Health Risks and Behaviors
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.13–16 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 2010, 63 percent of people age 65 and over reported receiving a flu shot in the past 12 months; however, there were differences by race and ethnicity. Sixty-six percent of non-Hispanic Whites reported receiving a flu shot, compared with 52 percent of non-Hispanic Blacks and 54 percent of Hispanics.
- In 2010, about 60 percent of people age 65 and over had ever received a pneumonia vaccination. Despite increases in the rates for all groups over time, in 2010, non-Hispanic Whites were more likely to have received a pneumonia vaccination (64 percent) compared with non-Hispanic Blacks (46 percent) or Hispanics (39 percent).
- The percentage of older people receiving vaccinations increased with age. In 2010, about 70 percent of persons age 85 and over had received a flu shot, compared with 68 percent of persons age 75–84 and 59 percent of persons age 65–74. For pneumonia vaccinations, 68 percent of persons 85 and over had ever received a pneumonia vaccination compared with 55 percent of persons age 65–74.
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
- Among women age 65 and over, the percentage who had a mammogram within the preceding two years almost tripled from 23 percent in 1987 to 64 percent in 2010. 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 but, in recent years, this difference has disappeared.
- Older women who were poor were less likely to have had a mammogram in the preceding two years than older women who were not poor. In 2010, 51 percent of women age 65 and over who lived in families with incomes of less than 100 percent of the poverty threshold reported having had a mammogram. Among older women living in families with incomes of 400 percent or more of the poverty threshold, 75 percent reported having had a mammogram.
- Older women without a high school diploma were less likely to have had a mammogram than older women with a high school diploma. In 2010, 54 percent of women age 65 and over without a high school diploma reported having had a mammogram in the preceding two years, compared with 63 percent of women who had a high school diploma and 71 percent of women who had at least some college education.
Indicator 23. Diet Quality
Dietary intake affects the health of older Americans, because poor diet quality is associated with cardiovascular disease, hypertension, type 2 diabetes, osteoporosis, and some types of cancer.18 An
index that assesses the multidimensional components of diet is useful in describing diet quality. The Healthy Eating Index-2005,19,20 developed by the U.S. Department of Agriculture (USDA) Center for Nutrition Policy and Promotion, measures compliance with the diet-related recommendations of the 2005 Dietary Guidelines for Americans.18 It has 12 components, and a higher score indicates a higher quality diet. Intakes equal to or better than the standards set for each component are assigned a maximum score of 100 percent. For the nine adequacy components (e.g., total fruit), no intake gets zero percent, and scores increase up to 100 percent as the intakes increase towards the standard. The three moderation components (e.g., sodium) are scored in reverse; that is, excessively high intakes get zero percent and as intakes decrease toward the standard, scores increase up to 100 percent. Scores are averages across all adults based on usual dietary intake.
- In 2007–2008, the average diet of older Americans (age 65 and over) scored 100 percent for only three dietary components: whole fruit, total grains, and meat and beans. In other words, diets for these three components met the standard, while nine fell short—ranging from 33 percent (sodium) to 90 percent (total fruit).
- The average diet of adults age 75 and over was superior in quality to the average diet of their younger counterparts, age 65–74, for total fruit, whole grains, milk, saturated fat, and sodium. For total vegetables and oils, adults’ age 65–74 average diets were better than those age 75 and over.
- Average intakes of calories from solid fats, alcoholic beverages, and added sugars were too high and thus remained well below the quality standards for both age groups.
- Major improvements in the nutritional health of older Americans could be made by increasing intakes of whole grains, dark green and orange vegetables and legumes, and fat-free or low-fat milk products and by incorporating foods and beverages that are lower in sodium and have fewer calories from solid fats, alcoholic beverages, and added sugars.
Indicator 24. Physical Activity
Physical activity is beneficial for the health of people of all ages, including the age 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.21,22 Research has shown that even among frail and very old adults, mobility and functioning can be improved through physical activity.23 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.24 In 2008, the Department of Health and Human Services released updated guidelines for aerobic activity and muscle-strengthening activities for Americans.
- In 2010, about 11 percent of people age 65 and over reported participating in leisure-time aerobic and muscle-strengthening activities that met the 2008 Federal physical activity guidelines. The percentage of older people meeting the physical activity guidelines decreased with age, ranging from 14 percent among people age 65–74 to 4 percent among people age 85 and over.
- Men age 65 and over were more likely than women in the same age group to meet the physical activity guidelines (14 percent and 8 percent, respectively, in 2010). Older non-Hispanic Whites reported higher levels of physical activity than non-Hispanic Blacks (12 percent compared with 5 percent).
- The percentage of older people meeting the Federal physical activity guidelines increased over time. In 1998, about 6 percent of people age 65 and over met the guidelines, compared with 11 percent in 2010.
Indicator 25. Obesity
Obesity is a major cause of preventable disease and premature death.25 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.26,27
- As with other age groups, the percentage of people age 65 and over who are obese has increased since 1988–1994. In 2009–2010, 38 percent of people age 65 and over were obese, compared with 22 percent in 1988–1994.
- In 2009–2010, 45 percent of women age 65–74 and 30 percent of women age 75 and over were obese. This is an increase from 1988–1994, when 27 percent of women age 65–74 and 19 percent of women age 75 and over were obese.
- Older men followed similar trends: 24 percent of men age 65–74 and 13 percent of men age 75 and over were obese in 1988–1994, compared with 43 percent of men age 65–74 and 27 percent of men age 75 and over in 2009–2010.
- Over the past 12 years, between 1999–2000 and 2009–2010, there has been no significant trend in women, but among men there has been an increase in obesity prevalence.
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 third leading cause of death among people age 65 and over) increased 57 percent between 1981 and 2009 (see “Indicator 15: Mortality”). This increase reflects, in part, the cumulative effects of cigarette smoking over time.28,29
- The percentage of older Americans who were current cigarette smokers declined between 1965 and 2010. Most of the decrease during this period was the result of the declining prevalence of cigarette smoking among men (from 29 percent in 1965 to 10 percent in 2010). For the same period, the percentage of women who smoked cigarettes has remained relatively constant (10 percent in 1965 and 9 percent in 2010).
- In 2010, the percentage of older Americans who were current smokers was similar for Whites and Blacks.
- A large percentage of both men and women age 65 and over were former smokers. In 2010, about 53 percent of older men previously smoked cigarettes, while 29 percent of women age 65 and over were former smokers.
Indicator 27. Air Quality
As people age, their bodies are less able to compensate for the effects of environmental hazards. Air pollution can aggravate chronic heart and lung diseases, leading to increased medication use, more visits to health care providers, admissions to additional 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 level of the Environmental Protection Agency’s (EPA) national standards. Ozone and particulate matter (PM), especially the 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.30–34
- In 2010, about 32 percent of people age 65 and over lived in counties with poor air quality for ozone, compared with 52 percent in 2000.
- A comparison of 2000 and 2010 showed a reduction in exposure to PM 2.5 pollution. In 2000, about 41 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 5 percent of people age 65 and over in 2010.
- The percentage of people age 65 and over living in counties that experienced poor air quality for any air pollutant decreased from 64 percent in 2000 to 36 percent in 2010.
- In 2010, nearly 40 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 124 million people lived in counties where monitored air in 2010 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 2.5.
Indicator 28. Use of Time
How individuals spend their time reflects their financial and personal situations, needs, and desires.
Time-use data show that as Americans get older, they spend more of their time in leisure activities.
- In 2010, older Americans spent on average more than one-quarter of their time in leisure activities. This proportion increased with age: Americans age 75 and over spent 32 percent of their time in leisure activities, compared with 22 percent for those age 55–64.
- On an average day, people age 55–64 spent 16 percent of their time (almost four hours) working or doing work-related activities compared with 5 percent (about one hour) for people age 65–74 and 1 percent (about 15 minutes) for people age 75 and over.
Leisure activities are those done when free from duties such as working, household chores or caring for others. During these times, individuals have flexibility in choosing what to do.
- Watching TV was the activity that occupied the most leisure activity time—more than one-half of the total—for Americans age 55 and over.
- Americans age 75 and over spent a higher percentage of their leisure time reading (12 percent versus 7 percent) and relaxing and thinking (9 percent versus 5 percent) than did Americans age 55–64.
- The proportion of leisure time that older Americans spent socializing and communicating—such as visiting friends or attending or hosting social events—declined with age. For Americans age 55–64, about 11 percent of leisure time was spent socializing and communicating compared to 8 percent for those age 75 and over.