December, 2007
As baby boomers age, and life expectancy continues to increase, the proportion of Missouri’s senior population will increase from about 13 percent today to approximately 15 percent by 2010, and to 18 percent by 2020. The increase in the absolute number of seniors, as well as the proportion of the population they comprise, will have an impact on Missouri families, communities and local economies. As baby boomers age, their values and life experiences will influence Missourians’ perceptions of the resources, needs, capacities and strengths of seniors. The Missouri Senior Report is a resource to inform state and local policy makers, service providers and families, in planning for the impact of an increasingly older Missouri.
The report includes comparative information on the status of seniors, including trends for which indicator data are available, as well as annual population estimates, population projections, and health and wellness information. Brief articles on the status of Missouri seniors’ mental health trends, health disparities and housing costs also are included. A resource section provides contact information and a brief description of activities or services offered for seniors and those who serve them.
Trend data are available for eight indicators. Statewide, Missouri has improved on four of these indicators between the base and current years considered. Improvements are noted in health status, healthcare access, transportation and crime. Trends declined for measures of household composition, workforce participation and long term care. The economic well-being indicator for seniors changed marginally (0.33% to 0.34%).
However, trends in these indicators vary within the state, affecting Missouri communities differently. Demographically, Missouri is a diverse state. The county populations range from over one million in St. Louis County to fewer than 2,300 in Worth County. In addition to variation between counties, the demographic, cultural and economic characteristics of Missouri communities vary greatly by urban, suburban or rural nature.
To address this diversity, while providing comparative data, the report presents 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 on demographics, quality of life and wellness are included for each county. As communities learn to accommodate to aging trends, they will confront specific challenges and opportunities. The indicators in the report will be used to track the direction of change.
Understanding Senior Report Outcome and Status Indicators
Senior Report indicators present a brief annual snapshot of each Missouri county. The indicators and measures were selected through input from many Missourians with a personal and/or professional passion for the well-being of seniors. A standing advisory committee provides input into the structure and content of the report. The web site (www.missouriseniorreport.org) includes additional measures and graphics viewable on the website and available for downloading. The Missouri Senior Report 2006 is fully archived and accessible at the Senior Report website. You may also access a print-ready version of Missouri Senior Report 2007 from the web site.
Indicators Missouri Senior Report 2007 is organized around two types of information: “outcome” and “status” indicators. Outcome indicators measure progress over time. Tracking trends in these indicators supports efforts to 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. They provide contextual information to support the interpretation of outcome measures.
Measures were considered for “face validity,” or the meaningfulness of the indicator to describe counties comparatively and across time. Each outcome measure was reviewed for (a) assurance of sufficient numbers of cases to yield a reasonable estimate, and (b) relatively normal distribution of estimates among counties. Measures of statistical significance are available on the web site.
A composite county ranking also has been calculated, based on the sum of the standardized values for seven 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 derived from reliable sources and 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 Board of Healing Arts and the Department of Social Services) as well as federal reporting agencies (such as the Bureau of Labor Statistics and the F.B.I. Uniform Crime Reporting System).
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). The glossaries of outcome and status indicators provide a detailed description of the construction and source of each measure.
The cultural and economic diversity of the state presents challenges to substantive comparisons, even when standards of methodological comparability have been met. For example, seniors in Missouri’s cities without a valid Missouri driver’s license are more likely to have access to affordable, reliable public and private transportation, than are seniors in rural communities. To enhance the quality of the Senior Report transportation indicator, Missouri’s Area Agencies on Aging are working collaboratively to implement a standardized transportation services tracking system. The system was piloted this year, and we anticipate incorporating this information in 2008, allowing the report of an index of transportation modes available to seniors by county.
Identifying annually available county-level indicators is necessary to produce a resource that provides timely and meaningful information to inform effective public policy. However, the use of secondary data sources also introduces the risk that changes in the structure of the data—or issues in data quality—may occur. For instance, such changes might be adjusted by alternate administrative procedures, and the corrections might not be reflected in the data set. When these situations occur, it may be necessary to change the measure used to describe the indicator or, alternatively, to note the impact of a data inconsistency in reporting. For example, as of 2005, physicians were no longer required to report the percentage of the time they practice by county. The Senior Report advisory group determined it was more accurate to continue reporting 2004 information, than to use less specific 2005 information, when describing seniors’ access to primary care.
In 2009 the U.S. Census Bureau will release the American Community Survey (ACS) for counties with populations of 20,000 or more; in 2010 ACS data will be available for all levels of census geography. The American Community Survey will provide consistently gathered, comparable county-level information about Missourians that can be disaggregated by age, race, and many other relevant characteristics. The ACS will likely be used as a resource in future Senior Reports.
Outcome Indicators 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 percent of seniors filing joint Missouri income tax returns was used to gauge household composition. Between 2000 and 2005, the percent of seniors filing joint income tax returns declined marginally from 44.8 to 43.8 percent. In 2005 the percent of seniors filing joint returns ranged from a high of 57.5 percent in Washington County to a low of 27.6 percent in Knox County.
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. Census poverty estimates for the senior population are not available annually; however, there are estimates on the numbers of low-income individuals and seniors who receive Supplemental Security Income (SSI). The Bureau of Economic Analysis provides these annual estimates. Therefore, a relative index of economic well-being was created by calculating the SSI payment as a percentage of total personal income. In Missouri, overall SSI payments represent one-third 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 two percent in Pemiscot County to a low of under one-tenth of a percent in Platte and St. Charles Counties.
Workforce Participation
Senior participation in the workforce may be viewed as either an adverse or 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, workforce participation is the result of an increased availability in less physically-demanding service and retail jobs, and if seniors want to remain economically and socially engaged, the outcome can be positive. On balance, the advisory committee views an increase in senior workforce participation as positive. Yet, senior participation in the Missouri workforce decreased from 9.8 percent in 2001 to 8.2 percent in 2005. By county, senior participation in the workforce ranged from a low of under one percent in Douglas County to a high of nearly 17 percent in Taney County in 2005.
Transportation
Transportation is necessary, in order to obtain goods and services, or 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 indicates that transportation is an issue. The percent of Missouri seniors with a valid driver’s license increased from 76.7 percent in 2001 to 81.5 percent in 2006. In suburban (and especially 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 2005 the percent of Missouri seniors with a valid driver’s license ranged from a high of 97.0 percent in Daviess County, to a low of approximately 53 percent 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 group selected the measure of “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 decreased from 71.4 in 2001, to 70.6 in 2005. In 2005 the rate ranged from a high of 158.1 per 10,000 seniors in Ripley County to 8.3 in Clark County.
Health Care Access
One measure of health care access for seniors is the number of primary care physicians per 1,000 seniors. Overall access improved in Missouri between 2000 and 2004, largely because the number of primary care physicians per 1,000 Missourians increased from the equivalent of 5.1 to 5.5 full-time physicians. In 2004 access to primary care physicians ranged from a low of under one-half of one full-time primary care physician per 1,000 seniors in Bollinger County to over 15 per 1,000 seniors in Boone County.
Long Term Care
Long term care represents a significant health care cost for both seniors, who tend to have limited incomes, and for the state, due to Medicaid expenditures. The number and value of long-term care insurance policies would be a useful measure for this indicator. However, these data are 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 have increased from $122 per capita in 2002 to $138 per capita in 2006¬—a 25% increase in three years in unadjusted dollars. However, because the measure is confounded between counties by differential rates of Medicaid eligibility and differential health care costs, this measure is not used in the construction of the overall county index of senior well-being.
Crime
At regional planning meetings for the report, participants consistently expressed a concern about crime and its relation to seniors. Accordingly, the number of property and violent crimes per 1,000 persons is reported as an outcome measure. Overall, the Missouri crude crime rate declined from 48.8 in 2001 to 45.4 in 2006. In 2006 the crude crime rate ranged from a low of 3.7 crimes per 1,000 persons in Schuyler County to a high of 146.9 in St. Louis City.
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, particularly those over 75 or those living on fixed incomes, are vulnerable. According to the 2006 American Community Survey (ACS), households with seniors comprise approximately one-half million of Missouri’s 2.3 million households. Of these senior households, 28.9 percent reported spending more than 30 percent of their income on housing costs. County-level 2006 ACS data are available for counties with populations of 65,000 or more. While this measure is reported for counties for which it is available, it will not be considered in the composite ranking until comparable data are available for all counties.
Status Indicators Demographics
The proportion of seniors in Missouri’s population was 13.5 percent in 2000 and 13.3 percent in 2006. By 2010 the proportion of Missouri’s population aged 65 or over is projected to be nearly 15 percent, and by 2020 the proportion is projected to be more than 18 percent – proportions higher than the nation overall. Missouri’s total population is approaching six million and in recent years has sustained slow but steady overall growth—a slightly more than four percent increase between 2000 and 2006. The state’s senior population (65 and older) also grew slowly from 755,838 in 2000 to 778,891 in 2006—a three percent increase. The recent consistent growth of the senior population (compared to the state’s total population) reflects the smaller cohorts of people born during the Great Depression and World War II. However, the first baby boomers will turn 65 in 2011, beginning a trend of relative growth in the senior population that will continue until approximately 2030. An important characteristic of the senior population is the greater proportion of women than men. This gender difference is projected to moderate somewhat, but remain a persistent feature of the older population, and carries implications for the types of services seniors need.
Quality of Life
Six measures of the overall quality of life among seniors are included as status indicators. The most recent source for these measures is the 2000 U.S. Census, although the introduction of the American Community Survey will provide annual estimates for most Missouri counties in 2009 and all counties by 2010.
Owner-Occupied Housing
Seniors’ housing needs are more likely to be met if they live in owner-occupied housing. In 2000, Missouri reported a higher percentage of owner-occupied housing among seniors (79.1%) than the nation overall (77.6%). The rate ranged from 91 percent in Hickory County to 61 percent in St. Louis City.
Seniors Living in Families
Family life enhances the senior population’s well-being. 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 2000, 17.6 percent of Missouri seniors lived in family households, compared with 16.6 percent nationally. By county, the percent of seniors living in family households ranged from a high of 33 percent in Hickory County to fewer than 11 percent in Platte County.
Median Value of Owner-Occupied Housing
Home ownership is a significant asset for most seniors, and the relative value of housing is a useful indicator of county assets. In 2000, the median value of owner-occupied housing in Missouri was $86,900 compared with $111,800 nationally. By county, the median value of housing ranged from a high of $127,800 in Platte County to a low of $34,300 in Worth County.
Seniors in Poverty
The proportion of seniors living in poverty is a direct measure of economic need. However, the Census infrequently measures senior poverty rates at the county level. In 2000 the overall poverty rate among seniors in Missouri was 9.9 percent compared with 10.9 percent nationally. In 2000 by county, the poverty rate among seniors ranged from a low of 5.1 percent in St. Charles County to a high of 23.2 percent in Pemiscot County.
Average Income of Senior Households
In 2000 the average income of households headed by seniors in Missouri was $37,822, compared with $41,712 nationally. In 2000 by county, average household income ranged from more than $51,000 in St. Louis County to just under $21,600 in Putnam County.
Seniors with a College Education
A high proportion of seniors with a college education increase the capacity of communities to contribute to the quality of life of seniors. In 2000, 11.8 percent of Missouri seniors had a college education compared with 15.4 percent for the United States. The state’s senior population with a college education in 2000 ranged from 27.9 percent in Boone County to 3.0 percent in Schuyler County.
Health and Wellness
The health and wellness of Missouri seniors can be gauged in several ways. The report presents seven indicators related to long-term health and wellness. These indicators have been selected, since preventative practices can be adopted to foster improved health. These wellness measures are taken from health survey data for which the best estimate available is a multi-county regional measure. Find additional information, and references about health indicators and health practices, at 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, 2006
In 2006 the percent of Missouri seniors reporting they participated in no exercise was higher (35.9%) than the national rate among seniors (32.7%).
No Sigmoidoscopy or Colonoscopy, 2006
Approximately 47 percent of Missouri seniors report not having a screening test for colon cancer (sigmoidoscopy or colonoscopy) within the past 10 years.
High Blood Pressure, 2005
The state and federal rates are the same (54.8%) for seniors who have been told by a health care professional that they have high blood pressure.
Obesity, 2005
Slightly more Missouri seniors (24.3%) have a body mass index indicating obesity than seniors nationally (22.0%).
Smoking, 2006
Marginally more Missouri seniors report currently smoking (8.7%) than seniors nationally (8.6%).
No Mammography, 2006
A greater percent of Missouri senior women (39.8%) have not had a mammogram in the past year than senior women nationally (21.6%).
High Cholesterol, 2005
More Missouri seniors (55.3%) have been told by a health care professional that they have high cholesterol levels than seniors nationally (50.6%).
Conclusion
The report offers valuable information on the current status of Missouri’s senior population, and highlights areas of strength and opportunity. It is intended to increase awareness of the demographic issues that will affect Missouri in the next decade and beyond. Communities, policy leaders and individuals are encouraged to use this report as a tool to assess, plan and respond to the impact of the increasing population.
This file last modified Wednesday December 19, 2007, 10:48:34
For more information about the report and to request printed copies please contact:
at 573-751-6062 or info@dhss.mo.gov
Questions/Comments regarding this page or this web site are strongly encouraged and can be sent to
OSEDA, Office of Social and Economic Data Analysis Telephone: (573)882-7396
602 Clark Hall, Columbia, MO 65211
