A call to action for individuals and their communities
2017
Senior Report
2 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
America’s Health Rankings® and America’s Health Rankings® Senior Report were built upon the World Health Organization definition of health: “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”
Our model reflects that determinants of health directly influence health outcomes, with determinants accounting for three-quarters and outcomes accounting for one-quarter of each state’s overall score and ranking. Four categories of determinants are included in our model of health: Behaviors, Community & Environment, Policy and Clinical Care.
Behaviors
Policy ClinicalCare
Health Outcomes
Community &Environment
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 1
State Rankings on Senior Health
The HEALTHIEST States
America’s Health Rankings Senior Report oers a comprehensive analysis of senior population health on a national and state-by-state basis across 34 measures of senior health.
HAWAII
3MINNESOTA
1UTAH
2The States with the Biggest
OPPORTUNITIES FOR IMPROVEMENT
OKLAHOMA
48MISSISSIPPI
50KENTUCKY
49
31 to 4021 to 3011 to 20 41 to 501 to 10RANK: Not Ranked
AK
ME
WI
WA
ID
MT ND
IL
MINY
OR
NV
WYSD
IN
PA
NJCO
NE
MO KY
WV
VA
MD
DE
AZ NM
KS
ARTN NC
SCOK
LAMS AL GA
TX
FL
OH
VT NH
MN MA
IA CT
RI
CA UT
HI
DC
For more information please visit us at AmericasHealthRankings.org
2 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Executive SummaryAmerica’s Health Rankings® Senior Report
The 2017 America’s Health Rankings® Senior Report provides a comprehensive analysis of senior population health on a national and state-by-state basis across 34 measures of senior health. This report’s model is based on the historical America’s Health Rankings model of health and was adapted in 2013 for the senior population under the guidance of an advisory group of experts in the fields of aging and senior health. The 2017 edition marks the fifth publication of this meaningful report, which continues to serve as a benchmark of senior health for individuals, community leaders, policymakers, media and public health professionals.
Successes and Challenges in Senior Health
In this year’s report, we observed national improvements in several clinical care measures, and challenges in community & environment measures related to nutrition and access to healthy foods. Notably, the premature death rate among seniors increased in the past year after three consecutive years of decline, a trend that mirrors the trajectory of years of potential life lost before age 75 in the general population, as was reported in the December 2016 release of America’s Health Rankings Annual Report.
Nationally, clinical care measures — hospital readmissions, preventable hospitalizations, hospital deaths and hospice care use — have improved since the first Senior Report was published in 2013. In many cases, these are promising trends that reflect consistent improvements each year from 2013 to 2017. Improvements were also made in the outcome measures intensive care unit (ICU) use and hip fracture hospitalizations.
In the past year:
• Preventable hospitalizations decreased 7 percent from 53.8 to 49.9 discharges per 1,000 Medicare enrollees, continuing a four-year decline.
Since the 2013 edition:
• Hospital readmissions decreased 7 percent, from 15.9 percent to 14.8 percent of hospitalized Medicare enrollees.
• Hospital deaths decreased 30 percent from 30.1 percent to 21.0 percent and hospice care use increased 42 percent from 36.7 percent to 52.0 percent of chronically ill Medicare decedents aged 65 years and older.
• ICU use in the last six months of life decreased 9 percent from 15.2 percent to 13.8 percent of Medicare decedents aged 65 years and older.
• The hip fracture hospitalization rate decreased 21 percent from 7.3 to 5.8 hospitalizations per 1,000 Medicare enrollees, continuing a four-year decline.
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 3
As a nation, obesity, nutrition and access to healthy food remain challenges for seniors. Obesity and food insecurity both increased, while Supplemental Nutrition Assistance Program (SNAP) reach and community support expenditures decreased.
In the past year:
• Obesity prevalence rose to 27.6 percent of adults aged 65 years and older in 2017, representing a five-year high.
• Food insecurity rose to 15.8 percent of adults aged 60 years and older.
• Community support funding for public nutrition, transportation, and other social services for seniors aged 60 and older living in poverty decreased 6 percent.
In the past two years, SNAP reach decreased 7 percent from 75.2 percent to 70.1 percent of adults aged 60 years and older living in poverty.
2017 Senior Health Rankings
The Senior Report ranks each state across 26 measures of health determinants and eight measures of health outcomes. The healthiest states for seniors are spread throughout the United States, while the least-healthy states are clustered in the southern region.
Minnesota ranks as the healthiest state for seniors this year. The state held the top spot in the first two years of the Senior Report. Utah improved to second, while Hawaii (third), Colorado (fourth) and New Hampshire (fifth) round out the top five states in 2017.
Mississippi ranks 50th this year. The state also held this ranking in the first two years of the Senior Report. Kentucky (49th), Oklahoma (48th), Louisiana (47th) and Arkansas (46th) round out the bottom five states, representing the states with the greatest opportunities for improvement.
California made the greatest improvement in rank in one year, rising 12 spots from 28th to 16th. South Dakota also made great strides this year, rising 10 spots from 25th to 15th. Pennsylvania and Alaska both dropped eight spots, now ranking 26th and 29th, respectively.
Improving the Health of Our Nation’s Seniors
With this report, United Health Foundation equips stakeholders with five years of senior health and well-being data that encourages continued conversations among policymakers, public health officials and community leaders, and drives action to promote better health for our nation’s seniors. As a nation, we have experienced impressive improvements in critical areas of senior health since the launch of the first America’s Health Rankings Senior Report in 2013. With this year’s report, we are reminded of persistent social and economic barriers to proper nutrition and access to healthy foods, and continued successes in measures of clinical care.
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ContentsExecutive Summary 2
Introduction 6
Findings 8
State Rankings 8
Largest Changes in Ranking Since 2016 14
National Findings 16
Successes 16
Challenges 18
Core Measures 21
Supplemental Measures 66
State Summaries 70
Appendix 125
Core Measures Table 126
Supplemental Measures Table 129
Methodology 130
Model Development 132
2017 Senior Report Advisory Group 134
The Team 135
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According to the Administration on Aging, 14.5 percent, or about one in every seven Americans, was 65 years old or older in 2014. This translates to 46.2 million seniors, a 28 percent increase since 2004. This proportion of older adults is expected to grow to 21.7 percent of the population by 2040. Not only will the next generation of seniors rapidly grow in numbers, but according to last year’s America’s Health Rankings® Senior Report, the next group of seniors are projected to have a higher prevalence of obesity and diabetes, and a lower prevalence of high health status. The increasing number of older adults combined with the growing prevalence of obesity, diabetes and other chronic diseases threaten to create serious challenges for our health care system. In order to learn where and how to take action to improve the health of current and future seniors, we assessed the current status of senior health in the fifth edition of America’s Health Rankings Senior Report.
The report offers a comprehensive and convenient analysis of senior population health on a national and state-by-state basis. It includes 34 measures of health and well-being, all selected under the guidance of an advisory group of experts in the fields of aging and senior health. Comprehensive
rankings were calculated as well as rankings for each individual measure. Where available, subpopulation data were analyzed to gain a clearer picture of health within each state.
Now in its fifth year, the report serves to:
• Provide a benchmark for senior population health by state. State-level data allow community leaders, public health officials and policymakers to monitor health trends over time and to compare senior health measures with other states and the nation.
• Stimulate discussion and action to improve senior population health. The report’s purpose is to kindle and continue to fuel dialogue and action among individuals, community leaders, the media, policymakers and public health officials by providing accurate, reliable and trustworthy information based on a holistic view of health.
This year, America’s Health Rankings Senior Report presents five years of senior health data, allowing for the examination of national- and state-level trends. Each year we also present the strengths, challenges and highlights of every state to facilitate a shared discussion on improving senior population health.
This report continues to build an informational foundation that creates awareness about senior health in every state
Introduction
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 7
Selection Process for the 34 MeasuresThe selection of the 34 measures that make up America’s Health Rankings Senior Report is driven by these five factors:1. The measures represent a broad range of
issues that affect senior health.2. Individual measures meet commonly
accepted health-measurement criteria.3. Data are available at the state level.4. Data are current and updated periodically.5. The aspect being measured is amenable to
change.
While imperfect, these 34 measures are some of the best available indicators of health determinants and outcomes affecting senior health. An additional seven supplemental measures are provided to better describe the health of seniors in each state. Where available, measures are stratified by various subpopulations, such as gender and race, for a more in-depth look within each state.
— the next and most vital step is to take action. Learn more about this report at www.www.AmericasHealthRankings.org. Here you can explore the data from this report and its related America’s Health Rankings reports about general population health, the health of women and children, and the health of those who have served in the U.S. armed forces. Website tools allow you to interact with the data, to understand which measures have the greatest impact on your state’s relative health, and to share these findings with others.
America’s Health Rankings model of health includes two types of measures — determinants and outcomes (see Selection Process for the 34 Measures). Determinants are personal, social, economic and environmental factors that influence the future health of the population, whereas outcomes represent the current health status of the population. For a state to improve the health of its older population, efforts should focus on improving health determinants. The four categories of health determinants are behaviors, community & environment, policy and clinical care. The measures of senior health chosen for this report are interdependent and are related to what we do, where we live, the care we receive, and outcomes we experience. For example, a community’s effort to reduce physical inactivity could affect obesity, management of joint pain, frequency of falls and effectiveness of diabetes management, to name a few.
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State Rankings
Minnesota is the leading state for senior health in 2017, a title it also held in the first two years of the America’s Health Rankings Senior Report. Utah (second) reached its highest ranking in the report’s five-year history, after rising four spots this year. Hawaii (third), Colorado (fourth) and New Hampshire (fifth) round out the top five states.
• Massachusetts dropped from first place to sixth.
• Vermont also left the top five, taking eighth place this year.
Findings
Tables 1 and 2 display the 2017 rankings for all states, by rank and alphabetically.
Minnesota’s strengths include a low percentage of seniors who face the threat of hunger and a high percentage who visited a dentist. Improvements in the prevalence of excessive drinking, pain management and obesity in the state in the past year also influenced the state’s rise to the top spot this year. Minnesota continues to struggle with a low percentage of seniors with a dedicated health care provider and a high percentage of low-care nursing home residents. Minnesota maintained its No. 1 ranking in health outcomes and improved five rankings to third in health determinants.
Utah improved its health outcomes ranking this year moving up seven spots to second. The state ranks 27th this year in policy, rising 14 spots in the past year. A decline in geriatrician shortfall and the addition of healthcare-associated infection policies (a new measure this year) contributed to improvements in this category. Utah continues to rank first for a low smoking prevalence despite a 16 percent increase in the percentage of seniors smoking in the past year. Of note, Utah’s overall score is only 1 percent below Minnesota’s score (Figure 1).
SEE YOUR STATE’S STRENGTHS, CHALLENGES AND HEALTH HIGH-LIGHTS IN THE STATE SUMMARY SECTION (PAGES 70–122).
ALL STATES,
STRENGTHS ANDCHALLENGES
N O M AT T E R T H E I R R A N K I N G , H AV E
1 2 3 4 5MINNESOTA UTAH HAWAII COLORADO NEW HAMPSHIRE
The Healthiest States for Seniors
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 9
Table 12017 Alphabetical Ranking
Table 22017 Ranking
2017Rank State Score2017
Rank State Score
1 Minnesota 0.6592 Utah 0.6533 Hawaii 0.6194 Colorado 0.5955 New Hampshire 0.5596 Massachusetts 0.5457 Connecticut 0.5268 Vermont 0.5039 Washington 0.40310 Wisconsin 0.36311 Maine 0.33812 Oregon 0.32713 Rhode Island 0.30514 Maryland 0.27315 South Dakota 0.26916 California 0.26317 Delaware 0.24118 North Dakota 0.23919 Iowa 0.21720 New Jersey 0.15621 New York 0.13122 Idaho 0.08623 Arizona 0.07924 Nebraska 0.05725 Virginia 0.03626 Pennsylvania 0.02527 Michigan 0.00327 Montana 0.00329 Alaska 0.00230 Florida -0.01831 Kansas -0.02732 North Carolina -0.05633 South Carolina -0.10934 New Mexico -0.12335 Ohio -0.15236 Illinois -0.22137 Wyoming -0.23138 Texas -0.24439 Indiana -0.31640 Nevada -0.32341 Georgia -0.33242 Missouri -0.35643 Alabama -0.43144 Tennessee -0.47845 West Virginia -0.52246 Arkansas -0.63447 Louisiana -0.74148 Oklahoma -0.75449 Kentucky -0.76350 Mississippi -0.791
43 Alabama -0.43129 Alaska 0.00223 Arizona 0.07946 Arkansas -0.63416 California 0.2634 Colorado 0.5957 Connecticut 0.52617 Delaware 0.24130 Florida -0.01841 Georgia -0.3323 Hawaii 0.61922 Idaho 0.08636 Illinois -0.22139 Indiana -0.31619 Iowa 0.21731 Kansas -0.02749 Kentucky -0.76347 Louisiana -0.74111 Maine 0.33814 Maryland 0.2736 Massachusetts 0.54527 Michigan 0.0031 Minnesota 0.65950 Mississippi -0.79142 Missouri -0.35627 Montana 0.00324 Nebraska 0.05740 Nevada -0.3235 New Hampshire 0.55920 New Jersey 0.15634 New Mexico -0.12321 New York 0.13132 North Carolina -0.05618 North Dakota 0.23935 Ohio -0.15248 Oklahoma -0.75412 Oregon 0.32726 Pennsylvania 0.02513 Rhode Island 0.30533 South Carolina -0.10915 South Dakota 0.26944 Tennessee -0.47838 Texas -0.2442 Utah 0.6538 Vermont 0.50325 Virginia 0.0369 Washington 0.40345 West Virginia -0.52210 Wisconsin 0.36337 Wyoming -0.231
2017
RA
NK
ING
NEW HAMPSHIRE
The Healthiest States for Seniors
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Findings
-1 -0.8 -0.6 -0.4 -0.2 0 0.2 0.4 06 0.8
MinnesotaUtahHawaiiColoradoNew HampshireMassachusettsConnecticutVermontWashingtonWisconsinMaineOregonRhode IslandMarylandSouth DakotaCaliforniaDelawareNorth DakotaIowaNew JerseyNew YorkIdahoArizonaNebraskaVirginiaPennsylvaniaMichiganMontanaAlaskaFloridaKansasNorth CarolinaSouth CarolinaNew MexicoOhioIllinoisWyomingTexasIndianaNevadaGeorgiaMissouriAlabamaTennesseeWest VirginiaArkansasLouisianaOklahomaKentuckyMississippi
Figure 12017 Overall Score*
* Weighted standard deviation relative to U.S. value
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The healthiest states for seniors are spread throughout the United States, while the least-healthy states are clustered in the southern region (Figure 2). Mississippi is 50th this year. Other states in the bottom five are Kentucky (49th), Oklahoma (48th), Louisiana (47th) and Arkansas (46th).
• Kentucky lost some ground this year, moving down four rankings from 45th to 49th.
• West Virginia improved one ranking this year to rise out of the bottom five.
Mississippi faces challenges in food insecurity, poverty and premature death. The state’s behaviors ranking dropped from 22nd to 45th this year. These changes are potentially due to increases in the prevalence of obesity and physical inactivity, as well as the removal of the underweight measure from the model this year, which, at third, was the state’s second-highest ranking measure in 2016 (see 2017 Edition
Figure 22017 Ranking U.S. Map
1 to 10 11 to 20 21 to 30 31 to 40 41 to 50 not ranked
DC
RI
DE
The healthiest states for seniors are spread throughout the United States, while the least-healthy states are clustered in the southern region.
California improved 12 places from 28th to 16th.
Pennsylvania dropped eight spots from 18th to 26th.
South Dakota improved 10 places from 25th to 15th.
Delaware improved five positions from 22nd to 17th.
Alaska dropped eight places from 21st to 29th.
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Findings
Figure 32017 Determinants Ranking U.S. Map
1 to 10 11 to 20 21 to 30 31 to 40 41 to 50 not ranked
DC
RI
DE
The five healthiest states for seniors rank in top 10 for health determinants, while the five least-healthy states rank in the bottom six for health determinants.
Model and Measure Revisions). Despite this, Mississippi maintained high rankings in two other behaviors measures this year — low prevalence of excessive drinking (third) and high prevalence of pain management among seniors with arthritis (ninth).
In Kentucky, increases in the prevalence of physical inactivity and smoking negatively impacted the state’s ranking this year; all states in the bottom five continue to face these two challenges. Kentucky ranks 50th in health outcomes, representing no change from 2016, while dropping three rankings to 47th in health determinants. Most notable is the state’s large drop in policy ranking in the past year from 21st to 30th.
The five healthiest states for seniors rank in top 10 for health determinants (Figure 3), but vary within the determinant categories
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Figure 42017 Outcomes Ranking U.S. Map
1 to 10 11 to 20 21 to 30 31 to 40 41 to 50 not ranked
DC
RI
DE
The five healthiest states for seniors rank in the top five for health outcomes.
— behaviors, community & environment, policy and clinical care. The five least-healthy states rank in the bottom six for health determinants.
The five healthiest states for seniors rank in the top five for health outcomes (Figure 4), while the least-healthy states rank in the bottom 10 for health outcomes and show similar clustering in the southern region to the overall ranking map.
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Largest Changes in Ranking Since 2016
This year, several states made notable gains in their relative ranking (Table 3). Seven states improved four or more rankings. California and South Dakota made the greatest strides. Several states also declined in ranking in the last year (Table 4). Nine states dropped four or more rankings with Alaska and Pennsylvania experiencing the largest drops in ranking.
California achieved its highest ranking in the Senior Report’s five-year history. California improved 12 places from 28th to 16th.
• Decreases in the prevalence of smoking, physical inactivity and obesity in the past year, as well as maintaining a low prevalence of seniors with teeth extractions and a low premature death rate influenced its improvement. California ranks well in healthcare-associated infection policies, a new measure this year.
• Challenges to California’s senior health include a high prevalence of excessive drinking and falls, a low percentage of volunteerism and Supplemental Nutrition Assistance Program (SNAP) reach, and a high percentage of intensive care unit (ICU) use in the last six months of life. In addition, California has historically ranked in the bottom five states for home-delivered meals and this trend continues despite a revised definition of the measure this year (see 2017 Edition Model and Measure Revisions).
South Dakota reached its best ranking in the Senior Report’s five-year history. South Dakota improved 10 places from 25th to 15th.
• In the past year, South Dakota experienced a decrease in the prevalence of excessive
drinking, an increase in the percentage of able-bodied seniors, an increase in the prevalence of pain management for seniors with arthritis and an increase in the prevalence of seniors with a dedicated health care provider, all of which influenced the improvement in overall ranking. Additional factors include a continued high prevalence of volunteerism, a low prevalence of frequent mental distress and a low percentage of lCU use in the last six months of life.
• South Dakota continues to be challenged by a low percentage of hospice care use and SNAP reach. A new challenge this year is an increase in the prevalence of smoking among seniors.
Delaware improved five places this year from its lowest ranking on record.
• An increase in the percentage of nursing home beds rated four- or five-stars (a revised definition) and a decrease in the percentage of seniors living in poverty influenced Delaware’s improvement, as well as a continued decrease in the percentage of seniors suffering from food insecurity and increases in the prevalence of a dental visit and volunteerism. Delaware also received
Findings
California improved 12 places from 28th to 16th.
South Dakota improved 10 places from 25th to 15th.
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• Community support (a revised definition) expenditures remain a strength in Pennsylvania. The state also benefited from a high score in HAI policies (a new measure).
• Factors impacting Alaska’s drop in ranking are increases in the prevalence of excessive drinking and obesity in older adults. Additional challenges for Alaska this year were a low percentage of hospice care use and diabetes management and a low prevalence of seniors with a dedicated health care provider.
• On the positive side, Alaska experienced a large increase in the prevalence of pain management among seniors with arthritis.
a high score in a new measure, healthcare-associated infection (HAI) policies (see 2017 Edition Model and Measure Revisions).
• Challenges for Delaware are a continued high prevalence of frequent mental distress and a low prevalence of pain management among seniors with arthritis, as well as a decrease in the percentage of Medicare enrollees with creditable prescription drug coverage and increases in the prevalence of physical inactivity and excessive drinking this year.
Both Pennsylvania and Alaska dropped eight places after reaching their best Senior Report ranking in 2016. Pennsylvania dropped from 18th to 26th, Alaska dropped from 21st to 29th.
• Pennsylvania seniors continue to struggle with a high percentage of ICU use in the last six months of life and a low percentage of quality nursing home beds (a revised definition), and had a slight drop in the percentage of seniors with a dedicated health care provider in the past year. Pennsylvania is also disadvantaged by a low prevalence of pain management among seniors with arthritis.
California 16 28 12South Dakota 15 25 10Delaware 17 22 5Arizona 23 27 4Montana 27 31 4Utah 2 6 4Virginia 25 29 4
Kentucky 49 45 -4Nebraska 24 20 -4New Jersey 20 16 -4Massachusetts 6 1 -5Florida 30 24 -6Vermont 8 2 -6Idaho 22 15 -7Alaska 29 21 -8Pennsylvania 26 18 -8
Table 3States with Largest One-Year Improvement in Ranking
Table 4States with Largest One-Year Decline in Ranking
2017 2016 Change 2017 2016 Change
Delaware improved five positions from 22nd to 17th.
Pennsylvania dropped from 18th to 26th, while Alaska dropped from 21st to 29th.
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7%FROM 53.8 TO 49.9 DISCHARGES PER 1,000 MEDICARE ENROLLEES AGED 65 YEARS AND OLDER
IN THE PAST YEAR,PREVENTABLE HOSPITALIZATIONSDECREASED BY
The 2017 America’s Health Rankings Senior Report finds improvements in several clinical care measures across the nation that are offset by nutrition and food access challenges, as well as an increase in the premature death rate among seniors aged 65 to 74 years.
Successes
This year’s report finds improvements in several clinical care and health outcomes measures.
• Hospital readmissions decreased 7 percent since 2013, from 15.9 percent to 14.8 percent. Hospital readmission is the percentage of Medicare enrollees aged 65 years and older who were readmitted within 30 days of discharge. Returning to a hospital within a short period of time after being discharged is costly and often avoidable.
• Preventable hospitalizations decreased 7 percent from 53.8 to 49.9 discharges per 1,000 Medicare enrollees in the past year, continuing a four-year decline. Since 2013, preventable hospitalizations have declined 25 percent. Preventable hospitalizations are excess hospital admissions for chronic or acute illnesses where hospitalization may have been avoided if the condition had been properly managed in an outpatient setting. Conditions that can usually be managed outside of a hospital include diabetes, infectious disease, hypertension, chronic obstructive pulmonary disorder and asthma.
• The percentage of hospice care and hospital deaths among chronically ill Medicare decedents have continuously improved since 2013. Since the first Senior Report in 2013, hospital deaths decreased 30 percent from 30.1 percent to 21.0 percent and hospice care increased 42 percent from 36.7 percent to 52.0 percent of chronically ill Medicare decedents aged 65 years and older.
National Findings
30%
FROM 15.9 % TO 14.8 % OF MEDICARE ENROLLEES AGED 65 YEARS AND OLDER
FROM 30.1 % TO 21.0% OF CHRONICALLY ILL MEDICARE DECEDENTS AGED 65 YEARS AND OLDER
7%SINCE THE 2013 EDITION,HOSPITAL READMISSIONSDECREASED BY
SINCE THE 2013 EDITION,HOSPITAL DEATHSDECREASED BY
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 17
• Health screenings may help detect diseases early, when treatment is easiest and most effective. Since the 2015 edition, health screenings increased 19 percent from 60.7 percent to 72.4 percent of seniors receiving recommended screenings. Health screenings reflect the percentage of women aged 65 to 74 years who reported receiving a mammogram in the past two years and the percentage of adults aged 65 to 75 years who reported receiving colorectal cancer screening within the recommended time periods. While this measure is limited to two types of cancer screenings, health screenings go beyond cancer screening and include procedures such as blood pressure checks, diabetes screenings and cholesterol checks.
• Since the 2013 edition, Intensive Care Unit (ICU) use in the last six months of life decreased 9 percent from 15.2 percent to 13.8 percent of Medicare decedents aged 65 years and older. While not correlated with better outcomes or longer life, ICU use is correlated with availability of critical care beds, which could indicate a supply-induced demand. Overuse of the critical care system often goes against the wishes of dying patients and is costly.
• Decreases in bone density and muscle mass associated with aging substantially increases the rate of hip fractures. Hip fractures often result in hospitalization, surgery and extensive rehabilitation in a long-term care facility and may signal the end of independence for older adults. Since the 2013 edition, the hip fracture hospitalization rate decreased 21 percent from 7.3 to 5.8 hospitalizations per 1,000 Medicare enrollees.
21%FROM 7.3 TO 5.8 HOSPITALIZATIONS PER 1,000 MEDICARE ENROLLEES AGED 65 YEARS AND OLDER
SINCE THE 2013 EDITION,
THE HIP FRACTURE HOSPITALIZATION RATEDECREASED BY
19%
9%
FROM 60.7 % TO 72.4% OF SENIORS RECEIVING RECOMMENDED SCREENINGS
FROM 15.2 % TO 13.8% OF MEDICARE DECEDENTS AGED 65 YEARS AND OLDER
SINCE THE 2015 EDITION,HEALTH SCREENINGSINCREASED BY
SINCE THE 2013 EDITION,ICU USE IN THE LAST SIX MONTHS OF LIFE DECREASED BY
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National Findings
Challenges
There was a 1 percent increase in premature death in the senior population, a measure of mortality among adults aged 65 to 74. The premature death rate increased from 1,786 to 1,797 deaths per 100,000 adults aged 65 to 74 years in the past year. Though the change is small, it represents the first increase in premature death after three consecutive years of decline. It echoes findings observed in the America’s Health Rankings Annual Report in December 2016, which showed an increase in the years of potential life lost before age 75 (YPLL-75) over the past two editions following two decades of predominantly declining YPLL-75 rates.
Additionally, a higher percentage of seniors today are struggling with maintaining a healthy weight and proper nutrition. Food insecurity —meaning reduced food intake and/or disrupted eating patterns due to lack of resources for food — is on the rise. Compared with younger adults, seniors living at home are at an increased risk of hunger due to health conditions, disability and functional limitations that impact their ability to obtain or prepare food. Home-delivered meal programs can enhance quality of life, provide a stable source of nutrition, increase nutrient intake and help older adults remain independent despite functional limitations. More than 4.8 million low-income adults aged 60 years and older rely on SNAP to stretch their monthly food budget.
• Since the 2013 edition, obesity increased 9 percent from 25.3 percent to 27.6 percent of adults aged 65 years and older, reaching the highest prevalence in the report’s history. Obesity prevalence is higher among non-Hispanic black and Hispanic seniors, and those with lower education and income. The causes of obesity are complex and include lifestyle, social and physical environment, genetics and medical history.
1,797
9%
7%
DEATHS PER 100,000 ADULTS AGED 65 TO 74 YEARS
SINCE THE 2013 EDITION,OBESITY INCREASED BY
SINCE THE 2015 EDITION,SNAP REACHDECREASED BY
FROM 25.3 % TO 27.6% OF ADULTS AGED 65 YEARS AND OLDER
FROM 75.2 % TO 70.1% OF ADULTS AGED 60 YEARS AND OLDER LIVING IN POVERTY
IN THE PAST YEAR,THE PREMATURE DEATH RATE INCREASED FROM 1,786 TO
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• In the past two years, SNAP reach decreased 7 percent from 75.2 percent to 70.1 percent of adults aged 60 years and older living in poverty. The Supplemental Nutrition Assistance Program (SNAP) is the largest federal nutrition program helping millions of low-income Americans access food and improve economic security and health outcomes. According to a 2016 article in Aging, compared with younger age groups, older adults who are eligible for SNAP are significantly less likely to participate in the program. The U.S. Department of Agriculture reports that only 42 percent of eligible seniors participate in SNAP, compared with 83 percent of all eligible adults.
• Since 2013, food insecurity, a measure of the percentage of seniors facing the threat of hunger, increased 16 percent from 13.6 percent to 15.8 percent of adults aged 60 years and older.
• Community support funding for public nutrition, transportation and other social services for seniors living in poverty decreased 6 percent in the past year. Seniors value living in their own home safely and independently. Several federal and state programs offer support to seniors, allowing them to remain independent at home, and a major source of this funding is The Older Americans Act (OAA). OAA dollars are used by states to fund personal care, congregate meals, transportation and nutrition-education programs for seniors. The 2015 National Survey of OAA Participants documented that 92 percent of home-delivered meal recipients said that receiving meals helped them stay in their own homes.
16%
SINCE THE 2013 EDITION,
FOOD INSECURITYA MEASURE OF THE PERCENTAGE OF SENIORS FACING THE THREAT OF HUNGER,
FROM 13.6 % TO 15.8% OF ADULTS AGED 60 YEARS AND OLDER
INCREASED BY
6%
IN THE PAST YEAR,
COMMUNITY SUPPORT FUNDINGFOR PUBLIC NUTRITION, TRANSPORTATION, AND OTHER SOCIAL SERVICES FOR SENIORS LIVING IN POVERTY
FROM $572 TO $536 PER ADULT AGED 60 YEARS AND OLDER LIVING IN POVERTY
DECREASED BY
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Core Measures
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Ranking
CORE MEASURES
Rank State Value (%)
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
Behaviors
Oral health naturally declines with age, and problems arise if routine care is not maintained. Poor oral health can have a large impact on quality of life by negatively affecting the ability to chew, speak and interact socially, in addition to increasing the risk for certain diseases such as diabetes and oral cancer. Most individuals lose dental insurance coverage when they retire, and Medicare generally does not cover dental care. This means the majority of seniors pay out-of-pocket for most or all dental expenses, which impacts dental care use. Evidence indicates that older adults who use preventive dental care reduce their dental bills and out-of-pocket payments.
Dental Visit by StatePercentage of adults aged 65 years and older who reported visiting a dental health professional within the past 12 months
by Dental Visit
Data source: CDC, Behavioral Risk Factor Surveillance System, 2014For details: www.AmericasHealthRankings.org/SR17/DentalVisitsBiennial data
>=71.0% 67.5% to 70.9% 64.5% to 67.4% 60.5% to 64.4% <=60.4%
DC
RI
DE
Dental Visit
706050403020100
2013* 2014 2015 2016 2017
% O
F A
DU
LTS
AG
ED 6
5+
EDITION YEAR
65.7%65.7%65.7%65.6%65.6%69.2%*
1 Hawaii 78.12 Minnesota 75.63 Connecticut 75.14 New Hampshire 74.15 Michigan 72.46 Massachusetts 71.96 Vermont 71.98 Wisconsin 71.69 California 71.310 Utah 71.011 Colorado 70.912 Washington 70.613 Virginia 70.514 Rhode Island 70.415 Iowa 70.015 New Jersey 70.017 Maryland 69.918 Delaware 69.719 Nebraska 68.020 Oregon 67.521 Maine 67.422 Kansas 66.723 North Dakota 66.424 Florida 66.224 Wyoming 66.226 New York 65.827 South Dakota 65.428 Arizona 65.329 Alaska 64.529 Pennsylvania 64.531 Ohio 63.732 Montana 63.533 North Carolina 63.434 New Mexico 63.235 Idaho 62.536 Illinois 62.237 Georgia 62.138 Texas 61.239 South Carolina 60.840 Indiana 60.541 Nevada 59.742 Missouri 58.843 Tennessee 58.644 Alabama 57.945 Louisiana 57.246 Kentucky 57.047 Oklahoma 55.448 Arkansas 54.549 Mississippi 54.050 West Virginia 48.6 United States 65.7 District of Columbia 65.1
* Not comparable to later years due to methodology change
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 23
Prevalence by Race/Ethnicity
*Non-Hispanic
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
Prevalence by Urbanicity
Rural Suburban
Urban
Rural Suburban
Urban
Prevalence by Education
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Prevalence by Income
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Prevalence by Gender
Female Male
FemaleMale
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
0 20 40 60
0 20 40 60Adults aged 65+, %
0 20 40 60 80
0 20 40 60 80Adults aged 65+, %
Adults aged 65+, %
Adults aged 65+, %
Adults aged 65+, %
66.8% 64.4% 49.9% 66.8% 80.4% 47.1% 64.4% 75.2%
— 46.0% 68.8% 62.7% 75.5% 86.4% 32.9% 47.3% 68.9% — 26.0% — 39.0% 55.8% 88.2% 49.9% 68.8% 85.9%
22.4% 38.9% 61.0% 47.0% 61.1% 70.8% 60.4% 70.2% 81.8% 77.7% 84.7% 90.9%
31.6% 46.3% 58.7% 57.2% 67.4% 79.1% 64.1% 79.4% 87.4% 73.2% 87.1% 94.6%
43.7% 60.5% 76.5% 49.2% 68.8% 79.5% 49.9% 67.7% 81.9%
Dental Visit by Subpopulations
24 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
Behaviors
Although moderate alcohol consumption has been shown to lower all-cause mortality rates in older adults, excessive alcohol consumption in seniors can lead to sleep disorders, depression, anxiety, suicide, liver diseases, cardiovascular diseases — including stroke — and cancers of the head, neck and esophagus. Heavy drinking can exacerbate health problems such as diabetes and high blood pressure and may increase the risk of dementia and cognitive dysfunction. The rate of alcohol-attributable deaths among seniors is more than twice the rate in the general population (60.3 per 100,000 compared with 28.5 per 100,000). Bereavement, loneliness and social isolation may contribute to excessive drinking in older adults.
Excessive Drinking by StatePercentage of adults aged 65 years and older who reported either binge drinking (having four or more [women] or five or more [men] drinks on one occasion in the past month) or chronic drinking (having eight or more [women] or 15 or more [men] drinks per week)
by Excessive Drinking
Data source: CDC, Behavioral Risk Factor Surveillance System, 2015For details: www.AmericasHealthRankings.org/SR17/ExcessiveDrinking
<=4.8% 4.9% to 6.4% 6.5% to 7.1% 7.2% to 7.9% >=8.0%
DC
RI
DE
6.7%6.7%6.6%———
1 West Virginia 3.32 Tennessee 3.83 Mississippi 3.94 Arkansas 4.24 Oklahoma 4.24 Utah 4.27 Kentucky 4.38 Alabama 4.58 South Dakota 4.510 Kansas 4.811 Virginia 5.112 Georgia 5.313 North Carolina 5.414 Indiana 5.515 New Mexico 5.616 Missouri 5.917 Ohio 6.017 South Carolina 6.019 Louisiana 6.419 Nebraska 6.419 Rhode Island 6.422 Iowa 6.523 Maryland 6.623 Texas 6.625 Colorado 6.725 North Dakota 6.727 California 7.027 Massachusetts 7.027 Pennsylvania 7.030 New York 7.131 Idaho 7.231 Minnesota 7.231 New Jersey 7.234 Connecticut 7.334 Delaware 7.334 Wyoming 7.337 Arizona 7.537 New Hampshire 7.537 Vermont 7.540 Florida 7.940 Maine 7.942 Illinois 8.043 Michigan 8.343 Montana 8.345 Washington 8.546 Oregon 9.447 Hawaii 9.548 Nevada 9.849 Wisconsin 10.450 Alaska 10.7 United States 6.7 District of Columbia 9.8
Excessive Drinking
706050403020100
2013 2014 2015 2016 2017
% O
F A
DU
LTS
AG
ED 6
5+
EDITION YEAR
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 25
Prevalence by Race/Ethnicity
*Non-Hispanic
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
Prevalence by Urbanicity
Rural Suburban
Urban
Rural Suburban
Urban
Prevalence by Education
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Prevalence by Income
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Prevalence by Gender
Female Male
FemaleMale
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
1.0% 5.3% 10.7% 4.9% 8.7% 15.0%
— 10.3% — — 2.8% 5.3% 4.4% 5.5% 12.5% — 14.3% — 4.1% 5.9% 7.9% 3.1% 7.1% 19.7%
3.8% 4.5% 7.3% 2.1% 6.0% 12.1% 3.2% 7.6% 14.3% 4.1% 8.2% 15.4%
2.6% 5.2% 10.2% 3.2% 6.9% 12.1% 5.0% 8.2% 16.1% 4.4% 11.1% 19.8%
2.2% 4.9% 11.1% 2.9% 6.5% 9.7% 3.1% 6.3% 13.0%
Excessive Drinking by Subpopulations
Adults aged 65+, %
5.3% 8.7%
0 4 8 12
0 2 4 6Adults aged 65+, %
0 4 8
0 2 4 6 8 10 12Adults aged 65+, %
Adults aged 65+, %
Adults aged 65+, %
26 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
Behaviors
Obesity contributes to cognitive decline, heart disease, diabetes, stroke and certain cancers. Recent research suggests that the strength of the association between obesity and mortality risk increases with age. The causes of obesity are complex and include lifestyle, social and physical environment, genetics and medical history. Obese seniors experience more hospitalizations, emergency department visits and use of outpatient health services than non-obese seniors. Older adults are more likely to have poor diet and decreased physical activity that contribute to obesity. Growing evidence illustrates the importance of the built environment and community design in promoting a healthy lifestyle.
Obesity by StatePercentage of adults aged 65 years and older with a body mass index of 30.0 or higher based on reported height and weight
by Obesity
Data source: CDC, Behavioral Risk Factor Surveillance System, 2015For details: www.AmericasHealthRankings.org/SR17/Obesity
<=25.2% 25.3% to 27.3% 27.4% to 29.3% 29.4% to 30.5% >=30.6%
DC
RI
DE
Obesity
27.6%27.6%27.5%26.7%26.3%25.3%
1 Hawaii 17.92 Colorado 20.03 New Mexico 22.34 California 22.85 Montana 23.26 Nevada 23.97 Arizona 24.28 Rhode Island 24.49 New York 24.910 Massachusetts 25.211 Connecticut 25.512 Florida 25.813 Utah 26.214 South Dakota 26.515 North Carolina 26.716 New Jersey 26.916 Vermont 26.918 Washington 27.219 Idaho 27.319 Wyoming 27.321 Tennessee 27.722 New Hampshire 27.823 Delaware 27.924 Oklahoma 28.125 Minnesota 28.525 South Carolina 28.527 Oregon 28.928 Maine 29.028 Ohio 29.030 Virginia 29.331 Maryland 29.431 Missouri 29.433 Indiana 29.534 Georgia 29.734 Texas 29.736 Arkansas 29.837 Michigan 30.038 Alabama 30.239 West Virginia 30.340 Kansas 30.541 Mississippi 30.841 Pennsylvania 30.843 North Dakota 30.944 Iowa 31.145 Kentucky 31.246 Illinois 31.347 Wisconsin 31.848 Nebraska 32.049 Louisiana 33.650 Alaska 34.7 United States 27.6 District of Columbia 29.7
30
25
20
15
10
5
0
2013 2014 2015 2016 2017
% O
F A
DU
LTS
AG
ED 6
5+
EDITION YEAR
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 27
Prevalence by Race/Ethnicity
*Non-Hispanic
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
Prevalence by Urbanicity
Rural Suburban
Urban
Rural Suburban
Urban
Prevalence by Education
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Prevalence by Income
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Prevalence by Gender
Female Male
FemaleMale
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
16.9% 27.0% 34.1% 19.1% 28.2% 36.8%
26.1% 31.8% 45.9% — 11.9% 12.3% 24.2% 36.6% 48.9% — 24.4% — 22.7% 33.5% 43.6% 11.8% 26.5% 33.0%
17.2% 33.4% 55.9% 16.7% 29.1% 35.7% 19.0% 28.0% 40.2% 13.7% 21.1% 32.8%
16.8% 31.8% 44.4% 16.9% 29.8% 45.3% 14.9% 27.3% 37.0% 15.4% 23.0% 35.1%
16.0% 29.6% 35.8% 18.7% 26.6% 39.8% 11.8% 26.0% 34.6%
Obesity by Subpopulations
Adults aged 65+, %
27.0% 28.2%
0 10 20 30
0 10 20 30Adults aged 65+, %
0 10 20 30
0 10 20 30Adults aged 65+, %
Adults aged 65+, %
Adults aged 65+, %
28 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
Behaviors
Almost half of adults aged 65 years and older have arthritis, a leading cause of disability. Among adults with arthritis, 27 percent report severe joint pain. In addition to pain, arthritis is associated with aches, stiffness and swelling. It is more common in older adults, overweight individuals and those with a history of joint injury. Opioids are often prescribed to adults with arthritis but non-pharmaceutical approaches such as self-management education and physical activity are also effective. Research suggests physical activity can decrease pain and improve function by 40 percent. Physical activity can also improve mobility, mood and quality of life for many adults with arthritis.
Pain Management by StatePercentage of adults aged 65 years and older with arthritis who reported that arthritis or joint pain does not limit their usual activities
by Pain Management
Data source: CDC, Behavioral Risk Factor Surveillance System, 2015For details: www.AmericasHealthRankings.org/SR17/PainManagementBiennial data
>=50.4% 47.8% to 50.3% 44.9% to 47.7% 42.8% to 44.8% <=42.7%
DC
RI
DE
46.5%46.5%46.1%46.1%51.7%51.7%
1 Louisiana 54.92 Oregon 54.83 Alabama 53.43 Kentucky 53.45 Arkansas 53.16 Alaska 53.07 West Virginia 51.88 Oklahoma 51.29 Mississippi 50.610 Washington 50.411 North Carolina 50.112 South Carolina 49.613 Arizona 48.714 Georgia 48.515 South Dakota 48.416 Vermont 48.317 Florida 48.218 New York 48.119 Texas 48.020 New Mexico 47.821 Massachusetts 47.522 Missouri 47.423 Connecticut 47.223 Kansas 47.225 Tennessee 46.726 Illinois 46.527 North Dakota 45.528 Ohio 45.229 California 45.130 Utah 44.931 Wisconsin 44.432 Michigan 44.232 Rhode Island 44.234 New Jersey 44.135 Colorado 44.035 Minnesota 44.037 Nevada 43.638 Maine 43.438 Montana 43.440 Indiana 42.841 Nebraska 42.342 Virginia 42.243 Idaho 41.844 Delaware 41.445 Wyoming 41.046 New Hampshire 40.947 Iowa 40.048 Hawaii 39.549 Maryland 39.250 Pennsylvania 37.2 United States 46.5 District of Columbia 48.2
Pain Management
60
50
40
30
20
10
0
2013 2014 2015 2016 2017
% O
F A
DU
LTS
AG
ED 6
5+
WIT
H A
RTH
RITI
S
EDITION YEAR
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 29
Prevalence by Race/Ethnicity
*Non-Hispanic
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
Prevalence by Urbanicity
Rural Suburban
Urban
Rural Suburban
Urban
Prevalence by Education
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Prevalence by Income
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Prevalence by Gender
Female Male
FemaleMale
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
36.6% 47.9% 57.5% 35.8% 44.1% 57.3%
53.5% 59.0% 67.9% 32.9% 37.4% — 39.0% 51.6% 62.3% — 42.5% — 36.5% 51.6% 70.2% 36.9% 45.5% 56.8%
31.8% 53.7% 64.5% 30.4% 45.2% 57.0% 38.0% 46.6% 60.1% 33.0% 42.0% 50.8%
39.2% 54.4% 65.0% 33.2% 45.1% 55.4% 30.9% 40.3% 52.5% 26.7% 39.5% 55.8%
38.5% 49.2% 63.1% 34.7% 45.6% 60.7% 36.9% 46.4% 56.5%
Pain Management by Subpopulations
Adults aged 65+ with arthritis, %
47.9% 44.1%
0 20 40 60
0 10 20 30 40 50Adults aged 65+ with arthritis, %
0 10 20 30 40 50
0 10 20 30 40 50Adults aged 65+ with arthritis, %
Adults aged 65+ with arthritis, %
Adults aged 65+ with arthritis, %
30 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
Behaviors
Older adults are less likely to meet aerobic and muscle-strengthening physical activity recommendations than younger adults. Aging causes muscle mass and strength to decrease, which may challenge older adults to remain active. Physical inactivity increases the risk of cardiovascular disease, cancer, diabetes, hypertension, obesity and premature death. Increasing physical activity prevents and helps manage numerous chronic diseases. Physical activity has also been shown to increase bone density, reduce falls, prevent memory loss and decrease depression. Growing evidence illustrates the importance of environment and community design to promote physical activity for seniors.
Physical Inactivity by StatePercentage of adults aged 65 years and older with fair or better health status who reported doing no physical activity or exercise other than their regular job in the past 30 days
by Physical Inactivity
Data source: CDC, Behavioral Risk Factor Surveillance System, 2015For details: www.AmericasHealthRankings.org/SR17/PhysicalInactivity
<=27.4% 27.5% to 30.6% 30.7% to 32.7% 32.8% to 34.7% >=34.8%
DC
RI
DE
31.3%31.3%31.2%33.1%28.7%30.3%
1 California 21.62 Washington 22.03 Colorado 22.34 Oregon 24.85 Idaho 25.26 Hawaii 25.37 New Mexico 26.18 Utah 26.49 Arizona 27.110 Wisconsin 27.411 Nevada 28.112 New Hampshire 28.313 Florida 28.914 Vermont 29.015 Montana 29.116 South Dakota 29.417 Alaska 29.517 Minnesota 29.519 Connecticut 30.520 Michigan 30.621 Maine 30.722 South Carolina 31.323 Iowa 31.424 Wyoming 31.525 Maryland 31.625 North Carolina 31.627 Georgia 32.428 Kansas 32.529 Nebraska 32.630 Rhode Island 32.731 North Dakota 33.232 Massachusetts 33.332 New York 33.334 Missouri 33.635 Ohio 33.836 Illinois 34.137 New Jersey 34.238 Delaware 34.439 Texas 34.739 Virginia 34.741 Pennsylvania 35.042 Indiana 35.943 West Virginia 36.744 Tennessee 38.145 Alabama 38.546 Louisiana 39.047 Arkansas 40.248 Oklahoma 41.249 Kentucky 42.350 Mississippi 42.8 United States 31.3 District of Columbia 29.0
Physical Inactivity
35302520151050
2013 2014 2015 2016 2017% O
F A
DU
LTS
AG
ED 6
5+ IN
FA
IR
OR
BETT
ER H
EALT
H
EDITION YEAR
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 31
Prevalence by Race/Ethnicity
*Non-Hispanic
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
Prevalence by Urbanicity
Rural Suburban
Urban
Rural Suburban
Urban
Prevalence by Education
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Prevalence by Income
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Prevalence by Gender
Female Male
FemaleMale
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
23.4% 33.9% 46.3% 17.9% 27.9% 39.8%
33.7% 33.9% 49.2% 20.2% 23.8% 27.1% 25.1% 36.8% 55.7% — 24.7% — 23.7% 33.9% 45.2% 14.6% 30.5% 41.6%
28.6% 43.7% 57.4% 27.6% 36.8% 47.9% 18.2% 28.4% 40.6% 11.1% 19.3% 29.2%
26.1% 39.2% 51.0% 21.1% 31.8% 43.1% 17.1% 26.3% 41.8% 12.7% 19.3% 34.2%
21.2% 37.7% 46.9% 23.1% 32.8% 46.2% 20.6% 31.1% 41.5%
Physical Inactivity by Subpopulations
Adults aged 65+, %
33.9% 27.9%
0 10 20 30
0 10 20 30Adults aged 65+ in fair or better health, %
0 10 20 30 40
0 10 20 30 40Adults aged 65+ in fair or better health, %
Adults aged 65+ in fair or better health, %
Adults aged 65+ in fair or better health, %
32 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
Behaviors
Smoking damages nearly every organ and causes such diseases as cataracts, respiratory disease, heart disease, stroke and cancer. It is also associated with accelerated cognitive decline, dementia and early cognitive impairment. Adults 65 years and older experience a higher prevalence of chronic obstructive pulmonary disease (COPD) than younger adults, and smoking causes about 80 percent of all COPD deaths. Smoking is the leading cause of preventable death in the United States. Cigarette smoking and secondhand smoke account for an estimated 480,000 deaths yearly and an additional 8.6 million people have a serious smoking-related illness.
Smoking by StatePercentage of adults aged 65 years and older who are smokers (reported smoking at least 100 cigarettes in their lifetime and currently smoke every or some days)
by Smoking
Data source: CDC, Behavioral Risk Factor Surveillance System, 2015For details: www.AmericasHealthRankings.org/SR17/Smoking
<=7.6% 7.7% to 8.6% 8.7% to 9.0% 9.1% to 10.7% >=10.8%
DC
RI
DE
Smoking
8.7%8.7%8.8%8.7%8.8%8.9%
1 Utah 5.22 California 6.12 Hawaii 6.14 New Hampshire 6.74 Texas 6.76 Connecticut 7.37 Minnesota 7.48 New Jersey 7.58 Rhode Island 7.510 Maryland 7.611 Idaho 7.812 Washington 8.013 Colorado 8.113 Maine 8.113 New York 8.116 North Dakota 8.216 Wisconsin 8.218 Florida 8.418 Montana 8.420 Virginia 8.621 Delaware 8.721 Kansas 8.721 Massachusetts 8.724 Alaska 8.824 Arizona 8.824 Illinois 8.824 Nebraska 8.824 South Carolina 8.829 Oregon 8.930 Pennsylvania 9.030 Vermont 9.032 North Carolina 9.133 Wyoming 9.434 Iowa 9.735 South Dakota 9.836 Ohio 9.937 Alabama 10.237 Georgia 10.239 Michigan 10.340 Mississippi 10.740 West Virginia 10.742 New Mexico 10.843 Indiana 10.944 Missouri 11.045 Arkansas 11.445 Louisiana 11.447 Kentucky 12.347 Nevada 12.349 Oklahoma 13.050 Tennessee 13.8 United States 8.7 District of Columbia 10.2
10
8
6
4
2
0
2013 2014 2015 2016 2017
% O
F A
DU
LTS
AG
ED 6
5+
EDITION YEAR
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 33
Prevalence by Race/Ethnicity
*Non-Hispanic
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
Prevalence by Urbanicity
Rural Suburban
Urban
Rural Suburban
Urban
Prevalence by Education
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Prevalence by Income
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Prevalence by Gender
Female Male
FemaleMale
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
4.5% 8.1% 14.7% 6.1% 9.5% 15.5%
— 16.6% 33.9% 5.7% 6.3% — 7.9% 12.0% 19.3% — 5.6% — 4.6% 6.2% 14.2% 4.6% 8.5% 13.6%
6.4% 12.1% 21.4% 6.5% 9.8% 16.7% 5.0% 9.1% 15.1% 2.1% 4.6% 8.3%
7.9% 13.1% 21.9% 6.0% 9.1% 15.8% 3.9% 7.2% 14.4% 2.6% 4.3% 9.8%
4.9% 9.4% 13.9% 5.2% 7.9% 13.0% 4.6% 7.7% 12.9%
Smoking by Subpopulations
Adults aged 65+, %
8.1% 9.5%
0 4 8 12 16
0 2 4 6 8Adults aged 65+, %
0 4 8 12
0 4 8 12Adults aged 65+, %
Adults aged 65+, %
Adults aged 65+, %
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
34 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)Poor quality care in nursing homes, including elder abuse and exploitation, has an enormous impact on the health and finances of U.S. nursing home residents. Low staffing and inadequate staff training contribute to poor resident health outcomes. Millions of dollars are spent yearly for medical treatments and hospitalizations for nursing home resident falls, pressure ulcers, urinary incontinence, malnutrition, dehydration and ambulatory care-sensitive diagnoses. Quality nursing home practices can largely prevent these negative health outcomes, and nursing homes nationwide are making efforts toward systematic quality improvement. The Centers for Medicare & Medicaid Services has a five-star quality rating system for nursing homes to assist older adults and families in finding a quality facility.
Nursing Home Quality by StatePercentage of certified nursing home beds rated four- or five-stars over a three-month period
by Nursing Home Quality
Data source: U.S. HHS, Centers for Medicare & Medicaid Services, Nursing Home Compare, 2017For details: www.AmericasHealthRankings.org/SR17/Nursing-HomeQuality
>=52.2% 49.6% to 52.1% 46.0% to 49.5% 35.2% to 45.9% <=35.1%
DC
RI
DE
42.4%42.4%42.4%*42.5%*——
1 Maine 56.42 Washington 56.33 Utah 55.44 Vermont 55.15 Minnesota 55.06 Rhode Island 54.07 Delaware 53.58 New Hampshire 53.09 Colorado 52.510 Arizona 52.211 Idaho 51.611 New Jersey 51.613 Montana 51.514 California 51.315 Hawaii 51.216 Alabama 50.717 North Dakota 50.518 Florida 50.118 Oregon 50.120 Wisconsin 49.621 Nebraska 49.122 Connecticut 48.922 Iowa 48.924 Wyoming 48.225 Arkansas 47.625 South Carolina 47.627 New York 47.228 Michigan 47.129 Indiana 46.029 Massachusetts 46.031 South Dakota 44.832 Missouri 44.633 Alaska 43.934 Kansas 43.435 Nevada 42.236 Maryland 41.537 Tennessee 40.238 Ohio 38.639 Mississippi 37.240 Pennsylvania 35.241 Illinois 35.042 Virginia 34.643 New Mexico 32.144 Oklahoma 31.645 Georgia 31.546 Kentucky 29.547 North Carolina 28.248 Texas 27.849 Louisiana 27.050 West Virginia 25.8 United States 42.4 District of Columbia 55.4
Nursing Home Quality
45
30
15
0
2013 2014 2015* 2016* 2017
% O
F BE
DS
RATE
D 4
- O
R 5-
STA
RS
EDITION YEAR
* Not comparable to later years due to methodol-ogy change
Community & Environment: Macro
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 35
Ranking
CORE MEASURES
Rank State Value (%)Poverty rates among seniors increase with age. Poverty rates are also higher for women than men, for Hispanics and blacks than whites, and for people in relatively poor health versus those in relatively good health. Poverty influences environmental exposures and health-related behaviors, and is associated with increased risk of mortality and chronic disease. Low-income seniors have a harder time paying for appropriate chronic disease management and preventive care, and often have low health literacy. Many seniors live on limited incomes and have modest savings. The last major economic crisis affected many seniors, impacting retirement and pension incomes, retiree health benefits and Medicaid assistance.
Poverty by StatePercentage of adults aged 65 years and older who live in households at or below 100 percent of the poverty threshold
by Poverty
Data source: US Census Bureau, American Community Survey, 2015For details: www.AmericasHealthRankings.org/SR17/Poverty
Community & Environment: Macro
<=7.2% 7.3% to 7.8% 7.9% to 8.5% 8.6% to 9.9% >=10.0%
DC
RI
DE
Poverty
9.0%9.0%9.5%9.5%9.3%9.3%
1 Alaska 4.52 New Hampshire 6.13 Delaware 6.24 Vermont 6.65 Utah 6.86 Minnesota 6.97 Colorado 7.07 Iowa 7.09 Wisconsin 7.110 Connecticut 7.210 Indiana 7.212 Kansas 7.312 Maryland 7.312 Oregon 7.312 Virginia 7.316 Nebraska 7.416 Washington 7.418 Montana 7.618 Ohio 7.620 Hawaii 7.820 Michigan 7.820 Pennsylvania 7.823 New Jersey 7.924 Wyoming 8.025 South Dakota 8.326 Nevada 8.426 Oklahoma 8.428 Illinois 8.528 Missouri 8.528 West Virginia 8.531 Idaho 8.732 Maine 8.833 North Dakota 8.934 Arizona 9.035 Massachusetts 9.235 North Carolina 9.237 South Carolina 9.338 Georgia 9.739 Tennessee 9.840 Alabama 9.940 California 9.942 Arkansas 10.342 Florida 10.342 Rhode Island 10.342 Texas 10.346 New Mexico 11.147 Kentucky 11.247 New York 11.249 Mississippi 12.550 Louisiana 12.8 United States 9.0 District of Columbia 15.2
10
8
6
4
2
0
2013 2014 2015 2016 2017
% O
F A
DU
LTS
AG
ED 6
5+
EDITION YEAR
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
36 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)Retirement provides additional free time that some seniors fill with volunteering. Volunteering provides a service for communities and organizations, and it provides seniors with positive social interactions, a greater level of social support, and often a sense of meaning and purpose. Studies show that older adults who volunteer have better cognitive performance, fewer depressive symptoms, higher activity levels and better mental well-being than seniors who do not volunteer. The health benefits of volunteering may extend beyond psychological well-being; higher rates of volunteerism are associated with lower rates of mortality and heart disease, and a longer life span.
Volunteerism by StatePercentage of adults aged 65 years and older who reported volunteering in the past 12 months
by Volunteerism
Data source: Corporation for National & Community Service, 2013-2015For details: www.AmericasHealthRankings.org/SR17/Volunteerism
>=29.9% 26.4% to 29.8% 23.3% to 26.3% 21.0% to 23.2% <=20.9%
DC
RI
DE
Volunteerism
26.0%26.0%26.4%26.4%26.1%26.0%
1 Utah 45.92 Minnesota 36.83 South Dakota 36.34 North Dakota 36.15 Nebraska 35.46 Kansas 34.67 Wisconsin 34.58 Vermont 34.29 Iowa 33.410 Delaware 29.910 Maine 29.910 Washington 29.913 Idaho 29.214 Oregon 28.815 Connecticut 28.616 Virginia 28.117 Alaska 27.918 Colorado 26.618 Missouri 26.620 Montana 26.421 New Hampshire 26.221 Wyoming 26.223 Ohio 26.123 Pennsylvania 26.125 South Carolina 26.026 Maryland 25.426 North Carolina 25.428 Indiana 24.429 Oklahoma 24.230 Alabama 23.330 Michigan 23.332 Illinois 22.233 Arizona 22.133 Massachusetts 22.135 California 21.836 Tennessee 21.637 Texas 21.538 New Jersey 21.439 New Mexico 21.039 West Virginia 21.041 Georgia 20.341 Mississippi 20.343 Rhode Island 20.144 Arkansas 19.645 Hawaii 19.246 Kentucky 18.947 Florida 18.748 New York 17.649 Louisiana 17.450 Nevada 16.8 United States 26.0 District of Columbia 28.4
30
25
20
15
10
5
0
2013 2014 2015 2016 2017
% O
F A
DU
LTS
AG
ED 6
5+
EDITION YEAR
Community & Environment: Macro
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 37
Ranking
CORE MEASURES
Rank State Value (%)Seniors value living in their own home safely and independently. Several federal and state programs offer support to seniors allowing them to remain independent at home. The Older Americans Act (OAA), governed by the U.S. Administration on Aging, is a major source of funding to states for nutritional and social support services for seniors and their caregivers. OAA funding is used by states for services such as personal care, congregate meals, transportation and health promotion. Community public health spending is associated with reducing preventable mortality, especially in low-resource communities. Higher levels of OAA spending in a state are also associated with fewer low-care nursing home residents.
Community Support by StateExpenditures captured by the Administration on Aging per adult aged 60 years and older living in poverty
by Community Support
Data source: U.S. HHS, Administration on Aging, State Program Reports, American Community Survey, 2014For details: www.AmericasHealthRankings.org/SR17/CommunitySup-port
Community & Environment: Micro
>=$890 $540 to $889 $395 to $539 $270 to $394 <=$269
DC
RI
DE
$536$536$572———
1 Alaska 3,5992 Massachusetts 2,7343 New Hampshire 2,2334 Wyoming 2,0615 Vermont 1,4736 North Dakota 1,3897 Pennsylvania 1,2238 Montana 9789 New York 89910 Utah 89011 Nebraska 88512 Florida 79913 South Dakota 79414 Delaware 70715 Alabama 66616 Iowa 64417 Indiana 59018 Wisconsin 57519 New Jersey 55420 Connecticut 54021 Hawaii 53922 New Mexico 52323 Arkansas 50924 Missouri 47425 Kansas 47226 West Virginia 44427 Ohio 42928 Colorado 39829 Michigan 39730 Louisiana 39531 Minnesota 39432 Maryland 35833 Illinois 34934 Virginia 34535 North Carolina 33436 Oregon 33137 Maine 31538 Oklahoma 30439 Idaho 27440 California 27041 Georgia 25442 Washington 25343 Tennessee 25244 Arizona 24145 Rhode Island 23946 Kentucky 23047 Texas 21848 Nevada 20948 South Carolina 20950 Mississippi 188 United States 536 District of Columbia 1,623
Community Support
600
500
400
300
200
100
0
2013 2014 2015 2016 2017
DO
LLA
RS P
ER A
DU
LT
AG
ED 6
0+
IN P
OV
ERTY
EDITION YEAR
Rank State Value ($)
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
38 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)Food insecurity — meaning food intake was reduced and/or eating patterns were disrupted due to lack of resources for food — affected an estimated 5.7 million seniors in 2014. Compared with younger adults, seniors living at home are at an increased risk of hunger due to health conditions, disability and functional limitations that impact their ability to obtain or prepare food. Poor food-management skills, lack of reliable social support, transportation and poverty also contribute to an elevated risk of food insecurity. Research indicates that food insecurity is a strong predictor of health problems such as heart disease, cancer, stroke, pulmonary disease, depression and diabetes.
Food Insecurity by StatePercentage of adults aged 60 years and older who faced the threat of hunger in the past 12 months
by Food Insecurity
Data source: National Foundation to End Senior Hunger, The State of Senior Hunger in America, 2014For details: www.AmericasHealthRankings.org/SR17/FoodInsecurity
<=11.3% 11.4% to 13.6% 13.7% to 15.4% 15.5% to 17.2% >=17.3%
DC
RI
DE
Food Insecurity
15.8%15.8%15.5%14.8%14.3%13.6%
1 North Dakota 7.32 Montana 9.03 Alaska 9.74 Massachusetts 9.95 New Hampshire 10.16 Minnesota 10.27 Iowa 10.68 New Mexico 10.89 Wyoming 11.110 Idaho 11.311 Wisconsin 11.512 Washington 11.713 South Dakota 11.914 Virginia 12.015 Maryland 12.416 Delaware 12.517 New Jersey 12.818 Pennsylvania 13.119 Nevada 13.320 Utah 13.621 Colorado 13.722 Hawaii 14.022 Illinois 14.024 Rhode Island 14.525 Nebraska 14.926 Michigan 15.027 Florida 15.128 West Virginia 15.229 Connecticut 15.429 Vermont 15.431 Kansas 15.731 Oregon 15.733 Tennessee 15.834 Arizona 15.934 California 15.934 Indiana 15.937 Oklahoma 16.038 Missouri 16.639 Maine 17.040 Alabama 17.241 Kentucky 17.542 Ohio 17.643 Georgia 17.844 North Carolina 18.045 Texas 19.046 New York 19.346 South Carolina 19.348 Louisiana 23.749 Mississippi 24.350 Arkansas 24.9 United States 15.8 District of Columbia 19.0
16
12
8
4
0
2013 2014 2015 2016 2017
% O
F A
DU
LTS
AG
ED 6
0+
EDITION YEAR
Community & Environment: Micro
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 39
Ranking
CORE MEASURES
Rank State Value (%)Access to healthy food is a struggle for some older adults and is of particular concern for seniors living at home. The Older Americans Act home-delivered meal services target seniors at high risk for undernutrition and food insecurity due to illness, minority status, isolation or poverty. Home-delivered meal programs can enhance quality of life, provide a stable source of nutrition, increase nutrient intake, and help older adults remain independent and in their homes despite functional limitations. Increasing the number of seniors in all states receiving home-delivered meals by 1 percent has a projected cost savings of $109 million to states’ Medicaid programs.
Home-delivered Meals by StateNumber of meals served as a percentage of seniors aged 60 years and older with independent-living difficulty
by Home-delivered Meals
Data source: U.S. HHS, Administration on Aging, State Program Reports, American Community Survey, 2014For details: www.AmericasHealthRankings.org/SR17/HomeDeliveredMeals
Community & Environment: Micro
>=20.9% 14.2% to 20.8% 10.2% to 14.1% 6.7% to 10.1% <=6.6%
DC
RI
DE
10.2%10.2%————
1 Wyoming 51.02 New Hampshire 45.73 North Dakota 41.14 Montana 33.05 Massachusetts 28.96 Vermont 27.67 Alaska 24.58 Nebraska 22.39 Missouri 21.610 Utah 20.911 Iowa 18.812 Kansas 18.013 Michigan 17.914 Wisconsin 17.115 Delaware 16.816 Mississippi 15.917 New Mexico 15.518 Arkansas 14.919 Louisiana 14.520 South Dakota 14.221 West Virginia 13.322 Maine 13.123 Ohio 12.224 Minnesota 11.924 Oregon 11.926 Alabama 11.326 New York 11.328 Illinois 10.929 Nevada 10.330 Idaho 10.231 Texas 10.132 New Jersey 10.033 Pennsylvania 9.534 Oklahoma 9.035 Colorado 8.836 South Carolina 7.937 Connecticut 7.338 Rhode Island 6.839 North Carolina 6.739 Virginia 6.739 Washington 6.742 Hawaii 6.543 Kentucky 6.444 Arizona 5.745 California 5.445 Indiana 5.445 Maryland 5.448 Georgia 5.349 Florida 5.250 Tennessee 4.0 United States 10.2 District of Columbia 21.4
Home-delivered Meals
12
10
8
6
4
2
0
2013 2014 2015 2016 2017% O
F A
DU
LTS
AG
ED 6
0+
WIT
H
IND
EPEN
DEN
T LI
VIN
G D
IFFI
CU
LTY
EDITION YEAR
40 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
Policy
Geriatricians are specially trained to meet the unique needs of older adults in both outpatient and inpatient settings. In inpatient settings, seniors receiving care in special geriatric units have better function at the time of discharge, and inpatient rehabilitative services involving geriatricians result in lower nursing home admissions and improved function at follow-up compared with standard care. In outpatient settings, geriatricians tend to provide better medication management than other clinicians. With a growing senior population, the number of needed geriatricians will continue to rise. Although the American Geriatrics Society estimates a 2016 shortfall of 13,176 geriatricians, only 96 internal medicine or family medicine residents entered geriatrics fellowship programs in 2013.
Geriatrician Shortfall by StatePercentage of geriatricians required to meet estimated need
by Geriatrician Shortfall
Data source: The American Geriatrics Society, 2016For details: www.AmericasHealthRankings.org/SR17/Geriatrician-Shortfall
<=54.8% 54.9% to 65.6% 65.7% to 72.2% 72.3% to 79.5% >=79.6%
DC
RI
DE
65.7%65.7%65.1%65.1%58.9%65.6%
1 Hawaii 22.72 Massachusetts 39.03 Maryland 39.64 New York 42.35 Connecticut 44.16 Pennsylvania 49.47 Rhode Island 53.38 North Dakota 54.39 New Jersey 54.710 New Hampshire 54.811 Minnesota 56.612 Maine 58.913 Illinois 60.614 North Carolina 61.515 Washington 63.016 Wisconsin 63.217 Virginia 63.418 Colorado 63.619 Oregon 64.420 Alaska 65.621 Michigan 67.222 Vermont 67.323 California 67.824 New Mexico 68.025 Missouri 68.126 Arkansas 70.127 Delaware 70.328 Texas 70.829 Ohio 70.930 South Carolina 72.231 Georgia 72.332 Kansas 73.333 South Dakota 74.534 West Virginia 76.635 Nevada 76.836 Arizona 76.937 Florida 77.038 Utah 77.539 Iowa 78.840 Kentucky 79.541 Indiana 79.942 Nebraska 80.243 Alabama 80.444 Wyoming 81.645 Tennessee 82.446 Louisiana 83.147 Oklahoma 84.848 Mississippi 84.949 Idaho 88.350 Montana 89.2 United States 65.7 District of Columbia 23.1
Geriatrician Shortfall
706050403020100
2013 2014 2015 2016 2017% O
F G
ERIA
TRIC
IAN
S N
EED
ED
EDITION YEAR
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 41
Ranking
CORE MEASURES
Rank State Value (%)
Healthcare-associated infections (HAIs) are a significant but often preventable issue for patients receiving care in hospitals and other health care settings. HAIs among seniors are concerning because they are high users of health care services and often have comorbidities that can increase the risk of HAIs. Approximately one out of 25 hospitalized patients will get an HAI. There were an estimated 722,000 HAIs in U.S. acute care hospitals in 2011 and approximately 75,000 patients with HAIs died as a result. Annual costs associated with HAI for the five major infections were $9.8 billion. Early identification of HAI in patients can reduce these costs.
Healthcare-associated Infection (HAI) Policies by StatePercentage of 24 reporting and validation policies implemented in the state to monitor healthcare-associated infections (HAI) in hospitals
by Healthcare-associated Infection (HAI) Policies
Data source: CDC, National and State Healthcare Associated Infections Progress Report, 2014For details: www.AmericasHealthRankings.org/SR17/HAIPolicy
Policy
>=75.0% 58.3% to 74.9% 50.0% to 58.2% 25.0% to 49.9% <=24.9%
DC
RI
DE
48.2%48.2%————
1 Delaware 83.31 Maine 83.31 Maryland 83.31 New York 83.35 Arkansas 79.25 California 79.25 Utah 79.28 Connecticut 75.08 Hawaii 75.08 North Carolina 75.08 Oregon 75.08 Pennsylvania 75.08 Tennessee 75.08 West Virginia 75.015 Colorado 66.715 Texas 66.717 New Jersey 62.517 South Dakota 62.519 Massachusetts 58.319 Washington 58.321 Alabama 54.221 Mississippi 54.223 Georgia 50.023 Indiana 50.023 Iowa 50.023 Kansas 50.023 Louisiana 50.023 Michigan 50.023 Minnesota 50.023 New Hampshire 50.023 Wisconsin 50.032 South Carolina 45.833 Illinois 37.533 North Dakota 37.535 Oklahoma 29.236 Alaska 25.036 Arizona 25.036 Idaho 25.036 Kentucky 25.036 New Mexico 25.036 Rhode Island 25.042 Nevada 16.742 Ohio 16.742 Vermont 16.745 Virginia 12.546 Missouri 8.346 Montana 8.348 Florida 0.048 Nebraska 0.048 Wyoming 0.0 United States 48.2 District of Columbia 58.3
Healthcare-associated Infection (HAI) Policies
50
40
30
20
10
0
2013 2014 2015 2016 2017
% O
F PO
LIC
IES
IN P
LAC
E
EDITION YEAR
42 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
Policy
Low-care nursing home residents do not require the full suite of services provided by nursing homes and may be able to live in a less restrictive environment. Such community-based services as Meals on Wheels, visiting home health aides, transportation programs, and technology-delivered health care programs may allow older adults to be cared for and remain in a less restrictive setting. Providing nursing home services to low-care residents is expensive, and states with greater investment in home-delivered meal programs have a lower proportion of low-care nursing home residents. Beyond cost, aging in place has emotional, social and health benefits.
Low-care Nursing Home Residents by StatePercentage of nursing home residents who do not require physical assistance for late-loss activities of daily living
by Low-care Nursing Home Residents
Data source: Brown University, Shaping Long Term Care in America Project, 2015For details: www.AmericasHealthRankings.org/SR17/LowCareNHResidents
<=7.6% 7.7% to 10.5% 10.6% to 12.6% 12.7% to 15.2% >=15.3% Data not available
DC
RI
DE
11.7%11.7%11.8%12.2%12.2%12.2%
1 Maine 3.82 Hawaii 4.03 Utah 4.54 South Carolina 5.75 Tennessee 5.86 Maryland 6.47 North Carolina 6.78 Kentucky 6.99 Pennsylvania 7.410 Indiana 7.611 Florida 8.511 New York 8.511 Oregon 8.514 Washington 8.615 Vermont 9.016 Virginia 9.217 Georgia 9.717 Michigan 9.719 Arizona 10.420 California 10.520 Idaho 10.522 Massachusetts 10.923 Nevada 11.124 New Jersey 11.324 Wisconsin 11.326 Texas 11.427 Ohio 11.727 West Virginia 11.729 Alabama 12.230 Delaware 12.631 Mississippi 13.132 New Hampshire 13.433 Rhode Island 13.534 New Mexico 13.735 Connecticut 13.936 Louisiana 14.237 Colorado 14.438 Nebraska 14.539 North Dakota 14.740 Minnesota 15.241 Arkansas 15.542 Wyoming 15.943 South Dakota 16.944 Illinois 17.044 Iowa 17.046 Montana 18.347 Kansas 20.048 Oklahoma 23.049 Missouri 24.3 United States 11.7 Alaska NA District of Columbia NA
Low-care Nursing Home Residents
14121086420
2013 2014 2015 2016 2017
% O
F RE
SID
ENTS
EDITION YEAR
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 43
Ranking
CORE MEASURES
Rank State Value (%)Prescription drug coverage decreases financial strain and is associated with a 10 percent reduction in nonadherence due to cost. Roughly nine out of 10 Medicare beneficiaries used one or more prescription drugs in 2011. Medicare beneficiaries can obtain Medicare Part D, a voluntary Medicare drug benefit, through two types of private plans, a stand-alone prescription drug plan or a Medicare Advantage (Part C) plan that covers prescription drugs. Medicare Part D plans vary by state in cost and coverage. Medicare beneficiaries spent $578 out-of-pocket on average for prescription drugs in 2011. However, 10 percent of beneficiaries spent an average $1,358 out-of-pocket.
Prescription Drug Coverage by StatePercentage of Medicare enrollees aged 65 years and older who have a creditable prescription drug plan
by Prescription Drug Coverage
Data source: The Henry J. Kaiser Family Foundation, State Health Facts, 2014For details: www.AmericasHealthRankings.org/SR17/PrescriptionDrug
Policy
>=87% 86% 85% 83% to 84% <=82%
DC
RI
DE
87%87%85%87%87%87%
1 California 891 Iowa 891 Minnesota 891 Ohio 895 Connecticut 885 New York 885 Rhode Island 888 Alabama 878 Arizona 878 Florida 878 Indiana 878 Kentucky 878 Michigan 878 Missouri 878 Nebraska 878 North Carolina 878 Pennsylvania 878 Tennessee 8719 Illinois 8619 Louisiana 8619 Massachusetts 8619 North Dakota 8619 South Carolina 8619 West Virginia 8625 Arkansas 8525 Colorado 8525 Delaware 8525 Georgia 8525 Nevada 8525 New Jersey 8525 Oregon 8525 Texas 8525 Vermont 8534 Hawaii 8434 Maine 8434 Mississippi 8434 South Dakota 8438 Idaho 8338 Kansas 8338 New Mexico 8338 Washington 8338 Wisconsin 8343 Utah 8244 Oklahoma 8144 Virginia 8146 Montana 8046 Wyoming 8048 Alaska 7948 New Hampshire 7950 Maryland 76 United States 87 District of Columbia 68
Prescription Drug Coverage
90
60
30
0
2013 2014 2015 2016 2017
% O
F M
EDIC
ARE
EN
ROLL
EES
AG
ED 6
5+
EDITION YEAR
44 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
Policy
The Supplemental Nutrition Assistance Program (SNAP) is the largest federal nutrition program, helping millions of low-income Americans access food and improve economic security and health outcomes. More than 4.8 million low-income households with adults aged 60 and older rely on SNAP to stretch their monthly food budget. On average, they received $108 per month in 2016 to help put food on the table. Federal Nutrition Services works with states to promote SNAP; however, only 42 percent of eligible seniors participate in the program. Barriers to enrollment include lack of knowledge about the program and how it works, stigma associated with receiving services and difficulty completing an application.
SNAP Reach by StateNumber of adults aged 60 years and older who participate in Supplemental Nutrition Assistance Program (SNAP) as a percentage of adults aged 60 years and older living in poverty
by SNAP Reach
Data source: U.S. Department of Agriculture, Food and Nutrition Service, 2015; American Community Survey, 2015For details: www.AmericasHealthRankings.org/SR17/SNAPReach
>=88.5% 74.8% to 88.4% 62.1% to 74.7% 51.3% to 62.0% <=51.2%
DC
RI
DE
70.1%70.1%67.4%75.2%——
1 New York 119.32 Vermont 115.23 Oregon 111.64 Alaska 107.65 Rhode Island 107.26 Massachusetts 98.87 Connecticut 95.48 Illinois 94.79 New Jersey 89.810 Maryland 88.511 Hawaii 87.611 Pennsylvania 87.613 Wisconsin 87.514 Michigan 86.115 Washington 81.516 Florida 81.417 Maine 81.318 Ohio 77.019 Nevada 74.920 Georgia 74.821 West Virginia 73.822 Tennessee 72.623 Virginia 70.324 North Carolina 67.625 Delaware 67.226 New Mexico 65.927 Minnesota 65.328 Texas 64.229 Mississippi 63.330 Oklahoma 62.131 Alabama 60.032 Kentucky 58.433 South Carolina 58.034 Iowa 57.335 Louisiana 56.136 New Hampshire 55.237 Missouri 54.438 Nebraska 52.639 North Dakota 51.640 Colorado 51.341 Indiana 50.242 Arizona 50.043 Arkansas 47.344 Kansas 46.445 South Dakota 46.046 Montana 45.447 Idaho 43.948 Utah 41.849 California 20.850 Wyoming 20.5 United States 70.1 District of Columbia 83.9
SNAP Reach
80
60
40
20
0
2013 2014 2015 2016 2017
% O
F A
DU
LTS
AG
ED 6
0+
LIV
ING
IN P
OV
ERTY
EDITION YEAR
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 45
Ranking
CORE MEASURES
Rank State Value (%)
Clinical Care
Seniors with a dedicated health care provider are better positioned to receive care that can prevent, detect and manage health conditions. Having a primary care provider is associated with greater patient-provider communication and trust, and an increased likelihood that patients will receive appropriate care. Older adults who live in areas with a larger primary care physician workforce are less likely to be hospitalized for preventable reasons and have lower death rates than those living in areas with fewer primary care physicians. Having a regular health care provider has been associated with lower health care costs, and improvements in overall health status and chronic care management for asthma, hypertension and diabetes.
Dedicated Health Care Provider by StatePercentage of adults aged 65 years and older who reported having a personal doctor or health care provider
by Dedicated Health Care Provider
Data source: CDC, Behavioral Risk Factor Surveillance System, 2015For details: www.AmericasHealthRankings.org/SR17/DedicatedH-CProvider
>=95.7% 95.2% to 95.6% 94.3% to 95.1% 93.1% to 94.2% <=93.0%
DC
RI
DE
Dedicated Health Care Provider
94.8% 1 Massachusetts 98.12 Maine 96.93 Rhode Island 96.64 Connecticut 96.45 New Hampshire 96.25 Pennsylvania 96.27 Alabama 96.17 Ohio 96.19 Delaware 95.910 Arkansas 95.710 Maryland 95.710 New York 95.713 California 95.613 Michigan 95.615 Florida 95.516 Illinois 95.416 Vermont 95.418 Indiana 95.318 Missouri 95.320 South Carolina 95.221 North Carolina 95.122 Kansas 95.022 Wisconsin 95.024 Nebraska 94.825 Hawaii 94.725 Louisiana 94.725 New Jersey 94.728 Kentucky 94.629 Washington 94.430 Colorado 94.330 Mississippi 94.330 Tennessee 94.333 Iowa 94.234 Virginia 94.135 Oregon 93.936 Oklahoma 93.537 Utah 93.438 Georgia 93.339 South Dakota 93.139 West Virginia 93.141 Idaho 92.542 Minnesota 92.343 Arizona 92.144 North Dakota 91.745 Texas 91.546 New Mexico 91.147 Montana 91.048 Nevada 90.949 Wyoming 89.750 Alaska 87.4 United States 94.8 District of Columbia 95.3
100
80
60
40
20
0
2013 2014 2015 2016 2017
% O
F A
DU
LTS
AG
ED 6
5+
EDITION YEAR
94.8%94.3%94.3%95.1%94.9%
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
46 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)
Clinical Care
Diabetes risk increases with age, affecting more than a quarter of adults aged 65 and older. The prevalence in older adults is expected to rise in the next two decades. Older adults with diabetes have higher rates of premature death, disability, and comorbid conditions such as heart disease, stroke, infection, eye disease, kidney disease, and nerve disease than those without diabetes. They are also at increased risk of cognitive impairment, polypharmacy, falls, urinary incontinence, pain, and institutionalization. Proper management of diabetes among older adults is critical to detect the onset and progression of complications, manage comorbidities and prevent premature death.
Diabetes Management by StatePercentage of Medicare enrollees aged 65 to 75 years with diabetes receiving a blood lipids test
by Diabetes Management
Data source: The Dartmouth Atlas of Health Care, 2014For details: www.AmericasHealthRankings.org/SR17/Diabetes-Management
>=82.3% 80.5% to 82.2% 78.5% to 80.4% 74.8% to 78.4% <=74.7%
DC
RI
DE
80.3% 1 Massachusetts 85.72 Florida 85.43 New Jersey 84.54 Hawaii 83.65 Delaware 83.45 Wisconsin 83.47 New York 83.38 North Carolina 82.79 Tennessee 82.39 Virginia 82.311 New Hampshire 82.211 Rhode Island 82.213 South Carolina 82.114 Connecticut 81.914 Pennsylvania 81.916 Kentucky 81.317 Alabama 81.117 Texas 81.119 Illinois 80.920 Maryland 80.521 Iowa 80.021 Maine 80.023 Georgia 79.824 North Dakota 79.324 West Virginia 79.326 Missouri 79.227 Minnesota 79.128 California 78.929 Michigan 78.830 Louisiana 78.530 Ohio 78.532 Indiana 77.733 Arkansas 77.434 Washington 76.935 Mississippi 76.736 Oregon 76.637 Nevada 76.238 Arizona 75.839 Vermont 75.640 Kansas 74.841 Utah 74.542 South Dakota 74.043 Nebraska 73.844 Colorado 73.345 Idaho 71.846 Oklahoma 71.547 Montana 69.048 Alaska 65.648 New Mexico 65.650 Wyoming 59.7 United States 80.3 District of Columbia 72.6
Diabetes Management
90
60
30
0
2013 2014 2015 2016 2017
% O
F M
EDIC
ARE
EN
ROLL
EES
AG
ED 6
5 TO
75
WIT
H D
IABE
TES
EDITION YEAR
80.3%81.0%80.8%80.7%80.7%
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 47
Ranking
CORE MEASURES
Rank State Value (%)
Clinical Care
The influenza (flu) vaccine helps protect individuals against seasonal influenza, a contagious viral respiratory infection that can have mild to severe symptoms. Adults aged 65 and older are at high risk of developing flu-related complications. Seniors are strongly encouraged to get vaccinated. It is estimated that between 71 and 85 percent of flu-related deaths occur in individuals aged 65 and older, and more than half of hospitalizations for flu are among older adults. The Centers for Disease Control and Prevention estimated that flu vaccination prevented approximately 5.1 million illnesses, 2.5 million medical visits and 71,000 hospitalizations during the 2015-2016 flu season. Medicare covers the cost of annual flu vaccination.
Flu Vaccine by StatePercentage of adults aged 65 years and older who reported receiving a flu vaccine in the past year
by Flu Vaccine
Data source: CDC, Behavioral Risk Factor Surveillance System, 2015For details: www.AmericasHealthRankings.org/SR17/FluVaccine
>=65.6% 61.7% to 65.5% 60.9% to 61.6% 57.6% to 60.8% <=57.5%
DC
RI
DE
60.7% 1 South Dakota 70.62 North Carolina 70.43 Iowa 70.14 West Virginia 69.15 Oklahoma 69.06 Missouri 68.57 Colorado 67.37 Kentucky 67.39 Texas 66.310 Connecticut 65.611 Delaware 65.312 Nebraska 65.213 Minnesota 64.814 Pennsylvania 63.915 Mississippi 63.316 New Hampshire 62.916 Rhode Island 62.918 Maine 62.819 South Carolina 62.720 Kansas 61.721 Alabama 61.621 California 61.623 Virginia 61.524 Montana 61.424 Washington 61.426 Indiana 61.327 Hawaii 61.228 Maryland 61.028 Massachusetts 61.030 Vermont 60.931 New Jersey 60.732 New York 59.733 Tennessee 59.634 Arkansas 59.435 Louisiana 59.136 Utah 59.037 North Dakota 58.838 New Mexico 58.139 Ohio 57.740 Michigan 57.641 Idaho 57.142 Illinois 57.043 Oregon 56.944 Georgia 55.745 Alaska 54.746 Nevada 54.347 Wyoming 53.248 Wisconsin 52.949 Arizona 52.650 Florida 51.4 United States 60.7 District of Columbia 54.5
Flu Vaccine
706050403020100
2013 2014 2015 2016 2017
% O
F A
DU
LTS
AG
ED 6
5+
EDITION YEAR
60.7%59.8%62.8%60.1%60.6%
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
48 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)
Clinical Care
Health screenings may lead to disease detection early, when treatment is easiest and most effective. This measure is limited to two types of cancer screenings. However, health screenings go beyond cancer and include routine procedures such as blood pressure, diabetes and cholesterol checks. Breast cancer and colon cancer risk increases with age and the U.S. Preventive Services Task Force recommends screening older adults up to ages 74 and 75, respectively. Mammography and colorectal cancer screening tests have saved thousands of lives and are two important weapons in fighting cancer. Barriers to receiving health screenings include limited knowledge of available services, lack of physician recommendation and no symptoms of disease.
Health Screenings by StatePercentage of women aged 65 to 74 years who reported receiving a mammogram in the past two years and the percentage of adults aged 65 to 75 years who reported receiving colorectal cancer screening within the recommended time period
by Health Screenings
Data source: CDC, Behavioral Risk Factor Surveillance System, 2014For details: www.AmericasHealthRankings.org/SR17/HealthScreeningsBiennial data
>=77.0% 73.0% to 76.9% 71.4% to 72.9% 67.7% to 71.3% <=67.6%
DC
RI
DE
72.4% 1 Massachusetts 80.92 New Hampshire 80.63 Maine 80.54 Wisconsin 79.45 Delaware 78.26 Rhode Island 77.87 Minnesota 77.48 Florida 77.38 Michigan 77.310 Maryland 77.011 Connecticut 75.712 California 75.613 Georgia 74.414 Utah 74.315 Hawaii 74.116 Oregon 74.017 Alabama 73.918 Washington 73.719 Colorado 73.220 Vermont 73.021 North Carolina 72.821 South Dakota 72.823 Louisiana 72.723 New Jersey 72.723 Virginia 72.726 South Carolina 72.527 Ohio 72.227 Tennessee 72.229 Iowa 71.830 Kentucky 71.431 Arizona 70.932 Pennsylvania 70.033 New York 69.833 North Dakota 69.835 Kansas 69.536 Nevada 68.537 Texas 68.437 West Virginia 68.439 Nebraska 68.040 Idaho 67.741 Montana 67.642 Missouri 67.143 Indiana 66.044 Illinois 65.845 Mississippi 65.246 Alaska 65.047 Oklahoma 64.748 Arkansas 64.549 New Mexico 64.450 Wyoming 64.1 United States 72.4 District of Columbia 70.8
Health Screenings
80
60
40
20
02013* 2014 2015 2016 2017
% O
F SE
NIO
RS W
ITH
RE
CO
MM
END
ED S
CRE
ENIN
GS
EDITION YEAR
72.4%72.4%60.7%60.7%59.8%*
* Not comparable to later years due to methodol-ogy change
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 49
Prevalence by Race/Ethnicity
*Non-Hispanic
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
Prevalence by Urbanicity
Rural Suburban
Urban
Rural Suburban
Urban
Prevalence by Education
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Prevalence by Income
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Prevalence by Gender
Female Male
FemaleMale
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
0 20 40 60
0 20 40 60Seniors with recommended screenings, %
0 20 40 60 80
0 20 40 60 80Seniors with recommended screenings, %
Seniors with recommended screenings, %
Seniors with recommended screenings, %
Seniors with recommended screenings, %
66.9% 78.6% 56.1% 66.9% 77.2% 69.9% 78.6% 86.6%
50.7% 55.7% 66.2% — 67.9% 72.0% 51.8% 75.3% 87.4% — 75.3% — 40.6% 63.0% 78.7% 64.1% 73.4% 81.3%
37.7% 59.3% 76.8% 51.3% 70.0% 78.5% 62.6% 73.7% 82.6% 68.9% 80.5% 87.6%
41.7% 61.9% 73.8% 61.2% 72.8% 83.8% 66.7% 78.3% 90.5% 70.9% 83.2% 91.3%
55.7% 67.8% 82.3% 61.5% 73.4% 81.8% 65.9% 74.4% 84.0%
Health Screenings by Subpopulations
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
50 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)
Clinical Care
Home health and personal care aides enable seniors to remain in their homes after aging-related functional losses make independence difficult. Aides can be used for short periods such as recovery from surgery or for long periods to care for those with functional decline or chronic illness. A range of assistance is available, from skilled nursing care to assistance with activities of daily living. In-home and community-based services are less expensive than institutional services. Providing more home-based services may reduce spending growth in the long-term care sector. National annual spending on long-term care services was estimated to be between $211 billion and $317 billion in 2011.
Home Health Care by StateNumber of personal care and home health aides per 1,000 adults aged 75 years and older
by Home Health Care
Data source: Bureau of Labor Statistics, 2015For details: www.AmericasHealthRankings.org/SR17/HomeHealthCare* The data appearing in this edition are the same as the data that appeared in the 2016 edition. A data update was not available at the time of this publication.
>=127.4 108.4 to 127.3 84.2 to 108.3 76.7 to 84.1 <=76.6
DC
RI
DE
110.6 1 Alaska 278.82 Minnesota 268.33 New York 242.14 New Mexico 211.25 Texas 198.56 Vermont 172.37 Wisconsin 164.58 Louisiana 159.79 Maine 152.210 Pennsylvania 127.411 Colorado 123.412 West Virginia 122.513 Idaho 120.814 Massachusetts 120.615 Kansas 119.216 Missouri 116.917 Connecticut 114.218 Arkansas 111.519 Ohio 109.420 Arizona 108.421 North Carolina 107.122 North Dakota 105.723 Illinois 103.424 Virginia 101.925 Michigan 99.626 Indiana 99.327 Oregon 95.828 Rhode Island 93.529 Iowa 86.630 New Hampshire 84.231 Mississippi 83.732 Delaware 83.533 Washington 83.134 Oklahoma 82.535 Montana 80.236 Hawaii 80.037 Utah 78.938 South Carolina 78.739 Nevada 78.040 New Jersey 76.740 Wyoming 76.742 California 72.442 Maryland 72.444 Nebraska 61.845 Tennessee 61.246 Kentucky 56.547 Georgia 53.548 Alabama 53.049 South Dakota 49.050 Florida 28.7 United States 110.6 District of Columbia 301.7
Home Health Care
120
100
80
60
40
20
0
2013 2014 2015 2016 2017*
NU
MBE
R O
F H
OM
E H
EALT
H C
ARE
W
ORK
ERS
PER
1,00
0 A
DU
LTS
AG
ED 7
5+
EDITION YEAR
110.6*110.6*104.395.493.8
Rank State Value
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 51
Ranking
CORE MEASURES
Rank State Value (%)
Clinical Care
Hospice care is intended for terminally ill patients and emphasizes pain control and emotional support for patients and families. The number of individuals receiving hospice care increased 243 percent from 3.5 percent in 2000 to 12 percent in 2014. It can be provided in a patient’s home, where most seniors prefer to die, or in a freestanding hospice facility. Older adults accounted for 84 percent of hospice patients in 2014. Financial concerns can be a major burden for patients and families facing a terminal illness. Medicare covers certified services for patients with a prognosis of six months or less of life; more than 85 percent of hospice patients were covered by the Medicare hospice benefit in 2014.
Hospice Care by StatePercentage of Medicare decedents aged 65 years and older who were enrolled in hospice during the last six months of life after diagnosis of a condition with a high probability of death
by Hospice Care
Data source: The Dartmouth Atlas of Health Care, 2014For details: www.AmericasHealthRankings.org/SR17/HospiceCare
>=58.3% 53.6% to 58.2% 50.1% to 53.5% 45.7% to 50.0% <=45.6%
DC
RI
DE
52.0% 1 Arizona 65.82 Utah 65.53 Delaware 61.64 Florida 61.25 Georgia 60.16 Ohio 59.57 Rhode Island 59.28 South Carolina 58.58 Texas 58.510 Iowa 58.311 Michigan 57.212 Oregon 57.013 Oklahoma 56.114 Louisiana 55.415 Colorado 55.216 Alabama 54.817 Wisconsin 54.718 New Mexico 53.919 Arkansas 53.720 Missouri 53.621 Kansas 53.222 North Carolina 53.123 Idaho 52.524 Illinois 52.025 Pennsylvania 50.826 Indiana 50.626 Minnesota 50.628 Nebraska 50.529 Mississippi 50.330 Nevada 50.131 Maine 50.032 Maryland 49.333 Virginia 48.834 Connecticut 48.134 New Hampshire 48.136 New Jersey 47.837 California 47.438 Massachusetts 47.139 Washington 47.040 Hawaii 45.740 Tennessee 45.742 West Virginia 45.143 Montana 44.144 Kentucky 43.445 South Dakota 39.746 Vermont 37.047 New York 33.448 Wyoming 32.449 Alaska 32.250 North Dakota 30.7 United States 52.0 District of Columbia 44.9
Hospice Care
60
50
40
30
20
10
0
2013 2014 2015 2016 2017
% O
F M
EDIC
ARE
D
ECED
ENTS
AG
ED 6
5+
EDITION YEAR
52.0%51.4%50.6%47.5%36.7%
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
52 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)
Clinical Care
Most seniors prefer to die in the comfort of their own home, with a free-standing hospice facility as their second choice. End-of-life care in a hospital carries a high economic burden and, in many circumstances, may be avoidable. Family support, physician support and hospice enrollment have been shown to improve congruence between preferred and actual place of death. Studies show that patients who lack caregivers are more likely to die in an institution than patients with caregivers. The percentage of older patients dying in hospitals has declined 30 percent since the first Senior Report was published in 2013, from 30.1 percent to 21.0 percent.
Hospital Deaths by StatePercentage of deaths occurring in a hospital among chronically ill Medicare decedents aged 65 years and older
by Hospital Deaths
Data source: The Dartmouth Atlas of Health Care, 2014For details: www.AmericasHealthRankings.org/SR17/HospitalDeaths
<=17.6% 17.7% to 19.8% 19.9% to 20.8% 20.9% to 23.5% >=23.6%
DC
RI
DE
21.0% 1 Utah 14.32 Arizona 15.33 Iowa 16.34 Colorado 16.55 Ohio 16.66 Delaware 17.17 Rhode Island 17.28 Idaho 17.39 Wisconsin 17.510 Montana 17.611 Georgia 18.112 Oregon 18.213 Florida 18.414 Michigan 18.515 New Mexico 18.716 Texas 18.917 Pennsylvania 19.217 South Dakota 19.219 Minnesota 19.520 New Hampshire 19.821 Kansas 20.022 Indiana 20.123 Arkansas 20.223 Nebraska 20.225 Illinois 20.325 Wyoming 20.327 Oklahoma 20.527 South Carolina 20.529 Louisiana 20.730 Maine 20.831 North Carolina 20.932 Washington 21.133 Missouri 21.734 Kentucky 22.035 Nevada 22.336 Maryland 22.536 Tennessee 22.538 Massachusetts 23.239 Connecticut 23.440 Alabama 23.541 Virginia 23.642 Mississippi 23.743 North Dakota 23.943 Vermont 23.945 West Virginia 24.046 California 24.447 New Jersey 25.648 Alaska 26.249 Hawaii 26.750 New York 30.0 United States 21.0 District of Columbia 27.6
Hospital Deaths
35302520151050
2013 2014 2015 2016 2017
% O
F M
EDIC
ARE
D
ECED
ENTS
AG
ED 6
5+
EDITION YEAR
21.0%21.5%22.8%25.0%30.1%
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 53
Ranking
CORE MEASURES
Rank State Value (%)
Clinical Care
Returning to a hospital within a short period of time after being discharged is costly and often avoidable. Hospital readmissions disproportionately occur among patients covered by Medicare and vary by where a patient lives and the health care system providing a patient’s care. Confusion about prescribed medications after discharge, miscommunication between care teams of such important information as new test results, and improper follow-up care after release are among the reasons patients are readmitted to a hospital. Some readmissions are necessary when unexpected problems occur, but many are preventable through discharge planning, care coordination and effective communication with patients and their families.
Hospital Readmissions by StatePercentage of Medicare enrollees aged 65 years and older who were readmitted within 30 days of hospital discharge
by Hospital Readmissions
Data source: The Dartmouth Atlas of Health Care, 2014For details: www.AmericasHealthRankings.org/SR17/Hospital-Readmissions
<=13.7% 13.8% to 14.3% 14.4% to 14.7% 14.8% to 15.3% >=15.4% Data not available
DC
RI
DE
14.8% 1 Idaho 12.12 Utah 12.43 Hawaii 12.64 Colorado 12.85 Oregon 13.06 Montana 13.17 South Dakota 13.38 Vermont 13.68 Washington 13.610 Maine 13.710 Nebraska 13.712 New Mexico 13.913 Alaska 14.013 North Dakota 14.013 Wyoming 14.016 Iowa 14.116 Kansas 14.116 Minnesota 14.119 Wisconsin 14.220 Arizona 14.320 Indiana 14.320 North Carolina 14.323 Alabama 14.423 California 14.423 South Carolina 14.426 Georgia 14.626 New Hampshire 14.626 Oklahoma 14.629 Pennsylvania 14.729 Texas 14.729 Virginia 14.732 Connecticut 14.832 Delaware 14.834 Massachusetts 14.934 Tennessee 14.936 Illinois 15.037 Missouri 15.237 New Jersey 15.239 Michigan 15.339 Nevada 15.339 New York 15.339 Ohio 15.339 Rhode Island 15.344 Mississippi 15.445 Florida 15.546 Arkansas 15.646 Kentucky 15.646 Louisiana 15.649 West Virginia 15.8 United States 14.8 District of Columbia 14.4 Maryland NA
Hospital Readmissions
181614121086420
2013 2014 2015 2016 2017
% O
F H
OSP
ITA
LIZE
D M
EDIC
ARE
EN
ROLL
EES
AG
ED 6
5+
EDITION YEAR
14.8%15.0%15.5%15.9%15.9%
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
54 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)
Clinical Care
Preventable hospitalizations are excess hospital admissions for chronic or acute illnesses where hospitalization may have been avoided if the condition had been maintained in an outpatient setting. Conditions that can usually be managed outside of a hospital include diabetes, infectious disease, hypertension, chronic obstructive pulmonary disorder and asthma. Routine care in outpatient settings for non-emergent acute or chronic conditions, such as those listed above can prevent complications, more severe disease and the need for hospitalization. Improved continuity of care is associated with fewer preventable hospitalizations in older adults. The number of preventable hospitalizations reflects the availability, accessibility, affordability and quality of a population’s use of primary care for ambulatory care services.
Preventable Hospitalizations by StateNumber of discharges for ambulatory care-sensitive conditions per 1,000 Medicare enrollees aged 65 years and older
by Preventable Hospitalizations
Data source: The Dartmouth Atlas of Health Care, 2014For details: www.AmericasHealthRankings.org/SR17/Preventable-Hospitalizations
<=37.1 37.2 to 46.2 46.3 to 50.3 50.4 to 56.6 >=56.7
DC
RI
DE
49.9 1 Hawaii 23.52 Utah 28.83 Colorado 32.13 Idaho 32.15 Washington 32.66 Oregon 33.47 California 35.78 Alaska 36.09 Arizona 37.010 Minnesota 37.111 Vermont 38.812 Montana 39.813 Nevada 42.414 New Mexico 43.115 Virginia 43.616 New Hampshire 44.817 Wisconsin 45.118 Maryland 46.118 Wyoming 46.120 North Dakota 46.220 South Carolina 46.222 Connecticut 46.323 Nebraska 46.924 South Dakota 47.025 Maine 47.526 New York 47.627 Iowa 48.228 North Carolina 49.029 Delaware 50.230 New Jersey 50.331 Pennsylvania 51.532 Georgia 51.833 Kansas 51.934 Massachusetts 52.835 Texas 54.336 Florida 55.137 Rhode Island 55.338 Illinois 55.839 Michigan 56.140 Missouri 56.641 Indiana 57.042 Oklahoma 59.243 Ohio 59.844 Tennessee 59.945 Alabama 61.146 Arkansas 61.947 Louisiana 67.548 Mississippi 67.849 West Virginia 71.950 Kentucky 77.0 United States 49.9 District of Columbia 39.1
Preventable Hospitalizations
70
60
50
40
30
20
0
2013 2014 2015 2016 2017
DIS
CH
ARG
ES P
ER 1
,00
0 M
EDIC
ARE
EN
ROLL
EES
AG
ED 6
5+
EDITION YEAR
49.953.859.364.966.6
Rank State Value
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 55
Ranking
CORE MEASURES
Rank State Value (%)
Outcomes
Nearly 35 percent of adults aged 65 and older report one or more disabilities. Arthritis is the most common cause of disability in older adults, accounting for more than 23 percent of cases. Chronic diseases including diabetes and congestive heart failure may be precursors to disability. Seniors with a disability are more likely to require hospitalization and long-term care than those without a disability, and medical care costs can be up to three times greater for disabled than nondisabled seniors. While some disabilities are largely unavoidable, the extent to which they interfere with one’s life can be mitigated through exercise, special equipment or aids, and community support programs.
Able-bodied by StatePercentage of adults aged 65 years and older with no cognitive, visual, auditory, ambulatory, self-care, and/or independent living difficulty disability
by Able-bodied
Data source: U.S. Census Bureau, American Community Survey, 2015For details: www.AmericasHealthRankings.org/SR17/AbleBodied
>=67.3% 65.6% to 67.2% 64.1% to 65.5% 61.5% to 64.0% <=61.4%
DC
RI
DE
64.6% 1 Connecticut 69.02 Delaware 68.53 Wisconsin 68.34 Maryland 68.25 Minnesota 68.06 New Hampshire 67.46 New Jersey 67.46 South Dakota 67.49 Colorado 67.39 Iowa 67.311 Massachusetts 67.211 Virginia 67.213 Hawaii 67.014 New York 66.615 Florida 66.516 Illinois 66.416 Nebraska 66.416 Vermont 66.419 Maine 65.920 Montana 65.620 Pennsylvania 65.620 Rhode Island 65.623 Ohio 65.424 Arizona 65.125 Nevada 64.826 California 64.726 Utah 64.728 Michigan 64.629 Washington 64.230 North Dakota 64.131 Wyoming 63.832 Georgia 63.532 Kansas 63.532 North Carolina 63.535 Idaho 63.036 Missouri 62.937 South Carolina 62.638 Oregon 62.439 Indiana 62.240 Texas 61.541 Alaska 60.442 Tennessee 60.343 Louisiana 60.244 New Mexico 59.445 Kentucky 59.346 Oklahoma 58.747 Alabama 58.648 Arkansas 57.749 Mississippi 57.450 West Virginia 56.5 United States 64.6 District of Columbia 65.4
Able-bodied
706050403020100
2013 2014 2015 2016 2017
% O
F A
DU
LTS
AG
ED 6
5+
EDITION YEAR
64.6%64.0%63.7%63.6%63.2%
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
56 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)
Outcomes
Annually, approximately 29 percent of adults aged 65 and older report a fall. Hip fractures due to falls are the most common cause of trauma-related hospitalization and loss of independence among older adults. Such injuries can severely limit mobility, contribute to social isolation and even cause premature death. Women fall more often than men and experience three-quarters of all hip fractures. The risk of falls and injury increases with age and is greatest for adults aged 75 and older. Medicare paid for 87 percent of direct fall-related medical expenses in 2015, which totaled approximately $36 billion.
Falls by StatePercentage of adults aged 65 years and older who reported they had fallen in the past 12 months
by Falls
Data source: CDC, Behavioral Risk Factor Surveillance System, 2014For details: www.AmericasHealthRankings.org/SR17/FallsBiennial data
<=26.8% 26.9% to 28.0% 28.1% to 29.6% 29.7% to 31.6% >=31.7%
DC
RI
DE
28.7% 1 Hawaii 20.62 New Jersey 23.63 Louisiana 24.94 Florida 25.05 Maryland 25.16 Virginia 25.67 Minnesota 26.18 Connecticut 26.59 West Virginia 26.610 Rhode Island 26.811 Nevada 26.912 Colorado 27.113 North Dakota 27.214 Illinois 27.415 Arizona 27.516 New York 27.717 New Mexico 27.817 Wisconsin 27.819 Delaware 28.019 Mississippi 28.019 New Hampshire 28.019 North Carolina 28.023 Nebraska 28.124 South Dakota 28.525 Georgia 28.625 Massachusetts 28.625 Pennsylvania 28.628 South Carolina 29.229 Alabama 29.430 Utah 29.631 Idaho 29.931 Maine 29.933 Ohio 30.133 Tennessee 30.135 Texas 30.336 Kansas 30.537 California 30.738 Oklahoma 30.839 Washington 31.240 Iowa 31.641 Oregon 31.741 Vermont 31.743 Indiana 31.844 Kentucky 32.144 Wyoming 32.146 Montana 32.247 Missouri 32.448 Michigan 32.649 Alaska 32.950 Arkansas 34.3 United States 28.7 District of Columbia 30.1
Falls
30
25
20
15
10
5
0
2013* 2014 2015 2016 2017
% O
F A
DU
LTS
AG
ED 6
5+
EDITION YEAR
28.7%28.7%28.4%28.4%16.1%*
* Not comparable to later years due to methodol-ogy change
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 57
Prevalence by Race/Ethnicity
*Non-Hispanic
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
Prevalence by Urbanicity
Rural Suburban
Urban
Rural Suburban
Urban
Prevalence by Education
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Prevalence by Income
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Prevalence by Gender
Female Male
FemaleMale
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
0 5 10 15 20 25 30
0 5 10 15 20 25 30Adults aged 65+, %
0 5 10 15 20 25 30
0 5 10 15 20 25 30Adults aged 65+, %
Adults aged 65+, %
Adults aged 65+, %
Adults aged 65+, %
30.3% 26.5% 23.3% 30.3% 35.2% 17.4% 26.5% 33.6%
22.8% 34.2% 41.5% 18.0% 19.6% 28.5% 15.8% 23.1% 40.7% — 23.9% — 17.1% 26.4% 35.6% 24.4% 29.6% 34.0%
17.9% 30.2% 43.8% 18.7% 27.2% 34.0% 22.7% 29.9% 34.4% 20.9% 28.0% 36.8%
23.4% 32.1% 40.6% 19.7% 29.0% 37.6% 16.8% 26.1% 32.3% 18.1% 24.8% 32.2%
19.2% 31.4% 40.2% 22.3% 28.4% 41.0% 22.1% 28.8% 40.8%
Falls by Subpopulations
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
58 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)
Outcomes
Frequent Mental Distress (FMD) is characterized by 14 or more days of self-reported poor mental health in the past month, and emphasizes the burden of chronic and likely severe mental health issues in a population. Older adults with FMD are more likely to engage in behaviors that contribute to poor health such as smoking, physical inactivity and poor diet. Activity limitations due to physical, mental or emotional problems, as well as avoidance of medical care due to cost are associated with FMD in older adults. Chronic and severe mental health episodes are treatable and may be preventable through simple, cost-effective and time-efficient screening procedures, early interventions and quality care.
Frequent Mental Distress by StatePercentage of adults aged 65 years and older who reported their mental health was not good 14 or more days in the past 30 days
by Frequent Mental Distress
Data source: CDC, Behavioral Risk Factor Surveillance System, 2015For details: www.AmericasHealthRankings.org/SR17/FrequentMen-talDistress
<=5.5% 5.6% to 6.7% 6.8% to 7.5% 7.6% to 8.4% >=8.5%
DC
RI
DE
7.4% 1 Iowa 4.62 South Dakota 4.73 Minnesota 4.94 North Dakota 5.15 Colorado 5.35 Nebraska 5.37 Kansas 5.47 Vermont 5.49 Hawaii 5.59 Nevada 5.511 Maine 5.612 Virginia 5.713 New Hampshire 6.113 Wisconsin 6.115 Texas 6.216 Idaho 6.517 Connecticut 6.617 Pennsylvania 6.617 Washington 6.620 Michigan 6.721 Montana 6.822 Maryland 7.022 Massachusetts 7.022 New Jersey 7.022 Ohio 7.026 Missouri 7.126 Wyoming 7.128 Utah 7.229 Rhode Island 7.330 New Mexico 7.530 South Carolina 7.532 Arizona 7.632 California 7.632 Indiana 7.635 Alaska 8.035 Illinois 8.037 Kentucky 8.138 Georgia 8.238 Mississippi 8.240 Arkansas 8.440 Florida 8.440 Oregon 8.440 Tennessee 8.444 Delaware 8.645 Oklahoma 8.746 Alabama 8.846 North Carolina 8.848 West Virginia 9.049 New York 9.550 Louisiana 10.4 United States 7.4 District of Columbia 7.5
Frequent Mental Distress
8
6
4
2
0
2013 2014 2015 2016 2017
% O
F A
DU
LTS
AG
ED 6
5+
EDITION YEAR
7.4%7.4%———
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 59
Prevalence by Race/Ethnicity
*Non-Hispanic
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
Prevalence by Urbanicity
Rural Suburban
Urban
Rural Suburban
Urban
Prevalence by Education
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Prevalence by Income
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Prevalence by Gender
Female Male
FemaleMale
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
0 2 4 6 8 10 12
0 2 4 6Adults aged 65+, %
0 2 4 6 8 10 12
0 2 4 6 8 10 12Adults aged 65+, %
Adults aged 65+, %
Adults aged 65+, %
Adults aged 65+, %
8.2% 6.4% 5.5% 8.2% 10.7% 2.8% 6.4% 10.1%
— 13.4% 17.7% 4.2% 6.1% 6.1% 5.9% 9.1% 12.9% — 7.1% — 6.3% 11.7% 19.6% 4.3% 6.8% 9.2%
7.1% 12.3% 19.2% 3.5% 7.4% 9.8% 3.8% 7.0% 10.7% 2.5% 4.4% 6.7%
6.2% 11.7% 18.1% 2.9% 6.9% 11.1% 3.0% 5.5% 8.8% 1.8% 3.6% 8.3%
2.3% 7.5% 11.3% 4.2% 6.8% 13.2% 3.4% 7.2% 10.8%
Frequent Mental Distress by Subpopulations
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
60 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)
Outcomes
Self-reported health status is an indicator of how individuals perceive their health. It is used as an indicator of population health and is an independent predictor of mortality. It is influenced by life experience, the health of loved ones, social support and similar factors that affect overall well-being. Research shows that better self-reported health status is associated with better performance across clinical risk factors (body mass index, cholesterol, blood pressure), health behaviors and cognitive capacity. Those with a better self-reported health status have lower rates of mortality from all causes, which makes this a valuable measure of comprehensive health.
High Health Status by StatePercentage of adults aged 65 years and older who reported that their health is very good or excellent
by High Health Status
Data source: CDC, Behavioral Risk Factor Surveillance System, 2015For details: www.AmericasHealthRankings.org/SR17/HealthStatus
>=45.6% 43.7% to 45.5% 41.0% to 43.6% 38.2% to 40.9% <=38.1%
DC
RI
DE
41.2% 1 Colorado 52.32 New Hampshire 51.33 Vermont 48.64 Minnesota 48.45 Idaho 48.36 Maine 48.07 Massachusetts 47.98 Montana 46.49 Utah 46.310 Arizona 45.611 Maryland 45.512 Connecticut 45.413 Washington 45.213 Wyoming 45.215 Oregon 45.116 California 44.816 Rhode Island 44.816 Wisconsin 44.819 Virginia 44.620 Nebraska 43.721 Nevada 43.622 Alaska 42.822 Delaware 42.824 Florida 42.225 South Dakota 42.126 Iowa 42.027 Hawaii 41.427 Kansas 41.427 Michigan 41.430 Ohio 41.031 Illinois 40.832 South Carolina 40.433 New Jersey 39.934 New Mexico 39.535 North Dakota 39.436 Pennsylvania 39.237 Missouri 39.138 Indiana 38.539 Georgia 38.340 New York 38.240 Texas 38.242 North Carolina 36.943 Tennessee 35.944 Arkansas 34.945 Kentucky 34.146 West Virginia 33.747 Louisiana 32.648 Oklahoma 32.349 Alabama 30.950 Mississippi 29.0 United States 41.2 District of Columbia 44.4
High Health Status
454035302520151050
2013 2014 2015 2016 2017
% O
F A
DU
LTS
AG
ED 6
5+
EDITION YEAR
41.2%41.2%41.8%39.9%38.4%
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 61
Prevalence by Race/Ethnicity
*Non-Hispanic
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
American Indian/Alaskan Native*Asian*Black*
Hawaiian/Pacific Islander*Hispanic
White*
Prevalence by Urbanicity
Rural Suburban
Urban
Rural Suburban
Urban
Prevalence by Education
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Less than High SchoolHigh School Graduate
Some CollegeCollege Graduate
Prevalence by Income
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Less than $25,000$25,000 to $49,999$50,000 to $74,999
$75,000 or More
Prevalence by Gender
Female Male
FemaleMale
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
Minimum U.S. MaximumState Value Value State Value
0 10 20 30 40
0 10 20 30 40Adults aged 65+, %
0 10 20 30 40 50 60
0 10 20 30 40 50 60Adults aged 65+, %
Adults aged 65+, %
Adults aged 65+, %
Adults aged 65+, %
41.6% 40.7% 28.5% 41.6% 54.4% 29.6% 40.7% 51.7%
21.7% 27.7% 35.1% 30.5% 44.4% 51.4% 16.0% 26.6% 49.1% — 23.5% — 15.4% 22.1% 37.3% 32.0% 44.7% 65.8%
13.7% 20.6% 32.8% 26.5% 36.2% 45.1% 33.1% 44.8% 55.9% 48.1% 58.0% 65.6%
19.0% 26.8% 36.5% 29.7% 40.2% 49.9% 35.2% 50.2% 64.9% 50.8% 60.8% 69.9%
22.6% 36.1% 52.3% 28.4% 41.5% 53.0% 32.1% 41.0% 53.4%
High Health Status by Subpopulations
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
62 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)
Outcomes
Hip fractures increase substantially with age due to decreased bone density and muscle mass. Osteoporosis, physical inactivity, poor vision, certain medications and general frailty contribute to falls and hip fractures. Hip fractures often result in hospitalization, surgery and extensive rehabilitation in a long-term care facility and may signal the end of independence for older adults. More than 250,000 adults aged 65 years and older are hospitalized each year for hip fractures and a quarter of previously independent seniors remain in a long-term care facility one year after injury. Nutritional supplementation, medications, hip protectors and exercise regimens to maintain mobility, balance and strength may reduce hip fracture risk.
Hip Fractures by StateNumber of hospitalizations for hip fracture per 1,000 Medicare enrollees aged 65 years and older
by Hip Fractures
Data source: The Dartmouth Atlas of Health Care, 2014For details: www.AmericasHealthRankings.org/SR17/HipFractures
<=5.1 5.2 to 5.5 5.6 to 5.9 6.0 to 6.7 >=6.8
DC
RI
DE
5.8 1 Hawaii 3.02 Alaska 4.72 Vermont 4.72 Washington 4.75 California 4.86 Minnesota 4.96 Rhode Island 4.98 Wisconsin 5.09 Connecticut 5.19 Idaho 5.19 Maryland 5.19 New Hampshire 5.19 New York 5.19 Oregon 5.115 Massachusetts 5.216 New Jersey 5.317 Maine 5.417 Utah 5.419 Iowa 5.519 Michigan 5.519 North Dakota 5.519 Pennsylvania 5.523 Colorado 5.623 Delaware 5.623 Illinois 5.623 Montana 5.627 Nevada 5.727 South Dakota 5.729 Virginia 5.830 Arizona 5.931 Indiana 6.031 Nebraska 6.033 Florida 6.133 New Mexico 6.133 Ohio 6.136 Wyoming 6.337 Kansas 6.537 South Carolina 6.539 Missouri 6.640 North Carolina 6.741 Louisiana 6.941 Texas 6.943 West Virginia 7.044 Georgia 7.145 Alabama 7.246 Tennessee 7.347 Arkansas 7.447 Kentucky 7.447 Mississippi 7.450 Oklahoma 7.7 United States 5.8 District of Columbia 5.5
Hip Fractures
8
6
4
2
0
2013 2014 2015 2016 2017HO
SPIT
ALI
ZATI
ON
S PE
R 1,0
00
M
EDIC
ARE
EN
ROLL
EES
AG
ED 6
5+
EDITION
5.85.96.27.37.3
Rank State Value
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 63
Ranking
CORE MEASURES
Rank State Value (%)
Outcomes
Overuse of the critical care system often goes against the wishes of dying patients and is costly. Research indicates many patients receive care they would not choose in their final days. While not correlated with better outcomes or longer life, intensive care unit (ICU) use is correlated with availability of ICU beds; this could indicate a supply-induced demand. Areas with higher ICU use are high-use areas in other aspects as well, including physician visits and hospitalizations. End-of-life care accounts for a quarter of all Medicare spending for seniors, which means that minimizing ICU use offers a chance for meaningful cost savings and better adherence to patient preferences.
ICU Use by StatePercentage of Medicare decedents aged 65 years and older spending seven or more days in the intensive care unit (ICU)/critical care unit during the last six months of life
by ICU Use
Data source: The Dartmouth Atlas of Health Care, 2014For details: www.AmericasHealthRankings.org/SR17/ICUUse
<=6.8% 6.9% to 10.4% 10.5% to 13.0% 13.1% to 15.2% >=15.3%
DC
RI
DE
13.8% 1 North Dakota 4.22 Vermont 4.93 Idaho 5.04 Maine 5.15 Oregon 5.36 Minnesota 6.07 Utah 6.18 Wisconsin 6.38 Wyoming 6.310 Iowa 6.810 Montana 6.812 New Hampshire 7.113 South Dakota 7.314 Rhode Island 7.815 Massachusetts 8.216 Colorado 8.617 Washington 9.218 Arkansas 9.519 Alaska 9.720 Kansas 10.421 Nebraska 11.022 Maryland 11.223 Mississippi 11.724 New York 11.825 Oklahoma 12.026 New Mexico 12.127 Georgia 12.228 North Carolina 12.829 Indiana 12.930 Michigan 13.031 Delaware 13.432 Connecticut 13.532 Louisiana 13.534 Missouri 13.834 Tennessee 13.836 Alabama 14.136 South Carolina 14.138 Hawaii 14.339 Ohio 14.440 Arizona 15.241 Virginia 15.342 Pennsylvania 15.443 Kentucky 15.544 Texas 15.945 West Virginia 16.046 Illinois 16.247 Nevada 16.948 California 17.649 Florida 20.050 New Jersey 22.6 United States 13.8 District of Columbia 13.6
ICU Use
16
12
8
4
0
2013 2014 2015 2016 2017
% O
F M
EDIC
ARE
D
ECED
ENTS
AG
ED 6
5+
EDITION YEAR
13.8%14.2%14.7%15.2%15.2%
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
64 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Ranking
CORE MEASURES
Rank State Value (%)
Outcomes
Premature death reflects the rate of death for seniors aged 65 to 74. In 2014, heart disease, cancer, chronic lower respiratory disease, cerebrovascular disease and Alzheimer’s disease were the top five causes of death in U.S. adults aged 65 and older. Many premature deaths are preventable through lifestyle changes. Evidence-based smoking interventions can greatly decrease premature deaths attributable to cancer, and heart disease is tied to modifiable risk factors including obesity, diabetes and physical inactivity. Interventions that encourage healthy lifestyles and use of clinical preventive services can be effective in reducing premature death in seniors.
Premature Death by StateDeaths per 100,000 adults aged 65 to 74 years
by Premature Death
Data source: CDC, National Center for Health Statistics, 2015For details: www.AmericasHealthRankings.org/SR17/PrematureDeath
<=1,603 1,604 to 1,671 1,672 to 1,794 1,795 to 2,043 >=2,044
DC
RI
DE
1,797 1 Hawaii 1,4262 Colorado 1,4663 Connecticut 1,4884 California 1,5045 Massachusetts 1,5366 Minnesota 1,5427 Utah 1,5558 New York 1,5699 New Jersey 1,57010 Florida 1,60311 Arizona 1,61011 Idaho 1,61013 Washington 1,61114 New Hampshire 1,63315 Vermont 1,64016 South Dakota 1,64517 North Dakota 1,65718 Rhode Island 1,65919 New Mexico 1,66820 Wisconsin 1,67121 Delaware 1,68422 Maryland 1,68723 Alaska 1,70124 Oregon 1,71125 Montana 1,73226 Nebraska 1,75727 Virginia 1,75928 Maine 1,76429 Wyoming 1,78030 Iowa 1,79431 Illinois 1,81032 Pennsylvania 1,87933 Texas 1,90534 Kansas 1,91135 Michigan 1,92436 Nevada 1,94137 North Carolina 1,95638 South Carolina 1,98439 Missouri 2,03140 Georgia 2,04341 Ohio 2,05142 Indiana 2,09743 Louisiana 2,20844 Tennessee 2,25045 Alabama 2,29846 West Virginia 2,32347 Oklahoma 2,33048 Arkansas 2,36049 Kentucky 2,39450 Mississippi 2,470 United States 1,797 District of Columbia 2,021
Premature Death
2000
1600
1200
800
400
02013 2014 2015 2016 2017
DEA
THS
PER
100
,00
0
AD
ULT
S A
GED
65–
74
EDITION YEAR
1,7971,7861,8031,9091,909
Rank State Value
2017 Average U.S. Value
20172016201520142013
Year U.S. Value
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 65
Ranking
CORE MEASURES
Rank State Value (%)
Outcomes
Older adults without natural teeth are at increased risk of heart disease and stroke. Absence of natural teeth affects nutrition. Dentures are less efficient for chewing than natural teeth; people using dentures may gravitate to soft foods and avoid fruits and vegetables. Untreated dental caries and periodontal disease are the most common causes of teeth extractions, but other causes include trauma, crowding and disease. Preventable risk factors include poor diet and tobacco use. The percentage of seniors without natural teeth is decreasing, likely due to improved access to oral health care, public water fluoridation programs and reduced smoking rates. However, disparities exist by age and race/ethnicity.
Teeth Extractions by StatePercentage of adults aged 65 years and older who reported having had all teeth removed due to tooth decay or gum disease
by Teeth Extractions
Data source: CDC, Behavioral Risk Factor Surveillance System, 2014For details: www.AmericasHealthRankings.org/SR17/TeethExtractionsBiennial data
<=12.3% 12.4% to 14.3% 14.4% to 16.4% 16.5% to 19.3% >=19.4%
DC
RI
DE
14.9% 1 Hawaii 6.42 California 8.73 Colorado 10.44 Connecticut 10.54 Minnesota 10.56 Washington 11.17 Utah 11.28 Arizona 12.28 New Hampshire 12.210 Texas 12.311 Maryland 12.911 Michigan 12.911 Oregon 12.914 Florida 13.014 New Jersey 13.016 Alaska 13.417 Wisconsin 13.618 Rhode Island 13.819 Nebraska 14.120 North Dakota 14.321 Massachusetts 14.422 Idaho 14.922 New York 14.924 Iowa 15.025 Virginia 15.126 New Mexico 15.726 Pennsylvania 15.728 Delaware 16.029 South Dakota 16.130 Kansas 16.431 Illinois 16.532 Montana 16.733 Vermont 16.934 Nevada 17.035 Wyoming 17.236 Maine 17.537 Indiana 18.038 Ohio 18.138 South Carolina 18.140 Georgia 19.341 North Carolina 19.642 Missouri 19.943 Louisiana 20.544 Arkansas 21.745 Alabama 22.246 Oklahoma 22.446 Tennessee 22.448 Mississippi 22.549 Kentucky 23.950 West Virginia 33.6 United States 14.9 District of Columbia 11.0
Teeth Extractions
181614121086420
2013* 2014 2015 2016 2017
% O
F A
DU
LTS
AG
ED 6
5+
EDITION YEAR
14.9%14.9%16.1%16.1%16.5%*
* Not comparable to later years due to methodology change
66 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
SUPPLEMENTAL MEASURES
Education fosters health; it enables people to learn about, create and maintain a healthy lifestyle. Education is a strong predictor of life expectancy as well as overall well-being. Individuals with more education are more likely to have higher incomes, better health insurance coverage and increased access to preventive health care. Increasing educational attainment has been shown to improve the
Percentage of adults aged 65 years and older who reported having a college degree
Data source: U.S. Census Bureau, American Community Survey, 2015For details: www.AmericasHealthRankings.org/SR17/SR17/Education
>=30.1% 27.0% to 30.0% 24.4% to 26.9% 21.2 to 24.3% <=21.1%
DC
RI
DE
Education
30
25
20
15
10
5
0
% O
F A
DU
LTS
AG
ED 6
5+
health status of the population as a whole; each additional year of education is associated with an increase in health-promoting behaviors and a decrease in mortality risk. Investments in early childhood education can positively influence long-term health and reduce health care expenditures.
2013 2014 2015 2016 2017EDITION YEAR
Mammography screening has been widely accepted as an important part of breast cancer detection and mortality reduction, but professional opinions are changing in light of evidence that benefits don’t always outweigh the harms for asymptomatic women at average risk. Despite increased breast cancer risk with advancing age, the U.S. Preventive Services Task Force does not recommend for
Percentage of female Medicare enrollees aged 75 years and older who had at least one screening mammogram
Data source: The Dartmouth Atlas of Health Care, 2014For details: www.AmericasHealthRankings.org/SR17/SR17/OveruseMammography
<=21.3% 21.4% to 22.9% 23.0% to 24.3% 24.4% to 25.3% >=25.4%
DC
RI
DE
Overuse — Mammography
25
20
15
10
5
0
% O
F FE
MA
LE M
EDIC
ARE
EN
ROLL
EES
AG
ED 7
5+
or against mammography screening in women 75 years and older. The predominant risk of mammography screening in women age 75 and older are false-positives and overdiagnosis. For elderly women who have cognitive or functional impairments, overdiagnosis and the resulting overtreatment can be especially burdensome, leading to psychological harms and costly follow-up.
2013 2014 2015 2016 2017EDITION YEAR
Behaviors
Clinical Care
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 67
More than four million U.S. adults aged 65 years and older have cognitive difficulty. The number of people living with cognitive impairment (CI) may double in the next two decades as the baby boomer population ages. Age is the greatest risk factor for CI. Seniors with CI experience more hospitalizations and higher-than-
Percentage of adults aged 65 years and older who reported having cognitive difficulty
Data source: U.S. Census Bureau, American Community Survey, 2015For details: www.AmericasHealthRankings.org/SR17/SR17/Cognition
<=7.5% 7.6% to 8.2% 8.3% to 8.7% 8.8% to 10.2% >=10.3%
DC
RI
DE
Cognition
10
8
6
4
2
02013 2014 2015 2016 2017
% O
F A
DU
LTS
AG
ED 6
5+
EDITION YEAR
average annual health care costs compared with those without CI. Alzheimer’s disease is the most expensive disease, costing more than heart disease and cancer in the last five years of life. Evidence suggests that keeping intellectually engaged and physically active promote healthy cognitive aging.
The risk of developing prostate cancer increases with age, is higher in blacks than whites, and is higher in men with a family history of the disease or certain inherited genetic conditions. The U.S. Preventive Services Task Force recommends against prostate-specific antigen (PSA) screening in all age groups, stating the benefits do not outweigh the harms to men in the general U.S.
Percentage of male Medicare enrollees aged 75 years and older who had a screening prostate-specific antigen (PSA) test
Data source: The Dartmouth Atlas of Health Care, 2014For details: www.AmericasHealthRankings.org/SR17/SR17/OverusePSA
<=12.8% 12.9% to 15.9% 16.0% to 17.3% 17.4% to 19.8% >=19.9%
DC
RI
DE
Overuse — PSA Test
20
16
12
8
4
0
% O
F M
ALE
MED
ICA
RE
ENRO
LLEE
S A
GED
75+
population. Despite the recommendation against PSA screening for men at average risk, many are still receiving the screening. The average annual expenditures on prostate cancer screening and downstream procedures during 2007 to 2009 were $447 million in 2009 U.S. dollars.
2013 2014 2015 2016 2017EDITION YEAR
Clinical Care
Outcomes
68 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
SUPPLEMENTAL MEASURES
Chronic conditions are those that last more than a year, require ongoing medical attention, and may limit activities of daily living (ADLs). They are largely preventable and contribute to an increased risk of mortality. The prevalence of multiple chronic conditions (MCC) among older adults is much higher than the prevalence in the general population. Compared with adults with
Percentage of Medicare enrollees aged 65 years and older with four or more chronic conditions
Data source: U.S. HHS, Centers for Medicare & Medicaid Services, 2015For details: www.AmericasHealthRankings.org/SR17/SR17/Multi-pleChronicConditions
<=28.7% 28.8% to 33.6% 33.7% to 38.3% 38.4% to 40.5% >=40.6%
DC
RI
DE
Multiple Chronic Conditions
40
30
20
10
0
% O
F M
EDIC
ARE
EN
ROLL
EES
AG
ED 6
5+
no comorbidities or ADL limitations at age 65, those with three or more comorbidities spend an additional $35,000 on medical care over their lifetime and live 5.3 fewer years on average. Tobacco use, insufficient physical activity, poor diet and excessive alcohol consumption are major modifiable behaviors contributing to MCC.
2013 2014 2015 2016 2017EDITION YEAR
Depression can impair the physical, mental and social functioning of older adults. Risk factors include lack of social support, chronic disease and loss of a loved one. The prevalence of depression is highest in seniors who are hospitalized or require home health care, compared with seniors living independently. Depression in older adults is often undiagnosed or misdiagnosed, since the main
Percentage of adults aged 65 years and older who reported being told by a health professional that they have a depressive disorder
Data source: CDC, Behavioral Risk Factor Surveillance System, 2015For details: www.AmericasHealthRankings.org/SR17/SR17/Depression
<=13.4% 13.5% to 14.5% 14.6% to 15.7% 15.8% to 17.2% >=17.3%
DC
RI
DE
Depression
2013 2014 2015 2016 2017EDITION YEAR
1614121086420
% O
F A
DU
LTS
AG
ED 6
5+
symptom experienced may not be sadness, but low motivation, lack of energy or physical problems such as worsening arthritis or headaches. Older adults with depression may have higher health care costs due to a higher likelihood of multiple comorbid conditions, higher medication use and longer hospital stays.
Outcomes
Outcomes
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 69
Suicide is the 10th-leading cause of death in the United States. The national age-adjusted suicide rate was 13.3 per 100,000 individuals in 2015. That same year, the rate was 16.1 deaths per 100,000 adults aged 65 to 84 and 19.4 deaths per 100,000 adults aged 85 and older. Risk factors in older adults include psychiatric illness,
Number of deaths due to intentional self-harm per 100,000 adults aged 65 years and older
Data source: CDC, National Vital Statistics System, 2013-2015For details: www.AmericasHealthRankings.org/SR17/SR17/Suicide
<=12.3 12.4 to 15.6 15.7 to 17.9 18.0 to 21.4 >=21.5
DC
RI
DE
Suicide
181614121086420
DEA
THS
PER
100
,00
0
AD
ULT
S A
GED
65+
substance abuse, physical illness and disability, cognitive decline and social isolation. Suicide among adults aged 65 and older has an estimated lifetime cost to society of $1.1 billion in combined medical and work-loss related expenses.
2013 2014 2015 2016 2017EDITION YEAR
Outcomes
State Summaries
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 71
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 1Determinants Rank: 36Outcomes Rank: 47
ALA
BA
MA
Strengths:• High prevalence of pain management• High prevalence of seniors with a
dedicated provider• Low prevalence of excessive drinking
Challenges: • High premature death rate• High prevalence of smoking• Low prevalence of high health status
Highlights: • In the past year, community support
increased 94% from $344 to $666 per adult aged 60+ in poverty.
• In the past two years, low-care nursing home residents decreased 16% from 14.5% to 12.2% of residents.
• In the past three years, hospital readmissions decreased 6% from 15.3% to 14.4% of hospitalized Medicare enrollees aged 65+.
• Since 2013, obesity increased 11% from 27.1% to 30.2% of adults aged 65+.
• Since 2013, poverty decreased 8% from 10.8% to 9.9% of adults aged 65+.
• Since 2013, preventable hospitalizations decreased 24% from 80.1 to 61.1 discharges per 1,000 Medicare enrollees.
Ranking: Alabama is 43rd this year; it was 44th in 2016. The state ranks 47th for general population health and 44th for the health of women and children.
State Health Department Website: www.adph.org
57.94.5
30.253.438.510.2
-0.060
50.79.9
23.3-0.001$66617.211.3
-0.002-0.004
80.454.212.287
60.0-0.041
96.181.161.673.953.054.823.514.461.1
-0.013
-0.117
58.629.430.97.214.18.8
229822.2
-0.313
-0.431
+++++++++++++++++++
++++++++++++++++++++++++
++++++++++++++++
+++++++++++++++++++++++++++++
++
++++++++++++
+
448
383
453730
164030311540263131
43212983131
7172117481640234533
36
472949453646454547
43
Alabama
10.918.521.242.725.123.218.3
46474045375031
++++++++++
43
72 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 8Determinants Rank: 26Outcomes Rank: 32
ALA
SK
A
Strengths:• High community support expenditures• Low prevalence of food insecurity• Low rate of preventable hospitalizations
Challenges: • High prevalence of obesity• High prevalence of excessive drinking• Low prescription drug coverage
Highlights: • In the past year, excessive drinking
increased 20% from 8.9% to 10.7% of adults aged 65+.
• In the past year, frequent mental distress increased 40% from 5.7% to 8.0% of adults aged 65+.
• In the past two years, pain management increased 15% from 45.9% to 53.0% of adults aged 65+ with arthritis.
• Since 2013, preventable hospitalizations decreased 34% from 54.5 to 36.0 discharges per 1,000 Medicare enrollees.
• Since 2013, smoking decreased 29% from 12.4% to 8.8% of adults aged 65+.
• Since 2013, ICU use in the last six months of life increased 17% from 8.3% to 9.7% of Medicare decedents aged 65+.
Ranking: Alaska is 29th this year; it was 21st in 2016. The state ranks 30th for general population health and 28th for the health of women and children.
State Health Department Website: dhss.alaska.gov/Pages/default.aspx
64.510.734.753.029.58.8
-0.099
43.94.527.9
0.083$3,599
9.724.50.1670.249
65.625.0
—79
107.6-0.037
87.465.654.765.0278.832.226.214.036.0
-0.106
0.007
60.432.942.84.79.78.0
1,70113.4
-0.005
0.002
+++++++++++++++++++
++++++++++++++++++++++++++++++++++++++++
++++++++++++++++++
+++++++++++++++++++++
+++
+++++++++++++++++++++++++
+++
2950506172439
331
171213753
2036—484
28
504845461
4948138
49
26
41492221935231632
29
Alaska
10.611.230.122.619.212.616.8
4439127
24
+++++++++++++++++++++++++++++
29
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 73
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 4Determinants Rank: 25Outcomes Rank: 22
AR
IZO
NA
Strengths:• Low prevalence of obesity• Low percentage of hospital deaths• High percentage of quality nursing home
beds
Challenges: • Low flu vaccination coverage• Low SNAP enrollment• High geriatrician shortfall
Highlights: • In the past two years, flu vaccination
coverage decreased 12% from 60.0% to 52.6% of adults aged 65+.
• In the past three years, food insecurity increased 29% from 12.3% to 15.9% of adults aged 60+.
• In the past three years, volunteerism increased 26% from 17.6% to 22.1% of adults aged 65+.
• Since 2013, obesity increased 10% from 22.0% to 24.2% of adults aged 65+.
• Since 2013, preventable hospitalizations decreased 30% from 52.9 to 37.0 discharges per 1,000 Medicare enrollees.
• Since 2013, hip fractures decreased 18% from 7.2 to 5.9 hospitalizations per 1,000 Medicare enrollees.
Ranking: Arizona is 23rd this year; it was 27th in 2016. The state ranks 29th for general population health and 43rd for the health of women and children.
State Health Department Website: www.azdhs.gov
65.37.5
24.248.727.18.8
0.075
52.29.022.1
0.016$24115.95.7
-0.030-0.014
76.925.010.487
50.0-0.069
92.175.852.670.9108.465.815.314.337.0
0.019
0.011
65.127.545.65.915.27.6
1,61012.2
0.068
0.079
28377139248
103433274434444132
3636198
4237
433849312012
20919
25
24151030403211822
23
Arizona
8.416.127.832.625.318.923.9
23351816403745
++++++++++++++++++
23+++++++++++++++++++++++++++
+++++++++++++++++++
++++++++++++++++
+++++++++++++++++++++++++++++++++
+++
+++++++++++++++++++++++++++++++
+++
74 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 1Determinants Rank: 45Outcomes Rank: 48
AR
KA
NS
AS
Strengths:• Low prevalence of excessive drinking• High percentage of healthcare-
associated infection reporting policies• Low percentage of ICU use
Challenges: • High prevalence of physical inactivity• High prevalence of smoking • High prevalence of food insecurity
Highlights: • In the past two years, low-care nursing
home residents decreased 10% from 17.3% to 15.5% of residents.
• In the past two years, health screenings increased 26% from 51.1% to 64.5% of seniors receiving recommended screenings.
• In the past three years, obesity increased 15% from 25.9% to 29.8% of adults aged 65+.
• Since 2013, hospital readmissions decreased 7% from 16.7% to 15.6% of hospitalized Medicare enrollees aged 65+.
• Since 2013, preventable hospitalizations decreased 22% from 79.3 to 61.9 discharges per 1,000 Medicare enrollees.
• Since 2013, high health status increased 10% from 31.6% to 34.9% of adults aged 65+.
Ranking: Arkansas is 46th this year; it was 47th in 2016. The state ranks 48th for general population health and 49th for the health of women and children.
State Health Department Website: www.healthy.arkansas.gov
54.54.2
29.853.140.211.4
-0.115
47.610.319.6
-0.041$50924.914.9
-0.053-0.094
70.179.215.585
47.3-0.049
95.777.459.464.5111.553.720.215.661.9
-0.059
-0.318
57.734.334.97.49.58.4
2,36021.7
-0.316
-0.634
++++++++++++++++
+++++++++++++++++
+++++++++++++++
++++++++++++++++++++++++
+
+++++++++++++
+
484
365
474541
254244402350184744
26541254334
10333448181923464643
45
485044471840484448
46
Arkansas
11.216.018.636.519.518.219.9
473448253
3436
++++++++++++++++
46
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 75
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 12Determinants Rank: 13Outcomes Rank: 21
CA
LIFO
RN
IA
Strengths:• Low prevalence of physical inactivity• Low prevalence of obesity • Low prevalence of smoking
Challenges: • High percentage of ICU use• Low percentage of volunteerism• High percentage of seniors in poverty
Highlights: • In the past year, smoking decreased 24%
from 8.0% to 6.1% of adults aged 65+.• In the past year, excessive drinking
decreased 18% from 8.5% to 7.0% of adults aged 65+.
• In the past year, poverty decreased 7% from 10.6% to 9.9% of adults aged 65+.
• In the past three years, geriatrician shortfall increased 16% from 58.2% to 67.8% of geriatricians needed.
• In the past three years, food insecurity decreased 8% from 17.2% to 15.9% of adults aged 60+.
• Since 2013, preventable hospitalizations decreased 31% from 51.9 to 35.7 discharges per 1,000 Medicare enrollees.
Ranking: California is 16th this year; it was 28th in 2016. The state ranks 16th for general population health and 10th for the health of women and children.
State Health Department Website: www.cdph.ca.gov
71.37.0
22.845.121.66.1
0.218
51.39.921.8
-0.007$27015.95.4
-0.029-0.036
67.879.210.589
20.80.000
95.678.961.675.672.447.424.414.435.7
0.006
0.188
64.730.744.84.817.67.6
1,5048.7
0.075
0.263
9274
29122
144035334034454037
235
201
4918
13282112423746237
23
13
2637165
48324221
16
California
10.013.730.134.621.518.917.3
3812922133728
+++++++++++++++++++++++
16+++++++++++++++++++++++++++++++
+++++++++++++++++++
++++++++++++++++++++++
+++++++++++++++++++++++++++++
++++
++++++++++++++++++++++++++++++
++++
76 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 3Determinants Rank: 5Outcomes Rank: 3
CO
LOR
AD
O
Strengths:• Low prevalence of obesity• Low prevalence of physical inactivity• Low percentage of seniors living
in poverty
Challenges: • Low SNAP enrollment• Low prescription drug coverage• High percentage of low-care nursing
home residents
Highlights: • In the past two years, smoking decreased
11% from 9.1% to 8.1% of adults aged 65+.• In the past two years, low-care nursing
home residents increased 13% from 12.7% to 14.4% of residents.
• In the past three years, hospital readmissions decreased 14% from 14.8% to 12.8% of hospitalized Medicare enrollees aged 65+.
• In the past three years, hip fractures decreased 25% from 7.5 to 5.6 hospitalizations per 1,000 Medicare enrollees.
• Since 2013, poverty decreased 14% from 8.1% to 7.0% of adults aged 65+.
• Since 2013, preventable hospitalizations decreased 31% from 46.6 to 32.1 discharges per 1,000 Medicare enrollees.
Ranking: Colorado is fourth this year; it was seventh in 2016. The state ranks 10th for general population health and 14th for the health of women and children.
State Health Department Website: www.cdphe.state.co.us
70.96.7
20.044.022.38.1
0.183
52.57.0
26.60.082$39813.78.8
0.0080.089
63.666.714.485
51.3-0.038
94.373.367.373.2123.455.216.512.832.1
0.094
0.329
67.327.152.35.68.65.3
1,46610.4
0.266
0.595
++++++++++++++++++++++++++++
+++++++++++++++++++++++++++++++++
++++++++++++++++++
+++++++++++++++++++++++++++++++++++++++++
+++++
+++++++++++++++++++++++++++++++++++++++++
+++++
11252
353133
9718132821352617
181537254029
304471911154431
5
9121
23165233
4
Colorado
7.616.136.325.822.312.823.8
113524171044
++++++++++++++++++++++++++
4
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 77
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 2Determinants Rank: 6Outcomes Rank: 6
CO
NN
ECTI
CU
T
Strengths:• Low geriatrician shortfall• High percentage of able-bodied seniors• Low percentage of seniors living
in poverty
Challenges: • High percentage of low-care nursing
home residents• High percentage of hospital deaths • Low percentage of home-delivered
meals
Highlights: • In the past year, excessive drinking
increased 9% from 6.7% to 7.3% of adults aged 65+.
• In the past two years, volunteerism increased 9% from 26.3% to 28.6% of adults aged 65+.
• In the past three years, flu vaccination coverage increased 10% from 59.5% to 65.6% of adults aged 65+.
• Since 2013, food insecurity increased 45% from 10.6% to 15.4% of adults aged 60+.
• Since 2013, preventable hospitalizations decreased 23% from 60.4 to 46.3 discharges per 1,000 Medicare enrollees.
• Since 2013, hip fractures decreased 18% from 6.2 to 5.1 hospitalizations per 1,000 Medicare enrollees.
Ranking: Connecticut is seventh this year; it was ninth in 2016. The state ranks third for general population health and fourth for the health of women and children.
State Health Department Website: www.dph.state.ct.us
75.17.3
25.547.230.57.3
0.120
48.97.2
28.60.075$54015.47.3
-0.0050.069
44.175.013.988
95.40.106
96.481.965.675.7114.248.123.414.846.3
0.032
0.328
69.026.545.45.1
13.56.6
1,48810.5
0.198
0.526
33411231966
221015172029373320
58
35574
4141011173439322214
6
18129
3217346
7
Connecticut
8.114.031.339.324.616.710.8
18156
3432235
+++++++++++++++++++++++++
7++++++++++++++++++++++++++++
+++++++++++++++++++++++++++++++
+++++++++++++++++++++++++++
+++++++++++++++++++++++++++++++++++
+++++
++++++++++++++++++++++++++++++++++++++++
+++++
78 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 5Determinants Rank: 11Outcomes Rank: 25
DEL
AW
AR
E
Strengths:• Low percentage of seniors living
in poverty• High percentage of healthcare-
associated infection reporting policies• High percentage of able-bodied seniors
Challenges: • High prevalence of frequent mental
distress• High prevalence of physical inactivity • Low prevalence of pain management
Highlights: • In the past year, poverty decreased 17%
from 7.5% to 6.2% of adults aged 65+.• In the past two years, low-care nursing
home residents decreased 13% from 14.5% to 12.6% of residents.
• In the past two years, health screenings increased 15% from 67.8% to 78.2% of seniors receiving recommended screenings.
• In the past three years, ICU use in the last six months of life decreased 18% from 16.3% to 13.4% of Medicare decedents aged 65+.
• Since 2013, preventable hospitalizations decreased 14% from 58.6 to 50.2 discharges per 1,000 Medicare enrollees.
• Since 2013, volunteerism increased 40% from 21.3% to 29.9% of adults aged 65+.
Ranking: Delaware is 17th this year; it was 22nd in 2016. The state ranks 31st for general population health and 22nd for the health of women and children.
State Health Department Website: www.dhss.delaware.gov/dhss
69.77.3
27.941.434.48.7
-0.067
53.56.2
29.90.119$70712.516.8
0.0590.178
70.383.312.685
67.20.000
95.983.465.378.283.561.617.114.850.2
0.088
0.199
68.528.042.85.613.48.6
1,68416.0
0.042
0.241
+++++++++++++++++
+++++++++++++++++++++++++++++++++++++++++
++++++++++++++++++++
+++++++++++++++++++++++++++++++++++++++++
++++
+++++++++++++++++++++++++++
++++
18342344382131
731041416151410
271
30252518
95115
3236
32292
11
21922233144212825
17
Delaware
6.114.326.240.927.817.213.6
1172342472814
+++++++++++++++++++++
17
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 79
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 6Determinants Rank: 29Outcomes Rank: 28
FLO
RID
A
Strengths:• High percentage of hospice care use• High percentage of quality
nursing home beds• Low prevalence of obesity
Challenges: • Low flu vaccination coverage• Low percentage of healthcare-associated
infection reporting policies• Low percentage of volunteerism
Highlights: • In the past year, excessive drinking
decreased 11% from 8.9% to 7.9% of adults aged 65+.
• In the past year, frequent mental distress increased 15% from 7.3% to 8.4% of adults aged 65+.
• In the past two years, volunteerism decreased 7% from 20.2% to 18.7% of adults aged 65+.
• Since 2013, obesity increased 10% from 23.4% to 25.8% of adults aged 65+.
• Since 2013, flu vaccination coverage decreased 11% from 57.6% to 51.4% of adults aged 65+.
• Since 2013, preventable hospitalizations decreased 16% from 65.3 to 55.1 discharges per 1,000 Medicare enrollees.
Ranking: Florida is 30th this year; it was 24th in 2016. The state ranks 36th for general population health and 40th for the health of women and children.
State Health Department Website: www.floridahealth.gov
66.27.9
25.848.228.98.4
0.040
50.110.318.7
-0.036$79915.15.2
0.003-0.033
77.00.08.587
81.4-0.044
95.585.451.477.328.761.218.415.555.1
-0.007
-0.043
66.525.042.26.1
20.08.4
1,60313.0
0.025
-0.018
24401217131817
184247361227493036
37481181633
152
508
50413453629
29
154
24334940101428
30
Florida
8.714.926.845.425.523.020.2
27232150414938
++++++++++++++
30+++++++++++++++++++++++++
+++++++++++++++++++++
++++++++++++++++++
+++++++++++++++++++++++++++++++
+++
+++++++++++++++++++++++++++++
+++
80 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 2Determinants Rank: 39Outcomes Rank: 39
GEO
RG
IA
Strengths:• Low prevalence of excessive drinking• High prevalence of pain management• High percentage of hospice care use
Challenges: • High hip fracture hospitalization rate• Low percentage of quality nursing
home beds• High prevalence of smoking
Highlights: • In the past year, community support
decreased 13% from $293 to $254 per adult aged 60+ in poverty.
• In the past two years, poverty decreased 12% from 11.0% to 9.7% of adults aged 65+.
• In the past two years, health screenings increased 16% from 64.0% to 74.4% of seniors receiving recommended screenings.
• In the past three years, hospital readmissions decreased 6% from 15.6% to 14.6% of hospitalized Medicare enrollees aged 65+.
• In the past three years, ICU use in the last six months of life decreased 14% from 14.2% to 12.2% of Medicare decedents aged 65+.
• Since 2013, high health status increased 16% from 32.9% to 38.3% of adults aged 65+.
Ranking: Georgia is 41st this year; it was 39th in 2016. The state ranks 41st for general population health and 45th for the health of women and children.
State Health Department Website: dph.georgia.gov
62.15.329.748.532.410.2
-0.042
31.59.7
20.3-0.086$25417.85.3
-0.047-0.133
72.350.09.785
74.8-0.013
93.379.855.774.453.560.118.114.651.8
-0.010
-0.198
63.528.638.37.1
12.28.2
2,04319.3
-0.133
-0.332
++++++++++++++++++++
++++++++++
+++++++++++++++++++
+++++++++++++++++++++++++++
++
+++++++++++++++++++
+
37123414273727
453841454143484646
312317252022
3823441347511263232
39
322539442738404039
41
Georgia
9.917.625.039.024.121.916.8
36412632274824
+++++++++++++++
41
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 81
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 2Determinants Rank: 4Outcomes Rank: 2
HA
WA
II
Strengths:• Low prevalence of obesity• Low geriatrician shortfall• Low hip fracture hospitalization rate
Challenges: • Low prevalence of pain management• High prevalence of excessive drinking• Low percentage of volunteerism
Highlights: • In the past year, obesity increased 27%
from 14.1% to 17.9% of adults aged 65+.• Since 2013, food insecurity decreased
12% from 15.9% to 14.0% of adults aged 60+.
• In the past two years, flu vaccination coverage decreased 12% from 69.9% to 61.2% of adults aged 65+.
• In the past three years, hospital readmissions decreased 11% from 14.2% to 12.6% of hospitalized Medicare enrollees aged 65+.
• In the past three years, ICU use in the last six months of life increased 17% from 12.2% to 14.3% of Medicare decedents aged 65+.
• In the past year, frequent mental distress increased 17% from 4.7% to 5.5% of adults aged 65+.
Ranking: Hawaii is third this year; it was fifth in 2016. The state ranks first for general population health and seventh for the health of women and children.
State Health Department Website: health.hawaii.gov
78.19.517.939.525.36.1
0.141
51.27.819.2
0.021$53914.06.5
0.0040.025
22.775.04.084
87.60.134
94.783.661.274.180.045.726.712.623.5
0.031
0.332
67.020.641.43.014.35.5
1,4266.4
0.288
0.619
1471
48624
152045262122422929
182
34112
254271536404931
15
4
131
271
389112
3
Hawaii
10.37.6
28.833.624.719.913.1
411
1620334112
+++++++++++++++++++++
3+++++++++++++++++++++++++++
+++++++++++++++++++++++++
++++++++++++++++++++++++++
++++++++++++++++++++++++++++++++++
+++++
+++++++++++++++++++++++++++++++++++++++
+++++
82 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 7Determinants Rank: 30Outcomes Rank: 15
IDA
HO
Strengths:• Low prevalence of physical inactivity• Low prevalence of food insecurity• Low percentage of hospital readmissions
Challenges: • High geriatrician shortfall• Low prescription drug coverage• Low prevalence of pain management
Highlights: • In the past year, flu vaccination coverage
increased 6% from 54.0% to 57.1% of adults aged 65+.
• In the past year, excessive drinking increased 41% from 5.1% to 7.2% of adults aged 65+.
• In the past two years, hospital readmissions decreased 12% from 13.7% to 12.1% of hospitalized Medicare enrollees aged 65+.
• In the past three years, volunteerism decreased 27% from 39.8% to 29.2% of adults aged 65+.
• Since 2013, high health status increased 20% from 40.4% to 48.3% of adults aged 65+.
• Since 2013, preventable hospitalizations decreased 26% from 43.6 to 32.1 discharges per 1,000 Medicare enrollees.
Ranking: Idaho is 22nd this year; it was 15th in 2016. The state ranks 15th for general population health and 26th for the health of women and children.
State Health Department Website: www.healthandwelfare.idaho.gov
62.57.2
27.341.825.27.8
-0.003
51.68.7
29.20.058$27411.310.2
0.0270.085
88.325.010.583
43.9-0.143
92.571.857.167.7
120.852.517.312.132.1
0.009
-0.053
63.029.948.35.15.06.5
1,61014.9
0.139
0.086
+++++++++++++++++++++
++++++++++++++++++++++++++++++++
+++++++++++
+++++++++++++++++++++++++++++++
+++
++++++++++++++++++++++++++++++++++
+++
3531194351123
113113193910301718
493620384747
414541401323813
20
30
353159316112215
22
Idaho
8.615.824.527.324.014.222.4
2531297
261442
+++++++++++++++++++++
22
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 83
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: no changeDeterminants Rank: 41Outcomes Rank: 33
ILLI
NO
IS
Strengths:• High SNAP enrollment• Low geriatrician shortfall• High percentage of able-bodied seniors
Challenges: • High prevalence of obesity• Low percentage of quality nursing
home beds• High percentage of low-care nursing
home residents
Highlights: • In the past year, excessive drinking
increased 23% from 6.5% to 8.0% of adults aged 65+.
• In the past two years, low-care nursing home residents decreased 36% from 26.7% to 17.0% of residents.
• In the past three years, obesity increased 13% from 27.7% to 31.3% of adults aged 65+.
• Since 2013, hospice care use increased 38% from 37.8% to 52.0% of Medicare decedents aged 65+.
• Since 2013, preventable hospitalizations decreased 26% from 75.0 to 55.8 discharges per 1,000 Medicare enrollees.
• Since 2013, volunteerism decreased 13% from 25.6% to 22.2% of adults aged 65+.
Ranking: Illinois is 36th this year; it was 36th in 2016. The state ranks 26th for general population health and 21st for the health of women and children.
State Health Department Website: www.dph.illinois.gov
62.28.031.346.534.18.8
-0.127
35.08.5
22.2-0.038$34914.010.9
0.009-0.029
60.637.517.086
94.7-0.015
95.480.957.065.8103.452.020.315.055.8
-0.040
-0.211
66.427.440.85.616.28.0
1,81016.5
-0.009
-0.221
36424626362443
412832373322282534
133344198
23
16194244232425363839
41
161431234635313133
36
Illinois
7.513.024.337.322.918.012.3
963126203210
++++++++++++++++++++++++++
36+++++++++++++
+++++++++++++++++++++
+++++++++++++++++++
+++++++++++++++++++++++++
+
++++++++++++++++++++++
++
84 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 2Determinants Rank: 38Outcomes Rank: 39
IND
IAN
A
Strengths:• Low percentage of seniors living
in poverty• Low percentage of low-care nursing
home residents• Low percentage of hospital readmissions
Challenges: • High prevalence of smoking• High prevalence of physical inactivity• High premature death rate
Highlights: • In the past two years, smoking increased
14% from 9.6% to 10.9% of adults aged 65+.
• In the past two years, SNAP reach decreased 11% from 56.3% to 50.2% of adults aged 60+ in poverty.
• In the past three years, preventable hospitalizations decreased 25% from 76.0 to 57.0 discharges per 1,000 Medicare enrollees.
• In the past three years, health screenings increased 20% from 55.0% to 66.0% of seniors receiving recommended screenings.
• Since 2013, geriatrician shortfall increased 9% from 73.1% to 79.9% of geriatricians needed.
• Since 2013, food insecurity increased 57% from 10.1% to 15.9% of adults aged 60+.
Ranking: Indiana is 39th this year; it was 37th in 2016. The state ranks 39th for general population health and 36th for the health of women and children.
State Health Department Website: www.in.gov/isdh
60.55.5
29.542.835.910.9
-0.155
46.07.2
24.40.041$59015.95.4
-0.0140.027
79.950.07.687
50.2-0.027
95.377.761.366.099.350.620.114.357.0
-0.027
-0.182
62.231.838.56.012.97.6
2,09718.0
-0.133
-0.316
+++++++++++++
++++++++++++++++++++++++++
++++++++++++++++++
++++++++++++++++++++++++++
++
+++++++++++++++++
++
40143340424348
291028211734453628
41231084126
18322643262622204134
38
394338312932423739
39
Indiana
8.715.818.839.321.317.115.1
2731473492718
++++++++++++++++++++
39
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 85
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: no changeDeterminants Rank: 18Outcomes Rank: 17
IOW
A
Strengths:• Low prevalence of frequent
mental distress• Low prevalence of food insecurity • High percentage of volunteerism
Challenges: • High prevalence of obesity• Low prevalence of pain management• High percentage of low-care nursing
home residents
Highlights: • In the past year, frequent mental distress
decreased 16% from 5.5% to 4.6% of adults aged 65+.
• In the past three years, preventable hospitalizations decreased 20% from 60.5 to 48.2 discharges per 1,000 Medicare enrollees.
• In the past three years, ICU use in the last six months of life decreased 25% from 9.1% to 6.8% of Medicare decedents aged 65+.
• Since 2013, obesity increased 7% from 29.1% to 31.1% of adults aged 65+.
• Since 2013, smoking increased 37% from 7.1% to 9.7% of adults aged 65+.
• Since 2013, geriatrician shortfall increased 10% from 71.7% to 78.8% of geriatricians needed.
Ranking: Iowa is 19th this year; it was 19th in 2016. The state ranks 17th for general population health and eighth for the health of women and children.
State Health Department Website: idph.iowa.gov
70.06.531.1
40.031.49.7
-0.098
48.97.0
33.40.105$64410.618.8
0.0790.184
78.850.017.089
57.3-0.057
94.280.070.171.886.658.316.314.148.2
0.070
0.099
67.331.642.05.56.84.6
1,79415.00.118
0.217
15224447233438
227981671189
3923441
3435
33213
292910316276
18
9402619101
302417
19
Iowa
6.812.919.732.426.714.313.5
25
4515451513
++++++++++++++++++++++++
19++++++++++++++++
+++++++++++++++++++++++++++++++++++++++++
+++++++++++++++
++++++++++++++++++++++++++++++++++++++
++++
++++++++++++++++++++++++++++++++++
++++
86 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 1Determinants Rank: 28Outcomes Rank: 31
KA
NS
AS
Strengths:• High percentage of volunteerism• Low prevalence of frequent mental
distress• Low prevalence of excessive drinking
Challenges: • High percentage of low-care nursing
home residents• Low prescription drug coverage• High prevalence of obesity
Highlights: • In the past two years, obesity increased
18% from 25.9% to 30.5% of adults aged 65+.
• In the past two years, SNAP reach decreased 18% from 56.6% to 46.4% of adults aged 60+ in poverty.
• In the past two years, health screenings increased 15% from 60.6% to 69.5% of seniors receiving recommended screenings.
• In the past three years, food insecurity increased 37% from 11.5% to 15.7% of adults aged 60+.
• Since 2013, hospice care use increased 33% from 40.0% to 53.2% of Medicare decedents aged 65+.
• Since 2013, hospital deaths decreased 25% from 26.8% to 20.0% of Medicare decedents aged 65+.
Ranking: Kansas is 31st this year; it was 32nd in 2016. The state ranks 27th for general population health and 25th for the health of women and children.
State Health Department Website: www.kdheks.gov
66.74.8
30.547.232.58.7
0.012
43.47.3
34.60.084$47215.718.0
0.0230.107
73.350.020.083
46.4-0.142
95.074.861.769.5119.253.220.014.151.9
-0.001
-0.024
63.530.541.46.510.45.4
1,91116.4
-0.003
-0.027
+++++++++++++++++++++++
+++++++++++++++++++++++++++++++
++++++++++
++++++++++++++++++++++++++++++
+++
+++++++++++++++++++++++++
++
22104023282119
34126112531122116
322347384446
22402035152121163326
28
32362737207
343031
31
Kansas
7.815.525.735.025.818.317.9
13282523433530
+++++++++++++++++++
31
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 87
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 4Determinants Rank: 47Outcomes Rank: 50
KEN
TUC
KY
Strengths:• Low prevalence of excessive drinking• Low percentage of low-care nursing
home residents• High flu vaccination coverage
Challenges: • High prevalence of physical inactivity• High prevalence of smoking • High hip fracture hospitalization rate
Highlights: • In the past two years, food insecurity
increased 16% from 15.1% to 17.5% of adults aged 60+.
• In the past three years, hospital readmissions decreased 8% from 16.9% to 15.6% of hospitalized Medicare enrollees aged 65+.
• In the past three years, preventable hospitalizations decreased 25% from 102.9 to 77.0 discharges per 1,000 Medicare enrollees.
• Since 2013, smoking increased 18% from 10.4% to 12.3% of adults aged 65+.
• Since 2013, obesity increased 24% from 25.1% to 31.2% of adults aged 65+.
• Since 2013, hospital deaths decreased 31% from 32.1% to 22.0% of Medicare decedents aged 65+.
Ranking: Kentucky is 49th this year; it was 45th in 2016. The state ranks 45th for general population health and 34th for the health of women and children.
State Health Department Website: chfs.ky.gov/dph/
57.04.331.253.442.312.3
-0.145
29.511.218.9
-0.131$23017.56.4
-0.042-0.173
79.525.06.987
58.4-0.040
94.681.367.371.456.543.422.015.677.0
-0.068
-0.426
59.332.134.17.415.58.1
2,39423.9
-0.337
-0.763
467
453
494746
464746494641434448
403688
3230
28167
30464434465044
47
454445474337494950
49
Kentucky
10.514.918.642.721.718.020.0
43234845153237
++++++++++++++
49+++++++++++++++
+++++++++
+++++++++++++++++++
++++++++++++++++++++++
+
++++++++++
+
88 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 3Determinants Rank: 50Outcomes Rank: 43
LOU
ISIA
NA
Strengths:• High percentage of hospice care use• High percentage of home-delivered
meals• High prevalence of pain management
Challenges: • High prevalence of obesity• High percentage of seniors in poverty• High prevalence of smoking
Highlights: • In the past two years, health screenings
increased 30% from 55.8% to 72.7% of seniors receiving recommended screenings.
• In the past two years, volunteerism increased 7% from 16.2% to 17.4% of adults aged 65+.
• In the past two years, low-care nursing home residents decreased 38% from 22.8% to 14.2% of residents.
• Since 2013, flu vaccination coverage decreased 16% from 70.2% to 59.1% of adults aged 65+.
• Since 2013, obesity increased 17% from 28.7% to 33.6% of adults aged 65+.
• Since 2013, hospice care use increased 49% from 37.3% to 55.4% of Medicare decedents aged 65+.
Ranking: Louisiana is 47th this year; it was 50th in 2016. The state ranks 49th for general population health and 48th for the health of women and children.
State Health Department Website: dhh.louisiana.gov
57.26.4
33.654.939.011.4
-0.171
27.012.817.4
-0.171$39523.714.5
-0.060-0.231
83.150.014.28656.1
-0.081
94.778.559.172.7159.755.420.715.667.5
-0.028
-0.511
60.224.932.66.913.510.4
2,20820.5
-0.230
-0.741
++++++++++++++
++++++++++++++
++++++++++++++
+++++++++++++++++++++++++++
+
++++++++++++++
+
4519491
464549
495049503048194950
462336193540
2530352381429464735
50
433
47413250434343
47
Louisiana
10.318.220.143.722.620.518.5
41444348194332
+++++++++++
47
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 89
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 3Determinants Rank: 12Outcomes Rank: 14
MA
INE
Strengths:• Low percentage of ICU use• High percentage of quality nursing
home beds• Low percentage of low-care nursing
home residents
Challenges: • High prevalence of excessive drinking• High prevalence of food insecurity• Low prescription drug coverage
Highlights: • In the past two years, health screenings
increased 16% from 69.6% to 80.5% of seniors receiving recommended screenings.
• In the past three years, hip fractures decreased 22% from 6.9 to 5.4 hospitalizations per 1,000 Medicare enrollees.
• In the past three years, volunteerism increased 10% from 27.3% to 29.9% of adults aged 65+.
• Since 2013, food insecurity increased 39% from 12.2% to 17.0% of adults aged 60+.
• Since 2013, preventable hospitalizations decreased 20% from 59.3 to 47.5 discharges per 1,000 Medicare enrollees.
• Since 2013, obesity increased 18% from 24.5% to 29.0% of adults aged 65+.
Ranking: Maine is 11th this year; it was eighth in 2016. The state ranks 22nd for general population health and 11th for the health of women and children.
State Health Department Website: www.maine.gov/dhhs
67.47.9
29.043.430.78.1
-0.046
56.48.8
29.90.078$31517.013.1
-0.0120.066
58.983.33.884
81.30.091
96.980.062.880.5152.250.020.813.747.5
0.085
0.196
65.929.948.05.45.15.6
1,76417.5
0.142
0.338
21402838211328
13210153739223521
1211
34177
2211839313010254
12
1931617411283614
11
Maine
7.615.730.433.625.69.617.6
11298
20421
29
+++++++++++++++++++++++++
11++++++++++++++++++++
++++++++++++++++++++++++++++
+++++++++++++++++++++++++
++++++++++++++++++++++++++++++++++++++++
++++
+++++++++++++++++++++++++++++++++
++++
90 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: no changeDeterminants Rank: 19Outcomes Rank: 7
MA
RY
LAN
D
Strengths:• Low geriatrician shortfall• High percentage of healthcare-
associated infection reporting policies• High percentage of able-bodied seniors
Challenges: • Low prescription drug coverage• Low percentage of home-delivered meals• Low prevalence of pain management
Highlights: • In the past three years, high health status
increased 12% from 40.5% to 45.5% of adults aged 65+.
• In the past three years, volunteerism decreased 14% from 29.5% to 25.4% of adults aged 65+.
• Since 2013, obesity increased 13% from 26.1% to 29.4% of adults aged 65+.
• Since 2013, smoking decreased 17% from 9.2% to 7.6% of adults aged 65+.
• Since 2013, hospice care use increased 51% from 32.6% to 49.3% of Medicare decedents aged 65+.
• Since 2013, preventable hospitalizations decreased 26% from 62.7 to 46.1 discharges per 1,000 Medicare enrollees.
Ranking: Maryland is 14th this year; it was 14th in 2016. The state ranks 18th for general population health and 23rd for the health of women and children.
State Health Department Website: dhmh.maryland.gov
69.96.6
29.439.231.67.6
-0.039
41.57.3
25.40.027$35812.45.4
0.0060.034
39.683.36.476
88.50.096
95.780.561.077.072.449.322.50.046.1
0.005
0.095
68.225.145.55.111.27.0
1,68712.9
0.178
0.273
+++++++++++++++++++++
+++++++++++++++++++++++++
++++++++++++++++++++++++++
++++++++++++++++++++++++++++++++++
++++
+++++++++++++++++++++++++++++++++++++
++++
17233149251026
361226233215452826
316
50106
1020281042323601824
19
45119222222117
14
Maryland
8.013.432.638.322.915.913.0
16103
30202011
+++++++++++++++++++++++++++++
14
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 91
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 5Determinants Rank: 2Outcomes Rank: 9
MA
SS
AC
HU
SET
TS
Strengths:• High community support expenditures• High percentage of home-delivered meals• Low geriatrician shortfall
Challenges: • Low percentage of volunteerism• Low percentage of hospice care use• High prevalence of physical inactivity
Highlights: • In the past two years, food insecurity
decreased 15% from 11.6% to 9.9% of adults aged 60+.
• In the past three years, obesity increased 12% from 22.6% to 25.2% of adults aged 65+.
• In the past three years, ICU use in the last six months of life decreased 14% from 9.5% to 8.2% of Medicare decedents aged 65+.
• Since 2013, high health status increased 12% from 42.6% to 47.9% of adults aged 65+.
• Since 2013, preventable hospitalizations decreased 27% from 72.8 to 52.8 discharges per 1,000 Medicare enrollees.
• Since 2013, volunteerism decreased 6% from 23.5% to 22.1% of adults aged 65+.
Ranking: Massachusetts is sixth this year; it was first in 2016. The state ranks second for general population health and first for the health of women and children.
State Health Department Website: www.mass.gov/eohhs/gov/departments/dph/
71.97.0
25.247.533.38.7
0.058
46.09.222.1
-0.011$2,734
9.928.90.1790.167
39.058.310.986
98.80.101
98.185.761.080.9120.647.123.214.952.8
0.051
0.377
67.228.647.95.28.27.0
1,53614.4
0.168
0.545
6271021322114
29353334245213
219221965
11
281
143838343412
2
112571515225219
6
Massachusetts
8.317.232.138.028.115.18.1
21404
2948161
+++++++++++++++++++++++
6+++++++++++++++++++++++++
+++++++++++++++++++++++++++++++++
++++++++++++++++++++++++++
++++++++++++++++++++++++++++++++++
+++++
++++++++++++++++++++++++++++++++++++
+++++
92 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 1Determinants Rank: 24Outcomes Rank: 34
MIC
HIG
AN
Strengths:• High percentage of home-delivered
meals• Low percentage of seniors living
in poverty• High SNAP enrollment
Challenges: • High premature death rate• Low flu vaccination coverage• High prevalence of excessive drinking
Highlights: • In the past year, excessive drinking
increased 15% from 7.2% to 8.3% of adults aged 65+.
• In the past two years, health screenings increased 19% from 64.7% to 77.3% of seniors receiving recommended screenings.
• In the past three years, smoking increased 34% from 7.7% to 10.3% of adults aged 65+.
• In the past three years, geriatrician shortfall increased 10% from 61.0% to 67.2% of geriatricians needed.
• In the past three years, preventable hospitalizations decreased 20% from 70.3 to 56.1 discharges per 1,000 Medicare enrollees.
• In the past three years, hospital readmissions decreased 5% from 16.1% to 15.3% of hospitalized Medicare enrollees aged 65+.
Ranking: Michigan is 27th this year; it was 26th in 2016. The state ranks 34th for general population health and 32nd for the health of women and children.
State Health Department Website: www.michigan.gov/mdhhs
72.48.3
30.044.230.610.3
-0.078
47.17.8
23.30.027$39715.017.9
0.0250.052
67.250.09.787
86.10.033
95.678.857.677.399.657.218.515.356.1
0.009
0.016
64.632.641.45.513.06.7
1,92412.9
-0.013
0.003
++++++++++++++++++
++++++++++++++++++++++++++++++
+++++++++++++++++++++++
+++++++++++++++++++++++++++++++++
+++
++++++++++++++++++++++++++
+++
5433732203935
282030232926132024
21231781413
1329408
251114393920
24
284827193020351134
27
Michigan
8.714.523.441.123.120.814.3
27193343224416
++++++++++++++++++
27
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 93
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 3Determinants Rank: 3Outcomes Rank: 1
MIN
NES
OTA
Strengths:• High percentage of volunteerism• Low percentage of ICU use • Low prevalence of frequent
mental distress
Challenges: • High percentage of low-care nursing
home residents• Low prevalence of seniors with a
dedicated provider• High prevalence of excessive drinking
Highlights: • In the past three years, volunteerism
decreased 6% from 39.3% to 36.8% of adults aged 65+.
• In the past three years, food insecurity increased 19% from 8.6% to 10.2% of adults aged 60+.
• In the past three years, ICU use in the last six months of life decreased 19% from 7.4% to 6.0% of Medicare decedents aged 65+.
• Since 2013, obesity increased 20% from 23.7% to 28.5% of adults aged 65+.
• Since 2013, poverty decreased 17% from 8.3% to 6.9% of adults aged 65+.
• Since 2013, preventable hospitalizations decreased 27% from 50.6 to 37.1 discharges per 1,000 Medicare enrollees.
Ranking: Minnesota is first this year; it was fourth in 2016. The state ranks fourth for general population health and fifth for the health of women and children.
State Health Department Website: www.health.state.mn.us
75.67.2
28.544.029.57.4
0.063
55.06.9
36.80.148$39410.211.9
0.0480.196
56.650.015.289
65.30.013
92.379.164.877.4
268.350.619.514.137.1
0.078
0.350
68.026.148.44.96.04.9
1,54210.5
0.309
0.659
231253517711
562231624168
1123401
2715
42271372
261916105
3
574663641
1
Minnesota
6.913.526.828.724.110.512.0
51121102739
++++++++++++++++++++++++++++++
1+++++++++++++++++++++++++
+++++++++++++++++++++++++++++++++++++++
++++++++++++++++++++
+++++++++++++++++++++++++++++++++++++++
+++++
+++++++++++++++++++++++++++++++++++++++++++++
+++++
94 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 2Determinants Rank: 49Outcomes Rank: 45
MIS
SIS
SIP
PI
Strengths:• Low prevalence of excessive drinking• High percentage of home-delivered meals• High prevalence of pain management
Challenges: • High prevalence of physical inactivity• High percentage of seniors in poverty• Low prevalence of high health status
Highlights: • In the past two years, poverty decreased
13% from 14.3% to 12.5% of adults aged 65+.
• In the past two years, volunteerism decreased 20% from 25.3% to 20.3% of adults aged 65+.
• In the past three years, food insecurity increased 19% from 20.5% to 24.3% of adults aged 60+.
• In the past three years, preventable hospitalizations decreased 21% from 85.8 to 67.8 discharges per 1,000 Medicare enrollees.
• Since 2013, obesity increased 10% from 27.9% to 30.8% of adults aged 65+.
• Since 2013, the percentage of adults aged 65+ with no disability increased 6% from 54.0% to 57.4%.
Ranking: Mississippi is 50th this year; it was 48th in 2016. The state ranks 50th for general population health and 50th for the health of women and children.
State Health Department Website: www.msdh.state.ms.us
54.03.9
30.850.642.810.7
-0.141
37.212.520.3-0.117$18824.315.9
-0.065-0.182
84.954.213.184
63.3-0.083
94.376.763.365.283.750.323.715.467.8
-0.097
-0.504
57.428.029.07.411.78.2
2,47022.5
-0.287
-0.791
++++++++++++++++
+++++++++++++
++++++++++++
+++++++++++++++++++
+
+++++++++++++++
+
493419
504045
394941485049165049
482131342941
30351545312942444847
49
491950472338504845
50
Mississippi
12.114.819.639.320.919.815.9
502146347
4021
+++++++++++++++++
50
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 95
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 2Determinants Rank: 40Outcomes Rank: 42
MIS
SO
UR
I
Strengths:• High percentage of home-delivered meals• High flu vaccination coverage • Low prevalence of excessive drinking
Challenges: • High percentage of low-care nursing
home residents• Low percentage of healthcare-associated
infection reporting policies• High prevalence of smoking
Highlights: • In the past year, SNAP reach decreased
11% from 61.3% to 54.4% of adults aged 60+ in poverty.
• In the past two years, low-care nursing home residents increased 15% from 21.1% to 24.3% of residents.
• In the past three years, hip fractures decreased 20% from 8.2 to 6.6 hospitalizations per 1,000 Medicare enrollees.
• Since 2013, preventable hospitalizations decreased 22% from 73.0 to 56.6 discharges per 1,000 Medicare enrollees.
• Since 2013, volunteerism decreased 10% from 29.5% to 26.6% of adults aged 65+.
• Since 2013, obesity increased 12% from 26.2% to 29.4% of adults aged 65+.
Ranking: Missouri is 42nd this year; it was 40th in 2016. The state ranks 37th for general population health and 35th for the health of women and children.
State Health Department Website: www.dhss.mo.gov
58.85.9
29.447.433.611.0
-0.113
44.68.5
26.60.022$47416.621.6
0.0260.048
68.18.3
24.387
54.4-0.132
95.379.268.567.1
116.953.621.715.256.6
-0.006
-0.204
62.932.439.16.613.87.1
2,03119.9
-0.153
-0.356
42163122344440
32281825243891925
25464983745
18266
42162033374028
40
364737393426394242
42
Missouri
8.816.821.738.423.616.818.6
31393831232533
++++++++++++++++
42+++++++++++++++
+++++++++++++++++++++++++++++
+++++++++++++
++++++++++++++++++++++++++++++
++
++++++++++++++++
+
96 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 4Determinants Rank: 32Outcomes Rank: 23
MO
NTA
NA
Strengths:• Low prevalence of food insecurity• Low prevalence of obesity • Low percentage of hospital readmissions
Challenges: • High geriatrician shortfall• High percentage of low-care nursing
home residents• Low SNAP enrollment
Highlights: • In the past two years, SNAP reach
decreased 10% from 50.5% to 45.4% of adults aged 60+ in poverty.
• In the past three years, pain management decreased 23% from 56.0% to 43.4% of adults aged 65+ with arthritis.
• In the past three years, food insecurity decreased 34% from 13.7% to 9.0% of adults aged 60+.
• In the past three years, hip fractures decreased 24% from 7.4 to 5.6 hospitalizations per 1,000 Medicare enrollees.
• Since 2013, volunteerism decreased 16% from 31.6% to 26.4% of adults aged 65+.
• Since 2013, flu vaccination coverage increased 10% from 55.9% to 61.4% of adults aged 65+.
Ranking: Montana is 27th this year; it was 31st in 2016. The state ranks 23rd for general population health and 31st for the health of women and children.
State Health Department Website: www.dphhs.mt.gov
63.58.3
23.243.429.18.4
-0.002
51.57.6
26.40.064$9789.0
33.00.1490.213
89.28.318.380
45.4-0.233
91.069.061.467.680.244.117.613.139.8
-0.041
-0.063
65.632.246.45.66.86.8
1,73216.7
0.066
0.003
+++++++++++++++++++++
+++++++++++++++++++++++++++++++++++++++++
++++++
+++++++++++++++++++++++++
++
+++++++++++++++++++++++++++++
+++
32435
38151822
1318201882467
504646464649
4747244135431061240
32
20468
231021253223
27
Montana
6.815.329.025.124.714.026.9
227153
331247
++++++++++++++++++++++++
27
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 97
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 4Determinants Rank: 30Outcomes Rank: 19
NEB
RA
SK
A
Strengths:• High percentage of volunteerism• High percentage of home-delivered meals• Low prevalence of frequent mental
distress
Challenges: • Low percentage of healthcare-associated
infection reporting policies• High prevalence of obesity • High geriatrician shortfall
Highlights: • In the past three years, obesity increased
19% from 26.8% to 32.0% of adults aged 65+.
• In the past three years, hospital readmissions decreased 12% from 15.6% to 13.7% of hospitalized Medicare enrollees aged 65+.
• In the past three years, hip fractures decreased 20% from 7.5 to 6.0 hospitalizations per 1,000 Medicare enrollees.
• Since 2013, food insecurity increased 94% from 7.7% to 14.9% of adults aged 60+.
• Since 2013, geriatrician shortfall increased 10% from 72.6% to 80.2% of geriatricians needed.
• Since 2013, preventable hospitalizations decreased 28% from 65.4 to 46.9 discharges per 1,000 Medicare enrollees.
Ranking: Nebraska is 24th this year; it was 20th in 2016. The state ranks 12th for general population health and 17th for the health of women and children.
State Health Department Website: www.dhhs.ne.gov/
68.06.4
32.042.332.68.8
-0.087
49.17.4
35.40.108$88514.922.3
0.0640.172
80.20.014.587
52.6-0.129
94.873.865.268.061.850.520.213.746.9
-0.009
-0.053
66.428.143.76.011.05.3
1,75714.1
0.110
0.057
19194841292437
211656112581012
4248388
3844
24431239442823102331
30
16232031215
261919
24
Nebraska
7.114.422.831.525.216.111.2
718351338217
+++++++++++++++++++++++++
24++++++++++++++++++
++++++++++++++++++++++++++++++++++++++
++++++++++++
+++++++++++++++++++++++++++
+++
++++++++++++++++++++++++++++++++
+++
98 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 2Determinants Rank: 46Outcomes Rank: 26
NEV
AD
A
Strengths:• Low prevalence of obesity• Low prevalence of frequent mental
distress• Low rate of preventable hospitalizations
Challenges: • High prevalence of smoking• Low percentage of volunteerism• High percentage of ICU use
Highlights: • In the past two years, smoking decreased
20% from 15.4% to 12.3% of adults aged 65+.
• In the past two years, health screenings increased 28% from 53.6% to 68.5% of seniors receiving recommended screenings.
• In the past three years, food insecurity decreased 29% from 18.8% to 13.3% of adults aged 60+.
• In the past three years, flu vaccination coverage increased 9% from 50.0% to 54.3% of adults aged 65+.
• Since 2013, preventable hospitalizations decreased 27% from 58.1 to 42.4 discharges per 1,000 Medicare enrollees.
• Since 2013, hospice care use increased 26% from 39.7% to 50.1% of Medicare decedents aged 65+.
Ranking: Nevada is 40th this year; it was 42nd in 2016. The state ranks 35th for general population health and 47th for the health of women and children.
State Health Department Website: dhhs.nv.gov/
59.79.8
23.943.628.112.3
-0.152
42.28.416.8
-0.038$20913.310.3
0.007-0.032
76.816.711.185
74.9-0.071
90.976.254.368.578.050.122.315.342.4
-0.101
-0.355
64.826.943.65.7
16.95.5
1,94117.0
0.033
-0.323
+++++++++++++++
+++++++++++++++++++++
+++++++++++++++
++++++++++++++++++++
+
++++++++++++++++++++++++++
++
4148637114747
352650374819292735
354223251938
48374636393035391348
46
25112127479
363426
40
Nevada
8.713.324.933.220.015.329.6
279
281941750
+++++++++++++++++++++++++
40
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 99
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 2Determinants Rank: 8Outcomes Rank: 4
NEW
HA
MP
SH
IRE
Strengths:• High percentage of home-delivered meals• Low percentage of seniors living
in poverty• Low prevalence of food insecurity
Challenges: • Low prescription drug coverage• Low prevalence of pain management• High prevalence of excessive drinking
Highlights: • In the past year, community support
increased 6% from $2,098 to $2,233 per adult aged 60+ in poverty.
• In the past two years, health screenings increased 13% from 71.5% to 80.6% of seniors receiving recommended screenings.
• In the past three years, preventable hospitalizations decreased 23% from 58.2 to 44.8 discharges per 1,000 Medicare enrollees.
• Since 2013, obesity increased 12% from 24.8% to 27.8% of adults aged 65+.
• Since 2013, geriatrician shortfall increased 42% from 38.5% to 54.8% of geriatricians needed.
• Since 2013, hospital deaths decreased 27% from 27.3% to 19.8% of Medicare decedents aged 65+.
Ranking: New Hampshire is fifth this year; it was third in 2016. The state ranks sixth for general population health and third for the health of women and children.
State Health Department Website: www.dhhs.state.nh.us
74.17.5
27.840.928.36.7
0.052
53.06.1
26.20.099$2,233
10.145.7
0.1840.283
54.850.013.479
55.2-0.066
96.282.262.980.684.248.119.814.644.8
0.057
0.326
67.428.051.35.17.16.1
1,63312.2
0.234
0.559
437224612415
8221935211
102332483636
511162
303420261610
8
6192912131484
5
New Hampshire
6.913.731.231.625.912.014.7
51271444517
++++++++++++++++++++++++++++
5++++++++++++++++++++++++
+++++++++++++++++++++++++++++++++++++++++++
+++++++++++++++
+++++++++++++++++++++++++++++++++++++++
+++++
+++++++++++++++++++++++++++++++++++++++++
+++++
100 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 4Determinants Rank: 22Outcomes Rank: 20
NEW
JER
SEY
Strengths:• Low prevalence of smoking • High percentage of diabetes
management• High percentage of able-bodied seniors
Challenges: • High percentage of ICU use• High percentage of hospital deaths• Low percentage of volunteerism
Highlights: • In the past two years, health screenings
increased 25% from 58.3% to 72.7% of seniors receiving recommended screenings.
• Since 2013, premature death decreased 8% from 1,710 to 1,570 deaths per 100,000 adults aged 65 to 74.
• Since 2013, preventable hospitalizations decreased 27% from 68.8 to 50.3 discharges per 1,000 Medicare enrollees.
• Since 2013, geriatrician shortfall increased 31% from 41.8% to 54.7% of geriatricians needed.
• Since 2013, volunteerism increased 13% from 18.9% to 21.4% of adults aged 65+.
• Since 2013, obesity increased 8% from 25.0% to 26.9% of adults aged 65+.
Ranking: New Jersey is 20th this year; it was 16th in 2016. The state ranks ninth for general population health and 19th for the health of women and children.
State Health Department Website: www.state.nj.us/health
70.07.2
26.944.134.27.5
0.005
51.67.921.4
0.032$55412.810.0
0.0270.059
54.762.511.385
89.80.048
94.784.560.772.776.747.825.615.250.3
-0.037
0.076
67.423.639.95.3
22.67.0
1,57013.0
0.080
0.156
+++++++++++++++++++++++
+++++++++++++++++++++++++++++
+++++++++++++++++++++++++
+++++++++++++++++++++++++
+++
+++++++++++++++++++++++++++++++++
++++
15311634378
20
112338221917321722
9172425910
2533123403647373038
22
62
3316502291420
20
New Jersey
8.010.828.144.121.321.29.9
16217499
463
+++++++++++++++++++++++++
20
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 101
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 1Determinants Rank: 34Outcomes Rank: 35
NEW
MEX
ICO
Strengths:• Low prevalence of obesity• Low prevalence of food insecurity• Low percentage of hospital readmissions
Challenges: • High prevalence of smoking• High percentage of seniors in poverty• Low percentage of quality nursing
home beds
Highlights: • In the past year, poverty decreased 16%
from 13.2% to 11.1% of adults aged 65+.• Since 2013, obesity increased 12% from
19.9% to 22.3% of adults aged 65+. • Since 2013, food insecurity decreased
49% from 21.2% to 10.8% of adults aged 60+.
• Since 2013, geriatrician shortfall increased 19% from 57.1% to 68.0% of geriatricians needed.
• Since 2013, hospice care use increased 27% from 42.5% to 53.9% of Medicare decedents aged 65+.
• Since 2013, preventable hospitalizations decreased 21% from 54.9 to 43.1 discharges per 1,000 Medicare enrollees.
Ranking: New Mexico is 34th this year; it was 33rd in 2016. The state ranks 38th for general population health and 37th for the health of women and children.
State Health Department Website: www.health.state.nm.us
63.25.6
22.347.826.110.8
0.083
32.111.121.0
-0.108$52310.815.5
0.061-0.047
68.025.013.783
65.9-0.092
91.165.658.164.4211.253.918.713.943.1
-0.028
-0.083
59.427.839.56.112.17.5
1,66815.7
-0.040
-0.123
34153
207
427
43463947228171239
243634382642
4648384941815121435
34
441734332630192635
34
New Mexico
11.417.629.929.618.313.327.7
4841111111148
++++++++++++++++++++
34++++++++++++++++++++++++++
+++++++++++++++++++++++
+++++++++++++
++++++++++++++++++++++++++++
++
++++++++++++++++++++++++
++
102 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 2Determinants Rank: 17Outcomes Rank: 27
NEW
YO
RK
Strengths:• High SNAP enrollment• High percentage of healthcare-
associated infection reporting policies• Low prevalence of obesity
Challenges: • High prevalence of frequent
mental distress• High percentage of seniors in poverty • High percentage of hospital deaths
Highlights: • In the past year, obesity decreased 9%
from 27.3% to 24.9% of adults aged 65+.• In the past year, frequent mental distress
increased 25% from 7.6% to 9.5% of adults aged 65+.
• In the past three years, premature death decreased 7% from 1,680 to 1,569 deaths per 100,000 adults aged 65 to 74.
• Since 2013, food insecurity increased 40% from 13.8% to 19.3% of adults aged 60+.
• Since 2013, hospice care use increased 40% from 23.8% to 33.4% of Medicare decedents aged 65+.
• Since 2013, preventable hospitalizations decreased 28% from 66.3 to 47.6 discharges per 1,000 Medicare enrollees.
Ranking: New York is 21st this year; it was 23rd in 2016. The state ranks 13th for general population health and 20th for the health of women and children.
State Health Department Website: www.health.state.ny.us
65.87.1
24.948.133.38.1
0.038
47.211.217.6
-0.071$89919.311.3
-0.010-0.081
42.383.38.588
119.30.182
95.783.359.769.8242.133.430.015.347.6
-0.035
0.104
66.627.738.25.111.89.5
1,56914.9
0.027
0.131
+++++++++++++++++++++++++
++++++++++++++++++
+++++++++++++++++++++++++++++
++++++++++++++++++++++++++++
++++
++++++++++++++++++++++++++++++
+++
2630918321318
274748439
46263442
4111511
107
32333
4750392637
17
1416409244982227
21
New York
8.615.127.041.620.821.610.0
252620446474
++++++++++++++++++++++
21
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 103
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 2Determinants Rank: 21Outcomes Rank: 39
NO
RTH
CA
RO
LIN
A
Strengths:• High flu vaccination coverage• Low percentage of low-care nursing
home residents• High percentage of healthcare-
associated infection reporting policies
Challenges: • Low percentage of quality nursing
home beds• High prevalence of food insecurity • High hip fracture hospitalization rate
Highlights: • In the past two years, poverty decreased
8% from 10.0% to 9.2% of adults aged 65+.
• In the past two years, high health status decreased 6% from 39.3% to 36.9% of adults aged 65+.
• In the past three years, premature death decreased 5% from 2,058 to 1,956 deaths per 100,000 adults aged 65 to 74.
• In the past three years, hospital readmissions decreased 7% from 15.3% to 14.3% of hospitalized Medicare enrollees aged 65+.
• Since 2013, food insecurity increased 15% from 15.7% to 18.0% of adults aged 60+.
• Since 2013, preventable hospitalizations decreased 22% from 62.6 to 49.0 discharges per 1,000 Medicare enrollees.
Ranking: North Carolina is 32nd this year; it was 30th in 2016. The state ranks 32nd for general population health and 30th for the health of women and children.
State Health Department Website: www.dhhs.state.nc.us
63.45.426.750.131.69.1
0.050
28.29.2
25.4-0.061$33418.06.7
-0.041-0.102
61.575.06.787
67.60.070
95.182.770.472.8107.153.120.914.349.0
0.059
0.077
63.528.036.96.712.88.8
1,95619.6
-0.133
-0.056
33131511253216
473526423544394345
14878
249
21822121223120288
21
321942402846374139
32
North Carolina
9.914.924.437.725.217.716.7
36233028383123
++++++++++++++++++
32+++++++++++++++++++++++
++++++++++++++
+++++++++++++++++++++++++++
++++++++++++++++++++++++++++++++++++
+++
++++++++++++++++++
++
104 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 1Determinants Rank: 20Outcomes Rank: 13
NO
RTH
DA
KO
TA
Strengths:• Low prevalence of food insecurity• High percentage of volunteerism• Low percentage of ICU use
Challenges: • High prevalence of obesity• High percentage of low-care nursing
home residents• Low percentage of hospice care use
Highlights: • In the past two years, health screenings
increased 30% from 53.8% to 69.8% of seniors receiving recommended screenings.
• In the past two years, smoking decreased 19% from 10.1% to 8.2% of adults aged 65+.
• In the past two years, food insecurity decreased 45% from 13.2% to 7.3% of adults aged 60+.
• In the past two years, SNAP reach increased 25% from 41.3% to 51.6% of adults aged 60+ in poverty.
• In the past three years, hospital deaths increased 8% from 22.2% to 23.9% of Medicare decedents aged 65+.
• Since 2013, obesity increased 27% from 24.4% to 30.9% of adults aged 65+.
Ranking: North Dakota is 18th this year; it was 17th in 2016. The state ranks 11th for general population health and 13th for the health of women and children.
State Health Department Website: www.ndhealth.gov
66.46.7
30.945.533.28.2
-0.051
50.58.936.1
0.087$1,389
7.341.1
0.1750.262
54.337.514.786
51.6-0.043
91.779.358.869.8105.730.723.914.046.2
-0.075
0.094
64.127.239.45.54.25.1
1,65714.3
0.145
0.239
+++++++++++++++++++
+++++++++++++++++++++++++++++++++++++++++
+++++++++++++++++
++++++++++++++++++++++
++++
+++++++++++++++++++++++++++++++++++
++++
23254327311629
173341061332
83339193932
44243733225043132045
20
3013351914172013
18
North Dakota
7.912.419.832.829.816.110.8
144
441750215
+++++++++++++++++++++++
18
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 105
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 3Determinants Rank: 35Outcomes Rank: 36
OH
IO
Strengths:• High prescription drug coverage• High percentage of hospice care use• Low percentage of hospital deaths
Challenges: • High prevalence of food insecurity• High prevalence of smoking • High prevalence of obesity
Highlights: • In the past two years, food insecurity
increased 36% from 12.9% to 17.6% of adults aged 60+.
• In the past two years, health screenings increased 23% from 58.8% to 72.2% of seniors receiving recommended screenings.
• In the past three years, pain management decreased 20% from 56.2% to 45.2% of adults aged 65+ with arthritis.
• In the past three years, hospital deaths decreased 19% from 20.5% to 16.6% of Medicare decedents aged 65+.
• In the past three years, preventable hospitalizations decreased 24% from 78.5 to 59.8 discharges per 1,000 Medicare enrollees.
• In the past three years, hip fractures decreased 15% from 7.2 to 6.1 hospitalizations per 1,000 Medicare enrollees.
Ranking: Ohio is 35th this year; it was 38th in 2016. The state ranks 40th for general population health and 33rd for the health of women and children.
State Health Department Website: www.odh.ohio.gov
63.76.0
29.045.233.89.9
-0.075
38.67.626.1
0.014$42917.612.2
-0.015-0.001
70.916.711.789
77.0-0.018
96.178.557.772.2
109.459.516.615.359.8
0.008
-0.086
65.430.141.06.1
14.47.0
2,05118.1
-0.066
-0.152
31172828353633
381823292742233830
2942271
1825
73039271965
394322
35
233330333922413836
35
Ohio
8.115.820.239.822.317.315.4
18314237173019
++++++++++++++++++++
35++++++++++++++++++
++++++++++++++++++++++++
+++++++++++++++++++
+++++++++++++++++++++++++++++++++
++
++++++++++++++++++++
++
106 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 1Determinants Rank: 48Outcomes Rank: 49
OK
LAH
OM
A
Strengths:• Low prevalence of excessive drinking• High flu vaccination coverage • High prevalence of pain management
Challenges: • High prevalence of smoking• High hip fracture hospitalization rate• High percentage of low-care nursing
home residents
Highlights: • In the past two years, high health status
decreased 10% from 35.7% to 32.3% of adults aged 65+.
• In the past two years, poverty decreased 13% from 9.7% to 8.4% of adults aged 65+.
• In the past two years, smoking increased 31% from 9.9% to 13.0% of adults aged 65+.
• In the past three years, ICU use in the last six months of life increased 12% from 10.7% to 12.0% of Medicare decedents aged 65+.
• Since 2013, hospital deaths decreased 32% from 30.3% to 20.5% of Medicare decedents aged 65+.
• Since 2013, preventable hospitalizations decreased 27% from 81.0 to 59.2 discharges per 1,000 Medicare enrollees.
Ranking: Oklahoma is 48th this year; it was 49th in 2016. The state ranks 46th for general population health and 46th for the health of women and children.
State Health Department Website: www.ok.gov/health
55.44.228.151.241.213.0
-0.135
31.68.4
24.2-0.038$30416.09.0
-0.017-0.055
84.829.223.081
62.1-0.194
93.571.569.064.782.556.120.514.659.2
-0.046
-0.430
58.730.832.37.7
12.08.7
2,33022.4
-0.324
-0.754
+++++++++++++++++
+++++++++++++++++++
+++++++++
+++++++++++++++++++++++
+
++++++++++++
+
474
248
484944
442629373837343940
473548443048
36465
47341327264241
48
463848502545474649
48
Oklahoma
9.318.522.639.821.518.620.8
33473637133639
+++++++++++++++
48
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 107
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: no changeDeterminants Rank: 9Outcomes Rank: 24
OR
EGO
N
Strengths:• Low percentage of ICU use• Low percentage of hospital readmissions• High SNAP enrollment
Challenges: • High prevalence of excessive drinking• Low percentage of able-bodied seniors• Low flu vaccination coverage
Highlights: • In the past year, pain management
increased 16% from 47.3% to 54.8% of adults aged 65+ with arthritis.
• In the past two years, low-care nursing home residents increased 31% from 6.5% to 8.5% of residents.
• In the past two years, health screenings increased 21% from 61.1% to 74.0% of seniors receiving recommended screenings.
• In the past three years, flu vaccination coverage increased 6% from 53.9% to 56.9% of adults aged 65+.
• Since 2013, obesity increased 17% from 24.6% to 28.9% of adults aged 65+.
• Since 2013, preventable hospitalizations decreased 22% from 42.9 to 33.4 discharges per 1,000 Medicare enrollees.
Ranking: Oregon is 12th this year; it was 12th in 2016. The state ranks 21st for general population health and 27th for the health of women and children.
State Health Department Website: public.health.oregon.gov/
67.59.4
28.954.824.88.9
0.061
50.17.3
28.80.078$33115.711.9
-0.0040.074
64.475.08.585
111.60.089
93.976.656.974.095.857.018.213.033.4
0.052
0.277
62.431.745.15.15.38.41,71112.9
0.051
0.327
20462724
2912
181214153631243219
198112538
353643162712125611
9
38411595
40241124
12
Oregon
10.019.929.227.024.712.624.2
3850146
337
46
++++++++++++++++++++
12+++++++++++++++++++++++++
+++++++++++++++++++++++++++++
++++++++++++++++++++++++++
++++++++++++++++++++++++++++++++++
+++++
+++++++++++++++++++++++++++++
++++
108 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 8Determinants Rank: 23Outcomes Rank: 30
PEN
NS
YLV
AN
IA
Strengths:• High community support expenditures• Low percentage of low-care nursing
home residents• Low geriatrician shortfall
Challenges: • Low prevalence of pain management• Low percentage of quality nursing
home beds• High prevalence of obesity
Highlights: • In the past year, flu vaccination coverage
increased 7% from 59.6% to 63.9% of adults aged 65+.
• In the past two years, poverty decreased 6% from 8.3% to 7.8% of adults aged 65+.
• In the past three years, hospital readmissions decreased 7% from 15.8% to 14.7% of hospitalized Medicare enrollees aged 65+.
• Since 2013, obesity increased 10% from 28.0% to 30.8% of adults aged 65+.
• Since 2013, pain management decreased 30% from 52.9% to 37.2% of adults aged 65+ with arthritis.
• Since 2013, geriatrician shortfall increased 25% from 39.4% to 49.4% of geriatricians needed.
Ranking: Pennsylvania is 26th this year; it was 18th in 2016. The state ranks 28th for general population health and 24th for the health of women and children.
State Health Department Website: www.health.state.pa.us
64.57.0
30.837.235.09.0
-0.177
35.27.826.1
-0.003$1,223
13.19.5
0.0550.053
49.475.07.487
87.60.118
96.281.963.970.0127.450.819.214.751.5
0.031
0.025
65.628.639.25.515.46.6
1,87915.7
0.000
0.025
+++++++++++++
+++++++++++++++++++++++++++++
+++++++++++++++++++++++++++++
++++++++++++++++++++++++++++++++++++
+++
++++++++++++++++++++++++++
+++
29274150413050
40202332718331523
6898113
5141432102517293115
23
202536194217322630
26
Pennsylvania
8.313.921.740.521.417.015.6
21143840122620
++++++++++++++++++++++
26
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 109
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 2Determinants Rank: 15Outcomes Rank: 11
RH
OD
E IS
LAN
D
Strengths:• High SNAP enrollment• High percentage of quality nursing
home beds• Low prevalence of obesity
Challenges: • Low percentage of volunteerism• High percentage of seniors in poverty• Low community support expenditures
Highlights: • In the past year, community support
decreased 20% from $300 to $239 per adult aged 60+ in poverty.
• In the past two years, volunteerism increased 9% from 18.5% to 20.1% of adults aged 65+.
• In the past three years, ICU use in the last six months of life decreased 31% from 11.3% to 7.8% of Medicare decedents aged 65+.
• Since 2013, poverty increased 13% from 9.1% to 10.3% of adults aged 65+.
• Since 2013, hospital deaths decreased 44% from 30.7% to 17.2% of Medicare decedents aged 65+.
• Since 2013, hip fractures decreased 21% from 6.2 to 4.9 hospitalizations per 1,000 Medicare enrollees.
Ranking: Rhode Island is 13th this year; it was 11th in 2016. The state ranks 14th for general population health and ninth for the health of women and children.
State Health Department Website: www.health.state.ri.us
70.46.4
24.444.232.77.5
0.073
54.010.320.1
-0.014$23914.56.8
-0.014-0.028
53.325.013.588
107.20.047
96.682.262.977.893.559.217.215.355.3
0.059
0.151
65.626.844.84.97.87.3
1,65913.8
0.153
0.305
14198
323089
64243354524383633
736335511
311166
2877
39378
15
20101661429181811
13
Rhode Island
9.014.226.240.525.016.711.2
3216234036237
+++++++++++++++++++++
13++++++++++++++++++++++++++++
+++++++++++++++++++
+++++++++++++++++++++++
++++++++++++++++++++++++++++++++++++++++
++++
+++++++++++++++++++++++++++++++++++++
++++
110 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 1Determinants Rank: 27Outcomes Rank: 38
SO
UTH
CA
RO
LIN
A
Strengths:• Low percentage of low-care nursing
home residents• Low prevalence of excessive drinking • High percentage of hospice care use
Challenges: • High premature death rate• High prevalence of food insecurity• High hip fracture hospitalization rate
Highlights: • In the past two years, SNAP reach
decreased 20% from 72.5% to 58.0% of adults aged 60+ in poverty.
• In the past two years, health screenings increased 20% from 60.5% to 72.5% of seniors receiving recommended screenings.
• Since 2013, preventable hospitalizations decreased 25% from 61.2 to 46.2 discharges per 1,000 Medicare enrollees.
• Since 2013, obesity increased 13% from 25.2% to 28.5% of adults aged 65+.
• Since 2013, volunteerism increased 17% from 22.3% to 26.0% of adults aged 65+.
• Since 2013, food insecurity increased 13% from 17.1% to 19.3% of adults aged 60+.
Ranking: South Carolina is 33rd this year; it was 34th in 2016. The state ranks 42nd for general population health and 39th for the health of women and children.
State Health Department Website: www.scdhec.gov
60.86.028.549.631.38.8
0.000
47.69.3
26.00.014$20919.37.9
-0.054-0.041
72.245.85.786
58.0-0.003
95.282.162.772.578.758.520.514.446.2
0.033
-0.010
62.629.240.46.514.17.5
1,98418.1
-0.098
-0.109
++++++++++++++++++++++
++++++++++++++++++
++++++++++++++++++++
++++++++++++++++++++++++++++++++++++
+++
++++++++++++++++++++
++
39172512222421
253725294846364838
30324193320
2013192638827232013
27
372832373630383838
33
South Carolina
10.216.424.237.327.219.916.8
40383226464124
++++++++++++++
33
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 111
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 10Determinants Rank: 16Outcomes Rank: 10
SO
UTH
DA
KO
TA
Strengths:• High flu vaccination coverage• High percentage of volunteerism• Low prevalence of frequent mental
distress
Challenges: • Low percentage of hospice care use• Low SNAP enrollment • High prevalence of smoking
Highlights: • In the past year, SNAP reach increased
15% from 40.0% to 46.0% of adults aged 60+ in poverty.
• In the past year, poverty decreased 22% from 10.6% to 8.3% of adults aged 65+.
• In the past two years, health screenings increased 23% from 59.3% to 72.8% of seniors receiving recommended screenings.
• In the past two years, smoking increased 17% from 8.4% to 9.8% of adults aged 65+.
• In the past three years, preventable hospitalizations decreased 25% from 63.0 to 47.0 discharges per 1,000 Medicare enrollees.
• In the past three years, high health status increased 10% from 38.2% to 42.1% of adults aged 65+.
Ranking: South Dakota is 15th this year; it was 25th in 2016. The state ranks 24th for general population health and 18th for the health of women and children.
State Health Department Website: doh.sd.gov
65.44.5
26.548.429.49.8
0.073
44.88.3
36.30.079$79411.914.2
0.0600.139
74.562.516.984
46.0-0.100
93.174.070.672.849.039.719.213.347.0
-0.001
0.111
67.428.542.15.77.34.7
1,64516.1
0.157
0.269
278141516359
31253141313201314
331743344543
39421
214945177
2426
16
6242527132162910
15
South Dakota
7.413.123.230.228.915.89.7
87
341249192
++++++++++++++++++++++++++
15+++++++++++++++++++++++++++
++++++++++++++++++++++++++++++++++
+++++++++++
++++++++++++++++++++++++++++
++++
+++++++++++++++++++++++++++++++++++
++++
112 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 1Determinants Rank: 42Outcomes Rank: 44
TEN
NES
SEE
Strengths:• Low prevalence of excessive drinking• Low percentage of low-care nursing
home residents• High percentage of healthcare-
associated infection reporting policies
Challenges: • High prevalence of smoking• High prevalence of physical inactivity• Low percentage of able-bodied seniors
Highlights: • In the past two years, food insecurity
decreased 26% from 21.4% to 15.8% of adults aged 60+.
• In the past two years, flu vaccination coverage decreased 19% from 73.4% to 59.6% of adults aged 65+.
• In the past two years, health screenings increased 22% from 59.4% to 72.2% of seniors receiving recommended screenings.
• Since 2013, smoking increased 27% from 10.9% to 13.8% of adults aged 65+.
• Since 2013, hospice care use increased 52% from 30.0% to 45.7% of Medicare decedents aged 65+.
• Since 2013, preventable hospitalizations decreased 28% from 83.4 to 59.9 discharges per 1,000 Medicare enrollees.
Ranking: Tennessee is 44th this year; it was 43rd in 2016. The state ranks 44th for general population health and 42nd for the health of women and children.
State Health Department Website: health.state.tn.us
58.63.827.746.738.113.8
-0.117
40.29.821.6
-0.048$25215.84.0
-0.034-0.082
82.475.05.887
72.60.038
94.382.359.672.261.245.722.514.959.9
-0.055
-0.215
60.330.135.97.3
13.88.4
2,25022.4
-0.263
-0.478
+++++++++++++++
+++++++++++++
+++++++++++++++++++++++
++++++++++++++++++++++
+
++++++++++++
+
4322125445042
373936414333504243
458582212
309
3327454036344442
42
423343463440444644
44
Tennessee
10.718.320.539.222.020.819.3
45454133164434
++++++++++++
44
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 113
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 3Determinants Rank: 37Outcomes Rank: 37
TEX
AS
Strengths:• Low prevalence of smoking• High percentage of healthcare-
associated infection reporting policies• High flu vaccination coverage
Challenges: • Low percentage of quality nursing
home beds• High prevalence of food insecurity • High prevalence of physical inactivity
Highlights: • In the past year, flu vaccination coverage
increased 13% from 58.7% to 66.3% of adults aged 65+.
• In the past two years, low-care nursing home residents decreased 20% from 14.3% to 11.4% of residents.
• In the past two years, health screenings increased 28% from 53.4% to 68.4% of seniors receiving recommended screenings.
• In the past three years, smoking decreased 31% from 9.7% to 6.7% of adults aged 65+.
• In the past three years, ICU use in the last six months of life decreased 15% from 18.7% to 15.9% of Medicare decedents aged 65+.
• Since 2013, preventable hospitalizations decreased 25% from 72.3 to 54.3 discharges per 1,000 Medicare enrollees.
Ranking: Texas is 38th this year; it was 41st in 2016. The state ranks 33rd for general population health and 41st for the health of women and children.
State Health Department Website: www.dshs.state.tx.us
61.26.629.748.034.76.7
-0.021
27.810.321.5
-0.106$21819.010.1
-0.044-0.150
70.866.711.485
64.2-0.016
91.581.166.368.4198.558.518.914.754.3
0.028
-0.159
61.530.338.26.915.96.2
1,90512.3
-0.084
-0.244
38233419394
25
484237464745314547
281526252824
45179375816293517
37
403540414415331037
38
Texas
9.814.825.040.120.719.016.1
352126395
3922
++++++++++++++++++++
38+++++++++++++++++++++
+++++++++++
+++++++++++++++++++
+++++++++++++++++++++++++++++++++++
++
+++++++++++++++++++++
++
114 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 4Determinants Rank: 1Outcomes Rank: 12
UTA
H
Strengths:• Low prevalence of smoking• High percentage of volunteerism• Low percentage of ICU use
Challenges: • Low prescription drug coverage• Low SNAP enrollment• Low percentage of diabetes
management
Highlights: • In the past three years, poverty increased
11% from 6.1% to 6.8% of adults aged 65+.• In the past three years, smoking
increased 11% from 4.7% to 5.2% of adults aged 65+.
• In the past three years, preventable hospitalizations decreased 23% from 37.2 to 28.8 discharges per 1,000 Medicare enrollees.
• In the past three years, hip fractures decreased 24% from 7.1 to 5.4 hospitalizations per 1,000 Medicare enrollees.
• In the past three years, ICU use in the last six months of life decreased 19% from 7.5% to 6.1% of Medicare decedents aged 65+.
• Since 2013, hospital deaths decreased 26% from 19.2% to 14.3% of Medicare decedents aged 65+.
Ranking: Utah is second this year; it was sixth in 2016. The state ranks eighth for general population health and sixth for the health of women and children.
State Health Department Website: www.health.utah.gov
71.04.2
26.244.926.45.2
0.220
55.46.8
45.90.160$89013.620.90.0710.231
77.579.24.582
41.8-0.031
93.474.559.074.378.965.514.312.428.8
0.087
0.507
64.729.646.35.46.17.2
1,55511.2
0.146
0.653
++++++++++++++++++++++++++++++++
++++++++++++++++++++++++++++++++++++++++++++
+++++++++++++++++
++++++++++++++++++++++++++++++++++++
+++++
+++++++++++++++++++++++++++++++++++++
+++++
1041330811
3511
10201095
3853
434827
374136143721223
1
26309177
287712
2
Utah
7.918.429.927.723.714.121.4
1446118
251340
+++++++++++++++++++++++
2
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 115
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 6Determinants Rank: 6Outcomes Rank: 8
VER
MO
NT
Strengths:• Low percentage of ICU use• High SNAP enrollment• Low percentage of seniors living
in poverty
Challenges: • Low percentage of healthcare-associated
infection reporting policies• High prevalence of excessive drinking • Low percentage of hospice care use
Highlights: • In the past two years, poverty decreased
10% from 7.3% to 6.6% of adults aged 65+.• In the past three years, food insecurity
increased 43% from 10.8% to 15.4% of adults aged 60+.
• In the past three years, hip fractures decreased 32% from 6.9 to 4.7 hospitalizations per 1,000 Medicare enrollees.
• Since 2013, smoking increased 45% from 6.2% to 9.0% of adults aged 65+.
• Since 2013, obesity increased 13% from 23.8% to 26.9% of adults aged 65+.
• Since 2013, hospice care increased 57% from 23.5% to 37.0% of Medicare decedents aged 65+.
Ranking: Vermont is eighth this year; it was second in 2016. The state ranks fifth for general population health and second for the health of women and children.
State Health Department Website: www.healthvermont.gov
71.97.5
26.948.329.09.0
0.060
55.16.6
34.20.140$1,473
15.427.6
0.1050.246
67.316.79.085
115.20.017
95.475.660.973.0172.337.023.913.638.8
0.004
0.328
66.431.748.64.74.95.4
1,64016.90.176
0.503
6371616143013
44835
29674
22421525214
163930206
464381125
6
1641322715338
8
Vermont
8.518.536.526.124.39.7
22.0
244715
30241
+++++++++++++++++++++++
8++++++++++++++++++++++++++
+++++++++++++++++++++++++++++++++++++++++++
++++++++++++++++++++
++++++++++++++++++++++++++++++++
+++++
++++++++++++++++++++++++++++++++++++
+++++
116 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 4Determinants Rank: 33Outcomes Rank: 18
VIR
GIN
IA
Strengths:• Low prevalence of frequent mental
distress• Low percentage of seniors living
in poverty• Low prevalence of excessive drinking
Challenges: • Low prescription drug coverage• Low percentage of healthcare-associated
infection reporting policies• Low percentage of quality nursing home
beds
Highlights: • In the past two years, obesity increased
11% from 26.4% to 29.3% of adults aged 65+.
• In the past two years, low-care nursing home residents increased 8% from 8.6% to 9.2% of residents.
• In the past two years, health screenings increased 15% from 63.0% to 72.7% of seniors receiving recommended screenings.
• In the past three years, preventable hospitalizations decreased 26% from 59.0 to 43.6 discharges per 1,000 Medicare enrollees.
• In the past three years, hip fractures decreased 25% from 7.7 to 5.8 hospitalizations per 1,000 Medicare enrollees.
• Since 2013, hospital deaths decreased 29% from 33.3% to 23.6% of Medicare decedents aged 65+.
Ranking: Virginia is 25th this year; it was 29th in 2016. The state ranks 19th for general population health and 12th for the health of women and children.
State Health Department Website: www.vdh.state.va.us
70.55.1
29.342.234.78.6
-0.019
34.67.328.1
0.016$34512.06.7
0.0130.029
63.412.59.281
70.3-0.080
94.182.361.572.7101.948.823.614.743.6
-0.007
-0.076
67.225.644.65.815.35.7
1,75915.1
0.113
0.036
+++++++++++++++++++++
++++++++++++++++++++++++++
+++++++++++++++
+++++++++++++++++++++++++++++
++
+++++++++++++++++++++++++++++++
+++
1311
3042392024
421216273414392227
174516442339
349
2323243341291529
33
11619294112272518
25
Virginia
8.213.229.535.624.415.317.1
2081324311727
+++++++++++++++++++++++++
25
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 117
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 1Determinants Rank: 10Outcomes Rank: 16
WA
SH
ING
TON
Strengths:• Low prevalence of physical inactivity• High percentage of quality nursing
home beds• Low rate of preventable hospitalizations
Challenges: • High prevalence of excessive drinking• Low community support expenditures• Low prescription drug coverage
Highlights: • In the past year, poverty decreased 12%
from 8.4% to 7.4% of adults aged 65+.• In the past two years, health screenings
increased 18% from 62.3% to 73.7% of seniors receiving recommended screenings.
• In the past two years, smoking increased 10% from 7.3% to 8.0% of adults aged 65+.
• In the past three years, hip fractures decreased 30% from 6.7 to 4.7 hospitalizations per 1,000 Medicare enrollees.
• In the past three years, food insecurity decreased 19% from 14.5% to 11.7% of adults aged 60+.
• Since 2013, preventable hospitalizations decreased 30% from 46.4 to 32.6 discharges per 1,000 Medicare enrollees.
Ranking: Washington is ninth this year; it was 10th in 2016. The state ranks seventh for general population health and 16th for the health of women and children.
State Health Department Website: www.doh.wa.gov
70.68.527.250.422.08.0
0.125
56.37.4
29.90.106$25311.76.7
0.0110.117
63.058.38.683
81.50.012
94.476.961.473.783.147.021.113.632.60.021
0.275
64.231.245.24.79.26.6
1,61111.1
0.128
0.403
124518102125
216107
4212392315
151914381516
293424183339328518
10
2939132171713616
9
Washington
9.617.631.828.424.212.619.7
344159
297
35
+++++++++++++++++++++++
9++++++++++++++++++++++++++++
+++++++++++++++++++++++++++++++++
++++++++++++++++++++++
++++++++++++++++++++++++++++++++
+++++
+++++++++++++++++++++++++++++++++++
+++++
118 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 1Determinants Rank: 43Outcomes Rank: 46
WES
T V
IRG
INIA
Strengths:• Low prevalence of excessive drinking• High percentage of healthcare-
associated infection reporting policies• High flu vaccination coverage
Challenges: • Low percentage of able-bodied seniors• Low percentage of quality nursing
home beds• High premature death rate
Highlights: • In the past year, food insecurity increased
26% from 12.1% to 15.2% of adults aged 60+.
• In the past two years, health screenings increased 15% from 59.5% to 68.4% of seniors receiving recommended screenings.
• In the past three years, preventable hospitalizations decreased 30% from 103.1 to 71.9 discharges per 1,000 Medicare enrollees.
• In the past three years, hip fractures decreased 16% from 8.3 to 7.0 hospitalizations per 1,000 Medicare enrollees.
• Since 2013, geriatrician shortfall increased 14% from 67.0% to 76.6% of geriatricians needed.
• Since 2013, poverty decreased 14% from 9.9% to 8.5% of adults aged 65+.
Ranking: West Virginia is 45th this year; it was 46th in 2016. The state ranks 43rd for general population health and 38th for the health of women and children.
State Health Department Website: www.dhhr.wv.gov
48.63.3
30.351.836.710.7
-0.076
25.88.521.0
-0.080$44415.213.3
0.011-0.069
76.675.011.786
73.80.002
93.179.369.168.4122.545.124.015.871.9
-0.081
-0.224
56.526.633.77.0
16.09.0
2,32333.6
-0.298
-0.522
++++++++++++++++++
++++++++++++++++++++
+++++++++++++++++++++
+++++++++++++++++++++
+
+++++++++++++
+
501
397
434034
502839442628212341
34827192117
3924437124245494946
43
509
46434548465046
45
West Virginia
11.615.715.642.821.117.222.5
492950478
2843
+++++++++++++++
45
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 119
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
50
OV
ERA
LL R
AN
K
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
2013 2014 2015 2016 2017EDITION YEAR
Change: 3Determinants Rank: 14Outcomes Rank: 5
WIS
CO
NS
IN
Strengths:• Low percentage of ICU use• High percentage of volunteerism• Low prevalence of food insecurity
Challenges: • High prevalence of excessive drinking• High prevalence of obesity • Low flu vaccination coverage
Highlights: • In the past two years, food insecurity
increased 19% from 9.7% to 11.5% of adults aged 60+.
• In the past two years, health screenings increased 17% from 67.8% to 79.4% of seniors receiving recommended screenings.
• In the past three years, geriatrician shortfall increased 19% from 52.9% to 63.2% of geriatricians needed.
• Since 2013, obesity increased 18% from 26.9% to 31.8% of adults aged 65+.
• Since 2013, hospice care use increased 59% from 34.5% to 54.7% of Medicare decedents aged 65+.
• Since 2013, hospital deaths decreased 30% from 25.0% to 17.5% of Medicare decedents aged 65+.
Ranking: Wisconsin is 10th this year; it was 13th in 2016. The state ranks 20th for general population health and 15th for the health of women and children.
State Health Department Website: www.dhs.wisconsin.gov
71.610.431.844.427.48.2
-0.073
49.67.1
34.50.111$57511.517.1
0.0620.174
63.250.011.383
87.5-0.008
95.083.452.979.4164.554.717.514.245.1
0.069
0.161
68.327.844.85.06.36.1
1,67113.6
0.202
0.363
8494731101632
209751811141111
162324381321
225
484717919177
14
31716881320175
10
Wisconsin
6.814.522.132.823.612.114.1
219371723615
+++++++++++++++++++++++++++
10++++++++++++++++++++
+++++++++++++++++++++++++++++++++++++++
+++++++++++++++++++
+++++++++++++++++++++++++++++++++++++++++
++++
++++++++++++++++++++++++++++++++++++++++
+++++
120 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Rating Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
0
10
20
30
40
502013 2014 2015 2016 2017
OV
ERA
LL R
AN
K
EDITION YEAR
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
OVERALLRANK:
Change: 2Determinants Rank: 44Outcomes Rank: 29
WYO
MIN
G
Strengths:• High percentage of home-delivered meals• High community support expenditures• Low percentage of ICU use
Challenges: • Low prescription drug coverage• Low SNAP enrollment• Low prevalence of pain management
Highlights: • In the past year, poverty increased 29%
from 6.2% to 8.0% of adults aged 65+.• In the past two years, SNAP reach
decreased 26% from 27.7% to 20.5% of adults aged 60+ in poverty.
• In the past three years, hip fractures decreased 23% from 8.2 to 6.3 hospitalizations per 1,000 Medicare enrollees.
• Since 2013, preventable hospitalizations decreased 21% from 58.2 to 46.1 discharges per 1,000 Medicare enrollees.
• Since 2013, smoking decreased 20% from 11.8% to 9.4% of adults aged 65+.
• Since 2013, obesity increased 34% from 20.4% to 27.3% of adults aged 65+.
Ranking: Wyoming is 37th this year; it was 35th in 2016. The state ranks 25th for general population health and 29th for the health of women and children.
State Health Department Website: www.health.wyo.gov
66.27.3
27.341.031.59.4
-0.079
48.28.026.2
0.043$2,061
11.151.00.1750.218
81.60.015.980
20.5-0.238
89.759.753.264.176.732.420.314.046.1
-0.143
-0.241
63.832.145.26.36.37.1
1,78017.2
0.011
-0.231
+++++++++++++++++
++++++++++++++++++++++++++++++++++++++
++++++
+++++++++++++++++++
+
+++++++++++++++++++++++++
++
24341945243336
2424212049136
444842465050
49504750404825131850
44
314413368
26293529
37
Wyoming
7.516.227.722.921.311.1
29.4
93719294
49
+++++++++++++++++++++++++++
37
2013 2014 2015 2016 2017EDITION YEAR
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 121
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
2017 2017 No 1Value Rank State
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
DIS
TRIC
T O
F C
OLU
MB
IA
Strengths:• Low prevalence of physical inactivity• High community support expenditures• High percentage of healthcare-
associated infection reporting policies
Challenges: • High percentage of seniors in poverty• High prevalence of smoking • High prevalence of obesity
Highlights: • In the past two years, hospital
readmissions decreased 9% from 15.8% to 14.4% of hospitalized patients aged 65+.
• In the past two years, poverty increased 9% from 14.0% to 15.2% of adults aged 65+.
• In the past two years, smoking increased 28% from 8.0% to 10.2% of adults aged 65+.
• In the past three years, obesity increased 55% from 19.1% to 29.7% of adults aged 65+.
• Since 2013, volunteerism increased 25% from 22.7% to 28.4% of adults aged 65+.
• Since 2013, preventable hospitalizations decreased 27% from 53.4 to 39.1 discharges per 1,000 Medicare enrollees.
State Health Department Website: doh.dc.gov
65.19.829.748.229.010.2—
55.415.228.4
—$1,623
19.021.4——
23.158.3NA68
83.9—
95.372.654.570.8301.744.927.614.439.1—
—
65.430.144.45.513.67.5
2,02111.0—
—
———————
—————————
——————
——————————
—
—————————
-—
District of Columbia
7.613.840.434.718.215.0NA
———————
122 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® S E N I O R R E P O R T 2 0 17
78.13.317.954.921.65.2
0.220
56.44.5
45.90.160
$3,5997.3
51.00.1840.283
22.783.33.889
119.30.182
98.185.770.680.9301.765.814.312.123.5
0.094
0.507
69.020.652.33.04.24.6
1,4266.4
0.309
0.659
2017 2017 No 1Value Rank State
Supplemental MeasuresCognition (% of adults aged 65+ with difficulty)
Depression (% of adults aged 65+)Education (% of adults aged 65+ with college degree)
Multiple Chronic Conditions (% of Medicare enrollees aged 65+)Overuse—Mammography (% female Medicare enrollees aged 75+)
Overuse—PSA Test (% male Medicare enrollees aged 75+)Suicide (deaths per 100,000 adults aged 65+)
6.17.6
40.422.618.29.68.1
BehaviorsDental Visit (% of adults aged 65+)
Excessive Drinking (% of adults aged 65+) Obesity (% of adults aged 65+)
Pain Management (% of adults aged 65+ with arthritis) Physical Inactivity (% of adults aged 65+ in fair or better health)
Smoking (% of adults aged 65+)Behaviors Total
Community & EnvironmentNursing Home Quality (% of four- & five-star beds)
Poverty (% of adults aged 65+)Volunteerism (% of adults aged 65+)
Community & Environment—Macro TotalCommunity Support (dollars per adult aged 60+ in poverty)
Food Insecurity (% of adults aged 60+)Home-delivered Meals (% of adults aged 60+ with independent living difficulty)
Community & Environment—Micro TotalCommunity & Environment Total
PolicyGeriatrician Shortfall (% of needed geriatricians)
Healthcare-associated Infection Policies (% of policies in place)Low-care Nursing Home Residents (% of residents)Prescription Drug Coverage (% of adults aged 65+)
SNAP Reach (% of adults aged 60+ in poverty)Policy Total
Clinical CareDedicated Health Care Provider (% of adults aged 65+)
Diabetes Management (% of Medicare enrollees aged 65 to 75) Flu Vaccine (% of adults aged 65+) Health Screenings (% of adults with recommended screenings)
Home Health Care (number of workers per 1,000 adults aged 75+)Hospice Care (% of Medicare decedents aged 65+)
Hospital Deaths (% of Medicare decedents aged 65+)Hospital Readmissions (% of hospitalized Medicare enrollees aged 65+)
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees)Clinical Care Total
All Determinants
OutcomesAble-bodied (% of adults aged 65+)
Falls (% of adults aged 65+)High Health Status (% of adults aged 65+)
Hip Fractures (hospitalizations per 1,000 Medicare enrollees)ICU Use (% of Medicare decedents aged 65+)
Frequent Mental Distress (% of adults aged 65+)Premature Death (deaths per 100,000 adults aged 65 to 74)
Teeth Extractions (% of adults aged 65+) All Outcomes
OVERALL
RATINGSymbol Rank
+++++++++
+++++
+
1–1011–2021–3031–4041–50
UN
ITED
STA
TES
Highlights: • Since 2015, health screenings increased
19% from 60.7% to 72.4% of seniors receiving recommended screenings.
• Since 2015, SNAP reach decreased 7% from 75.2% to 70.1% of adults aged 60+ in poverty.
• Since 2013, ICU use in the last six months of life decreased 9% from 15.2% to 13.8% of Medicare decedents aged 65+.
• Since 2013, hospital readmissions decreased 7% from 15.9% to 14.8% of hospitalized Medicare enrollees aged 65+.
• Since 2013, hip fractures decreased 21% from 7.3 to 5.8 hospitalizations per 1,000 Medicare enrollees.
• In the past three years, premature death decreased 6% from 1,909 to 1,797 deaths per 100,000 adults aged 65 to 74.
• Since 2013, obesity increased 9% from 25.3% to 27.6% of adults aged 65+.
• Since 2013, food insecurity increased 16% from 13.6% to 15.8% of adults aged 60+.
• Since 2013, preventable hospitalizations decreased 25% from 66.6 to 49.9 discharges per 1,000 Medicare enrollees; in the past year the rate decreased 7%.
• Since 2013, hospital deaths decreased 30% from 30.1% to 21.0% of Medicare decedents aged 65+.
State Health Department Website: www.hhs.gov
65.76.727.646.531.38.7—
42.49.0
26.0—
$53615.810.2——
65.748.211.787
70.1—
94.880.360.772.4110.652.021.014.849.9
—
—
64.628.741.25.813.87.4
1,79714.9—
—
———————
—————————
——————
——————————
—
—————————
—
United States
9.015.025.837.823.118.216.5
———————
124 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 125
Appendix
126 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Community Support
Food Insecurity
Home-delivered Meals
Nursing Home Quality
Poverty
Volunteerism
Dental Visit*
Excessive Drinking
Obesity
Pain Management
Physical Inactivity
Smoking
Expenditures captured by the Administration on Aging per adult aged 60 years and older living in poverty
Percentage of adults aged 60 years and older who faced the threat of hunger in the past 12 months
Number of meals served as a percentage of seniors aged 60 years and older with independent-living difficulty
Percentage of certified nursing home beds rated four- or five-stars over a three-month period
Percentage of adults aged 65 years and older who live in households at or below 100 percent of the poverty threshold
Percentage of adults aged 65 years and older who reported volunteering in the past 12 months
Percentage of adults aged 65 years and older who reported visiting a dental health professional within the past 12 months
Percentage of adults aged 65 years and older who reported either binge drinking (having four or more [women] or five or more [men] drinks on one occasion in the past month) or chronic drinking (having eight or more [women] or 15 or more [men] drinks per week)
Percentage of adults aged 65 years and older with a body mass index of 30.0 or higher based on reported height and weight
Percentage of adults aged 65 years and older with arthritis who reported that arthritis or joint pain does not limit their usual activities
Percentage of adults aged 65 years and older with fair or better health status who reported doing no physical activity or exercise other than their regular job in the past 30 days
Percentage of adults aged 65 years and older who are smokers (reported smoking at least 100 cigarettes in their lifetime and currently smoke every or some days)
U.S. Department of Health and Human Services (HHS), Administration on Aging, State Program Reports; U.S. Census Bureau, American Community Survey, 2014
National Foundation to End Senior Hunger, The State of Senior Hunger in America, 2014
U.S. HHS, Administration on Aging, State Program Reports; U.S. Census Bureau, American Community Survey, 2014
U.S. HHS, Centers for Medicare & Medicaid Services, Nursing Home Compare, Dec 2016–Feb 2017
U.S. Census Bureau, American Community Survey, 2015
Corporation for National & Community Service, 2013-2015
Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System, 2014
CDC, Behavioral Risk Factor Surveillance System, 2015
CDC, Behavioral Risk Factor Surveillance System, 2015
CDC, Behavioral Risk Factor Surveillance System, 2015
CDC, Behavioral Risk Factor Surveillance System, 2015
CDC, Behavioral Risk Factor Surveillance System, 2015
Table 5Core Measures
Measure Description Source, Data Year(s)
Appendix
Behaviors
Community & Environment
* The data appearing in this edition are the same that appeared in the 2016 edition. A data update was not available at the time of this publication.
** The prescription drug coverage data used in the 2016 edition was from 2012; the data in this edition is from 2014.
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 127
Geriatrician Shortfall
Healthcare-associated Infection (HAI) Policies
Low-care Nursing Home Residents
Prescription Drug Coverage**
SNAP Reach
Dedicated Health Care Provider
Diabetes Management
Flu Vaccine
Health Screenings*
Home Health Care*
Hospice Care
Hospital Deaths
Hospital Readmissions
Preventable Hospitalizations
Percentage of geriatricians required to meet estimated need
Percentage of 24 reporting and validation policies implemented in the state to monitor healthcare-associated infections in hospitals
Percentage of nursing home residents who do not require physical assistance for late-loss activities of daily living
Percentage of Medicare enrollees aged 65 years and older who have a creditable prescription drug plan
Number of adults aged 60 years and older who participate in Supplemental Nutrition Assistance Program (SNAP) as a percentage of adults aged 60 years and older living in poverty
Percentage of adults aged 65 years and older who reported having a personal doctor or health care provider
Percentage of Medicare enrollees aged 65 to 75 years with diabetes receiving a blood lipids test
Percentage of adults aged 65 years and older who reported receiving a flu vaccine in the past year
Percentage of women aged 65 to 74 years who reported receiving a mammogram in the past two years and the percentage of adults aged 65 to 75 years who reported receiving colorectal cancer screening within the recommended time period
Number of personal care and home health aides per 1,000 adults aged 75 years and older
Percentage of chronically ill Medicare decedents aged 65 years and older who were enrolled in hospice during the last six months of life
Percentage of deaths occurring in a hospital among chronically ill Medicare decedents aged 65 years and older
Percentage of hospitalized Medicare enrollees aged 65 years and older who were readmitted within 30 days of discharge
Number of discharges for ambulatory care-sensitive conditions per 1,000 Medicare enrollees aged 65 years and older
American Geriatrics Society, 2016
CDC, National and State Healthcare Associated Infections Progress Report, 2014
Brown University, Shaping Long Term Care in America Project, 2015
The Henry J. Kaiser Family Foundation, State Health Facts, 2014
U.S. Department of Agriculture, Food and Nutrition Service; U.S. Census Bureau, American Community Survey, 2015
CDC, Behavioral Risk Factor Surveillance System, 2015
The Dartmouth Atlas of Health Care, 2014
CDC, Behavioral Risk Factor Surveillance System, 2015
CDC, Behavioral Risk Factor Surveillance System, 2014
U.S. Department of Labor, Bureau of Labor Statistics, 2015
The Dartmouth Atlas of Health Care, 2014
The Dartmouth Atlas of Health Care, 2014
The Dartmouth Atlas of Health Care, 2014
The Dartmouth Atlas of Health Care, 2014
Measure Description Source, Data Year(s)
Clinical Care
Policy
* The data appearing in this edition are the same that appeared in the 2016 edition. A data update was not available at the time of this publication.
** The prescription drug coverage data used in the 2016 edition was from 2012; the data in this edition is from 2014.
128 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Able-bodied
Falls*
Frequent Mental Distress
High Health Status
Hip Fracture
ICU Use
Premature Death
Teeth Extractions*
Percentage of adults aged 65 years and older with no cogni-tive, visual, auditory, ambulatory, self-care and/or indepen-dent living difficulty disability
Percentage of adults aged 65 years and older who reported they had fallen in the past 12 months
Percentage of adults aged 65 years and older who reported their mental health was not good 14 or more days in the past 30 days
Percentage of adults aged 65 years and older who reported that their health is very good or excellent
Number of hospitalizations for hip fracture per 1,000 Medi-care enrollees aged 65 years and older
Percentage of Medicare decedents aged 65 years and older spending seven or more days in the intensive care unit (ICU)/critical care unit during the last six months of life
Deaths per 100,000 adults aged 65 to 74 years
Percentage of adults aged 65 years and older who reported having had all teeth removed due to tooth decay or gum disease
Table 5Core Measures
Measure Description Source, Data Year(s)
Appendix
Outcomes U.S. Census Bureau, American Community Survey, 2015
CDC, Behavioral Risk Factor Surveillance System, 2014
CDC, Behavioral Risk Factor Surveillance System, 2015
CDC, Behavioral Risk Factor Surveillance System, 2015
The Dartmouth Atlas of Health Care, 2014
The Dartmouth Atlas of Health Care, 2014
CDC, National Vital Statistics System, 2015
CDC, Behavioral Risk Factor Surveillance System, 2014
* The data appearing in this edition are the same that appeared in the 2016 edition. A data update was not available at the time of this publication.
** The prescription drug coverage data used in the 2016 edition was from 2012; the data in this edition is from 2014.
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 129
Education
Overuse —Mammography
Overuse — PSA Test
Cognition
Depression
Multiple Chronic Conditions
Suicide
Percentage of adults aged 65 years and older who reported having a college degree
Percentage of female Medicare enrollees aged 75 years and older who had a screening mammogram
Percentage of male Medicare enrollees aged 75 years and older who had a screening prostate-specific antigen (PSA) test
Percentage of adults aged 65 years and older who reported having cognitive difficulty
Percentage of adults aged 65 years and older who reported being told by a health professional that they have a depres-sive disorder
Percentage of Medicare enrollees aged 65 years and older with four or more chronic conditions
Number of deaths due to intentional self-harm per 100,000 adults aged 65 years and older
Table 6Supplemental Measures
Measure Description Source, Data Year(s)
Outcomes
U.S. Census Bureau, American Community Survey, 2015
The Dartmouth Atlas of Health Care, 2014
The Dartmouth Atlas of Health Care, 2014
U.S. Census Bureau, American Community Survey, 2015
Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System, 2015
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, 2015
CDC, National Vital Statistics System, 2013-2015
Behaviors
Clinical Care
130 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
MethodologyRankings Calculation
For each measure, the most recent state-level data as of March 6, 2017, were obtained from secondary sources (Tables 5 and 6) and presented as the “value.” The score for each state is based on the following formula:
This score indicates the number of standard deviations a state is above or below the national value. A 0.00 indicates a state has the same value as the nation. States with higher values than the national value have a positive score, while states that perform below the national
value have a negative score. To prevent an extreme score from exerting excessive influence, the maximum score for a measure is capped at +/- 2.00. If a U.S. value is not available from the original data source for a measure, the mean of all state values is used. If a value is not available for a state, the state’s score is set to zero.
The overall score is calculated by adding the products of the score of each core measure multiplied by its assigned weight (the percentage of the total overall ranking). Each of the five model categories is assigned a different weight (Table 7) and the weight for each measure within a model category is distributed equally among all the measures in the category. The overall ranking is the ordering of each state according to the overall score. The ranking of individual measures is the ordering of each state according to the measure’s value. Ties in values are assigned equal ranks. Not all changes in rank are statistically significant.
Behavioral Risk Factor Surveillance System Measures
Behavioral Risk Factor Surveillance System (BRFSS) data are analyzed using STATA v14.2 to account for the complex survey design. Data are limited to adults aged 65 and older. Responses of “refused”, “don’t know” or “not sure” are excluded from the analysis, but are reflected in standard error and confidence interval estimates. Prevalence estimates are also calculated by sex, race, education and income subpopulations. Estimates are suppressed if
1. Gather data 2. Normalize state values for each measure using U.S. value (calculate z score)
3. Eliminate outliers 4. Multiply by weights 5. Sum weighted scores
6. Rank states by sum of all measure scores
Σ–2σ –1σ μ 1σ 2σ
BehaviorsCommunity & Environment
Public & Health PoliciesClinical Care
Health Outcomes
Score =State value – National value
Standard deviation of all state values
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 131
the denominator is less than 50 or the relative standard error is greater than 30 percent. For calculating subpopulation estimates, the population of interest is specified in a manner that avoids deletion of cases and ensures an accurate estimation of variance.
BRFSS data are based on self-report and exclude those without a telephone and those who are institutionalized. Dental visit, falls, health screenings, pain management and teeth extractions are collected biennially.
Calculated Variables
Community support, home-delivered meals, home health care and Supplemental Nutrition Assistance Program (SNAP) reach are calculated measures based on data from two different sources (Table 5). The numerator data for community support and home-delivered meals are from the U.S. Department of Health and Human Services, Administration on Aging, State Program Reports. For home health care, the numerator data are from the U.S. Bureau of Labor Statistics. For SNAP reach, the numerator data are from the U.S. Department of Agriculture, Food and Nutrition Service. The denominator data for all four variables are from the U.S. Census Bureau’s American Community Survey for the matching data year and population characteristics (e.g., 60 years and older living in poverty). Because the numerator and denominator come from different sources, it is possible for states to have values greater than 100 percent. This occurs in SNAP reach when the estimate of eligible people (denominator) is lower than the estimate of participants (numerator). This should not be interpreted to mean that all eligible persons are participating in SNAP.
Healthcare-associated infection (HAI) policies is the percent of 24 HAI reporting and data validation policies a state has in place according to the Centers for Disease Control and Prevention’s National and State HAI Progress Report. The policies assessed in the report fall under the following four categories: State has a reporting mandate, state health department has
access to the data, state checks the data for quality and completeness, and state reviews medical records to determine accuracy. To create the measure, we counted the number of policies that are in place for each of the six types of HAI: Central-line associated bloodstream infections, catheter-associated urinary tract infections, surgical site infections (abdominal hysterectomy and colon surgery), and laboratory identified hospital-onset methicillin-resistant Staphylococcus aureus bloodstream infections and Clostridium difficile infections. The best possible score is 100 percent, meaning the state has all 24 policies in place (i.e. all four policies in place for each of the six HAI types).
Data Considerations
Data presented in this report are aggregated at the state level and cannot be used to make inferences at the individual level. Values and rankings from prior years are updated on www.AmericasHealthRankings.org to reflect known errors or updates from the reporting source. Therefore information appearing in this edition compared with prior printed editions may be different. For the most current data see the website.
The prescription drug coverage data used in the 2016 edition were from 2012; the data in this edition are from 2014. A data update for home health care was not available from the Bureau of Labor Statistics prior to our 2017 data deadline.
Determinants 75 Behaviors 25 Community & Environment 20 Policy 15 Clinical Care 15
Outcomes 25
Table 7Model Category Weights
Model Category Weight (%)
132 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
The measures and model for America’s Health Rankings Senior Report were developed by an advisory group (See 2017 Senior Report Advisory Group) of experts in the fields of aging and senior health for the inaugural edition in 2013. The panel was charged with identifying the areas of health and well-being most pertinent to the older adult population and developing a model for assessing population health at the state level.
Each year, the advisory group reviews the model and measures to improve existing measures, integrate new data sources and make adjustments for changing availability of information. In addition to the changes implemented in 2017, we continue to explore new data sources that could enhance our model of senior health. In particular, we are interested in state-level data for topics such as social support, polypharmacy and medication adherence, elder abuse, transportation support and malnutrition diagnosis.
2017 Edition Model and Measure Revisions
The following changes were made at the recommendation of the advisory group:
Dropped Measures Underweight: While malnutrition and undernourishment are serious issues among seniors, underweight is not a major health concern. Being underweight is not an automatic indication of poor health; some
Model Developmentadults are underweight and healthy. A better way to address malnutrition would be with a malnutrition diagnosis measure or a measure that focuses on adequate and balanced nutrition. Other measures in this report that focus on nutrition and food access are food insecurity, home-delivered meals and Supplemental Nutrition Assistance Program reach. Although underweight was dropped from the model, it is available as a supplemental measure on our website. With the removal of underweight from the model, the behaviors category weight was redistributed equally among the remaining behaviors measures.
Recommended Hospital Care: The percentage of hospitalized adults aged 65 years and older receiving recommended hospital care ranged from 95.5% in Mississippi to 98.7% in Maine in the 2016 edition. This small geographic variation fails to distinguish any meaningful differences among states. With the removal of recommended hospital care from the model, the clinical care category weight was redistributed equally among the remaining clinical care measures. New MeasureHealthcare-associated Infection (HAI) Policies: This measure was added to replace recommended hospital care. HAI policies is the percentage of 24 reporting and validation policies implemented in each state to monitor healthcare-associated infections in hospitals (see calculation details in Methodology). With the addition of this measure to the model, the policy category weight was redistributed equally among the five policy measures.
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Revised MeasuresNursing Home Quality: The definition of nursing home quality reported in the 2016 edition used a one-month snapshot of time to capture quality. Substantial changes can occur on a month-to-month basis and a one-month snapshot may misrepresent states, especially those with few nursing homes that dominate the market. For example, if a nursing home with many beds moved in or out of the four- or five-star group for the month in which the state data was extracted, it could dramatically change the state’s value. To reduce the volatility of this measure, the 2017 edition definition uses a three-month average. The new definition approximates the old definition, but is not directly comparable.
Home-delivered meals: The denominator used in the 2016 edition definition of home-delivered meals was the total number of seniors aged 65 years and older living in poverty. It was revised in the 2017 edition to adults aged 60 years and older with independent living difficulty. This denominator better reflects the program objective of keeping seniors with independent-living difficulties in their homes regardless of income. The numerator will remain the same, the number of seniors aged 60 years and older served an Older Americans Act-funded meal. The 2017 edition home-delivered meals data are not comparable to previous years.
Health Screenings: The method of calculating health screenings was refined to better account for the slight difference in age recommendations between colorectal cancer screening and mammography screening. To allow for comparability, health screenings data for all prior editions were adjusted using the new method. Health screenings is a composite measure that captures the percentage of women who reported receiving a mammogram within the past two years (aged 65 to 74 years) and the recommended colorectal cancer screening within the recommended time frame (aged 65 to 75 years), and the percentage of men aged 65 to 75 years who reported receiving the recommended colorectal cancer screening within the recommended time frame.
134 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
Soo Borson, M.D.Professor Emerita, University of Washington
School of MedicineResearch Professor, University of Minnesota
School of MedicineDementia Care Research and Consulting Randy Brown, Ph.D.Director of Health ResearchMathematica Policy Research Julie Bynum, M.D., M.P.H.Associate Professor of MedicineThe Dartmouth Institute for Health Policy &
Clinical PracticeGeisel School of Medicine at Dartmouth Tom Eckstein, M.B.A.Principal and author, America’s Health RankingsArundel Metrics, Inc. Sarah Milder, M.P.H.Principal and author, America’s Health RankingsArundel Metrics, Inc.
Rhonda Randall, D.O.Chief Medical Officer, UnitedHealthcare Retiree
SolutionsSenior Medical Advisor, United Health Foundation
2017 Senior Report Advisory Group
Barbara Resnick, Ph.D., R.N., C.R.N.P., F.A.A.N., F.A.A.N.P.
Professor of NursingChairman of the Board, American Geriatrics
SocietySonya Ziporkin Gershowitz Chair in GerontologyUniversity of Maryland Anna Schenck, Ph.D., M.S.P.H.Professor of the Practice, Associate Dean for
PracticeDirector, Public Health Leadership Program and
the North Carolina Institute for Public HealthUNC Gillings School of Global Public HealthUniversity of North Carolina at Chapel Hill Lynn Shaull, M.A.Director, Health ImprovementAssociation of State and Territorial Health Officials Judy R. Simon, M.S., R.D., L.D.N.Nutrition and Health Promotion Programs
ManagerMaryland Department of AgingChair, Healthy Aging Dietetic Practice GroupAcademy of Nutrition and Dietetics
The Senior Report Advisory Group provided guidance in the selection of measures and the design of the 2017 America’s Health Rankings Senior Report.
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 135
Aldrich DesignEmily AldrichJenna BrouseAndrea Egbert Arundel Metrics, Inc.Melanie BuhlTom EcksteinMary Ann HonorsLaura HoughtalingAlexia MagalaSarah MilderKristin Shaw
The Glover Park GroupKate AckermanAlvaro GiorgettaJoe GonzalesTaylor HidenLee JenkinsAmanda KeatingRachel MillardAndy OareLaura PetersonDan StoneAmelia Williams
The TeamAmerica’s Health Rankings Senior Report is a team effort in which all contribute a vital part to the creation and dissemination of this report. Members of the team, listed alphabetically by organization, follow:
Reservoir Communications GroupChristine HarrisonDavid LumbertRobert Schooling RoninWare Inc.T.J. Kellie
United Health FoundationKristy DuffeyAlyssa EricksonL.D. PlattDr. Rhonda RandallDanielle VaralloAnne Yau
136 AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org
America’s Health Rankings® Senior Report is available in its entirety at www.AmericasHealthRankings.org. Visit the site to request or download additional copies. America’s Health Rankings Senior Report — 2017 Edition is funded entirely by United Health Foundation, a recognized 501(c)(3) organization.
Data contained within this document was obtained from and used with permission of:
U.S. Department of Agriculture, Food and Nutrition Service U.S. Department of Health and Human Services Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System National and State Healthcare Associated Infections Progress Report National Vital Statistics System Administration on Aging, State Program Reports Centers for Medicare & Medicaid Services Nursing Home Compare U.S. Department of Commerce U.S. Census Bureau, American Community Survey U.S. Department of Labor, Bureau of Labor Statistics American Geriatrics Society Brown University, Shaping Long Term Care in America Project Corporation for National & Community ServiceThe Dartmouth Atlas of Health Care The Henry J. Kaiser Family Foundation, State Health Facts National Foundation to End Senior Hunger, The State of Senior Hunger in America United Health Foundation encourages the distribution of information contained in this publication for non-commercial and charitable, educational or scientific purposes. Please acknowledge America’s Health Rankings Senior Report as the source and provide the following notice: ©2017 United Health Foundation. All Rights Reserved. Please acknowledge the original source of specific data as cited.
Arundel Metrics, Inc., of Saint Paul, Minnesota, conducted this project for and in cooperation with United Health Foundation.Design by Aldrich Design, Saint Paul, Minnesota.Questions and comments on the report should be directed to United Health Foundation at [email protected] ©2017 United Health Foundation
AMERICA’S HEALTH RANKINGS® SENIOR REPORT www.AmericasHealthRankings.org 137
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America’s Health Rankings® is available in its entirety at www.AmericasHealthRankings.org. Visit the website to request or download additional copies.
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