Findings National Findings | 2017 Senior Report

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. 

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.
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. 

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.
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