The number of Missourians age 65 and older is projected to grow by some 450,000 over the next 15 years, bringing the total number of seniors to an estimated 1,255,000. This growth will increase the proportion of seniors in the state’s population from an estimated 13.6 percent today to 15.1 percent by 2015 and to 19.1 percent by 2025. As the baby boomers age, their values and life experiences will influence Missourians’ perceptions of the resources, needs, capacities and strengths of seniors. Missouri Senior Report 2009 is a resource to inform state and local policy makers, service providers and families, as they plan for the impact of an increasingly older Missouri.
The report provides a snapshot of the status of Missouri seniors. It addresses their economic well-being, household and community engagement, health care status and access to medical treatment. The report also includes annual population projections and evaluations of seniors’ quality of life and wellness. It includes articles on Missouri’s senior tax levies and health disparities among seniors.
Trend data are available for eight indicators. Statewide, Missouri has improved on four of these indicators between 2000 and 2008. Improvements are noted in workforce participation, housing, transportation and health care access. The economic well-being indicator has remained relatively constant. Trends declined for household composition, long term-care costs and health status. The economic contribution, civic engagement and safety indicators were created just last year, making a trend analysis not yet meaningful.
Trends in the eight indicators vary throughout the state, reflecting the state’s demographic diversity. The county populations range from nearly one million in St. Louis County to about 2,000 in Worth County. Changes in population patterns also vary greatly. Between 2000 and 2008, Christian County, sandwiched between Springfield and Branson, grew by an estimated 37 percent in total population and 45 percent in senior population. In contrast, Worth County in northwest Missouri experienced almost a 14 percent decline in total population and a 4 percent decline in the number of seniors.
Missouri includes counties that are urban, suburban or rural. That character greatly affects each county’s economy, culture and senior population. For instance, seniors in Missouri’s most rural counties, particularly those in northern Missouri, tend to be older and more reliant on retirement income than seniors in more populated areas. Seniors in Missouri’s metropolitan counties are more likely to have convenient access to health care, access to transportation, and participate in the workforce. To address this diversity, the report presents comparative information for individual Missouri counties. The report ranks each county on annually updated outcome indicators. It also includes an overall county composite rank – a summary index of the overall well-being of seniors by county. To place these annual outcome measures in the broader community context, “status” indicators describe the demographic composition, quality of life, and health and wellness of seniors.
Understanding Senior Report Outcome and Status Indicators
The Senior Report indicators present an annual snapshot of each of Missouri’s counties. The indicators and measures were selected through input from many Missourians with a personal or professional passion for the well-being of seniors. The Senior Report Advisory Committee provides ongoing input into the structure and content of the report. A subcommittee of the advisory committee selected topics and authors for the articles included in this year’s report.
The Missouri Senior Report 2009 Web site is: www.missouriseniorreport.org. It features the content in the printed report and allows users to access data used to calculate the outcome and status indicators. For example, the population estimates can be viewed by age and gender. The data, provided in both tabular and graphic format, can be viewed online and downloaded. The ‘County Profile Tables’ feature (accessible under ‘Quick Links’) allows users to select a specific county and browse tabular data by outcome and status indicators. The ‘Dynamic Reports Generator Menu’ (accessible by clicking on the ‘Data’ icon located in the header) allows users to select multiple counties, years and indicators to produce downloadable tables and graphs for use in presentations and reports. Previous senior reports are archived and accessible at the site. You may also access a print-ready version of Missouri Senior Report 2009.
Indicators Missouri Senior Report 2009 is organized around “outcome” and “status” indicators. Outcome indicators measure progress over time. Tracking trends in those indicators can help improve the health, social, and economic well-being of Missouri seniors. Counties are ranked by each outcome indicator. The indicator rankings are combined to compute the composite outcome ranking. Status indicators present demographic, quality of life, and health status measures for a single point in time.
The composite index ranking is based on the sum of the standardized values for nine of the outcome measures. It represents an overall measure of the well-being of seniors. The purpose of the ranking is to help focus improvement on local factors that contribute to the quality of life of Missouri seniors.
Outcome and status measures are tested for statistical reliability and validity. Because outcome indicators are measured annually, they are collected from various sources, including state administrative records such as the Missouri Board of Healing Arts and the Missouri Department of Social Services, and federal reporting agencies such as the U.S. Census Bureau and the Bureau of Labor Statistics.
Status indicators describing population characteristics are derived from the U.S. Census Bureau. Health and wellness indicators are drawn from the Center for Disease Control Behavioral Risk Factor Surveillance Survey (BRFSS) instrument. The health and wellness indicators are available through a Missouri Department of Health and Senior Services and Missouri Foundation for Health partnership. The glossaries of outcome and status indicators provide a detailed description of the construction and source of each measure.
Emerging Issues
The Office of Social and Economic Data Analysis conducted a 2008 survey to learn how the senior report is used in communities around the state and discover what features and information might be added to enhance the report’s value. We learned the issues that concern seniors, their loved ones and caregivers. Missourians spoke to us about the cost of prescription drugs, the need for better transportation options and the desire for seniors to remain in their homes and communities as long as possible. We were told about the value of social engagement, the fear of under-reporting of elder abuse and financial exploitation and the need to prepare for the aging of the baby boom generation.
As Missouri Senior Report 2009 goes to print, the United States continues to face a severe economic recession. High unemployment and mortgage defaults have led many people to deplete their retirement accounts. The recession has had a profound impact on seniors. This report begins to reflect the impact of the downturn. The value of an annual report is that it can reveal trends and allow policymakers to be informed as they address the concerns and desires of a community. We also want to know what you think of this report. Contact us at 573-884-5116 or via the Web at: www.MissouriSeniorReport.org.
Outcome Indicators Economic Well-being
Economic well-being for seniors can be measured by the percentage of seniors living in poverty. In 2000 the poverty rate for Missouri seniors was 9.9 percent, as compared to 10.9 percent nationally. While ACS poverty estimates for the senior population are now available annually at the state level, they will not be provided by the U.S. Census Bureau at the county level until 2011. However, Bureau of Economic Analysis county-level estimates on the numbers of low-income individuals and seniors who receive Supplemental Security Income (SSI) are available on an annual basis. Therefore, a relative index of economic well-being was created by calculating SSI payments as a percentage of total personal income. In Missouri, overall SSI payments represent 0.33 of one percent of total personal income, consistent with last year’s estimate. By county, this index of economic well-being ranges from a high of nearly 2 percent in Pemiscot County to a low of under 0.10 of one percent in Platte and St. Charles counties.
Workforce Participation
Senior participation in the workforce may be viewed as either an adverse or a positive outcome. An adverse view may result if seniors work because they are strapped for cash and would prefer to be fully retired. If, however, seniors want to remain economically and socially engaged and are employed in service and retail jobs that do not require strenuous physical activity, the outcome can be viewed as positive. On balance, the advisory committee views an increase in senior workforce participation as positive. Senior participation in the Missouri workforce has increased from 9.8 percent in 2001 to 11.9 percent in 2007, after dipping to 8.2 in 2005. By county, senior participation in the workforce ranged from a low of approximately 1.5 percent in Douglas County to a high of 24 percent in Taney County in 2007.
Economic Contribution
Seniors spend a great deal locally, frequently at higher rates than people younger than 65. This report includes a measure that provides the ratio of seniors’ economic contribution relative to the proportion of seniors in a county’s population. Overall, Missouri’s seniors are responsible for about 15.8 percent of consumer expenditures, yet comprise 13.6 percent of the state’s population. Seniors’ economic impact ranged widely among counties. Seniors’ spending accounted for 10.7 percent of all spending in St. Charles County, but more than 33 percent in Cedar County. In all but 11 Missouri counties, seniors’ expenditures exceed the proportion of the senior population.
Housing
The U.S. Department of Housing and Urban Development (HUD) considers families who pay more than 30 percent of their income for housing as ‘cost burdened’; these families may have difficulty affording necessities such as food, clothing, transportation and medical care. Housing costs include mortgage or rent, taxes, insurance and utilities. Seniors living on fixed incomes are particularly vulnerable to fluctuations in housing costs. On average, 28.2 percent of Missouri’s seniors are cost burdened. When considered by county, the number of seniors burdened by housing costs ranged from approximately 15.4 percent in Andrew County to 41.7 percent in St. Louis City.
Transportation
Transportation is necessary in order to obtain goods and services and to participate in work and social activities. Whether seniors have the capacity to meet their transportation needs is often measured by how many hold a valid driver’s license. Transportation needs are also likely to vary, depending on the availability of mass transit. Whatever transportation arrangements seniors make, the lack of a driver’s license in Missouri indicates that transportation is an issue. The number of Missouri seniors with a valid driver’s license increased from 76.7 percent in 2001 to 84.2 percent in 2008. In suburban and rural counties with lower percentages of licensed senior drivers, transportation is likely to be a more pressing issue than in similar counties with higher percentages of senior drivers, or in more urbanized areas that have public and private transportation resources. In 2008, the percentage of Missouri seniors with a valid driver’s license ranged from a high of 95 percent in Benton, Camden, Cass, Daviess, Douglas, Ozark, Stone and Taney counties, to a low of 54.8 percent in St. Louis City.
Household Composition
The 2000 U.S. Census indicates Missouri had a relatively large proportion of seniors living in single person households. Seniors who live with someone are less likely to be socially isolated and may have help with many issues. Consequently, household composition is an important indicator for seniors’ well-being. Because census measures of single person households are not available annually, the percentage of seniors filing joint Missouri income tax returns was used to gauge household composition. Between 2001 and 2007, the number of seniors filing joint income tax returns declined from 44.7 to 39.9 percent. In 2007 the number of seniors filing joint returns ranged from a high of 52.9 percent in Pulaski County to a low of 25.3 percent in Knox County.
Civic Engagement
Seniors contribute to their communities through a wide range of civic, humanitarian and religious volunteer activities. Capturing these activities consistently across counties and over time remains a challenge. However, we can know the degree to which seniors participate in the most fundamental of democratic activities – voting. Civic engagement is measured using the number of seniors as registered voters and as participants in elections on an annual basis. In 2008, Sullivan County seniors were registered to vote and voted at the highest rate, while Howell County seniors had the lowest rate of voter participation.
Long-Term Care
Long-term care represents a significant health care cost for seniors, who tend to have limited incomes, and for Missouri because of MOHealthNet (Medicaid). The number and value of long-term care insurance policies would be a useful measure for this indicator. However, that information is not reported by county. Consequently, this report presents the portion of long-term care costs paid by Medicaid for in-home and institutionalized long-term care services per capita. This annual measure shows the trend, if not the full expense, of long-term care. Long-term care costs increased from $122 per capita in 2000 to $143 per capita in 2008. However, both health care costs and the percentage of people eligible for Medicaid vary greatly by county. Therefore, this indicator is not used in the construction of the overall county index of senior well-being.
Safety
Understanding the relationship between seniors and safety is complicated. As with all populations, seniors are at risk of becoming victims of property and violent crimes. However, seniors who are physically or psychologically vulnerable are at increased risk of suffering accidents and abuse within their own homes. While crime data by age of victim is unavailable, we can measure the overall crime rate in a county. For the safety indicator, we included cases of abuse and neglect as reported through the Missouri Department of Health and Senior Services’ Elder Abuse and Neglect Hotline. These combined data sources are reported as an indexed rate per 1,000 persons. Carroll County experienced the lowest crime and senior abuse incidents in 2008, occurring at a rate of 11.1 per 1,000 persons, while St. Louis City experienced the highest rate of 83 per 1,000 persons. Accordingly, the number of property and violent crimes per 1,000 persons is reported as an outcome measure. The Missouri overall crime rate declined from 48.8 in 2001 to 43.1 in 2008. In 2008 the crude crime rate ranged from a low of 4.4 crimes per 1,000 persons in Chariton County to a high of 115.2 in St. Louis City.
Health Status
Selecting one health status measure for the senior population is particularly difficult because of the wide range of health issues confronting seniors. The Missouri Department of Health and Senior Services tracks numerous health and mental health indicators to inform communities of health status needs. The senior report advisory committee decided to base this indicator on the “number of hospitalizations and ER visits for diabetes, averaged over three years per 10,000 seniors.”
Tracking diabetes-related care is a valuable proxy for health status because (a) the number of cases by county is sufficient to produce a reliable rate; (b) diabetes is related to many other health problems; and (c) effective preventive measures can reduce the incidence of diabetes and related health problems. The rate of diabetes hospitalizations and ER visits per 10,000 seniors in Missouri increased slightly, from 71.6 in 2002 to 72.6 in 2006. In 2006 the rate ranged from a high of 166.1 per 10,000 seniors in Pemiscot County to 6.7 in Worth County.
Health Care Access
Health care access is essential for the overall well-being of seniors. Reliable, convenient access to primary care increases the capacity of seniors to live independently. The senior report measures health care access for seniors as a rate of the number of primary care physicians per 1,000 seniors. Primary care physicians frequently serve a demographically diverse patient base. However, primary care specialties are typically defined as: family practice, family medicine, general practice, internal medicine, general surgery, gynecology/obstetrics, and pediatrics. The physician’s professional registration database captures practice specialties and was matched to Missouri’s Bureau of Narcotics and Dangerous Drugs (BNDD) database, which requires physicians to report the counties in which they practice. Based on those data, the rate of primary care physicians per 1,000 seniors increased from a state rate of 7.1 in 2004 to 13.1 in 2008. In 2008 access to primary care physicians ranged from a low of no full-time primary care physicians practicing in Hickory County to more than 42 per 1,000 seniors in Boone County.
Status Indicators Demographics
The proportion of seniors in Missouri’s population was 13.5 percent in 2000 and 13.6 percent in 2008. By 2015 the proportion of Missouri’s population aged 65 or older is projected to increase to 15.1 percent; by 2025, to 19.1 percent. Those proportions will be higher than the proportion of seniors in the nation overall. Missouri’s total population is 5,911,605. Between 2000 and 2008, the state sustained a slow but steady 5.4 percent overall growth. The state’s 65 and older population also grew relatively slowly during this period, from 755,837 in 2000 to 805,235 in 2008, an increase of about 6.5 percent. The first baby boomers will turn 65 in 2011, beginning a trend of relative growth in the senior population that will continue until 2030. An important characteristic of the senior population is that women outnumber men. In 2008, nearly 70 percent of Missourians age 85 or older were women. That gender difference is projected to moderate somewhat in the next 15 years. By 2015, women are projected to be about 68 percent of the 85 and older population; by 2025, 65 percent.
Quality of Life
Missouri Senior Report 2009 includes six measures from the U.S. Census Bureau that speak to the overall quality of life of seniors. By 2011, the U.S. Census Bureau’s American Community Survey will release annual estimates for those measures for all Missouri counties. This year’s report includes ACS estimates for counties with populations of 65,000 or more. For counties with a population smaller than 65,000, the Office of Social and Economic Data Analysis calculated estimates for 2008 based on current population estimates and ACS Public Use Microdata Area regional estimates.
Owner-Occupied Housing
Seniors’ housing needs are more likely to be met if they live in owner-occupied housing. According to the ACS 2008 estimate, Missouri reported that 80.9 percent of seniors lived in owner-occupied housing, an increase of almost two percentage points from 2000. The rate ranged from 92.8 percent in Maries County to about 64.9 percent in St. Louis City.
Seniors Living in Families
Family life enhances the senior population’s well-being. Seniors who live alone are more likely to be socially isolated and at greater risk of accidental injury and physical and mental illness. The census defines families as two or more related persons living in the same household. Persons residing in single person households are not reported as “families.” In 2008, 62.6 percent of Missouri seniors lived in family households. By county, the number of seniors living in family households ranged from a high of 76.4 percent in Stone County to approximately 47.7 percent in DeKalb County.
Median Value of Owner-Occupied Housing
The ownership of a house represents a significant asset for most seniors, and the relative value of housing is a useful indicator of both seniors’ and community assets. In 2008, the median value of owner-occupied housing in Missouri was $141,500, up from $89,800 in 2000. By county, the median value of housing ranged from a high of $202,800 in St. Charles County to a low of $48,255 in Worth County.
Seniors in Poverty
The proportion of seniors living in poverty is a direct measure of economic need. According to 2008 ACS-based estimates, 9.3 percent of Missouri seniors lived in poverty, compared to 9.9 percent in 2000. The poverty rate for seniors ranged from a low of 2.5 percent in St. Charles County to a high of nearly 22 percent in Sullivan County.
Average Income of Senior Households
In 2008, the average income estimate for Missouri’s senior households was $44,665, ranging from $67,615 in Boone County to $22,676 in Putnam County.
Seniors with a College Education
Seniors with a higher education generally tend to fare better on household and community wealth, and well-being. In 2008, an estimated 16.4 percent of Missouri seniors had completed a college education. The highest proportion of graduates – 36.5 percent – lived in Boone County. The lowest was 3.7 percent in both Schuyler and Ste. Genevieve counties.
Health and Wellness
The health and wellness of Missouri seniors can be gauged in several ways. This report focuses on seven indicators of long-term health and wellness that can be influenced by preventative practices and public health interventions. Because of variations in sample size and response rates at the county level, age-cohort specific reporting may vary from state-level estimates. Additional information about both regional and county-level data, as well as references about health indicators and health practices, can be found on the Missouri Department of Health and Senior Services’ Web sites www.dhss.mo.gov/CommunityDataProfiles/ and www.dhss.mo.gov/Health/index.html.
No Exercise, 2007
In 2007, 38.5 percent of Missouri seniors reported they did not exercise compared with the national rate of 32.5 percent. Individual counties ranged widely in the percentage of seniors not engaging in exercise. Fifty percent of Dunklin County seniors reported engaging in no exercise, while less than 24 percent of Webster County seniors reported limited physical activities.
No Sigmoidoscopy or Colonoscopy, 2007
Approximately 37 percent of Missouri seniors report not having a screening test for colon cancer (sigmoidoscopy or colonoscopy) within the past 10 years. Fifty-three percent of Worth County seniors had not undergone the screening within a 10-year period compared to slightly less than 14 percent in St. Louis City.
High Blood Pressure, 2007
About 40 percent of Missouri seniors reported a diagnosis of high blood pressure compared with 58 percent of seniors nationwide. The range within Missouri counties varied greatly. Consistent with national trends, 57 percent of New Madrid seniors reported receiving a diagnosis of high blood pressure. But only 27 percent of Cass County seniors reported receiving this diagnosis.
Obesity, 2007
Slightly more than 25 percent of Missouri seniors responding to the county-level study reported a body mass index (BMI) that indicated obesity, compared with 22 percent of seniors nationally. Thirty-seven percent of Clark County seniors reported their BMI in the obese range, compared to slightly less than 16 percent in Mississippi County.
Smoking, 2007
Approximately 11 percent of Missouri seniors reported they smoked, compared with 8.6 percent seniors nationally. The highest rate in Missouri was Madison County, where more than 21 percent of seniors reported smoking. Dade, Lafayette and Perry counties had the lowest number of reported senior smokers with 4 percent or less.
No Mammography, 2007
Of women age 65 and older surveyed through the 2007 county-level study, half reported not having a mammogram in the past year. Female seniors in Jackson County were the least likely to undergo the procedure, female seniors in St. Charles County the most likely.
High Cholesterol, 2007
About 25 percent of Missouri seniors reported having been told by a health care professional that they have high cholesterol levels. Mississippi County reported the highest percentage at more than 42 percent. Cooper and Cape Girardeau counties reported the lowest proportion of seniors with unhealthy cholesterol levels with less than 15 percent.
This file last modified Thursday April 29, 2010, 15:53:25
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