Findings Health Outcomes | 2023 Senior Report

Executive Brief Foreword Introduction National HighlightsFindingsHealth Outcomes Social and Economic Factors Clinical Care Behaviors State RankingsAppendixMeasures Table Data Source Descriptions MethodologyState Summaries

US Summary

2023 Senior Report – Executive Brief 2023 Senior Report 2023 Senior Report – State Summaries 2023 Senior Report – County-Level Maps for Risk of Social Isolation 2023 Senior Report – Measures Table 2023 Senior Report – Infographics 2023 Senior Report – Report Data (All States)

HEALTH OUTCOMES | MORTALITY
Persistent disparities were found throughout the report by gender, race/ethnicity, age, geography, education and income.
Early Death
For the second year in a row, the early death rate continued to increase, reversing the trend on a decade-long decline.
In 2021, life expectancy at age 65 was 18.4 additional years, and yet many older adults do not live to see their 75th birthday. Research estimates that 48% of all premature deaths are due to preventable causes.
Changes over time. Nationally, the early death rate — deaths per 100,000 adults ages 65-74 — significantly increased 4% from 2,072 to 2,151 between 2020 and 2021 and 22% (from 1,765) since 2019. These increases reversed the nearly decade-long progress of a 4% decline in early death rates between 2011 and 2019. There were 724,266 deaths among adults ages 65-74 in 2021, nearly 50,000 more deaths than in 2020, and 169,000 more than in 2019.
The early death rate significantly increased in 25 states, led by 22% in Alaska (1,768 to 2,163 deaths per 100,000 adults ages 65-74) and 18% in West Virginia (2,589 to 3,066) between 2020 and 2021. Over the same period, the rate significantly decreased in six states, led by 15% in New Jersey (2,036 to 1,727), 14% in New York (2,026 to 1,737) and 10% in Connecticut (1,742 to 1,570). Some racial/ethnic and gender groups experienced significant increases in the early death rate, including 6% among white older adults (1,999 to 2,124), 5% among females (1,627 to 1,716) and 2% among males (2,582 to 2,640). Over the same period, the rate significantly decreased by 3% among Black (3,184 to 3,100) and Hispanic (1,955 to 1,894) older adults.

Disparities. The early death rate was 2.0 times higher in Mississippi (3,147 deaths per 100,000 adults ages 65-74) than Hawaii (1,552), the states with the highest and lowest rates in 2021. The early death rate significantly varied by race/ethnicity and gender. The rate was:​
2.9 times higher among Black (3,100) compared with multiracial (1,058) and Asian (1,082) older adults.*
1.5 times higher among males (2,640) than females (1,716).
Related Measure: Suicide
While suicide among older adults has remained relatively stagnant in recent years, 27,962 older adults died by suicide in 2019-2021. Nationally, the suicide rate significantly increased 9% among those ages 85 and older (19.4 to 21.1 deaths per 100,000 ages 65 and older) and significantly decreased 4% among those ages 65-74 (15.8 to 15.1) between 2016-2018 and 2019-2021. The suicide rate significantly varied by gender, race/ethnicity and age in 2019-2021. The rate was 6.3 times higher among males (31.5) than females (5.0); 4.6 times higher among white (20.3) compared with Black* (4.4) older adults; and 1.4 times higher among those ages 85 and older compared with those ages 65-74.
* Estimates for Black and multiracial (6.0) older adults were not significantly different from each other based on non-overlapping 95% confidence intervals.

Behavioral Health
Drug Deaths
Drug overdose deaths among older adults have been on the rise the past two decades, largely due to opioids. Older adults are among those most impacted by the opioid crisis, as they are often prescribed opioids to help them cope with chronic pain or recover from surgical procedures. 
Changes over time. Nationally, the drug death rate — deaths due to drug injury (unintentional, suicide, homicide or undetermined) per 100,000 adults ages 65 and older — significantly increased 43% from 6.9 to 9.9 between 2016-2018 and 2019-2021 and 136% from 4.2 in 2008-2010. In 2019-2021, 16,380 older adults died from drug injury, an increase of 5,804 since 2016-2018. The drug death rate significantly increased in 30 states* and the District of Columbia, led by 94% in Hawaii (7.9 to 15.3 deaths per 100,000 adults ages 65 and older), 92% in Illinois (5.2 to 10.0) and 90% in the District of Columbia (39.6 to 75.3) between 2016-2018 and 2019-2021. By gender, the drug death rate significantly increased 61% among males (8.9 to 14.3) and 17% among females (5.4 to 6.3).
Opioids have been a major component of this rise. Opioid deaths surged more dramatically than the overall drug death rate (involving all drug types), more than doubling since 2014-2016 from 2.6 to 5.4 deaths per 100,000​ adults ages 65 and older. In particular, deaths due to synthetic opioids, such as fentanyl and tramadol, increased 175% among older adults between 2016-2018 and 2019-2021.
Disparities. The drug death rate was 4.3 times higher in Maryland (16.6 deaths per 100,000 adults ages 65 and older) than Nebraska (3.9), the states* with the highest and lowest rates in 2019-2021. However, the highest rate was in the District of Columbia (75.3). The drug death rate significantly varied by race/ethnicity and gender. The rate was:
10.8 times higher among Black (24.8) compared with Asian (2.3) older adults.​ The rate was also higher among American Indian/Alaska Native (9.1), white (8.7), multiracial (7.1) and Hispanic (7.0) older adults compared with Asian older adults. 
2.3 times higher among males (14.3) than females (6.3).
* Data not available for North Dakota and South Dakota in 2019-2021; state rankings are based on 48 states.
* Estimates for Black and multiracial (6.0) older adults were not significantly different from each other based on non-overlapping 95% confidence intervals.


Cognitive Difficulty
Cognitive impairment can be caused by Alzheimer’s disease, brain injury, stroke, medication side effects, vitamin B12 deficiency and depression. As the 65-and-older population increases, the number of older adults living with Alzheimer’s disease is projected to reach 12.7 million by 2050.
Changes over time. Nationally, the percentage of adults ages 65 and older who reported having physical, mental or emotional problems or difficulty remembering, concentrating or making decisions significantly decreased 6% from 8.3% to 7.8% between 2019 and 2021. In 2021, nearly 4.3 million older adults reported cognitive difficulty, a decrease of 62,308 from 2019. Between 2019 and 2021, cognitive difficulty significantly decreased in four states: 32% in Delaware (8.7% to 5.9%), 18% in Maryland (7.6% to 6.2%), 17% in Wisconsin (6.4% to 5.3%) and 12% in Pennsylvania (7.8% to 6.9%). Over the same period, cognitive difficulty significantly increased 31% in Idaho (7.1% to 9.3%).
Disparities. Cognitive difficulty was 2.0 times higher in Mississippi (10.7%) than Wisconsin (5.3%), the states with the highest and lowest percentages in 2021.

Physical Health
Multiple Chronic Conditions
Chronic conditions last more than a year and require ongoing medical attention and/or limit daily functions such as eating, bathing and mobility. Adults with multiple chronic conditions represent one of the highest-need segments of the population, as each chronic condition may require additional medication and monitoring.
Changes over time. Nationally, the percentage of Medicare beneficiaries* ages 65-74 with three or more of 21 chronic conditions identified by the Centers for Medicare & Medicaid Services (CMS) increased 13% from 46% to 52% between 2020 and 2021. Multiple chronic conditions increased by 13% or more in 34 states and the District of Columbia, led by 29% in Alaska (28% to 36%) and 27% in both Vermont (30% to 38%) and Montana (30% to 38%).​ All racial/ethnic and gender groups experienced increases in multiple chronic conditions. By group, increases were:
18% among Asian/Pacific Islander (40% to 47%), 16% among white (45% to 52%), 12% among American Indian/Alaska Native (50% to 56%), 9% among Black (53% to 58%) and 9% among Hispanic (44% to 48%) Medicare beneficiaries ages 65-74.
16% among female (45% to 52%) and 13% among male (46% to 52%) Medicare beneficiaries ages 65-74.
Disparities. The prevalence of multiple chronic conditions was 1.8 times higher in Alabama (64%) than in Wyoming (35%), the states with the highest and lowest prevalences in 2021​. Multiple chronic conditions varied by race/ethnicity. The prevalence was 1.2 times higher among Black (58%) compared with Asian/Pacific Islander (47%) Medicare beneficiaries ages 65-74.
* Limited to Medicare beneficiaries who were enrolled in the fee-for-service program.


Frequent Physical Distress
Frequent physical distress is an indicator of health-related quality of life and the burden of physical illness in a population. It is associated with such chronic health conditions as diabetes, hypertension and chronic obstructive pulmonary disease as well as risk factors such as smoking, obesity and physical inactivity.
Changes over time. Nationally, the percentage of adults ages 65 and older who reported their physical health was not good 14 or more days in the past 30 days increased 9% from 14.5% to 15.8% between 2020 and 2021. Despite this increase, the prevalence remains 9% lower than in 2019 (17.4%). Between 2020 and 2021, frequent physical distress increased in two states: 43% in Wyoming (11.8% to 16.9%) and 41% in New Jersey (11.6% to 16.3%). Some racial/ethnic, income, gender and metropolitan groups experienced significant increases in frequent physical distress including: 28% among Black older adults (14.2% to 18.2%); 20% among older adults with a household income less than $25,000 (22.6% to 27.2%); 18% among older adults with an income of $25,000-$49,999 (14.3% to 16.9%); 15% among males (13.3% to 15.3%); and 9% among older adults living in metropolitan areas (14.1% to 15.3%).

Disparities. Frequent physical distress was 2.1 times higher in West Virginia (22.4%) than South Dakota and Connecticut (10.6%), the states with the highest and lowest percentages in 2021. Frequent physical distress varied by income, race/ethnicity, education and metropolitan status. The prevalence was:
3.0 times higher among older adults with a household income less than $25,000 (27.2%) than those with an income of $75,000 or more (9.0%).
2.5 times higher among American Indian/Alaska Native (23.1%) compared with Asian (9.1%) older adults. Hispanic (22.0%), multiracial (20.5%), other race (18.5%) and Black (18.2%) older adults also had a high rate. Hawaiian/Pacific Islander older adults (11.3%) also had a low rate.*
2.5 times higher among older adults with less than a high school education (26.2%) than college graduates (10.3%).
1.1 times higher among older adults living in non-metropolitan (17.4%) than metropolitan (15.3%) areas.
* Estimates within the five highest and two lowest groups were not significantly different from each other, respectively, based on non-overlapping 95% confidence intervals.