The State of 

Aging and Health 

in America

2004

www.cdc.gov/aging

www.miahonline.org
About this Series of Reports:

The State of Aging and Health in America 2004 is the third annual volume in a series that 

presents a snapshot of the entire health and aging landscape in the United States or another

area of the world. The reports are produced by the Merck Institute of Aging & Health

(MIAH) and various partnership organizations that are recognized leaders in the aging field.

Previous partners include the Gerontological Society of America and the Pan American

Health Organization.

These reports are the signature publication of MIAH, and they present the most current

information and statistics, often commissioned specifically for the report, on the health of

older adults.

MIAH is a non-profit organization, funded by the Merck Company Foundation, and located

in Washington, DC. The organization is dedicated to improving the health and independence of

older adults around the world through information and education. It is especially concerned

with the education of primary care physicians in geriatrics. The Institute currently funds projects

in the United States, Europe and Latin America.
Executive Summary

I

"As the nation's health protection agency, CDC strives to help older adults come to realize that

poor health or disabilities are not inevitable consequences of aging. The State of Aging and Health

in America 2004 is an important tool for all professionals striving to ensure that older adults

achieve their full life expectancy."

— Julie Louise Gerberding, MD, MPH, Director, Centers for Disease Control and Prevention

“In the United States, 20% of all Americans, or about 70 million people, will have passed their 

65th birthday by 2030. The demographic tidal wave is coming. Aging in the 21st century, however,

is more than just a matter of numbers. The average 75-year-old has three chronic 

conditions and uses five prescription drugs. Older adults also have unique challenges and different

medical needs than younger adults. Consequently, it is not enough to be aware of the demographic imperative; we must also be prepared for it. That is exactly what this publication is

designed to help us do. This report presents information and recommendations on what policy

makers, practicing physicians and patients can and must do to ensure not just longer lives but

better lives for Americans. It presents specific calls to action to help promote good health, prevent

chronic disease and postpone disability for older adults. Most of all, this report forces us to realize

that we must face our demographic challenge with sustained attention and significant action.”

— Patricia P. Barry, MD, MPH, Executive Director, Merck Institute of Aging & Health

“The mission of the Gerontological Society of America is to bring together research, education and

practice to improve the quality of life as we age. That very same idea echoes throughout The State

of Aging and Health in America 2004. This report shows that if we, as a nation, are to help older

adults not simply survive, but thrive, we must increase research, intensify education and improve practice in geriatrics. This report will also fill a unique niche on any bookshelf, in that it is simultaneously 

reference book, Blueprint and roadmap. In terms of transforming the promise of active aging into

reality for all Americans, this publication points out where we are, where we must go and, through

its thoughtful calls to action, how to get there. Perhaps, above all, this report provides further hope

that Browning was correct when he wrote, ‘Come grow old with me, the best is yet to be.’ The

Gerontological Society of America is proud to be a part of this year’s publication.”

— Terrie Fox Wetle, PhD, President, Gerontological Society of America
II

The Merck Institute of Aging & Health (MIAH), the

Centers for Disease Control and Prevention (CDC) and

the Gerontological Society of America (GSA) are releasing

this report to assess the health status of the growing

number of older Americans and to make recommendations

to improve the mental and physical health of all Americans

in their later years. 

This report is divided into six sections. Two sections

offer report cards—one at the national level and one for

individual states and the District of Columbia—that show

whether older Americans are meeting specific health 

targets set in Healthy People 2000. The other four sections

examine issues that are critical to improving our ability to

meet these targets. The following is a brief description of

each of the report’s six main sections:

An Introduction to the Health of Older Americans 

More Americans are living longer, and the proportion of

the U.S. population that is age 65 or older is growing 

rapidly. Life expectancy increased dramatically during

the past century, from 47 years for Americans born in

1900 to 77 years for those born in 2001. These same 

factors—improved medical care and prevention efforts—

that are partly responsible for the dramatic increases in life

expectancy have also produced a major shift in the leading

causes of death in the United States in the past century,

from infectious diseases and acute illnesses to chronic 

diseases and degenerative illnesses.

The tragedy of the leading chronic disease killers is that

they are often preventable. Although the risk of disease and

disability clearly increases with age, poor health is not an

inevitable consequence of aging. Adopting healthier

behaviors—regular physical activity, a healthy diet and 

a smoke-free lifestyle—and getting regular screenings

(mammograms and colonoscopies, for example) can 

dramatically reduce a person’s risk for many chronic diseases, including the leading causes of death and disability.

The National Report Card on Healthy Aging

The national report card presents data on 15 indicators

related to older adult health status, health behaviors, 

preventive care and screening, and injuries. These 

indicators were chosen because they are each modifiable

and present a comprehensive picture of older adult health:

• Physically unhealthy days 

• Frequent mental distress

• Oral health: Complete tooth loss

• Disability

• No leisure-time physical activity

• Eating five or more fruits and vegetables daily

• Obesity

• Current smoking

• Flu vaccine in past year

• Pneumonia vaccine 

• Mammogram within past two years

• Ever had a sigmoidoscopy or colonoscopy

• Up-to-date on select preventive services

• Cholesterol screening

• Hip fracture hospitalizations

The national report card shows the most current data

for each indicator and assigns a grade of “pass” or “fail”

based on Healthy People 2000 targets. 

The State-by-State Report Card on Healthy Aging

The report card for the 50 states and the District of

Columbia presents, for each indicator, the best- and worstranked states and the number of states that met each

target. The report card shows mixed progress since The

State of Aging and Health in America 2002 report was

released and considerable variation among the states in

meeting the targets. 

Spotlight: Physical Activity and Older Americans

Regular physical activity is a critical element of an overall

healthy lifestyle, which can extend years of independent

living, reduce disability and improve the quality of life of

older people. However, our knowledge of the benefits of

physical activity for older adults has not yet been fully

turned into action. The challenge, and the opportunity, is

to make physical activity more accessible to older adults of

all ages, abilities and interests. 

Our Nation’s Health Care Workforce: 

Is it Ready for the Graying of America?

Beginning in 2012, nearly 10,000 Americans will turn 65

every day, and by 2030 20% of the population will have

passed their 65th birthday. The aging of America, however,

is more than a matter of numbers. The average 75 year

old has three chronic conditions and uses five different

prescription drugs; older patients also have unique health

care challenges and different medical needs than younger

adults. Unfortunately, America’s health care workforce

lacks the training to provide appropriate care at the 

present time, and it is wholly unprepared for the coming

senior boom. There are far too few health care providers

specifically trained in geriatrics; moreover, there is a gap

between what many primary care providers know, and

what they need to know, to optimally treat older patients.
III

Addressing this problem requires immediate attention and

action at the national level and calls for:

• Increasing the funding for geriatric training

• Quickly incorporating new research into practice

• Adopting new practices to achieve change

• Enlisting the support of professional organizations to

affect change

• Recruiting new people into geriatrics

• Enhancing the skills of community practitioners

• Developing interest in geriatrics across clinical disciplines

• Increasing geriatric education in health care at all levels

State Examples

Across the United States, states are engaged in innovative

efforts to improve the health and quality of life of older

Americans. Four examples of these efforts are included in

this report: Kansas, Maine, North Carolina, and

Washington.

Goals for Improving the Health of Older Americans:

• To achieve the national goals for reducing health risk

behaviors

• To increase opportunities for all older Americans to reap

the benefits of regular physical activity 

• To encourage states and communities to adopt innovative

methods to promote healthy aging among the adults

they serve

To assist in meeting these goals, MIAH, CDC and

GSA have included Calls to Action on the following topics

related to older adult health:

• Monitoring recent physical health

• Addressing frequent mental distress

• Improving oral health

• Promoting healthy behaviors

• Increasing the use of clinical preventive services

• Implementing a national falls prevention plan

• Increasing physical activity among older adults

• Preparing our health care workforce for an aging

society

V

An Introduction to the Health of Older Americans 01

The National Report Card on Healthy Aging 07

The State-by-State Report Card on Healthy Aging 17

Spotlight: Physical Activity and Older Americans 21

Our Nation’s Health Care Workforce: Is it Ready for the Graying of America? 27

State Examples 31

Appendix 35

Table of Contents

The dramatic gain in life expectancy in the 20th century

was, in large measure, due to improved sanitation, better

medical care and increased use of preventive health 

services. A key challenge for the 21st century will be to

ensure that these added years are quality years. 

Chronic Diseases Are Now the

Leading Causes of Death

The same factors—improved medical care and prevention

efforts—that are largely responsible for the dramatic

increases in life expectancy have also produced a major

shift in the leading causes of death in the United States

in the past century, from infectious diseases and acute 

illnesses to chronic diseases and degenerative illnesses.2

In 1900, the leading killers of all age groups in the

United States were pneumonia and influenza, tuberculosis,

and gastritis and enteritis.3 In 2000, the top three causes

of death for all ages were heart disease (30% of all

deaths), cancer (23%) and stroke (7%).4 These same

three chronic diseases were also the leading causes of

death among Americans age 65 and older in 2000,

accounting for 60% of all deaths in this age group

(Figure 2).4

The tragedy of these leading killers is that they are

often preventable. Although the risk of disease and 

disability clearly increases with advancing age, poor

health is not an inevitable consequence of aging. Three

behaviors—smoking, poor diet and physical inactivity—

were the actual causes of almost 35% of U.S. deaths in

2000.5 These behaviors often underlie the development

of the nation’s leading chronic disease killers: heart 

disease, cancer, stroke and diabetes. Adopting healthier

behaviors—regular physical activity, a healthy diet and a

smoke-free lifestyle—and getting regular screenings

(mammograms and colonoscopies, for example) can 

dramatically reduce a person’s risk for most chronic 

diseases, including the leading causes of death.6

01

THE U.S. POPULATION IS AGING. The United States is in the midst of a longevity revolution. Life

expectancy increased dramatically during the past century, from 47 years for Americans born in

1900 to 77 years for those born in 2001.1 Not only are more Americans living longer, but the 

proportion of the U.S. population that is age 65 years and older is also growing. That growth will

increase rapidly as baby boomers, those born between 1946 and 1964, begin to reach age 65 in

2011. Since 1900, the U.S. population has tripled, but the number of older adults has increased

11-fold, from 3.1 million in 1900 to 35 million in 2000. By 2030, when all of the baby boomers

have reached age 65, the number of older Americans is expected to reach 71 million, or roughly

20% of the U.S. population.2

An Introduction to the Health of

Older Americans 
Chronic Diseases Cause Pain and

Disability and Increase Health Care

Costs

Deaths are only part of the picture of the burden 

of chronic diseases among older Americans. These 

conditions can cause years of pain, disability, and loss 

of function and independence before resulting in death.

Currently, at least 80% of older Americans are living with

at least one chronic condition, and 50% have at least

two.2 Diabetes, for example, with its deadly and debilitating complications, affects approximately one in five

Americans age 65 and older, and the aging of the U.S.

population, in conjunction with the obesity epidemic, will

only intensify its impact. The number of adults age 75

and older with diabetes is projected to increase from

about 1 million in 2000 to more than 4 million in 2050.2

In addition to the hardships that chronic diseases

impose on individuals and their families, these diseases

are a major contributor to health care costs. Over twothirds of current health care costs are for treating 

chronic illnesses; among older Americans, almost 95% 

of health care expenditure is for chronic diseases.7

Alzheimer’s disease alone, for example, costs the nation

more than $50 billion each year in Medicare and

Medicaid expenditures. As the population ages and this

devastating disease becomes more prevalent, these costs

are projected to rise by as much as 54% by 2010.8

02

f.2

IN 2001, CHRONIC DISEASES WERE THE

LEADING CAUSES OF DEATH AMONG

U.S. ADULTS AGE 65 AND OVER

Heart Disease

Cancer

Stroke

Chronic Lower

Respiratory

Diseases

Influenza &

Pneumonia

0%

5%

10%

15%

20%25%

Percent of all deaths

Source: CDC, National Center for Health Statistics, National Vital Statistics

Report, 2002

Diabetes

Alzheimer’s

Disease

All Other Causes

30%35%

22.8%

3.0%

3.0%

3.1%

5.9%

8.0%

21.7%

32.4%

f.1

2000 2015

2025

THE PERCENTAGE OF THE U.S. POPULATION AGE 65 AND OVER WILL 

DRAMATICALLY INCREASE IN THE NEXT 20 YEARS

Source: US Bureau of the Census, 2003

5%-9.9%

15%-19.9%

10%-14.9%

20%-30%
The burden of many chronic diseases and conditions—

especially hypertension, diabetes and cancer—varies

widely by race and ethnicity. For example, among adults

age 65 and older in 2000–2001, 65% of Blacks had hypertension, compared with 49% of Hispanic Americans and

47% of Whites.9 Twenty-five percent of Hispanic

Americans and 23% of Blacks had diabetes, compared

with 14% of Whites.9 Twenty-two percent of Whites had

some form of cancer, compared with 10% of Hispanic

Americans and Blacks.9

Chronic Diseases Diminish Quality of

Life for Older Adults

Among older adults, chronic diseases and their related

activity limitations are a major health problem, and these

conditions often reduce seniors’ health-related quality of

life. The percentage of older adults who report very

good or excellent health decreases with age. Data from

the 2001 National Health Interview Survey (NHIS) 

indicated that 43% of men and women aged 65 years 

and older reported very good or excellent health, 

compared with 34% of those age 75–84 and only 28% 

of those 85 or older.10

The same NHIS data showed that the percentage of

older adults who reported very good or excellent health

varied by race. Among adults aged 65 years and older, for

example, 40% of Whites but only 25% of Blacks reported

very good or excellent health (Figure 4).

The Challenges of Preserving the

Health of an Aging Society

The increase in lifespan and the growing burden of

chronic diseases among older Americans have created

several new challenges. Chief among these are health

care costs, an increase in the number of Americans who

serve as caregivers to family members, the complexities

of managing multiple medications, and greater long term

care needs. Meeting these challenges is critical to ensuring

that the years that Americans can look forward to are also

quality years.

Health Care Costs 

The increasing number of Americans age 65 or older has

the potential to greatly increase the nation’s already high

health care costs: 

• The cost of providing health care for one person age

65 or older is three to five times greater than the cost

for someone younger than 65.2

• By 2030, health care spending will increase by 25%

simply because the population will be older, and this is

before inflation or new technologies are taken into

account.11

• Medicare spending has grown more than seven-fold in

the past two decades, from $33.9 billion in 1980 to

$252.2 billion in 2002, and is projected to double again

by 2012.12

03

f.3

PREVALENCE OF SELECTED CHRONIC

CONDITIONS AMONG ADULTS AGE 65

AND OVER, 2000-2001

Stroke

Diabetes

Any Cancer

0%

10%20%30%40%

50%

*A respondent was considered to have “arthritic symptoms” if s/he answered “yes”

to the following questions: “During the past 12 months, have you had pain, aching,

stiffness, or swelling in or around a joint?” and “Were these symptoms present on

most days for at least one month?”

Source: CDC, National Center for Health Statistics, National Health Interview

Survey, 2000-2001

Coronary Heart

Disease

Arthritic 

Symptoms*

Hypertension

60%

49.2%

35.9%

20.4%

19.9%

15.2%

8.6%

0

f.4

SELF-REPORTED HEALTH STATUS 

FOR ADULTS AGE 65 AND OVER 

VARIES BY RACE

All races

Source: CDC, National Center for Health Statistics, National Health Interview

Survey, 2001

Fair/Poor

Excellent/

Very Good

Good

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

White Black

26.6%

35.3%

38.1%

24.9%

35.6%

39.5%

41.3%

33.4%

25.2%
Caregiving

Nearly 79% of people who need long-term care 

live at home or in community settings rather than in 

institutions. In 1997, about 22 million U.S. households

(roughly one in every four households) were involved in

caring for someone age 50 or older, and this number is

expected to rise to 39 million households by 2007.13

Fifty-nine percent of the adult U.S. population either

is or expects to be a family caregiver. The value of the

services that family caregivers provide for “free” is 

estimated to be $257 billion a year.13 Although caregiving

has its rewards, which usually include increased satisfaction

with the level of care that the loved one is receiving, 

providing these services creates additional health and

social burdens: 

• Of those who provide at least 21 hours of care a week

for a family member or friend, 61% have suffered

from depression.14

• Older caregivers who have a history of chronic illness

themselves and caregiving-related stress have a 63%

higher death rate than their peers who are not caregivers.14

• American businesses lose between $11 billion and $29

billion each year as a result of employees caring for

family members age 50 and older.14

Medications Management

Especially when combined with a healthy lifestyle, 

medications can lessen the burden of illness and disability

on individuals, their families and society. When 

appropriately prescribed, administered and monitored,

medications are a cost-effective way to help older adults

maintain health, recover from illness or control 

symptoms of chronic disease. 

Despite these potential benefits, medication for older

adults poses several serious challenges, including the 

following:

• People age 65 and older make up 13% of the U.S.

population, yet they account for 34% of all prescription

medications and 30% of all nonprescription medications.

Because older adults often take numerous medications

prescribed by multiple providers, their risk for adverse

reactions to a medication or combination of medications is greater than that of younger, healthier adults.15

• Among older adults, adverse reactions such as dizziness,

numbness, dehydration, loss of appetite, nausea and

diarrhea can have more dramatic consequences than

among younger adults. These consequences can

include falls, depression, confusion, hallucinations, 

and malnutrition.15

• Because the aging process affects how an older person’s

body absorbs, uses and eliminates medications, older

people are at risk of being given medications or

dosages that are inappropriate for their age.15

• Memory impairment and sensory changes such as

vision loss that often occur among older adults can

create additional challenges for correctly adhering to

complex medication regimens.15 

Long Term Care 

Perhaps the greatest challenges for both families and our

society are those associated with long term care needs.

In 1997, more than 1.4 million older Americans, or

4% of the older population, were in nursing homes. The

likelihood of being in a nursing home increases as people

get older: in 1997, 13% of the nursing home population

was age 65–74, 33% was age 75-84, and 46% was age 85

or older.13

The costs of long term care are expected to continue

increasing as the population ages. However, public

health programs that decrease disability among older

Americans and help them maintain their independence

offer opportunities to lessen these increases.

Twentieth-century advances in our knowledge of the

critical factors in protecting and promoting health have

given us many opportunities for overcoming these 

challenges. The health indicators presented in the 

following chapters point the way to these opportunities.

By working to meet the goals for each of these key 

indicators, our nation can help ensure that all of its 

citizens can look forward not just to living long, but to

living well. 

04
05

REFERENCES

1. National Center for Health Statistics. Health, United States, 2003. Hyattsville, MD: U.S. Department of Health and Human Services,

Centers for Disease Control and Prevention; 2003. 

2. Centers for Disease Control and Prevention. Public health and aging: trends in aging—United States and worldwide. MMWR

2003;52(06):101-106. 

3. Centers for Disease Control and Prevention. Unrealized Prevention Opportunities: Reducing the Health and Economic Burden of

Chronic Disease. Atlanta: U.S. Department of Health and Human Services; 2000.

4. National Center for Health Statistics. Mortality Report. Hyattsville, MD: U.S. Department of Health and Human Services; 2002. 

5. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA 2004;291(10):1238-1245.

6. Blackman DK, Kamimoto LA, Smith SM. Overview: surveillance for selected public health indicators affecting older adults—United

States. MMWR 1999;48(SS8):1-6. 

7. Hoffman C, Rice D, Sung HY. Persons with chronic conditions: their prevalence and costs. JAMA 1996;276(18):1473-1479.

8. Alzheimer’s Association. Medicare and Medicaid costs for people with Alzheimer’s disease. April 3, 2001. Available at

http://www.alz.org/Media/newsreleases/alzreport.pdf (accessed April 30, 2004).

9. National Center for Health Statistics. Prevalence of selected chronic conditions by age, sex, race, and Hispanic origin: United States,

1997-2001. (Table) Available at http://209.217.72.34/aging/eng/TableViewer/Wdsview/ dispviewp.asp?ReportId=144 (accessed April 30,

2004).

10. National Center for Health Statistics. Respondent-assessed health by age, sex, and race: United States, 1982-2001. NHIS (NHIH01d-c)

(Table). Available at http://209.217.72.34/aging/eng/TableViewer/Wdsview/dispviewp.asp?ReportId=8 (accessed May 4, 2004).

11. Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention. Physical Activity and Older Americans:

Benefits and Strategies. June 2002. Available at http://www.ahrq.gov/ppip/activity.htm (accessed June 22, 2004).

12. Medicare Payment Advisory Commission. A Data Book: Healthcare Spending and the Medicare Program. June 2003. Section 5:

National health care and Medicare spending. Available at http://www.medpac.gov/ (accessed May 5, 2004).

13. Family Caregiver Alliance. Fact sheet: selected long term care statistics. Available at

http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=440 (accessed May 5, 2004).

14. National Family Caregivers Association. Fact sheet: family caregiving statistics. Available at http://www.nfcacares.org (accessed May

5, 2004).

15. American Society on Aging. Live Well, Live Long: Health Promotion and Disease Prevention for Older Adults. Optimal medications

use module. Available at http://www.americansocietyonaging.org/cdc/module3/phase1 (accessed June 22, 2004).

07

This section reports on 15 indicators related to older adult health status, behaviors, preventive care

and screening, and injuries. These indicators were chosen because they are each modifiable and

present a comprehensive picture of older adult health. The report card in Table 1 shows the most

current data for each indicator and assigns a grade of “pass” or “fail” based on Healthy People

2000 targets. The rest of the section describes the indicators in greater detail.

The National Report Card on

Healthy Aging

Health Status Indicators

Indicator 1: Physically unhealthy days 

• CDC’s Behavioral Risk Factor Surveillance System

(BRFSS) collects data on physically unhealthy days,

defined as the overall number of days during the previous

30 days when the respondent reported that his/her 

physical health (which includes physical illness and

injury) was not good. 

• The high prevalence of chronic diseases and their related

activity limitations among older adults has been linked

with a decrease in health-related quality of life.3 BRFSS

data from 1993-2001 show that the average number of

physically unhealthy days in the last 30 days reported by

respondents increased significantly with age, from 1.9

days among those aged 18-24 years to 5.2 days for those

aged 65 and older. Older women reported roughly one

more unhealthy day per month than men. Factors 

associated with fewer unhealthy days included having a

college degree, being employed, having never smoked,

and having some level of physical activity.4

CALL TO ACTION: 

MONITORING RECENT PHYSICAL HEALTH

Older adults report many more physically unhealthy days than

younger adults. Many of these unhealthy days are due to the

pain and discomfort associated with chronic diseases and 

conditions that increase with age, including arthritis, back and

neck pain, diabetes, cardiovascular disease and cancer.1

Clinicians, family members and others who have contact with

older adults should be aware that the aches, pains and physical

ailments of older adults are typically more common in the

winter months of January, February and March than in the

summer months of June, July and August – perhaps in part due

to the increase of influenza and the relative lack of physical

activity in those months. Self-reports of poor physical health 

can be a marker for identifying physical illnesses that are 

undiagnosed or that require better management by either the

clinician or the patient. Periodic monitoring of physically

unhealthy days was recently found to be useful in evaluating

the effectiveness of a nutritional-support home-delivered meals

program for home-bound older adults in Canada, demonstrating

that brief measures of perceived health are a feasible and costeffective option for evaluating programs for older adults.2
08

TABLE 1. THE NATIONAL REPORT CARD ON HEALTHY AGING: HOW HEALTHY ARE AMERICA’S SENIORS?

* Data for Indicators 1-14 were collected by CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Data for Indicator 15, hip fracture hospitalizations, come from CDC’s 

National Center for Health Statistics, National Hospital Discharge Survey. See Appendix for a full description of these data sources. 

† Grade is based on the attainment of Healthy People 2000 targets. See Appendix for a full description of Healthy People 2000 and Healthy People 2010 targets.

‡ Indicators 1, 2, 4, and 13 are more recently developed measures and, as such, do not have Healthy People 2000 targets. Data related to Indicator 7, obesity, were combined with the over

weight category in Healthy People 2000 and, therefore, obesity has no individual Healthy People 2000 target.

ç Frequent mental distress is defined as having had 14 or more mentally unhealthy days in the previous month. Data from the 2000 and 2001 BRFSS are combined here to get a 

sufficient sample size. 

ƒ Disability was defined on the basis of an affirmative response to either of the following two questions on the 2001 BRFSS: “Are you limited in any way in any activities because of physical, mental

or emotional problems?” or “Do you now have any health problem that requires you to use special equipment, such as a cane, wheelchair, a special bed, or a special telephone?”

¶ Healthy People 2010 segments the nutrition target into multiple categories of fruits and vegetables. See Appendix for a full description of this change.

# Healthy People 2000 defined a target for overweight, but not obesity. Because current standards separate these two conditions, obesity data are included in this report. The Healthy 

People 2010 definition of obesity is a body mass index (BMI) of >30 kg/m2.

** For men, three services are included: flu vaccine in past year, ever had a pneumonia vaccine, and ever had sigmoidoscopy or colonoscopy. For women, these same three services plus a 

mammogram within past two years are included.

†† Healthy People 2010 has separate hip fracture hospitalization targets for men and women, and no target for the total number.

Data for Persons Age 65 or Older* Healthy People Grade Healthy People

Indicator (Data Year) 2000 Target (pass/fail)† 2010 Target

Health Status 

1. Physically unhealthy days (mean 5.5 (2001) ‡ ‡ ‡

number of days in past month)

2. Frequent mental distress (%)ç 6.3 (2000-2001) ‡ ‡ ‡

3. Oral health: Complete 22.4 (2002) 20 Fail 20

tooth loss (%)

4. Disability (%)ƒ 30.8 (2001) ‡ ‡ ‡

Health Behaviors

5. No leisure time physical activity 32.9 (2002) 22 Fail 20

in past month (%)

6. Eating 5+ fruits and vegetables 32.4 (2002) 50 Fail N/A¶

daily (%)

7. Obesity (%)# 19.5 (2002) ‡ ‡ 15

8. Current smoking (%) 10.1 (2002) 15 Pass 12

Preventive Care & Screening

9. Flu vaccine in past year (%) 68.6 (2002) 60 Pass 90

10. Ever had pneumonia 63.0 (2002) 60 Pass 90

vaccine (%)

11. Mammogram within past 77.2 (2002) 60 Pass 70

2 years (%)

12. Ever had sigmoidoscopy or 58.3 (2002) 40 Pass 50

colonoscopy (%)

13. Up to date on select 

preventive services (%)**

Men 34.4 (2002) ‡ ‡ ‡

Women 33.4 (2002) ‡ ‡ ‡

14. Cholesterol checked within 85.4 (2001) 75 Pass 80

past 5 years (%)

Injuries

15. Hip fracture hospitalizations 525 (men) 607 (total) Fail 474 (men)

(per 100,000 persons) 1127 (women) 416 (women)

877 (total) (2002) N/A (total) ††

Summary of Findings: 

• The nation has met targets for 6 of the 10 indicators in this report that are measured by Healthy People 2000.

• In 2002, the target for pneumonia vaccination was reached.
Indicator 2: Frequent mental distress

• To assess general mental health status, the BRFSS asks

respondents for the number of days in the past 30 days

that their mental health was not good because of

stress, depression and problems with emotions.

Respondents who report 14 or more days of poor

mental health are defined as having frequent mental

distress (FMD). This 14-day minimum period is

selected because a similar period is often used by

health care providers and researchers as a marker for

clinical depression and anxiety disorders, and a longer

duration of reported symptoms is associated with a

higher level of activity limitation.5

• The presence of frequent mental distress varies by race

and ethnicity (Figure 5). Individuals of Asian/Pacific

Islander descent have a much lower prevalence of FMD

compared with other racial and ethnic groups, while

Hispanic Americans have the highest prevalence. 

• Unlike physical health, mental health seems to improve

with age. BRFSS data from 1993-2001 show that 10.5%

of adults aged 18-24 years reported frequent mental 

distress, whereas FMD was reported by only about 6%

of adults aged 65 years and older. Some researchers

attribute this improvement to more personal and social

resources, better coping skills, and stronger social and

spiritual supports among older Americans.

Indicator 3: 

Oral health: Complete tooth loss

• The percentage of older adults who have lost all of their

natural teeth has declined substantially since the 1950s,

when more than half of adults older than age 65 were

toothless.9, 10 This decline is the result of enormous

improvements in the field of oral health in the last 

50 years, including community water fluoridation,

advanced dental technology, better oral hygiene, and

more frequent use of dental services (Figure 6).

• Despite this increase in tooth retention, almost a quarter

of Americans aged 65 and older in 2002 had lost all of

their teeth. Tooth loss among older adults is more

common in some parts of the country (e.g., Appalachia)

and among groups defined by certain socioeconomic,

racial/ethnic and health characteristics, including having

an annual income of less than $15,000, having less than 

a high school education, having diabetes and being a

non-Hispanic black. 

09

CALL TO ACTION: 

ADDRESSING FREQUENT MENTAL DISTRESS

Although older adults usually report fewer mental health

problems than do younger people, many still suffer from

unnecessary mental distress.6 Some older adults have

untreated or inadequately treated mental conditions and

could benefit from diagnosis by a health professional and

full access to the best available mental health treatment.

Others who find themselves suffering from loneliness, lacking

resources to overcome health-related activity limitations, or

living in a difficult family or community situation could

lessen their distress by getting involved with group support,

self-care, and other community-based social service 

programs. 

Self-reports of mental distress should be monitored 

as an indicator of the overall burden of mental health

problems in older populations. Although mental distress 

is undesirable by itself, it has also been associated with

unhealthy and risky behaviors that can inhibit recovery

from an illness or cause new physical or mental health

problems.7 Clinicians, social workers, and others who have

contact with older adults could help to identify 

those who might be suffering from mental distress by 

periodically asking them how their mental (as well as 

physical) health has been lately. They could also help these

older persons by alerting them to situations that could 

trigger frequent mental distress and informing them of

mental health and social services that are provided by their

particular health insurance or medical provider, the

Veterans Administration, the aging services network 

supported by the Administration on Aging (AOA), the

Substance Abuse and Mental Health Services

Administration (SAMHSA), United Way organizations,

AARP, and other health and social service organizations.

Recently, SAMHSA, AOA and the National Council on

the Aging partnered to create a toolkit for organizations

that provide services to older adults, such as senior centers,

adult day care services, nutrition programs, state agencies,

health and social service programs, and faith-based initiatives. Called Get Connected! Linking Older Adults with

Medication, Alcohol and Mental Health Resources, the

toolkit introduces service providers to substance abuse and

misuse issues and mental health problems among older

adults. The toolkit also outlines a five-step process for

establishing a program, developing resources, conducting

education sessions and planning future programming.8

To order the Get Connected! toolkit, contact SAMHSA’s

National Clearinghouse for Alcohol and Drug Information

call (800) 729-6686 (English and Spanish) or 1-(800) 487-

4889 (TDD), or e-mail info@health.org. Ask for GCKIT.
• Older adults who have retained their natural teeth

remain at risk for the two oral diseases most prevalent in

all age groups: dental caries (cavities) and periodontal

disease. About 30% of adults with their natural teeth

have untreated dental caries, and about 25% of older

adults have lost tooth-supporting structures because of

advanced periodontal disease. 

Indicator 4: Disability

• In this report, disability is defined as an affirmative

response to either of the following two questions asked 

in the 2001 BRFSS: “Are you limited in any way in

any activities because of physical, mental or emotional 

problems?” or “Do you now have any health problem

that requires you to use special equipment, such as a

cane, wheelchair, a special bed or a special telephone?”

• Older adults are particularly affected by disability: the

overall rate of disability in the United States is 18%;

however, among Americans age 65 and older, rates of

disability increase to 30.8%. 

• Although people with disabilities report poor health

more often than those without disabilities,11 disability

does not necessarily equate to poor health.12

10

f.5

IN 2000-2001, THE PREVALENCE OF

FREQUENT MENTAL DISTRESS VARIED

WIDELY BY RACE/ETHNICITY

Native American/

Alaska Native

Asian/ 

Pacific Islander

0%

2%4%

6%

8%

Source: CDC, Behavioral Risk Factor Surveillance System, 2000-2001

Hispanic

Black, 

non-Hispanic

White, 

non-Hispanic 

10%

12%

0%

f.6

FROM 1957 TO 1994, COMPLETE TOOTH

LOSS DECLINED AMOUNG ADULTS OVER

AGE 65

1957-1958

Sources: U.S. Public Health Service, 1960 and CDC, National Center for Health

Statistics, National Health and Nutrition Examination Surveys I and III, 1975,

1996

10%

20%

30%

40%

50%

60%

1971-1974 1988-1994

20%-

Healthy

People 2000

target

CALL TO ACTION: 

IMPROVING ORAL HEALTH

Practices such as drinking fluoridated water, carefully

brushing and flossing teeth, and getting regular 

professional oral health care have been shown to be

instrumental in maintaining and improving oral health.

These measures are the only ways that older adults can

avoid losing their teeth or requiring extensive treatment

to curb infection and restore tooth function. Rates of

these conditions vary widely among older people of 

different socioeconomic backgrounds, and this variation

offers strong evidence that many older adults have not

benefited fully from improvements in preventing and

controlling oral diseases. 

The following guidelines can help all older adults

improve their oral health and lower their risk for dental

decay and tooth loss:

• Drink fluoridated water and use fluoride toothpaste.

Fluoride provides protection against dental decay at

all ages.

• Practice good oral hygiene. Careful tooth brushing

and flossing to reduce dental plaque can help prevent

periodontal disease. 

• Get professional oral health care. Professional care

helps to maintain the overall health of the teeth and

mouth and helps to detect precancerous or cancerous

lesions early in their development.

• Avoid tobacco. Smokers have a seven times greater

risk of developing periodontal disease than nonsmokers. Spit tobacco containing sugar also increases

the risk of dental decay.

• Limit alcohol. Drinking excessive amounts of alcohol

is a risk factor for oral and throat cancers. Alcohol

and tobacco used together are the primary risk 

factors for these cancers.

• Get dental care before undergoing chemotherapy or

radiation to the head or neck. These therapies can

damage or destroy oral tissues and can cause severe

mucosal inflammation and ulcers, loss of salivary

function, rampant decay and bone destruction.

7.9%

2.1%

10.0%

8.6%

5.9%

55.4%

45.6%

28.6%
11

• Disability among older adults, as measured by 

limitations in instrumental activities of daily living, has

declined since the early 1980s.13 

Health Behavior Indicators

Indicator 5: Physical activity

• Few factors contribute as much to successful aging as

having a physically active lifestyle. Being physically active

helps older people remain mobile and independent. In 

fact, regular physical activity can help prevent or control

many of the health problems that often reduce the quality

and length of life of older adults, including obesity, 

arthritis, high blood pressure, diabetes, osteoporosis,

stroke, depression and colon cancer. 

• Older people do not need to engage in strenuous physical

activity to improve their health. Daily walking, alone or

in conjunction with other leisure-time activities such as

gardening, offers many health benefits.16

• Despite the proven health benefits of physical activity,

data from the 2002 BRFSS show that one-third of adults

age 65 and older do not engage in leisure time physical

activities. 

Indicator 6: Eating five or more fruits and

vegetables daily

• Eating a diet rich in fruits and vegetables may help reduce

the risk of some cancers and other chronic conditions,

such as diabetes and cardiovascular disease.

• Compared with other age groups, a higher proportion 

of older Americans are eating five or more fruits and 

vegetables daily, but they are still not meeting the Healthy

People 2000 target (Figure 7).

Indicator 7: Obesity 

• Maintaining a healthy body weight is important to older

adults’ health because being obese is associated with a

greater risk of chronic diseases such as cardiovascular 

disease and diabetes. Obesity can also worsen conditions

such as arthritis.

• An individual whose body mass index (BMI) is greater

than or equal to 30kg/m2 is classified as obese. 

• BRFSS data show that the prevalence of obesity among

adults age 65 and older increased from approximately

12% in 1990 to 19% in 2002.17

Indicator 8: Current smoking

• An estimated 46.2 million adults in the United States

smoke cigarettes even though this single behavior will

result in death or disability for half of all regular smokers.

Cigarette smoking is responsible for more than 440,000

premature deaths each year in the United States.18

• Although most older adults who were regular smokers

have quit smoking, about 10% of Americans older than

age 65 still smoked cigarettes in 2002. 

• Even elderly smokers who quit can gain significant health

benefits. For example, a smoker’s risk of heart disease

begins to fall almost immediately after quitting, regardless

of how long that person has smoked.19

CALL TO ACTION: 

PROMOTING HEALTHY BEHAVIORS AMONG

OLDER ADULTS 

The current gap between life expectancy and healthy

years of life can be narrowed. Research shows that

simple behavioral changes can improve the health

condition of older adults.14 These improvements in

health can be achieved through a combination of

practicing healthful behaviors, effectively identifying

disease, modifying health risks, and managing 

chronic conditions. An important way to promote

healthy behaviors among older adults is to improve

patient-provider communication and to provide 

time for counseling and referral regarding lifestyle

modifications, so that older adults can adopt or

maintain these behaviors. To reach these goals,

providers need more time to provide counseling and

ready access to community resources from the public

health and aging services networks on lifestyle 

interventions. In particular, older adults with 

disabilities such as vision problems and literacy 

difficulties require special attention. Many of these

challenges could be addressed through general 

systems improvement recommended for primary

care, improved communications and identification 

of community resources.15

0%

f.7

THE PERCENTAGE OF PEOPLE MEETING

THE “5-A-DAY” FRUIT AND VEGETABLE

RECOMMENDATION VARIES BY AGE

18-24

Source: CDC, Behavorial Risk Factor Surveillance System, 2002

10%

20%

30%

40%

50%

60% 50%-

Healthy People

2000 target

25-34 35-44 45-54 55-64 65+

Age groups

19.3% 19.2% 21.0% 21.7% 24.6%

32.2%
12

Preventive Care and Screening

Indicators

Indicator 9: Flu vaccine in past year

Indicator 10: Ever had pneumonia vaccine 

• Although influenza and pneumonia can largely be 

prevented through vaccination, these two diseases still

kill thousands of older adults each year. Of the roughly

36,000 deaths due to influenza each year during the

1990s, 90% were among people age 65 or older. In

1998, an estimated 3,400 adults age 65 or older died as 

a result of invasive pneumococcal disease. 

• The Healthy People 2000 targets of vaccinating 60% of

noninstitutionalized older Americans against influenza 

and 60% against pneumonia appear to have been met 

nationally; however, vaccination rates vary significantly

among different racial and ethnic groups. Older Black

and Hispanic American adults are immunized for these

two diseases much less frequently than their White

counterparts (Figure 8).

Indicator 11: Mammogram within past

two years 

• Mammography is the best available method to detect

breast cancer in its earliest, most treatable stage, several

years before a lump can be felt.21

• Timely mammography screening among women older

than age 40 could prevent approximately 17% of all

deaths from breast cancer, and this reduction in risk

increases as women get older.22

• Seventy-five percent of all diagnosed cases of breast

cancer are among women aged 50 years of age and

older.21 Even though mammograms for women age 65

and older are covered by Medicare, in 2002 more than

0%

f.8

IN 2002, OLDER BLACK AND HISPANIC

ADULTS WERE NOT IMMUNIZED AS 

FREQUENTLY AS OLDER WHITE ADULTS

Source: CDC, Behavioral Risk Factor Surveillance System, 2002

10%

20%

30%

40%

50%

60%

60%-

Healthy People

2000 target

Influenza Vaccine Pneumonia Vaccine

70%

80%

CALL TO ACTION: INCREASING THE USE OF

CLINICAL PREVENTIVE SERVICES

Broader use of clinical preventive services is one of

the keys to preserving and extending the health of

older Americans. Medicare covers many essential

clinical preventive services for older adults, including

immunization for influenza and pneumococcal disease and screening for the early detection of selected

cancers (e.g., breast, cervical and colorectal cancers),

diabetes, cardiovascular disease, osteoporosis and

glaucoma. These services, coupled with appropriate

follow-up, are effective in preventing disease or

detecting disease in the early stages, when treatment

is more effective. 

Because research has shown that older adults are

motivated by health care providers’ recommendations

for screening and immunization, better educating 

seniors on recommended preventive measures is 

essential.20 Community organizations can promote

and facilitate access to preventive measures by hosting health fairs and “Immunization Days” where

older people live and congregate and by widely publicizing the benefits and local availability of immunization and screening services. 

A variety of players—health care providers, aging

services providers, public health agencies, hospitals,

nursing agencies, health insurance programs, faithbased institutions, senior centers, and communitybased organizations—all have key roles in ensuring

that older Americans benefit from these services.

Communities should ensure that they have a designated focal point for coordinating and facilitating the

efforts of these important community players in

increasing the use of preventive services. 

One example of a successful coordinating effort is

the Sickness Prevention Achieved through Regional

Collaboration (SPARC) program. SPARC coordinates and nurtures a regional network of providers

and organizations that implement local strategies for

increasing access to clinical preventive services.

Partners include representatives of local hospitals, 

medical practices, public health agencies, social service organizations and community advocacy groups.

SPARC serves as the bridge between medicine and

public health. Although it does not directly provide

services, SPARC helps medical practices more effectively provide preventive services, helps make prevention measures more widely available, and helps establish local accountability for the delivery of care. For

more information, visit www.sparc-health.org. 

69.0%

50.6% 54.8% 64.8%

44.5% 44.4%

White, non-Hispanic Black, non-Hispanic Hispanic
20% of women in this age group had not had a 

mammogram within the past two years. 

Indicator 12: Colorectal cancer screening

• Colorectal cancer is the second-leading cause of cancer

death in the U.S.23 Early detection through screening

greatly increases the chances of survival and is covered

by Medicare for adults age 65 and older.

• The data included in this report are graded against the

Healthy People 2000 goals, which used the target of “at

least 40% of people age 50 and older who have ever

received a sigmoidoscopy.” Current screening recommendations from the U.S. Preventive Services Task

Force, however, are more comprehensive for adults age

50 and older who are at average risk. For this population,

routine screening with one or a combination of the 

following tests is recommended: a fecal occult blood test

(FOBT) annually, a flexible sigmoidoscopy every 5 years,

a double-contrast barium enema every 5 years, and a

colonoscopy every 10 years.24

Indicator 13: Up-to-date on select 

preventive services

• The “up-to-date” indicator presents a composite picture

of the preventive care and screening behaviors of older

adults. Indicators 9 - 12 measure the use of selected

clinical preventive services that are covered by Medicare

and recommended for adults age 65 and older (mammography is covered for women only). While each is

independently important, older adults need to use all of

them, not just one or two, to protect their health. 

• Many older Americans are not getting the benefits of

immunizations and cancer screening, medicine’s most

effective tools for preventing some of the leading causes

of death. Although these services are covered by

Medicare, in 2002 only one third of older Americans

received these measures on the recommended schedule. 

Indicator 14: Cholesterol screening

• Because high serum cholesterol is a major risk factor for

coronary heart disease (CHD), which is the leading

cause of illness and death among older men and women,

periodic cholesterol screening is an essential component

of preventive health care. 

• Lowering the cholesterol levels of older adults who have

CHD can prolong and improve the quality of their lives

and reduce their risk of heart attack or stroke. For older

adults without CHD, lowering cholesterol levels reduces

the high risk that it will develop.25

Indicator 15: Hip fracture hospitalizations

• Hip fracture, the most serious type of all fall-related

fractures, is a leading contributor to death, disability,

and reduced quality of life among older adults.26, 27 Up

to 25% of hip fracture patients die within one year.28

For those who survive, hip fractures often substantially

reduce the ability to remain independent.29

• In 2002, there were more than double the number 

of hospitalizations for hip fractures for women than

men (1,127 hospitalizations per 100,000 persons for

women, compared with 525 hospitalizations per

100,000 persons for men). 

• From 1990 to 2002, hospitalization rates for hip 

fracture varied from year to year, but always remained

significantly above the Healthy People 2000 target of

607 per 100,000 (Figure 9).

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

f.9

HIP FRACTURE HOSPITALIZATION RATES

CONSISTENTLY EXCEED THE NATIONAL

TARGET

0

200400

600

800

1000

rate per 100,000 persons

Source: CDC, National Center for Health Statistics, National Hospital

Discharge Survey, 1990-2002

607 per 100,000-

Healthy People 2000

target

13

776

814

757

841

815

818

934

879

863

852

840

825

877
14

Selected Additional Resources

For additional information on the indicators described

above, please refer to the following internet-based

resources (please see the Spotlight: Physical Activity and

Older Adults section for resources related to physical 

activity):

Healthy People 2000 and Healthy People 2010

www.healthypeople.gov

Health-Related Quality of Life

www.cdc.gov/hrqol

Oral Health

www.cdc.gov/OralHealth/index.htm

Disability

www.cdc.gov/ncbddd/dh/default.htm

www.asaging.org/media/pressrelease.cfm?id=8

Nutrition and Obesity

www.cdc.gov/nccdphp/dnpa/nutrition.htm

www.cdc.gov/nccdphp/dnpa/obesity/index.htm

www.5aday.gov 

www.nal.usda.gov/fnic/etext/000002.html

www.smallstep.gov 

www.niddk.nih.gov/health/nutrit/pubs/choose.htm

Tobacco

www.cdc.gov/tobacco 

www.cancer.org

www.lungusa.org

Immunizations

www.cdc.gov/nip 

www.asaging.org/media/pressrelease.cfm?id=38

Cancer Screening

www.cdc.gov/health/cancer.htm

www.cancer.org

Cholesterol Screening

www.cdc.gov/cvh 

Falls Prevention

www.cdc.gov/ncipc/duip/spotlite/falls.htm

www.asaging.org/media/pressrelease.cfm?id=9

Healthy Aging

www.cdc.gov/aging

CALL TO ACTION: IMPLEMENTING A NATIONAL

FALLS PREVENTION PLAN

Recognizing the need for a national strategy for 

preventing falls among older adults, the Archstone

Foundation and the Home Safety Council recently

funded the National Council on the Aging’s Center for

Healthy Aging to spearhead a Falls Free Summit to

develop and advance a national action plan. A Steering

Committee of nationally recognized experts in the field

are working with key stakeholders from public health,

communities, researchers, policy makers, medical 

professionals, businesses, and consumers to reach 

consensus on goals and to commit to specific strategies.

The development of a national plan to prevent

falls and related injuries is just the first step. To

ensure older adults benefit from this important work,

implementation will require a broad partnership

among stakeholder groups.
References

1. Dominick KL, Ahern FM, Gold CH, Heller DA. Health-related quality of life among older adults with activity-limiting health conditions.

Journal of Mental Health and Aging 2003;9(1):43–53.

2. Keller HH, Ostbye T, Goy R. Nutritional risk predicts quality of life in elderly community-living Canadians. Journals of Gerontology,

Series A, Biological Sciences and Medical Sciences 2004;59(1):68–74.

3. Centers for Disease Control and Prevention. Surveillance for sensory impairment, activity limitation, and health-related quality of life

among older adults—United States, 1993–1997. MMWR Surveillance Summaries 1999;48(No.SS-8):131–156. 

4. Centers for Disease Control and Prevention. Measuring Healthy Days. Atlanta, Georgia: U.S. Department of Health and Human

Services; 2000.

5. Milazzo-Sayre LJ, Henderson MJ, Manderscheid RW. Serious and severe mental illness and work: what do we know? In: Bonnie RJ,

Monahan J, eds. Mental Disorder, Work Disability, and the Law. Chicago, Illinois: University of Chicago Press; 1997.

6. Strine TW, Balluz LI, Chapman DP, Moriarty DG, Owens MG, Mokdad AH. Risk behaviors and health care coverage among adults by

frequent mental distress status, 2001. American Journal of Preventive Medicine 2004;26(3):213–216. 

7. Moriarty DG, Zack MM, Kobau R. The Centers for Disease Control and Prevention’s Healthy Days Measures – Population tracking of

perceived physical and mental health over time. Health and Quality of Life Outcomes 2003 (Sept 2);1(37):1–8. Available at

www.hqlo.com/content/1/1/37 (accessed 7/20/04).

8. Substance Abuse and Mental Health Services Administration. Kit links service providers to resources for older adults. SAMHSA News

2004 (May/June);12(3). Available at http://alt.samhsa.gov/samhsa_news/VolumeXII_3/article9.htm (accessed 7/21/04).

9. U.S. Public Health Service. Loss of teeth—United States, June 1957–June 1958. PHS Publ No 584-B22, Series B No. 22. Washington,

CD: Government Printing Office, 1960.

10. National Center for Health Statistics (NCHS). Third National Health and Nutrition Examination Survey (NHANES III) Reference Manuals

and Reports [CD-ROM]. Hyattsville, MD: U.S. Department of Health and Human Services; 1996.

11. Centers for Disease Control and Prevention. Health-related quality of life and activity limitation—eight states, 1995. Morbidity and

Mortality Weekly Report 1998-2; 47:239–244.

12. Chamie M. What does morbidity have to do with disability? Disability and Rehabilitation 1995;17(7):323–337.

13. Centers for Disease Control and Prevention. Public health and aging: trends in aging—United States and worldwide. Morbidity and

Mortality Weekly Report 2003;52(06):101–106.

14. Fries JF. Measuring and monitoring success in compressing morbidity. Annals of Internal Medicine 2003;139:455–459.

15. Stone EG, Morton SC, Hulscher ME, et al. Interventions that increase use of adult immunization and cancer screening services: a metaanalysis. Annals of Internal Medicine 2002;136:641–651.

16. U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: U.S.

Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease

Prevention and Health Promotion; 1996.

17. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Online Trends Database. Available at

http://apps.nccd.cdc.gov/brfss/Trends/TrendData.asp (accessed 6/21/04).

18. Centers for Disease Control and Prevention. Annual smoking-attributable mortality, years of potential life lost, and economic costs—

United States, 1995–1999. Morbidity and Mortality Weekly Report 2002;51(14):300–303.April 12, 2002 / 51(14);300-3. 

19. Centers for Disease Control and Prevention. Healthy Aging: Preventing Disease and Improving Quality of Life Among Older

Americans, At A Glance 2002. Atlanta, GA: U.S. Department of Health and Human Services, 2002.

20. Elder JP. Williams SJ. Drew JA. Wright BL. Boulan TE. Longitudinal effects of preventive services on health behaviors among an elderly

cohort. American Journal of Preventive Medicine. 11(6):354-9, 1995.

21. American Cancer Society. Breast Cancer Quick Facts. Available at

www.cancer.org/docroot/GI/content/GI_2_9_Breast_Cancer_Quick_Facts.asp?sitearea=GI (accessed June 22, 2004). 

22. Centers for Disease Control and Prevention. Breast Cancer and Mammography Information. Available at www.cdc.gov/cancer/nbccedp/info-bc.htm (accessed June 22, 2004).

23. American Cancer Society. Cancer Facts and Figures, 2003. Atlanta, Georgia: American Cancer Society; 2003 [publication no. 5008.03].

24. Centers for Disease Control and Prevention. Colorectal cancer test use among persons aged >50 Years – United States, 2001. Morbidity

and Mortality Weekly Report 2003;52(10);193–196.

25. National Institutes of Health. National Cholesterol Education Program. Available at

www.nhlbi.nih.gov/health/prof/heart/other/hm_sp00/ncep.htm (accessed 6/21/04).

26. Wolinsky FD, Fitzgerald JF, Stump TE. The effect of hip fracture on mortality, hospitalization, and functional status: a prospective

study. American Journal of Public Health 1997;87(3):398–403.

27. Hall SE, Williams JA, Senior JA, Goldswain PR, Criddle RA. Hip fracture outcomes: quality of life and functional status in older adults

living in the community. Australian and New Zealand Journal of Medicine 2000;30(3):327–332.

28. Lu-Yao GL, Baron JA, Barrett JA, Fisher ES. Treatment and survival among elderly Americans with hip fracture: a population-based

study. American Journal of Public Health 1994;84(8):1287–1291.

29. Magaziner J, Hawkes W, Hebel JR, et al. Recovery from hip fracture in eight areas of function. Journal of Gerontology: Medical

Sciences 2000;55A(9):M498–M507.

15

17

The State-by-State Report Card

on Healthy Aging 

This section includes the report card for the 50 states and the District of Columbia. Table 2 presents, for

each indicator, the best- and worst-ranked states and how many states met each target. Table 3 

displays the most current data for each indicator by state, ranks the states, and assigns a grade of 

either “pass” or “fail” to each state based on Healthy People 2000 targets.

Summary of Findings: 

There is considerable variation

among the states for each 

indicator, and mixed progress

has been made since The State 

of Aging and Health in America

2002 report was released:

• No states met all the targets.

• Hawaii was most often the

ranked in the top five. 

• Thirty-seven states met the

target for pneumonia vaccine

this year, compared to only 

1 state in the 2002 report.

• All states are now meeting the

colorectal cancer screening

goal in Healthy People 2000.

• Variation among states can 

be significant. For example, 

in California and Hawaii,

which tied to rank best in the 

category of permanent tooth

loss, only 13.2% of older

adults had lost all of their

teeth—while Kentucky ranked

last in that category, with

42.5% of older adults experiencing complete tooth loss.

Data Healthy People Number of States Worst Ranked Best Ranked

Indicator Year* 2000 Target Meeting Target† State State

Health Status 

1. Physically unhealthy days (mean 2001 ‡ ‡ West Virginia Hawaii (3.0)

number of days in past month) (8.6)

2. Frequent mental distress (%)ç 2000-2001 ‡ ‡ Kentucky (11.8) Iowa (4.0)

3. Oral health: Complete 2002 20 15 Kentucky (42.5) California, Hawaii

tooth loss (%) (13.2)

4. Disability (%)ƒ 2001 ‡ ‡ Kentucky (39.1) Hawaii (21.2)

Health Behaviors

5. No leisure time physical activity 2002 22 2 Tennessee Hawaii (19.5)

in past month (%) (47.9)

6. Eating 5+ fruits and vegetables 2002 50 0 Louisiana Virginia (41.3)

daily (%) (21.0)

7. Obesity (%)¶ 2002 ‡ ‡ Michigan (25.2) Hawaii (11.7)

8. Current smoking (%) 2002 15 48 Kentucky (16.9) Utah (4.8)

Preventive Care & Screening

9. Flu vaccine in past year (%) 2002 60 47 Florida (57.0) Minnesota (76.6)

10. Ever had pneumonia 2002 60 37 DC (48.0) North Dakota

vaccine (%) (72.5)

11. Mammogram within past 2002 60 51 Oklahoma (68.4) Rhode Island

2 years (%) (85.8)

12. Ever had sigmoidoscopy or 2002 40 51 Nebraska Minnesota (75.3)

colonoscopy (%) (47.1)

13. Up to date on select 

preventive services (%)#

Male 2002 ‡ ‡ Missouri (25.9) Minnesota (50.7)

Female 2002 ‡ ‡ Louisiana (24.7) Minnesota (50.1)

14. Cholesterol checked within 2001 75 51 Idaho (77.2) DC (92.9)

past 5 years (%)

Injuries**

TABLE 2. STATE-BY-STATE REPORT CARD ON HEALTHY AGING

* Data for Indicators 1-14 were collected by CDC’s Behavioral Risk Factor Surveillance System (BRFSS). See Appendix for a full description of this data source.

† Includes 50 states and the District of Columbia. 

‡ Indicators 1, 2, 4, and 13 are more recently developed measures, and as such, do not have Healthy People 2000 targets. Data related to Indicator 7, Obesity, were combined with the 

Overweight category in Healthy People 2000, and therefore Obesity has no individual target. 

ç Frequent mental distress is defined as having had 14 or more mentally unhealthy days in the previous month. Data from the 2000 and 2001 BRFSS are combined here to get a 

sufficient sample size. 

ƒ Disability was defined on the basis of an affirmative response to either of the following two questions on the 2001 BRFSS: “Are you limited in any way in any activities because of physical, 

mental, or emotional problems?” or “Do you now have any health problem that requires you to use special equipment, such as a cane, wheelchair, a special bed, or a special telephone?”

¶ Healthy People 2000 defined a target for overweight, but not obesity. Because current standards separate these two conditions, obesity data are included in this report.

# For men, three services are included: flu vaccine in past year, ever had a pneumonia vaccine, and ever had sigmoidoscopy or colonoscopy. For women, these same three services plus a 

mammogram within past two years are included.

** There are no state-level data for Indicator 15, hip fracture hospitalizations.
18

7.7 49 9.0 49 29.9 42 Fail 37.9 48 36.3 39 Fail

3.7 2 6.0 18 24.4 32 Fail 29.1 14 32.5 24 Fail

5.9 40 7.3 38 19.4 12 Pass 33.3 38 26.9 7 Fail

7.7 49 7.7 46 29.2 41 Fail 37.8 47 38.2 42 Fail

5.1 12 5.9 17 13.2 1 Pass 29.7 17 25.8 6 Fail

5.7 33 6.8 35 18.7 10 Pass 25.4 4 25.5 5 Fail

5.1 12 5.2 9 15.9 5 Pass 27.8 9 31.1 17 Fail

5.5 24 6.3 28 25.0 36 Fail 23.6 3 33.9 29 Fail

5.2 17 8.3 47 16.7 7 Pass 27.5 7 33.4 27 Fail

4.7 5 5.9 16 20.9 18 Fail 26.3 5 35.8 36 Fail

5.8 38 6.7 32 31.7 44 Fail 27.9 10 36.2 38 Fail

3.0 1 4.4 3 13.2 1 Pass 21.2 1 19.5 1 Pass 

4.9 8 6.3 29 22.0 24 Fail 30.0 18 29.1 9 Fail

4.9 8 6.4 30 23.7 30 Fail 32.0 31 38.8 46 Fail

6.4 44 5.7 13 24.3 31 Fail 32.2 33 38.4 44 Fail

4.7 5 4.0 1 21.1 21 Fail 29.5 16 34.3 30 Fail

5.2 17 6.3 26 22.4 26 Fail 28.4 12 31.8 20 Fail

5.7 33 11.8 51 42.5 51 Fail 39.1 51 38.8 46 Fail

5.3 21 6.8 34 31.9 45 Fail 30.9 23 40.6 50 Fail

5.3 21 7.7 45 30.1 43 Fail 31.2 26 36.3 39 Fail

5.2 17 5.8 15 19.5 14 Pass 30.3 19 31.7 19 Fail

5.8 38 7.4 39 22.7 27 Fail 31.1 24 32.0 22 Fail

5.7 33 5.7 13 18.5 8 Pass 32.2 34 33.5 28 Fail

5.3 21 4.3 2 14.2 3 Pass 29.4 15 21.3 2 Pass 

7.5 48 6.1 20 34.2 48 Fail 38.4 50 38.6 45 Fail

5.5 24 6.1 19 26.0 40 Fail 30.8 22 39.6 48 Fail

4.4 3 4.9 7 20.9 18 Fail 31.4 27 30.2 15 Fail

4.5 4 6.3 25 25.3 37 Fail 32.1 32 29.7 12 Fail

5.6 31 7.6 42 20.5 16 Fail 31.9 30 30.0 14 Fail

4.8 7 4.7 5 21.5 22 Fail 28.5 13 31.3 18 Fail

5.0 11 6.2 22 20.0 15 Pass 23.4 2 31.8 20 Fail

6.3 43 8.3 48 24.7 35 Fail 33.6 39 29.3 11 Fail

5.9 40 7.5 41 18.5 8 Pass 32.6 36 35.5 33 Fail

7.1 47 7.6 43 32.4 46 Fail 34.2 42 39.9 49 Fail

5.1 12 4.7 6 22.9 28 Fail 31.5 28 29.9 13 Fail

5.2 17 5.4 12 23.5 29 Fail 27.6 8 35.7 35 Fail

6.8 45 6.7 33 32.9 47 Fail 35.8 44 38.2 42 Fail

5.6 31 6.2 23 18.8 11 Pass 37.8 46 24.2 4 Fail

5.7 33 5.2 10 25.3 37 Fail 30.6 21 35.2 32 Fail

5.5 24 7.4 39 22.2 25 Fail 26.8 6 35.6 34 Fail

6.2 42 7.6 43 24.6 33 Fail 31.1 24 29.2 10 Fail

5.5 24 6.2 21 24.6 33 Fail 34.1 41 32.9 26 Fail

5.1 12 4.6 4 35.6 49 Fail 28.3 11 47.9 51 Fail

5.5 24 6.9 37 19.4 12 Pass 30.5 20 34.6 31 Fail

4.9 8 6.2 24 14.5 4 Pass 32.4 35 32.7 25 Fail

5.5 24 6.9 36 21.6 23 Fail 31.7 29 32.3 23 Fail

6.9 46 6.3 26 21.0 20 Fail 33.9 40 36.6 41 Fail

5.7 33 5.4 11 16.5 6 Pass 37.7 45 23.3 3 Fail

8.6 51 10.0 50 41.3 50 Fail 38.3 49 36.1 37 Fail

5.1 12 6.6 31 20.5 16 Fail 32.9 37 27.7 8 Fail

5.5 24 5.2 8 25.5 39 Fail 34.5 43 30.7 16 Fail

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

Dist. of Columbia

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

Physically Unhealthy

Days (mean number

of days in past month)

2001

Frequent Mental

Distress† (%)

2000-2001

Oral Health: Complete

Tooth Loss (%)

2002

Disability† (%)

2002

No Leisure-Time

Physical Activity

(%) 2002

TABLE 3. STATE-BY-STATE REPORT CARD ON HEALTHY AGING*

Data Rank Grade Data Rank Grade Data Rank Grade Data Rank Grade Data Rank Grade

N/A‡ N/A‡ N/A‡

* Grades based on the attainment of Healthy People 2000 targets. See Appendix for full description of these targets.

† Defined in Table 2. 

‡ Indicators 1, 2, 4, and 13 are more recently developed measures, and as such, do not have Healthy People 2000 targets. Data related to Indicator 7, obesity, were combined with

the overweight category in Healthy People 2000, and therefore obesity has no individual Healthy People 2000 target.

NOTE: Rankings are based on the relative numeric scores for each indicator, with a ranking of “1” representing the greatest achievement.

Source: CDC Behavioral Risk Factor Surveillance System. See Appendix for full description of this data source.
19

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

Dist. of Columbia

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

Eating 5 or More

Fruits and Vegetables

Daily (%)

2001

Obesity† (%)

2002

Current Smoking (%)

2002

Flu Vaccine in Past

Year (%)

2002

Ever Had

Pneumonia Shot

(%) 

2002

Data Rank Grade Data Rank Grade Data Rank Grade Data Rank Grade Data Rank Grade

28.4 40 Fail 21.4 35 12.0 38 Pass 64.8 42 Pass 58.5 42 Fail

31.9 29 Fail 23.8 48 15.7 50 Fail 69.5 22 Pass 59.8 38 Fail

35.8 9 Fail 14.7 4 9.7 22 Pass 69.7 21 Pass 68.0 6 Pass

32.0 28 Fail 18.0 16 11.1 34 Pass 69.0 25 Pass 58.7 41 Fail

35.6 10 Fail 19.1 22 9.9 24 Pass 71.5 15 Pass 66.7 10 Pass

33.0 21 Fail 13.2 2 9.1 14 Pass 73.3 10 Pass 68.1 5 Pass

36.0 8 Fail 17.6 13 9.4 16 Pass 71.4 17 Pass 64.5 18 Pass

26.2 46 Fail 23.6 47 9.8 23 Pass 71.5 15 Pass 64.3 19 Pass

40.7 2 Fail 22.7 40 10.1 25 Pass 58.7 49 Fail 48.0 51 Fail

33.3 19 Fail 17.2 11 9.2 15 Pass 57.0 51 Fail 57.2 45 Fail

26.9 45 Fail 22.4 38 10.8 31 Pass 59.3 48 Fail 57.3 44 Fail

24.7 48 Fail 11.7 1 7.3 3 Pass 73.9 4 Pass 59.5 39 Fail

35.1 12 Fail 17.1 10 8.4 8 Pass 65.1 40 Pass 57.5 43 Fail

29.0 38 Fail 23.5 46 11.8 37 Pass 61.1 45 Pass 56.7 47 Fail

31.0 30 Fail 20.7 30 11.5 36 Pass 66.3 35 Pass 61.2 34 Pass

33.3 19 Fail 23.3 44 7.1 2 Pass 73.5 9 Pass 66.2 12 Pass

29.3 36 Fail 18.5 18 10.6 28 Pass 68.6 27 Pass 62.1 31 Pass

28.2 41 Fail 22.0 37 16.9 51 Fail 65.7 38 Pass 56.6 49 Fail

21.0 51 Fail 25.1 50 11.0 32 Pass 57.3 50 Fail 56.3 50 Fail

38.8 3 Fail 19.0 20 7.6 4 Pass 73.8 6 Pass 66.8 9 Pass

36.5 6 Fail 16.1 7 12.0 38 Pass 65.9 36 Pass 63.4 23 Pass

35.1 12 Fail 18.8 19 8.6 10 Pass 72.6 12 Pass 63.4 23 Pass

33.0 21 Fail 25.2 51 8.6 10 Pass 67.7 31 Pass 63.0 26 Pass

33.4 18 Fail 19.5 26 8.6 10 Pass 76.6 1 Pass 70.4 3 Pass

22.9 49 Fail 20.8 31 14.0 47 Pass 63.0 44 Pass 58.9 40 Fail

29.1 37 Fail 21.4 35 12.1 40 Pass 68.7 26 Pass 60.8 36 Pass

29.5 34 Fail 13.8 3 12.8 44 Pass 67.7 31 Pass 67.3 8 Pass

28.1 42 Fail 21.2 34 10.6 28 Pass 68.2 28 Pass 61.3 33 Pass

27.7 43 Fail 20.8 31 15.3 49 Fail 60.3 47 Pass 65.0 14 Pass

37.6 4 Fail 17.4 12 9.4 16 Pass 72.3 13 Pass 63.8 20 Pass

33.8 16 Fail 16.3 8 9.5 19 Pass 69.1 24 Pass 63.1 25 Pass

29.5 34 Fail 16.7 9 11.4 35 Pass 66.6 33 Pass 62.7 29 Pass

32.8 23 Fail 22.7 40 10.7 30 Pass 64.7 43 Pass 62.4 30 Pass

26.0 47 Fail 22.9 43 14.0 47 Pass 68.1 29 Pass 63.0 26 Pass

32.8 23 Fail 23.4 45 8.2 6 Pass 73.9 4 Pass 72.5 1 Pass

28.7 39 Fail 22.8 42 12.3 41 Pass 66.6 33 Pass 63.7 21 Pass

22.0 50 Fail 17.9 15 11.0 32 Pass 72.7 11 Pass 65.5 13 Pass

33.9 15 Fail 15.8 6 9.4 16 Pass 68.0 30 Pass 65.0 14 Pass

33.7 17 Fail 24.7 49 9.6 21 Pass 70.5 20 Pass 63.5 22 Pass

37.1 5 Fail 19.3 24 8.6 10 Pass 73.7 7 Pass 67.6 7 Pass

30.5 33 Fail 20.4 29 10.1 25 Pass 69.4 23 Pass 64.9 17 Pass

32.4 26 Fail 18.0 16 8.5 9 Pass 74.2 2 Pass 56.7 47 Fail

32.1 27 Fail 19.0 20 12.6 43 Pass 71.6 14 Pass 61.4 32 Pass

34.1 14 Fail 22.5 39 12.9 46 Pass 61.0 46 Pass 56.9 46 Fail

32.7 25 Fail 19.4 25 4.8 1 Pass 71.1 18 Pass 65.0 14 Pass

35.4 11 Fail 19.2 23 7.6 4 Pass 73.6 8 Pass 66.3 11 Pass

41.3 1 Fail 19.7 28 10.2 27 Pass 65.3 39 Pass 60.8 36 Pass

30.6 32 Fail 17.8 14 9.5 19 Pass 65.1 40 Pass 63.0 26 Pass

27.7 43 Fail 20.9 33 12.3 41 Pass 65.8 37 Pass 61.2 34 Pass

36.4 7 Fail 19.6 27 8.3 7 Pass 74.0 3 Pass 70.6 2 Pass

30.9 31 Fail 15.6 5 12.8 44 Pass 70.6 19 Pass 68.2 4 Pass

N/A‡
20

* Grades based on the attainment of Healthy People 2000 targets. See Appendix for full description of these targets.

† Defined in Table 2.

‡ Indicators 1, 2, 4, and 13 are more recently developed measures, and as such, do not have Healthy People 2000 targets. Data related to Indicator 7, obesity, were combined

with the overweight category in Healthy People 2000, and therefore obesity has no individual Healthy People 2000 target.

NOTE: Rankings are based on the relative numeric scores for each indicator, with a ranking of “”1”” representing the greatest achievement.

Source: CDC Behavioral Risk Factor Surveillance System. See Appendix for full description of this data source.

Mammogram in 

Past 2 Years (%)

2002

Ever Had

Sigmoidoscopy or

Colonoscopy† (%)

2002

Up-to-date on Select

Preventive Services

(men) (%) 

2002

Up-to-date on Select

Preventive Services

(women) (%) 

2002

Cholesterol 

Check in past 5

years (%) 

2001

Data Rank Grade Data Rank Grade Data Rank Grade Data Rank Grade Data Rank Grade

TABLE 3. CONTINUED

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

Dist. of Columbia

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

N/A‡ N/A‡

80.1 15 Pass 55.4 32 Pass 32.5 34 31.0 37 85.4 25 Pass

76.6 33 Pass 68.6 3 Pass 26.4 50 44.3 2 82.6 38 Pass

81.0 11 Pass 62.2 13 Pass 46.4 3 35.5 17 85.6 24 Pass

68.4 50 Pass 50.9 44 Pass 33.9 29 31.6 34 83.2 35 Pass

80.7 12 Pass 62.2 13 Pass 43.9 8 38.5 11 82.6 38 Pass

75.2 35 Pass 61.0 19 Pass 45.4 4 32.5 29 82.2 41 Pass

81.9 7 Pass 63.3 10 Pass 42.5 10 39.6 6 86.7 16 Pass

83.3 2 Pass 62.8 11 Pass 37.5 19 37.7 12 86.4 18 Pass

82.7 5 Pass 71.4 2 Pass 29.1 43 31.8 32 92.9 1 Pass

81.8 8 Pass 61.2 17 Pass 33.4 32 34.3 23 91.2 4 Pass

77.5 25 Pass 57.9 27 Pass 30.4 41 28.9 43 81.2 44 Pass

72.4 42 Pass 48.2 49 Pass 32.7 33 32.1 31 92.2 2 Pass

70.3 46 Pass 56.1 31 Pass 31.2 40 31.2 36 77.2 51 Pass

78.0 22 Pass 52.2 41 Pass 27.3 47 28.1 46 83.8 33 Pass

72.9 40 Pass 50.5 45 Pass 29.9 42 27.3 49 84.6 31 Pass

76.7 31 Pass 57.5 29 Pass 36.3 22 38.9 9 82.5 40 Pass

80.1 15 Pass 53.8 36 Pass 40.8 14 29.4 40 83.2 35 Pass

77.2 26 Pass 51.7 42 Pass 31.5 38 27.0 50 86.4 18 Pass

79.6 18 Pass 48.4 48 Pass 28.4 46 24.7 51 89.3 7 Pass

82.8 4 Pass 57.9 27 Pass 41.6 12 33.4 26 87.9 13 Pass

77.6 24 Pass 63.9 9 Pass 44.6 6 29.3 41 89.9 6 Pass

82.3 6 Pass 61.1 18 Pass 41.2 13 37.7 12 89.2 8 Pass

79.4 19 Pass 65.9 6 Pass 42.3 11 34.4 22 87.6 14 Pass

81.2 9 Pass 75.3 1 Pass 50.7 1 50.1 1 81.2 44 Pass

69.4 47 Pass 53.1 38 Pass 26.5 49 29.6 39 81.2 44 Pass

72.6 41 Pass 50.2 46 Pass 25.9 51 31.7 33 83.2 35 Pass

73.8 39 Pass 58.9 23 Pass 36.2 23 39.5 7 80.0 49 Pass

73.9 38 Pass 47.1 51 Pass 27.1 48 29.2 42 80.6 48 Pass

76.9 29 Pass 58.3 26 Pass 32.3 36 35.0 20 84.9 29 Pass

79.7 17 Pass 59.6 21 Pass 36.5 21 35.5 17 85.1 28 Pass

74.8 36 Pass 56.4 30 Pass 34.4 26 34.6 21 88.2 12 Pass

71.9 43 Pass 55.4 32 Pass 37.8 18 31.5 35 83.8 33 Pass

77.7 23 Pass 59.7 20 Pass 39.9 17 28.5 44 88.5 11 Pass

81.1 10 Pass 53.5 37 Pass 37.1 20 35.2 19 86.4 18 Pass

78.7 21 Pass 64.1 8 Pass 45.1 5 40.9 4 86.1 21 Pass

77.1 27 Pass 52.5 40 Pass 31.4 39 33.6 24 85.4 25 Pass

68.4 50 Pass 50.2 46 Pass 35.4 25 27.8 47 84.7 30 Pass

83.0 3 Pass 66.3 5 Pass 34.0 27 42.2 3 78.6 50 Pass

77.0 28 Pass 55.4 32 Pass 34.0 27 33.5 25 87.5 15 Pass

85.8 1 Pass 62.3 12 Pass 40.7 15 39.5 7 91.5 3 Pass

80.5 13 Pass 59.3 22 Pass 40.0 16 36.6 15 88.6 9 Pass

76.5 34 Pass 51.5 43 Pass 32.5 34 27.8 47 84.1 32 Pass

74.3 37 Pass 52.7 39 Pass 33.5 31 30.8 38 85.7 22 Pass

70.6 45 Pass 58.5 25 Pass 29.1 43 32.3 30 85.7 22 Pass

70.8 44 Pass 61.7 16 Pass 43.6 9 32.8 27 81.4 42 Pass

78.9 20 Pass 62.2 13 Pass 46.5 2 37.7 12 85.3 27 Pass

76.7 31 Pass 58.8 24 Pass 32.3 36 32.7 28 86.6 17 Pass

76.8 30 Pass 66.6 4 Pass 36.1 24 38.7 10 80.9 47 Pass

69.3 48 Pass 48.2 49 Pass 28.6 45 28.5 44 90.1 5 Pass

80.3 14 Pass 65.4 7 Pass 44.4 7 40.6 5 81.4 42 Pass

69.0 49 Pass 55.4 32 Pass 33.6 30 35.6 16 88.6 9 Pass
Regular physical activity can have substantial physical and mental health benefits for people of all

ages. However, our knowledge of the benefits of physical activity for older adults has not yet been

fully translated into action.1

Spotlight: Physical Activity and

Older Americans 

21

Benefits of Physical Activity

Physical Health Benefits

A strong body of scientific evidence shows that physical

activity can help older people maintain their health and

functional abilities. The following are examples of these

benefits:

• Regular physical activity can help reduce a person’s

risk for cardiovascular disease by increasing levels of

high-density lipoprotein (HDL) cholesterol, sometimes called the “good cholesterol.” Middle-aged and

older men and women who are regularly active have

significantly higher HDL cholesterol levels than those

who are sedentary.1

• Regular physical activity can help prevent the 

development of diabetes, high blood pressure, and

colon cancer and can reduce a person’s risk of dying

prematurely.2

• Balance training can help to prevent falls among older

people by helping them maintain and improve their

balance.3

• Regular physical activity helps maintain healthy bones

and muscles. It can also help to increase joint mobility

and improve the functional capacity of people with

osteoarthritis.2

Mental Health Benefits

Just as physical activity can reduce the risk of coronary

heart disease, type 2 diabetes, colon cancer, and other

chronic diseases and disabilities, it can also reduce the

risk of distress, anxiety and depression that may accompany these conditions. Physical activity can also help

alleviate symptoms of depression and anxiety from other

causes and improve the quality of life of older adults by

enhancing their psychological well-being.2 According to

Mental Health: A Report of the Surgeon General, 8%–20%

of older adults in the community and up to 37% in 

primary health care settings have symptoms of depression.4

Social support, a key component of good mental

health, has been consistently associated with being 

regularly physically active, and this relationship seems 

to be reciprocal: social support from friends and family

members may help older people be more physically

active, and being physically active can help older people

build their social networks. 

There is also evidence that higher levels of physical

activity and physical fitness are associated with better

cognitive functioning, including more efficient processing

necessary to perform complex cognitive tasks. However,

research is needed to determine to what extent these 

scientific findings relate to the performance of 

routine daily activities among older adults.5, 6
22

Financial Benefits

The many benefits of physical activity for older adults

extend beyond better health, improved functioning, and

increased quality of life to include significantly reduced

health care costs. Increasing physical activity could reduce

direct medical costs by $77 billion annually (in 2000 

dollars). Inactive adults have significantly higher direct

medical costs than active adults, and the costs associated

with physical inactivity increase with age, especially for

women (Figure 10).7 According to data from the 1987

National Medical Expenditures Survey, inactive women

45 years of age and older had at least double the health

care costs of their active counterparts.8

The impact of a lack of physical activity on medical

care costs is likely to grow as a result of an aging 

population, unless trends in physical activity change.

Among adults age 65 years and older, 95% of all health

care spending is for chronic diseases such as diabetes,

heart disease and stroke, cancer and arthritis. Because

physical activity can help prevent and control many of

these conditions, increasing physical activity among older

Americans has potential for reducing the financial burden

of chronic diseases.

In addition, fall-related injuries among older people

cost the nation more than $20 billion each year. By 2020,

the total annual cost of these injuries is expected to reach

$32.4 billion.6 By improving balance and muscle

strength, physical activity can reduce an older person’s

risk of falling and thus further reduce medical costs.1, 3

Trends in Physical Activity

CDC’s Behavioral Risk Factor Surveillance System

(BRFSS) data show that the percentage of older adults

who meet the recommended level of physical activity

(i.e., 30 minutes of moderate intensity activity, such as

brisk walking, five or more days per week) increased

modestly from 1988 to 2000 but is still relatively low

(Figure 11). The percentage of men age 65 years and

older who met the recommended level increased from

27.6% in 1988 to 35.1% in 2000. Women had consistently

lower levels of recommended activity than men and

showed less of an increase over time (from 23.4% in

1988 to 26.6% in 2000). These data suggest that, while

all older adults could benefit from increased levels of

physical activity, initially focusing interventions on older

women could help to reduce the disparity between the

sexes. 

Levels of Physical Activity in Selected

Local Areas

The BRFSS recently developed the Selected

Metropolitan/Micropolitan Area Risk Trends (SMART)

project, which provides local-level data that can be used

to track trends, identify health issues in the community,

and develop and evaluate health programs and policies.

The data available through this project include the levels

of physical activity among adults in participating 

metropolitan/micropolitan statistical areas (MMSAs). 

Figure 12 shows the levels of physical activity 

(recommended, insufficient, and inactive) among older

adults in a selected group of geographically diverse

MMSAs that asked the physical activity questions in

2002. Among these eight selected areas, PhoenixMesa-Scotsdale, AZ, had the highest percentage (43.2%)

of older adults meeting recommended levels of physical

activity, and St. Louis, MO, had the lowest percentage

f.10

IN 1987, MEDICAL COSTS ROSE WITH

INCREASING AGE, ESPECIALLY FOR 

INACTIVE WOMEN

Source: Pratt M, Macera CA, Wang G. Higher Direct Medical Costs Associated

with Physical Inactivity. The Physician and Sportsmedicine 28; No. 10, 2000; 63-70.

5000

4000

3000

2000

1000

0

45-54

6000

55-64 65-74 75+

Active women

Inactive women

Age group

Medical costs ($)

f.11

MORE MEN THAN WOMEN AGE 65 

AND OVER ARE ENGAGING IN 

RECOMMENDED* LEVELS OF PHYSICAL

ACTIVITY DURING THEIR LEISURE TIME

* Moderate intensity physical activity for >=5 days per week for >= 30 minutes each time.

Source: CDC, Behavioral Risk Factor Surveillance System, 1988-2000. 1988

40%

35%

30%

25%

20%

15%

10%

5%

0%

Men

Women

1989199019911992199319941995

1996

1997199819992000
(27.5%). The highest percentage of inactive seniors

(30.3%) was found in the Chicago-Naperville-Joliet, IL

MMSA, whereas Phoenix-Mesa-Scotsdale and Honolulu

each had only 14.7% of seniors reporting inactivity. 

Activity Patterns

The 2000 BRFSS asked respondents to report the two

physical activities or exercises that they had participated

in the most during the past month. Nearly 70% of

physically active older adults reported walking as the

type of physical activity or exercise they had spent the

most time doing during the past month. The next most

common physical activities were gardening (reported by

9.6%), bicycling (3.9%), home exercises (3.3%), and golf

(2.8%). About 12% of older adults reported participating

in other types of activities, which included aerobics classes,

swimming, weight lifting, running/jogging and tennis

(Figure 13). These data can help planners in health

departments, area agencies on aging, senior centers,

community agencies and other organizations as they

decide what types of physical activity programs to offer

older adults.

f.12

**Recommended physical activity is defined as reported moderate-intensity activities in

a usual week (i.e., brisk walking, bicycling for at least 30 minutes per day, at least 

5 days per week.) Insufficient physical activity is defined as doing more than 10 

minutes total per week of moderate intensity lifestyle activities, but less than the 

recommended level of activity. Inactivity is defined as less than 10 minutes total per

week of moderate intensity lifestyle activities.

Source: CDC Behavioral Risk Factor Surveillance System, 2002

PHYSICAL ACTIVITY LEVELS VARY BY

METROPOLITAN/MICROPOLITAN

STATISTICAL AREAS

Ashville, NC

Baltimore, MD

ChicagoNapervilleJoilet, IL

Denver-Aurora,

CO

Hartford, CT

Honolulu, HI

Phoenix-MesaScotsdale, AZ

St. Louis, MO

Inactive

Insufficient

Recommended**

0%

10%20%30%40%

50%

60%

f.13 OLDER ADULTS ENGAGE IN A VARIETY

OF PHYSICAL ACTIVITIES

Source: CDC, Behavioral Risk Factor Surveillance System, 2000

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

68.3%

9.6%

3.9%

2.8%

3.3%

12.1%

Other

Home Exercise

Golf

Bicycling

Gardening

Walking

23

27.6%

37.4%

41.9%

54.7%

40.2%

43.1%

34.0%

39.9%

36.8%

17.9%

16.1%

23.7%

24.2%

36.6%

28.4%

27.8%

31.8%

23.7%

24.2%

35.1%

18.0%

32.0%

25.0%

23.3%
24

CALL TO ACTION: INCREASING PHYSICAL ACTIVITY

Strategies to increase physical activity among older

adults

Despite ample evidence of the benefits of regular physical activity for older adults, most seniors do not achieve 

recommended levels of physical activity. The challenge,

and the opportunity, is to make physical activity more

accessible to older adults of all ages, abilities and interests. 

In 2001, the National Blueprint: Increasing Physical

Activity Among Adults Age 50 and Older1

(www.agingblueprint.org) was released as a joint effort of

many organizations. The publication was sponsored by

AARP, the American College of Sports Medicine, the

American Geriatrics Society, CDC, the National

Institute on Aging, and the Robert Wood Johnson

Foundation; approximately 50 other organizations 

provided input and support. This planning document

provides background information on the importance of

physical activity, identifies barriers to increasing physical

activity among older adults and recommends numerous

strategies for overcoming these barriers and helping

older adults be more physically active. 

In 2002, National Blueprint partners prioritized the

strategies and selected 18 of them (the top three in six 

different program areas). National organizations have

been selected to take the lead for each strategy as tactics

are developed and implemented over the next 12 to 24

months. These are described in a new document,

Strategic Priorities for Increasing Physical Activity Among

Adults Age 50 and Over: The National Blueprint Consensus

Conference Summary Report, which is available at

www.agingblueprint.org/StrategicPriorities.cfm.9

While these 18 nationally-focused strategies are

being implemented, there remain additional strategies

from the initial Blueprint document that states, 

communities, program planners, researchers, policy

makers and health care providers can put into practice 

to increase physical activity among their own populations.

The following is a sampling of what can be done at the

local level:

Research Strategies

• Identify barriers to walking for adults age 50 and older,

determine why these barriers exist, and develop specific

recommendations for how to overcome them.

Home and Community Strategies

• Establish partnerships among health, aging,

urban/community planning, transportation, 

environmental groups, recreation, social services and 

the private sector. Encourage these groups to work

together to define, create, promote and sustain 

communities that support lifelong physical activity.

Workplace Strategies

• Provide financial incentives for employers to incorporate

facilities that offer opportunities for physical activity

into their corporate land-use plans.

• Communicate to business leaders the benefits of physical

activity for older workers, especially those that support

management goals (e.g. cost-savings, reduced employee

absenteeism).

Medical Systems Strategies

• Identify community resources (e.g., YMCAs/YWCAs,

certified trainers, fitness clubs, etc.) that are quality

sources of information related to physical activity for

midlife and older adults, and share this information

through medical settings.

Policy/Advocacy Strategies

• Channel tools and funds to communities so they can

implement actions to increase physical activity among

residents age 50 and older. 

• Provide funding to community organizations to make

physical activity opportunities more readily accessible

and available to low-income populations. 

PROGRAMS THAT WORK

As part of the Blueprint project, a variety of national-level

activities have been initiated to identify programs that

successfully increase seniors’ levels of physical activity.

For example, in 2002, the National Council on the

Aging’s (NCOA) Center for Healthy Aging, with support

from the Robert Wood Johnson Foundation, conducted a

national competition to identify best practices in physical

activity programming. After a thorough review, 10 programs were awarded $1,000 and a certificate of achievement. For more information on this project, please visit

www.healthyagingprograms.org. 

1. Lifetime Fitness Program

One of the 10 programs selected by NCOA was the

Seattle/King County, WA-based Lifetime Fitness

Program. This evidence-based physical activity program

provides seniors with low-cost fitness classes taught by

certified fitness instructors. The one-hour classes meet

three times per week in ongoing, five-week sessions. The

classes include strength training with wrist and ankle

weights, as well as aerobics, stretching, and balancing

exercises. The program is designed to be safe and effective

for seniors with a wide range of physical abilities. This 
program began as a partnership between Senior Services of

Seattle/King County, Group Health Cooperative of Puget

Sound, and the University of Washington Health Promotion

Research Center, but now is being replicated in sites across

the U.S. Studies have shown a marked improvement in

participants’ physical and social functioning, as well as a

decline in areas such as pain, fatigue and depression.10

For information on this program, visit their website:

www.seniorservices.org/wellness/replication.htm.

2. PACE: People with Arthritis Can Exercise

PACE is an exercise program that was developed by the

Arthritis Foundation specifically for people with arthritis.

It uses gentle activities to help increase joint flexibility and

range of motion to maintain muscle strength. Two levels

of PACE, basic and advanced, are available to address the

varying levels of fitness and limitation among those with

arthritis. PACE participants have experienced such 

benefits as increased functional ability, increased self-care

behaviors, decreased pain and decreased depression.11

Trained leaders are required to implement this

course. For help in identifying trained leaders in your

area or for information on how to become a trained

leader, contact the Arthritis Program Director at the

state health department or the state/local Arthritis

Foundation Chapter. (For a listing of directors by state,

visit www.chronicdisease.org/NEW/cdd_members.htm.

For a listing of chapters, visit www.arthritis.org.)

3. Exercise: A Guide from the National Institute 

on Aging

The National Institute on Aging has developed a manual

and companion video that guides older adults through

safe and effective endurance, strength training, balance

and flexibility exercises. The program can be completed

on an individual basis or in a group setting. The 80-page

manual is available online for free, or may be ordered

along with the video for a cost of $7.00. The video 

features Margaret Richard, star of PBS’ exercise show

Body Electric. A Spanish language version is also 

available. For more information, visit 

www.nia.nih.gov/exercisebook/index.htm. 

Selected Additional Resources

For additional information on the importance of physical

activity and programs for older adults, please refer to the

following internet-based resources:

AARP Get Movin’ at 50 Plus

www.aarp.org/learn/course/Articles/a2003-06-13-

keepactivedescription.html

Administration on Aging’s You Can! Program

www.aoa.gov/youcan/

American Association for Active Lifestyles and Fitness

(AAALF) Training and Encouraging Senior Activity (TESA)

Project

www.aahperd.org/aaalf/template.cfm?template=tesa.html

American Society on Aging/CDC Media Backgrounder on

Physical Activity

www.asaging.org/media/pressrelease.cfm?id=40

Arthritis Foundation PACE Program

www.arthritis.org/events/getinvolved/ProgramsServices/

PACE.asp

Boston University Strong For Life Program

www.bu.edu/roybal/products/life.html

CDC Division of Nutrition and Physical Activity Growing

Stronger Program 

www.cdc.gov/nccdphp/dnpa/physical/growing_stronger/

index.htm

CHAMPS: Community Healthy Activities Model Program

for Seniors

www.ucsf.edu/champs/

Healthier U.S.

www.healthierUS.gov

Lifetime Fitness Program

www.seniorservices.org/wellness/replication.htm

National Blueprint: Increasing Physical Activity Among

Adults Age 50 and Older

www.agingblueprint.org

NCOA Best Practices in Physical Activity Programming

www.healthyagingprograms.org

NIA Exercise Guide for Older Adults

www.nia.nih.gov/exercisebook/index.htm

Silver Sneakers Program

www.silversneakers.com

Texas Department on Aging’s Texercise Program

www.texercise.com

Chronic Disease Directors Association

www.chronicdisease.org

25
26

References

1. National Blueprint on Physical Activity Among Adults Age 50 and Older. Princeton, NJ: Robert Wood Johnson Foundation; 2001. 

2. U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: U.S.

Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Diseases

Prevention and Health Promotion; 1996.

3. American Geriatrics Society, British Geriatrics Society, American Academy of Orthopedic Surgeons Panel on Falls Prevention.

Guideline for the prevention of falls in older persons. Journal of the American Geriatrics Society 2001;49:664-672.

4. U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of

Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services,

National Institutes of Health, National Institute of Mental Health,1999. 

5. Colcombe S, Kramer AF. Fitness effects on the cognitive function of older adults: A meta-analytic study. Psychological Science (In

Press).

6. Kramer, A.F., Colcombe S., Erickson, K., Belopolsky, A., McAuley, E., Cohen, N.J., Webb A., Jerome, G.J., Marquex, D.X., & Wszalek,

T.M. (2002)., Effects of Aerobic Fitness Training on Human Cortical Functioning. Journal of Molecular Neuroscience, 19, 227-231.

7. Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention. Physical Activity and Older Americans:

Benefits and Strategies. June 2002. http://www.ahrq.gov/ppip/activity.htm. Accessed April 26, 2004.

8. Pratt M, Macera CA, Wang G. Higher direct medical costs associated with physical inactivity. The Physician and Sportsmedicine

2000;28(10):63-70.

9. Strategic Priorities for Increasing Physical Activity Among Adults Age 50 and Over: The National Blueprint Consensus Conference

Summary Report. Princeton, NJ: Robert Wood Johnson Foundation; 2002. 

10. Wallace, J. I. et al. Implementation and effectiveness of a community-based health promotion program for older adults. Journal of

Gerontology: Medical Sciences 1998;53a(4): M301-M306.

11. Brady TJ, Kruger J, Helmick CG, Callahan LF, Boutaugh ML. Intervention programs for arthritis and other rheumatic diseases. Health

Education and Behavior. 2003;30(1):44-63.
27

The Graying of America

Starting in 2012, nearly 10,000 Americans will turn 65

every day. The total number of Americans over age 65 and

eligible for Medicare will double to over 70 million within

this generation, while the population over age 85 will

increase nearly five-fold, to almost 19 million, by midcentury. Obviously, the “baby boom” will soon become

the “senior boom.” 

The aging of America, however, is more than a simple

matter of numbers. As noted in the 2002 State of Aging 

& Health in America and other sources, older adults use

more health care services than any other age group.

Americans over age 65 today are only 13% of the 

population, but account for half of physicians’ visits and

half of all hospital stays. The average 75 year old has three

chronic conditions and uses five different prescription

drugs. Older patients also have unique health challenges

and different medical needs than younger adults.

Health Care Workforce: 

A Growing Need

Unfortunately, there is often a gap between what many

health care providers know, and what they need to know,

to optimally treat older patients. For example, a 2002

Merck Institute of Aging & Health (MIAH) survey of 250

practicing primary care physicians found that only half

believe their colleagues can adequately treat even common

geriatric problems. 

Only a small proportion of practicing health care

providers have had any formal training in geriatrics. Out

of 650,000 practicing physicians in the U.S., less than

9,000 are geriatricians, or about 2.5 geriatricians per

10,000 elderly, and that number is expected to fall to

about 6,000 in the near future. Fewer than 3% of current

medical students take any elective geriatric courses.

Additionally, only 720 pharmacists, out of 200,000, have

geriatric certification. A 1997 survey of 600 nursing 

baccalaureate programs showed than only 23% of schools

required a single course in geriatrics, and less than onehalf of one percent of nurses have advanced certification

in geriatrics. Among social workers, only 5% identify their

primary practice area as geriatrics. 

The shortage of qualified providers is only part of the

story. Too few geriatric specialists exist to train others.

The majority of educational curricula, including nursing,

pharmacy, medicine and dentistry, do not require 

geriatric training. Only 600 medical school faculty, out 

of 100,000, list geriatrics as their primary specialty.

Geriatricians compromise only one-half of one percent of

By 2030, 20% of all Americans will be age 65 or older. Unfortunately, America’s health care workforce is unprepared for the coming senior boom. There are too few health care providers specifically trained in geriatrics; moreover, there is a gap between what many primary care providers

know, and what they need to know, to optimally treat older patients. Addressing this problem

requires immediate attention and action at the national level.

Our Nation’s Health Care Workforce:

Is it Ready for the Graying of America? 
28

all medical educators in the U.S., which represents the

largest educational training gap in any field. Additionally,

60% of nursing schools have no geriatric faculty. 

Despite these numbers, there are a few encouraging

recent trends. In family medicine, 92% of all residency

programs in 2002 reported geriatrics as part of their

required curriculum. Many medical schools now have

departments or divisions of geriatrics within departments

of family medicine or internal medicine. All medical

schools also currently have a contact person for geriatric

medicine.

Even with these somewhat encouraging statistics, the

current Medicare system, with low reimbursement rates

for geriatric primary care, may discourage young physicians

from entering the field; these doctors are choosing more

lucrative, procedure-driven specialties. Also, many

physicians still see geriatrics as something “extra” not

“essential,” despite the demographic imperative.

Overall, the healthcare workforce lacks the training to

provide appropriate care at the present time, and it is

wholly unprepared for the graying of America. Despite

efforts to improve the situation, there is still an immediate

and continuing crisis. Demographic trends and an ever

expanding geriatric knowledge base demand not only

attention but immediate action.

Given the urgency, many individuals and organizations,

both public and private, have been working for years to

fund geriatric research, training, and education, and to

ensure geriatric training for all health care professionals.
CALL TO ACTION: PREPARING OUR HEALTH CARE

WORK FORCE FOR AN AGING SOCIETY

In April 2003, many of the leaders in the field of geriatrics

met in Washington, DC to discuss and recommend 

solutions to the shortage of healthcare workers specifically

trained in geriatrics. This landmark conference*, Bridging

the Workforce Gap for our Aging Society, was sponsored by

MIAH, the Department of Veterans Affairs (VA), the

National Institute on Aging (NIA), and the Health

Resources and Services Administration (HRSA).

The following recommendations were largely provided

and suggested by the conference participants. They are

primarily targeted to practicing primary care physicians,

because studies have shown they are usually the first line

of treatment for older adults. These recommendations

should be considered a viable national blueprint for 

helping older adults in the U.S. enjoy optimal health care.

1. Increase Funding for Training

Federal funding for geriatric research is over 50 times that

provided for geriatric training. Geriatric research cannot

help a single person unless it is translated into practice.

2. New Research Must be Incorporated

Research that leads to advances in the prevention and

treatment of debilitating diseases must be incorporated

into practice quickly. Federal agencies should participate

in and encourage timely dissemination of new research

findings into clinical practice.

3. New Practices for Achieving Widespread Change

Must be Adopted

Medicare performance measurement systems must 

thoroughly audit both quality of geriatric care and the use

of evidence-based best practices. They must also create

incentives, such as additional provider reimbursements,

for improvements in the quality of geriatric care. We 

also need new structures and systems to measure the 

effectiveness of local and individual approaches to changing

provider behavior, and therefore improving geriatric care.

4. Professional Organizations Must Help 

Affect Change

Organizations currently involved in evidence-based 

education need to coordinate their efforts. Credentialing

organizations need to offer professional development 

programs for practitioners. 

5. New People Must be Recruited to Geriatrics

Providing incentives, such as loan repayment, could

encourage more health professional students to choose

geriatrics. Additionally, the paradigm of aging as being

synonymous with “old and sick” must be changed; this

could help attract practitioners to geriatric fields. Media

campaigns could be utilized to create a more positive 

picture of aging. 

6. The Skills of Community Practitioners 

Must be Enhanced

Geriatric information resources must be developed that

address specific geriatric syndromes and conditions, and

therefore, provide convenient access to specialized 

information for health care providers. A broad coalition 

of geriatric advocates must advance a national agenda that

stresses geriatric professional development and quality

improvement that is linked to certification and higher

Medicare reimbursement. 

7. Interest in Geriatrics Must be Developed across

Clinical Disciplines

Geriatric specialists must work to build bridges with

other disciplines, helping to foster interdisciplinary

approaches as well as increasing knowledge of bestpractice geriatrics care. 

8. Geriatric Education in Health Care Must be

Increased at All Levels

Medical schools must initiate exposure to geriatrics by

requiring geriatric education. Residency programs must

also do more to incorporate geriatrics into training.

* Conference coordinators: Patricia P. Barry, MD, MPH (MIAH);

Marsha Goodwin-Beck, RN, MA, MSN (VA); Judith Salerno, MD,

MS (NIA); and Joan Weiss, PhD, RN, CRNP (HRSA). 

Conference participants: Robert Roswell, MD (VA); Gregg

Warshaw, MD (University of Cincinnati); Terry Fulmer, PhD, RN

(New York University); William J. Hall, MD (University of

Rochester); Dan Perry (Alliance for Aging Research); Richard

Hodes, MD (NIA); Robert Butler, MD (International Longevity

Center); Jerry C. Johnson, MD (American Geriatrics Society);

Carol Shultz (Gerontological Society of America); Capt. Kerry

Nesseler, OPHS, RN, MS (HRSA).

29

31

State Examples

Kansas ElderCount: County, AAA,

and State-Level Data Available for

Action

Kansas ElderCount is a collection of three geographic

levels of data: county, area agency on aging, and state.

The purpose of the data is to describe the well-being of

older adults in Kansas. These data were collected to

enhance public policy, program planning and general

understanding of the health and socioeconomic status of

older adults. Data were collected at the county level

because the smaller the geography, the more useful the

data for policy and planning purposes. Older populations

in urban and rural counties in Kansas are very different,

and reporting state-level data would only mask these

important differences. 

Staff at the Center on Aging worked with a 32-person

statewide advisory committee to identify and locate the

best indicators and secure county-level data for the year

2000. Data are also presented for the 11 area agencies

on aging in Kansas. The 36 indicators are grouped into

five categories: population, economics, health, community

living and nursing homes. The number and percentage

of adults in the county and state are reported for each

indicator. Counties are grouped into quintiles to illustrate

how each county compares with the other 104 counties in

the state on each indicator.

Kansas State Senator Sandy Praeger secured funding

from the Kansas Health Foundation and the Milbank

Memorial Fund to produce this 172-page booklet in

2002, which is also available on the Internet at

www2.kumc.edu/coa/eldercount. Having a State Senator

champion this project opened many doors of cooperation.

Other project partners included the Kansas Department

on Aging, the Kansas Task Force on Long Term Care

Services and the Center on Aging at the University of

Kansas Medical Center. 

Kansas was unable to obtain county-level data on all 

of the indicators that it would have liked to include. In

particular, data were not available on abuse, neglect and

exploitation of older adults; projections of growth of the

population aged 65 years and older; and data describing

the differences between the number of people receiving 

community-based services and the number needing them.

Kansas hopes to fill in many of these data gaps when the

book is eventually updated. In the meantime, this report

provides vital data for public policy and planning decisions

to prepare for the growth in the elder population in

Kansas, as in other states, in the coming decades. 

Maine Elder Women’s Health

Indicator Framework 

In the spring of 2001, the Maine Bureau of Health

(BOH) received a small grant from the Health Resource

and Services Administration’s Office on Women’s Health,

Region 1. The goals of the project were:

• To develop a set of indicators for monitoring the

health status of Maine’s elder women

• To identify data sources for these indicators and to

gather baseline data

• To identify opportunities for collaboration between

BOH and the Bureau of Elder and Adult Services

• To formulate recommendations for programs and 

policies to improve the health status of Maine’s elder

women

This project culminated with the report Assessing and

Monitoring the Health Status of Maine’s Elder Women: the

Elder Women’s Health Indicators Project. It is a starting

point, or place to begin the process of systematically

assessing and monitoring elder women’s health so that

interventions can be targeted, improvements can be

measured and policies can be formulated to ensure

focused approach to improving the health of Maine’s

elder women.

The framework for and content of this report were

designed for state policy makers and decision makers and

professionals in public health and elder services as well as

a general audience. The intent was to keep the framework as user-friendly as possible and to use language that

would communicate to the general public but to be 

specific enough to remain useful to public health and

social service professionals. The state-level data used

throughout the report come primarily from the Maine

Department of Human Services, Bureau of Health, Office
32

of Data, Research and Vital Statistics; the Behavioral Risk

Factors Surveillance System; Maine Hospital Discharge

Data; and the 2000 U.S. Census. 

Response to the report has been very positive.

Focusing on health indicators for elder women highlights a population that needs increased attention. To

obtain the report, contact Sharon Leahy-Lind, Women’s

Health Coordinator, Bureau of Health, Maine

Department of Human Services at 207-287-4577 or 

e-mail: sharon.leahy-lind@maine.gov.

A Healthy Profile of Older North

Carolinians

The proportion of older adults that make up North

Carolina’s population has increased in recent years, and

this increase is expected to continue for decades to come.

Currently, about 28% of North Carolinians are age 50

or older, and this proportion is projected to be 35% by

2030. To compile a picture of the health of older adults

in North Carolina, the North Carolina State Center for

Health Statistics, the North Carolina Division of Aging,

and the Older Adult Health Branch of the North

Carolina Division of Public Health, published A Health

Profile of Older North Carolinians in 2003. This report

uses North Carolina data from the Behavioral Risk

Factor Surveillance System surveys, death certificates,

cancer registries and hospital discharges. 

The report covers the following major health topics

among older adults: general health status and well-being,

health care access, health-related risk behaviors, heart

disease, stroke, cancer, chronic respiratory disease,

Alzheimer’s disease, influenza and pneumonia, diabetes,

motor vehicle injuries, suicide, arthritis, mental health

and osteoporosis/hip fractures. To capture the wide

range of ages that can fall within the “older adult” 

category, the report groups data into four age groups:

50–64, 65–74, 75–84, and 85 and above. In addition,

with the exception of the hospital discharge data, data

are broken down by race and sex, two factors that can

greatly influence a person’s health status and health care. 

The report provides a concise statistical picture of the

burden of health problems among older adults in North

Carolina. Although it does not discuss specific programs

for reducing these health problems, it provides health

and aging professionals and policy makers with a blueprint for prioritizing the health needs of older adults and

for designing and establishing programs and guidelines

to meet these needs. 

North Carolina’s 17 area agencies on aging are using

the publication to create a new four-year plan that

includes healthy aging issues. Universities, hospitals, and

county departments on aging have used the data in the

report to develop grants and request funding to address

problems among the older populations that they serve.

Aging advocacy groups, including AARP and Senior

Tarheel Legislatures, are using the information for policy

planning initiatives. Additionally, senior and community

centers have held healthy aging workshops to discuss the

data in the report with health care professionals and the

general public. The report is available on the Internet at

www.schs.state.nc.us/SCHS/.

Healthy Aging in Washington State—

The Need for Action

Healthy Aging in Washington State—the Need for Action

was developed by the Washington (WA) State

Department of Health (DOH) primarily to raise 

awareness among policy makers, employers, agencies and

organizations about the aging of Washington’s population

and the potential social, health and cost implications for

the coming years. The document provides guidance for

policy and environmental changes at the state, community

and work site levels to help people 45 years of age and

older adopt and maintain healthy behaviors to prevent or

delay the onset of age-related chronic conditions. The

major data and policy resources used included the U.S.

Census, WA Office of Financial Management, WA

BRFSS, WA Center for Health Statistics, health reports

by various DOH programs, the Washington State Plan for

Nutrition & Physical Activity, and the Guide to Community

Preventive Services.

The booklet has attracted the attention of a full 

spectrum of groups with an interest in aging issues, from

a small neglected senior center in a rural area to the

Governor’s Chief of Staff. Partners around the state have

used the booklet to inform program design and the

development of a state plan and training curriculum for

care providers, to help educate the public and health care

providers, and to increase awareness of aging issues

among agency senior staff, policy makers and elected

officials.

This call to action emphasizes the need for populationbased primary prevention of aging-related disease and

injury to improve health and quality of life and reduce

health care costs in the coming decades. The booklet

and healthy aging messages for the public are available

on line at www.doh.wa.gov/cfh/OHP/

stepstohealthyaging.htm.


35

Appendix

Major Data Sources and Technical

Information

CDC’s Behavioral Risk Factor Surveillance System

For the past two decades, CDC’s Behavioral Risk Factor

Surveillance System (BRFSS) has helped states survey

U.S. adults to learn about the wide range of personal

behaviors that affect their health. The BRFSS has

focused primarily on four behaviors: physical activity,

nutrition, tobacco use, and the use of proven preventive 

services (such as cancer screenings), all of which have a

tremendous impact on the rates of the nation’s leading

killers. The BRFSS describes these personal health

behaviors in terms of how common they are, whether

they are increasing over time, and which populations

might be most at risk. The information gathered

through this state-based telephone survey system is

essential to national, state, and local public health 

agencies as they monitor the need for and the 

effectiveness of various public health interventions. 

While the BRFSS is one of the most useful tools for

assessing the health of the older adult population, it has

at least three limitations. First, BRFSS excludes people

who don’t have land line telephones or are in institutions

(e.g. nursing homes). Second, people who are severely

impaired may not be adequately represented because of

the functional capacity required to participate in the

survey. Third, the data included in the BRFSS are all

self-reported and therefore have not been confirmed by 

a health care provider.

The BRFSS is administered and supported by the

Division of Adult and Community Health, National

Center for Chronic Disease Prevention and Health

Promotion, CDC. For more information, please visit

www.cdc.gov/brfss. 

CDC’s National Hospital Discharge Survey

The National Hospital Discharge Survey (NHDS),

which has been conducted annually since 1965, is a

national probability survey designed to meet the need for

information on characteristics of inpatients discharged

from non-Federal, short-stay hospitals in the United

States. The NHDS collects data from approximately

270,000 inpatient records acquired from a national

sample of about 500 hospitals. Only hospitals with an

average length of stay of fewer than 30 days for all

patients, general hospitals and children’s general hospitals

are included in the survey. The survey excludes federal,

military, and Department of Veterans Affairs hospitals, 

as well as hospital units of institutions (such as prison

hospitals) and hospitals with fewer than six beds staffed

for patient use. 

The NHDS is administered and supported by the

Hospital Care Statistics Branch, National Center for

Health Statistics, CDC. Data are disseminated annually

through published documents, public-use data tapes, 

data diskettes, CD-ROMs, and downloadable files. For

more information, please visit

www.cdc.gov/nchs/about/major/hdasd/nhds.htm.

CDC’s Data Warehouse on Trends in Health 

and Aging

With support from the National Institute on Aging,

CDC’s National Center for Health Statistics (NCHS)

has created the Data Warehouse on Trends in Health

and Aging, a Web-based, user-friendly tool that provides

access to up-to-date information on the health of older

Americans. This system is designed to show trends in

health–related behaviors, health status, health care use

and health care costs among older adults. A data dissemination tool called Beyond 20/20® is used to retrieve and

display customized tables of health information on older

men and women of various ages, races, and ethnicities. 

For more information, please visit

www.cdc.gov/nchs/agingact.htm.
36

Indicator Healthy People 2000 Target Healthy People 2010 Target

Health Status 

1. Physically unhealthy days No target specified No target specified

2. Frequent mental distress No target specified No target specified

3. Oral health: Complete tooth loss No more than 20% of adults age 65+ who No more than 20% of adults age 65+ who 

have lost all of their natural teeth have lost all of their natural teeth

4. Disability No target specified No target specified

Health Behavior

5. No leisure time physical activity No more than 22% of adults age 65+ with No more than 20% of adults age 18+ with 

in past month no leisure-time physical activity no leisure-time physical activity

6. Eating 5+ fruits & vegetables daily At least 50% of people age 65+ who eat Target redefined: fruits and vegetables 

5+ fruits and vegetables a day separated into multiple categories

7. Obesity Combined with the “Overweight” category; No more than 15% of adults age 20+ who

No more than 20% of people age 20+ who are obese (BMI>= 30)

are overweight (BMI>=27.3)

8. Current smoking No more than 15% of adults age 18+ who No more than 12% of adults age 18+ who 

smoke smoke

Preventive Care and Screening

9. Flu vaccine in past year At least 60% of adults age 65+ who had a At least 90% of adults age 65+ who had a 

flu shot within the past year flu shot within the past year

10. Ever had pneumonia vaccine At least 60% of adults age 65+ who have At least 90% of adults age 65+ who have 

ever received a pneumonia vaccine ever received a pneumonia vaccine

11. Mammogram within past 2 years At least 60% of women age 70+ who had a At least 70% of women age 40+ who had a 

mammogram within the past 2 years mammogram within the past 2 years

12. Ever had sigmoidoscopy or colonoscopy At least 40% of adults age 50+ who have At least 50% of adults age 50+ who have 

ever received a sigmoidoscopy ever received a sigmoidoscopy

13. Up-to-date on select preventive services No target specified No target specified

14. Cholesterol checked within past 5 years At least 75% the proportion of adults At least 80% the proportion of adults 

age 18+ who have had their cholesterol age 18+ who have had their cholesterol 

checked in the past 5 years checked in the past 5 years

Injuries

15. Hip fractures No more than 607 hospitalizations No more than 416 hospitalizations 

per 100,000 persons for hip fractures per 100,000 persons for women age 65+; 

for adults age 65+ no more than 474 hospitalizations per 100,000 

persons for men age 65+

TABLE 4. REPORT CARD INDICATORS AND HEALTHY PEOPLE TARGETS

Source: www.healthypeople.gov (accessed July 26, 2004)
Margaret J. Moore, MPH

Public Health Advisor, 

Centers for Disease Control and Prevention

Principal Writer

Project Co-Director

Phyllis Moir, MA

Technical Publications Writer/Editor, 

Centers for Disease Control and Prevention

Principal Writer

Michele M. Patrick, MGA

Communications Director, 

Merck Institute of Aging & Health

Project Co-Director

Members of Working Group

Lynda A. Anderson, PhD

Acting Chief, Health Care and Aging Studies Branch, 

Centers for Disease Control and Prevention

Greg O’Neill, PhD

Director, National Academy on an Aging Society

Nancy Whitelaw, PhD

Vice-President, National Council on the Aging

Acknowledgements for State of Aging 

and Health Report, 2004
Contributors

Jeanne Alongi, MPH

Bonita Lynn Beattie, MPT, MHA, PT

Laurence G. Branch, PhD

Mercedes Burn-Klug, MSW, MA

Sylvia E. Furner, MPH, PhD

Sharon Leahy-Lind, MPPM

Harold Lentzner, PhD

Christopher Maylahn, MPH

Ruth Palombo, PhD, MS, RD

Douglas Shenson, MD, MPH, MS

Betty H. Wiser, EdD

Continued...

Lina Balluz, MPH, ScD

Julie Bolen, PhD, MPH

David R. Brown, PhD

David Buchner, MD, MPH

John E. Crews, DPA

Deborah A. Galuska, PhD

Barbara F. Gooch, DMD, MPH

Kurt Greenlund, PhD

Andree C. Harris

Jennifer M. Hootman, PhD, ATC, FACSM

Susan Jernick, DPM, MPH

Rosemarie Kobau, MPH

Judy Kruger, PhD, MS

Jason E. Lang, MPH, MS

Yao-Hua Luo, PhD

Dolores Malvitz, DrPH

David G. Moriarty, BSEE

Louise Murphy

Wilmon Murphy

Suzanne M. Smith, MD, MPH, MPA

Joe Sniezek, MD, MPH

Judy A. Stevens, PhD

Carla P. White, MPH

Pascale Wortley, MD, MPH

Hatice Sahin Zahran, MD, MPH

CDC Foundation

Center for the Advancement of Health and

participants in the May 2004 Making Health

Count for Older Americans Summit

Centers for Disease Control and Prevention
2004 State of Aging and Health

Advisory Board Members

David Baldridge, PhD

Director, American Association for International Aging

William F. Benson

Consultant

James P. LoGerfo, MD

Professor, Medicine and Health Services

Director, University of Washington Health Promotion Research

Center

Bob Meyers 

President, National Press Foundation

Judith A. Salerno, MD, MS

Deputy Director, National Institute on Aging
www.cdc.gov/aging

www.miahonline.org