Background and Objectives: This translational research had 2 aims: first, to analyze and translate data from multiple original data sources to provide accurate, unbiased local community and statewide information about healthy aging; second, to work with stakeholders to use the tools to identify disparities in healthy aging and to support their efforts to advance healthy aging. Research Design and Methods: Data sources from the Centers for Medicare and Medicaid Services, Behavioral Risk Factor Surveillance System, U.S. Census American Community Survey, and other sources were analyzed using small area estimation techniques to determine age/gender-adjusted local community rates in Connecticut (CT), Massachusetts (MA), New Hampshire (NH), and Rhode Island (RI). Results: State-level analyses revealed gender and racial/ethnic disparities in healthy aging. A factor analysis identified 4 dimensions of community population healthy aging/morbidity: serious complex chronic disease, indolent conditions, physical disability, and psychological disability. Discussion and Implications: Healthy Aging Data Reports now exist for MA (2014, 2015, and 2018), NH (2019), RI (2016 and 2020), and CT (2021) and demonstrate differences in health by place. Each report includes community profiles for every city, town, and some urban neighborhoods with more than 170-197 indicators. The reports include maps of the statewide distribution of rates, an infographic, highlights report with state-specific multivariate analyses, and 18 interactive web maps, 18 regional interactive web maps, and technical documentation about data sources and methods. Overall, the research has identified variations in healthy aging and provided tools to track change over time to support age-friendly efforts in the region.

BACKGROUND AND OBJECTIVES:The purpose of this study was to develop a multidimensional measure of community healthy aging that is more nuanced than existing measures. The social-ecological framework guided this analysis of the latent structure of community prevalence rates of chronic diseases and functional impairments.RESEARCH DESIGN AND METHODS:The sample was 471 communities in Massachusetts (n = 319) and New Hampshire (n = 152). Data were drawn from publicly available healthy aging data reports for both states. Community prevalence rates for 45 chronic conditions, rates of mortality, and Medicare service utilization were estimated with the 2014-2015 Centers for Medicare & Medicaid Services (CMS) Medicare Beneficiary Summary Files and used in factor analyses to explore the latent structure of community healthy aging.RESULTS:Results revealed a multidimensional structure composed of 4 latent population health components: serious complex chronic disease, indolent chronic disease, physical disability, and psychological disability. We found that while lower community socioeconomic status is a major determinant of all 4 components of population health, it is predictably associated with higher levels of serious complex chronic disease and physical disability and yet surprisingly with lower levels of indolent chronic disease and psychological disability.DISCUSSION AND IMPLICATIONS:The 4-dimensional model provides a more nuanced measure of community healthy aging than mortality rate, and it identifies community health disparities that otherwise may go undetected. Understanding the multiple levels that influence community healthy aging may reveal new interventions or programs to improve it and allow policymakers or other stakeholders to more accurately tailor interventions to match the conditions of need.

Since 2014, 32 states implemented Medicaid expansion by removing the categorical criteria for childless adults and by expanding income eligibility to 138% of the federal poverty level (FPL) for all non-elderly adults. Previous studies found that the Affordable Care Act (ACA) Medicaid expansion improved rates of being insured, unmet needs for care due to cost, number of physician visits, and health status among low-income adults. However, a few recent studies focused on the expansion's effect on racial/ethnic disparities and used the National Academy of Medicine (NAM) disparity approach with a limited set of access measures. This quasi-experimental study examined the effect of Medicaid expansion on racial/ethnic disparities in access to health care for U.S. citizens aged 19 to 64 with income below 138% of the federal poverty line. The difference-in-differences model compared changes over time in 2 measures of insurance coverage and 8 measures of access to health care, using National Health Interview Survey (NHIS) data from 2010 to 2016. Analyses used the NAM definition of disparities. Medicaid expansion was associated with significant decreases in uninsured rates and increases in Medicaid coverage among all racial/ethnic groups. There were differences across racial/ethnic groups regarding which specific access measures improved. For delayed care and unmet need for care, decreases in racial/ethnic disparities were observed. After the ACA Medicaid expansion, most access outcomes improved for disadvantaged groups, but also for others, with the result that disparities were not significantly reduced.

Abstract Eye and visual health issues in older adults are prevalent, often undetected and untreated, but can contribute to poor physical and mental health issues, and higher mortality rates. The study describes state and local community rates of eye and visual health indicators (cataract, glaucoma, self-reported vision difficulty, and clinical diagnosis of blindness or visual impairment) of older adults 65+ in MA, NH, RI, and CT. Data sources used to calculate rates were: the American Community Survey (2014-2018 RI, 2012-2016 MA and NH, 2014-2018 CT) and the Medicare Current Beneficiary Summary File (2016-2017 RI, 2015 MA and NH, 2016-2017 CT). Small area estimation techniques were used to calculate age-sex adjusted community rates for more than 150 health indicators (https://healthyagingdatareports.org/). Disparities in rates were examined for 4 eye and visual health indicators: cataract, glaucoma, self-reported vision difficulty, and clinical diagnosis of blindness or visual impairment. Results showed variability in rates across states. MA had the highest rates of self-reported vision difficulty (5.8%) and blindness or visual impairment (1.5%), and the greatest differences in rates of self-reported vision difficulty (0.00-40.91%). CT had the highest rates of glaucoma (28.3%), and the greatest differences in rates of glaucoma (19.51-41.91%) and blindness or visual impairment (0.44-4.39%). RI had the highest rates of cataract (67.5%). Understanding the distribution of community rates makes disparities evident, and may help practitioners and policymakers to allocate resources to areas of highest need.

Abstract Behavioral health issues in older adults are prevalent and have negative consequences on quality of life and overall health, yet are often untreated. The present study compares state and local community rates of behavioral health indicators of older adults age 60+ in Massachusetts (MA), New Hampshire (NH), Rhode Island (RI), and Connecticut (CT). For this study rates were calculated from the following data sources: Medicare Current Beneficiary Summary File 2014-2018 (2014-2015 MA, NH, and 2016-2017 RI, CT) and the Behavioral Risk Factor Surveillance System (2013-2015 MA, 2014-2016 NH, 2015-2017 RI, CT). Small area estimation techniques were used to calculate age-sex adjusted community rates for more than 170 health indicators (https://healthyagingdatareports.org/). This research examines disparities in rates across the 4 states for 4 behavioral health indicators: substance use disorder (SUD), tobacco use disorder (TUD), opioid use disorder (OUD), and excessive drinking. Results varied across states with RI reporting the highest rates of substance (7.0%) and tobacco use (10.8%) disorders, CT had the highest rate of opioid use disorder (2.2%), and MA and RI reporting the highest rates of excessive drinking (9.3%). Overall, MA had the greatest disparities in rates for all indicators (SUD: 6.6% (5.35-15.99%); TUD: 10.2% (2.67-24.20%); excessive drinking: 9.3% (5.63-19.98%)), indicating behavioral health disparities by community are most pronounced in MA. This study found behavioral health issues are prevalent among New England older adults and should no longer be overlooked. Furthermore, visualizing the community rates makes disparities evident and may guide resources and services to areas of highest need.

Abstract The number of pedestrian crashes in the United States has increased by 35 percent from 2008 to 2017. Among all pedestrian fatalities in 2017, 48% were pedestrians aged 50 and older, which suggests a disproportionate threat to older residents’ health and safety. Massachusetts has a large older population and is experiencing increased numbers of older pedestrian crashes. This research identified risk factors and community characteristics contributing to older pedestrian crashes and suggests leveraging the state’s age-friendly efforts to speed the implementation of countermeasures. Based on ten-year statewide crash data (2006-2015) and community indicators from the 2018 Massachusetts Healthy Aging Data Report, this study examined 4,472 crashes across Massachusetts that involved pedestrians age 55 and over. The leading reasons for crashes were driver’s inattention, driver’s failure to yield right of way, and driver’s issues with visibility. Older pedestrians were hit while walking in the road, often in crosswalks at intersections. Many factors were found to contribute to older pedestrian crashes: time of day (rush hour), time of year (winter), and community factors (higher rates of disabilities, higher percentage of racial minority residents, higher number of cultural amenities, and lack of dementia-friendly community efforts. Greater awareness of older pedestrian safety risks is needed. Communities highlighted in this research warrant priority attention from planning, health, aging services, and transportation authorities to improve older pedestrian safety.

Abstract Cancer is one major health condition that affect people’s later life quality, which could be intervened from the community level. This study compares rates of lung cancer, colon cancer, breast cancer (in women), and prostate cancer (in men) among adults 65+ in 3 New England states (MA, NH, and RI). Data were from the Healthy Aging Data Report (see www.healthyagingdatareports.org), which reported on 150+ health indicators at the local community and state level. Data sources were the Current Medicare Beneficiary Summary File (years) and the American Community Survey (years). Small area estimation techniques were used to calculate age-sex adjusted community rates. Average state rates of cancers (range) are: Lung cancer MA 2.1 (1.0 – 4.4) NH 1.6 (0.9 – 2.9) RI 2.1 (1.3 – 2.9); Colon cancer MA 2.9 (1.8 – 4.1) NH 2.4 (1.8 – 3.7) RI 3.2 (1.6 – 4.5); Breast cancer MA 10.9 (5.3 – 16.4) NH 9.8 (5.4 – 14.8) RI 10.7 (7.2 – 13.9); Prostate cancer MA 13.8 (7.4 – 24.0) NH 11.5 (5.9 – 17.3) RI 13.8 (9.5 – 17.7). NH has the lowest rates on all four types of cancer; MA and NH were similar regarding average rates, but MA communities had the widest disparities for lung, breast and prostate cancer. Findings suggest within and between state variations in cancer rates. Policies and programs may target geographic areas/communities with high rates of cancers, examine environmental effects on cancer rates and develop strategies in reducing cancer rates.

Before the Affordable Care Act Medicaid expansion, nonelderly childless adults were not generally eligible for Medicaid regardless of their income, and Hispanics had much higher uninsured rates than other racial/ethnic subgroups. We estimated difference-in-differences models on Behavioral Risk Factor Surveillance data (2011-2016) to estimate the impacts of Medicaid expansion on racial/ethnic disparities in insurance coverage, access to care, and health status in this vulnerable subpopulation. Uninsured rates among all poor childless adults declined by roughly 9 percentage points more in states that expanded Medicaid. While expansion also had favorable impacts on most access and health outcomes among Whites in expansion states, there were relatively few such impacts among Blacks and Hispanics. Through 2016, Affordable Care Act Medicaid expansion was more effective in improving access and health outcomes among White low-income childless adults than mitigating racial/ethnic disparities.

Abstract Mental health issues in older adults are prevalent, yet often undetected or untreated and can contribute to poor physical health, increased disability, and higher mortality rates. The current study describes state and local community rates of mental health indicators of older adults 65+ in MA, NH, and RI. Data sources used to calculate rates were: the American Community Survey (2009-2013 RI, 2012-2016 MA and NH), the Medicare Current Beneficiary Summary File (2012-2013 RI, 2015 MA and NH), and the Behavioral Risk Factor Surveillance System (2012-2014 RI, 2013-2015 MA, and 2014-2016 NH). Small area estimation techniques were used to calculate age-sex adjusted community rates for more than 150 health indicators. This research examines disparities in rates for 3 mental health indicators depression, self-reported poor mental health, and self-reported poor/fair health status. Depression rates: MA 31.5% (19.91-48.82%), RI 30% (19.7-38.5%), and NH 28.8% (18.26-40.56%). Self-reported poor mental health: RI 7.5% (4.8-12.5%), MA 7.0% (2.10-16.59%), and NH 6.9% (3.42-10.13%). Self-reported fair/poor health: RI 20.4% (8.6-38.8%), MA 18.0%, (7.2-34.38%), and NH 16.5% (13.31-21.60%). Results showed variability in rates across states. MA had the highest rates of depression, the greatest differences in rates, and access to the most mental health providers. RI had the highest community rates for poor physical and mental health, and the highest percentage of residents age 85+. Understanding the distribution of community rates makes disparities evident, and may help practitioners and policymakers to allocate resources to areas of highest need. Research funded by the Tufts Health Plan Foundation.

This paper reports on a process evaluation using mixed methods to assess a Dementia Care Coordination Program, which is distinctive in using the medical system, rather than direct outreach, to identify and refer families to supports provided by an Alzheimer's Association chapter via dedicated care consultants. One care consultant received referrals from individual physicians, while the other, employed by a health plan, received referrals from health plan case managers. Through key informant interviews, focus groups, and physician and caregiver surveys, we identified key issues, finding high rates of stakeholder satisfaction, but some practical issues around information sharing and data tracking. We further found the health plan model of collaboration to offer significant potential for the systematic and early detection of potential clients, provided investments in minor systems change. The Dementia Care Coordination Program, therefore, represents a minimalist model of dementia-specific support, which could be further supplemented via more focused outreach and education.

Across New England stakeholders are promoting healthy aging by building age-friendly communities (healthyagingdatareports.org). Each state data report includes community profiles with 120+ indicators of healthy aging at the local community level (MA n=367; RI n=41; NH n=220). Rarely is healthy aging data reported at such a local level. Data from the Centers for Medicare and Medicaid Services, Behavior Risk Factor Surveillance System, US Census and other sources were analyzed using small area estimation techniques to determine age/sex adjusted community rates. Interactive online maps show the distribution of disease and highlight health disparities. Selected results include state rates for MA/RI adults 65+ with: diabetes (32%/36%), hypertension (78%/79%), stroke (13%/13%), Alzheimer’s disease or related dementias (14%/14%), depression (29%/30%), and 4+ chronic conditions (59%/64%). Multivariate analyses showed differences in population health and identified modifiable risk factors for community health.

Car crashes are events that result not only from the interaction of drivers and vehicles but also as a result of the spatial components of physical environments (e.g. roadways and land use). The GIS application is a tool to visualize the location of events and to identify hot spots or danger zones on the map by the interacting the location of crashes via latitude and longitude. This study pooled motor vehicle crashes that occurred in Massachusetts (2010–2012) in the Fatal Accident Recording System (FARS NHTSA). Sample (N=686) inclusion criteria were subjects had to have complete data on variables of interest and be involved in a crash resulting in at least one fatality. The majority of subjects were drivers age 35 to 59 (72.6%, n=498), with (27.4%, n=188) drivers age 65 and older. The Optimized Hot Spot analysis utilized the function of collapsing nearest points to test whether the collapsed points were clustered as hotspots significantly or not. By driver’s age and fatal crash, drivers age 35 to 59 had two specific hotspots near Boston and one hotspot near Fall River in MA. Drivers age 65 and older had five different hotspots along with the boundary of greater Boston. This difference in hotspots of fatal crash between younger and older drivers could be related with roadways, traffic volume, and population density. Identification of these crash hotspots will be beneficial for drivers and policy makers. The findings may alert drivers to high risk areas and policy makers can implement countermeasures.

An extensive body of research notes the protective effects of sense of control on health. Yet, there are still gaps in knowledge. One such gap is related to control beliefs and frailty. Frailty is an important clinical and public health problem as it is associated with various adverse health outcomes such as falls, mortality, institutionalization, and hospitalization. This study aimed to examine if a higher level of sense of control has a protective effect on frailty status of older adults. The study samples included individuals (N = 4,440) and couples (N = 1,878) aged 65 and older from the Health and Retirement study (2012 and 2014). Frailty was measured using 35 items on physical, psychological, and cognitive health. Multinomial regression and multilevel logistic regression were respectively utilized for individual-level and couple-level analyses. Results from both types of analyses showed that respondents who reported higher levels of control beliefs were less likely to belong to the frail group compared to the non-frail group (p < .000). Respondents who were female, older, had poorer self-rated health, and had lower wealth were also more likely to belong to the frail group. Sense of control may be an important coping resource that older adults with limited resources can turn to in later life. At times when physical health declines, older adults are encouraged to be more actively engaged in improving their sense of control to augment its protective effect on health.

The aging of the population has raised interest in optimal aging. Across New England older adults, policymakers, service providers, philanthropists, researchers, and advocates are working together to promote healthy aging (see mahealthyagingcollaborative.org). This effort has championed the use of data to inform policy development, resource allocation, and service delivery. In MA approximately 14% of the state is age 65 or older. We developed community profiles reporting more than 120 indicators of healthy aging for the 351 cities and towns in the state and 16 Boston neighborhoods. In RI approximately 21% of the state’s 1,052,567 residents are 60 or older. We created community profiles reporting 120+ indicators for the 41 cities and towns in RI. Rarely is data reported at such a local level. Analyses were conducted using data from CMS, BRFSS, US Census and other sources using small area estimation techniques to determine age/sex adjusted community rates. We compared community and state rates, and state rates to national rates. Interactive online maps show the distribution of disease. Selected results include state rates for MA/RI adults 65 or older ever being diagnosed with: diabetes (32%/36%), hypertension (78%/79%), stroke (13%/13%), Alzheimer’s disease or related dementias (14%/14%), depression (29%/30%), and 4+ chronic conditions (59%/64%). This poster describes both the methodology and findings of the reports. We also report on how communities have used these data for developing new partnerships, identifying priorities and becoming more age-friendly at the state and community levels. Research supported by the Tufts Health Plan Foundation.

Ninety-seven adults ranging in age from 60 to 95 (mean age = 72.56)completed the Computer Proficiency Questionnaire (CPQ) along with a battery that measured demographic information, socio-emotional variables and cognitive abilities.Hierarchical regression analyses examined the predictors of CPQ Total score as well as the three CPQ subscales (e.g., Basic Communication /Internet Use, Calendar Application Use/Advanced Communication Behaviors, and Basic Computer Use).After controlling for demographic variables, sense of control uniquely predicted Basic Communication behaviors/Internet Use; positive affect uniquely predicted Calendar Application Use as well as Advanced Communication Behaviors; inductive reasoning uniquely predicted Basic Computer Use.In addition, the relationship between inductive reasoning and CPQ Total Score was moderated by ethnicity.In African Americans elders the relationship between inductive reasoning and overall computer proficiency was significant and positive; while in European Americans there was no relationship.Discussion will focus on the importance of understanding the underlying antecedents of computer proficiency and the potential bidirectionality of the observed results.

adults in innovative ways.This intervention also has been able to open the door for older adults to seek resources that they may not have necessarily been exposed to.