Health Risks and Behaviors
Indicator 21: Vaccinations
Indicator 22: Mammography
Indicator 23: Dietary Quality
Indicator 24: Physical Activity
Indicator 25: Obesity
Indicator 26: Cigarette Smoking
Indicator 27: Air Quality
Indicator 21 : Vaccinations
Vaccinations against influenza and pneumococcal
disease are recommended for older Americans, who are at increased risk for
complications from these diseases compared with younger individuals.
Influenza vaccinations are given annually, and pneumococcal vaccinations are usually given once in a lifetime. The costs associated with
these vaccinations are covered under Medicare Part B.
In 2002, 66 percent of people age 65 and over reported
receiving a flu shot in the past 12 months.
Influenza vaccination rates have increased for all
groups in the past decade, but there are still differences by race and
ethnicity. Sixty-nine percent of non-Hispanic whites reported receiving a
flu shot compared with 50 percent of non-Hispanic
blacks and 49 percent of Hispanics.
In 2002, 56 percent of people age 65 and over had ever received a pneumonia vaccination.
Despite recent increases in the rates for all groups, non-Hispanic whites are more likely to have
received a pneumonia vaccination (60 percent) compared with non-Hispanic blacks (37 percent) or
Hispanics (27 percent).
Older people are more likely to have been vaccinated than younger people. In 2002, 61
percent of people age 65-74 had received a flu shot in the preceding 12 months compared with 70
percent of people age 85 and over. Fifty percent of people age 65-74 have ever received a pneumonia
vaccination compared with 63 percent of people age 85 and over.
Data for this indicator can be found in Tables 21a and 21b.
Indicator 22 : Mammography
Health care services and screenings can help prevent disease or detect it at an early,
treatable stage. Mammography has been shown to be effective in reducing breast cancer
mortality among women age 40 and over, especially for the 50-69 age group.
Among women age 65 and over, the percentage
who had a mammogram within the preceding 2 years almost
tripled from 23 percent in 1987 to 68 percent in 2000. While there was a
significant difference in 1987 between the percentage
of older non-Hispanic white women (24 percent) and the percentage of older
non-Hispanic black women (14 percent) who reported having had a mammogram, in
recent years this difference has disappeared.
Older women living below the poverty level were less
likely to have had a mammogram in the preceding 2 years than older women living
above the poverty level. In 2000, 55 percent of women age 65 and over living
below the poverty level reported having had a mammogram compared with 70
percent of older women living above the poverty level.
Older women without a high school diploma were less
likely to have had a mammogram than older women with a high school diploma. In
2000, 58 percent of women age 65 and over without a high school diploma
reported having had a mammogram in the preceding 2 years compared with 72
percent of women who had a high school diploma and 74 percent of women who had
some college education.
Data for this indicator can be found in Table 22.
Indicator 23 : Dietary Quality
Dietary quality plays a major
role in preventing or delaying the onset of chronic diseases such as coronary
heart disease, certain types of cancer, stroke, and Type 2 diabetes.35
A healthy diet can reduce some major risk factors for
chronic diseases, such as obesity, high blood pressure, and high blood
Dietary quality was rated good for a higher percentage of
the population age 65 and over (19 percent) than for people age 45-64 (12
percent). Even so, a majority of older people reported diets that needed
improvement (67 percent) or were poor (14 percent).
Older people living in poverty were less likely to report
a good diet (9 percent) than older people living above the poverty level (21
Older peoples' scores were lowest for the
components of the Healthy Eating Index measuring daily servings of fruit and
milk products. Older peoples' scores were highest for the components of
the index measuring cholesterol intake and the variety of the diet.
for this indicator can be found in Tables 23a and 23b.
Indicator 24 : Physical Activity
Physical activity is
beneficial for the health of people of all ages,
including the 65 and over population. It can reduce the risk of certain chronic
diseases, may relieve symptoms of depression, helps to maintain independent
living, and enhances overall quality of life.37,38
Research has shown that even among frail and very old adults, mobility and
functioning can be improved through physical activity.39
In 2001-2002, 21 percent of people age 65 and over
reported engaging in regular leisure time physical activity. The percentage of
older people engaging in regular physical activity was lower at older ages,
ranging from 26 percent among people age 65-74 to 9 percent among people age 85
and over. There was no significant change in
the percentage reporting physical activity between 1997 and 2002.
Men age 65 and over are more likely than women in the
same age group to report engaging in regular leisure time physical activity (26
percent and 18 percent, respectively, in 2001-2002). Older non-Hispanic white
people report higher levels of physical activity than non-Hispanic black people
or Hispanics (23 percent compared with 14 percent for Hispanics and 13 percent
for non-Hispanic blacks in 2001-2002).
Other forms of physical activity also contribute to
overall health and fitness. Strength training is recommended as part of a comprehensive physical activity program among older
adults and may help to improve balance and decrease risk of falls.40 Twelve
percent of older people reported engaging in strengthening exercises in 2001-2002.
Data for this indicator can be found in Tables 24a and 24b.
Indicator 25 : Obesity
Obesity and overweight have
reached epidemic proportions in the United States and may soon rival cigarette
smoking as a major cause of preventable disease and premature death.41
Both are associated with increased risk of coronary heart disease; Type 2
diabetes; endometrial, colon, postmenopausal breast, and other cancers; asthma
and other respiratory problems; osteoarthritis; and disability.42
,43 The increase in prevalence of obesity among older
adults has been especially dramatic.44
The percentage of older Americans who were obese or overweight increased significantly in the last 4 decades. In 1960-1962, 18 percent of
people age 65-74 were obese; 55 percent were overweight. By 1999-2002, more than one-third (36 percent) were obese; nearly three-quarters, or 73 percent,
were overweight. Most of the increase in the prevalence of obesity and
overweight has occurred since 1976-1980.
In 1999-2002, 32 percent of older women age 65 and over
were obese, compared with 27 percent of men. Conversely, older men were more
likely to be overweight (73 percent of men compared with 66 percent of women.)
The prevalence of obesity is greater among people age
65-74 than among people age 75 and over. Thirty-two percent of men age 65-74
are obese compared with 18 percent of men age 75 and over. Thirty-nine percent
of women age 65-74 are obese compared with 24 percent of women age 75 and over.
The prevalence of underweight among people age 65 and
over is quite low. In 1999-2002, 2 percent of older men and women were
underweight. Older women age 65 and over were three times as likely as their
male counterparts to be underweight (3 percent of women versus 1 percent of
for this indicator can be found in Table 25.
Indicator 26 : Cigarette Smoking
Smoking has been linked to an
increased likelihood of cancer, cardiovascular disease, chronic obstructive
lung diseases, and other debilitating health conditions. Among older people,
the death rate for chronic lower respiratory diseases (the fourth leading cause
of death among people age 65 and over) has increased since 1980.45
This increase reflects, in
part, the effects of cigarette smoking.46
The percentage of older Americans who are current
cigarette smokers has declined dramatically over the past 37 years. Most of the
decrease is the result of the declining prevalence of cigarette smoking among
men (from 29 percent in 1965 to 10 percent in 2002). The percentage of women
who smoke cigarettes has remained relatively constant, increasing slightly from
10 percent in 1965 before declining to 9 percent in 2002.
A similar pattern of decline is observed by race,
although the prevalence of smoking remains much higher for blacks. Again, the
decline is due almost exclusively to the higher percentage of cigarette smokers
among older black men, which declined from 36 percent in 1965 to 19 percent in
The long-run decline in the prevalence of cigarette
smoking also occurred in younger age groups. For example, 52 percent of men age
45-64 were current cigarette smokers in 1965. By 2002 this percentage had
declined by more than one-half to 25 percent. The corresponding percentages for
women age 45-64 are 32 percent and 21 percent, respectively.
A large percentage of men and women age 65 and over are
former smokers. In 2002, 57 percent of older men previously smoked cigarettes,
while nearly 29 percent of women age 65 and over were former smokers.
for this indicator can be found in Table 26a and 26b.
Indicator 27 : Air Quality
As people age, their bodies are
less able to compensate for the effects of environmental hazards. Air pollution
can aggravate heart and lung disease, leading to increased medication use, more
visits to health care providers, admissions to emergency rooms and hospitals,
and even death. An important indicator for environmental health is the
percentage of older adults living in areas that have measured air pollutant
concentrations above the Environmental Protection Agency's (EPA)
established standards. Ozone and particulate matter (PM) (especially smaller,
fine particle pollution called PM 2.5) have the
greatest potential to affect the health of older adults. Fine particle
pollution has been linked to premature death, cardiac arrhythmias and heart
attacks, asthma attacks, and the development of chronic bronchitis. Ozone, even
at low levels, can exacerbate respiratory diseases such as chronic obstructive
pulmonary disease or asthma.47-51
In 2002, 46 percent of people age 65 and over lived in
counties with poor air quality for ozone compared with 26 percent in 2000. The
hot, dry 2002 summer climate was particularly conducive to the formation of
ground-level ozone, and this, in turn, may have contributed to the higher ozone
measurements in 2002.
A comparison of 2000 and 2002 shows a reduction in PM
2.5. In 2000, 27 percent of people age 65 and over lived in a county where PM
2.5 concentrations were at times above the EPA standards compared with 19
percent of people age 65 and over in 2002.
The percentage of people age 65 and over living in
counties that experienced poor air quality for any air pollutant increased from
41 percent in 2000 to 49 percent in 2002. This increase was largely due to the
increased number of areas that experienced poor air quality for ozone in 2001
Air quality varies across the United States; thus, where people live can affect
their health risk. Each State monitors air quality and reports findings to the EPA. In turn, the EPA determines whether
pollutant measurements are above the standards that have been set to protect
In 2002, nearly 50 percent of the population lived in a
county where measured air pollutants reached concentrations above EPA
standards. This percentage was fairly consistent across all age groups,
including people age 65 and over.
Overall, approximately 146 million people lived in
counties where monitored air in 2002 was unhealthy at times because of high
levels of at least one of the six principal air pollutants: ozone, particulate
matter (PM), nitrogen dioxide, sulfur dioxide, carbon monoxide, and lead. The
vast majority of areas that experienced unhealthy air did so because of one or
both of two pollutants—ozone and PM.
Data for this indicator can be found in
Table 27a and 27b.