State and Community Examples

Using Data for Action at the State and Local Level

Implementing the Cognitive Decline and Caregiver Modules on the State-Based Behavioral Risk Factor Surveillance System (BRFSS)

Thanks to partnerships at the state and national levels, two modules are available for states to collect state-specific information through the Behavioral Risk Factor Surveillance System (BRFSS) Cognitive Decline and Caregiver modules. BRFSS is an ongoing data collection program designed to measure behavioral risk factors for adults aged 18 years and older, living in households. It is conducted in 50 states and includes the District of Columbia, Puerto Rico, Guam, and the US Virgin Islands. Information from the modules can be used to understand gaps and burden, develop state and national reports, inform state and local plans and policies, develop programs and community coalitions, and identify roles for public health.

Data from the Cognitive Decline module lays the groundwork for advancing public health’s understanding about increased confusion or memory loss and associated difficulties with work, social activities, and daily household chores. The Cognitive Decline module also includes questions about discussions with health care providers and assistance needed due to increased confusion or memory loss. Questions can be cross-linked with other questions on BRFSS to provide additional information about health behaviors, injury, and quality of life. From 2011–2013, 45 states including the District of Columbia and Puerto Rico included the Cognitive Decline module on their BRFSS. In 2011, CDC published a article with data from 21 states that added the module in 2011.

The Caregiver module examines various aspects of caregiving including caregiver experiences, demographic factors, and health behaviors so states can track this information over time and develop strategies to address the needs and gaps identified. The responses from the Caregiver module can also be analyzed using information from other questions on BRFSS, which allow for additional information about the health and well-being of caregivers. The Caregiver module was added in three states in 2009 and five states in 2010. The Alzheimer’s Association has developed reports for the states that added the module in 2009 [PDF 1.1M] and 2010 [PDF 326K].

In 2009, the BRFSS also included a core question about caregiving, and an article was published by CDC shows caregiver characteristics, by age and caregiving status, and compares these characteristics with those of non-caregivers.

State Alzheimer’s Disease Plans

Alzheimer’s disease plans aim to create the infrastructure and accountability to create programs and policies regarding the needs of people with the disease and supporting structures in communities. This is referred to as “dementia-capable [PDF – 357KB]“—being skilled in identifying people with dementia and working effectively with them and their caregivers, knowledgeable about the kinds of services needed, and aware of agencies and individuals that provide such services. A comprehensive plan helps to unite state public health partners around a range of issues including creating dementia-capable support services for people at all stages of the disease; reporting state estimates of Alzheimer’s disease prevalence; assuring quality of long-term care; providing home and community services; helping identify and track the availability of diagnostic services; protecting the safety of people who wander; and supporting caregivers and health care professionals. As of April 2014, 28 states have published Alzheimer’s disease plans, and the City of San Francisco, California, developed a plan to address the growing crisis in dementia care, and an economic analysis of that care.

Nearly all of the published plans include public health recommendations and strategies for monitoring the burden of cognitive decline, public awareness, early detection, and communication about brain health. A majority of state plans include early detection and diagnosis as a main focal point, and several states have taken significant steps toward accomplishing established goals in such areas as creating public awareness campaigns and promoting access to early detection and diagnosis.

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Integrating Early Detection and Diagnosis of Alzheimer’s Disease into Medical Homes

ACT on Alzheimer’s is a voluntary, statewide collaboration focused on transforming Minnesota’s medical and long-term care systems and communities to better support individuals with Alzheimer’s disease and other dementias and their families. Its members—representing more than 50 medical, academic, community, government, business, and nonprofit organizations throughout the state—are guided by a common vision, five goals, and specific success measures to gauge progress. The first of those goals is “increase early identification of Alzheimer’s disease and improve ongoing treatment based on recommended care practices.” Corresponding success measures call for incorporating dementia specific practices into applicable providers’ curricula; and offering a practice algorithm that supports screening, early diagnosis and intervention, and quality care. The effort embraces the innovative, cost-saving medical care home model for delivering preventive and primary care that focuses on patient needs, improved access to care, and increased care coordination. If successful, by June 2018, 75% of medical care home providers who received the practice algorithm will have implemented that algorithm into their practices.

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A Healthy Profile of Older North Carolinians

The proportion of older adults that make up North Carolina’s population has increased in recent years, and this increase is expected to continue for decades to come. Currently, about 28% of North Carolinians are age 50 or older, and this proportion is projected to be 35% by 2030. To compile a picture of the health of older adults in North Carolina, the North Carolina State Center for Health Statistics, the North Carolina Division of Aging, and the Older Adult Health Branch of the North Carolina Division of Public Health, published A Health Profile of Older North Carolinians in 2003. This report uses North Carolina data from the Behavioral Risk Factor Surveillance System (BRFSS) surveys, death certificates, cancer registries, and hospital discharges.

The report covers the following major health topics among older adults: general health status and well-being, health care access, health-related risk behaviors, heart disease, stroke, cancer, chronic respiratory disease, Alzheimer’s disease, influenza and pneumonia, diabetes, motor vehicle injuries, suicide, arthritis, mental health, and osteoporosis/hip fractures. To capture the wide range of ages that can fall within the “older adult” category, the report groups data into four age groups: 50–64, 65–74, 75–84, and 85 and above. In addition, with the exception of the hospital discharge data, data are broken down by race and sex, two factors that can greatly influence a person’s health status and health care.

The report provides a concise statistical picture of the burden of health problems among older adults in North Carolina. Although it does not discuss specific programs for reducing these health problems, it provides health and aging professionals and policy makers with a blueprint for prioritizing the health needs of older adults and for designing and establishing programs and guidelines to meet these needs.

North Carolina’s 17 Area Agencies on Aging are using the publication to create a new 4-year plan that includes healthy aging issues. Universities, hospitals, and county departments on aging have used the data in the report to develop grants and request funding to address problems among the older populations that they serve. Aging advocacy groups, including AARP and Senior Tarheel Legislatures, are using the information for policy planning initiatives. Additionally, senior and community centers have held Healthy Aging workshops to discuss the data in the report with health care professionals and the general public. The report is available on the Internet at [PDF-2.9M].

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Florida Examines Its Older Adult Population

In 2010, the Florida Needs Assessment Survey was administered to 1,850 adults aged 60 years or older living in the state of Florida, through a cooperative effort of the Florida Department of Elder Affairs and the Bureau of Business and Economic Research at the University of Florida. The assessment covered demographics, living situation, self-care limitations, nutrition, housing, healthcare, emergency preparedness, transportation, social engagement and community factors, caregiving, information and assistance needs, volunteerism, and abuse/neglect/exploitation issues. To ensure representation traditionally “hard to measure” groups, oversampling was done among low-income, minority, and rural populations.

The assessment results are available at the state and Planning and Service Area (PSA) level to allow for maximum flexibility in using the data. The reports (available at provide an excellent example of how other states can proactively examine their older adult population to best serve their needs.

Source: Florida Department of Elder Affairs. Web site:

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Maine Elder Women’s Health Indicator Framework

In the spring of 2001, the Maine Bureau of Health (BOH) received a small grant from the Health Resource and Services Administration’s (HRSA) Office on Women’s Health, Region 1. The goals of the project were:

  • To develop a set of indicators for monitoring the health status of Maine’s elder women.
  • To identify data sources for these indicators and to gather baseline data
  • To identify opportunities for collaboration between BOH and the Bureau of Elder and Adult Services
  • To formulate recommendations for programs and policies to improve the health status of Maine’s elder women.

This project culminated with the report Assessing and Monitoring the Health Status of Maine’s Elder Women: the Elder Women’s Health Indicators Project. This report is not intended to be a comprehensive analysis of all of the issues associated with the health of Maine’s elder women. Instead it is a starting point, or place to begin the process of systematically assessing and monitoring elder women’s health so that interventions can be targeted, improvements can be measured, and policies can be formulated to ensure a targeted and focused approach to improving the health of Maine’s elder women.

The framework for and content of this report were designed for state policy makers and decision makers and professionals in public health and elder services as well as a general audience. The state-level data used throughout the report come primarily from the Maine Department of Human Services, Bureau of Health, Office of Data, Research and Vital Statistics; the Behavioral Risk Factors Surveillance System (BRFSS); Maine Hospital Discharge Data; and the 2000 US Census.

Response to the report has been very positive. Focusing on health indicators for elder women highlights a population that needs increased attention. To obtain the report, contact Sharon Leahy-Lind, Women’s Health Coordinator, Bureau of Health, Maine Department of Human Services at 207-287-4577 or e-mail

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Missouri Senior Report — Ahead of the Baby Boom: Missouri Prepares

By 2020, the older adult population in Missouri is expected to exceed 1.2 million, or nearly 1 in 5 Missouri residents. To prepare for this shift in demographics, state officials have developed the Missouri Senior Report: Ahead of the Baby Boom: Missouri Prepares. This 2006 report provides county-level data and other useful information to help state and local policy makers, service providers, and older adults themselves plan for future needs. Prior to this report national and state-level data on older adults could only be obtained from multiple sources, and the data were rarely provided in a format that was user-friendly to consumers.

To develop this report, state officials collected input from Missouri’s 10 Area Agencies on Aging and from a series of 47 town hall meetings attended by more than 500 residents from around the state. Useful indicators and measures of the status of older adults for the report were identified through these discussions and meetings. The Report is available online at

The Report reflects a collaborative effort of the Missouri Department of Health and Senior Services (DHSS), the Office of Social and Economic Data Analysis (OSEDA) at the University of Missouri-Columbia, and other agencies and organizations with an interest in promoting health and quality of life among older adults. It provides demographic data, rates the state and each county on several key measures, and ranks the counties on the basis of a composite score for all measures. It also includes articles written by academic partners on the topics of mental health, health and socioeconomic disparities, and transportation. DHSS and University of Missouri Extension staff members are available to consult with communities to use the data for strategic planning.

The Report serves not only as a source of data for planning and policy decisions, but also as a tool for health education and promotion, providing information about the demographic shifts in the state’s population and the need for changes in areas such as housing, transportation, and employment. It will be updated annually and address emerging topics of concern.

To supplement the Report, Missouri also has an interactive health data system, Missouri Information for Community Assessment (MICA). This system allows users to summarize data from a variety of sources, create and download tables, prepare geographic presentations, choose priorities for health policy and planning initiatives based on county and state data. An evidence-based intervention component for selected topics is in development that will enable users to choose interventions to address selected health issues. The MICA system is available at

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