Indicator Definitions – Older Adults
The older adult population is growing substantially, and by 2060 almost a quarter of the U.S. population will be aged 65 years or older. Aging increases the risk of many chronic diseases such as dementia, heart disease, type 2 diabetes, arthritis, and cancer. Several of these diseases can also increase the incidence of falls, which are a leading cause of injury for this age group. Older adults are also more vulnerable to severe illness from infections, including flu and pneumonia.
Need estimates specific to older adults?
CDI estimates across all topics areas are provided for adults 65 years and older where possible. Please see specific topic indicators and select view By Age.
Implementing effective strategies for healthy aging are needed to improve the length and quality of life of older adults, as well as their long-term ability to live independently. CDI now provides specific estimates for adults ages 65 and older for most indicators. States and partners can use these data to examine issues specific to older adults and make informed decisions on how to address these issues.
Definition Details
| Population: | Medicare beneficiaries aged 65 years and older |
| Numerator: | Hospitalizations with principal diagnosis of International Classification of Diseases (ICD)-10-CM code I50 among Medicare-eligible resident people aged 65 years and older. |
| Denominator: | Residents 65 years and older who were eligible for Medicare Part A benefits on July 1 of the calendar year, excluding members of health maintenance organizations. |
| Measure: | Number of hospitalizations and hospitalization rates (crude and age-adjusted) |
| Time Period of Case Definition: | Calendar year |
| Summary: | Heart failure happens when the heart cannot pump enough blood and oxygen to support other organs in your body. Heart failure is a serious condition, but it does not mean that the heart has stopped beating. Nearly 6.7 million (2.3%) Americans ages ≥20 years have heart failure (NHANES 2017–2020) and it occurs more often in males (2.7%) than females (1.9%).1 Heart failure was the primary cause of 85,037 of the 695,547 heart disease deaths in 2020.2 Additionally, the death rate for heart failure has increased from 18.7/100,000 population in 2011 to 25.6/100,000 in 2021.2 Early diagnosis and treatment can improve quality and length of life for people who have heart failure.3 |
| Notes: | Because heart failure is a chronic disease that can have a long preclinical phase, years might pass before changes in behavior or clinical practice affect population morbidity and mortality. Additionally, data reflects hospitalizations only and may under-estimate burden of disease particularly as heart failure is increasingly treated in an outpatient setting. |
| Data Source: | Centers for Medicare and Medicaid Services (CMS) Part A claims data |
| Related Objectives or Recommendations: | Healthy People 2030 objective: HDS-09. Reduce heart failure hospitalizations in adults |
| Related CDI Topic Area: | Cardiovascular Disease |
| Reference 1: | Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics—2023 update: a report from the American Heart Association. Circulation. 2023;147(8):e93–e621. doi:10.1161/CIR.0000000000001123 |
| Reference 2: | National Center for Health Statistics. Underlying Cause of Death. CDC WONDER, Centers for Disease Control and Prevention, US Dept of Health and Human services; Accessed January 13, 2022 and February 21, 2022. https://wonder.cdc.gov/Deaths-by-Underlying-Cause.html |
| Reference 3: | National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. Heart Failure. Centers for Disease Control and Prevention, US Dept of Health and Human services; Accessed December 9, 2022. https://www.cdc.gov/heartdisease/heart_failure.htm |
| Population: | Medicare beneficiaries aged 65 years and older |
| Numerator: | Hospitalizations with any diagnosis of ICD-10-CM codes J40-44 among Medicare-eligible resident persons aged 65 years and older. |
| Denominator: | Residents 65 years and older who were eligible for Medicare Part A benefits on July 1 of the calendar year. |
| Measure: | Annual number of hospitalizations and hospitalization rates (crude and age-adjusted) [cases per 1,000] |
| Time Period of Case Definition: | Calendar year |
| Summary: | In 2020, there were 247,314 (82.92 per 1,000 Medicare enrollees aged ≥ 65 years) hospitalizations with COPD as any diagnosis.1 In addition, COPD coexists with other conditions, including cardiovascular disease, diabetes, and other respiratory diseases such as pneumonia, that have high hospitalization rates.2 Risk factors for COPD-related hospitalization include patients with COPD who have a past history of similar events, severe airflow limitation, poor health status, increased age, presence of emphysema, leukocytosis,3 poor health-related quality of life and lack of regular physical activity.4 Disease-management programs, in addition to pharmacologic or surgical interventions, have been shown to reduce hospitalization among patients with severe COPD at risk for acute exacerbations of COPD.5 |
| Notes: | Multiple admissions for an individual patient can falsely elevate the number of persons with COPD. Medicare claims records cannot identify incident (new) hospitalizations for COPD. |
| Data Source: | Centers for Medicare and Medicaid Services (CMS) Part A claims data |
| Related Objectives or Recommendations: | Healthy People 2030 objective: RD-04. Reduce hospitalizations for chronic obstructive pulmonary disease (COPD) (developmental). |
| Related CDI Topic Area: | Chronic Obstructive Pulmonary Disease |
| Reference 1: | National Center for Chronic Disease Prevention and Health Promotion. Chronic Disease Indicators. Centers for Disease Control and Prevention, US Dept of Health and Human services; Accessed March 9, 2023. https://www.cdc.gov/cdi/ |
| Reference 2: | Agustí A, Celli BR, Criner GJ, et al. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Am J Respir Crit Care Med. 2023;207(7):819-837. doi:10.1164/rccm.202301-0106PP |
| Reference 3: | Müllerova H, Maselli DJ, Locantore N, et al. Hospitalized exacerbations of COPD: risk factors and outcomes in the ECLIPSE cohort. Chest. 2015;147(4):999-1007. doi: 10.1378/chest.14-0655 |
| Reference 4: | Bahadori K, FitzGerald JM. Risk factors of hospitalization and readmission of patients with COPD exacerbation–systematic review. Int J Chron Obstruct Pulmon Dis. 2007;2(3):241-51. |
| Reference 5: | Marchetti N, Criner GJ, Albert RK. Preventing acute exacerbations and hospital admissions in COPD. Chest. 2013;143(5):1444-1454. doi: 10.1378/chest.12-1801 |
| Population: | Medicare beneficiaries aged 65 years and older |
| Numerator: | Hospitalizations with first-listed diagnosis of ICD-10-CM codes J40–44 among Medicare-eligible resident persons aged 65 years and older. |
| Denominator: | Residents 65 years and older who were eligible for Medicare Part A benefits on July 1 of the calendar year. |
| Measure: | Annual number of hospitalizations and hospitalization rates (crude and age-adjusted) [cases per 1,000] |
| Time Period of Case Definition: | Calendar year |
| Summary: | In 2020, there were 165,248 (5.44 per 1,000 Medicare enrollees aged ≥ 65 years) hospitalizations with COPD as the first-listed diagnosis.1 Risk factors for hospitalization include patients with COPD who have a past history of similar events, severe of airflow limitation, poor health status, increased age, presence of emphysema, leukocytosis,2 poor health-related quality of life and lack of regular physical activity.3 Disease-management programs, in addition to pharmacologic and surgical interventions, have been shown to reduce hospitalization among patients with severe COPD at risk for acute exacerbations of COPD.4 |
| Notes: | Multiple admissions for an individual patient can falsely elevate the number of persons with COPD. Medicare claims records cannot identify incident (new) hospitalizations for COPD. Patients with COPD are often hospitalized with pneumonia and/or cardiovascular diseases, which may be the first-listed diagnosis. |
| Data Source: | Centers for Medicare and Medicaid Services (CMS) Part A claims data |
| Related Objectives or Recommendations: | Healthy People 2030 objective: RD-04. Reduce hospitalizations for chronic obstructive pulmonary disease (COPD) (developmental). |
| Related CDI Topic Area: | Chronic Obstructive Pulmonary Disease |
| Reference 1: | National Center for Chronic Disease Prevention and Health Promotion. Chronic Disease Indicators. Centers for Disease Control and Prevention, US Dept of Health and Human services; Accessed March 9, 2023. https://www.cdc.gov/cdi/ |
| Reference 2: | Müllerova H, Maselli DJ, Locantore N, et al. Hospitalized exacerbations of COPD: risk factors and outcomes in the ECLIPSE cohort. Chest. 2015;147(4):999-1007. doi: 10.1378/chest.14-0655 |
| Reference 3: | Bahadori K, FitzGerald JM. Risk factors of hospitalization and readmission of patients with COPD exacerbation–systematic review. Int J Chron Obstruct Pulmon Dis. 2007;2(3):241-51. |
| Reference 4: | Marchetti N, Criner GJ, Albert RK. Preventing acute exacerbations and hospital admissions in COPD. Chest. 2013;143(5):1444-1454. doi: 10.1378/chest.12-1801 |
| Population: | Adults aged 65 years and older |
| Numerator: | Adults aged 65 years and older who report they have had a pneumonia shot (pneumococcal vaccination) |
| Denominator: | Adults aged 65 years and older |
| Measure: | Annual prevalence (crude and age-adjusted) |
| Time Period of Case Definition: | Current |
| Summary: | Pneumococcal infections, a disease caused by bacteria called Streptococcus pneumoniae, can range from ear and sinus infections to pneumonia and bloodstream infections.1 Pneumococcal pneumonia causes an estimated 150,000 hospitalizations each year in the United States; pneumococcal meningitis and bacteremia killed about 3,250 people in the United States in 2019.1 Although pneumococcal disease can be very serious, there are vaccines to help prevent the disease.2 It is recommended that adults aged 65 years and older receive the vaccine.2 |
| Notes: | Respondents might not distinguish between influenza and pneumococcal (Streptococcus pneumoniae) vaccinations. |
| Data Source: | Behavioral Risk Factor Surveillance System (BRFSS) |
| Related Objectives or Recommendations: | Healthy People 2030: IID‑D03: Increase the proportion of adults aged 19 years or older who get recommended vaccines |
| Related CDI Topic Area: | Older adults |
| Reference 1: | About Pneumococcal Disease. Centers for Disease Control and Prevention. Updated September 1, 2020. Accessed March 31, 2023. https://www.cdc.gov/pneumococcal/about/index.html |
| Reference 2: | Kobayashi M, Farrar JL, Gierke R, et al. Use of 15-valent pneumococcal conjugate vaccine and 20-valent pneumococcal conjugate vaccine among U.S. adults: updated recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71(4):109-117. doi: 10.15585/mmwr.mm7104a1 |
| Population: | Adults aged 65 years and older |
| Numerator: | Adults aged 65 years and older who report having lost six or more natural teeth due to tooth decay or gum disease. |
| Denominator: | Adults aged 65 years and older. |
| Measure: | Prevalence (crude and age-adjusted) |
| Time Period of Case Definition: | Lifetime |
| Summary: | Estimates from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) indicated 33.0% of US adults aged ≥ 65 years had lost six or more teeth, decreasing from 39.6% in 2012.1 Despite improvement in tooth retention, disparities in tooth loss by race and ethnicity, education level, income, and smoking status remain.1, 2 Dental caries (tooth decay or cavities) and periodontal (gum) disease are leading causes of tooth loss. Because having ≥20 teeth is necessary for functional dentition, even partial tooth loss can compromise person’s essential chewing and speech functions and diminish quality of life.3 Older adults with selected chronic conditions (e.g., diabetes and heart disease) had significantly higher prevalence of severe or complete tooth loss than those without the condition.4Personal, professional, and population-based strategies to prevent and control gum disease and tooth decay can help prevent tooth loss.5, 6 |
| Notes: | Questions are part of the rotating core, currently collected in even years. |
| Data Source: | Behavioral Risk Factor Surveillance System (BRFSS) |
| Related Objectives or Recommendations: | Healthy People 2030 objective: OH-05. Reduce the proportion of adults aged 45 years and over who have lost all their teeth |
| Related CDI Topic Area: | Oral Health |
| Reference 1: | Centers for Disease Control and Prevention, Division of Oral Health. Oral Health Data. Centers for Disease Control and Prvention; 2020. https://www.cdc.gov/oralhealthdata/. |
| Reference 2: | Centers for Disease Control and Prevention, Division of Oral Health. Oral Health Surveillance Report: Trends in Dental Caries and Sealants, Tooth Retention, and Edentulism, United States, 1999–2004 to 2011–2016. Centers for Disease Control and Prevention; 2019. https://www.cdc.gov/oralhealth/publications/OHSR-2019-index.html |
| Reference 3: | Griffin SO, Jones JA, Brunson D, Griffin PM, Bailey WD. Burden of oral disease among older adults and implications for public health priorities. Am J Public Health. 2012;102(3):411-418. doi:10.2105/AJPH.2011.300362 |
| Reference 4: | Parker ML, Thornton-Evans G, Wei L, Griffin SO. Prevalence of and changes in tooth loss among adults aged ≥50 years with selected chronic conditions — United States, 1999–2004 and 2011–2016. MMWR Morb Mortal Wkly Rep. 2020;69(21):641-6. |
| Reference 5: | Centers for Disease Control and Prevention, Division of Oral Health. Oral Health Conditions. Centers for Disease Control and Prevention; 2022. https://www.cdc.gov/oralhealth/conditions |
| Reference 6: | National Institutes of Health. Oral Health in America: Advances and Challenges. US Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research; 2021. https://www.ncbi.nlm.nih.gov/pubmed/35020293 |
| Population: | Adults aged 65 years and older |
| Numerator: | Adults aged 65 years and older who report having lost all of their natural teeth due to tooth decay or gum disease |
| Denominator: | Adults aged 65 years and older. |
| Measure: | Prevalence (crude and age-adjusted) |
| Time Period of Case Definition: | Lifetime |
| Summary: | Estimates from the Behavioral Risk Factor Surveillance System (BRFSS) indicated the prevalence of edentulism (i.e., having lost all natural teeth or complete tooth loss) among US adults aged ≥ 65 years decreased from 16.2% in 2012 to 13.8% in 2020.1 Despite improvement in tooth retention over the past decades, disparities remain across some populations, such as higher prevalence of edentulism in adults with lower income and lower educational level, and current smokers.2 Dental caries (tooth decay or cavities) and periodontal (gum) disease are leading causes of tooth loss. Complete tooth loss substantially limit food choices and eating and chewing ability, and affect quality of life.3 Older adults with chronic conditions (e.g., diabetes and heart disease) had significantly higher prevalence of severe and complete tooth loss than those without the condition.4 Personal, professional, and population-based strategies to prevent and control gum disease and tooth decay can help ensure tooth retention.5, 6 |
| Notes: | Questions are part of the rotating core, currently collected in even years. |
| Data Source: | Behavioral Risk Factor Surveillance System (BRFSS) |
| Related Objectives or Recommendations: | Healthy People 2030 objective: OH-05. Reduce the proportion of adults aged 45 years and over who have lost all their teeth. |
| Related CDI Topic Area: | Oral Health |
| Reference 1: | Centers for Disease Control and Prevention, Division of Oral Health. Oral Health Data. Centers for Disease Control and Prevention; 2020. https://www.cdc.gov/oralhealthdata/ |
| Reference 2: | Centers for Disease Control and Prevention, Division of Oral Health. Oral Health Surveillance Report: Trends in Dental Caries and Sealants, Tooth Retention, and Edentulism, United States, 1999–2004 to 2011–2016. Centers for Disease Control and Prevention; 2019. https://www.cdc.gov/oralhealth/publications/OHSR-2019-index.html |
| Reference 3: | Griffin SO, Jones JA, Brunson D, Griffin PM, Bailey WD. Burden of oral disease among older adults and implications for public health priorities. Am J Public Health. 2012;102(3):411-8. |
| Reference 4: | Parker ML, Thornton-Evans G, Wei L, Griffin SO. Prevalence of and changes in tooth loss among adults aged ≥50 years with selected chronic conditions — United States, 1999–2004 and 2011–2016. MMWR Morb Mortal Wkly Rep. 2020;69(21):641-6. |
| Reference 5: | Centers for Disease Control and Prevention, Division of Oral Health. Oral Health Conditions. Centers for Disease Control and Prevention; 2022. https://www.cdc.gov/oralhealth/conditions |
| Reference 6: | National Institutes of Health. Oral Health in America: Advances and Challenges. US Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research; 2021. https://www.ncbi.nlm.nih.gov/pubmed/35020293 |
Additional Data Sources
| Older Adults – Healthy People 2030 | health.gov |
Last Reviewed: July 24, 2023