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Healthy Older Adults COMMUNITY HEALTH ASSESSMENT Prepared by: HealtheConnectionsHealthPlanning November 2013

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Appendix 6 - Madison County 2013 Community Health Assessment Healthy Older Adults

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Healthy Older Adults

COMMUNITY HEALTH ASSESSMENT

Prepared by:

HealtheConnectionsHealthPlanning

November 2013

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Overarching Goal Statement

Healthy People in Every Stage of Life:

All people, and especially those at greater risk of health disparities, will achieve their

optimal lifespan with the best possible quality of health in every stage of life.

Strategic Goal Statement

Live Better, Longer:

Increase the number of older adults (aged 50 or older) who live long, high-quality,

productive, and independent lives.

Healthy Older Adults

TABLE OF CONTENTS

Introduction ....................................................................................................................... 1

Key Findings ...................................................................................................................... 2

Demographics and Social Determinants ...................................................................... 3

Morbidity and Mortality ................................................................................................... 4

Cancer ................................................................................................................................ 5

Cerebrovascular Disease ................................................................................................ 5

Heart Disease ..................................................................................................................... 6

Injury .................................................................................................................................... 7

Alzheimer’s Disease .......................................................................................................... 9

Healthy Care ................................................................................................................... 10

Clinical Preventive Services .......................................................................................... 10

Cancer Screening .......................................................................................................... 11

Emergency Department Use and Hospitalizations .................................................. 11

Long Term Care Needs .................................................................................................. 17

Office for the Aging ....................................................................................................... 18

Data Tables ...................................................................................................................... 19

Older Adult Table Sources ............................................................................................. 22

References ...................................................................................................................... 23

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TABLE 1 2010 2015 2020 2025 2030 2035 2040

Ages 60+ 13,831 15,907 18,496 20,701 21,699 21,425 20,770

Ages 65+ 9,794 11,253 13,144 15,399 17,137 17,903 17,282

Ages 75+ 4,241 4,439 5,245 6,259 7,331 8,753 9,708

Ages 85+ 1,201 1,242 1,225 1,264 1,458 1,815 2,132

Ages 60-74 9,590 11,468 13,251 14,442 14,368 12,672 11,062

Ages 75-84 3,040 3,197 4,020 4,995 5,873 6,938 7,576

Minority Elderly 60 and over 267 303 409 523 674 839 1,005

Ages 65+ 182 231 271 377 489 619 818

Ages 75+ 95 100 115 171 204 291 413

Disabled Ages 5 and Over 8,303 8,827 9,485 10,058 10,338 10,315 10,201

Ages 60 and over 4,357 5,011 5,826 6,521 6,835 6,749 6,542

Poverty Age 65+ 684

Below 150% 1856

Below 200% 2931

Housing (Own/Rent), 65+ 4,825/1,174

New York State Office for the Aging. County Data Book, Selected Characteristics, Madison County, 2011

INTRODUCTION

Older adults are the fastest growing segment of the pop-ulation. In 2010, there were an estimated 40.4 million adults over the age of 65 in the United States, an increase of 15.3%, since 2000. This trend was similar in Madison County (13%) where the population of adults, age 65 and older, grew from 8,661 in 2000 to 9,794 in 2010. The New York State Office of the Aging estimates that a significant amount of growth in this age demographic will occur be-tween 2010 and 2025 as the baby boomers age. Baby boomers are defined as individuals born between 1946 and 1964, or presently between ages 49 and 67. By 2025, the number of adults over the age of 60 in Madison Coun-ty will grow by almost 6,870 people; an almost a 50% in-crease from the County’s 2010 population.1

Projected Increase in the Elderly Population in Madison County 2010-2040

As adults age, the primary health goal will be to promote and facilitate extended good health, quality of life, and aging in place. Nationally, life expectancy has been steadily increasing.2

Older adults are the greatest users of the healthcare system and care for the elderly becomes most expensive in the final years of life. To continue on the path of sustained vitality, preventive health care screenings and treatments as well as education and chronic disease management will become essen-tial tools to foster positive health outcomes for this age group.

Healthy People 2020 goals to improve the health of this age group are focused around the appropriate use of Medicare benefits, access to clinical core preventive services, increasing self-management bene-fits and chronic disease education, increasing physical and cognitive function, and expanding and edu-cating the health work force to include more geriatric certified providers.

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KEY FINDINGS

Healthy Care

The percentage of adults receiving the recommended cancer screenings is higher in Madison County than in the state, and currently exceeds the NYS Prevention Agenda Objectives. This trend is true for colorectal screenings (72.3% vs. 66.3), breast cancer screening (86.8% vs. 83.1%) as well as most other screening activities. State data indicates a slight disparity in breast cancer screening in low income groups (83.1% vs. 76.7 %).

In Madison County, a higher percentage of adults aged 65+ had all their permanent teeth extracted due to decay or gum disease compared to the New York State average (26.5% vs. 19.4%). New York State data suggests that the percentage of low income elderly with all their permanent teeth extracted is almost 8% higher than individuals in higher income brackets.

Cerebrovascular disease mortality rates are significantly higher in Madison County compared to NYS (43.7 per 100,000 vs. 27.5 per 100,000)

Based on 2008 – 2010 cancer data, Madison County demonstrates a higher incidence rate for all can-cers (525.2 per 100,000) than NYS (499.9 per 100,000). In particular, Lung and Prostate cancer inci-dence rates in Madison County (86.2 per 100,000 and 197.4 per 100,000) are significantly higher than the NYS incidence rates for these two cancers (70.2 per 100,000 and 165.7 per 100,000 respectively).

Healthy Behaviors

In 2008, 74% of adults 65+ had a flu vaccination in Madison County which is on average with the state and better than the prevention agenda goal of 66.2%. Access to the flu vaccine did not seem to vary with income.

Similarly, 78% of adults 65+ had a pneumonia shot or vaccine compared to 65% in the state. Access to the pneumonia vaccine also did not seem to vary by income.

Despite high percentages of vaccinations, Madison County had a significantly higher crude pneumonia/flu hospitalization rate for adults 65+ when compared to the state (182.8 vs. 127.9).

Healthy Environments

In 2008, 17.8% of all adults had a fall within the last 3 months and almost 6% had a fall that caused an injury. In both cases, low income adults are at higher risk; 23% of low-come adults had a fall in the past three months and 8% had a fall that caused an injury. In both cases, Madison County is similar to the state percentages (17.3% and 4.6% respectively).

The county has a much lower rate of hospitalizations due to falls per 10,000 in the adult population 65+ when compared to state averages (144.5 vs. 204.6)

Key

Indicates a favorable status compared to New York State

and/or when compared to Madison County’s previous data.

Indicates an unfavorable but similar status compared to

New York State and/or when compared to Madison County’s

previous data (difference within 10%).

Indicates an unfavorable and worse status compared to New

York State and/or when compared to Madison County’s

previous data (difference greater than 10%).

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DEMOGRAPHICS AND SOCIAL DETERMINANTS OF HEALTH

The composition of Madison County’s older adult population is similar to state and local patterns. About 13.8% of the county is over the age of 65, and 1.7% is over the age of 85. The majority of the area’s older adult population lives at home (67.2%), about a quarter (25.4%) lives alone, and 3.7% live in a skilled nursing facility.3 The percentage of older adults living alone (25.4%) is slightly lower than that of the state (29.0%). Comparable to the state and nation, women in Madison County live longer than their male counter-parts. There are more elder women, than men, that live alone or reside in skilled nursing facilities in the county. Fewer older adults are disabled in Madison County than the national average (26.2% ver-sus 37.9%).3,4

Characteristics of the Madison County Elderly Population

Madison County older adults have more financial re-sources than their national counterparts. The percent-age living below 100% of the poverty level is lower in the county than in the state (7.0% versus 9.4%). More Madison County elders receive income from retirement (54.4% versus 49.0%), earnings (36.2% versus 34.2%) and social security (96.6% versus 91.9%) than their na-tional counterparts.3

TABLE 2 Number

Percent of Elderly

Population

Percent of Total

Population

Total Adults 65+ 10,076 100.0% 13.7%

65-74 years 5,645 55.1% 7.7%

75-84 years 3,271 31.9% 4.5%

85+ years 1,323 12.9% 1.7%

Housing

Live with a child or other relative 556 5.5% 0.7%

Live alone 2,559 25.4% 3.5%

Male 676 6.7% 0.9%

Female 1,883 18.7% 2.6%

In a nursing home 373 3.7% 0.5%

Socioeconomic

Disabled 2,643 26.2% 3.5%

Covered by Health Insurance 10,068 99.9% 13.7%

Below 100 percent of poverty level 681 7.0% 0.9%

100-149 percent of poverty level 1,206 12.4% 1.6%

U.S. Census, 2010

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Morbidity and Mortality In 2009, the leading causes of death in Madison County were cancer, heart disease, chronic lower respiratory disease (CLRD), stroke and unintentional injury. Rates of cancer, CLRD, stroke, and unin-tentional injury are higher in Madison County than State averages.5 Causes of mortality in older adults in New York State, excluding New York City, vary significantly by age. The leading cause of death for adults ages 65-74 is cancer, closely followed by heart disease. In older age groups, mortality from cancer begins to decrease while mortality from heart disease con-tinues to increase. Mortality from stroke and pneumonia begin to rise as well.

New York State Department of Health, Vital Statistics, 2013

Figure 1

New York State Department of Health, Vital Statistics, 2012

Figure 2

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Cancer Over the past 35 years, the incidence of cancer has in-creased and is consistently higher in males. The in-crease in incidence is likely overstated by the imple-mentation of more rigorous screening standards and procedures over the course of time resulting in earlier and higher rates of detection. While incidence rates have risen over time, mortality has decreased likely due to earlier detection and advanced surgical and medical treatments.7 Based on 2008 – 2010 cancer data, Madison County demonstrates a higher incidence rate for all cancers (525.2 per 100,000) than NYS (499.9 per 100,000). In particular, Lung and Prostate cancer incidence rates in Madison County (86.2 per 100,000 and 197.4 per 100,000) are significantly higher than the NYS incidence rates for these two cancers (70.2 per 100,000 and 165.7 per 100,000 respectively).

Cerebrovascular Disease Cerebrovascular disease (i.e., stroke) is caused by damage to vessels that supply blood to the brain. Hypertension (i.e., high blood pressure) is a leading contributor to cerebrovascular disease, as it dam-ages the blood vessel linings. Sustained hypertension permanently damages blood vessels making them more vulnerable to changes in blood pressure. Cerebrovascular disease primarily affects older adults or those with a history of diabetes, smoking, or ischemic heart disease. The 2008-2012 NYS Prevention Agenda set the goal of reducing Cerebrovascular Disease mortality from 32.6 to 24.0 deaths per 100,000. Although state level mortality rates have demonstrated a de-cline, rates in Madison County remain high. Healthy People 2020 have set the objective of reducing stroke deaths from 42.2 to 33.8 per 100,000.

Cerebrovascular Disease indicators in Madison County Adults (Ages 18+) 2008-2010

Hypertension is not frequently the primary reason for an emergency room visit but is often a second or third diagnosis contributing to the primary cause. In Madison County, adults aged 25-64 with some diagnosis of hypertension made 926 visits to the emergency departments resulting in a use rate of 13.6 visits per 1,000 population for adults ages 25-44, 33.5 for adults ages 45-64 and 24.9 for adults ages 25-64.6

TABLE 3 Madison

County NYS

Cerebrovascular (Stroke) disease mortality (per 100,000) 43.7 27.5

Percent high blood pressure among adults 26.9 25.7

Percent blood pressure medication 82.1 78.5

Percent blood cholesterol checked within the past 5 years (adults) 75.5 77.3

New York State Department of Health-BRFSS, 2008-2009, Community Health Indicator Reports, 2011

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Hypertension is not frequently the primary reason for an emergency room visit but is often a second or third diagnosis contributing to the primary cause. In Madison County, adults aged 25-64 with some diagnosis of hypertension made 926 visits to the emergency departments resulting in a use rate of 13.6 visits per 1,000 population for adults ages 25-44, 33.5 for adults ages 45-64 and 24.9 for adults ages 25-64.6

Heart Disease According to the American Heart Association 83.6 million adults in the United States have at least one form of cardio vascular disease. Roughly halve of these individuals (42.2 million) are age 60 and above. Nationwide the leading causes of death for older Americans are heart related in 2009.8 Madi-son County heart disease mortality rates are consistently lower than New York State’s.

Heart Disease Deaths per 100,000, 2004-2010

Figure 3

New York State Department of Health, SPARCS data, 2009

Madison NYS Madison NYS Madison NYS

TABLE 4 2008-2010 2008-2010 2006-2010 2006-2010 2004-2010 2004-2010

Total 178.0 244.5 177.3 251.3 182.5 257.4 Total (Age-adjusted) 163.0 212.9 163.3 221.3 170.2 229.6

Aged 65 years and over 1,087.2

1,549.8 1,100.6 1,611.6 1,154.0 1,668.1

Aged 65 years and over; Male 1,249.2 1,612.6 1,218.5 1,672.8 1,335.2 1,720.4

Aged 65 years and over; Female 958.4

1,505.6 1,007.7

1,568.8 1,011.9

1,631.8

Source:http://www.healthindicators.gov/Indicators/Heartdiseasedeaths-per-100000_83/Profile, March 2013.Date accessed: Dec 2, 2013.

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Injury

Falls are the leading cause of fatal injury among adults aged 65 and above.11 Annually 35-40% of peo-ple 65 and older fall at least one time. However, less than have of these individuals discuss their acci-dent with their healthcare provider. Roughly a quarter of people who hurt themselves falling suffer moderate to serious injuries ranging from cuts to head trauma.12 Primarily due to falling, men and women ages 75 and over are at high risk for traumatic brain injury. Consequently, elderly 75 years and above have the highest rates of TBI-related death and hospitalization.13

In Madison County, fall related injuries combined to be the leading cause of ED visits. As individuals aged the percentage of serious falls treated in the ED more than doubled, increasing from 23% to 55%.6

New York State Department of Health, SPARCS data, 2009. These injuries may have or may have not involved falling (*).The category “Fall Related” is now a range due to un-specified 4% in the “Obj w-w/o sub fall” group (+).

Figure 4

New York State Department of Health, SPARCS data, 2009

Figure 5

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New York State Department of Health, SPARCS data, 2009

Figure 6

New York State Department of Health, SPARCS data, 2009.

Figure 7

According to the New York State of Health, statewide 60% of fall-related hospitalizations in older residents took place in the home, 36% of fall-related emergency department visits took place in homes.14

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Alzheimer’s Disease Alzheimer’s Disease has emerged as a signifi-cant concern among the older adult popula-tion. According to the Alzheimer’s Association 2013 Factsheet, Alzheimer’s was the sixth leading cause of death and the fifth leading cause of death in those 65 and over in the Unit-ed States in 2010. Deaths from Alzheimer’s have increased 68% between 2000 and 2010 nationwide while other leading causes of mor-tality decreased during the same time period. The Alzheimer’s Association estimates that by 2050, 16 million people will have the disease. 9 In New York State, in 2010, 2,616 deaths were due to Alzheimer’s Disease. Age adjusted death rates due to Alzheimers in Madison County at first glance appear to be low (17.3 per 100,000). However, the mortality rate in older adults 65 and over is quite high and is higher than the state mortality rate of 98.7 per 100,000.10

Alzheimer’s Disease Deaths per 100,000, Madison County, 2004-2010

The number of Medicare beneficiaries for Alzheimer ’s disease and related disorders has been in-creasing in New York State since 2007. This trend can also be seen in the Syracuse Metropolitan Ser-vice Area, which includes much of Madison County. As the population ages, more and more residents are living with this disease.

Alzheimer's Disease, Related Disorders, or Senile Dementia Medicare Beneficiaries

TABLE 5 2008-2010 2006-2010 2004-2010

Total 17.3 17.3 17.9 Total (Age-adjusted) 15.9 16 16.9 Aged 65 years and over 122.6 124.1 132.2 Aged 65 years and over; Male NA NA 67.6 Aged 65 years and over; Female

172.6 181.9 182.8

Source: healthindicators.gov/indicators/Alzheimers ,,March 2013. Date accessed: June 6, 2013.

TABLE 6 2010 2009 2008 2007

New York State Total 12.2% 12.1% 11.9% 11.8% Aged 65 years and over 14.2% 14.0% 13.7% 13.5% Aged <65 years 3.5% 3.4% 3.4% 3.3%

Syracuse Metropolitan Service Area 10.2% 10.1% 9.9% 9.9% Aged 65 years and over 12.2% 12.0% 11.7% 11.6% Aged <65 years 2.1% 2.2% 2.3% 2.2%

Source: healthindicators.gov/indicators/Alzheimers ,,March 2013. Date accessed: June 6, 2013.

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HEALTHY CARE Clinical Preventive Services Preventive care is an important component of con-tinued and long term health especially as adults age. Early detection of illness and chronic disease can prolong life and improve the quality drastically. The US Preventive Services Task Force (USPSTF) recom-mends a set of clinical preventive services for per-sons 65 and older with a set of core preventive ser-vices that are age and gender appropriate. The core services include colorectal, cervical and breast can-cer screening, influenza and pneumococcal vaccina-tions and screening for lipid disorders.15 In 2012 only 25% of the population ages 50-64 in the United States and less than 40% of adults aged 65+ were up to date on their core set of services (i.e cancer screenings, diabetes screenings, vac-cines, blood pressure and cholesterol monitoring) despite that most if not all are covered by most insurance plans including Medicaid and Medicare. Healthy People 2020 aims to increase the propor-tion of men from (46.3% to 50.9%) and women from (47.9% to 52.7 %) by the year 2020.16

Key Issues and Indicators for Adults Ages 50-64:

Mammogram within the past two years

Pap test within the last three years

Colorectal cancer screening

Cholesterol screening within the past 5 years

Binge drinking within the past 30 days

Colorectal cancer screening

No leisure-time physical activity within past month

Influenza vaccination within the past year

Pneumococcal vaccination ever amount persons at risk

Obesity- current

Smoking-current

High blood pressure ever

Moderate depressive symptoms within past two weeks

Up to date with core set of clinical services (see above)

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Cancer Screening Cancer screening rates in Madison County surpass state rates and meet Healthy People 2020 guide-lines.

Emergency Department Use and Hospitalizations Older adults have the highest use rates of the emergency department (ED) than any other age group. In 2009, the top 5 diagnoses of ED utilization among seniors aged 45 to 64 in Madison County were superficial injuries, sprains and strains, chronic obstructive pulmonary disease (COPD), open wounds, and abdominal pain. There were a total of 5,627 ED visits made by adults in this age group . The top 10 diagnoses below represent 42.1% of ED use by 45-64 year olds on Madison.6

Figure 8

New York State Department of Health-BRFSS, 2008-2009

Figure 9

New York State Department of Health, SPARCS data, 2009

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ED utilization among seniors aged 65 to 84 in Madison County was similar to the younger age group. For residents ages 45-64 the most common reasons for ED visits were superficial injuries, chronic obstructive pulmonary disease (COPD), chest pain, abdominal pain, and cardiac dysrhythmias. There were a total of 1,982 ED visits made by seniors ages 65-84 in 2009. The top 10 diagnoses below rep-resent 40% of ED use by this age group. Of those visiting the ED from this age group, 61% were treat-ed and released.6

In 2009, the leading causes of ED utilization (top 5 diagnoses) among seniors aged 85 and older in Madison County were superficial injuries, urinary tract infections, upper respiratory disease, open wounds and back pain. Visits from the top 10 diagnoses made up 43% of ED use in this age group. Of those visiting the ED from this age group, 57% were treated and released. Madison seniors 85 and above made a total of 918 ED visits.6

Figure 10

New York State Department of Health, SPARCS data, 2009.

Figure 11

New York State Department of Health, SPARCS data, 2009.

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Among older adults visiting the Emergency Department, 39% were subsequently hospitalized. The leading causes of hospitalization (top diagnoses) among seniors aged 65 to 84 in 2009, were from pneumonia, COPD, Congestive heart failure, and Cardiac Dysrhythmias. The top 10 diagnoses made up 42% of all admissions.

Of adults 85+ visiting the ED, 43% were admitted. Leading causes of hospitalization (top 5 diagnoses) among seniors aged 85 and older in 2009 were a result of pneumonia, congestive heart failure, uri-nary tract infections, hip fractures and dehydration. The top 10 diagnoses made up 52% of all admis-sions.

Figure 12

New York State Department of Health, SPARCS data, 2009

New York State Department of Health, SPARCS data, 2009

Figure 13

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For adults ages 45-64, the most common reasons for of hospitalization (top diagnoses) were sprains and strains, superficial injury, chest pain, COPD, and back pain. In 2009, the top 10 diagnoses made up 38.2% of all admissions for this age group.6

Among older adults 65 and above visiting the Emergency Department, 39% were subsequently hos-pitalized. The leading causes of hospitalization (top diagnoses) among seniors aged 65 to 84 in 2009, were from pneumonia, COPD, Congestive heart failure, and Cardiac Dysrhythmias. The top 10 diag-noses made up 42% of all admissions.6

Figure 14

New York State Department of Health, SPARCS data, 2009

Figure

New York State Department of Health, SPARCS data, 2009

Figure 15

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New York State Department of Health, SPARCS data, 2009

Figure 16

Of adults 85+ visiting the ED, 43% were admitted. Leading causes of hospitalization (top 5 diagnoses) among seniors aged 85 and older in 2009 were a result of pneumonia, congestive heart failure, uri-nary tract infections, hip fractures and dehydration. The top 10 diagnoses made up 52% of all admis-sions.6 Madison residents ages 45-64 were discharged home or into self-care in over 90% of cases. Discharg-es to a Certified Home Health Agency (CHHA) or short-term hospital care constituted less than 5% of discharges.

Figure 17

New York State Department of Health, SPARCS data, 2009.

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The vast majority of hospital admitted seniors aged 65-84 were subsequently discharged home or into self-care (48%). Roughly one quarter of individuals were discharged into skilled nursing facilities, and 13% into certified home health care.6

Most hospital admitted seniors aged 85 and older were discharged into a licensed nursing facility (48%). One quarter of individuals were discharged home or into self-care, and 16% into certified home health agencies.6

Of individuals aged 65 to 84 who were treated and released, 90% were discharged home or under self-care, and of individuals 85+, 87% who were treated and released were discharged home or un-der self-care. Short-term hospital for inpatient care was the discharge location for 6% of seniors aged 65 to 84.

New York State Department of Health, SPARCS data, 2009.

Figure 18

New York State Department of Health, SPARCS data, 2009.

Figure 19

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Long Term Care Needs As the baby boomers begin to age, an inventory of the resources available to the elderly population needs to be examined. It is the goal of the county, communities, and families to keep residents inde-pendent in the community as long as possible or improve quality of life for those that are unable to be independent. In Madison County, housing options for the elderly are limited and there are not enough alternatives for people who are unable to remain independent. In Madison County, there are a total of 400 skilled nursing facility beds between two hospital based facilities, and two community based facilities. Oneida Healthcare beds are located in the eastern ser-vice area, Community Memorial and Crouse Community Center beds are located in the southern ser-vice area, and Stonehedge beds are in the western service area of the county.17

Madison County Supply of Nursing Home Beds - 2013

The majority of nursing home beds (90.5%) were filled by adults over the age of 65, and 54% were filled by adults over the age of 85. The majority of nursing home residents (76%) are female.19

Nursing Home Utilization in Madison County 2011

As the population ages, a greater demand for these beds is anticipated. Should County facilities be-come full, residents would have to move out of county to neighboring Oneida and Onondaga counties for skilled nursing facility care.

Health Facilities Master File

TABLE 7 - Area Beds Location

Oneida Healthcare, ECF 160 Oneida

Community Memorial Hospital, SNF 40 Hamilton

Crouse Community Center, Inc. 120 Cazenovia Stonehedge Acquisition Chittenango

80 Chittenango

RHCF Patients, 2011 2010 Population

TABLE 8 Number

Percent

Distribution

Percent

Female Number Percent

Distribution

Use Rate/1000

pop

% of pop using

services

All Ages 363 95.8% 76.9% 73,442 100.0% 4.9 0.5%

0-64 20 5.3% 55.0% 63,203 86.1% 0.3 0.0%

0-54 6 1.6% 66.7% 53,944 73.5% 0.1 0.0%

55-64 14 3.7% 50.0% 9,259 12.6% 1.5 0.2%

65+ 343 90.5% 78.1% 10,239 13.9% 33.5 3.3%

65-74 37 9.8% 70.3% 5,645 7.7% 6.6 0.7%

75-84 98 25.9% 74.5% 3,271 4.5% 30.0 3.0%

85 + 204 53.8% 80.9% 1,323 1.8% 154.2 15.4%

Health Facilities Master File

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Office for the Aging In 2012, the Office for the Aging (OFA) in Madison County surveyed older adults, their care givers and families on regarding issues and concerns they may have or are challenged with. Of the 835 individu-als contacted, 725 were by phone call, 548 to consumers of OFA services, and 86 to caregivers and families of older adults. The majority of contacts were with people over the age of 60 (649) and the majority female (570). The majority of contacts requested consumer and caregiver support mainly related to caregiver training and case/care management (188), Health Insurance Information Coun-seling and Assistance Program HIICAP (192) mainly related to Health Insurance (Medicare) Infor-mation and Counseling , general information about Medicaid and subsidized prescription benefits, and transportation (68). The OFA assists by mailing personalized packets, providing telephone follow up, and assisting with applications for funded services and programs.

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DATA TABLES

Year Madison NYS Year Madison NYS Status

Healthy Care

Cancer Screening

Percentage of adults 50+ who ever used a Home Blood Stool Test 2008 48.3 34.9 2008-2009 43.6 38.1 ~

Percentage of Adults 50+ who used Home Blood Stool Test Used within past year 2008 21.0 11.5 2008-2009 15.9 14.6

Percentage of Adults 50+ who used Home Blood Stool Test used within past 2 years 2008 27.7 18.2 2008-2009 23.6 20.5

Percentage of Women 50 Years or Older Who had a Mammogram within the Last Two Years, New York State

2008 91.9 82.9 2008-2009 86.8 83.1

Percentage of Adults 50 Years or Older Who Have Ever Received a Sigmoidoscopy or Colonoscopy, New York State

2008 71.9 66.0 2008-2009 71.3 66.6

Percentage of adults 50+ with a sig-moidoscopy or colonoscopy within the past 10 years

2008 71.6 64.3 2008-2009 69.6 64.6

Access to Care

Percentage of adults 65+ that had all per-manent teeth extracted due to decay or gum disease

2008 30.8 18.4 2008-2009 26.5 19.4

Chronic Disease Management

Asthma

Asthma hospitalization rate for all ages per 10,000 population 2004-2006 10.1 21.0 2008-2010 9.2 20.3

Asthma hospitalization rate for 5-64 years of age per 10,000 population 2004-2006 6.6 16.2 2008-2010 6.8 15.4

Percentage of adults ever diagnosed with asthma (lifetime) N/A N/A N/A 2008-2009 18.1 16.5

Asthma Hospitalization Rate for people ages 45-64 years N/A N/A N/A 2008-2010 8.5 21.8

Asthma Hospitalizations 65+ years 2004-2006 21.6 30.0 2008-2010 17.5 32.2

Asthma mortality rate for all ages (per 1,000,000) 2004-2006 13.1 13.4 2008-2010 0.0 1.2

Chronic Obstructive Pulmonary Disease

Hospitalization rate for COPD (per 10,000) 2004-2006 28.6 36.7 2008-2010 39.1 41.3

Mortality rate for chronic obstructive pulmo-nary disease (per 100,000) 2004-2006 64.8 31.3 2011 56.0 31.1

Chronic Lower Respiratory Disease

Chronic Lower Respiratory Disease hospi-talization rate per 10,000 N/A N/A N/A 2011 31.0 37.5

Mortality rate for chronic lower respiratory disease 2004-2006 64.8 31.3 2008-2010 56.0 31.1

Stroke

Cerebrovascular Disease (Stroke) Hospital-ization Rate per 10,000 2004-2006 23.8 26.7 2008-2010 23.5 25.1

Cerebrovascular (Stroke) disease mortality (per 100,000) 2004-2006 43.6 30.5 2008-2010 43.7 27.5

Cerebrovascular disease premature death (ages 36-64) N/A N/A N/A 2008-2010 9.3 10.6

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Diseases of the Heart

Mortality Rate for Diseases of the heart per 100,000 2004-2006 180.9 237.2 2008-2010 166.8 207.6

Age adjusted percentage of adults with coronary heart disease 2008 8.0 6.2 2008-2009 7.2 6.3

Coronary heart disease hospitalizations (per 10,000) 2004-2006 59.8 61.2 2010 42.1 43.8

Mortality rate for coronary heart disease per 100,000 2004-2006 136.0 198.3 2008-2010 113.7 169.4

Congestive heart failure hospitalization rate per 10,000 (ages 18+ years) 2004-2006 28.0 46.3 2010 27.7 40.1

Mortality rate for congestive heart failure per 100,000 2004-2006 13.8 12.7 2008-2010 9.0 11.3

Age adjusted percentage of adults with Cardiovascular disease 2008 9.9 7.8 2008-2009 9.1 7.6

Mortality rate from cardiovascular disease 2004-2006 251.5 285 2008-2010 226.7 250.9

Age-adjusted heart attack hospitalization rate per 10,000 N/A N/A N/A 2010 15.4 15.5

Age-adjusted Heart Disease Death Rate per 100,000 N/A N/A N/A 2010 166.8 207.6

Diabetes

Percentage of adult population ever diag-nosed with diabetes 2008 6.2 9.7 2008-2010 7.4 9.0

Hospitalization rate for diabetes mellitus per 10,000 2004-2006 8.2 19.7 2011 4.5 5.6

Diabetes mellitus mortality rate per 100,000 population 2004-2006 11.6 18.7 2011 15.3 16.6

Cirrhosis

Hospitalization rate for cirrhosis (per 10,000) 2004-2006 28.6 36.7 2008-2010 1.7 2.7

Mortality rate for cirrhosis (per 100,000) 2004-2006 5.7 6.0 2010 3.9 6.4

Healthy Behaviors

Healthy Weight

Percent of adults that are obese 2003 23.5 22.9 2008-2009 26.2 23.1

Percent of home care patients that were overweight or obese N/A N/A N/A 2008 64.7 N/A

Percent of home care patients that are overweight - males N/A N/A N/A 2008 30.9 N/A ~

Percent of home care patients that are overweight - females N/A N/A N/A 2008 29.3 N/A ~

Percent of home care patients that are obese - males N/A N/A N/A 2008 37.4 N/A ~

Percent of homecare patients that are obese - females N/A N/A N/A 2008 32.6 N/A ~

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Infection Free Living

Percent of adults 65+ with flu shot past year N/A N/A N/A 2011 73.9 60.0

Percent of adults aged 65+ with flu shots N/A N/A N/A 2008-2009 64.1 74.4

Percentage of adults 65+ that ever had a pneumonia vaccine N/A N/A N/A 2008-2009 77.7 65.2

Percent of adults aged 65+ with pneumonia shot or pneumococcal vaccine N/A N/A N/A 2008-2009 71.3 64.2

Pneumonia Mortality Rate 2004 27.3 25.8 2011 1.7 2.5

Pneumonia/flu hospitalizations in adults 65+ 2004-2006 204.6 172.8 2008-2010 182.8 127.9

Healthy Environments

Resources for the Elderly

Nursing home beds per 10,000 population N/A N/A N/A 2009 57.4 61.2 ~

Licensed Hospital Beds per 10,000 N/A N/A N/A 2009 20.2 32.0 ~

Falls

Age-adjusted percentage of adults that had a fall within the past 3 months 2008 16.5 13.9 2008-2009 17.8 17.3

Age-adjusted percentage of adults who had a fall that caused an injury within the past 3 months

N/A N/A N/A 2008-2009 5.9 4.6

Fall related hospitalization age 65+ years per 10,000 2004-2006 138.4 196 2008-2010 144.5 204.6

Key

Indicates a favorable status compared to New York State and/or when compared to

Madison County’s previous data.

Indicates an unfavorable but similar status compared to New York State and/or when

compared to Madison County’s previous data (difference within 10%).

Indicates an unfavorable and worse status compared to New York State and/or when

compared to Madison County’s previous data (difference greater than 10%).

~ Neither favorable nor unfavorable; comparison unavailable

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OLDER ADULT TABLES SOURCES

DEMOGRAPHICS -Selected Causes of Death by Resident County New York State – 2011 https://www.health.ny.gov/statistics/vital_statistics/2011/table38.htm -Death Rates* For Selected Causes of Death by Resident County New York State – 2011 https://www.health.ny.gov/statistics/vital_statistics/2011/table39.htm HEALTHY CARE Cancer Screening -NYS BRFSS: http://www.health.ny.gov/statistics/brfss/expanded/2009/county/docs/madison.pdf Access to Care -NYS BRFSS: http://www.health.ny.gov/statistics/brfss/expanded/2009/county/docs/madison.pdf Asthma -Madison County-County Health Assessment Indicators: http://www.health.ny.gov/statistics/chac/chai/chai_25.htm Chronic Obstructive Pulmonary Disease -Madison County-County Health Assessment Indicators: http://www.health.ny.gov/statistics/chac/chai/chai_25.htm Chronic Lower Respiratory Disease -Madison County-County Health Assessment Indicators: http://www.health.ny.gov/statistics/chac/chai/chai_25.htm Stroke -Madison County-County Health Assessment Indicators: http://www.health.ny.gov/statistics/chac/chai/chai_25.htm Diseases of the Heart -Madison County-County Health Assessment Indicators: http://www.health.ny.gov/statistics/chac/chai/chai_25.htm Diabetes -Madison County-County Health Assessment Indicators: http://www.health.ny.gov/statistics/chac/chai/chai_25.htm Cirrhosis -Madison County-County Health Assessment Indicators: http://www.health.ny.gov/statistics/chac/chai/chai_25.htm Resources for the Elderly -Health Facilities Master File Falls -NYS BRFSS: http://www.health.ny.gov/statistics/brfss/expanded/2009/county/docs/madison.pdf HEALTHY BEHAVIORS Healthy Weight -NYS BRFSS: http://www.health.ny.gov/statistics/brfss/expanded/2009/county/docs/madison.pdf Infection Free Living -NYS BRFSS: http://www.health.ny.gov/statistics/brfss/expanded/2009/county/docs/madison.pdf

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REFERENCES

1 New York State Office for the Aging. County Data Book, Selected Characteristics, Madison County, 2011 2 National Center for Health Statistics, National Vital Statistics Reports. Web:www.cdc.gov/nchs. <http://www.infoplease.com/ipa/A0005148.html.> Date accessed: March 15, 2013. 3 U.S. Census, 2010 4 U.S. Census, 2010, SF2 data 5 New York State Department of Heatlh “ Leading Causes of Death by County” <http://www.health.ny.gov/statistics/leadingcauses_death/deaths_by_county.htm.> Date accessed: June 6, 2013 6 Statewide Planning and Research Cooperative System (SPARCS), 2009 7 New York State Department of Health“The Influence of an Increase in Screening on Incidence And Mortality Rates - Statistics Teaching Tools“ http://www.health.ny.gov/diseases/chronic/screening.htm. Date accessed Dec 2, 2013. 8 American Heart Association “Older Americans & Cardiovascular Diseases” <http://www.heart.org/idc/groups/heartpublic/@wcm/@sop/@smd/documents/downloadable/ucm_319574.pdf.> Date accessed Dec 2, 2013. 9 Alzheimer’s Association. 2013 Alzheimer’s Disease Facts and Fast Figures. < www.alz.org/facts..> Date accessed: March 15, 2013. 10 < healthindicators.gov/indicators/Alzheimers> , March 2013. Date accessed: June 6, 2013 11 CDC “Injuries Among Older Adults” < http://www.cdc.gov/ncipc/olderadults.htm.> Date accessed Nov 25 2013. 12 CDC “Falls Among Older Adults: An Overview “ http://www.cdc.gov/homeandrecreationalsafety/Falls/adultfalls.html.> Date accessed Nov 25 2013. 13 CDC “Injury Prevention & Control: Traumatic Brain Injury “ http://www.cdc.gov/traumaticbraininjury/seniors.html.> Date Accessed Nov 26 2013. 14 New York State Department of Health “Falls in Older Adults, New York State” <http://www.health.ny.gov/prevention/injury_prevention/falls_in_older_adults_nys.htm.> Date accessed: Nov 25 2013. 15 Centers for Disease Control and Prevention. Clinical Preventive Services. 2012.< www.cdc.gov/aging/services.> Date accessed: May 15, 2013. 16 Healthy People “2020 Objectives” <http://healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=31>. Date accessed: March 15, 2013. 17 Health Facilities Master File,2013.

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NYS Expanded Behavioral Risk Factor Surveillance System County Specific Report 2008-2009

Statewide Planning and Research Cooperative System (SPARCS), 2009

Asthma Emergency Department Visits in NYS by Region and Count (2008-2010)

Asthma Hospital Discharge Data in New York State by Region and County (2008-2010)

NYS Cancer Statistics, Incidence and Mortality Data average for most recent five years

NYS Cancer Statistics, Early Stage of Disease Diagnosis

NYS Cancer Statistics, Estimated Prevalence

Vital Statistics of New York 2010 Mortality Data, Death Summary Information by Age New York State Exclu-sive of New York City, 2010

Vital Statistics of New York 2010 Mortality Data, Death and Death Rates by Selected Causes New York State Exclusive of New York City, 2010

Vital Statistics of New York, 2010, Mortality Data, Deaths from Five Leading Causes of Death by Age and Race/Ethnicity

Vital Statistics of New York 2010 Mortality Data, Selected Causes of Death by Resident County including Dis-eases of the Heart and Cerebrovascular Disease (Stroke)

Vital Statistics of New York State, Annual Vital Statistics Tables, 2010, Death and Death Rates by age and Resi-dent County, New York State, 2010

Vital Statistics of New York State, Annual Vital Statistics Tables, 2010, Age –Sex Adjusted Death Rates and Se-lected Causes of Death by Resident County

Vital Statistics of New York State, Annual Vital Statistics Tables, 2010, Deaths due to Suicide by Race/Ethnicity, Sex and Age, by Region, New York State, 2010

United States Department of Labor, Bureau of Labor Statistics, Nonfatal Occupational Injuries and Illnesses Requiring Days Away from Work, 2011

Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report (MMWR) Adult Blood Lead Epidemiology and Surveillance, United States, 2008-2009

United States Department of Labor, Bureau of Labor Statistics, Sprains and Strains Most Common Work Place Injury, April 2005

U.S. Census Bureau, 2010 SF2 100% data

U. S. Census Bureau, 2011 5 year ACS

New York State Department of Health Community Health Indicator Reports, Cardiovascular Disease Indica-tors

Joe LaLone Consulting, Community Tobacco Survey of Adult Residents of Madison County, New York, Dec 2012

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Office of Alcohol and Substance Abuse Services, Service Need Profile, September, 2012

Zogby International, Community Survey, August 2012

http://www.healthindicators.gov/Indicators/Clinical-preventive-measure-use-males-65-years-percent_1261/Profile/ClassicData

Health Indicators Warehouse Health Indicators Warehousehttp://www.healthindicators.gov/Indicators/Clinical-preventive-measure-use-females-65-years-percent_1262/Profile/ClassicData

Centers for Disease Control and Prevention, AARP, American Medical Association. Promoting Preventive Ser-vices for adults ages 50-64: Community and Clinical Partnerships. Atlanta, GA: National Association of Chronic Disease Directors. 2009. Available at www.cdc.gov/aging.

Healthy People 2020. Older Adults Topics and Objectives. http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=31

Centers for Disease Control and Prevention. Clinical Preventive Services. 2012. www.cdc.gov/aging/services

New York State Office for the Aging. County Data Book, Selected Characteristics, Madison County, 2011.

Madison County Office for the Aging, Inc. NY Connects Monthly Report for December 2012.

Medicaid Institute at United Hospital Fund. Medicaid Long-Term Care in New York: Variation by Region and County. 2010. Available at www.uhfnyc.org

US Department of Health and Human Services, Administration on Aging. A Profile of Older Americans: 2011.available at: www.aoa.gov/Aging_Statistics/Profile/2011/docs/2011profile.pdf

Alzheimer’s Association. 2013 Alzheimer’s Disease Facts and Fast Figures. Available at www.alz.org/facts

Alzheimer’s Association. New York State Alzheimer’s Statistics. Available at www.alzo.org/facts

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For Report Information please contact:

Madison County Department of Health

www.healthymadisoncounty.org © 2013

Madison County Department of Health

PO Box 605 • Wampsville, NY 13163

Tel: 315‐366‐2361 • Fax: 315‐366‐2697

[email protected]

For Report Information please contact:

Madison County Department of Health

www.healthymadisoncounty.org © 2013

Madison County Department of Health

PO Box 605 • Wampsville, NY 13163

Tel: 315‐366‐2361 • Fax: 315‐366‐2697

[email protected]