 5.3 4.8 5.8 2 6.7 5.5 7.9 2 61.9 59.6 64.3 1
Nebraska 4.8 4.4 5.2 2 6.2 5.2 7.2 2 64.1 62.2 66.1 1
Nevada 5.6 4.8 6.3 3 7.9 5.7 10.2 3 59.8 55.9 63.7 2
New Hampshire 5.0 4.5 5.5 2 6.4 5.2 7.6 2 59.9 57.3 62.4 2
New Jersey 5.2 4.8 5.7 2 7.6 6.4 8.9 3 59.0 56.8 61.2 2
New Mexico 5.9 5.4 6.5 3 7.9 6.6 9.2 3 63.4 61.1 65.8 1
New York 5.1 4.7 5.5 2 7.3 6.2 8.4 3 59.1 57.0 61.2 2
North Carolina 5.8 5.3 6.3 3 7.1 5.8 8.4 2 51.7 49.5 53.9 3
North Dakota 5.1 4.5 5.6 2 5.6 4.3 6.9 2 56.4 53.6 59.1 2
Ohio 5.4 4.9 5.8 2 7.1 6.0 8.2 2 54.5 52.3 56.8 2
Oklahoma 6.4 5.9 6.9 4 8.4 7.2 9.5 3 49.6 47.5 51.7 3
Oregon 5.4 4.9 5.9 2 6.3 5.1 7.6 2 65.6 63.2 68.0 1
Pennsylvania 5.3 4.9 5.6 2 5.9 5.1 6.8 2 54.1 52.1 56.0 2
Rhode Island 5.0 4.5 5.4 2 7.0 5.8 8.3 2 57.6 55.2 60.1 2
South Carolina 5.5 4.9 6.0 2 6.1 5.1 7.2 2 51.1 48.7 53.6 3
South Dakota 4.3 3.8 4.8 1 4.4 3.4 5.5 1 54.9 52.4 57.4 2
Tennessee 5.4 4.8 6.1 2 5.4 4.2 6.5 1 46.5 43.6 49.4 3
Texas 5.9 5.5 6.3 3 6.6 5.6 7.6 2 61.3 59.2 63.4 2
Utah 5.0 4.6 5.5 2 6.2 5.1 7.3 2 70.9 68.8 73.0 1
Vermont 4.7 4.3 5.1 1 5.1 4.1 6.1 1 60.3 58.0 62.6 2
Virginia 5.3 4.7 5.9 2 5.9 4.7 7.1 2 63.6 60.6 66.6 1
Washington 4.8 4.5 5.1 2 5.3 4.7 6.0 1 68.1 66.8 69.5 1
West Virginia 6.9 6.3 7.6 4 10.5 8.8 12.2 4 33.4 30.8 36.1 4
Wisconsin 5.5 4.9 6.2 2 5.4 3.9 6.8 1 62.2 59.2 65.3 1
Wyoming 5.3 4.8 5.8 2 5.6 4.5 6.7 2 62.0 59.7 64.4 1
* Defined in Table 2.
† Data are for U.S. adults aged 65 years or older.
‡ A confidence interval (CI) describes the level of uncertainty of an estimate and specifies the range in which the true value is likely to fall. This
report uses a 95% level of significance, which means that 95% of the time, the true value falls within these boundaries. When comparing
prevalence of variables across states or years, we recommend the use of confidence intervals. If the confidence intervals overlap, the difference is
not statistically significant.
§ Scores are calculated as quartiles and show state performance relative to all other states. 1 = top 25%; 4 = bottom 25%.
Source: CDC, Behavioral Risk Factor Surveillance System, 2009–2010. See Appendix for a full description of this data source.
PAGE 30 The State of Aging and Health in America 2013
Table 3. State-by-State Report Card on Healthy Aging (continued)
Disability* (%) 2010 No Leisure-Time Physical
Activity (%) 2010
Eat Fruit 2 or More
Times
a Day (%) 2009
Eat Vegetables 3 or More Times
a Day (%) 2009
Data† L CI‡ U CI Score§ Data† L CI‡ U CI Score§ Data† L CI‡ U CI Score§ Data† L CI‡ U CI Score§
Alabama 40.2 37.9 42.6 3 35.1 32.7 37.4 3 30.4 27.5 33.3 4 27.7 24.7 30.7 3
Alaska 46.5 38.6 54.4 4 31.4 24.0 38.9 2 39.6 31.9 47.3 2 27.0 20.4 33.6 3
Arizona 39.0 35.9 42.1 3 26.8 24.0 29.5 1 45.5 42.1 48.9 1 28.6 25.5 31.6 3
Arkansas 44.1 41.2 46.9 4 37.3 34.5 40.1 4 32.4 29.4 35.3 3 32.5 29.4 35.5 2
California 37.0 35.3 38.7 2 26.0 24.4 27.6 1 48.5 46.5 50.4 1 32.3 30.5 34.1 2
Colorado 38.7 36.7 40.6 3 24.8 23.1 26.6 1 45.9 43.7 48.0 1 29.9 27.9 32.0 3
Connecticut 32.9 30.5 35.3 1 29.5 27.1 31.8 2 49.0 46.3 51.7 1 32.3 29.8 34.9 2
Delaware 39.0 36.0 42.0 3 29.9 27.2 32.7 2 39.6 36.2 43.0 2 27.3 24.1 30.4 3
District of Columbia 35.6 32.5 38.8 2 26.4 23.4 29.3 1 51.3 47.8 54.8 1 33.8 30.5 37.2 2
Florida 37.3 35.7 39.0 2 27.9 26.4 29.4 2 44.1 41.9 46.3 2 31.4 29.4 33.5 2
Georgia 39.1 36.5 41.8 3 34.9 32.3 37.4 3 36.8 33.9 39.8 3 31.2 28.4 34.1 2
Hawaii 30.2 27.6 32.7 1 23.2 20.8 25.7 1 42.5 39.6 45.4 2 31.7 28.9 34.4 2
Idaho 40.7 38.5 43.0 3 31.0 28.9 33.2 2 40.9 38.0 43.7 2 31.3 28.6 34.0 2
Illinois 37.2 34.4 40.0 2 34.3 31.6 37.1 3 44.8 42.1 47.6 2 26.3 23.9 28.7 3
Indiana 36.2 34.2 38.2 2 34.6 32.6 36.5 3 37.5 35.2 39.8 3 26.0 23.9 28.2 3
Iowa 35.1 32.8 37.3 2 34.7 32.5 37.0 3 40.9 38.4 43.3 2 27.4 25.1 29.7 3
Kansas 40.1 38.1 42.0 3 31.0 29.2 32.9 2 35.0 33.7 36.4 3 31.0 29.7 32.3 2
Kentucky 40.5 37.8 43.2 3 39.7 37.1 42.4 4 32.4 29.8 35.0 3 32.2 29.5 34.9 2
Louisiana 39.7 37.3 42.1 3 35.9 33.6 38.2 4 33.0 30.8 35.2 3 21.2 19.3 23.0 4
Maine 36.7 34.6 38.8 2 29.7 27.7 31.6 2 46.3 44.0 48.6 1 32.5 30.3 34.6 2
Maryland 37.0 34.6 39.4 2 33.8 31.4 36.3 3 42.6 39.9 45.3 2 30.6 28.0 33.1 2
Massachusetts 33.5 31.6 35.4 1 29.6 27.8 31.5 2 47.9 45.8 50.1 1 29.3 27.3 31.3 3
Michigan 38.1 36.2 40.0 2 32.1 30.2 33.9 3 42.9 40.8 45.0 2 27.2 25.3 29.2 3
Minnesota 34.4 31.8 37.0 2 31.4 28.9 34.0 2 43.3 40.8 45.8 2 27.1 24.8 29.4 3
Mississippi 43.9 41.7 46.1 4 38.1 36.0 40.2 4 27.8 26.1 29.6 4 22.1 20.5 23.8 4
Missouri 43.5 40.5 46.5 4 36.9 34.0 39.8 4 37.5 34.3 40.6 3 28.7 25.7 31.7 3
Montana 40.8 38.4 43.2 3 32.8 30.5 35.1 3 43.5 41.0 45.9 2 29.6 27.4 31.9 3
Nebraska 38.9 36.9 40.8 3 33.9 32.0 35.8 3 44.4 42.3 46.5 2 29.9 28.0 31.8 3
Nevada 37.7 34.0 41.5 2 34.7 30.9 38.5 3 36.4 32.5 40.4 3 24.6 20.9 28.3 4
New Hampshire 35.4 33.0 37.8 2 28.6 26.3 30.8 2 46.4 43.6 49.2 1 32.3 29.6 35.0 2
New Jersey 33.2 31.1 35.2 1 35.0 32.9 37.2 3 47.7 45.4 50.1 1 28.6 26.4 30.8 3
New Mexico 41.3 38.9 43.7 3 26.1 24.0 28.2 1 37.7 35.5 40.0 3 32.2 29.9 34.5 2
New York 37.4 35.4 39.4 2 29.6 27.7 31.5 2 48.8 46.0 51.7 1 26.8 24.3 29.4 3
North Carolina 39.7 37.6 41.8 3 31.9 29.9 33.9 3 33.7 31.4 35.9 3 29.1 27.0 31.3 3
North Dakota 37.0 34.4 39.6 2 33.1 30.5 35.6 3 46.2 43.3 49.1 1 27.5 24.9 30.2 3
Ohio 37.5 35.4 39.6 2 36.0 33.9 38.0 4 40.1 37.9 42.3 2 26.9 24.9 28.9 3
Oklahoma 45.4 43.4 47.5 4 38.0 36.0 40.0 4 25.8 23.8 27.7 4 30.0 27.9 32.1 3
Oregon 41.1 38.7 43.5 3 24.2 22.1 26.3 1 40.7 37.9 43.5 2 31.3 28.6 34.0 2
Pennsylvania 35.8 34.0 37.7 2 34.1 32.3 35.9 3 44.4 42.1 46.7 2 26.8 24.7 28.8 3
Rhode Island 36.2 33.8 38.6 2 34.8 32.4 37.1 3 45.3 42.6 48.0 1 31.9 29.3 34.5 2
South Carolina 39.8 37.4 42.1 3 32.8 30.6 35.1 3 31.5 29.1 33.9 4 27.1 24.8 29.5 3
South Dakota 39.5 37.1 41.9 3 32.0 29.7 34.3 3 42.9 40.4 45.4 2 27.0 24.7 29.3 3
Tennessee 38.6 35.8 41.5 3 39.2 36.4 42.0 4 32.1 29.3 34.8 4 39.1 36.1 42.1 1
Texas 37.4 35.4 39.4 2 32.9 31.0 34.8 3 36.7 34.2 39.3 3 32.3 29.7 35.0 2
Utah 40.8 38.5 43.0 3 26.8 24.8 28.8 1 42.0 39.6 44.4 2 27.1 24.8 29.3 3
Vermont 36.8 34.6 39.0 2 28.6 26.5 30.7 2 49.3 46.8 51.8 1 31.0 28.7 33.3 2
Virginia 39.8 36.5 43.2 3 33.0 29.8 36.1 3 42.4 38.9 45.9 2 35.1 31.7 38.6 1
Washington 42.7 41.2 44.1 4 23.3 22.0 24.5 1 42.3 40.8 43.8 2 32.2 30.7 33.6 2
West Virginia 41.8 39.1 44.6 3 39.8 37.0 42.5 4 33.3 30.6 35.9 3 25.2 22.7 27.7 4
Wisconsin 33.0 30.1 36.0 1 28.7 25.9 31.5 2 48.2 44.2 52.3 1 27.6 23.8 31.3 3
Wyoming 39.0 36.6 41.3 3 33.0 30.7 35.3 3 41.8 39.3 44.4 2 30.0 27.6 32.4 3
* Defined in Table 2.
† Data are for U.S. adults aged 65 years or older.
‡ A confidence interval (CI) describes the level of uncertainty of an estimate and specifies the range in which the true value is likely to fall. This report uses
a 95% level of significance, which means that 95% of the time, the true value falls within these boundaries. When comparing prevalence of variables
across states or years, we recommend the use of confidence intervals. If the confidence intervals overlap, the difference is not statistically significant.
§ Scores are calculated as quartiles and show state performance relative to all other states. 1 = top 25%; 4 = bottom 25%.
Source: CDC, Behavioral Risk Factor Surveillance System, 2009–2010. See Appendix for a full description of this data source.
The State of Aging and Health in America 2013 PAGE 31
Table 3. State-by-State Report Card on Healthy Aging (continued)
Obesity* (%) 2010 Current Smoker (%) 2010 Medication for High Blood Pressure* (%)
2010
Data† L CI‡ U CI Score§ Data† L CI‡ U CI Score§ Data† L CI‡ U CI Score§
Alabama 26.3 24.0 28.6 4 10.3 8.7 11.9 3 95.2 93.7 96.7 2
Alaska 22.9 16.4 29.4 3 10.8 5.2 16.4 3 93.6 90.3 96.9 3
Arizona 21.5 18.9 24.2 2 8.9 7.0 10.8 2 90.7 88.0 93.4 4
Arkansas 23.7 21.2 26.1 3 10.4 8.7 12.2 3 92.8 90.7 94.9 3
California 21.0 19.6 22.5 2 6.1 5.2 7.0 1 92.0 90.7 93.3 4
Colorado 18.2 16.6 19.8 1 8.2 7.0 9.4 2 92.7 91.1 94.3 3
Connecticut 22.0 19.8 24.2 2 5.0 4.0 6.0 1 93.5 91.7 95.4 3
Delaware 27.6 24.8 30.4 4 7.1 5.6 8.6 2 95.2 93.4 96.9 2
District of Columbia 21.2 18.3 24.0 2 10.2 8.1 12.4 3 93.2 91.1 95.2 3
Florida 22.2 20.8 23.7 2 8.4 7.5 9.3 2 94.4 93.0 95.8 2
Georgia 25.1 22.7 27.5 3 10.7 9.0 12.4 3 95.4 93.9 97.0 2
Hawaii 15.7 13.6 17.8 1 7.2 5.8 8.7 2 91.1 89.0 93.3 4
Idaho 25.4 23.4 27.5 3 8.6 7.3 9.8 2 90.5 88.3 92.8 4
Illinois 25.1 22.3 27.9 3 8.5 6.9 10.1 2 94.1 92.5 95.7 2
Indiana 29.2 27.3 31.1 4 8.0 6.9 9.0 2 95.0 93.8 96.2 2
Iowa 27.3 25.1 29.4 4 7.3 6.1 8.5 2 93.4 91.7 95.0 3
Kansas 25.7 24.0 27.5 3 7.9 6.8 8.9 2 94.5 93.6 95.3 2
Kentucky 27.0 24.7 29.4 4 10.7 9.1 12.2 3 94.1 92.4 95.7 2
Louisiana 28.2 26.0 30.4 4 10.1 8.6 11.6 3 95.3 94.1 96.5 2
Maine 24.3 22.5 26.2 3 7.6 6.6 8.7 2 93.0 91.6 94.4 3
Maryland 24.5 22.2 26.7 3 8.3 6.9 9.7 2 95.6 94.3 96.9 2
Massachusetts 22.9 21.1 24.6 3 7.6 6.6 8.6 2 94.9 93.6 96.2 2
Michigan 27.3 25.5 29.1 4 8.0 7.0 9.1 2 93.5 92.3 94.8 3
Minnesota 24.3 21.9 26.7 3 8.4 6.7 10.1 2 98.0 97.1 99.0 1
Mississippi 27.3 25.2 29.3 4 9.2 7.9 10.4 2 96.1 95.2 96.9 1
Missouri 26.3 23.6 29.0 4 9.9 8.1 11.6 3 95.2 93.6 96.7 2
Montana 22.1 20.0 24.1 2 9.0 7.7 10.3 2 90.6 88.8 92.3 4
Nebraska 24.0 22.2 25.7 3 7.7 6.6 8.9 2 94.6 93.4 95.9 2
Nevada 21.8 18.3 25.2 2 14.6 11.9 17.3 4 93.6 91.4 95.8 3
New Hampshire 23.5 21.3 25.7 3 7.8 6.4 9.1 2 93.1 91.2 95.0 3
New Jersey 24.8 22.8 26.8 3 8.0 6.8 9.1 2 95.1 93.7 96.4 2
New Mexico 20.3 18.3 22.3 2 9.6 8.1 11.0 2 90.1 88.2 91.9 4
New York 22.2 20.4 24.0 2 7.5 6.4 8.5 2 94.3 92.9 95.7 2
North Carolina 24.6 22.6 26.7 3 9.3 7.9 10.6 2 95.3 94.2 96.5 2
North Dakota 24.5 22.1 26.8 3 9.2 7.7 10.8 2 95.9 94.5 97.3 2
Ohio 27.0 25.0 29.0 4 10.3 9.0 11.6 3 94.1 92.8 95.4 2
Oklahoma 26.1 24.2 28.0 4 10.9 9.6 12.2 3 94.0 92.6 95.3 3
Oregon 25.1 22.9 27.3 3 8.1 6.7 9.5 2 93.6 91.9 95.4 3
Pennsylvania 26.7 25.0 28.4 4 7.7 6.7 8.6 2 94.6 93.3 95.8 2
Rhode Island 22.9 20.8 25.0 3 8.5 7.1 9.9 2 96.2 95.0 97.4 1
South Carolina 26.0 23.9 28.2 4 8.1 6.5 9.6 2 95.9 94.7 97.1 2
South Dakota 22.2 20.1 24.3 2 7.1 5.9 8.4 2 92.6 91.0 94.3 3
Tennessee 24.7 22.3 27.1 3 9.2 7.5 10.9 2 95.3 93.6 97.1 2
Texas 28.4 26.4 30.4 4 8.5 7.2 9.8 2 93.7 92.3 95.1 3
Utah 24.9 22.9 27.0 3 4.6 3.6 5.5 1 91.5 89.7 93.2 4
Vermont 23.4 21.5 25.4 3 5.8 4.8 6.8 1 91.0 89.2 92.8 4
Virginia 23.7 20.6 26.7 3 8.5 6.8 10.2 2 95.0 93.2 96.8 2
Washington 23.9 22.7 25.1 3 7.2 6.5 7.9 2 91.2 90.2 92.3 4
West Virginia 25.9 23.4 28.4 4 10.8 9.1 12.5 3 96.0 94.6 97.4 1
Wisconsin 24.0 21.3 26.7 3 6.7 5.2 8.3 1 95.0 93.1 97.0 2
Wyoming 22.8 20.7 24.9 3 9.1 7.7 10.4 2 91.1 89.2 93.0 4
* Defined in Table 2.
† Data are for U.S. adults aged 65 years or older.
‡ A confidence interval (CI) describes the level of uncertainty of an estimate and specifies the range in which the true value is likely to fall. This
report uses a 95% level of significance, which means that 95% of the time, the true value falls within these boundaries. When comparing
prevalence of variables across states or years, we recommend the use of confidence intervals. If the confidence intervals overlap, the difference is
not statistically significant.
§ Scores are calculated as quartiles and show state performance relative to all other states. 1 = top 25%; 4 = bottom 25%.
Source: CDC, Behavioral Risk Factor Surveillance System, 2009–2010. See Appendix for a full description of this data source.
PAGE 32 The State of Aging and Health in America 2013
Table 3. State-by-State Report Card on Healthy Aging (continued)
Flu Vaccine in Past Year
(%) 2010
Ever Had Pneumonia Vaccine
(%) 2010
Mammogram in Past 2 Years
(%) 2010
Data† L CI‡ U CI Score§ Data† L CI‡ U CI Score§ Data† L CI‡ U CI Score§
Alabama 63.2 60.7 65.6 3 65.6 63.1 68.0 3 81.0 77.7 84.3 2
Alaska 63.7 56.3 71.1 3 66.5 58.8 74.2 3 71.8 60.9 82.7 4
Arizona 67.2 64.3 70.2 2 71.8 68.9 74.7 1 85.3 81.8 88.7 1
Arkansas 69.6 66.9 72.2 2 67.3 64.6 70.1 3 79.8 75.9 83.6 3
California 63.0 61.2 64.8 3 62.6 60.8 64.4 4 87.5 85.2 89.8 1
Colorado 73.4 71.5 75.2 1 73.3 71.4 75.2 1 81.3 78.6 84.0 2
Connecticut 72.4 70.0 74.7 1 69.2 66.8 71.7 2 87.2 84.1 90.3 1
Delaware 66.9 64.0 69.8 2 70.0 67.1 72.9 2 88.3 85.2 91.4 1
District of Columbia 62.0 58.8 65.3 4 65.4 62.0 68.7 3 89.4 85.7 93.1 1
Florida 65.6 64.0 67.2 3 69.9 68.4 71.5 2 87.9 86.2 89.5 1
Georgia 61.8 59.1 64.5 4 64.4 61.6 67.1 4 86.5 83.5 89.6 1
Hawaii 73.2 70.8 75.5 1 66.8 64.1 69.5 3 82.9 79.3 86.5 2
Idaho 60.7 58.4 63.0 4 66.2 63.9 68.4 3 73.0 69.4 76.6 4
Illinois 65.5 62.6 68.3 3 61.9 58.9 64.9 4 80.5 76.3 84.6 3
Indiana 66.4 64.4 68.4 2 68.8 66.9 70.8 2 79.8 77.1 82.6 3
Iowa 70.4 68.3 72.6 1 70.3 68.1 72.6 2 84.5 81.5 87.5 2
Kansas 68.6 66.8 70.5 2 68.5 66.6 70.3 2 82.9 80.2 85.6 2
Kentucky 67.7 65.2 70.2 2 64.6 61.8 67.3 4 77.5 74.2 80.7 3
Louisiana 64.3 61.9 66.6 3 67.4 65.1 69.7 3 80.6 77.6 83.5 3
Maine 72.0 70.1 73.9 1 71.8 69.8 73.8 1 86.0 83.5 88.5 1
Maryland 68.7 66.2 71.1 2 66.5 64.0 69.0 3 85.9 82.8 89.1 1
Massachusetts 72.4 70.5 74.2 1 71.2 69.3 73.1 1 89.8 87.6 92.0 1
Michigan 67.5 65.6 69.3 2 67.8 65.9 69.6 3 85.5 83.2 87.9 1
Minnesota 72.0 69.5 74.5 1 70.4 67.8 72.9 2 86.5 83.4 89.6 1
Mississippi 66.1 64.0 68.2 3 67.6 65.5 69.8 3 75.5 72.6 78.5 4
Missouri 67.1 64.3 69.8 2 71.2 68.5 73.9 1 75.5 70.8 80.2 4
Montana 65.5 63.1 67.8 3 71.8 69.5 74.0 1 76.6 72.8 80.4 3
Nebraska 71.2 69.5 73.0 1 70.9 69.0 72.7 1 78.1 75.1 81.0 3
Nevada 59.3 55.4 63.2 4 66.6 62.6 70.5 3 77.0 70.5 83.4 3
New Hampshire 71.3 68.9 73.6 1 71.2 68.9 73.6 1 86.5 83.6 89.5 1
New Jersey 65.7 63.6 67.9 3 64.3 62.1 66.5 4 79.6 76.5 82.8 3
New Mexico 69.3 67.1 71.5 2 68.6 66.3 70.9 2 79.4 76.1 82.7 3
New York 68.3 66.3 70.3 2 66.1 64.0 68.2 3 81.9 78.9 84.8 2
North Carolina 69.7 67.6 71.7 2 71.2 69.1 73.3 1 83.7 81.0 86.4 2
North Dakota 66.4 63.9 69.0 2 70.9 68.4 73.4 1 79.3 75.4 83.3 3
Ohio 64.8 62.7 66.9 3 68.5 66.4 70.5 2 84.2 81.6 86.9 2
Oklahoma 70.9 69.0 72.7 1 72.6 70.8 74.5 1 72.3 69.1 75.6 4
Oregon 65.0 62.5 67.4 3 74.0 71.7 76.2 1 81.7 78.3 85.0 2
Pennsylvania 68.0 66.1 69.8 2 70.6 68.8 72.4 2 82.4 79.7 85.2 2
Rhode Island 70.3 68.1 72.6 1 71.7 69.5 74.0 1 88.4 85.5 91.2 1
South Carolina 67.4 65.1 69.6 2 70.0 67.8 72.2 2 83.6 80.5 86.8 2
South Dakota 72.0 69.8 74.2 1 68.0 65.7 70.4 2 84.6 81.3 87.9 2
Tennessee 66.6 63.8 69.3 2 66.1 63.3 68.8 3 81.7 77.8 85.6 2
Texas 67.2 65.3 69.1 2 68.5 66.5 70.5 2 78.5 75.8 81.2 3
Utah 68.2 66.1 70.3 2 68.3 66.2 70.5 2 77.7 74.4 81.1 3
Vermont 71.5 69.4 73.5 1 72.8 70.8 74.9 1 85.0 82.2 87.8 2
Virginia 68.9 66.0 71.8 2 72.1 69.2 75.0 1 80.9 76.9 84.8 2
Washington 69.3 67.9 70.6 2 72.8 71.5 74.1 1 82.7 80.8 84.5 2
West Virginia 66.4 63.8 69.0 2 62.4 59.6 65.1 4 78.0 74.1 82.0 3
Wisconsin 68.4 65.4 71.3 2 73.1 70.3 76.0 1 83.7 79.4 88.0 2
Wyoming 65.1 62.8 67.4 3 69.4 67.1 71.7 2 76.9 73.5 80.3 3
* Defined in Table 2.
† Data are for U.S. adults aged 65 years or older.
‡ A confidence interval (CI) describes the level of uncertainty of an estimate and specifies the range in which the true value is likely to fall. This
report uses a 95% level of significance, which means that 95% of the time, the true value falls within these boundaries. When comparing
prevalence of variables across states or years, we recommend the use of confidence intervals. If the confidence intervals overlap, the difference is
not statistically significant.
§ Scores are calculated as quartiles and show state performance relative to all other states. 1 = top 25%; 4 = bottom 25%.
Source: CDC, Behavioral Risk Factor Surveillance System, 2009–2010. See Appendix for a full description of this data source.
The State of Aging and Health in America 2013 PAGE 33
Table 3. State-by-State Report Card on Healthy Aging (continued)
Colorectal Cancer
Screening (%) 2010
Up-to-Date on Selected
Preventive Services: Men* (%)
2010
Up-to-Date on Selected
Preventive Services: Women*
(%) 2010
Fall With Injury Within
Past Year (%) 2010
Data† L CI‡ U CI Score§ Data† L CI‡ U CI Score§ Data† L CI‡ U CI Score§ Data† L CI‡ U CI Score§
Alabama 70.2 67.3 73.1 3 46.8 42.2 51.3 2 42.2 39.3 45.2 4 31.9 26.2 37.6 2
Alaska 68.4 58.9 78.0 3 37.0 23.6 50.3 4 46.6 36.0 57.2 3 31.3 12.0 50.6 2
Arizona 74.6 71.0 78.2 2 49.0 43.8 54.3 2 52.4 48.4 56.3 1 26.3 19.8 32.7 1
Arkansas 66.6 63.1 70.2 3 48.5 43.6 53.4 2 48.0 44.3 51.8 2 31.7 25.3 38.1 2
California 73.1 70.6 75.5 2 42.1 39.1 45.1 3 44.3 42.0 46.6 3 30.8 26.8 34.8 2
Colorado 74.5 72.1 76.8 2 53.7 50.2 57.3 1 55.2 52.5 58.0 1 32.2 27.1 37.2 2
Connecticut 79.2 76.3 82.1 1 52.9 48.4 57.3 1 52.4 49.1 55.8 1 31.8 25.1 38.5 2
Delaware 74.5 70.8 78.2 2 49.4 44.3 54.5 2 51.3 47.5 55.2 2 31.0 23.5 38.5 2
District of Columbia 76.1 72.3 80.0 1 45.5 39.8 51.2 3 46.4 42.2 50.7 3 31.1 23.4 38.7 2
Florida 77.7 75.7 79.8 1 52.4 49.7 55.2 1 50.6 48.5 52.8 2 34.6 30.6 38.5 3
Georgia 73.6 70.5 76.8 2 39.9 35.1 44.6 4 45.6 42.2 49.1 3 36.5 30.1 42.8 3
Hawaii 70.0 66.6 73.5 3 46.1 41.6 50.5 2 53.1 49.5 56.8 1 30.0 22.7 37.2 2
Idaho 66.2 63.4 69.1 4 42.8 38.9 46.6 3 42.9 39.8 45.9 3 33.0 27.8 38.2 3
Illinois 69.3 65.4 73.2 3 43.6 38.5 48.8 3 42.7 39.1 46.2 3 32.1 24.8 39.4 2
Indiana 71.2 68.6 73.7 2 49.3 45.5 53.0 2 47.6 45.0 50.2 2 29.8 25.1 34.4 2
Iowa 71.4 68.5 74.3 2 49.5 45.3 53.6 2 51.5 48.6 54.4 2 25.2 20.2 30.2 1
Kansas 71.6 69.2 74.0 2 47.4 44.1 50.7 2 50.4 47.9 53.0 2 26.4 22.2 30.6 1
Kentucky 71.3 68.2 74.4 2 46.5 41.4 51.5 2 45.0 41.7 48.3 3 35.9 30.0 41.8 3
Louisiana 69.8 66.9 72.6 3 46.7 42.4 51.1 2 45.0 42.1 47.9 3 24.9 19.4 30.5 1
Maine 80.0 77.8 82.2 1 51.3 47.7 55.0 1 55.1 52.3 57.9 1 30.3 25.4 35.2 2
Maryland 78.5 75.6 81.5 1 46.1 41.7 50.5 2 52.3 49.0 55.6 1 31.3 25.2 37.5 2
Massachusetts 78.1 75.7 80.5 1 53.2 49.5 56.9 1 53.8 51.1 56.4 1 34.6 29.2 40.0 3
Michigan 77.5 75.3 79.7 1 46.9 43.5 50.3 2 50.4 47.9 52.9 2 30.0 25.4 34.5 2
Minnesota 75.3 72.2 78.4 2 50.5 45.6 55.4 2 54.8 51.4 58.1 1 28.0 21.5 34.4 2
Mississippi 65.1 62.3 67.8 4 47.9 43.8 51.9 2 46.1 43.4 48.7 3 28.6 23.9 33.3 2
Missouri 69.5 65.9 73.1 3 51.3 46.1 56.6 1 49.0 45.2 52.8 2 25.3 19.2 31.4 1
Montana 67.7 64.7 70.7 3 47.1 43.1 51.1 2 47.9 44.7 51.0 2 22.8 18.2 27.4 1
Nebraska 70.5 68.0 73.0 3 51.9 48.3 55.4 1 51.1 48.6 53.6 2 27.9 23.5 32.2 2
Nevada 61.9 57.1 66.7 4 44.7 38.6 50.8 3 37.9 32.7 43.0 4 34.8 23.9 45.6 3
New Hampshire 79.0 76.4 81.7 1 51.3 46.9 55.6 1 54.7 51.4 58.0 1 33.0 26.8 39.1 3
New Jersey 70.8 68.0 73.5 3 48.8 44.8 52.8 2 44.6 41.8 47.3 3 34.2 28.3 40.2 3
New Mexico 67.4 64.4 70.4 3 47.6 43.5 51.7 2 48.6 45.4 51.8 2 42.2 36.4 47.9 4
New York 76.9 74.4 79.5 1 50.2 46.4 54.0 2 48.3 45.6 50.9 2 37.8 32.6 43.1 4
North Carolina 78.2 75.9 80.5 1 53.6 49.9 57.4 1 52.9 50.1 55.7 1 29.1 24.2 34.1 2
North Dakota 69.7 66.3 73.2 3 49.9 45.0 54.8 2 49.1 45.7 52.5 2 27.4 21.0 33.9 1
Ohio 70.8 68.1 73.4 3 44.9 41.1 48.8 3 48.5 45.8 51.3 2 33.9 28.9 39.0 3
Oklahoma 62.9 60.3 65.6 4 50.2 46.6 53.8 2 47.6 45.0 50.2 2 30.6 26.1 35.2 2
Oregon 73.2 70.1 76.2 2 49.6 45.3 53.9 2 50.2 47.0 53.4 2 34.0 27.9 40.1 3
Pennsylvania 72.2 69.7 74.8 2 51.8 48.3 55.2 1 52.3 49.8 54.7 1 29.8 25.5 34.1 2
Rhode Island 78.1 75.2 80.9 1 51.9 47.6 56.2 1 53.4 50.3 56.5 1 36.0 29.4 42.6 3
South Carolina 75.3 72.7 78.0 2 52.1 48.1 56.0 1 48.3 45.0 51.5 2 38.1 32.0 44.3 4
South Dakota 73.4 70.4 76.4 2 48.6 44.3 53.0 2 52.7 49.6 55.8 1 24.5 19.2 29.8 1
Tennessee 70.2 66.7 73.6 3 49.1 43.8 54.4 2 40.7 37.4 44.0 4 28.7 21.2 36.3 2
Texas 67.8 65.0 70.5 3 48.2 44.6 51.8 2 46.9 44.2 49.5 3 32.9 28.4 37.4 3
Utah 75.0 72.4 77.6 2 46.6 42.8 50.4 2 48.4 45.5 51.4 2 26.8 22.0 31.6 1
Vermont 78.0 75.5 80.4 1 53.3 49.4 57.2 1 56.1 53.2 59.1 1 28.9 23.8 33.9 2
Virginia 74.3 70.9 77.8 2 55.1 49.8 60.4 1 49.7 45.6 53.8 2 35.6 27.5 43.6 3
Washington 78.1 76.5 79.6 1 53.2 50.7 55.6 1 53.3 51.4 55.2 1 29.0 25.8 32.3 2
West Virginia 62.9 59.4 66.4 4 46.1 41.4 50.8 2 39.0 35.5 42.4 4 35.8 28.5 43.1 3
Wisconsin 76.6 73.1 80.2 1 49.4 44.0 54.9 2 55.2 51.1 59.2 1 23.6 16.6 30.7 1
Wyoming 67.1 64.2 70.0 3 46.4 42.2 50.5 2 48.8 45.7 51.9 2 27.4 21.8 32.9 1
* Defined in Table 2.
† Data are for U.S. adults aged 65 years or older.
‡ A confidence interval (CI) describes the level of uncertainty of an estimate and specifies the range in which the true value is likely to fall. This report uses
a 95% level of significance, which means that 95% of the time, the true value falls within these boundaries. When comparing prevalence of variables
across states or years, we recommend the use of confidence intervals. If the confidence intervals overlap, the difference is not statistically significant.
§ Scores are calculated as quartiles and show state performance relative to all other states. 1 = top 25%; 4 = bottom 25%.
Source: CDC, Behavioral Risk Factor Surveillance System, 2009–2010. See Appendix for a full description of this data source.
PAGE 34 The State of Aging and Health in America 2013
Using Data for Action at the State and Local Levels
Florida Examines Its Older Adult Population
In 2010, the Florida Needs Assessment Survey was administered to 1,850 adults aged 60 years or older
living in the state of Florida, through a cooperative effort of the Florida Department of Elder Affairs
and the Bureau of Business and Economic Research at the University of Florida. The assessment
covered demographics, living situation, self-care limitations, nutrition, housing, health care, emergency
preparedness, transportation, social engagement and community factors, caregiving, information
and assistance needs, volunteerism, and issues related to abuse, neglect, and exploitation. To ensure
representation for groups that are traditionally hard to measure, oversampling was done among low-
income, minority, and rural populations.
The assessment results are available at the state and Planning and Service Area (PSA) level to allow for
maximum flexibility in using the data. The reports (available at http://elderaffairs.state.fl.us/doea/needs_
assessment.php) provide an excellent example of how other states can proactively examine their older
adult population to best serve their needs.
Source: Florida Department of Elder Affairs Web site. http://elderaffairs.state.fl.us/doea/needs_assessment.php.
http://elderaffairs.state.fl.us/doea/needs_assessment.php
http://elderaffairs.state.fl.us/doea/needs_assessment.php
http://elderaffairs.state.fl.us/doea/needs_assessment.php
The State of Aging and Health in America 2013 PAGE 35
Spotlight: Mobility
Mobility Impairment Increases Risk of Illness
Mobility—the ability to move around effectively and safely in the environment—is fundamental to the
health and well-being of older adults. Mobility has also been defined as “movement in all of its forms,
including transferring from a bed to a chair, walking for leisure and the completion of daily tasks,
engaging in other activities associated with work and play, exercising, driving a car, and using other
forms of passenger transport.”1
For older adults, the effects of chronic conditions and geriatric syndromes can cause limitations in
mobility (impaired mobility) that can lead to dependence in activities of daily living and other adverse
outcomes.2 Impaired mobility is associated with several health problems, including depression,
cardiovascular disease, cancer, and injuries secondary to falls and automobile crashes. These illnesses
and injuries can lead to increased risk of death.1 Impaired mobility can also reduce a person’s access to
goods and services and limit contact with friends and relatives.
Mobility restrictions have consequences for the health and well-being of older adults,
which often result in a cascade effect of continuing deterioration.
—CDC’s Healthy Aging Research Network
PAGE 36 The State of Aging and Health in America 2013
Figure 6. Percentage of Medicare enrollees aged 65 years or older who are unable to perform
certain physical functions
Source: Federal Interagency Forum on Aging-Related Statistics. Older Americans 2010:
Key Indicators of Well-Being.
10
3
1
14
7
1919
5
2
23
15
32
0
5
10
15
20
25
30
35
Stoop/kneel Reach
overhead
Write Walk 2–3
blocks
Lift 10 lbs. Any of these
Men Women
P
e
rc
e
n
ta
g
e
Physical Activity and the Physical Environment
Previous efforts to help people improve their mobility have focused on encouraging
physical activity, such as walking. Social support interventions in community settings have
focused on changing people’s behavior by building, strengthening, and maintaining social
networks that provide supportive relationships for behavior change. The Community Guide
(www.thecommunityguide.org) provides information on evidence-based programs and
recommendations related to health interventions for behavior change. Table 4 provides
examples of behavioral and social approaches to increasing physical activity.
Table 4. Recommended Interventions for Promoting Physical Activity
Approach Recommended Strategies Description of Strategies
Behavioral and Social
Approaches
Individually adapted
health behavior change
programs.
Individually adapted health behavior change
programs seek to increase physical activity by
teaching people how to incorporate physical
activity into their daily routines. Programs are
tailored to each individual’s specific interests,
preferences, and readiness for change.
Social interventions in
community settings.
Social support interventions seek to change phy-
sical activity behavior by building, strengthening,
and maintaining social networks that provide
supportive relationships for behavior change.
Source: Adapted from The Guide to Community Preventive Services, www.thecommunityguide.org.
www.thecommunityguide.org
www.thecommunityguide.org
The State of Aging and Health in America 2013 PAGE 37
Environmental and Policy Approaches
Because walking is the most commonly reported form of physical activity among older adults,
improving community environments to support walking is a promising approach to increase physical
activity in this population.3 Research shows that modifying a community’s physical environment
to ensure access to places to exercise and removing barriers to walking may increase the physical
activity of older adults. Specific actions include building and repairing sidewalks.4 Recent research
has shown that neighborhood environments that include built or physical (place-oriented) and
social (people-oriented) components are associated with health status and health behaviors.5 Table 5
provides examples of environmental approaches to increasing physical activity.
Table 5. The Guide to Community Preventive Services: Recommendations Summary
of Environmental Interventions for Promoting Physical Activity
Approach Recommended Strategies Description of Strategies
Environmental
Approaches
Community-scale and urban
design land-use policies
Environmental approaches are designed to provide opportunities,
support, and cues to help people be more physically active. They
may involve
•
•
•
•
The physical environment.
Social networks.
Organizational norms and policies.
Laws.
Source: www.thecommunityguide.org/pa/environmental-policy/
communitypolicies.html
Creation of or improved access
to places for physical activity
Creation of or improving access to places for physical activity
involves the efforts of employers, coalitions, agencies, and
communities as they attempt to change the local environment to
create opportunities for physical activity. Such changes include
creating walking trails, building exercise facilities, or providing access
to existing nearby facilities.
Source: www.thecommunityguide.org/pa/environmental-policy/
communitypolicies.html
Street-scale urban design
land-use policies
Street-scale urban design and land-use policies involve the efforts
of urban planners, architects, engineers, developers, and public
health professionals to change the physical environment of small
geographic areas, generally limited to a few blocks, in ways that
support physical activity.
Source: www.thecommunityguide.org/pa/environmentalpolicy/
streetscale.html
www.thecommunityguide.org/pa/environmental
communitypolicies.html
www.thecommunityguide.org/pa/environmental
communitypolicies.html
www.thecommunityguide.org/pa/environmentalpolicy/streetscale.html
www.thecommunityguide.org/pa/environmentalpolicy/streetscale.html
PAGE 38 The State of Aging and Health in America 2013
Public Health Action and Environmental Change
The Health Impact Pyramid (Figure 7) illustrates approaches and strategies that support and
promote mobility by enhancing our understanding of the multiple factors and interactions that
can influence mobility.
Figure 7. A Framework for Public Health Action:
The Health Impact Pyramid
The base of the pyramid shows the factors that can have the greatest influence on determinants of
health. Identification of priority polices and environmental strategies for increasing mobility among
older adults starts here. The next level is contextual change, designed to create a healthier
infrastructure. Examples include improvement to the built environment, such as designing
communities to promote increased physical activity and enacting policies that encourage
walking, bicycling, and public transit instead of driving.
Policies and environmental strategies designed to improve mobility can change physical and
social environments in positive ways—much like other successful public health strategies, such
as efforts to reduce smoking.6
The Community Guide is also a resource for evidence-based recommendations related to
environmental change. The guide helps support other tools for public health references, such
as Healthy People 2020. Because older adults may be more vulnerable to the influence of their
residential environment, they tend to stay within their neighborhoods rather than travel outside
them.7 Implementing recommended environmental and policy approaches may help to reduce
barriers in residential and workplace environments, thus improving physical activity for older adults.
Public health action related to mobility and healthy aging starts with coordination of strategic
action. Strategies related to transportation, neighborhood design and safety, housing, and
healthy lifestyle play an important role in promoting mobility.8
C
a
al
erv
r ec e
t
Adapted from: Frieden TR. A framework for public health action; the health impact pyramid. Am J Public Health, 2010;100:590–5.
The State of Aging and Health in America 2013 PAGE 39
Regional Collaboration Makes for Lifelong Communities
The Atlanta Regional Commission (ARC) Area Agency on Aging’s (AAA) Lifelong
Communities initiative illustrates the importance of collaboration to support healthy aging.
In 2007, the ARC and the Carl Vinson Institute of the University of Georgia published a report
called Older Adults in the Atlanta Region: Preference, Practices, and Potential of the 55+
Population.9 This report found that most older adults in the study area have been “aging
in place” and living in the region an average of 37 years and that most hope to continue to
age in place. The majority of people surveyed (64%) also stated that they would live in their
current home as long as they could. For these older adults to attain this goal of not only
aging, but also living in place, they will need communities that support mobility on every
level, from walking to public transportation.
In response to the evidence of a growing need for supportive communities that enhance
mobility, and recognizing that providing services alone cannot meet the needs of an
aging population, the ARC created a broad plan to transform neighborhoods, cities, and
counties into places where people of all ages can live throughout their lifetime. The ARC
AAA developed the Lifelong Communities (LLC) initiative to set three new objectives for
its programs and services: promote housing and transportation options, encourage healthy
lifestyles, and expand access to services. Research has shown these three elements are
essential components of age-friendly communities, and each contributes to older adults’ need
for greater accessibility and mobility.
Research has also shown that most people outlive their ability to drive by 6 to 10 years.10
With up to a decade yet to live after turning in their keys, people need other options for
getting around their communities. To address this need, the ARC is developing a coordinated
human services transportation (HST) plan for the 18-county Atlanta region. The planning
process is guided by the Human Services Transportation Advisory Committee, which includes
representatives from various groups advocating for the needs of older adults. As part of
this effort, the AAA developed a Senior Mobility Program in 2010 to expand transportation
options for older adults throughout the 10-county region. The program is also helping the
AAA address transportation needs at the community level as part of the LLC initiative. Since
the program’s inception, the AAA has seen support and funding grow for local transportation
voucher programs. The agency has also seen increased use of a walkability assessment tool
and the creation of a senior carpool program at a senior center in Cobb County, Georgia.
To be able to take advantage of transportation options (including walking), people must
have a certain level of personal mobility. One of the aims of the LLC initiative is to encourage
healthy lifestyles by supporting older adults’ efforts to be physically active, eat healthy, and
use preventive health services (e.g., medical exams, screenings). Recent studies link a lack of
mobility or impaired mobility to an increase in other health problems, as well as a decrease
in health-related quality of life.11
The ARC AAA works with a variety of partners to offer diverse, evidence-based programs
that help older adults maintain or improve their ability to walk safely and independently.
Examples include programs that improve access to places for physical activity, such as those
that build community gardens, design streets to increase mobility, and promote land-use
policies that foster affordable, mixed-use housing options.
PAGE 40 The State of Aging and Health in America 2013
Stepping Up to a More Walkable Hendersonville
All residents should be able to walk safely in their communities, whether for physical activity,
enjoyment, or simply to get where they want to go. For older adults, being able to walk not
only promotes physical and mental well-being, but it also helps them to stay more connected
to their communities. Any actions taken to improve pedestrian safety for this group will
automatically benefit all residents.
Taking Action
To address this public health concern,
community leaders in Hendersonville,
North Carolina, came together to
implement a pilot program called Walk
Wise, Drive Smart. The goal of the
program is to make neighborhoods in
Hendersonville and surrounding areas
more pedestrian-friendly for older adults.
Hendersonville is an ideal testing ground
for this program because more than 30%
of residents are aged 65 years or older.
Walk Wise, Drive Smart is supported
in part by the Healthy Aging Research
Network (HAN), which is funded by the
Healthy Aging Program and is part of a
network of Prevention Research Centers
that works with community partners
across the country. The program is led
by the University of North Carolina
Highway Safety Research Center, the City
of Hendersonville, and the Council on
Aging for Henderson County.
These organizations have a well-
established partnership that includes
more than 75 other organizations, such
as a senior center, local hospitals, a transportation group, an environmental and conservation
organization, the county health department, local YMCA and AARP affiliates, and the Area
Agency on Aging. The program also is an integral part of the Henderson County Livable and
Senior Friendly Community Initiative, which serves more than 100,000 people throughout the
county, and it is supported by the local business community.
To plan the Walk Wise, Drive Smart program, officials assessed walking conditions in 10
Hendersonville neighborhoods. They collected information with the HAN Environmental
Audit Tool (www.prc-han.org/tools-environment#envaudit) and through a series of
neighborhood meetings and interviews. The resulting data pointed to the need to provide
walking programs for people at different levels of fitness and to improve pedestrian facilities
(www.prc-han.org/tools-environment#envaudit
The State of Aging and Health in America 2013 PAGE 41
(e.g., sidewalks, crosswalks, traffic signals) to reduce walking hazards for older adults. The
data also indicated a need to change the driving habits of residents to get them to slow
down and yield to pedestrians.
To build community awareness and support for pedestrian safety, program officials
��
��
��
��
��
��
Developed pedestrian safety plans.
Conducted walking audits of individual neighborhoods.
Established neighborhood walking routes.
Upgraded pedestrian facilities on walking routes in selected neighborhoods.
Developed walking maps and materials on how to walk and drive safely.
Installed outdoor benches at strategic locations.
One innovative feature of the Walk Wise, Drive Smart program is that it provides incentives
(e.g., coupons for prize drawings) to courteous drivers (e.g., those who yield to pedestrians
in crosswalks). The program also has an easy-to-use Web site that posts current information
about program-sponsored walks, hikes, and presentations on pedestrian safety, as well as
other walking-related events that are free and open to the public.
During its initial implementation phase, the program regularly collected community feedback
through surveys and interviews. This information was used to ensure that the program was
meeting residents’ needs and interests.
Implications and Impact
Since the Walk Wise, Drive Smart program began in 2005, it has helped to educate city
officials and residents in Hendersonville about pedestrian safety. It also has made it easier for
city officials to plan and implement changes to the environment to improve local walkways
and roadways.
For example, city officials focused on improving the safety and walkability of certain walking
routes and designated them as “senior friendly.” They modified traffic patterns in some
neighborhoods to reduce speeding drive-through traffic. They also collected data to identify
specific problems that could increase the risk of injury for walkers, and this information was
used to promote policy changes.
The Walk Wise, Drive Smart program in Hendersonville demonstrates the power of city
officials and informed citizens to work together to make policy and environmental changes
to make it easier for all residents, especially older adults, to walk safely in their communities.
Residents embraced the value of walking and created many new opportunities for people of
all ages and abilities to participate.
This program can serve as a model for other small to midsize communities across the
United States. More information about the Walk Wise, Drive Smart program is available online
at www.walk-wise.org.
www.walk-wise.org
PAGE 42 The State of Aging and Health in America 2013
Driving
In 2009, there were 33 million licensed drivers aged 65 years or older in the United States.12
Driving helps older adults stay mobile and independent, but the risk of being injured or killed in a
motor vehicle crash increases with age. An average of 500 older adults are injured every day in motor
vehicle crashes.13
Older adults are at risk because
��
�
Starting at age 75, fatal crash rates increase per mile traveled. This is largely caused by older adults’
increased susceptibility to injury and medical complications, not their increased tendency to get
into crashes.
�Age-related declines in vision and cognitive functioning (the ability to reason and remember), as
well as physical changes, may affect some older adults’ driving abilities.14
Older adults can use several strategies to stay safe on the road. For example, they can exercise regularly
to increase strength and flexibility, have their vision checked by an eye doctor at least once a year, wear
corrective lenses or glasses as required, drive in good weather and daylight, and use roads that are well-
lit and have intersections with left turn arrows. Communities can also ensure that their streets are safer
or offer alternatives to driving.
Promote Alternatives: Complete Streets
“Complete streets” are designed and operated to allow safe access for all users. The essential
components of a complete street follow these principles:
�� A vision for all users, including pedestrians, motorists, bicyclists, and transit passengers of all ages
and abilities.
�� A design that can apply to new or retrofitted road projects and includes planning, operations,
and maintenance for the right of way. It encourages street connectivity and can be adopted by all
agencies to cover all roads.
�� A design that uses the latest and best criteria and guidelines and complements the community. It
also sets performance standards with measureable outcomes and steps to implement the policies
associated with integration.15
The State of Aging and Health in America 2013 PAGE 43
State Examples of Complete Street Policies
“…the roadway system of the Commonwealth should safely accommodate all users
of the public right-of-way including: pedestrians, (including people requiring mobility
aids); bicyclists; drivers and passengers of transit vehicles, trucks, automobiles, and
motorcycles.”
— Massachusetts: Project Development and Design Guide
“The department of transportation and the county transportation departments shall adopt
a complete streets policy that seeks to reasonably accommodate convenient access and
mobility for all users of the public highways…including pedestrians, bicyclists, transit
users, motorists, and persons of all ages and abilities.”
— Hawaii: Act 054
Source: National Complete Streets Coalition, www.completestreets.org/webdocs/policy/cs-state-policies
The Future of Smart Growth: Improving the Quality of Life for All Generations
“Smart growth” is defined as development patterns that create attractive, distinctive, walkable
communities that give people of varying age, income levels, and physical ability a range of safe,
affordable, and convenient choices in where they live and how they get around.
According to the U.S. Environmental Protection Agency, “communities across the country
are using creative strategies to develop in ways that preserve natural lands and critical
environmental areas, protect water and air quality, and reuse already-developed land. They
conserve resources by reinvesting in existing infrastructure and reclaiming historic buildings.
By designing neighborhoods that have shops, offices, schools, churches, parks, and other amenities
near homes, communities are giving their residents and visitors the option of walking, bicycling,
taking public transportation, or driving as they go about their business. A range of different types
of homes makes it possible for senior citizens to stay in their homes as they age, young people to
afford their first home, and families at all stages in between to find a safe, attractive home they
can afford. Through smart growth approaches that enhance neighborhoods and involve local
residents in development decisions, these communities are creating vibrant places to live, work,
and play. The high quality of life in these communities makes them economically competitive,
creates business opportunities, and improves the local tax base.”16
Looking Ahead: A Framework for Mobility to Support Older Adults
The role of states and their partners in promoting community approaches to mobility to support older
adults is to help people in different disciplines work together to advance action and research. The
National Association of Chronic Disease Directors, the Healthy Aging Research Network (HAN), and
CDC’s Healthy Aging Program are working together to develop an agenda to promote mobility among
older adults who live in the community. This project will allow partners to compare the views of a
broad group of stakeholders, including content experts, practitioners, and decision makers across the
nation. The resulting framework will identify priority strategic actions, and provide useful information
for policy makers, funders, community planners, organizations vested in the well-being of older adults
and healthy communities, and researchers who work on mobility.
www.completestreets.org/webdocs/policy/cs-state-policies
PAGE 44 The State of Aging and Health in America 2013
The foundation for this project comes from the work of the HAN on environmental changes
including an audit tool and protocol for assessing the walkability of streets and communities.
The HAN created an Environmental and Policy Change (EPC) Clearinghouse to help states work
on collaborative projects. The resources in the clearinghouse were chosen for their relevance and
usefulness to people working in the fields of aging and disability services, public health, planning,
architecture, engineering, recreation, transportation, and health care.
The EPC Clearinghouse provides resources, tools, and strategies that support local efforts in
environmental and policy change for healthy aging. Examples include tool kits, best practices, case
studies, and process steps for engaging other stakeholders. Other resources include guidelines for
working with decision makers at various levels of government and environmental and policy change
information specific to older adults in the areas of walkability, livable communities, transportation,
older pedestrians and drivers, access to healthy foods, universal design, and rural community issues.
As of Spring 2013, the EPC clearinghouse resources have been integrated into the AARP Livable
Communities Web site (www.aarp.org/livable), which highlights resources for community leaders to
learn, plan, and act to create livable communities for all ages.
As the public health sector continues to collaborate with aging services to improve physical
activity options at the individual level, we must look ahead to the following areas of mobility
research and interventions:
��
�
�
�
Bringing together stakeholders in communities to ensure joint planning and collaborations
that focus on environmental changes to support livable communities for all ages.
�Addressing beliefs, motivations, and perceptions about mobility among individuals and
families to help them overcome self-restricted mobility limitations or to effectively cope
with the circumstances related to mobility restriction.
�Modifying the environment through policy change to make the most of the available
mobility options.
�Providing appropriate assistive devices to enhance mobility inside and outside the home.17
A public health emphasis on aging, mobility, and quality of life is essential to improving people’s
health across their lifespan.
Related Resources
Older Adults and Driving
www.cdc.gov/Features/OlderDrivers
Complete Streets
www.completestreets.org
Smart Growth
www.smartgrowth.org
CDC-HAN Environmental Audit Tool
www.prc-han.org/docs/HAN-audit-tool-protocol-090309
Environmental Policy Change Clearinghouse
http://depts.washington.edu/hansite/drupal
www.aaro.org/livable
www.cdc.gov/Features/OlderDrivers/
www.completestreets.org
www.smartgrowth.org
www.prc-han.org/docs/HAN-audit-tool-protocol-090309
http://depts.washington.edu/hansite/drupal/
The State of Aging and Health in America 2013 PAGE 45
1. Satariano WA, Guralnik JM, Jackson RJ, Marottoli RA, Phelan EA, Prohaska TR. Mobioity and aging: new
directions for public health action. Am J Public Health. 2012;102(8):1508-1515.
2. Branch LG, Meng H, Guralnik JM. Disability and functional status. In: Prohaska T, Anderson LA, Binstock R,
eds. Public Health for an Aging Society. Baltimore, MD: Johns Hopkins University Press; 2012.
3. Hoehner CM, Brennan Ramirex LK, Elliott MB, Handy SL, Brownson RC. Perceived and objective
environmental measures and physical activity among urban adults. Am J Prev Med. 2005;28:105-116.
4. Wilcox S, Castro C, King AC, Houseman R, Brownson RC. Determinants of leisure-time physical activity in rural
older and ethnically diverse women in the United States. J Epidemiol Communit Health. 2000;54:667-672.
5. Khan LK, Sobush K, Keener D, et al. Recommended community strategies and measurements to prevent
obesity in the United States. MMWR Morb Mortal Wkly Rep. 2009;58:1-26.
6. Frieden TR. A framework for public health action: the health impact pyramid. Am J Public Health.
2010;100:590-595.
7. Glass TA, Balfour JL. Neighborhoods, aging, and functional limitations. In: Kawachi I, Berkman LF, eds.
Neighborhoods and Health. New York, NY: Oxford University Press; 2003:303-334.
8. Hunter RH, Sykes K, Lowman SG, Duncan R, Satariano WA, Belza B. Environmental and policy change to
support healthy aging. J Aging Soc Policy. 2011;23:(4):354-371.
9. Atlanta Regional Commission. Older Adults in the Atlanta Region: Preference, Practices and Potential of the
55+ Population. Atlanta, GA: Atlanta Regional Commission; 2007.
10. Foley DJ, Heimovitz HK, Guralnik J, Brock D. Driving life expectancy of persons aged 70 years and older in
the United States. Am J Prev Med. 2002;92(8):1284-1289.
11. Groessl EJ, Kaplan RM, Rejeski WJ, et al. Health-related quality of life in older adults at risk for disability. Am J
Prev Med. 2007;33(3):214-218.
12. US Department of Transportation, Federal Highway Administration. Highway statistics 2009. US Department of
Transportation Web site. http://www.fhwa.dot.gov/policyinformation/statistics/2009/dl22.cfm.
13. US Department of Transportation, Federal Highway Administration. Traffic safety facts 2008. US Department of
Transportation Web site. http://www-nrd.nhtsa.dot.gov/Pubs/811161 .
14. Owsley C. Driver Capabilities in Transportation in an Aging Society: A Decade of Experience. Technical
Papers and Reports from a Conference: Bethesda, MD; Nov. 7–9, 1999. Washington, DC: Transportation
Research Board; 2004.
15. Smart Growth America. National Complete Streets Coalition. Policy elements. Smart Growth America Web site.
http://www.smartgrowthamerica.org/complete-streets/changing-policy/policy-elements.
16. US Environmental Protection Agency. About smart growth. US Environmental Protection Agency Web site.
http://www.epa.gov/smartgrowth/about_sg.htm#principles.
17. Prohaska TR, Anderson LA, Hooker SP, Hughes SL, Belza B. Mobility and aging: transference to transportation.
J Aging Res. 2011. Epub 2011 Aug 15.
References
http://www.fhwa.dot.gov/policyinformation/statistics/2009/dl22.cfm
http://www-nrd.nhtsa.dot.gov/Pubs/811161.PDF
http://www.smartgrowthamerica.org/complete-streets/changing-policy/policy-elements
http://www.epa.gov/smartgrowth/about_sg.htm#principles
The State of Aging and Health in America 2013 PAGE 47
Appendix
Healthy People 2020 Objectives
Healthy People 2020 is a set of 10-year national objectives for improving the health of all Americans.
For the past 30 years, Healthy People 2020 objectives have been implemented to measure the impact
of prevention activities, encourage collaborations across communities and sectors, and empower
individuals to make informed health decisions. These objectives set specific targets to help guide states,
communities, and professional organizations to identify, develop, and evaluate programs and policies
that promote healthy aging. Healthy People 2020 objectives and targets were developed in consultation
with a wide range of experts on the basis of the best available and most current scientific knowledge.
In this report, several of the indicators used to assess the health of adults aged 65 years or older are
based on Healthy People 2020 targets. Some of these targets (i.e., no leisure-time physical activity,
obesity, current smoking, taking medication for high blood pressure, mammogram within past 2 years,
and colorectal cancer screening) are for age groups beyond just 65 years or older. For these targets,
this report focuses on whether the older adult population met the general target. The Behavioral
Risk Factor Surveillance System is not the official tracker for most Healthy People 2020 targets, but it
provides state-level data that are the basis for this report.
Table 6. Report Indicators and Associated Healthy People 2020 Targets
Indicator Healthy People 2020 Target
Health Status
1. Physically unhealthy days No target specified.
2. Frequent mental distress No target specified.
3. Oral health: tooth retention (%) No target specified.
4. Disability (%) No target specified.
Health Behaviors
5. No leisure-time physical activity No more than 32.6% of adults aged 18 or older with no leisure-time physical activity.
6. Eating fruits and vegetables daily:
Eating ≥2 fruits daily (%)
Eating ≥3 vegetables daily (%)
Healthy People 2020 tracks the overall increase in fruit and vegetable consumption,
rather than separating it into two components.
7. Obesity (%) No more than 30.6% of adults aged 20 or older who are obese.
8. Current smoking (%) No more than 12% of adults aged 18 or older who smoke.
9. Taking medication for high blood pressure At least 77.4% of adults aged 18 or older with high blood pressure/hypertension
taking the prescribed medications to lower their blood pressure.
Preventive Care and Screening
10. Flu vaccine in past year (%) At least 90% of adults aged 65 or older who had a flu shot within the past year.
11. Ever had pneumonia vaccine (%) At least 90% of adults aged 65 or older who had ever received a pneumonia vaccine.
12. Mammogram within past 2 years (%) At least 81.1% of women aged 50–74 have had a mammogram in the past 2 years.
13. Colorectal cancer screening (%) At least 70.5% of adults will receive a colorectal cancer screening based on the
most recent guidelines.
14. Up-to-date on select preventive services (%)
Men
Women
At least 50.9% of men and 52.7% of women aged 65 years or older are up-to-date on
a core set of clinical preventive services. For men, 3 services are included (flu vaccine
in past year, ever had pnemonia vaccine, and colorectal cancer screening. For women,
these same services are included, plus a mammogram within past 2 years.
Injuries
15. Fall with injury within past year (%) No target specified.
Source: U.S. Department of Health and Human Services, www.healthypeople.gov.
www.healthypeople.gov
PAGE 48 The State of Aging and Health in America 2013
Healthy People 2020 Older Adult Objectives
To better understand the determinants of healthy aging in various populations and settings,
specific Healthy People 2020 measures related to older adults were defined, with the overall
goal of improving their health, function and quality of life. Table 7 shows these measures.
Table 7. Healthy People 2020 Older Adult Objectives
Objective
No.
Objective
OA-1 Increase the proportion of older adults who use the Welcome to Medicare benefit.
OA-2 Increase the proportion of older adults who are up-to-date on a core set of clinical preventive services.
OA-3 Increase the proportion of older adults with one or more chronic health conditions, and report
confidence in managing their conditions.
OA-4 Increase the proportion of older adults who receive Diabetes Self-Management Benefits.
OA-5 Reduce the proportion of older adults who have moderate to severe functional limitations.
OA-6 Increase the proportion of older adults with reduced physical or cognitive function who engage in
moderate or vigorous leisure-time physical activities.
OA-7 Increase the proportion of the health care workforce with geriatric certification.
OA-8 Reduce the proportion of noninstitutionalized older adults with disabilities with unmet need for
long-term servicesand supports.
OA-9 Reduce the proportion of unpaid caregivers of older adults who report an unmet need for caregiver
support services.
OA-10 Reduce the rate of pressure ulcer-related hospitalizations among older adults.
OA-11 Reduce the rate of emergency department visits caused by falls among older adults.
OA-12 Increase the number of states, the District of Columbia, and tribes that collect and make publicaly
available information on the characteristics of victims, perpetrators, and cases of elder abuse,
neglect, and exploitation.
Indicator Selection
The indicators for The State of Aging and Health in America 2013 were modified and updated
from previous versions of the report to reflect current public health priorities and available data.
Two new indicators are included in the 2013 edition of the report: taking medication for high
blood pressure, which replaces cholesterol checked within past 5 years, and fall with injury
within the past year, which replaces hip fracture hospitalizations. All indicators were selected
on the basis of their relative importance to older adult health, the availability of data for at least
35 states, and the ability to take action on the particular indicator.
The State of Aging and Health in America 2013 PAGE 49
Data Source
Behavioral Risk Factor Surveillance System
This report features data on key indicators of health and well-being for U.S. adults aged 65 years or older.
These data are from CDC’s Behavioral Risk Factor Surveillance System (BRFSS). For more than 2 decades,
BRFSS has helped states survey U.S. adults regarding a wide range of personal behaviors that affect
their health. The BRFSS focuses primarily on physical activity, nutrition, tobacco use, and use of proven
preventive services (such as cancer screenings), all of which can affect the rates of the nation’s leading
health-related causes of death. BRFSS survey questions assess how many people engage in these and
other health and risk behaviors, whether these behaviors are increasing over time, and which populations
might be most at risk. The crucial information gathered through this state-based telephone survey system
is used by national, state, and local public health agencies to monitor the need for and the effectiveness
of various public health interventions.
Although the BRFSS is one of our most useful tools for assessing the health of the older adult
population, it has a few limitations. First, it excludes people who do not have telephones or who live in
institutions, such as nursing homes. Second, it may underrepresent people who are severely impaired
because they lack the functional capacity required to participate in the survey. Third, all responses to
the BRFSS are self-reported and, therefore, have not been confirmed by a health care provider.
Because BRFSS data are collected at the state level, the national data estimates provided in
Table 1 are actually the mean data for the 50 states and the District of Columbia. The BRFSS is
administered and supported by the CDC. For more information, visit www.cdc.gov/brfss.
www.cdc.gov/brfss
PAGE 50 The State of Aging and Health in America 2013
Notes
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Acknowledgements
Contributors
Serena Weisner, MS
Atlanta Regional Commission, Area Agency on Aging
Mary Blumberg
Atlanta Regional Commission, Area Agency on Aging
Debra C. Nichols, MD, MPH
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
Lynda A. Anderson, PhD
Angela Deokar, MPH
Carla Doan, MS
Andree Harris
Rosemarie Kobau, MPH, MAPP
Kristina Theis, MPH
Ann Dellinger, PhD
Pete Menzies, MA
Editorial and Graphic Support
Michael Weeks, MAPW
Centers for Disease Control and Prevention
Peggy Dana
Centers for Disease Control and Prevention
Advisory Board Members
William Benson
Health Benefits, ABCs
Cathie Berger, LCSW
Atlanta Regional Commission, Area Agency on Aging
Eileen R. Daley, RN, MPH
Black Hawk County Health Department
Turner Goins, PhD
Oregon State University
Mary Leary, PhD
Easter Seals Project ACTION
Carol McPhillips-Tangum, MPH
National Association of Chronic Disease Directors
Amy Slonim, PhD
CDC-AARP Liaison
Pamela Van Zyl York, MPH, PhD
Minnesota State Department of Health
Project Codirectors/Principal Writers
Jessica Gill, MPH
Centers for Disease Control and Prevention
Maggie Moore, MPH
Centers for Disease Control and Prevention
Consultant
Mary Adams, MS, MPH
On Target Health Data, LLC
www.cdc.gov/aging
www.cdc.gov/aging
- TITLE: The State of Aging and Health in America 2013
Foreword
Executive Summary
An Introduction to the Health of Older Americans
Call to Action: Developing a New Healthy Brain Initiative Road Map
Call to Action: Addressing Lesbian
, Gay, Bisexual, and Transgender (LGBT) Aging and health Issuses
The National Report Card on H
ealthy Aging
Call to Action: Using Data on Physical Unhealthy D
ays Guide Interventions
Call to Action: Addressing Mental Distress in Older Adults
Call to Action: Monitoring Vaccination Rates for Shingles
Spotlight: Mobility
The State-by-State Report Card on Healthy Aging
Appendix
Acknowledgements