Does where you live affect your health?  Environmental factors such as water and air quality may immediately come to mind, however additional community influences also impact the overall health of local residents. 

The United Health Foundation is a private, not-for-profit organization which works to enhance personal and community health and health care.  Using data from a variety of government and a few private sources, the foundation compiles an annual report called America’s Health Rankings, which describes current trends in our national and state populations. A separate report is generated related to the older adult population, and states are evaluated according the following measures:

Behaviors: Included in this category are the percentages of individuals age 65 and over who demonstrate excessive drinking, obesity, physical inactivity, and smoking. The percentage of people who visit a dentist, and those who are able to manage their arthritis (out of all who have a diagnosis of arthritis) are also included.

Community & Environment:  Nursing home quality (percent of 4-5 star beds), volunteerism, poverty, community support (dollars per adult age 60+ living in poverty), food insecurity, and percent of people age 60+  who receive home delivered meals (for those with independent living difficulty) are the topics which are part of this measure.

Policy: This measure considers geriatrician shortfall (physicians who specialize in caring for older adults), health care associated infection policies, percent of low care nursing home residents, prescription drug coverage (percent of Medicare enrollees age 65+), and SNAP reach (supplemental nutrition assistance program – participants per 100 adults age 60+living in poverty).

Clinical Care:  Data involving the percent of adults age 65+ who have a dedicated health care provider, diabetes management (percent of Medicare enrollees age 65-75), flu vaccine rates, health screenings (percent receiving recommended screenings), home care workers (number of workers per 1,000 adults age 75+), hospice care, hospital deaths, hospital readmissions, and preventable hospitalizations (discharges per 1,000 Medicare enrollees) comprise this aspect of the rankings.

Health outcomes:  These statistics are influenced by personal choices and the presence or absence of programs and policies to address the measures which are listed above. Outcomes which are evaluated for the report are able bodied adults, early death (deaths per 100,000 adults age 65-74), falls, frequent mental distress, high health status, hip fractures, ICU use, and tooth extractions.

America’s Health Rankings began publishing their report about the older adult population in 2013.  Since that time, Pennsylvania’s overall rank has fluctuated between the high teens and low 20s, and PA was tied for 19th place in the most recent report.  Our state received higher ranks for Policy (2nd place) and Clinical Care (11th place), and lower ranks for Behaviors (22nd place), Community & Environment (28th place), and Health Outcomes (34th place).

PA’s strengths were noted to be a significant number of older adults who have a dedicated health care provider, quality arthritis management, and high community support expenditures.  Additional positive state highlights include a decrease in excessive drinking and number of early deaths (for ages 65-74), as well as an increase in flu vaccination rates.

However, PA is experiencing challenges with our high rates of obesity and intensive care unit utilization, and fewer people who consider their overall health status to be high.  In addition, poverty, food insecurity, and episodes of mental distress have increased among our older adult population.

How is the United States of America doing as a nation?

On the plus side, over the past several years the Supplemental Nutrition Assistance Program is reaching more impoverished older adults and overall food insecurity has decreased, hospital deaths have decreased and the use of hospice services is increasing, older adults reporting high health status has increased, and we have higher numbers of home care workers (although a shortage continues) https://keystoneelderlaw.com/health-care-system/shortage-long-term-care-workers/.

On the negative side of statistics, the U.S. has seen an increase in excessive drinking, obesity, and depression among older adults.

Based on this report, if you are utilizing health data as part of deciding where to move within the U.S., the healthiest states are Hawaii, Utah, Connecticut, Minnesota, and Colorado.  At the opposite end of the spectrum are West Virginia, Oklahoma, Louisiana, Kentucky, and Mississippi.

The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”  The measures utilized by America’s Health Rankings were chosen to reflect this definition.  For the complete report, visit https://assets.americashealthrankings.org/app/uploads/ahr-senior-report_2019_final.pdf.

Karen Kaslow, RN, BSN

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