Tuesday, May 23, 2017

Poor health habits by Louisiana’s seniors lead to poor health rankings

Author: David J. Holcombe, M.D., M.S.A., Regional Medical Director, Region 6 (Alexandria Region)

In conjunction with America’s Health Rankings, there is a specific report issued annually for senior health for each state. America’s Health Rankings Senior Report for 2016 is the most recent report available and it usually parallels health rankings for Louisiana as a whole, with some exceptions. 

Once again, Louisiana did not rank high for its Senior Health Report. In fact our state had an overall ranking of 50 out of 50 states.

The ranking is divided into two sections, “Determinants” (or factors that determine health outcomes) and “Outcomes.” Although we are 43/50 for outcomes compared to other states, we ranked 50/50 for our determinants.

Determinants (or health factors as they are sometimes called) help to predict future outcomes.  Being last in determinants does not bode well for the future.

How do our results look and what do they mean? Health determinants are divided into behaviors, community and environmental factors, policy and clinical care. Let’s focus on those areas that need improvement (areas in which we ranked in the bottom 10) as shown here:

  • Smoking: We ranked 46 out of 50
  • Obesity: 48
  • Physical Inactivity: 45, and
  • Infrequent Dental Visits: 45

Negative results for community and environmental factors include:
  • Poverty: 48
  • Low rates of Volunteerism: 50
  • Poor Nursing Home Quality: 50, and
  • Food Insecurity: 49

We also ranked poorly for “low-care” seniors in nursing homes (43) and an inadequate number of specialty doctors to care for seniors (43).

Finally, Louisiana continues to rank low in several clinical care measures such as high numbers of hospitalized seniors (44), preventable hospitalizations (47) and hospital readmissions (48.)

When combined, all of these 13 low factors (or determinants) contribute to poor outcomes as previously mentioned. These poor outcomes include high numbers of hip fractures (42), low numbers of seniors with self-reported very good or excellent health status (48), high premature deaths (44) the number of dental extractions (43) and frequent mental distress (42).

A few “supplemental measures” add to the grim picture with high numbers of seniors with multiple chronic conditions (48) and cognitive problems (44) when compared with other states.

Are there any bright spots in this dark picture? In fact, yes, we have a few reasons to be optimistic as Louisiana has high numbers of seniors who get their annual flu shot (12), lots of home health workers (8), infrequent falls (3) and a low number of senior suicides (25). 

Although it was not the object of the report, the close association between low incomes, low educational level and poor health continues to haunt Louisiana. Our reputation as a “happy state” belies the fact that our happiness may be rooted in a poor understanding of our numerous health shortcomings. Everyone knows senior citizens who are happy, healthy and even wealthy, but there are huge numbers that are not. Ignorance about our health outcomes should not equate with bliss.

As a society, we can work to improve the health status of our most vulnerable citizens (both the very young and very old), especially by improving their economic and educational prospects. 

Our investments in youth education and job training will reap dividends for our elderly both now and in the future. The best treatment is always prevention, so we need to look upstream for the causes of so many ills that beset our elderly citizens and act accordingly. 

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