Effective programs to help seniors manage their arthritis and diabetes. A good number of high-quality nursing homes. Declining obesity rates among those over age 65.
These are among the positive factors that have helped improve health conditions among New Jersey’s roughly 1.35 million seniors, according to the America’s Health Rankings Senior Report for 2019, based on a variety of federal and foundation data.
The findings — portions of which were released Tuesday by UnitedHealth Foundation, which funds the work, in advance of the public unveiling today — showed New Jersey now ranks 21st nationwide for the health of its elderly residents, up from 23rd in 2018. The state reached its peak 19th place in 2016 and 2017.
The Senior Report, which dates to 2013, is based on data related to five categories: health behaviors, like smoking, obesity and disease management; community and environment, including poverty rates and nursing home availability; public policy matters; clinical care; and health outcomes, such as mental distress, hip fractures and use of intensive-care hospital services.
Among other things, the findings show the state also does fairly well on vaccinating elderly residents, with more than 63 percent inoculated against the flu. It has decent policies in place to protect against hospital or nursing home-related infections, reaches more than nine out of 10 seniors in need with federal food assistance, and has a fairly low smoking rate for this age group, with roughly 8 percent lighting up.
Low rate of physical activity
However, New Jersey ranks 42nd nationwide when it comes to the level of physical activity among its seniors, the report found, and 45th for volunteerism, with just over one in five seniors donating their time or skills in this way. And it ranks 47th in terms of the relatively high number of elderly patients who die in the hospital; roughly one in four Garden State elders now dies in a hospital facility.
In addition, the state ranked 39th for the relatively low percentage of seniors who engage hospice care — less than half, versus a high of two-thirds in the best performing state, Utah. It also has room for improvement when it comes to the number of home healthcare workers per population — although there has been an increase in this workforce nationwide — and the rate of hospital re-admissions for those over age 65.
Evelyn Liebman, New Jersey advocacy director for AARP, had not reviewed the new rankings, but said these kinds of reports help advocates and policymakers assess “where we are and where we need to go. We can also look to other states that rank higher for best practices.”
Liebman praised the researchers for their focus on factors that contribute to social isolation among elderly residents, a growing concern at AARP. This issue, combined with rising rates of depression and greater inactivity, suggests policymakers have more work to do to create active, livable communities for older New Jerseyans, she said.
“Social isolation can undermine the health of older adults,” Liebman said. “New Jersey should be a great place to grow up and grow older.”
Improving end-of-life care
The report comes as New Jersey policymakers have invested new attention in improving end-of-life care, which is more expensive here than elsewhere in the U.S. and frequently fails to align with the patient’s or family’s wishes. The state Department of Health is working with hospital officials and other provider groups to improve the healthcare system’s mechanisms for recording and tracking end-of-life care plans, and advocates are working with community leaders to encourage greater planning.
Nationwide, the UnitedHealth report found that Hawaii remains the healthiest state in 2019, as it was the previous year, followed by Utah and Connecticut. Mississippi, was at the bottom of the list for the second year, followed by Kentucky and Louisiana. A number of New England states ranked in the top 10 and several mid-Atlantic neighbors fared better than New Jersey, with Delaware at No. 15, New York at No. 16, and Pennsylvania at No. 19.
(The UnitedHealth Foundation also produces an annual America’s Health Rankings report, that dates back nearly three decades, which ranked New Jersey 11th nationwide for the health of all residents in 2018. Other comparative healthcare reports, like a scorecard produced by the Commonwealth Fund, place the Garden State in the middle of the pack nationwide. The foundation is the nonprofit philanthropic organization associated with UnitedHealthcare, the national health insurance giant, and related companies.)
This year’s Senior Report includes a new focus on the health of younger seniors, or those ages 65 to 74, a group that is growing quickly and is more ethnically diverse than its elders. While younger seniors nationwide reported lower smoking rates and premature death rates than in the past, and greater health overall, they are drinking more, have higher rates of diabetes and obesity, and are more likely to commit suicide than they were years ago.
Since the first Senior Report came out in 2013, the use of hospice care has increased nearly 50 percent, the home healthcare workforce has grown by 44 percent, and food insecurity for those over age 65 has declined by 14 percent, researchers found. The authors called the trend, “encouraging progress in the availability and use of services that help older adults remain in their homes and communities.”
However, depression has jumped nearly 20 percent nationwide in the past year alone, drinking has risen 12 percent since 2016, and more than 5 percent of elderly adults said they now avoid medical care out of concern about the cost, the report found. “At a time when the use of support services for seniors is increasing, seniors still face challenges — especially with mental health, unhealthy behaviors and not visiting a doctor when needed due to cost,” the authors noted.