2017 Rankings Show Progress, Challenges
With the holidays just around the corner, many families will enjoy multigenerational gatherings. Not nearly as many will take the opportunity to discuss expectations and plans for the most senior members of the family ... but perhaps they should.
Earlier this year, UnitedHealth Foundation released "America's Health Rankings Senior Report 2017: A Call to Action for Individuals and Their Communities." The report provided a mixed bag of good news and concerns facing the nation's fastest-growing population segment.
Rhonda Randall, DO
"We continue to see improvements in clinical care," said Rhonda Randall, DO, chief medical officer for UnitedHealthcare Retiree Solutions. Now in its fifth year, Randall said the annual ranking allows providers, researchers, insurers and population health managers to begin to see trends over time for seniors.
Since the first senior report was released in 2013, Randall said there have been decreases in hospital readmissions, deaths in the hospital, preventable hospitalizations, and less time in the intensive care unit during the last six months of life. Additionally, there has been an increase in the use of hospice care.
Nationally, there was a 7 percent decrease in preventable hospitalizations (from 53.8 to 49.9 discharges per 1,000 Medicare enrollees) just in the past year. Since the first edition of the senior rankings in 2013, there has been a 7 percent decrease in hospital readmissions, a 30 percent decrease in hospital deaths, a 21 percent decline in hip fracture hospitalizations, and a 9 percent drop in ICU use at the end of life in the Medicare population.
However, Randall continued, "We continue to see challenges in our lifestyle - in the choices we make around our health."
Despite receiving good clinical care once the system is accessed, a growing issue is the volume of individuals who require that access. "Not only are we seeing a higher percentage of people turning 65 with a chronic condition, but we're also seeing more people over age 65," Randall said of the country's demographic shift. In 2011, baby boomers began turning 65, and an average of 10,000 boomers celebrate the milestone birthday every day. By the time the last of the boomers hit retirement age in 2029, Pew Research Center projects 18 percent of the American population will be 65 or older.
While the sheer volume of seniors could strain the delivery system, Randall said social determinants of health add to that burden. In creating the annual "America's Health Rankings®" and subsequent senior report, UnitedHealth Foundation uses the World Health Organization definition of health: "Health is a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity." Therefore, the UnitedHealth reports consider 34 measures including the impact of behaviors, policy, and community and environment, in addition to clinical care, to assess health outcomes.
"Obesity increased by 9 percent from the 2013 edition," Randall said of the 27.6 percent of adults 65 and older who now fit the criteria. "Food insecurity increased by 16 percent over the last five years." Additionally, she noted, data from the U.S. Department of Agriculture shows there has been a decrease in SNAP reach, which has gone down by 7 percent over the last two years for adults 60 and older living in poverty.
Similar to other health rankings, the Southeast was once again well represented at the bottom with Georgia (41), Alabama (43), Tennessee (44), Arkansas (46), Louisiana (47), Kentucky (49) and Mississippi (50) making up seven of the last 10. Higher rates of physical inactivity and smoking were a common thread among states at the bottom. On the other end of the scale, the five healthiest states for seniors were Minnesota, Utah, Hawaii, Colorado and New Hampshire.
Randall was quick to say, "Every state, no matter where it's ranked, has areas it should be proud of and areas where there is room for improvement." She noted, "There's no silver bullet to being ranked high on this list, but I can tell you the states that tend to rank highest on the list have a tendency to also rank very high in individual behaviors."
In addition to behavioral factors, environment and policy supports also have a major impact in how well seniors fare. Within the category of community and environment, the report looked at six key measures, including giving back.
"We look at volunteerism," Randall said. "It's a proxy for purpose. We know that has a lot of positive effects on aging," she continued of staying plugged into the community. Research has shown seniors with a reason to get up and do good typically have fewer depressive symptoms, better cognitive performance, higher activity levels and better mental wellbeing. Higher rates of volunteerism have also been associated with lower rates of mortality and heart disease.
"Another call to action, I think, is around home-delivered meals," Randall said of a measure where the large majority of states have room to improve. "That can be a significant benefit to the senior community," she continued, adding a stable source of nutrition is a key factor in being able to age in place. The 2017 report stated that increasing the number of seniors receiving home-delivered meals by 1 percent in each state has a projected cost savings of $109 million to Medicaid programs.
Randall said the annual report is intended to be put to use by providers, policymakers and community representatives at a local, state and national level. "It's definitely meant to be a call to action," she said. Randall encouraged stakeholders to go online to americashealthrankings.org and click on the 2017 senior report to take a deeper dive on specific measures to foster dialogue about what is working and where there is need to improve on behalf seniors.
Alabama by the Numbers
Overall Rank: 43 (up one slot from 2016)
Determinants Rank: 36
Outcomes Rank: 47
The Good - National Rank
Pain Management (% of adults 65+ with arthritis): 3
Excessive Drinking (% of adults 65+): 8
Community Support (dollars per adult 60+ in poverty): 15
Dedicated Health Provider (% of adults 65+): 7
Hospice Care (% of Medicare decedents 65+): 16
The "Needs Improvement" - National Rank
Physical Inactivity (% of adults 65+ in fair or better health): 45
Geriatrician Shortfall (% of needed geriatricians): 43
Home Health Care (number of workers per 1,000 adults 75+): 48
Preventable Hospitalizations (discharges per 1,000 Medicare enrollees): 45
Able-bodied (% of adults 65+): 47
High Health Status (% of adults 65+): 49
Depression (% of adults 65+): 47
Multiple Chronic Conditions (% of Medicare enrollees 65+): 45
Premature Death (deaths per 100,000 adults 65-74): 45
• In the past year, community support increased 94 percent from $344 to $666 per adult aged 60+ living in poverty.
• In the past two years, low-care nursing home residents (those at the lower end of acuity) decreased 16 percent from 15.5 percent to 12.2 percent of residents.
• Hospital readmissions have decreased 6 percent from 15.3 percent to 14.4 percent of hospitalized Medicare enrollees aged 65+ over the last three years. Since 2013, preventable hospitalizations have decreased 24 percent from 80.1 to 61.1 discharges per 1,000 Medicare enrollees.
• On the flip side, obesity has increased 11 percent since 2013, rising from 27.1 percent to 30.2 percent among adults aged 65+.