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United StatesAppendixCore MeasuresSupplemental MeasuresMethodologyModel DevelopmentAdvisory GroupThe TeamCopyright
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDistrict of ColumbiaUnited StatesAppendixCore MeasuresSupplemental MeasuresMethodologyModel DevelopmentAdvisory GroupThe TeamCopyrightThe measures and model for America’s Health Rankings®Senior Report were developed by an 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 adults 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 Measure
Healthcare-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.
Revised Measures
Nursing 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.