S ongquan D eng / Shutterstock .com - University of Nevada School ...

Songquan Deng / Shutterstock.com

Elders Count Nevada 2013 

Sanford Center for Aging/146 

Division of Health Sciences 

University of Nevada, Reno 

Reno, NV 89557-0146 

www.unr.edu/sanford 

Report Prepared by: 

Angela D. Broadus, PhD 

Teresa M. Sacks, MPH 

Elizabeth R. Fadali, ABD 

Marketing and Communications: 

Richelle W. O’Driscoll, MA 

Director, Public Affairs 

Division of Health Sciences, School of Medicine 

Editor: 

Edward G. Cohen, MS 

Graphic Design: 

Lori Kunder 

Kunder Design Studio 

This report was funded by the Marion G. Thompson Charitable Trust and the Graham and 

Jean Sanford Endowment and made possible through partnerships between Sanford Center for 

Aging, University of Nevada, Reno, the Center for Economic Development at the University of 

Nevada, Reno, the Nevada State Health Division, the Nevada State Office of Rural Health, and 

Nevada Aging and Disability Services Division. 

Copyright Information: Information contained in this report may be reproduced or disseminated without permission; 

however, appropriate citation is appreciated. 

Recommended Citation: Broadus, A.D., Sacks, T.M., & Fadali, E.R. (2013). Elders Count Nevada. University of Nevada, 

Reno: Sanford Center for Aging. 

Report Availability: To receive a copy of Elders Count Nevada, please visit the Sanford Center for Aging website for a 

free download at http://www.unr.edu/sanford/programs/elderscount2013.

Sanford Center for Aging 

Mission and vision 

Vision: 

To become recognized across Nevada and beyond as leaders in aging-related research, 

education, and community outreach. 

Mission: 

The mission of the Sanford Center for Aging is to enhance the quality of life for older persons 

through innovation and leadership in interdisciplinary aging-related research, education, and community outreach. 

Significant Background: 

The Sanford Center for Aging is funded in the large part through a substantial endowment made by 

Mrs. Jean Sanford in 1992. The express purpose of this endowment was “…to support the activities… 

which are directed in whole or substantial part towards research, teaching, and publicizing ways and means 

to improve quality of life for [older adults].” 

“The best policies are driven by the best data. This report is an excellent start toward developing 

the training programs necessary to expand the workforce Nevada needs to care for its growing and 

diverse population of older adults. The Division of Health Sciences is committed to improving the 

health and well-being of our seniors through excellence in education and research.” 

Thomas L. Schwenk, M.D., Vice President, Division of Health Sciences, University of Nevada, Reno and 

Dean, University of Nevada School of Medicine 

“Our aging society is the greatest demographic shift of the 21st Century. 

As concerned and compassionate Nevadans, we need to prepare our communities 

to meet the needs of this growing population.” 

Grady Tarbutton, Director 

Washoe County Senior Services

Advisory Committee 

In alphabetical order… 

Caleb Cage 

Executive Director, Nevada Office of Veterans 

Services 

5460 Reno Corporate Dr. Suite 131 

Reno, NV 89511 

Phone: (775) 688-1653 

cagec@veterans.nv.gov 

Jeff Fontaine 

Executive Director, Nevada Association of 

Counties 

Phone: (775) 883-7863 

jfontaine@nvnaco.org 

Pam Gallion, M.Ed., MBA 

Director, Cannon Survey Center 

Division of Educational Outreach 

University of Nevada, Las Vegas 

Phone: (702) 895-0486 

pam.gallion@unlv.edu 

Tina Gerber-Winn, MSW 

Deputy Division Administrator 

Nevada Aging and Disability Services Division 

Phone: (775) 687-4210 

trgerber@adsd.nv.gov 

Tabor Griswold, MS 

Health Services Research Analyst 

Nevada Office of Rural Health & 

Office of Health Professions Research Policy 

University of Nevada School of Medicine 

Phone: (775) 682-8475 

tgriswold@medicine.nevada.edu 

Jeff Hardcastle, AICP 

Nevada State Demographer 

Nevada Small Business Development Center 


Phone: (775) 784-6353 

jhardcas@unr.edu 

Thomas R. Harris, PhD 

Director, UCED, State Extension Specialist 

Economics Department 


Phone: (775) 784-1681 

harris@cabnr.unr.edu 

Denise Montcalm, PhD 

Interim Director, Sanford Center for Aging 

Director, School of Social Work 


Phone: (775) 784-6542 

Montcalm@unr.edu 

Tim Mueller 

Special Projects Manager 

NDOT Transportation/Multimodal Planning 

Phone: (775) 888-7351 

tmueller@dot.state.nv.us 

Betty Munley, BA 

Senior Advocate 

University of Nevada Alumni 1955 

1865 Simpson Avenue 

Reno, NV 89503 

Cell: (775) 345-5144 

Home: (775) 747-3574 

John F. Packham, PhD 

Director of Health Policy Research 

Nevada Office of Rural Health & 

Office of Health Professions Research Policy 

University of Nevada School of Medicine 

Phone: (775) 784-1235 

jpackham@medicine.nevada.edu 

Julia Peek, MHA 

Manager, Office of Public Health Informatics and 

Epidemiology 

Bureau of Health Statistics, Planning, 

Epidemiology and Response 

Nevada State Health Division 

Phone: (775) 684-4192 

jpeek@health.nv.gov 

Luana Ritch, PhD 

Quality Assurance Specialist 

Health and Human Services Division 

Mental Health/Developmental Services Agency 


Phone: (775) 684-5912 

lritch@mhds.nv.gov 

Grady Tarbutton 

Director 

Washoe County Senior Services 

Phone: (775) 328-6141 

GTarbutton@washoecounty.us

Wei Yang, MD, PhD 

Professor of Epidemiology and Biostatistics 

School of Community Health Sciences 

Director, Nevada Center for Health Statistics and 

Informatics 

Phone: (775) 682-7094 

weiyang@unr.edu 

Significant Contributors 

Jill R. Berntson, Social Services Chief, Aging and 

Disability Services Division, Elder Rights 

Kirsten Bugenig, MPA, MSG, Research Division, 

Legislative Counsel Bureau 

Edward G. Cohen, MS, Mendoza College of 

Business, University of Notre Dame, Elders Count 

Nevada (2013), Editor 

Robert Dick, PhD, Temp Faculty, Economics 

Department, University of Nevada, Reno 

Betty Dodson, PhD, Director, Gerontology 

Academic Program, Emerita 

Elizabeth Fadali, MA, ABD, Economics 


Lori Kunder, Graphic Designer, Kunder Design 

Studio 

Nevada State Health Division: Bureau of 

Health Statistics, Planning, Epidemiology and 

Response, Office of Public Health Informatics 

and Epidemiology 

• Jay Kvam, MSPH, State Biostatistician 

• Kyra Morgan, Biostatistician II 

• Sandi Noffsinger, MPH, HIV/Hepatitis/ 

STD/TB Surveillance and Control Manager 

• Jennifer Thompson, Biostatistician II 

• Brad Towle, MA, MPA, Health Program 

Specialist 

Student Contributors 

Julie Kilgore, Field Study, Community Health 

Sciences, University of Nevada, Reno 

• Adviser: Gerold B. Dermid, PhD, 

Coordinator, Community Relations and 

Field Studies, Community Health Sciences, 


Shawna Dale Koehler-Larson, Gerontology 

Independent Study, Community Health Sciences, 


• Adviser: Susan G. Harris, PhD, Coordinator, 

Gerontology Academic Program, Sanford 

Center for Aging, Health Science Division, 


Jeffery Stroup, Graduate Research Assistant, 

Economics Department, University of Nevada, 

Reno 

• Adviser: Thomas Harris, Director, UCED, 

State Extension Specialist, Economics 


Eugenia Larmore, Graduate Research Assistant, 

Economics Department, University of Nevada, 

Reno 

• Adviser: Thomas Harris, Director, UCED, 

State Extension Specialist, Economics 



Teresa M. Sacks, MPH (Project Director) 

Health Research Analyst 



Phone: (775) 784-1612 

sackst@unr.edu 

Angela D. Broadus, PhD (Primary Author) 

Special Projects Coordinator 



Phone: (775) 784-6824 

broadusad@gmail.com

Elders Count Nevada 2013 

Executive Summary 1 

POPULATION 

Highlights 6 

Population Growth & Projections 7 

Population by County 8 

Migration 9 

Population Distribution by Age & Sex 10 

Race & Ethnicity 12 

Education 12 

Living Arrangements 13 

Marital Status & Grandparenting 14 

Civic Engagement 15 

Veterans 17 

Data Tables 19 

TRANSPORTATION & 

INFRASTRUCTURE 

Highlights 32 

Transportation Safety 33 

Transportation Access for Older Adults 33 

Older Adult Ridership 34 

Nevada’s Transportation Infrastructure 34 


ECONOMICS 

Highlights 40 

Labor Force Participation 41 

Median Household Income 42 

Household Income by Quintile 44 

Assets 45 

Social Security Benefits 45 

Poverty 46 

Consumer Expenditure Shares 47 

Veterans 48 

Data Table 50 

HEALTH STATUS 

Highlights 52 

Life Expectancy 54 

Mortality (Causes of Death) 54 

Self-Reported Health Status 56 

Disability 57 

Visual & Hearing Health 61 

Oral Health 62 

Mental Health 64 

Suicide 65 

Veterans 67 


HEALTH RISKS & BEHAVIORS 

Highlights 92 

Tobacco Use 95 

Alcohol Use 96 

Illicit Drug Use 98 

Gambling & Other Process Addictions 100 

Dietary Quality 101 

Physical Activity 103 

Overweight & Obesity 105 

Cholesterol & Blood Pressure 107 

Influenza & Pneumonia Vaccinations 109 

Cancer Screenings 110 

HIV/AIDS & Other Sexually 

Transmitted Diseases 112 

Falls & Fall-Related Injuries 114 

Elder Abuse, Neglect, & Exploitation 115 

Motor Vehicle Accidents 117 

Veterans 118 


HEALTH CARE 

Highlights 156 

Medical Services Use & Health 

Insurance Coverage 158 

Health Policy Reform 159 

Medicare & Medicaid Enrollment 160 

Workforce Resources 162 

Caregivers 163 

Prescription Drugs 165 

Expenditures 167 

Nursing Home Facilities 168 

Nursing Home Residents 170 

Veterans 171 


APPENDIX 

Data Limitations, Challenges & Cautions 187 

References 189 

Table of Contents 

9

Executive Summary 

This report was compiled by the Sanford Center for 

Aging, Division of Health Sciences, at the University 

of Nevada, Reno, in partnership with the Nevada 

State Health Division and the Nevada Aging and 

Disability Services Division, Department of Health 

and Human Services. Significant contributors to 

this report include the Nevada State Demographer; 

Department of Economics, College of Business at 

the University of Nevada, Reno; the Nevada Office 

of Veterans Services; and the Nevada Department of 

Transportation/Multimodal Planning. In particular, 

we thank the Elders Count Nevada (2013) Advisory 

Committee for members’ expertise, guidance, 

and tireless chapter reviews and The Marion G. 

Thompson Charitable Trust for their support in 

making this report possible. 

Elders Count Nevada (2013) is the third installment 

(the first two appeared in 2007 and 2009) in a series 

of reports designed to provide insight into the overall 

health and well-being of Nevada’s elders. The vision 

for Elders Count Nevada originated with Dr. Lawrence 

J. Weiss, former director of the Sanford Center for 

Aging, who believed the voice of Nevada’s elders 

needed to be heard and their circumstances known 

in a state with one of the fastest-growing senior 

populations. We are honored to continue this legacy 

with the publication of Elders Count Nevada (2013). 

The 2013 report utilizes data from authoritative 

sources and has been expanded considerably 

to include information by geographic region of 

residency (i.e., urban and rural/frontier regions); 

our state’s older veteran population; the burden of 

substance use, misuse and abuse; and a new chapter 

on transportation and infrastructure as it relates to 

access, safety and ridership. 

The report contains vital information on six key 

topics: population, transportation and infrastructure, 

economics, health status, health risks and behaviors, 

and health care. New this year are chapter highlights 

presented at the beginning of each section. These are 

intended to provide fast facts on key findings. More 

extensive information is located within each section 

and sub-section of the report. Source citations for 

the highlighted information are located within the 

individual sections. Where available, information has 

been presented by region, gender, and age cohort. In 

some instances, data specific to Nevada elders age 65 

and older was not available. 

A departure has been made from the original format 

of Elders Count Nevada to provide the reader with 

additional information in a narrative format. The data 

and information are presented for interpretation and 

use by the reader. For this report, descriptive analysis 

is provided. More advanced statistical analysis would 

be required for interpreting relationships among 

variables. 

For the purposes of this report, the terms “elder,” 

“senior” and “older adult” have been used 

interchangeably. In most cases, these terms refer to 

an individual 65 or older; however, data have also 

been presented by age group categories, 50-64 year 

olds, 65-74 (the “young old”), 75-84 (the “old”) and 

age 85 and older (the “oldest old”). 

EXECUTIVE SUMMARY 

1


A special note concerning the three geographic regions 

identified in the report: 

Nevada’s 17 counties are designated as urban, 

metropolitan, rural, frontier, micropolitan or nonmetro 

depending on the specific group responsible 

for making the designation. For example, the Office 

of Management and Budget (OMB) delineates 

three metropolitan statistical areas based upon each 

having a minimum of one city with a population 

of 50,000 or more, the centrality of the county or 

counties, and the fact that the county has adjacent 

counties with economic and social ties to the county 

(Griswold & Packham, 2011). These areas include 

Carson City, Las Vegas-Paradise, and the Reno- 

Sparks Metropolitan Statistical Area. Storey County 

is included as part of the Reno-Sparks area because 

of its economic ties to Washoe County. Of the 

remaining counties, five are micropolitan counties 

with an urbanized population between 10,000 and 

50,000 and adjacent counties with economic and 

social ties. Nevada’s micropolitan counties are 

Churchill, Douglas, Elko, Eureka and Nye. The 

remaining eight counties are designated as “nonmetro.” 

In order to meet the needs of Elders Count Nevada 

(2013) stakeholders statewide, this report divides 

county data into three regional groups: 1) Northern 

Urban/Metropolitan (i.e., Washoe County and 

Carson City), 2) Southern Urban/Metropolitan (i.e., 

Clark County), and 3) Rural/Frontier. Classification 

criteria from the National Center for Frontier 

Communities (NCFC, 2012) were utilized for 

regional distinctions. More detail is presented in the 

Population by County sub-section. 

Regional designations are important for highlighting 

the differences in older adults’ ability to access 

health care and other core services. Regional data 

allow stakeholders and partners to quickly see the 

differences between the two largest urban centers 

in the state. Information by individual counties 

has been provided where appropriate. The three 

metropolitan statistical areas also are characterized 

as urban areas in the 2010 Census. The remaining 

counties are rural, but a number of them have urban 

clusters within them (U.S. Census Bureau, 2010). 

Latest Count 

Elder population is growing: Between 2000 and 

2010, when Nevada’s population grew faster than 

any other state, on a percentage basis, the state’s 

senior population grew by 48.2%, more than any 

state except Alaska. As of 2011, Nevada had 340,000 

people 65 or older in the total population of 2.72 

million. 

Proportion of elders is growing: Nationally and 

in Nevada, as the baby boom generation ages, the 

proportion of the population that is 65 and older is 

growing. The elder segment is currently 11.5% in 

Nevada and is projected to grow to about 16% by 

2030. 

Positive Findings and Trends 

Lower prevalence of obesity: In 2011, an estimated 

18.1% of Nevada adults 65 and older met the criteria 

for obesity, compared with about a third of seniors 

nationally. 

Relatively healthier finances: Despite the recession 

and despite having the highest unemployment 

rate in the nation between 2008 and 2010, Nevada 

seniors managed to maintain a lower poverty rate 

and a higher median income than seniors nationally. 

Medical students staying in Nevada upon 

graduation is higher than the national average: 

Between 2000 and 2010, medical school enrollment 

nearly tripled in Nevada, and the state is retaining 

a higher percentage of its medical school graduates 

than other states. In addition, all medical schools 

now require coursework in geriatric medicine, which 

promises more effective treatment of senior illnesses 

in the future. In spite of this encouraging news, 

the current number of active physicians, physician 

assistants, nurse practitioners, nurses, and dentists in 

Nevada is discouraging. 

Familiar Issues 

Problem gambling: Nevada has the nation’s 

highest rate of adults who meet diagnostic criteria 

for pathological gambling. Problem gambling is less 

prevalent among older than younger adults, but 

older adults have fewer economic resources and less 

time to recoup losses. 

2

Divorce: Sixteen percent of Nevada men 60 and 

older are divorced, compared with 10.8% nationally. 

For older women, the rate is 18.7%, compared with 

13.3% nationally. 

Suicides: Since 2008, Nevada has ranked either 

fourth or fifth in the nation for the number of 

suicides. The state’s rate is consistently above the 

national rate and in 2009 suicide was the seventhleading 

cause of death among Nevada adults 55-64. 

Tobacco: Although tobacco use in Nevada has 

steadily declined—from 28.2% in 1996 to 21.3% in 

2010—the state continues to rank in the top third 

and is the worst in the West. 

Excess drinking: The rate of heavy alcohol use 

among older adults in Nevada (4.8%) is much higher 

than the national rate (1.7%). 

Civic apathy: Since 1989 the trend in Nevada has 

been toward increasing volunteerism, but between 

2008 and 2010, older adults in Nevada had the 

nation’s lowest average level of volunteerism. 

Many factors may contribute to this issue including 

Nevada’s transient population, a largely rural/frontier 

geography, an individualistic versus group-focused 

culture, or volunteer hours being under-reported. 

Wide disparities in wealth: Between 2006 and 

2010, the wealthiest one-fifth of households with 

someone 65 or older reported estimated average 

household income 12 times greater than the lowest 

fifth ($123,000 vs. $9,900). Sixty percent of 65+ 

households reported income of less than $32,000. 

Emergent Concerns 

More AIDS among older adults: Among Nevada 

adults 55 and older, the rate of AIDS diagnosis in 

2010 (6.3 per 100,000) was significantly higher than 

the rate nationally (5.4 per 100,000). 

A big rise in Alzheimer’s: From 2000 to 2010, the 

incidence of Alzheimer’s disease among Nevada 

adults 65 and older rose by 38%. This compares with 

12% nationwide. 

Health and Wellness Divide Along 

Wealth, Education Lines 

Education: More than 85% of college graduates 

65 and older rate their health as good to excellent, 

compared with 58.3% of people the same age with 

less than a high school diploma. 

Income: Nearly 90% of residents 65 and older who 

have incomes over $75,000 rate their health as good 

to excellent, compared with only about 52% with 

incomes less than $15,000 a year. 

Other Key Findings 

Veterans are concentrated around Vegas: 

In 2010, almost two-thirds of the state’s nearly 

150,000 veterans 55 or older lived in the Las Vegas- 

Henderson area. 

Families are carrying an increasing care load: 

Between 2006 and 2009, the number of Nevada’s 

unpaid or family caregivers increased by 40%. 

Lack of public transit may accelerate nursing 

home placement: Although 4 out of 5 residents 

surveyed rank transportation as either very or most 

important in preventing nursing home placement, 

accessibility is often lacking in rural areas. More than 

50% of Humboldt County residents in outlying areas 

have no access to public transportation and Ely has 

no public transit system. 

Prevalent nursing home dangers: In 2009, more 

than 1 in 4 (27.1%) Nevada nursing homes were 

found to have deficiencies severe enough to lead 

to actual harm or place residents in jeopardy. This 

reverses a decreasing trend between 2005 through 

2007. 

Acknowledgements 

As employees of an institution of higher learning, 

we are pleased to have provided practical experience 

to two undergraduate students who assisted in the 

research and development of the report. We thank 

their advisers in the Gerontology Academic Program 

(GAP), and the School of Community Health 

Sciences for the opportunity to engage their students. 


Recent rise in abuse, neglect: Between 2011 and 

2012, allegations of abuse, neglect and exploitation of 

elders each increased by 22%. 

3

As indicated in the Executive 

Summary, the Elders Count 

Nevada (2013) expands the 

2009 report with the addition of 

information on older Nevada veterans 

and a focus on regional and gender 

differences. The following section 

examines Nevada’s elder population 

in 10 areas, including: 

• Growth projections 

• Counties 

• Migration to and from the state 

• Population distribution by age and 

sex 

• Race/ethnicity 

• Educational attainment 

• Living arrangements 

• Marital status and grandparenting 

• Civic engagement 

• Older veterans 

Within each area and where possible, 

data is cross-tabulated by age cohort, 

sex and region. Cross-tabulation helps 

convey how specific demographic 

variables interrelate. For example, 

through cross-tabulation it is easier 

to see the distribution of males and 

females living in different regions of 

the state. 

Population 

Population Growth & Projections 

Population by County 

Migration 

Population Distribution by Age & Sex 

Race & Ethnicity 

Education 

Living Arrangements 

Marital Status & Grandparenting 

Civic Engagement 

Veterans 

Photo courtesy of Nevada Office of Veterans Services 

Author: Angela D. Broadus 

Content Reviewers: Jeff Hardcastle, Caleb Cage

Population 

Highlights 

Population Growth and Projections 

• From 2000 to 2010, Nevada’s population of 

adults 65 and older increased by 48.2%, while 

the population of adults 85 and older increased 

77.7%. 

• From 2010 to 2030, the percentage of Nevadans 

65 and older is projected to increase from 11.5% 

to 16.1% of the state’s population. 


• The Nevada counties with the highest percentage 

of older adults are located in Esmeralda (26.2%), 

Nye (24.6%), Mineral (22.7%), and Douglas 

(21.1%) counties. 

Migration 

• Migration to Nevada’s urban areas from outside 

the state accounted for 92% (26,824 individuals) 

of the total migration by older adults. In addition, 

24% of the adults 75 and older who migrated to 

Nevada moved to the Rural/Frontier regions of 

the state. 

Population Distribution by Age 

• 29.6% of the state population is 50 or older; and 

11.5% of the state population is 65 or older. 

Education 

• Fewer older Nevadans (33.2%) than older 

U.S. adults (34.4%) have earned a high school 

diploma or GED; however, more Nevada seniors 

than U.S. seniors have completed an associate’s 

(5.1% versus 3.9%) or bachelor’s (11.7% versus 

11.3%) degree. Fewer older Nevadans (8.1%) 

have completed graduate or professional degree 

compared with older U.S. adults (8.8%). 


• In Nevada, higher percentages of older women 

than older men live alone. 

• A higher percentage of older males live alone 

in the Rural/Frontier regions than in the urban/ 

metropolitan regions. 

• A higher percentage of older females live alone 

in the Northern Urban/Metropolitan region than 

do so in other regions. 

Marital Status and Grandparenting 

• The highest percentage of married adults 60 and 

older live in the Rural/Frontier regions (62.8%). 

• The majority (73.6%) of Nevada children 18 and 

younger living with a grandparent reside in the 

Southern Urban/Metropolitan region. 

• Almost all (94.7%) of Nevada grandparents who 

are solely responsible for their grandchildren live 

in Rural/Frontier regions of the state. 


• Between 2008 and 2010 Nevada had the lowest 

average level of civic engagement across the 

nation for older adults and the highest level of 

unemployment. 

• Since 1989 the trend in Nevada has been toward 

increasing volunteerism. 

• Volunteerism was highest among Nevadans 

16-19 and 45-54; and lowest among Nevadans 

20-24 and 75 and older. 

Race and Ethnicity 

• Nevada’s population continues to show 

increasing diversity. 

• Although the state is majority White (54.1%), 

Hispanics/Latinos(as) make up the largest 

historically under-represented group (26.5% 

Nevada versus 16.3% U.S.), and all minorities 

except Black or African American make up a 

larger percent of the population than do the 

same races/ethnicities on a national level. 

Veterans 

• In 2010 Nevada had 149,070 veterans 55 and 

older. 

• Of these, 22,842 resided in Rural/Frontier 

regions, 29,680 resided in the Northern Urban/ 

Metropolitan region, and 96,548 resided in the 

Southern Urban/Metropolitan region. 

6

Population Growth & Projections 

Historically, Nevada’s population growth has 

been dramatic (see Figure P1). From 1950 to 1960, 

Nevada experienced the second-largest percentage 

increase of any state, 78.2% (2011; Smith & Ahmed, 

1990). Over the next five decades, Nevada was 

the fastest-growing state. From 2000 to 2010, the 

U.S. population increased 9.7% while Nevada’s 

population increased 35.1% or by approximately 

702.300 individuals (Mackun, et al., 2011). Between 

2000 and 2010, Nevada’s population grew more than 

any other state, on a percentage basis. But Nevada’s 

growth slowed almost to a stop between 2010 and 

2011. 

During that year, the state’s growth rank dropped 

from first to 27th with an increase of only 0.8% (State 

& County Quickfacts, 2012; U.S. Census Bureau: 

Texas Gains, 2011). Wharton (2012) predicted 

Nevada’s rate of population growth will continue 

to fall with an estimated increase of only 0.6% 

from 2011 to 2012. Jeff Hardcastle, the Nevada 

State Demographer (2010) also projected slower 

population growth until at least until 2014. 

4,000,000 

3,500,000 

3,000,000 

2,500,000 

Fig. P1: Nevada's Historic and Projected Total and 65 

Years of Age and Over Population 1950 to 2030 

Nevada 

Population 65 and over 

600,000 

500,000 

400,000 

Possible explanations include the national economic 

recession, high unemployment rates, housing 

bubble, escalating gasoline prices, and high cost of 

living in Nevada (Hardcastle, 2012). 

The U.S. Census Bureau predicts that the share of 

the U.S. population 65 and older will increase from 

13.3% in 2010 to 19.7% by 2030 (U.S. Census Bureau, 

2012). Likewise, the Nevada State Demographer 

(Hardcastle, 2012) predicts that the share of the 

Nevada population 65 and older will increase from 

11.5% in 2010 to 16.1% by 2030. Table P1 and Figure 

P2 depict estimated (2010) and projected (2020, 2030) 

population changes for adults 65 and older. Using 

these data, Hardcastle (2012) projects that adults 

65-74 will grow the most as a percent of the state’s 

population (from 7.1% to 9.3%) between 2011 and 

2012. The next-largest gain will be by adults 75-84, 

expected to grow by 1.5% during the same period. 

350,000 

300,000 

250,000 

200,000 

150,000 

100,000 

50,000 

0 

Fig. P2: Nevada Population Growth: Year by 

Age 

65 to 74 Years of Age 

2010 2020 2030 

(Hardcastle, 2012) 

75 to 84 Years of Age 

85 Years of Age and 

Over 

Population 

Total 

2,000,000 

1,500,000 

1,000,000 

500,000 

300,000 

200,000 

100,000 

Over 65 

0 

1950 1960 1970 1980 1990 2000 2010 2020 2030 

0 

(U.S. Census Bureau, 2010 1 ) 

1 

Source: U.S. Census Bureau Population of States and Counties of the United States: 1790 to 1990 http://www.census.gov/population/www/ 

censusdata/pop1790-1990.html Accessed 9/23/2012; DP-1 Profile of General Demographic Characteristics: 2000 Census 2000 Summary File 1 (SF 1) 

100-Percent Data; DP-1 Profile of General Population and Housing Characteristics: 2010, 2010 Census Summary File 1; U.S. Census Bureau \DP-1 Profile 

of General Demographic Characteristics: 2000, Census 2000 Summary File 1 (SF 1) 100-Percent Data; DP-1 Profile of General Population and Housing 

Characteristics: 2010 Census Summary File 1; Census of Population:1950, Vol II Characteristics of the Population Part 28 Nevada; United States Census of 

Population 1960 Nevada General Social and Economic Characteristics; 1970 Census of Population Vol 1 Characteristics of the Population Part 30 Nevada; 

1980 Census of Population Detailed Population Characteristics Nevada PC80-1-D30; NV State Demographer’s Office, Nevada Population Information 

1990. 234,081 - U.S. Census Bureau’s five-year American Community Survey (2006-2010); 242,205 – Veterans Office of the Actuary, September 2011 

estimate (U.S. Department of Veterans Affairs, 2007); 243,865 - Nevada Rural and Frontier Health Data Book; Griswold & Packham (2011); 243,900 - 

Nevada Veterans Services Commission Quarterly Report, which includes Nevada and four California counties (2012, but data represents September 

2010); 300,000 – Nevada Office of Veterans Services (2011) 

7

Population 

From 2000 to 2010, the number of U.S. adults 65 and 

older increased 15.1% (or 5.3 million), higher than 

the 9.7% growth in the overall population during 

the same decade (Werner, 2011). This growth also 

was higher for older males (20.5%) than for older 

females (11.3%) and highest in those ranging from 

65 to 69 (30.4%). Between 2000 and 2010 Nevada’s 

65-and-older population increased by 48.2% 

(105,430 people), while the 85-and-older population 

increased by 77.7% (13,198 people; Werner, 2011). 

Figures P3 and P4 depict cohort population changes 

between 2010 and 2012 for Nevada adults 65 and 

older. The largest population changes occurred in the 

65- to 74-year-old cohort from 2011 to 2012 (3.9%) 

and in the 85-and-older cohort from 2010 to 2011 

(3.8%). The 65- to 74-year-old’s share of the Nevada 

population increased the most, while the 85-andolder 

percentage decreased the most. 

250,000 

200,000 

150,000 

100,000 

50,000 

0 

Fig. P3: Nevada Population Growth: Year by Age 

Cohort 

65-74 Yrs 

3.9% 

2.1% 2.0% 2.0% 

2010 2011 2012 


Fig. P4: Percent Population Change 

3.8% 

2.7% 

65 to 74 Yrs 75 to 84 Yrs 85 Yrs of Age and 

Over 


2.6% 

2.4% 

Total Age 60+ 

75-84 Yrs 

85 Yrs and Older 

% Change 2010-2011 

% Change 2011-2012 

1.0% 

0.6% 

Total Nevada 


The National Center for Frontier Communities 

(NCFC) added a designation of “Frontier” to the 

U.S. Census classifications of “urban” and “rural” 

based on a matrix of criteria that includes population 

density (i.e., seven or fewer persons per square 

mile) and travel distance (miles or minutes) from a 

market or service center (2012). Per these criteria, 

Nevada has three urban areas (Carson City, Clark 

and Washoe counties), two rural areas (Douglas and 

Storey counties) and 12 frontier counties (see Table 

P2). 

In 2011, 12 Nevada counties had higher estimated 

percentages of adults over the age of 65 than the rate 

for the United States as a whole (13.0%; see Table 

P3). All of these except the urban area of Carson City 

were located in the rural/frontier areas of the state 

(Quickfacts, U.S. Census Bureau, 2011). The highest 

percentages of older adults were located in Douglas 

(21.1%), Esmeralda (26.2%), Mineral (22.7%) and 

Nye (24.6%) counties. The lowest percentages were 

in Elko (8.7%) and Humboldt (10.3%) counties. 

Between 2007 and 2011, all counties experienced 

growth in the percentage of adults 65 and older 

except for Eureka and Lincoln, which dropped, and 

White Pine, which stayed the same (Elders Count 

Nevada, 2009). Counties with the largest percentage 

change included Storey (9.1%) and Pershing (5.0%). 

Population differences between 2007 and 2011 in the 

remaining counties ranged from 0.8% in Humboldt 

County to 3.9% in Lyon County. 

8

Migration 

As indicated in the section on Population Growth 

and Projections, Nevada was either the fastestgrowing 

or one of the fastest-growing states from 

1950 until 2010. Based on the 2009 American 

Community Survey, net migration from California 

accounted for the largest portion of this change 

(Ihrke, Faber, & Koerber, 2011). According to 

the Pew Research Center and based on a singleyear, 

2010 estimate, unauthorized immigrants are 

represented in the highest percentages in Nevada 

(7.2%), California (6.8%) and Texas (6.7%) (Passel & 

Cohn, 2011). Estimates for this population nationally 

ranged from 260,000 in 2009 (Department of 

Homeland Security, 2011; Hoefer, Rytina, & Baker, 

2010) to 190,000 in 2010 (Pew Research Center, 

Passel & Cohn, 2011). The 2009 Elders Count Nevada 

report indicated that the most likely country of origin 

for unauthorized immigrants was Mexico (Elders 

Count Nevada, 2009, p. 8); however, this is no 

longer the case. Recent findings reported by the Pew 

Research Center suggest that net migration from 

Mexico fell to virtually zero in 2012 (Passel, Cohn, & 

Gonzalez-Barerra, 2012). 

Five-year (2006-2010) estimates from the American 

Community Survey suggest that 141,414 people 

migrated to Nevada between 2006 and 2010. Of 

these, 87.1% migrated from a different state and 

12.9% moved to Nevada from abroad. In addition, 

approximately 6.6%, or 9,312, of the immigrants 

were 65 or older. In the same period, an estimated 

108,062 people emigrated from Nevada to a different 

state. Of these, approximately 7.7%, or 8,338 people, 

were 65 or older. The majority of adults 50 and older 

(92%, n = 26,824) migrated to urban areas of the 

state (see Figure P5 and Table P4). Of these, 76.4% 

migrated to the Southern Urban/Metro area, and 

approximately 16% migrated to the Northern Urban/ 

Metro area. An additional 8% migrated to the Rural/ 

Frontier area. 

15.6% 

Fig. P5: Percent of Total Migration 

76.4% 

8.0% 

Northern Migration 

Southern Migration 

Northern Migration Southern Migration Rural/Frontier Migration 

Rural/Frontier Migration 

(American Community Survey, 5-year Estimates-B07001, 2006-2010) 

The largest age group was adults in the preretirement 

age range (50-64, see Tables P4 and 

P10). In addition, almost 24% of adults 75 and older 

migrated to the Rural/Frontier areas of the state. 

This may be of concern as these areas often lack easy 

access to health care and other resources. 

Migration percentages by county and age (see Table 

P5) reveal that 76.4% of adults 50 and older migrated 

to Clark County, 14.1% to Washoe County, and 

1.5% to Carson City. Rural/Frontier counties with the 

highest migration percentages included Nye (2.3%), 

Douglas (1.6%) and Lyon (1.2%). More of Nevada’s 

oldest adults (75 and older) moved to Churchill 

(37.7%), Lander (24.2%), Lyon (51.2%) and Nye 

(27.2%) counties than did adults 65-74. 

Of total migration to Nevada by older adults, 89.6% 

moved to Nevada from a different state and 10.4% 

moved from abroad (see Table P6 and Figure P6). 

Older adults moving from abroad primarily moved to 

the urban areas of the state. 

% Rural/Frontier 

% Southern Urban 

% Northern Urban 

Fig. P6: Senior Migration to Nevada by Age and Area 

State Total 

12.8% 

19.1% 

23.8% 

14.8% 

11.2% 

20.1% 

15.0% 

16.6% 

61.4% 

68.1% 

68.7% 

68.3% 

75 and older 

65-74 

50-64 

Population 


9

Population 

Given current state and national economic 

conditions, it could be important to examine 

emigration from Nevada to another state (see Figure 

P7). In 2009 an estimated 108,062 individuals, or 

4.2%, of Nevada residents living in the state one 

year prior to the ACS survey moved from Nevada to 

another state. Of these, 21.1% (22,787) were 50 or 

older, and 7.7% (8,338) were 65 or older. Of those 

who moved out of Nevada, more than two-thirds of 

adults 50 or older (16,261 individuals) moved from 

the Southern Urban/Metro region; 17.8% (4,048) 

moved from the Northern Urban/Metro region; and 

10.9% (2,478) moved from the Rural/Frontier regions 

of the state. 

Fig. P7: Migration from Nevada 

A closer look at migration by age group and area 

reveals that, regardless of age, emigration from 

Nevada was highest among those living in the 

Southern Urban/Metro region (see Figure P8). 

Fig. P8: Annual Migration from Area: Age and Area 

73.5% 

67.1% 68.7% 

17.1% 19.0% 18.6% 

13.9% 12.6% 

9.4% 

50 to 64 years 65 to 74 years 75 years and over 

(U.S. Census Bureau, ACS 5-year Estimates-B07401, 2006-2010) 

% N. Urban 

% S. Urban 

71.4% 

17.8% 

10.9% 

N. Urban/Metropolitan S. Urban/Metropolitan Rural/Frontier 


Population Distribution by Age & Sex 

The 2010 Census found that males (50.6%) slightly 

outnumber females (49.4%) in Nevada, a reverse of 

the proportions nationally (males, 49.2%; females, 

50.8%). In addition, 29.6% (779,179) of the state’s 

population is 50 or older, and 11.5% is 65 or older 

(American Community Survey, 5-Year, 2006-2010). 

Of the total population 50 and older (see Table P7 

and Figure P9), the shares that are female 75-84 

(12.2%) and female 85+ (4.5%) are larger than the 

shares that are male in the same age ranges (11.2% 

and 2.8%, respectively; Hardcastle, 2012). 

Fig. P9: Nevada Population by Age and Sex 

Negligible differences exist across area of residence 

by gender or age (see Table P8 and Figure P10). 

70% 

60% 

50% 

40% 

30% 

20% 

10% 

0% 

Fig. P10: Population Percentages: Gender, Age, and 

Area 

S. Urban/Metropolitan 

50-64 65-74 75-84 85+ 50-64 65-74 75-84 85+ 

Male 

Female 

(U.S. Census Bureau: PCT 12 Sex by Age, 2010) 

N. Urban/Metropolitan 

Rural/Frontier 

59.4% 

61.8% 

23.8% 

24.3% 

Female 

Male 

12.2% 

11.2% 

4.5% 

2.8% 

10 

50 to 64 years 65 to 74 years 75 to 84 years 85 years and over 

(Hardcastle, 2012)

Population pyramids provide a quick visual 

representation of a particular state population by 

demographics such as age and gender. For example, 

the following Nevada population pyramids highlight 

the larger older population living in the rural/frontier 

regions of the state as compared to the southern 

and northern urban regions. As illustrated in the 

population pyramid Figure P11, the widest estimated 

population bands in Nevada span 25 to 49 years of 

age. In the 2007 population pyramid (2009 Elders 

Count Nevada), post-World War II baby boomers 

constituted the largest group. 

85 years and over 

80 to 84 years 















5 to 9 years 

Under 5 years 

































5 to 9 years 

5 to 9 years 

Under 5 years 

Under 5 years 

Fig. P11: Nevada Population Pyramid 2010 

8.0% 6.0% 4.0% 2.0% 0.0% 2.0% 4.0% 6.0% 8.0% 

Percentage of Total Population 

(U.S. Census Bureau: SF1, 2010) 

Fig. P20: Fig. Population P12: Population pyramid: Pyramid: Southern Southern 

Urban/Metroplitan Urban/Metroplitan Region Region 

% Male 

% Female 

Population distribution by age and area of the state 

shows significant differences (see Figures P12-P14). 

The Southern Nevada Urban/Metropolitan age 

distributions mirror those of the state as a whole. 

However, the largest population groups in the 

Northern Urban/Metropolitan region are ages 15-29 

and 45-64, while the largest groups for the Rural/ 

Frontier region are ages 10-19 and 40-69. 

Male % 

Male % 

Female % 

Female % 

8.0% 6.0% 

8.0% 

4.0% 

6.0% 

2.0% 

4.0% 

0.0% 

2.0% 

2.0% 

0.0% 

4.0% 

2.0% 4.0% 

6.0% 

6.0% 

8.0% 

Percentage 

8.0% 

Percentage 

of Total Population 

of Total Population 


















5 to 9 years 

Under 5 years 









Under 5 years 

Fig. P13: Population Pyramid: Northern 

Urban/Metropolitan Region 

8.0% 6.0% 4.0% 2.0% 0.0% 2.0% 4.0% 6.0% 8.0% 

Percentage of Total Population 


Fig. P14: Population Pyramid: Rural/Frontier Region 

8.0% 6.0% 4.0% 2.0% 0.0% 2.0% 4.0% 6.0% 8.0% 

Percentage of Population 


Male % 

Female % 

Male % 

Female % 

Population 

11

Population 

Race & Ethnicity 

Almost three-quarters of the Nevada population 

is White (54.1%). Hispanics/Latinos(as) represent 

the largest minority population (26.5%). With the 

exception of Black/African Americans (7.7% in 

Nevada versus 12.2% nationally), Nevada had a 

higher percentage of individuals from a racial or 

ethnic minority group than the nation as a whole 

(see Table P9). 

Among Nevada adults 65 and older, the majority 

are White (76.6%). The next three largest minority 

groups are Black/African American (5.8%), Asian 

(6.6%) and Hispanic/Latino/a (8.8%). Nevada has 

higher percentages of older adult minorities than the 

United States with the exception of Blacks/African 

Americans and those who self-identify as “some 

other race” (see Table P10). 

The Southern Urban/Metropolitan area of Nevada 

has the most diverse population of older adults. 

Although Whites constitute the majority (80.1%), 

8% are Black/African American or Asian, and 9.7% 

are Hispanic/Latinos(as). The Northern Urban/ 

Metropolitan area’s older adult population also is 

predominantly White (90.7%) with 6.2% Hispanic/ 

Latino(a) and 4.1% Asian. Nevada’s Rural/Frontier 

areas are the most White (93.6%) and American 

Indian/Alaskan Native (2.2%). The Rural/Frontier 

areas have the state’s lowest share of Hispanics/ 

Latinos(as), 4.2% (see Table P11). 

Education 

Education is believed to be a social determinant 

of health as it is highly correlated with socioeconomic 

status (World Health Organization, 2008). 

Education also appears to be a protective factor 

for specific health-related issues such as diabetes 

(Geyer, Hemstrom, Peter, & Vagero, 2006), obesity 

(HealthyPeople.gov, 2012) and heart disease (Cutler 

& Lleras-Muney, 2007). Research also has shown 

that the positive correlation between education and 

health appears to taper off between ages 50 and 

60 (Cutler & Lleras-Muney, 2007), possibly due to 

higher mortality in older adults with less education 

(Jemal, Ward, Anderson, Murray, & Thun, 2008). 


Adults in the urban areas of the state are more 

likely to have completed a bachelor’s, graduate or 

professional degree than those living in rural areas. 

In addition, higher percentages of older adults living 

in the rural/frontier areas have completed a high 

school degree or GED (see Table P12 and Figure 

P15) than have those living in the urban areas. 

Fig. P15: Nevada Education Attainment: Adults Age 65 and 

Older by Area 


% Northern Urban/Metro 

Slightly fewer Nevada adults 65 and older (33.2%) 

have completed high school, a GED or an alternative 

than have adults of the same age nationally (34.4%; 

see Table P12; American Community Survey, 5-Year 

Estimates-B15001, 2006-2010). However, slightly 

more Nevada adults 65 and older have completed 

some college (23.3% vs. 17.2% nationally), have 

associate’s degrees (5.1% vs. 3.9%) or have 

bachelor’s degrees [11.7% vs. 11.3%, (see Table 

P12)]. 

% Southern Urban/Metro 

0% 5% 10% 15% 20% 25% 30% 35% 40% 

High School or less High school graduate, GED, or alternative 

Some college, no degree Associate's degree 

Bachelor's degree Graduate or professional degree 

(American Community Survey, 5-Year Estimates-B15001, 2006-2010) 

12


According to the United States of Aging Survey (2012), 

older adults prefer to remain in their homes and 

“age in place” due their perception that this provides 

the best emotional and physical support. For some, 

however, this decision may increase isolation and 

its associated negative consequences. Seniors living 

alone with minimal social support face greater health 

consequences such as depression and substance 

abuse (Bosworth, Hays, George, & Steffens, 2002), 

hypertension (Cornwell & Waite, 2012), and decline 

in cognitive performance (Dickinson, Potter, Hybels, 

McQuoid & Steffens, 2011). This may be significant 

when considering U.S. Census Bureau estimates that 

27.6% of U.S. adults 65 years and older and 24.6% 

of Nevada adults in the same age category live alone 

(ACS 5-Year Estimate, 2006-2010). 

Women are more likely than are men to live alone 

due to several factors, including: 1) traditionally, 

women tend to marry men who are older than 

they are; 2) women are less likely to remarry when 

widowed, and 3) women tend to live longer than 

men. Seventy-two percent of U.S. women 65 and 

older live alone, compared with 27.6% of U.S. men. 

Although this same trend occurs in Nevada, the 

percentage of men living alone is higher (36.8%) 

than in the U.S. as a whole (see Figure P16). 

27.6% 

Fig. P16: Adults Age 65 and Older Living Alone 

36.8% 

72.4% 

63.2% 

27.6% 

24.6% 

United States 


% of Males 65+ Living Alone % Females 65+ Living Alone % of All Persons 65+ Living Alone 


50% 

45% 50% 

40% 45% 

35% 40% 

30% 35% 

25% 30% 

25% 

20% 

20% 

15% 

15% 

10% 10% 

5% 5% 

0% 0% 

90% 

80% 

70% 

60% 

50% 

40% 

30% 

20% 

10% 

0% 

Older U.S. men of all races and ethnicities are more 

likely to live with their spouse than with relatives 

or other people or alone (Jacobsen, Kent, Lee, & 

Mather, 2011). In 2008 and 2010, 72% of older men 

and 42% of older women lived with their spouse 

(Federal Agency Forum: Older Americans, 2011, p. 

8; Federal Agency Forum: Older Americans, 2012, p. 

8). Alternatively, older Hispanic and Asian women 

are almost as likely to live with other relatives (31% 

and 32%, respectively) as they are to live with a 

spouse (41% and 45%, respectively; Jacobsen et al., 

2011). Older White (41%) and Black (42%) women 

are more likely to live alone than either older Asian 

(22%) or Hispanic (27%) women. In addition, older 

White women are almost as likely to live alone (41%) 

as they are to live with a spouse (44%), and older 

Black women are almost as likely to live alone (42%) 

as to live with relatives (32%; see Figure P17 and 

P18). 

Fig. Fig. P17: P26: U.S. U.S. Living Living Arrangements: Arrangements: Female Female by by 

Race/Ethnicity Race/Ethnicity 

White White 

Black, Black, African African 

American American 

Asian Asian 

Hispanic Hispanic 

Alone Alone 

Living Living with Spouse with Spouse 

Living Living with Other with Other Relatives Relatives 

Living Living with Non-Relatives 

with Non-Relatives 

(Source: U.S. Census Bureau, Current Population Survey, Annual Social 

and Economic Supplement, 2008) 

(Jacobsen, Kent, Lee, & Mather, 2011) 

90% 

80% 

70% 

60% 

50% 

40% 

30% 

20% 

10% 

0% 

White 

White 

American 

Fig. 

Fig. 

P27: 

P18: 

U.S. 

U.S. 

Living 

Living 

Arrangements: 

Arrangements: 

Male 

Male 

by Race/Ethnicity 

by Race/Ethnicity 

Black, African 

American Black, African 

American 

Asian 

Asian 

Hispanic 

Hispanic 

Alone 

Alone 

Living with Spouse 

Living with Spouse 

Living with Other Relatives 

Living with Other Relatives 

Living with Non-Relatives 

Living with Non-Relatives 

Population 

Living arrangements for older adults vary from living 

alone to living with family or with non-relatives. 

In 2010, 30.1% of U.S. adults 18 and older lived in 

shared households with at least one additional adult 

(i.e., not the householder, spouse or cohabiting 

partner), and 1.4% of this population sharing 

households were 65 or older. The number of shared 

households nationally increased 11.4% from 2007 to 

2010 (Mykyta & Macartney, 2012). 

(Source: U.S. Census Bureau, Current Population Survey, Annual Social 

and Economic Supplement, 2008) 

(Jacobsen, Kent, Lee, & Mather, 2011) 

13

Population 

The lack of social support from living alone is an 

important issue for older Nevadans, particularly as 

the number of older adults in the state increases. 

In 2010, almost a quarter of Nevada’s older adult 

population (74,441 people) lived alone. Of these, 

48,788 (65.5%) lived in the Southern Urban/Metro 

region, 15,573 (20.9%) lived in the Northern Urban/ 

Metro region, and 10,080 (13.5%) lived in the Rural/ 

Frontier region. 

In all regions, females were more likely than were 

males to live alone. The highest percent of females 

living alone (65.3%) reside in the Northern Urban/ 

Metropolitan region, while 64% of females in the 

Southern Urban/Metropolitan region live alone. In 

the Rural/Frontier region, 56.4% of the females live 

alone (see Figure P19). 

36.0% 

Fig. P19: Adults Age 65+ Living Alone: Gender by 

Area 

34.7% 

43.6% 

64.0% 

65.3% 

56.4% 

23.7% 

27.7% 

Males Females % of Total 

Southern Urban/Metro 

Northern Urban/Metro 


24.5% 


Marital Status & Grandparenting 

14 

Nationally, males 60 and older are more likely to 

be married (73.8%) than are older females (47.8%). 

Older adults in Nevada exhibit a similar pattern with 

69.2% of older males married compared with 49.4% 

of older females (see Figure P20). 

Fig. P20: Comparison of Marital Status in Adults Age 60 

and Older: Location by Sex 

Never Married 

73.8% 

69.2% 

47.8% 49.4% 

34.0% 

10.8% 16.0% 

13.3% 

10.2% 9.5% 

5.2% 5.3% 5.0% 3.1% 

Married 

Divorced 

Widowed 

18.7% 

Male U.S. Male Nevada Female U.S. Female Nevada 

28.7% 


Divorce is more prevalent in Nevada than in other 

states. Sixteen percent of Nevada men 60 and older 

are divorced, compared with 10.8% nationally. For 

older Nevada women, the rate is 18.7%, compared 

with 13.3% nationally. In both Nevada and the 

United States as a whole, older women are much 

more likely than older men to be widowed (see Table 

P13). 

The majority of older Nevadans are married (see 

Figure P21). The highest marriage rate is in the Rural/ 

Frontier regions (62.8%); however, the proportions of 

all marital statuses are similar across regions. 

Fig. P21: Marital Status, Adults Age 60 and Older: 

Location 

Never Married 

58.8% 

56.6% 

19.7% 19.5% 20.2% 

17.0% 

4.5% 3.7% 3.3% 

62.8% 

Southern Urban/Metro Northern Urban/Metro Rural/Frontier 

Married 

Divorced 

Widowed 

16.3% 17.6% 


The 2010 Census estimated that 2.5 million 

grandparents nationally are caring for more than 

2.6 million children, and 7.8 million children live in 

homes where grandparents also reside (AARP, 2012). 

In Nevada, an estimated 42,103 children under age 

18 are living with a grandparent (ACS, B10001, 206- 

2010). Of those who live with their grandparents, 

the overwhelming majority, 73.6%, or approximately 

4,000 children, reside in the Southern Urban/ 

Metropolitan area, 16.3% (approximately 6,862) 

reside in the Northern Urban/Metropolitan area, and 

4.1%, or approximately 1,726, reside in the Rural/ 

Frontier area (see Figure P22).

Fig. P22: Percent of Children Living with 

Grandparents by Location 

73.6% 

16.3% 


Of the estimated 62,500 grandparents living with 

their grandchildren in Nevada, 46.9% (29,310) are 60 

and older, a higher percentage than found nationally 

(44.2%). Almost 15% (9,231) of these older Nevada 

grandparents are solely responsible for the children’s 

care compared with 13.5% nationally. Who will care 

for the children under age 18 when their grandparent 

dies? 

4.1% 


In the Southern region, 46.9% of grandparents 60 

and older are living with their grandchildren (see 

Figure P23). Of these, 29.3% are solely responsible 

for their grandchildren. Of the grandparents residing 

in the Northern Urban/Metro region, 63.2% reside 

with their grandchildren. Of these, 26.3% are solely 

responsible for their grandchildren. In the Rural/ 

Frontier region, 22.4% of grandparents live with 

their grandchildren, and almost all (94.7%) are solely 

responsible for their grandchildren. 

46.9% 

Fig. P23: Grandparenting Across Nevada 

63.2% 

29.3% 26.3% 

22.4% 

94.7% 


% Age 60+ % Solely Responsible 

Population 



“Civic engagement…actions wherein older adults 

participate in activities of personal and public concern 

that are both individually life enriching and socially 

beneficial to the community.” 

(Cuillnane, 2006) 

Civic engagement includes formal and informal 

volunteering, helping and socializing with neighbors, 

voting or registering to vote, participation in 

public meetings, and advocacy to influence local 

governments (Corporation for National and 

Community Services, 2011). Research suggests that 

communities benefit from civic engagement. For 

example, positive correlations exist between states 

with higher civic engagement and greater resilience 

against unemployment, and between higher civic 

engagement and lower levels of unemployment 

[National Conference on Citizenship (NCOC), 

2011]. (Note: These correlations also occur in reverse 

– higher unemployment correlates with lower 

volunteerism.) Communities particularly benefit 

from older adults’ participation in civic engagement 

through the use of social capital, experience 

and expertise found in this growing population 

(Cullinane, 2006). Older adults who engage in civic 

engagement also experience individual benefits. 

These include improvements in social connectedness, 

physical and mental health, and greater self-esteem 

(Martinez, Crooks, Kim & Tanner, 2011; Wilson & 

Simson, 2006, in Cullinane, 2006). 

Although the recorded number of Nevada volunteers 

has fallen from a high of 430,810 in 2007 to 418,017 

in 2010, the overall trend since 1989 has been toward 

greater volunteerism (see Figure P24). Despite this, 

between 2008 and 2010 Nevada had the lowest 

average level of civic engagement of all U.S. states 

(20.9%) and the highest level of unemployment 

(NCOC, 2011; VolunteeringinAmerica.com, 2011). 

Number of Volunteers 

500,000 

400,000 

300,000 

200,000 

100,000 

0 

Fig. P24: Nevada Volunteerism 

(Volunteering in America, 2011) 

R² = 0.724 

1989 2002 2003 2004 2005 2006 2007 2008 2009 2010 

Year 

15

Population 

As shown in Figure P25 below, volunteer rates in 

Nevada decline in early adulthood and again after 

retirement. Between 2008 and 2010, the volunteer 

rate for baby boomers (i.e., born between 1946 and 

1964) was 24.3%, while the rate for adults 65 and 

older was 16.6%. Interestingly, the median volunteer 

time investment for baby boomers was 68 hours, 

while for older adults the median was over 100 

hours. This would suggest that the volunteerism rate 

might not account for the actual number of hours 

elders devote to civic engagement. 

26.5% 

14.1% 

Fig. P25: Nevada Volunteer Rates 

19.0% 

23.2% 

26.9% 

19.3% 


20.6% 

R² = 0.6626 

11.5% 

16-19 20-24 25-34 35-44 45-54 55-64 65-74 75+ 

Age 

Nevada volunteer rates by age cohort are lower than 

national volunteer rates for the same age ranges (see 

Figure P26). 

As of February 2012, 2,929 seniors have participated 

in three Senior Corps programs: Foster Grandparent 

Program (290 participants), Retired and Senior 

Volunteer Programs (2,388 participants), and the 

Senior Companion Program (251; National and 

Community Service, 2012). These volunteers benefit 

their communities by engaging in a wide variety 

of activities that include tutoring and mentoring 

school-age children with special needs, providing 

companionship and transportation for frail and 

homebound seniors, and assisting their communities 

during crises (National and Community Service, 

2012). 

During the 2010 general election for Governor, 

Senator and federal Representative, the turnout rate 

for Nevada’s voting-eligible population was 41.1%, 

compared with a 41.0% turnout for the United States 

as a whole (McDonald, 2011). This was a decline 

from the 2008 general presidential election, when 

Nevada’s turnout rate was 57% versus a U.S. rate of 

61.6% (McDonald, 2011). When voter registration 

closed in May 2012, Nevada had approximately 1.05 

million active voters. Of these, approximately 24% 

(254,766) were 65 or older (Miller, 2012; see Table 

P14). 

Fig. P26: Volunteer Rates, 2008-2010: 

Nevada versus U.S. 

27.8% 

26.5% 

Nevada Volunteer 

Rates 

19.3% 

20.6% 

20.3% 

11.5% 

55-64 65-74 75+ 


16

Veterans 

Obtaining consistent population data for Nevada 

veterans was challenging. The source of data, time of 

data collection, and differing definitions for veterans 

resulted in inconsistent findings. For example, 

authoritative sources list the population of Nevada 

veterans anywhere from 234,081 to 300,000 2 . 

8.2% 

Fig. P27: Nevada Veterans: Percentage of Total by Age 

Group 

28.1% 

26.2% 

20.8% 

16.7% 

Population 

Information for this report comes primarily from 

the American Community Survey, 5-Year Estimates 

(2006-2010) because this data set is the most 

comprehensive and can be analyzed by any number 

of demographic variables. However, when available, 

we have also provided data from other sources, 

including the Nevada Office of Veterans Services 

(NOVS) and the Nevada Rural and Frontier Health 

Data Book (2011). 

18 to 34 years 35 to 54 years 55 to 64 years 65 to 74 years 75 years and older 

(U.S. Census Bureau: ACS 5-Year Estimates-B21001, 2006-2010) 

The majority of Nevada’s older adult veterans live in 

the Southern Urban/Metropolitan region of the state 

(64.8%); almost 20% live in the Northern Urban/ 

Metropolitan region, and 15.3% live in the Rural/ 

Frontier region (see Table P16 and Figure P28). 

Jurisdiction for the NOVS includes the state of 

Nevada and the California counties of Alpine, 

Lassen, Modoc and Mono (Nevada Office of 

Veterans Services, 2012). Per a 2011 quarterly report 

to the Veterans Services Commission, the veteran 

population for these combined areas was 243,900 

as of September 2010. This was a 4% increase over 

the Census calculations (Nevada Office of Veterans 

Services, 2012; U.S. Census Bureau: ACS 5-Year 

Estimates-B21001, 2006-2010). The NOVS veteran 

population consisted of 222,500 (91.2%) males and 

21,400 (8.8%) females. In addition, the majority of 

veterans served in at least one of four periods of war, 

while 26.4% were peacetime veterans (see Table P15; 

U.S. Department of Veterans Affairs, 2012) 

In 2010, the U.S. Census Bureau estimated the 

population of Nevada veterans at 234,081 (ACS 

5-Year Estimates, 2006-2010). Of these, 63.7%, or 

149,070, were 55 or older. This percentage is slightly 

lower than the national proportion (65.8%). By age 

group, 26.2%, or 61,419, were, 55-64; 20.8%, or 

48,686, were, 65-74; and 16.7%, 39,065, were 75 or 

older (see Figure P27). 

Fig. 28: Nevada Veterans, Age 55 and Older: Sex by 

Location 

64.8% 65.1% 64.8% 

19.9% 21.5% 19.9% 

15.4% 

13.4% 

Male Female Total 


15.3% 


The distribution of Nevada veterans across the state’s 

three population regions is similar (see Figure P29). 

Slightly more pre-retirement-age veterans (42.4%) 

live in the Northern Urban/Metropolitan region, and 

slightly more of Nevada’s oldest veterans live in the 

urban rather than rural or frontier regions. Finally, 

in the 65-74 age range, the share of veterans living 

in the Rural/Frontier region (35.4%) is higher than 

found in the other regions. This could be of concern 

when considering the possible lack of local resources, 

especially veteran-specific resources. 

2 

234,081 - U.S. Census Bureau’s five-year American Community Survey (2006-2010); 242,205 – Veterans Office of the Actuary, September 2011 

estimate (U.S. Department of Veterans Affairs, 2007); 243,865 - Nevada Rural and Frontier Health Data Book; Griswold & Packham (2011); 243,900 - 

Nevada Veterans Services Commission Quarterly Report, which includes Nevada and four California counties (2012, but data represents September 

2010); 300,000 – Nevada Office of Veterans Services (2011). 

17

Population 

Fig. P29: Nevada Veterans, Age 55 and Older: Age by 

Location 

41.0% 

42.4% 

32.3% 31.7% 

26.7% 25.9% 

40.4% 

35.4% 

24.2% 






Griswold and Packham’s (2011) estimated veteran 

population figures were approximately 4% larger 

than U.S. Census Bureau estimates (n=243,861). Age 

groupings also differed from the U.S. Census with 

older adults divided into ages 45 and under, 45-64, 

65-85 and 86 and older (see Figure P30). Using these 

data, 78,364 (32.1%) are 65-85, and 9,772 (4%) are 86 

and older. Consistent with the U.S. Census Bureau 

data, the majority of older veterans reside in the 

Southern Urban/Metropolitan area. 

Looking only at Nevada’s Rural/Frontier counties, 

the greatest concentrations of veterans are in Nye 

(3%), Lyon (2.8%) and Douglas (2.5%) counties. The 

fewest are in Esmeralda (0.1%) and Eureka (0.1%) 

counties (see Table P17; U.S. Census Bureau ACS 

5-Year Estimates-B21001, 2006-2010). Analysis of 

the rural veteran population by age group (e.g., 55- 

64, 65-74, 75 and older) across counties reveals the 

highest percentage of veterans 55 to 64 exists in Nye 

County (3.1%) with Douglas County (2.6%) a close 

second. For veterans 65-74, the highest percentages 

live in Nye (4.5%), Douglas (3.2%) and Lyon (2.9%) 

counties. Among rural veterans 75 and older, the 

highest percentages exist in Douglas (3.6%); Nye 

(3.3%) and Lyon (2.8%) counties (see Table P17). 

When the population of veterans within the Rural/ 

Frontier counties was examined, more veterans 55- 

64 were found to live in Douglas (27.5%), Esmeralda 

(41.5%), Lander (45.5%), Pershing (27.1%) and 

White Pine (29.3%) than were veterans from any 

other age group. In addition, Eureka (37.6%) and 

Storey (37.5%) counties have more veterans 65- 

74 than from any other age group. Veterans in the 

remaining counties are most likely to be ages 35-54 

(U.S. Census Bureau ACS 5-Year Estimates-B21001, 

2006-2010). 

67.8% 

Fig. P30: Percentage of Older Veterans by Location 

72.2% 

17.0% 

Age 65 to 85 

16.0% 15.2% 15.9% 

Southern Urban/Metropolitan Northern Urban/Metropolitan Rural/Frontier 

(Griswold & Packham, 2011) 

Age 86 and Older 

Of the Rural/Frontier counties, the largest percent 

of veterans reside in Douglas (6,526; 2.7%), Lyon 

(6,203; 2.5%) and Nye (5,319; 2.2%). Of those 65- 

85, the highest percentages are found in Nye (2,414; 

3.1%), Lyon (2,238; 2.9%), Douglas (1,547; 2.9%) and 

Elko (1,547; 2.0%) counties. Of those 86 and older, 

the highest percentages are in Douglas (271; 2.8%) 

and Lyon (256; 2.6%) counties (see Table P18). 

18

Table P1 

Nevada Population Growth by Cohort and Year 

Cohort 2010 2020 2030 

Pop % Pop % Pop % 

65 to 74 Years of Age 192,789 7.1% 261,055 8.6% 311,523 9.3% 

75 to 84 Years of Age 99,895 3.7% 129,900 4.3% 174,630 5.2% 

85 Years of Age and Over 31,316 1.2% 40,080 1.3% 52,535 1.6% 

Total Nevada 2,706,401 3,043,639 3,338,310 

Population 


19

Population 

20 

Table P2 

County and State Population 

County Pop 2010 Pop 2011 Pop 65+ % 65+ Pers/ Office of Census National 2103 Elders 

2011 2011 sq. Management Bureau Frontier Count: Urban 

mile & Budget 2010 Comm. and 

2010 Center Rural/Frontier 

Carson City 55,274 55,439 9,425 17.0% 382.1 Metropolitan Urban Urban N. Urban/Metro 

Churchill 24,877 24,637 3,868 15.7% 5.0 Micropolitan Rural Frontier Rural/Frontier 

Clark 1,951,269 1,969,975 230,487 11.7% 247.3 Metropolitan Urban Urban S. Urban/Metro 

Douglas 46,997 46,886 9,893 21.1% 66.2 Micropolitan Rural Rural Rural/Frontier 

Elko 48,818 49,491 4,306 8.7% 2.8 Micropolitan Rural Frontier Rural/Frontier 

Esmeralda 783 775 203 26.2% 0.2 Non-Metro Rural Frontier Rural/Frontier 

Eureka 1,987 1,979 265 13.4% 0.5 Micropolitan Rural Frontier Rural/Frontier 

Humboldt 16,528 16,735 1,724 10.3% 1.7 Non-Metro Rural Frontier Rural/Frontier 

Lander 5,775 5,841 701 12.0% 1.1 Non-Metro Rural Frontier Rural/Frontier 

Lincoln 5,345 5,311 993 18.7% 0.5 Non-Metro Rural Frontier Rural/Frontier 

Lyon 51,980 51,871 8,870 17.1% 26.0 Non-Metro Urban Frontier Rural/Frontier 

Mineral 4,772 4,593 1043 22.7% 1.3 Non-Metro Rural Frontier Rural/Frontier 

Nye 43,946 43,351 10,664 24.6% 2.4 Micropolitan Rural Frontier Rural/Frontier 

Pershing 6,753 6,734 956 14.2% 1.1 Non-Metro Rural Frontier Rural/Frontier 

Storey 4,010 3,896 771 19.8% 15.3 Metropolitan Rural Rural Rural/Frontier 

Washoe 421,407 425,710 53,639 12.6% 66.9 Metropolitan Urban Urban N. Urban/Metro 

White Pine 10,030 10,098 1,535 15.2% 1.1 Non-Metro Rural Frontier Rural/Frontier 

Nevada 2,700,552 2,720,028 340,003 12.5% 

U.S. 308,747,508 311,587,816 41,441,180 13.3% 

(Modified from Griswold & Packham, 2011, p. xii; State & County Quickfacts, 2012)

Table P3 

Percent Change of Nevada Population 65 and Older 

County 2007 Census Estimates % Age 65 Years and Older 

(2009 Elders Count) 2011 Census Estimates 

Carson City 15.8% 17.0% 

Churchill 13.6% 15.7% 

Clark 10.4% 11.7% 

Douglas 18.0% 21.1% 

Elko 7.4% 8.7% 

Esmeralda 24.7% 26.2% 

Eureka 14.9% 13.4% 

Humboldt 9.5% 10.3% 

Lander 9.1% 12.0% 

Lincoln 23.3% 18.7% 

Lyon 13.2% 17.1% 

Mineral 21.4% 22.7% 

Nye 20.9% 24.6% 

Pershing 9.2% 14.2% 

Storey 10.7% 19.8% 

Washoe 11.4% 12.6% 

White Pine 15.2% 15.2% 

NEVADA 11.1% 12.5% 

UNITED STATES 12.6% 13.0% 

Population 

(State & County Quickfacts, 2012; Note: Bolded counties have higher percentage of older adults than found in U.S.) 

Table P4 

Population Migration to Nevada, 2006-2010: Age by Area 

N. Urban S. Urban Rural/Frontier 

Moved from different state 

50-64 years 2,788 13,414 1,382 

65-74 years 732 3,952 346 

75+ years 605 2,355 547 

Sub-Total 4,125 19,721 2,275 

Moved from abroad 

50-64 years 320 1,894 56 

65-74 years 24 521 0 

75+ years 79 140 11 

Sub-Total: 423 2,555 67 

Total migration by region 4,548 22,276 2,342 


21

Population 

Table P5 

Percentage Senior Migration to Nevada, 2006-2010: Age within Counties 

Total by Age 

50-64 65-74 75 and Older Total 

% w/in % w/in % w/in % w/in 

Freq. County Freq. County Freq. County Freq. County 


Total 19,854 68.1% 5,575 19.1% 3,737 12.8% 29,166 100.0% 

Churchill 185 62.3% 0 112 37.7% 297 1.0% 

Clark 15,308 68.7% 4,473 20.1% 2,495 11.2% 22,276 76.4% 

Douglas 309 67.5% 91 19.9% 58 12.7% 458 1.6% 

Elko 192 77.7% 30 12.1% 25 10.1% 247 0.8% 

Esmeralda 0 15 100.0% 0 15 0.1% 

Eureka 0 0 0 0 0.0% 

Humboldt 117 84.8% 21 15.2% 0 138 0.5% 

Lander 25 75.8% 0 8 24.2% 33 0.1% 

Lincoln 8 100.0% 0 0 8 0.0% 

Lyon 151 44.2% 16 4.7% 175 51.2% 342 1.2% 

Mineral 29 100.0% 0 0 29 0.1% 

Nye 312 47.2% 169 25.6% 180 27.2% 661 2.3% 

Pershing 10 100.0% 0 0 10 0.0% 

Storey 0 0 0 0 0.0% 

Washoe 2,857 69.3% 650 15.8% 618 15.0% 4,125 14.1% 

White Pine 100 96.2% 4 3.8% 0 104 0.4% 

Carson City 251 59.3% 106 25.1% 66 15.6% 423 1.5% 


22

Table P6 

Senior Migration to Nevada, 2006-2010 within Counties by Age, Domestic and Abroad 

Total Moved from Different State Total Moved from Abroad 

50-64 65-74 75+ Total 50-64 65-74 75+ Total 

17,584 5,030 3,507 26,121 2,270 545 230 3,045 

67.3% 19.3% 13.4% 100.0% 74.5% 17.9% 7.6% 100.0% 

Nevada % Migration Age w/in County % within Nevada % Migration Age w/in County % within Nevada 

Churchill 56.9% 43.1% 1.0% 100.0% 1.2% 

Clark 68.0% 20.0% 11.9% 75.5% 74.1% 20.4% 5.5% 83.9% 

Douglas 68.4% 20.8% 10.8% 1.7% 47.6% 52.4% 0.7% 

Elko 77.7% 12.1% 10.1% 0.9% 0.0% 

Esmeralda 100.0% 0.1% 0.0% 

Eureka 0.0% 0.0% 

Humboldt 83.7% 16.3% 0.5% 100.0% 0.3% 

Lander 75.8% 24.2% 0.1% 0.0% 

Lincoln 100.0% 0.03% 0.0% 

Lyon 44.2% 4.7% 51.2% 1.3% 0.0% 

Mineral 100.0% 0.1% 0.0% 

Nye 47.2% 25.6% 27.2% 2.5% 0.0% 

Pershing 100.0% 0.0% 0.0% 

Storey 0.0% 0.0% 

Washoe 68.1% 16.7% 15.2% 14.3% 80.6% 6.4% 13.0% 12.4% 

White Pine 96.2% 3.8% 0.4% 0.0% 

Carson City 62.3% 28.1% 9.5% 1.4% 34.8% 65.2% 1.5% 


Population 

23

Population 

Table P7 

Nevada Population: Age 50 and Older 

Males 

Females 

Age Groups Population % Total Population % Total 

50 to 64 years 247,374 61.8% 252,862 59.4% 

65 to 74 years 97,108 24.3% 100,673 23.8% 

75 to 84 years 44,862 11.2% 51,529 12.2% 

85 years and over 11,017 2.8% 19,170 4.5% 

Total 400,361 422,234 


Table P8 

Population Percentages: Sex, Age, and Area 

Male 

Female 

50-64 65-74 75-84 85+ 50-64 65-74 75-84 85+ 

Southern 62.1% 24.0% 11.3% 2.3% 59.6% 24.0% 12.1% 4.3% 

Urban/Metro 

Northern 63.3% 23.1% 10.5% 3.2% 59.7% 22.3% 12.5% 5.6% 

Urban/Metro 

Rural/Frontier 58.3% 27.1% 11.9% 2.7% 57.8% 25.6% 12.3% 4.3% 

(U.S. Census: PCT 12 Sex by Age, 2010) 

24

Table P9 

U.S. versus Nevada: Race and Ethnicity 

United States Nevada 

Total Population: 308,745,538 2,700,551 

Not Hispanic or Latino: 

White alone 63.7% 54.1% 

Black or African American alone 12.2% 7.7% 

American Indian and Alaska Native alone 0.7% 0.9% 

Asian alone 4.7% 7.1% 

Native Hawaiian and Other Pacific Islander alone 0.2% 0.6% 

Some Other Race alone 0.2% 0.2% 

Two or More Races 1.9% 2.9% 

Hispanic or Latino: Of Any Race 16.3% 26.5% 

100.0% 100.0% 

Population 


Table P10 

U.S. versus Nevada, Adults Age 65 and Older: Race and Ethnicity 


Total: 40,267,984 324,359 

Not Hispanic or Latino: 

White alone 80.0% 76.6% 

Black or African American alone 8.4% 5.8% 

American Indian and Alaska Native alone 0.4% 0.7% 

Asian alone 3.4% 6.6% 

Native Hawaiian and Other Pacific Islander alone 0.1% 0.3% 

Some Other Race alone 0.1% 0.1% 

Two or More Races 0.7% 1.1% 

Hispanic or Latino: Of Any Race 6.9% 8.8% 

100.0% 100.0% 


25

Population 

Nevada Race/Ethnicity: Age 65 and Older 

Table P11 

S. Urban N. Urban Rural % % % 

Metro Metro Frontier S. Urban N. Urban Rural 

Metro Metro Frontier 

White 164,726 51,038 38,486 80.1% 90.7% 93.6% 

Black or African American 16,452 761 363 8.0% 1.4% 0.9% 

American Indian and Alaska Native 823 711 891 0.4% 1.3% 2.2% 

Asian 16,452 2,315 628 8.0% 4.1% 1.5% 

Native Hawaiian and Other 823 190 0 0.4% 0.3% 0.0% 

Pacific Islander 

Some other race 4,113 634 404 2.0% 1.1% 1.0% 

Two or more races 2,262 596 476 1.1% 1.1% 1.2% 

Hispanic or Latino origin (of any race) 19,948 3,482 1,723 9.7% 6.2% 4.2% 

Total population 205,650 56,292 41,097 100.0% 100.0% 100.0% 

(American Community Survey, 5-Year Estimates-S0103, 2006-2010) 

Table P12 

Education Attainment: 65 and older 

% % 

Southern Northern 

Urban Urban % Rural 

Educational Attainment U.S. % U.S. % NV Metro Metro Frontier 

High School or less 9,434,470 24.3% 18.7% 20% 14% 18% 

High school graduate, GED, 13,337,303 34.4% 33.2% 33% 31% 38% 

or alternative 

Some college, no degree 6,676,635 17.2% 23.3% 22% 26% 25% 

Associate’s degree 1,530,368 3.9% 5.1% 5% 5% 5% 

Bachelor’s degree 4,370,999 11.3% 11.7% 12% 14% 8% 

Graduate or professional degree 3,399,638 8.8% 8.1% 8% 10% 6% 

Totals 38,749,413 100% 100% 100% 100% 100% 


26

Table P13 

Marital Status in Adults 60 and Older: U.S. and Nevada Population 

Never Married % Married % Divorced % Widowed % 

Males 

U.S. 1,248,602 5.2 17,681,616 73.8 2,594,177 10.8 2,450,219 10.2 

Nevada 11,273 5.3 148,021 69.2 34,239 16.0 20,238 9.5 

Females 

U.S. 1,510,859 5.0 14,449,316 47.8 4,007,867 13.3 10,266,424 34.0 

Nevada 7,243 3.1 114,563 49.4 43,324 18.7 66,609 28.7 

Population 

(American Community Surey, 5-Year Estimates-B12002, 2006-2010) 

Table P14 

Nevada Secretary of State’s Voter Registration Statistics 

Age Group Democrat Green Indep. Libertarian Non- Other Republican Total 

American 

Partisan 

18-24 35,506 454 5,345 966 22,155 392 22,865 87,683 

25-34 59,196 832 8,575 1,504 33,300 835 43,349 147,591 

35-44 64,969 494 8,106 1,224 30,519 698 56,981 162,991 

45-54 79,625 370 8,481 1,122 28,961 648 80,775 199,982 

55-64 86,335 330 8,166 963 28,457 550 80,967 205,768 

65 and over 107,451 122 9,347 604 27,372 509 109,361 254,766 

Not Specified 14 0 2 0 5 0 6 27 

Statewide 433,096 2,602 48,022 6,383 170,769 3,632 394,304 1,058,808 

(Miller, 2012, Chart Directly from Website) 

27

Population 

Table P15 

U.S. Department of Veterans Affairs: Nevada Veterans 

Conflict or Arena Population Percent of Total 

Peace-time 64,300 26.4% 

War-time 179,600 73.6% 

• World War II (1939-1945) 17,700 7.3% 

• Korean Conflict (1950-1953) 25,100 10.3% 

• Vietnam War (1955-1975) 86,000 35.3% 

• Gulf-War (August 1990-February 1991) 62,200 25.5% 

Total 243,900* 

*Totals do not match, because veterans may have been in more than one conflict. 

(U.S. Department of Veterans Affairs, 2012) 

Table P16 

Population: Older Adult Veterans in the U.S. and Nevada 

Southern Northern 

Urban Urban Rural 

U.S. Nevada Metro Metro Frontier 

Male Veterans 25,397,315 143,769 93,095 28,541 22,133 

55 to 64 years: 16,518,862 59,055 37,994 12,149 8,912 

65 to 74 years: 4,202,152 46,935 30,119 8,970 7,846 

75 years and over: 4,676,301 37,779 24,982 7,422 5,375 

Female Veterans 485,712 5,301 3,453 1139 709 

55 to 64 years: 209,022 2,364 1,618 433 313 

65 to 74 years: 102,871 1,751 1,060 441 250 

75 years and over: 173,819 1,186 775 265 146 

Total Veterans Age 55+ 25,883,027 149,070 96548 29,680 22,842 


28

Table P17 

Nevada Veterans: Numbers and Percentage within Counties 

18-35 Years 35-54 Years 55-64 Years 65-74 Years 75 Years and Older 

Total Pop. of % w/in Pop. of % w/in Pop. of % w/in Pop. of % w/in Pop. of % w/in 

vets Vets County Vets County Vets County Vets County Vets County 

1,575 23.8% 1,931 29.2% 1,158 17.5% 1,424 21.5% 

Carson 6,609 521 7.9% 

341 10.1% 1,075 31.8% 966 28.5% 572 16.9% 430 12.7% 

Churchill 3,384 

13,980 8.9% 46,036 29.4% 39,612 25.3% 31,179 19.9% 25,757 16.5% 

Clark 156,564 

1,137 19.4% 1,615 27.5% 1,535 26.1% 1,407 24.0% 

Douglas 5,870 176 3.0% 

Elko 3,965 212 5.3% 1,301 32.8% 1,249 31.5% 849 21.4% 354 8.9% 

0.0% 30 13.8% 90 41.5% 68 31.3% 29 13.4% 

Esmeralda 217 0 

5.9% 39 19.3% 46 22.8% 76 37.6% 29 14.4% 

Eureka 202 12 

28 2.0% 511 37.4% 358 26.2% 253 18.5% 216 15.8% 

Humboldt 1,366 

8.1% 102 20.7% 224 45.5% 63 12.8% 63 12.8% 

Lander 492 40 

80 13.8% 175 30.3% 229 39.6% 88 15.2% 

Lincoln 578 6 1.0% 

10.4% 1,794 27.0% 1,666 25.1% 1,389 20.9% 1,097 16.5% 

Lyon 6,637 691 

4.7% 231 32.1% 197 27.4% 109 15.1% 149 20.7% 

Mineral 720 34 

1,421 20.1% 1,917 27.1% 2,203 31.1% 1,269 17.9% 

Nye 7,083 273 3.9% 

7.0% 369 40.8% 201 22.2% 197 21.8% 74 8.2% 

Pershing 904 63 

2.0% 155 24.0% 160 24.8% 242 37.5% 76 11.8% 

Storey 646 13 

2,870 7.6% 9,573 25.5% 10,651 28.3% 8,253 21.9% 6,263 16.7% 

Washoe 37,610 

11 0.9% 311 25.2% 361 29.3% 311 25.2% 340 27.6% 

White Pine 1,234 

19,271 8.2% 65,740 28.1% 61,419 26.2% 48,686 20.8% 39,065 16.7% 

Total 234,081 


Population 

29

Population 

30 

Table P18 

Nevada Veterans: Numbers and Percentage within Counties 

Across Across 

% Across 45 and % w/in % w/in 65 to % w/in the Over % w/in the 

Total Counties under county 45 to 64 County 85 County Counties 85 County Counties 

Carson 6,572 1,096 16.7% 2,759 42.0% 2,374 36.1% 3.0% 343 5.2% 3.5% 

Churchill 3,661 1.5% 689 18.8% 1,633 44.6% 1,199 32.8% 1.5% 140 3.8% 1.4% 

69.0% 36,846 21.9% 71,156 42.3% 53,106 31.6% 67.8% 7,056 4.2% 72.2% 

Clark 168,164 

Douglas 6,526 2.7% 1,148 17.6% 2,798 42.9% 2,309 35.4% 2.9% 271 4.2% 2.8% 

Elko 3,990 1.6% 664 16.6% 1,636 41.0% 1,547 38.8% 2.0% 143 3.6% 1.5% 

0.1% 18 13.2% 52 38.2% 60 44.1% 0.1% 6 4.4% 0.1% 

Esmeralda 136 

0.1% 30 17.0% 81 46.0% 62 35.2% 0.1% 3 1.7% 0.0% 

Eureka 176 

0.6% 230 16.9% 621 45.6% 467 34.3% 0.6% 44 3.2% 0.5% 

Humboldt 1,362 

0.2% 100 18.4% 250 46.0% 183 33.7% 0.2% 10 1.8% 0.1% 

Lander 543 

Lincoln 662 0.3% 126 19.0% 303 45.8% 225 34.0% 0.3% 8 1.2% 0.1% 

Lyon 6,203 2.5% 1,021 16.5% 2,688 43.3% 2,238 36.1% 2.9% 256 4.1% 2.6% 

0.2% 72 12.1% 232 38.9% 263 44.1% 0.3% 30 5.0% 0.3% 

Mineral 597 

Nye 5,319 2.2% 718 13.5% 2,068 38.9% 2,414 45.4% 3.1% 119 2.2% 1.2% 

0.3% 127 18.1% 313 44.7% 239 34.1% 0.3% 21 3.0% 0.2% 

Pershing 700 

0.3% 141 19.8% 331 46.6% 227 31.9% 0.3% 12 1.7% 0.1% 

Storey 711 

15.3% 7,210 19.3% 17,999 48.1% 10,982 29.4% 14.0% 1,218 3.3% 12.5% 

Washoe 37,409 

0.5% 149 13.2% 420 37.2% 469 41.5% 0.6% 92 8.1% 0.9% 

White Pine 1,130 

Total 243,861 100.0% 50,385 20.7% 105,340 43.2% 78,364 32.1% 100.0% 9,772 4.0% 100.0% 

69.0% 36,846 21.9% 71,156 42.3% 53,106 31.6% 67.8% 7,056 4.2% 72.2% 

Southern 168,164 

Urban/Metropolitan 

18.0% 8,306 18.9% 20,758 47.2% 13,356 30.4% 17.0% 1,561 3.5% 16.0% 

Northern 43,981 


Rural/Frontier 30,561 18.2% 5,233 17.1% 13,426 43.9% 11,902 38.9% 15.2% 1,551 5.1% 15.9% 

(Griswold & Packham, 2011)

In future years, Nevada will be billions 

of dollars short in road funding due in 

part to increases in inflation, increased 

use of alternative fuel vehicles, and new 

fuel efficiency standards expected to cut fuel 

consumption nearly in half after 2016. 

(Performance Analysis Division: State of Nevada 2011 

Facts and Figures, 2011, p. 15) 

Transportation 

& Infrastructure 

Transportation Access for Older Adults 

Older Adult Ridership 

Nevada’s Transportation Infrastructure 

Author: Angela D. Broadus 

Content Reviewer: Tim Mueller

TRANSPORTATION & infrastructure 

Highlights 

Mobility and transportation safety are crucial to 

the health and welfare of Nevada’s residents and 

are of utmost concern to the Nevada Department 

of Transportation (NDOT) and the Department 

of Public Safety (DPS). NDOT addresses mobility 

needs through various forms of public transportation, 

administration of the government’s Federal Transit 

Administration grants, and monitoring rural 

transit providers to ensure compliance with federal 

guidelines. In Nevada’s Strategic Highway Safety 

Plan for fiscal year 2012, the DPS also addressed 

transportation safety through the identification of 

five areas the DPS deemed crucial to the reduction of 

traffic accidents and fatalities: seat belt use, impaired 

driving, lane departures, intersection crashes and 

pedestrian safety (Nevada Department of Public 

Safety, 2011, p. 5). 

The following sections highlight transportation 

and infrastructure issues and resources particularly 

relevant to Nevada’s older adults. 

Transportation Safety 

• Age-related changes in vision, hearing, 

cognition and response time can compromise an 

individual’s ability to drive safely, resulting in the 

potential for decreased mobility and increased 

concerns about transportation safety. 


• From 2009 to 2001, total public-transportation 

ridership, including seniors, increased by almost 

14%. 

• In 2009 and 2011, Douglas County reported the 

highest level of ridership, while Storey County 

reported no use of public transportation. (Note: 

Ridership data did not provide a rationale for 

zero reported use of transportation within Storey 

County.) 

• From 2009 to 2011, ridership increased 

significantly in Washoe, Douglas and Lander 

counties and Carson City. 


• In 2011, NDOT began the second phase of the 

multi-agency study Connecting Nevada. Goals 

of this study included redefining Nevada’s 

transportation planning process through 

collaboration with federal, state, regional and 

local agencies and stakeholders, and improving 

Nevada’s transportation network for future 

generations. The study was expected to be 

completed in the first quarter of 2013 followed by 

data analysis and planning. To date, the project 

has connected with more than 150 stakeholders 

across the state. 


• Nevada has four transportation agencies that 

work to increase mobility for seniors: 

— Regional Transportation Commission of 

Washoe County 

— Regional Transportation Commission for 

Southern Nevada 

— Carson Area Metropolitan Planning 

Organization 

— Tahoe Metropolitan Planning Organization 

• Annual federal funding of approximately $8 

million allows Nevada’s public-transportation 

system to provide more than 1 million rides per 

year to seniors, people with disabilities, and the 

public. 

32

Transportation Safety 

As people age, many experience changes in 

vision, hearing, cognition and response time that 

compromise an individual’s ability to drive safely, 

resulting in the potential for decreased mobility 

and increased concerns about transportation safety 

(Staplin, Lococo, Stewart, & Decina, 1999). For 

example, in one Texas study, adults older than 65 who 

had been in an automobile accident were 1.8 times 

more likely than all adults 55-64 to have had a health 

condition or physical limitation prior to the accident 

(Griffin, 2004, p. 41). This association increased to 2.4 

times in adults 75 and older and to 3.1 times in adults 

85 and older (ibid, p. 42). In addition, after controlling 

for other factors, increases in age were associated with 

significant increases in the probability of dying from 

an automobile accident (see Figure T1). 


4 

3.5 

3 

2.5 

2 

1.5 

1 

0.5 

0 

Fig. T1: Relative Likelihood of Death in 

Automobile Accident by Age 

1.78 

2.59 

Death 

(Griffin, 2004, p. 35-36) 

To minimize the risk of unsafe drivers while meeting 

the mobility needs of older adults, it is essential 

that Nevada offers safe and reliable transportation 

alternatives. In the sections below, we first highlight 

Nevada’s general transportation infrastructure issues 

and the efforts to resolve the issues. Next, we discuss 

the availability and use of alternative modes of 

transportation for seniors. 

3.72 

65 Years and Older 



transportation & infrastructure 

Nevada has four transportation agencies that 

increase mobility for seniors (see Table T1). In 

addition, the Nevada Department of Transportation 

(NDOT) has three regional centers, in Las Vegas, 

Reno and Elko, and six sub-district offices, in 

Las Vegas, Carson City, Elko, Ely, Tonopah and 

Winnemucca. 

Public transportation improves the quality of 

life for many Nevada seniors and individuals 

with disabilities by providing access to needed 

services, food, medical assistance, social activities 

and employment. Annual federal funding of 

approximately $8 million allows Nevada’s public 

transportation system to provide more than 1 million 

rides per year to seniors, those with disabilities, 

and the general public (see, Table T3; Performance 

Analysis Division: State of Nevada 2011 Facts and 

Figures, 2011). Between 2010 and 2011, Federal 

Transit Administration funds allowed NDOT to 

purchase 400 buses and transit vehicles, and to hire 

additional rural drivers (p. 4). This funding was 

essential to meet growing public-transportation 

needs in 60 Nevada communities and the state’s 25 

federally recognized Indian colonies. 

The Grants Management Advisory Committee for 

the Nevada Department of Health and Human 

Services conducted a statewide needs survey in May 

2012 that included items about barriers to obtaining 

public transportation. Of the 3,059 participants 

who completed the online version of the survey, 

the highest percentage of respondents (~80%) 

identified the cost of gasoline as a barrier to travel 

(Grants Management Unit, 2012, p. 20). Other 

barriers included vehicle maintenance costs, lack 

of public transportation, lack of knowledge about 

how to use public transportation, lack of funds to 

use public transportation, and not driving. Survey 

participants believed that rural communities have 

greater problems accessing transportation than do 

urban communities. For example, respondents noted 

that Ely is more than a two-hour drive from Elko or 

a four-hour drive from Reno, but Ely has no public 

transit system and only one commercial airline 

flight per week. Over 50% of residents in Humboldt 

County live in outlying areas with no access to 

public transportation. However, Elko County has 

a good public-transportation system. Finally, the 

public transportation system in Las Vegas, although 

sophisticated, is not adequate to meet the needs of 

all its residents (Grants Management Unit, 2012). 

33



Although public transportation is essential to 

meeting the growing mobility needs of Nevada’s 

seniors, obtaining accurate data on senior ridership is 

problematic. Total ridership data do not exist specific 

to the older adult population. Where data have been 

collected, the data on riders 65 and older have been 

confounded with the inclusion of individuals with 

disabilities of all ages and the general public. Other 

transportation services that receive NDOT funds (i.e., 

sub-recipients), such as senior centers and regional 

services, do not collect age-specific data, although 

their passengers are primarily from local senior 

centers. For example, Churchill County and other 

sub-recipients in Douglas, Esmeralda, Humboldt, 

Lander, Lincoln, Lyon, Mineral and Pershing counties 

might not report ridership by age alone, even though 

they regularly pick up passengers from the county 

senior centers. Also, Douglas County operates the 

BlueGo transit with Lake Tahoe tourists, and the 

senior centers in Minden and Gardnerville operate 

the DART public transit system. Rural transit in White 

Pine operates through the White Pine County Senior 

Services (M. Gardner, Personal Communication, 

August 30, 2012). 

From the available data, it appears that total ridership, 

including seniors, increased by almost 14% between 

2009 and 2011 (see Table T2). By region, ridership 

increased in the Northern Urban/Metropolitan (0.2% 

to 3.9%) and Rural/Frontier (69.2% to 74.2%) regions 

and decreased in the Southern Urban/Metropolitan 

region (30.5% to 21.9%; see Figure T2). Douglas 

County had the highest level of ridership in both 

years. Interestingly, Storey County reported no use 

(or failed to report use) of the public transportation 

system. From 2009 to 2011, ridership increased 

significantly in Washoe, Douglas and Lander, counties 

and Carson City 1 . 

Fig. T2: Transit Ridership: Year by Region 

0.2% 

30.5% 

69.2% 

3.9% 

21.9% 

2009 2011 

74.2% 

Northern Urban/Metro Southern Urban/Metro Rural/Frontier 

(M. Gardner, Personal Communication, August 30, 2012; Performance 

Analysis Division: State of Nevada 2011 Facts and Figures, 2011) 


Building our state’s transportation infrastructure 

is essential to meet the growing mobility needs of 

Nevada’s growing senior population. According 

to Senator Harry Reid, “Nevada’s transportation 

infrastructure is stretched to the limit...44% of the 

state’s roads are congested, and many state roads 

are in need of repair” (Reid-Issues, n.d., para. 1 and 

7). In 2008, the American Society of Civil Engineers 

(ASCE, 2009-2012) identified three top infrastructure 

concerns for Nevada: bridges, roads, and drinking 

water/hazardous waste (see Table T3). In this 

next section, we review current bridge and road 

infrastructure issues that highlight the barriers to 

mobility faced by Nevada seniors. 

Bridges are categorized as deficient if they have 

structural issues (poor load-carrying conditions), 

functional issues (below current design standards) or 

seismic issues [below current earthquake-resistant 

standards (Performance Analysis Division: State of 

Nevada, 2011 Facts and Figures, 2011)]. Nevada has 

1,922 public bridges. Of these, NDOT maintains 

1,092; various governmental agencies maintain 792; 

and private citizens maintain 38. In 2011, NDOT 

designated almost 15% (or 285) of the bridges as 

deficient due to structural (18), functional (139), 

and seismic (128) problems (Nevada State Highway 

Preservation Report, 2011, page 39). 

34 

1 

Ridership data does not include the metropolitan transit services operating in Las Vegas, Reno and Carson City.

NDOT also is responsible for 20% of Nevada’s 

roads with over half of all vehicle miles traveled on 

NDOT-maintained roads. In 2007 and 2009, ASCE 

graded the U.S. road infrastructure with a “D” and a 

“D-” for poor-to-mediocre road conditions that cost 

Americans time and fuel and increase stress due to 

congestion. The conditions also cost motorists money 

in terms of road-induced need for auto repairs (see 

Table T3). 

In 2009, the American Recovery and Reinvestment 

Act allocated approximately $201 million to the 

Nevada Department of Transportation to improve 

the state’s transportation infrastructure and put 

Nevada residents back to work (NDOT: Projects and 

Programs, American Recovery and Reinvestment Act 

Overview, 2012). Approximately 30% of the money 

was allocated for transportation projects in the urban 

areas of the state (e.g., Clark and Washoe counties); 

3.5% was allocated to rural areas; and the remaining 

money was earmarked for other statewide projects. 

The 2011 Urban Mobility Report suggested that 

demand for new road construction and infrastructure 

repair in Las Vegas outstripped supplies by 30% 

(Schrank, Lomax, & Eisele, p. 50). In addition, in a 

review of 101 U.S. cities, Las Vegas ranked 36th in 

terms of traffic congestion. This resulted in 28 hours 

of delay per commuter annually, seven gallons of 

excess fuel per auto per year, and an estimated $532 

total annual cost per auto (Schrank, et al., 2011). 

These congestion figures translate into a total annual 

congestion cost of $530 million in Nevada when the 

excess fuel costs are taken into account and delays 

are valued at $16 per hour for individuals and $88 per 

hour for large commercial trucks. 

In 2011, NDOT embarked on the second phase of 

the two-part, multi-agency study called Connecting 

Nevada. A goal of this study was to redefine 

Nevada’s transportation-planning process through 

collaboration with federal, state, regional and local 

agencies and stakeholders. Another goal was to 

improve Nevada’s transportation network for seniors 

and future generations. 

Tasks of the study included increasing public and 

stakeholder involvement in planning for Nevada’s 

future transportation needs through formal needs 

analysis and group discussion, and development of 

a statewide travel-demand model, population and 

employment forecasts, and web map. The study 

was expected to be completed in the first quarter 

of 2013 followed by data analysis and planning. At 

the time of the publication of Elders Count Nevada 

(2013), the project had connected with more than 150 

stakeholders across the state. For more information, 

please see www.connectingnevada.org. 


35


Table T1 

Nevada Transportation Agencies 

• Regional Transportation Commission Washoe County (RTC Washoe) 

• Regional Transportation Commission for Southern Nevada (RTC) 

• Carson Area Metropolitan Planning Organization (CAMPO) 

• Tahoe Metropolitan Planning Organization (TMPO) 

(NDOT-Personal Communication, 2012) 

Table T2 

Transit Ridership by County: Statewide Small Urban and Rural Transportation 2009 & 2011 

County Total Rides** Percent of Total 

2009 2011 2009 2011 

Carson City 1,257 4,094 0.1% 0.3% 

Churchill 44,795 36,970 3.6% 2.6% 

Clark 378,829 309,357 30.5% 21.9% 

Douglas 604,363 869,241 48.7% 61.6% 

Elko 96,726 50,412 7.8% 3.6% 

Esmeralda 7,742 6,957 0.6% 0.5% 

Eureka 2,991 0 0.2% 0.0% 

Humboldt 12,582 12,641 1.0% 0.9% 

Lander 1,490 2,962 0.1% 0.2% 

Lincoln 2,164 2,523 0.2% 0.2% 

Lyon 33,614 25,566 2.7% 1.8% 

Mineral 6,476 7,283 0.5% 0.5% 

Nye 21,685 18,512 1.7% 1.3% 

Pershing 11,254 6,638 0.9% 0.5% 

Storey 0 0 0.0% 0.0% 

Washoe 1,750 51,289 0.1% 3.6% 

White Pine 13,394 7,493 1.1% 0.5% 

Total 1,241,112 1,411,938 100.0% 100.0% 

Northern Urban/Metro 3,007 55,383 0.2% 3.9% 

Southern Urban/Metro 378,829 309,357 30.5% 21.9% 

Rural/Frontier 859,276 1,047,198 69.2% 74.2% 

**Includes adults over age 65, disabled adults, and the general public 

(http://www.nevadadot.com/uploadedFiles/NDOT/About_NDOT/NDOT_Divisions/Planning/Performance_Analysis/Fact%20Book%202011%20 

Final(1).pdf, p. 48; M. Gardner, Personal Communication, August 30, 2012) 

36

Table T3 

ASCE: Key Infrastructure Facts 

Bridges: 

• Sixteen percent of Nevada’s bridges are structurally deficient or functionally obsolete. 

• There are 165 high hazard dams in Nevada...whose failure would cause a loss of life and significant 

property damage. 

• Twenty-seven of Nevada’s 744 dams are in need of rehabilitation to meet applicable state dam safety 

standards. 

• Thirty-five percent of high hazard dams in Nevada have no emergency action plan (EAP). An EAP 

is a predetermined plan of action to be taken including roles, responsibilities and procedures for 

surveillance, notification and evacuation to reduce the potential for loss of life and property damage in 

an area affected by a failure or mis-operation of a dam. 

Roads: 

• Vehicle travel on Nevada’s highways increased 117% from 1990 to 2007. 

• Thirteen percent of Nevada’s roads are in poor or mediocre condition. 

• Fifty-nine percent of Nevada’s major urban highways are congested. 

• Nevada’s transportation department has identified 10 mega projects costing an estimated $4.8 billion 

that need to be completed by 2015 to avoid gridlock in urban areas. 

(ASCE, 2009-2012, para. #1, http://www.infrastructurereportcard.org/state-page/nevada) 


37

The following section contains 

an overview of economic 

conditions affecting older adults 

in Nevada. Within each area and 

where possible, data is provided by 

age cohort and region. If relevant, the 

age group of 55-64 is also included as 

it shows the “future impact” of baby 

boomers as they age. 

The report relies mainly on data from 

the American Community Survey 

(ACS). The ACS is available for a 

one-year period (2010), three-year 

period (2008-2010), and a five-year 

period (2006-2010). The 2010 report 

provides the most recent data. The 

three- and five-year data are provided 

on a rolling-average basis and are 

less accurate because the information 

covers both recessionary and postrecessionary 

periods. 

As often as possible, the report relies 

on one-year 2010 ACS data. However, 

the data are available only for U.S., 

state and large-county areas. For 

Nevada, one-year 2010 ACS data are 

available only for Washoe and Clark 

counties. ACS five-year data are used 

to describe the situation facing all 

counties in Nevada. The ACS 5-Year 

Public Use Microdata Sample (PUMS): 

Nevada 2006-2010 was used to create 

special crosstabs not available through 

the Census Bureau FactFinder website. 

Economics 

Labor Force Participation 

Median Household Income 

Household Income by Income Quintile 

Assets 

Social Security Benefits 

Poverty 

Consumer Expenditure Shares 

Veterans 

Wherever possible, and beneficial to 

the report, the analysis compares data 

between 2006 (“pre-recession”) and 

2010 (“post-recession”). 

Authors: Elizabeth Fadali, Jeffery Stroup, Eugenia Larmore, Robert Dick 

Content Reviewers: Thomas Harris, Caleb Cage

Economics 

Highlights 

The effects of the recession of 2007 to 2009 were 

not yet evident in the economic data series used 

in the 2009 edition of Elders Count Nevada. Elders 

Count Nevada (2013) provides a first look at the 

impact of the recession on Nevada seniors. On 

average, Nevada seniors weathered these difficult 

economic times better than their younger age 

cohorts. However, averages and even medians may 

not provide a complete picture for the state’s most 

vulnerable, low income seniors. Listed below are 

highlights from the latest economic data on Nevada 

seniors. 


• Nevada seniors increased labor force 

participation rates from 2007 to 2010, continuing 

a national trend over the last two decades. 

• Labor force participation decreased with age 

from about 25% for Nevadans age 65-74 to only 

7% for seniors 75 and older. 


• Seniors’ median household incomes were much 

lower than for all other age groups, except for 

households with a householder younger than 25. 

• Seniors were the only age cohort whose incomes 

increased from 2006 to 2010. 

• There was wide variation in senior median 

household income across rural counties, ranging 

from $22,000 in Mineral County to $65,000 in 

Storey County. 

• Senior veteran households were found to be 

better off financially. 

Assets 

• U.S. data from the recently released Federal 

Reserve Survey of Consumer Finances indicated 

that families with a head of household age 65-74 

lost about 6% of their median net worth from 

2004 to 2010. 


• Fewer Nevada adults 65 or older (88.6%) than 

U.S. adults of the same age group (92.5%) 

received Social Security benefits. 

• In the United States, the average monthly Social 

Security benefit payment for those 65 and older 

was $1,150. Nevada residents had a slightly 

higher average monthly payment, $1,169. 

Poverty 

• The 2010 area poverty rates for Nevada senior 

households decreased from 2006, except in 

Washoe County. Rates were unavailable for 

rural/frontier counties. 

• Despite the recession, Nevada seniors managed 

to maintain a lower poverty rate than U.S. 

seniors. 

Nevada’s seniors have been able to maintain income 

and assets surprisingly well through a very difficult 

economic time. This does not mean that all seniors 

can comfortably provide for their shelter, food and 

health care. Seniors who lost substantial assets 

during the recession are much less likely to be able to 

recover than are their younger counterparts. 

Household Income, by Income Quintile 

• Average income for senior households in the 

bottom 20% of incomes was only $9,900, 88% of 

which came from Social Security payments. 

• Sixty percent of Nevada older adult households 

had an average income of $32,000 or less. 

• Social Security accounts for 55% or more of 

income for seniors with the lowest household 

incomes. 

40


A person is considered part of the labor force if 

he or she is either working (employed) or actively 

looking for work (unemployed). The Nevada civilian 

labor force in 2010 totaled approximately 1.4 million 

workers. Of this number, 81.2% were from the 

younger age cohorts (16 to 54 years of age), 14.5% 

were between 55 and 64 (“future impact”), 3.7% 

were 65 to 74 (“young old”), and 0.7% were 75 and 

older (“old” and “oldest old”; see Figure E1). Of 

Nevadans in the workforce who were 65 and older, 

57% were males and 43% were females. 

In 2010, people 65 and older made up a slightly 

higher percentage of the Nevada workforce (4.4%) 

than seniors nationwide (4.1%). In other words, 

of the 1.4 million workers in Nevada about 61,000 

were seniors. The Nevada rate also was higher than 

in neighboring western states of California (3.8%), 

Arizona (4.0%), Utah (3.1%) and Oregon (4.1%). 

Fig. E1: Percentage of Nevada Labor 

Force by Age Group 

14.5% 

3.7% 

0.7% 

Age 16 to 54 

Age 55 to 64 

Age 65 to 74 

Age 75 and older 

Labor force participation rates for older adults 

are projected to continue to increase over the 

coming decades (Bureau of Labor Statistics, 

“Employment Projections. Table 3.3. Civilian labor 

force participation rates by age, sex, race, and 

ethnicity”). Reasons for this may include “pulls” 

such as increased life span, improved health, and 

increased economic opportunities with higher 

salaries. Likely “pushes” include lack of retirement 

savings, concern about pensions, Social Security 

and Medicare sustainability, and, more recently, the 

Great Recession’s effects on housing and other asset 

holdings. 

In 2010, Nevada’s work-force-participation rates for 

residents were comparable to the national average, 

except for those 75 and older. 

When compared with seniors nationally, Nevada has 

a larger percentage of seniors in the workforce. By 

age cohort, these include 

• 55-64 years; 64% (Nevada), 64.3% (U.S.) 

• 65-74 years; 26% (Nevada), 24.8% (U.S.) 

• 75 and older; 7.3% (Nevada), 5.7% (U.S.) 

Economics 

81.2% 

(American Community Survey, 1-Year Estimate-B23001, 2010) 

The labor force participation rate gives the 

percentage of people in a given age group that are 

either working or are looking for work. The labor 

force participation rate for adults 65 and older in the 

United States fell steadily from 1948 to the late 1980s. 

Since then, participation has increased from 11.8% 

in 1990 to 17.4% in 2010. In other words, in 1990 

about 12 seniors out of a hundred were employed 

or looking for work. In 2010, about 17 seniors out 

of a hundred were employed or looking for work. 

The percentage of adults 55-64 in the labor force 

increased from 55.9% to 64.9% over the same period. 

Between 2006, near the height of the housing bubble, 

and 2010, post-recession, labor participation rates for 

Nevada residents 55-64 and 65-74 increased from 

62.4% to 64% and from 25.2% to 26%, respectively 

(see Figure E2). Increased participation rates may 

be in part a response to recessionary pressures 

on retirement assets and safety net and in part a 

continuation of the long-term U.S. trend. Labor 

participation rates for those 75 and older stayed 

about the same at 7.5% of total residents in the age 

group in 2006, compared with 7.3% in 2010. 

41

Economics 

Fig. E2: Nevada Labor Force Participation Rates by Age 

Cohort, 2006 vs. 2010 

62.4% 

64.0% 

25.2% 

26.0% 

7.5% 

7.3% 

Nevada 2006 

Nevada 2010 

64.2% 

Fig. E3: Labor Force Participation of Older Age Groups, by 

Region 

65.9% 64.8% 

59.0% 

26.3% 

29.6% 

26.6% 

20.7% 


Northern Urban 

Southern Urban 

Rural Frontier 

Age 55 to 64 Age 65 to 74 Age 75 and older 

(American Community Survey, 1-Year Estimates-B23001, 

2006 and 2010) 

7.5% 6.8% 8.1% 

Age 55 to 64 Age 65 to 74 Age 75 and older 

5.7% 

Labor participation rates vary by region (see Figure 

E3). The Northern Urban region had the highest 

percentage of residents 55-64 remaining in the 

workforce of any region (65.9%); its percentage 

of residents between 65 and 74 remaining in 

the workforce was also the highest (29.6%). The 

Southern Urban region had the highest share of 

residents 75 and older remaining in the workforce 

(8.1%). 

(American Community Survey, 5-Year Estimates- B23001, 2006-2010) 

Nationally in 2010, 92.2% of all of adults 65 and older 

who considered themselves in the labor force were 

employed. This is higher than the Nevada average of 

84.3%, the Clark County average of 83.9%, and the 

Washoe County average of 83.3%. In other words, 

unemployment rates were higher for Nevada seniors 

than seniors nationally or the rest of the population. 

42 


Income in the American Community Survey data 

is reported from the perspectives of either personal 

(individual) income, family income or household 

income. Depending on the purpose of the data, all 

perspectives may be of interest. However, household 

income tends to more accurately reflect the resources 

individuals have access to within a household. For 

example, an older adult may be part of a married 

couple and have no individual income, yet have 

partial or full access to the income of the spouse. 

There are policy issues for which personal income is 

the appropriate measure, yet in the interest of space 

not all perspectives can be presented here. 

Median household income represents the income 

that “divides the income distribution into two equal 

groups, one having incomes above the median, and 

the other having incomes below the median” (U.S. 

Census Bureau, American FactFinder Glossary, n.d.). 

The median income is the midpoint of all available 

income values for the households within a certain 

location. Household income includes income from 

all sources from all of a household’s members 15 or 

older, whether related or not. 

State of Nevada median income for households 

with a householder 65 or older was $38,951 in 2010 

(see Figure E4). This represented an increase of 

12.6% over the 2006 median income of $34,601. 

Households with a householder 65 or older were the 

only households whose median income increased 

during this period. Median income for all other age 

groups decreased during this period: by 18.7% for 

households with a householder less than 25 years; 

by 6.3% for 25-44 years; and by 4.4% for 45-64 

years. A comparison of components of income using 

2007 and 2010 PUMS data indicated that earnings 

from employment helped insulate senior incomes. 

Median earnings from employment for the senior 

population increased over this period while dropping 

considerably for the rest of households. 

Despite the increase, median income for households 

with a householder 65 or older was higher only 

than the median income for households with a 

householder under age 25. It was still considerably 

lower than the median income for the other age 

groups.

$70,000 

$65,000 

$60,000 

$55,000 

$50,000 

$45,000 

$40,000 

$35,000 

$30,000 

$25,000 

Fig. E4: Median Household Income by 

Age of Householder, Nevada, 2006-2010 

2006 2007 2008 2009 2010 

Householder under 25 years Householder 25 to 44 years 

Householder 45 to 64 years Householder 65 years and over 

(American Community Survey, 1-Year Averages-B19049, 

2006, 2007, 2008, 2009, 2010) 

The 2010 median income for Nevada seniors 

($38,951) was higher than the median income 

for U.S. seniors, $34,381 (see Figure E5). Median 

household incomes in Nevada have been higher 

than the U.S. average in the past, and older adults 

were able to maintain higher incomes despite the 

recession. Clark County had the highest median 

household income for this age group at $39,172 with 

Washoe County at $38,992. 

Nevada seniors had a higher median income 

compared with Arizona ($37,134) and Oregon 

($34,901). Median household income for Nevada 

seniors was lower compared with California 

($40,255) and Utah [$40,784 (ACS, 1-year average, 

“Median Household Income in the Past 12 Months 

(In 2010 Inflation-Adjusted Dollars) by Age of 

Householder”)]. 

On average, between 2006 and 2010, Storey County 

had the highest median income for households with 

a householder 65 or older at $65,446. Next came 

Douglas County, $45,915; Pershing County, $44,643; 

Carson City, $42,716; and Washoe County, $42,404. 

Mineral County had the lowest median household 

income, $22,058, followed by White Pine County, 

$24,507; Lincoln County, $25,538; Esmeralda 

County, $28,646; and Lander County, $31,250 (ACS, 

5-year average 2006-2010). 

Fig. E5: Median Household Income by 

Age of Householder 

Householder 65 

years and over 

Householder 45 to 

64 years 

Householder 25 to 

44 years 

Householder under 

25 years 

Washoe County, Nevada 


$29,408 

$29,598 

$29,942 

$24,143 

$38,992 

$39,172 

$38,951 

$34,381 

Clark County, Nevada 

United States 

$61,563 

$58,480 

$58,557 

$60,683 

$46,969 

$54,310 

$54,189 

$54,024 

(American Community Survey, 1-Year Average-B19049, 2010) 

Economics 

43

Economics 

Household Income by Income Quintile 

Income quintiles in the figure below give average 

income and sources of gross income across sections 

of the population. Incomes are averages for the 2006 

to 2010 period. Each quintile represents 20%, or 

one-fifth, of households with a householder 65 or 

older. Sources of household income vary widely over 

the income distribution of the senior population. 

Older adults within the lower-income quintiles are 

much more likely to depend on Social Security as 

their main source of income (see Figure E6). Social 

Security made up the largest proportion of any 

source of income for older adults in all four of the 

lower-income quintiles. The proportions ranged 

from 88% of income for the lowest quintile to 36% of 

income for the fourth-highest quintile. 

$140,000 

$120,000 

$100,000 

$80,000 

$60,000 

$40,000 

$20,000 

$- 

Fig. E6: Sources of Income for Nevada Households with 

Householders Age 65 and Older by Income Quintile 

$9,900 

$19,620 

$31,725 

$50,251 

$123,224 

Lowest 5th Second 5th Third 5th Fourth 5th Highest 5th 

Other 

Earnings 

Social Security 

Pensions 

Assets 

(American Community Survey, 5-Year PUMS: Nevada, 2006-2010) 

The majority (80%) of Nevada’s households with 

a householder 65 or older reported income of less 

than $51,000. Sixty percent reported income less 

than $32,000. Many of the older adult households 

with higher incomes may have a householder who 

is still employed. The largest spread in income by 

source was between work earnings. The average 

amount of earnings income for those in the highest 

fifth of households ($30,072) was 261 times greater 

than the earnings income for the lowest fifth ($115). 

The wealthiest fifth reported estimated average 

household income 12 times greater than the 

lowest fifth of Nevadans ($123,000 vs. $9,900). The 

wealthiest quintile received the largest proportion 

of their income from assets (32% of total income) 

followed by work earnings (24% of total income). 

The older the householder, the more likely the 

household was to be in the lower quintiles. Average 

age for older adults in the bottom quintile was 75.7 

years. Average age for older adults in the top quintile 

was 71.7 years (University Center for Economic 

Development analysis of Nevada 2006-2010 PUMS 

data from ACS). 

44

Assets 

Income does not fully account for differences in 

assets or liabilities. Assets and liabilities, such 

as owning a home or owing debt to credit card 

companies or health care providers, may greatly 

affect quality of life. Net worth is defined as value of 

gross assets minus liabilities. The Great Recession 

decreased net worth across all age groups including 

older adults, although older adults suffered the 

smallest decreases on average. Decreases in net 

worth are especially difficult for older adults because, 

for many, re-entering the workforce to compensate 

for such losses may no longer be possible, and there 

is relatively less time to compensate for lost savings 

even if re-entry is possible. 

From 2004 to 2010, median net worth for families 

headed by a person 45-54 years of age dropped from 

$167,000 to $118,000 (adjusted for inflation to 2010 

dollars), a decrease of 29% (see Figure E7). Families 

with a head of household in the pre-retirement age 

group, 55-64, lost 38% of their net worth over the 

same period, dropping from a median of $290,000 

to $179,000. Whether because of more conservative 

investments, greater ability to shield assets by staying 

in the workforce, less exposure to the housing 

bubble, or some other reason, families with a head of 

household from 65-74 experienced less of a decrease. 

In these households, median asset levels fell from 

$219,000 to $207,000 or 6%. Families with a head 

of household 75 or older saw median net worth 

increase from $188,000 to $217,000. 

Economics 

350 

Fig. E7: Median Net Worth of Families with 

Holdings by Age 

Thousands of 2010 Dollars 

300 

250 

200 

150 

100 

50 

Less than 35 

35-44 

45-54 

55-64 

65-74 

75 and Older 

0 

1989 1992 1995 1998 2001 2004 2007 2010 

(Bricker, Kennickell, Moore, & Sabelhaus, 2012, Table 4) 


U.S. Social Security is a social insurance program 

funded through payroll taxes (Federal Insurance 

Contributions Act or FICA). Social Security provides 

benefits for retirement, disability, survivorship and 

death. It is the largest government program in 

the world with outlays of about 5% of U.S. gross 

domestic product (Budget of the U.S. Government, 

FY 2013 Summary Tables). The Social Security 

system is widely credited with substantially reducing 

poverty rates for older adults. The U.S. poverty rate 

for older adults in 1959 was 35.2%. The rate in 2010 

was 11.2%. The drop coincided with the expansion of 

the Social Security system (Wentworth and Pattison, 

2002, ACS 2010 1-year estimates). 

In Nevada, 424,836 people received Social Security 

benefits (including disability benefits) in December 

2010. Of this total, 287,524 were 65 or older. 

December 2010 benefits paid to Nevadans totaled 

$489.4 million with $336.2 million paid to seniors 

(U.S. Social Security Administration, OASDI 

Beneficiaries by State and County, 2011). 

45

Economics 

In the United States in 2010, 92.6% of the population 

65 and older received Social Security benefits (see 

Figure E8). In Nevada in 2010, 88.6% of the older 

adult population received benefits. This proportion 

is higher for the Northern Urban/Metropolitan 

and Rural/Frontier regions—93.8% and 94.5%, 

respectively—and lower for the Southern Urban/ 

Metropolitan region, 86.1%. The ratio of beneficiaries 

to total residents 65 years is lower in the Southern 

Urban/Metropolitan region than for the state or nation 

as a whole. 

Fig. E8: Percentage of Social Security Recipients, Age 65 

and Older by Region 

92.6% 

88.6% 

93.8% 

86.1% 

(U.S. Social Security Administration, OASDI Beneficiaries 

by State and County, 2010) 

94.5% 

United States Nevada Northern Urban Southern Urban Rural Frontier 

In the United States, monthly Social Security benefit 

payments for adults age 65 averaged $1,150 (see 

Figure E9). Nevada residents averaged slightly more, 

$1,169. Southern Urban/Metropolitan region residents 

had the highest average benefit, $1,177, followed by 

those in the Northern Urban/Metropolitan region, 

$1,168, and Rural/Frontier region, $1,135. 

$1,150 

Fig. E9: Average Social Security Payment for Recipients 

Age 65 and Older by Region, 2011 

$1,169 $1,168 

$1,177 

(U.S. Social Security Administration, OASDI Beneficiaries by 

State and County, 2010) 

$1,135 

United States Nevada Northern Urban Southern Urban Rural Frontier 

Of the neighboring states, Idaho had the highest 

proportion of Social Security benefits recipients 65 

and older (95.1%), followed by Oregon (94.4%), 

Utah (90.7%), Nevada (88.6%) Arizona (85%) and 

California (83.9%). Possible reasons for the differences 

include the number of military personnel and state 

employees who are not eligible, older adults who have 

chosen to delay starting benefits, and undocumented 

immigrants who pay into the Social Security system 

but are not able to collect benefits. 

Idaho had the lowest average Social Security 

payment for recipients 65 and older ($1,184) followed 

by California ($1,193), Nevada ($1,221), Oregon 

($1,223) and Utah ($1,224). Arizona had the highest 

[$1,238 (U.S. Social Security Administration, OASDI 

Beneficiaries by State and County, 2010)]. 

Poverty 

46 

The poverty threshold is determined each year by 

the U.S. Census Bureau. This is the level of income 

below which families or individuals are considered to 

be lacking the resources to provide the food, shelter 

and clothing necessary to preserve health. Poverty 

thresholds vary by age, family size, and the number 

of related children under age 18. 

A two-person family with a householder 65 or older 

would need an income of $13,194 or greater to be 

above the poverty threshold in 2010. A single older 

adult would need $10,458 (U.S. Census Bureau, 

Poverty Thresholds, 2011). 

The share of households with a householder 65 

or older living below the poverty line decreased 

nationally from 11.7% in 2006 to 10.5% in 2010. In 

Nevada, the share dropped from 9.2% to 9.0%. Of 

the two most populous counties in the state, Clark 

County fell from 9.9% in 2006 to 9.4% in 2010. A 

higher percentage of senior households in Clark 

County were below the poverty level than in Washoe 

County or the state as a whole. Washoe County had 

the lowest percentage of senior households living 

below the poverty line, but the percentage increased 

from 7.0% in 2006 to 8.2% in 2010.

Using average five-year data between 2006 and 

2010, Southern Urban/Metropolitan was the region 

with the highest share (9.2%) of households with 

a householder 65 or older living under the poverty 

level (see Figure E10). This was higher than the state 

share, 8.8%. The Northern Urban/Metropolitan 

region had the lowest share, 7.2%, followed by the 

Rural/Frontier region at 9%. 

Fig. E10: Percentage of Households with Householder 

Age 65 or Older Living in Poverty, by Region 

Poverty rates increased with the age of householders. 

In Nevada, 8.1% of households with a householder 

65-74 lived below the poverty level (see Figure E11). 

The corresponding rates were 9.7% for households 

with a householder 75-84 and 11.9% for those with a 

householder 85 or older. 

Fig. E11: Percentage of Nevada Households Living in 

Poverty by Age Group of Householder 

8.9% 

8.1% 

9.7% 

11.9% 

Economics 

8.8% 

9.2% 9.0% 

7.2% 

All 65 and Older 65 to 74 Years Old 75 to 84 Years Old 85 and Older 

(American Community Survey, 5-Year PUMS: Nevada, 2006-2010) 

Nevada Northern Urban Southern Urban Rural Frontier 


Consumer Expenditure Shares 

Older adults contribute significantly to the economy 

by patronizing businesses and organizations. Net 

assets are highest for households with adults 65 and 

older and households with a householder in the 

55-64 age cohort. Older adults also typically own 

more financial assets. These provide a diversified 

source of income outside of wage earning, which 

can help stabilize finances when income from wages 

decreases. 

Considerable differences exist in expenditure 

patterns among age groups. With the exception 

of health care, older adults have lower average 

expenditure levels. Older adults spent more on 

health care. In households with heads ages 55-64, 

8% of expenditures were for health care, for those 

ages 65-74 health care expenditures were11%), and 

for those ages 75 and older,14%; see Figure E12). The 

share of total household budgets allocated to food 

is consistent across age groups, ranging from 12.2% 

for those with household heads 55-64 to 13.5% for 

those 75 and older. The share of household budgets 

spent on housing increases by age: 32% is spent by 

households headed by a person 55-64; 34% (same as 

national average) is spent by those 65-74; and 37% is 

spent by those 75 and older. Transportation costs, as 

a percentage of total household expenditures, show 

a decline with age, starting at 16.8% for household 

heads 55-64 (same as national average) and 

decreasing to 15.6% for those 65-74 and to 13.2% for 

those 75 and older. 

47

Economics 

60,000 

50,000 

40,000 

30,000 

20,000 

10,000 

- 

Fig. E12: U.S. Average Annual Household 

Expenditures by Age of Householder 

All consumer units 55 to 64 65 to 74 75 and older 

Other 

Housing 

Health Care 


(Bureau of Labor Statistics, Consumer Expenditure Survey, 2011) 

Food 

45,000 

40,000 

35,000 

30,000 

25,000 

20,000 

15,000 

10,000 

5,000 

- 

Fig. E13: Average Annual Household Expenditures 

for Households with Householder Age 65 and Older 

by Region 

Other 

Total 65 and over Northeast Midwest South West 

Housing 

Health Care 


(Bureau of Labor Statistics, Consumer Expenditure Survey, 2011) 

Food 

Nationally, the average annual expenditure for 

households headed by an individual 65 or older was 

$38,027 in 2011. Western-states households headed 

by individuals 65 or older spent, on average, $42,626, 

which is more than households in the Northeast 

($41,756), the Midwest ($35,666), or the South 

[$34,710; see Figure E13]. 

Veterans 

Older adult veterans in Nevada appear to be better 

off financially than other Nevadans 65 or older (see 

Figure E14). Income levels appear to be higher, and 

fewer veterans live below the poverty level (see 

Figure E15). 

Below is summary of points concerning older 

veterans 1 : 

• The second lowest 20% of households with an 

older veteran householder make $16,266 or less 

while the lowest 20% make $10,857 or less. 

• The highest 20% of households with an older 

veteran householder make over $135,477. 

The highest 20% of all households with a 

householder 65 and older make $110,250. 

• Approximately 9% of older adult households are 

below the poverty threshold. Less than 5% of 

households with older veterans are below that 

threshold. 

• At lower income levels, veterans tend to rely 

more on pensions as a percentage of their total 

income than do older adults in general. The 

differences tend to disappear at higher income 

levels (see Figure E16). 

• Veterans tend to rely less on Social Security as 

a percentage of their total income at all levels of 

income (see Figure E17). 

• A higher percentage of veterans’ income comes 

from earned income than does that of older 

adults in general (see Table E1). 

The reason older veterans appear to be better 

off than the general population of older adults 

is probably an expanded social safety net. In 

addition, older veterans are predominately male, 

and households with older adult males had higher 

median incomes than households with only older 

females (see Figure E17). 

Information pertaining to expanded benefits for 

veterans can be accessed at the U. S. Department 

of Veterans Affairs website, http://www.va.gov/ 

healthbenefits/online/. 

48 

1 

The source of all economic data in tables and charts below is University Center for Economic Development (UCED) analysis of Nevada PUMS five-year 

American Community Survey data. Data comparisons are made on a statewide basis because reliable lower-level geographic data is not available. 

Data are also not available to allow a breakdown of veterans into the young-old, old and oldest-old categories for multiple economic categories with 

adequate reliability.

$160,000 

$140,000 

$120,000 

$100,000 

$80,000 

$60,000 

$40,000 

Fig. E14: Average Income by Quintile for Households with 

Veterans Age 65 or Older vs. Households with Age 65 or 

Older Householder 

Veterans 

General Population 

Older Adults 

Economics 

$20,000 

$0 

Bottom Fifth Second Fifth Third Fifth Fourth Fifth Top Fifth 

(American Community Survey, 5-Year PUMS: Nevada 2006-2010) 

Fig. E15: Poverty Rates for Nevada Households with 

Heads Age 65 and older by Veteran Status 

8.9% 

Veterans 

4.9% 

General Population Older 

Adults 

Veterans 

General Population Older Adults 


Fig. E16: Pension Income for Nevada Households with 

Heads Age 65 and Older by Quintile and Veteran Status 

22.41% 

29.32% 

23.41% 

27.22% 27.66% 

Veterans 

General Population 

Older Adults 

16.15% 

18.28% 

16.92% 

10.41% 

7.74% 



160000 

140000 

120000 

100000 

Fig. E17: Older Veterans Average Income Sources by 

Quintile for Households with Older Veterans 

Other 

Earnings 

Social Security 

Pensions 

80000 

60000 

40000 

20000 

0 



49

Economics 

Table E1 

Income Comparisons by Percentage of Total Income (Older Veterans vs. All Older) 

Pension Income 

Social Security Income 

Veteran’s Older Adult Veteran’s Older Adult 

Income Income Income Income 

Bottom Fifth 10.41% 7.74% 76.10% 83.27% 

Second Fifth 22.41% 16.15% 52.16% 63.43% 

Third Fifth 29.32% 23.41% 34.69% 43.54% 

Fourth Fifth 27.22% 27.66% 23.06% 29.26% 

Top Fifth 16.92% 18.28% 10.80% 13.11% 

Earned Income 

Other Income 

Veteran’s Older Adult Veteran’s Older Adult 

Income Income Income Income 

Bottom Fifth 4.99% 4.19% 4.53% 2.49% 

Second Fifth 15.15% 11.13% 4.08% 3.91% 

Third Fifth 23.68% 20.68% 5.29% 4.32% 

Fourth Fifth 34.73% 28.87% 6.68% 4.77% 

Top Fifth 46.09% 39.82% 3.76% 4.18% 


50

Health, morbidity, and access 

to health care influences 

individual life expectancy. 

The average life expectancy within a 

nation or state provides an indicator 

of the general health status of the 

population. Per the 2008-2009 CDC 

report, The State of Aging and Health 

in America, Nevada is better off than 

nationally in the share of population 

that have suffered complete tooth 

loss (17.7% versus 18.0%). However, 

Nevada is worse off than nationally in 

terms of: 

• The share of its population that is 

disabled (37.1% versus 35.3%) 

• The frequency of mental distress, 

defined as 14 or more poor mental 

health days in 30 (8.2% versus 

6.7%) 

• The mean number of physically 

unhealthy days people experience 

(5.6% versus 5.3%). 

Finally, Nevada ranks 22nd in 

the nation in oral health based on 

complete tooth loss, 34th in terms of 

disability, 36th for mean number of 

physically unhealthy days, and 47th in 

frequency of mental distress. 

In this chapter, we examine health 

status in the nation and within Nevada 

among adults 65 and older. Sections 

address life expectancy, mortality and 

causes of death, self-reported health 

status, disability, oral health, mental 

health, and suicide. Specific changes 

from the Elders Count Nevada (2009) 

report include a brief section on visual 

and hearing health in older adults and 

a special section devoted to Nevada’s 

older veterans. 

Health Status 

Life Expectancy 

Mortality (Cause of Death) 

Self-Reported Health Status 

Disability 

Visual & Hearing Health 

Oral Health 

Mental Health 

Suicide 

Veterans 

Authors: Angela D. Broadus, Julie Kilgore 

Content Reviewers: Julia Peek, Brad Towle, Kyra Morgan, Luana Ritch, Wei Yang, Caleb Cage

Health Status 

Highlights 1 


• Nevada residents’ life expectancy of 77.6 years is 

slightly shorter than for the U.S. as a whole and 

ranks 37th among the states. 

• In Nevada, the average life span for males is 75.2 

years and the average for females is 80.2 years. 


• Since 2009, heart disease has been the most 

common cause of death in Nevada. Nevada 

ranks 13th for deaths related to cardiovascular 

disease. 

• In 2009, cancer was the second-most-common 

cause of death in Nevada. Of Nevadans 65 and 

older, 6,614 were newly diagnosed with the 

disease in 2009; 58% were males and 42% were 

females. 

• Compared to the U.S. as a whole, Nevada 

residents were more likely to smoke (21.3% 

versus 17.3%) in 2009, somewhat more likely to 

have recently engaged in physical activity (77% 

versus 76%), and were less likely to be obese 

(60.2% versus 63.8%). 

• From 2000 to 2010, Alzheimer’s disease increased 

in Nevada by 38% among adults 65 and older. 


• Fewer older Nevadans rated their health as 

“good” or “excellent” (69.9%) than did older 

adults nationally (72.1%). 

Disability 

• From 2009-2011, a higher percentage of older 

U.S. adults (36.8%) reported having a disability 

than older Nevadans (33.9%). 

• Of Nevadans 65 and older, the largest highest 

percentage claiming a disability (56.2% were 

males 75 and older living in the Rural/Frontier 

region). 

• Over a third (37.4%) of Nevada’s older adults 

reported their activities were limited because of 

physical, mental or emotional disability. 

• A greater percentage of older adults in the 

Northern Urban/Metropolitan region (41.3%) 

reported limitations due to disability than did 

older adults in the other regions. 

Visual and Hearing Health 

• The prevalence of vision impairment in 

Nevadans age 65 to 79 is comparable to that 

found nationally. For adults age 80 and older, 

the prevalence rate of vision impairment for 

Nevadans (15.8%) is lower than found nationally 

(17.3%) 

• A slightly larger share of Nevada adults (5.5%) 

suffer from eye blood vessel damage due to 

diabetes (i.e., diabetic retinopathy) than do 

adults nationally (5.4%). 

Oral Health 

• The majority (62.1%) of older Nevadans reported 

that they had visited a dentist, dental hygienist or 

dental clinic in the past year. 

• Over half of respondents with incomes less than 

$25,000 indicated that they did not access dental 

care in the year prior to the survey. The figures 

were 57.7% for incomes less than $15,000 and 

52.4% for incomes of $15,000-$24,000. 

• Older adults of higher socioeconomic status were 

less likely to report loss of all permanent teeth. 

Mental Health 

• A higher percentage of older adult females 

(29.5%) than males (17.1%) reported having had 

at least one bad mental health day in the past 

month. 

• Fewer than 1 in 10 (7.6%) of Nevada adults 

65 and older indicated that they had been 

prescribed medication or treatment for a mental 

health or emotional condition. 

• A higher percentage of older adults in the 65- 

74 age group (10.8%) reported being prescribed 

medication and/or treatment than did adults 75- 

84 (3.1%) or 85 and older (4.9%). 

• In 2009, suicide was the fifth-leading cause of 

death among older Nevadans age 55-64 and 

the 10th-leading cause of death in adults 65-74. 

Suicide was not among the 10 leading causes of 

death for Nevada adults 75 and older. 

• In 2009, the primary method for suicide in 

Nevada and U.S. adults, age 65-85 was by 

firearms (71.6% and 63.1%, respectively). The 

second primary method for suicide differed with 

Nevada adults dying by suffocation (10.3%) and 

U.S. adults dying by poisoning (10%). 

52 

1 

Percentages for Behavioral Risk Factor Surveillance System (BRFSS) data are based on older adults who responded to the survey and may not be 

representative of the state as a whole.

Veterans 

• Over half (51%) of the 394 Nevada veterans who 

completed the BRFSS question about military 

service indicated that they had served in a 

combat or war zone. 

• Approximately 9.3% of older Nevada veterans 

had been diagnosed with depression, anxiety or 

Post Traumatic Stress Disorder (PTSD). 

• In 2011, the rate of suicide per 100,000 among 

Nevada female veterans (26.7) was three times 

the rate of suicide among Nevada non-veteran 

females (8.4). The rate was more than five 

times higher than the national rate for females 

(4.9). Similarly, the suicide rate per 100,000 

for Nevada’s male veterans (48.3) was higher 

(61.5%) than the rate of suicide among Nevada’s 

non-veteran males (29.9%) and 151% higher 

than the national rate of male suicide (19.2). 

• Only 2% of older Nevada veterans received 

psychological or psychiatric counseling or 

treatment in the 12 months prior to the survey. 

Health Status 

53

Health Status 


Life expectancy is the average years of life for an 

individual or class of persons if death rates remain 

constant. Of the 221 nations that completed 

the World Health Organization Survey on life 

expectancy, the United States ranked 50th (World 

Health Organization, 2011). U.S. life expectancy 

has increased by almost 50 years since the turn 

of the 20th century (Whitley, 2008). Nevada’s life 

expectancy of 77.6 years is slightly shorter than for 

the United States as a whole and ranks 37th among 

the states (worldlifeexpectancy.com, 2011). 

Influences on life expectancy include health 

status, health risks and behaviors, and health care 

utilization, and these may differ by sex, race and 

ethnicity, education, and income. Life expectancy at 

birth in the United States is 78.5 years with about 

a five-year difference by sex (women live longer). 

In 2010 males had a life expectancy of 76 years at 

birth and females, 80.9 years (Crescioni, Gorina, 

Bilheimer & Gillum, 2010, see Figure HS1). By age 

65, life expectancy for males decreases by 2.7 years 

less than that of females. By the time males are 85 

years of age, life expectancy differences decrease 

to 1.1 years (Crescioni et al., 2010, p. 2). Possible 

reasons include the fact that older males have a 

higher percentage of diagnosed and undiagnosed 

heart disease (39%) than females (27%; ibid, p. 4), 

and a higher percentage have cancer (24.5% versus 

~20.5%, Crescioni et al., 2010, p. 5). 

75.2 

Fig. HS1: Years of Life Expectancy, 2010 

80.2 


77.6 

76.0 

80.9 

United States 

78.5 

(National Center for Health Statistics, 2012) 

Male 

Female 

In Nevada, the average lifespan for males is 75.2 

years and the average for females is 80.2 years. 

Douglas County had the highest life expectancy of 

all Nevada counties (see Table HS1). However, life 

expectancy is consistent across all regions of the 

state with females expected to live approximately six 

years longer than males. Race, ethnicity and other 

characteristics such as education level also may 

affect life expectancy. 

Total 

54 


The national age-adjusted death rate per 100,000 

increased marginally from 741.1 in 2009 (Kochanek, 

Xu, Murphy, Minino, & Kung, 2011) to 746.2 in 

2010 (Minino & Murphy, 2012). However, between 

2000 and 2010 national age-specific death rates 

for U.S. adults ages 45-64 decreased from 647.6 to 

605.7 (Minino & Murphy, 2012). Death rates for 

adults 65 and older also showed a decrease, from 

5,143.6 to 4,461.1. Between 2010 and 2011, rates 

of death decreased 1.6% for adults 65-74, 0.8% 

for adults 75-84, and 1.2% for adults 85 and older 

(Hoyert & Jiaquan, 2012). 

Unlike the generally decreasing mortality trend in 

the United States, Nevada’s age-adjusted death rate 

per 100,000 increased from 784.8 in 2009 (Kochanek 

et al., 2011) to 795.4 in 2010 (Minino & Murphy, 

2012). In addition, Nevada and Wyoming had the 

highest age-adjusted death rates in the western 

United States in 2010 with rates commensurate to 

some of the southern states in the United States 

(see Figure HS2).

Fig. HS2: Age-adjusted Death Rates per State and the District of 

Columbia: United States Preliminary 2010 

AK 

771.3 

OR 

723.2 

723.0 

CA 

646.8 

WA 

692.3 

NV 

795.4 

ID 

731.6 

HI 

589.6 

AZ 

693.1 

723.0 

UT 

703.2 

MT 

754.7 

WY 

778.8 

NM 

749.0 

CO 

682.7 

723.0 

ND 

704.6 

SD 

715.1 

NE 

717.8 

KS 

762.2 

TX 

772.3 

(Minino & Murphy, 2012, p. 3) 

The 10 most common causes of death across the 

nation vary by age group, but all include such 

chronic diseases as heart disease, cancer, diabetes 

and stroke. The most common cause nationally 

for adults 45-64 was cancer, and heart disease was 

the leading cause in adults 65 and older (see Table 

HS2). 

In 2007, cancer was the most common cause of 

death among Nevadans 55-64 and the secondleading 

cause among Nevadans 65 and older [Webbased 

Injury Statistics Query and Reporting System 

(WISQARS), 2012]. Cancer accounted for 23.2% of 

deaths overall, 32.3% for adults 55-64, and 23.6% for 

adults 65 and older. 

By 2009, heart disease had become the most 

common cause of death in Nevada with cancer 

second. Nevada ranks 13th for deaths related to 

cardiovascular disease (see Table HS3; American 

Heart Association, 2009). Factors associated with 

heart disease include smoking tobacco, lack of 

exercise, and obesity. Compared to the nation as 

a whole in 2009, Nevada residents 18 and older 

were more likely to smoke (21.3% versus 17.3%), 

somewhat more likely to engage in physical activity 

(77% versus 76%), and were less likely to be 

obese (60.2% versus 63.8%). Alzheimer’s disease 

(AD), the most common type of dementia, is the 

14th most common cause of death in the United 

States (Kochanek, Xu, Murphy, Minino, & Kung, 

2011). Nevada experienced a 38% increase in AD 

among adults 65 and older between 2000 and 2010. 

This compares with an estimated 12% increase 

nationwide (Smith, 2011; Hebert et al., as cited in 

Alzheimer’s Association, 2012). 

OK 

914.6 

589.9-692.6 

692.7-722.8 

722.9-766.8 

MN 

661.4 

IA 

721.7 

MO 

819.5 

AR 

892.6 

LA 

903.8 

WI 

719.0 

IL 

736.3 

MS 

961.9 

NY 

MI 

665.4 

764.2 

PA 

OH 766.0 

IN 815.7 

820.6 

WV VA 

KY 933.5 

741.5 

914.9 

NC 

TN 

804.7 

890.8 SC 

854.6 

AL GA 

939.4 846.1 

766.9-835.9 

840.0-961.9 

FL 

701.0 

VT 

718.7 

ME 

749.8 

NH, 690.4 

MA, 675.0 

RI, 722.0 

CT 

653.5 

NJ, 691.2 

DE, 769.9 

DC, 792.4 

Overall rate in 

the United States 

is 746.2 deaths 

per 100,000. 

An annual survey from 2005 to 2010 indicated that 

between 4.2% and 5% of Nevada residents had 

been told by a health care professional that they had 

suffered a heart attack, angina or coronary artery 

disease (see Table HS4; Center for Disease Control, 

2012). 

Cancer is the second-leading cause of death in 

Nevada (Kochanek, Xu, Murphy, Minino, & Kung, 

2011). Information about the percentage of adults 

with cancer is relevant as it affects the overall 

quality of life in older adults coping with emotional, 

financial and functional limitations affecting their 

independence. 

In 2009, 6,614 older Nevada residents were newly 

diagnosed with cancer (see Table HS5). Rates of 

these cases varied by region, age and gender (Nevada 

State Health Division: Central Cancer Registry, 

2012). Regionally in 2009, a higher proportion of 

newly diagnosed cases of cancer occurred in males 

than in females. In addition, among all newly 

diagnosed cases of cancer in 2009, 58% were older 

males and 42% older females. 

Also in 2009, 2,985 older Nevadans died of cancer 

(see Table HS6). The distribution of cancer-related 

mortality follows the same regional/sex pattern as 

was found with newly diagnosed cancer cases. A 

higher proportion of the cancer-related deaths in 

2009 were male; 54.7% were older males and 45.3% 

were older females. 

Health Status 

55

Health Status 


Health is a biopsychosocial construct that includes 

the individual’s biological/physical state and 

emotional state, self-perception of health, and 

perception of self-efficacy or ability to control 

one’s life (Pulkkinen, Kokkonen, & Makiaho, 

1998). Individual perceptions are important as they 

have been found to predict outcomes for “stroke 

(Emmelin et al., 2003), disability (Månsson & 

Råstam, 2001; Wilcox, Kasl, & Idler, 1996), healthcare 

utilization (Roos, Roos, Mossey, & Havens, 

1988 as cited in Sargent-Cox, Anstey, & Luszcz, 

2010, p. 143) and mortality (Benyamini & Idler, 

1999). 

As part of the University of Nevada, Las Vegas 

Cannon Survey Center’s Portrait of Nevada’s Seniors, 

2010, adults 50-99 were asked to rate their health 

(see Figure HS3). Just under half (49%) of the 

participants rated their health as very good (29%) 

to excellent (20%); 29% rated their health as good, 

14% as fair and 8% as poor (Gallion & LaHaie, 

2010, p. 19). 

Fig. HS3: Cannon Survey Center: Self- 

Reported Health 

Per the 2011 BRFSS report 2 , 14% of Nevada adults 

65 and older rated their own health as excellent, 

24% as very good, 31.9% as good, 21.8% as fair, 

and 8.4% as poor (see Table HS7). Fewer Nevadans 

65 and older rated their health as good to excellent 

(69.9%) than older adults nationally (72.1%; 

CDC: BRFSS, 2011). Likewise, slightly more older 

Nevadans rated their health as fair to poor (30.2%) 

than older adults nationally (26.5%; see Figure 

HS4). 

14.0% 

11.3% 

Fig. HS4: U.S. and Nevada Adults, Age 65 

and Older - Self-Reported Health Status 

26.9% 

24.0% 

33.9% 

31.9% 

(CDC: BRFSS, 2011) 

21.8% 

18.5% 

Across all Nevada regions, the majority of 

participants rated their health as good to excellent 

with less than a third in any region rating their health 

as fair to poor (see Figure HS5). 

8.4% 

Excellent Very Good Good Fair Poor 

Nevada U.S. (Median %) 

8.0% 

Overall 

75 or 

Older 

65-74 

50-64 

0% 

20.0% 

17.0% 

20.0% 

20.0% 

20% 

29.0% 

25.0% 

28.0% 

30.0% 

40% 

29.0% 

32.0% 

30.0% 

27.0% 

60% 

14.0% 8.0% 

18.0% 8.0% 

18.0% 4.0% 

13.0% 10.0% 

80% 

100% 

69.1% 

Fig. HS5: Nevada Adults, Age 65 and Older: 

Self-Reported Health Status by Region 

73.9% 

68.2% 

31.0% 




26.2% 

31.9% 

Excellent Very Good Good Fair Poor 

(Gallion & LaHaie, 2010) 

More than three-fourths of the Canon Survey 

Center’s participants 50-74 rated their health as 

good to excellent. Of those 75 or older, 74% rated 

their health as good to excellent. Within this older 

group, nearly a third (32%) rated their health as 

good and 17% rated it as excellent. Those rating 

their health as poor included 10% of participants 

50-64, 4% of those 65-74, and 8% those 75 or older. 

Good to Excellent 


Fair to Poor 

56 

2 

Note: Comparisons between the Cannon Survey Center and the BRFSS data cannot be made due to age differences in the surveyed population.

The proportion of adults 75-84 who rated their 

health as good to excellent (72.3%) was higher than 

for those ages 65-74 (70.9%) or 85 and older (53.8%; 

see Figure HS6). The proportion who rated their 

health as fair to poor was higher among adults 85 

and older (46.2%) than among those 65-74 (29.1%) 

or 75-84 (27.8%; see Figure HS6). Ratings of health 

as fair increased from 21.8% in adults 65-74 to 39.2% 

in adults 85 and older. Ratings of health as poor 

remained consistent at approximately 7% for adults 

65-74, and 85 and older (see Table HS7). 


Self-Reported Health Status by Age 

70.9% 

72.3% 

53.8% 

29.1% 

27.8% 

46.2% 

65-74 Years 

75-84 Years 

85 and Older 

58.3% 

41.7% 

66.1% 

33.9% 

70.9% 

29.0% 


85.4% 

14.5% 

Less than H.S. H.S. or G.E.D. Some Post H.S. College Graduate 

51.9% 

48.1% 


Education by Self-Reported Health Status 


Income by Self-Reported Health Status 

61.9% 

38.2% 

72.4% 74.1% 

27.5% 26.0% 

80.1% 

19.9% 


Fair to Poor 

89.3% 

10.7% 

Health Status 

< $15,000 $15,000 to 

$24,999 

$25,000 to 

$34,999 

$35,000 to 

$49,999 

$50,000 to 

$74,999 

$75,000+ 


Fair to Poor 


Fair to Poor 



Among adults 65 and older, a higher percentage of 

males rated their health as good to excellent (71.5%) 

than did females (68.4%). Socioeconomic factors 

impact health. The percentage of older adults who 

rated their health as good to excellent increased with 

higher educational attainment (see Figure HS7) and 

income (see Figure HS8). 

Disability 

The Americans with Disabilities Act (ADA) defines 

disability as a physical or mental impairment that 

substantially limits one or more major life activities of 

such individual (U.S. Department of Justice, 2009, 

Section 12102). Due to the physical and cognitive 

changes commensurate with aging, older adults 

may be particularly vulnerable to developing a 

disability that interferes with self-care and their 

ability to live independently. From 2009-2011, 

36.8% of older adults in the United States had a 

disability (American Community Survey, 3-Year 

Estimates-B18101, 2012). The rate for adults 65 

or older in Nevada was lower: 33.9% (109,839 

individuals; American Community Survey, 3-Year 

Estimates-B18101, 2012). 

Fewer Nevada females 65-75 (13.7%) than males 

of the same age cohort (16.4%) had a disability. 

For adults 75 and older, more females (20.4%) than 

males (17.4%) reported a disability (see Figure 

HS9). 

57

Health Status 

Fig. HS9: Nevada Adults, Age 65 and Older with 

Disability: Sex by Age 

Male 

20.4% 

16.4% 17.4% 

13.7% 

33.8% 

34.0% 

65-74 75 and older Total 65+ 

(American Community Survey, 3-Year Estimates, 

2009-2011-B18101; 2012) 

Female 

Fig. HS12: Nevada Adults, Age 65 and Older with a 

Disability: Region, Sex, and Age 

32.5% 

24.3% 26.4% 

56.2% 

45.6% 47.6% 

23.4% 26.0% 

19.7% 


2009-2011-B18101; 2012) 

51.0% 

47.3% 47.6% 

65 to 74 years 75 years and Older 65 to 74 years 75 years and Older 

Male 

Female 




A slightly smaller share of Nevada males 65 and 

older (33.8%) had a disability than U.S. males 

(35.3%; see Figure HS10). Thirty-four percent of 

older Nevada females had a disability, compared 

with 37.9% of older U.S. females (see Figure HS11). 

Fig. HS10: Nevada Adults, Age 65 and Older 

with Disabilities: U.S. and Nevada Males 

Male Nevada 

Male U.S. 

Physical, mental or emotional disabilities can 

limit daily activity, self-care, and the ability to 

live independently. More than one-third (37.4%) 

of Nevada adults 65 and older reported their 

activities were limited because of physical, mental 

or emotional disability, and this percentage has 

increased since 2003 (See Figure HS13; CDC: 

BRFSS, 2009, 2011). 

16.4% 15.5% 

17.4% 

19.9% 

33.8% 

35.3% 


Limited in Activities due to Disability 

37.4% 

32.0% 

27.0% 



2009-2011-B18101; 2012) 

Fig. HS11: Nevada Adults, Age 65 and Older 

with Disabilities: U.S. and Nevada Females 

13.7% 

13.1% 

20.4% 

24.8% 

34.0% 


37.9% 


2009-2011-B18101; 2012) 

Female Nevada 

Female U.S. 

Of Nevadans 65 and older, males 75 and older 

living in the Rural/Frontier region were the most 

likely to report having a disability (56.2%, see Table 

HS8). Least likely to report a disability were females 

65-74 living in the Northern Urban/Metropolitan 

region of the state (19.7%; see Figure HS12). 

2003 2007 2011 

(Center for Disease Control (CDC): Behavioral Risk Factor Surveillance 

System (BRFSS), 2007 in Elders Count Nevada, 2009, p. 29; 

CDC: BRFSS, 2011) 

Fewer older males (35.3%) than females (39.3%) 

reported limitations in activities due to disability 

(see Table HS9; CDC: BRFSS, 2011). In addition, 

the proportion of those who described being limited 

because of physical, mental, or emotional problems 

increased within age cohort: 65-74 (34.9%), 75-84 

(39.2%), 85 and older (53.1%). 

Fig. HS14: Nevada Adults Age 65 and Older: 

Region by Limitations in Activities 

37.4% 

36.0% 

41.3% 

38.9% 


Southern 

Urban/Metro 

Northern 

Urban/Metro 



58

Activity limitations due to disability also differed by 

race and ethnicity. A lower percentage of Hispanics 

(23.2%) reported limitations than did Whites (39.5%) 

or those of an “Other Race” (44.1%; see Figure 

HS15). (Note: Data for Black participants was not 

included due to small sample size.) 


Race/Ethnicity by Activity Limitations 

39.5% 

44.1% 


23.2% 

White Other Race Hispanic 

Living with a disability may require special 

equipment such as a cane, wheelchair, special bed 

or telephone. According to the Elders Count Nevada 

(2009) report, the need for special equipment due 

to disability among Nevada’s adults 65 and older 

increased from 15% in 2001 to 18% in 2007. This 

trend continued in 2011, with 19.7% of Nevada’s 

older adults reporting the need for special equipment 

(see Table HS10; CDC: BRFSS, 2011). 

Among those who responded to the survey, only 

minimal differences were noted by age. A greater 

percentage of respondents 85 and older (27.6%) 

indicated that they required special equipment for a 

disability. Only 16% of those 65-74 required assistive 

devices (see Figure HS17). 

Health Status 

Reported activity limitations by age, education 

and income revealed only minimal differences 3 . 

The percentage of individuals reporting limitations 

increased somewhat from age 65-74 (34.9%) to 75- 

84 (39.2%), and to 85 and older (53.1%). Although 

limitations did not differ a great deal by education, a 

larger percentage of older adults with a high school 

diploma or GED (41.1%) reported limitations due to 

disability than did those with less than a high school 

education (33.2%), some college (39.4%), or a college 

degree (34.1%). A lower percentage of older adults 

with annual incomes between $25,000 and $34,999 

(28.0%) reported limitations due to disability than 

did older adults in other income ranges (see Figure 

HS16). 

41.3% 


Income by Limitations 

47.0% 

28.0% 

40.2% 39.3% 

30.3% 


Age by Requires Special Equipment 

16.0% 

25.5% 


27.6% 

65-74 Years 75-84 Years 85 and Older 

Few regional or race/ethnicity differences were noted. 

However, differences were noted by sex, education 

and income. The percentage of older males requiring 

special equipment (13.2%) was significant lower than 

the percentage of older females (25.3%; see Figure 

HS18). 


Sex by Requires Special Equipment 

25.3% 

13.2% 

< $15,000 $15,000 to 

$24,999 

$25,000 to 

$34,999 

$35,000 to 

$49,999 

$50,000 to 

$74,999 

$75,000 and 

Higher 

Male 

Female 



3 

Note: Confidence intervals (C.I.) that do not overlap conclusively support that the variables are significantly different. However, confidence intervals 

that do overlap only “suggest” no significant differences between the variables. In cases where C.I. overlapped, we used phrases such as “no 

differences” or “minimal differences.” 

59

Health Status 

In addition, the share of older adults with college 

degrees who required special equipment (10.3%) was 

lower than for older adults with only some posthigh-school 

education (23.1%) or for adults with 

only a high school diploma/GED (21.1%; see Fig. 

HS19). Due to the small sample size of older adults 

with the lowest level of education, comparisons were 

not made (see Table HS9). 


Education by Requires Special Equipment 

21.5% 21.1% 

23.1% 


10.3% 


Of the older adults who responded to the BRFSS and 

earned less than $15,000 per year, 31.2% indicated 

that they required special equipment. Of those 

earning $15,000 to $24,999, 35.8% indicated they 

required special equipment. Percentages for survey 

participants in these two categories were higher than 

for older adults with higher incomes (see Figure 

HS20). 

When asked, How many days in the 30 days prior 

to the survey did poor physical or mental health limit 

you from doing your usual activities such as self-care, 

work or recreation? (BRFSS, 2011), the majority of all 

respondents (80%) reported no restrictions (see Table 

HS11). The percentages did not differ significantly by 

region, age, sex, race/ethnicity, education or income. 

Of those who reported restrictions in activities, 

10.1% of 65- to 74-year-olds indicated that activities 

were restricted from 1-10 days. For 11-20 days the 

figure was 3.4%, and for 21-30 days the figure was 

6.9%. Of the adults 75-84, 7% reported limitations 

from 1-10 days; 4% for 11-20 days, and 10.1% for 

21-30 days in the month prior to the survey. Just 

over 1% of adults 85 and older who responded to 

the survey reported restrictions from 1-10 days. 

No adults reported restrictions lasting from 11-20 

days, and 10.3% reported restrictions from 21-30 

days. Over one-third of respondents earning less 

than $15,000 per year (31.4%) reported restrictions, 

compared with less than one-fifth (11.5%) of older 

adults earning $75,000 a year. 


Income by Requires Special Equipment 

31.2% 

35.8% 

9.7% 

14.3% 12.4% 

9.1% 

< $15,000 $15,000 to 

$24,999 

$25,000 to 

$34,999 

$35,000 to 

$49,999 

$50,000 to 

$74,999 

$75,000 and 

Higher 


60

Visual & Hearing Health 

Age-associated declines in vision and hearing can 

negatively influence health literacy and health 

management in older adults (Echt, 2009, p. 11, in 

Improving Health Literacy, 2009). Statistics from 

the National Institutes of Health: National Eye 

Institute (2012), based on the 2010 U.S. Census, 

show that 2.9% of the U.S. population 40 and older 

suffered from vision impairment. By comparison, 

fewer Nevada adults 40 and older (2.3%) suffered 

from vision impairment. However, Nevada (5.5%) 

was higher than the U.S. (5.4%) in prevalence of 

diabetic retinopathy (i.e., diabetes precipitated 

damage to the eye blood vessels). Females reported 

more vision problems than males, with the 

exception of diabetic retinopathy. For this disorder, 

prevalence among females was 48.4% versus 51.6% 

among males (NIH: National Eye Institute, 2012). 

For adults age 65 and older, the prevalence of vision 

impairment increases with age. Nevada seniors 

have lower prevalence than found nationally in all 

vision indicators (e.g., vision impairment, macular 

degeneration, blindness, cataracts, glaucoma, 

hyperopia, and myopia). As with the younger 

population above, the exception to this is the 

prevalence of diabetic retinopathy. U.S. prevalence 

rates for diabetic retinopathy in adults 65-74 (8.8%) 

and adults age 75 and older (8.1%) are slightly 

lower than in Nevada adults of the same age (9% 

and 8.6%, respectively; NIH: National Eye Institute, 

2012). 

The National Institutes of Health (NIH) noted, 

“hearing loss is one of the most common conditions 

affecting older adults.” One-third of all adults 60 

and older and 50% of those 85 and older suffer 

from at least some level of hearing loss [National 

Institute on Deafness and Other Communication 

Disorders (NIDCD), 2012, para. 1] 4 . The NIDCD 

also reported that 12.3% of males and almost 14% 

of females 65 and older have tinnitus, a hearing 

problem distinguished by the perception of sound 

occurring from within the ear, and that only 20% 

of those with hearing loss acquire assistive devices 

like hearing aids (NIDCD: Quick Statistics, 2012). 

An AARP article suggested that the primary barrier 

to acquiring hearing aids for older adults is cost 

(Cropp, 2011). Nevada Medicaid covers the cost of 

hearing aids and hearing tests for adults at or below 

133% of poverty (Hearing Loss of Association, 

2012). 

Health Status 

4 

State-level data on hearing loss in older adults was not available. 

61

Health Status 

Oral Health 

As indicated in the Elders Count Nevada (2009) 

report, oral health is an important element of 

overall health and well-being. Lack of proper dental 

care can lead to oral pain, dental decay or cavities, 

gingivitis, and loss of teeth, all of which can lead 

to poor nutrition and diabetes (The Effects of Oral 

Health on Overall Health, 2009). Poor dental health 

is correlated positively with respiratory and heart 

diseases when oral bacteria enter the bloodstream 

through mouth lesions (Mayo Clinic, 2012). In older 

adults, poor oral hygiene may result in problems 

such as dry mouth, reduced sense of taste, tissue 

inflammation from poor-fitting dentures, thrush, 

and oral cancer (Mayo Clinic, 2012). Barriers to 

treatment for older adults include the financial 

cost of dental care when on a fixed income, lack of 

dental care as a provision of health insurance (i.e., 

Medicare does not include dental care), difficulties 

accessing the dental office due to transportation 

issues, and language barriers in older adult 

immigrants (Mayo Clinic, 2012). 

Nevada Adults, Age 65 and Older: Education by Visited a Dentist, Dental Hygienist or Dental Clinic in Past Year 

Of Nevada adults 65 and older who completed the 

BRFSS in 2010, 62.1% reported that they had visited 

a dentist, dental hygienist or dental clinic in the past 

year (see Table HS12, CDC: BRFSS, 2010). A review 

of the responses across a variety of demographic 

variables revealed differences across region and 

education. For example, approximately half of the 

Rural/Frontier area respondents (50.1%) indicated 

that they had visited a dentist, dental hygienist or 

dental clinic in the past year. A larger percentage 

of older adult respondents in the Southern Urban/ 

Metropolitan area (62.3%) and in the Northern 

Urban/Metropolitan area (69.5%) had sought dental 

care in the past year (see Figure HS21). 


Region by Visited a Dentist, Dental Hygienist or 

Dental Clinic in Past Year 

Of older adults having less than a high school 

education, 37.7% reported visiting a dentist, dental 

hygienist or dental clinic in the year prior to the 

survey (see Figure HS22). This percentage was 

lower than that reported by older adults with higher 

education. It was especially low compared with 

respondents with a college education (76.5%). Lack 

of easy access to care or awareness of the need 

for dental care may have played a role in these 

outcomes. 


Education by Visited a Dentist, Dental 

Hygienist or Dental Clinic in Past Year 

37.7% 

56.7% 

63.0% 


76.5% 


Minimal differences were noted across age, sex, race 

and income. However, more than half of the older 

adult respondents with incomes less than $25,000 

indicated that they did not access dental care in 

the past year (

Fig. HS23: National - Prevalence of Edentulism Among 

Older Adults by Age, Race and Ethnicity, and Poverty 

Level 

Hispanic 

Non-Hispanic Black 

Non-Hispanic White 

Above 100% of federal 

poverty level 

Below 100% of federal 

poverty level 

10.7% 

13.1% 

15.2% 

28.0% 

21.6% 

24.6% 

20.7% 

20.9% 

23.5% 

34.3% 

35.5% 

Fig. HS24: Nevada, Adults Age 65 and Older: 

Education by Permanent Teeth Removed 

64.5% 

21.8% 

78.2% 

15.1% 

(BRFSS, 2010) 

84.9% 

7.4% 

92.6% 


Yes 

No 

Health Status 

Total 

15.0% 

21.9% 

65-74 Years 75 Years and Older 

(Dye et al, 2012 – CDC/NCHS, National Health and Nutrition 

Examination Survey, 2009-2010, p. 4) 

This same pattern was noted with income. As 

income increased, the reported cases of loss of all 

permanent teeth in older Nevadans decreased (see 

Figure HS25). 

In Nevada, approximately 17% of the older adults 

who responded to the BRFSS had all of their 

permanent teeth removed (see Table HS13). Just 

over 15% of respondents 65-74 reported removal 

of all permanent teeth. The figures were 20.8% for 

those 75-84 and 18.7% for people 85 and older. 

Fewer older males reported having had their teeth 

removed (14.7%) than older females (19.4%). 

33.4% 

Fig. HS25: Nevada, Adults Age 65 and Older: 

Income by Permanent Teeth Removed 

66.6% 

22.8% 

77.2% 

< $15,000 $15,000 to 

$24,999 

85.1% 85.6% 87.7% 

14.9% 14.4% 12.3% 

$25,000 to 

$34,999 

Yes 

$35,000 to 

$49,999 

No 

$50,000 to 

$74,999 

7.7% 

92.3% 

$75,000 and 

Higher 

Increases in education were associated with 

decreases in the percentage of respondents 

reporting edentulism (see Figure HS24). 


As of August 2012, there were 4,406 Dental Health 

Professional Shortage Areas (HPSAs) within the 

United States, leaving 43.8 million people without 

adequate access to dental care [U.S. Department of 

Health and Human Services (DHHS), 2012]. Within 

Nevada, 15 of the 17 counties are designated as 

Dental HPSAs. Only Douglas and Lyon counties 

are not dental-shortage areas (DHHS, Find 

Shortage Areas, 2012). 

63

Health Status 

Mental Health 

According to the Institute of Medicine (IOM) of 

the National Academies, “one in five older adults 

in America have one or more [mental health and 

substance use] conditions” (2012, p. 1). Yet between 

FY 2009 and FY 2012, many U.S. states cut funding 

for mental health services. The cuts ranged from 

10.4% to 39.3% of each state’s general fund (NAMI, 

2011). Nevada cut 28.1% of its general budget for 

mental health services. From FY 2011 to FY 2012, 

Nevada cut 8.8% ($12.2 million) of its mental health 

budget, the third-steepest percentage reduction 

among the states. (NAMI, 2011, p. Appendix IV). 

The state also lost an estimated $10 million in 

enhanced federal Medicaid match (p. Appendix VI). 

Among those who responded to the 2011 BRFSS 

Nevada survey item regarding the frequency of poor 

mental health days, a higher percentage of older 

adult females (29.4) than males (17.1%) reported 

at least one bad mental health day in the past 30 

days. Only minimal percentage differences were 

noted in the number of bad health days by region, 

age cohort, race/ethnicity or income (see Table 

HS15). However, fewer older adults with a college 

education (14.2%) reported bad mental health days 

than those with less education (see Figure HS26). 

Fig. HS26: Nevada Adults Age 65 and Older: At 

Least One Mental Health Day per Month 

64 

Between 2005 and 2007, 21% of Nevada adults 65 and 

older reported at least one day of poor mental health 

in the past 30 days (Sanford Center for Aging, Elders 

Count Nevada, 2009, p. 31). By 2011, the percentage 

of older adults with at least one bad mental health day 

in the previous 30 had increased to 23.7% (see Table 

HS14, CDC: BRFSS, 2011). In addition, 19.2% of the 

older Nevadans who responded to the survey item 

about frequency of depressive symptoms indicated 

that they had felt “down, depressed or hopeless” at 

least one day in the previous two weeks (see Table 

HS15, CDC: BRFSS, 2011). 

Mental health disorders are not a normal part of 

aging. When not treated, such disorders may have 

serious negative effects on the health and wellbeing 

of seniors (Sanford Center for Aging, Elders 

Count Nevada, 2009, p. 31). Symptoms such as 

depression, anxiety, a sense of hopelessness, and 

even suicidal ideations may accompany loss of 

loved ones and friends, social isolation, and agingrelated 

declines in physical and mental function. 

In addition, mental health issues may co-occur 

with age-related chronic health conditions such 

as heart disease, cancer and diabetes. Mental 

health issues may be mistakenly viewed as a 

“normal consequence of these problems” (National 

Institute on Mental Health, n.d. Para. 1). In spite 

of the devastating consequences of mental health 

disorders in older adults and the prevalence of 

depression and anxiety, these conditions are 

underdiagnosed, underreported, and, consequently, 

under-treated. 

29.2% 

23.2% 

26.7% 


Of those who responded to the survey item 

regarding the frequency of depressive symptoms 

in the past two weeks (see Table HS15), the largest 

percentage of older adults in all regions experienced 

symptoms for 1-5 days (see Figure HS27). 


14.2% 


13.6% 


Region by Number of Days with Depressive 

Symptoms 

18.9% 

10.4% 




4.3% 

2.4% 3.1% 2.7% 

1.4% 

1.2% 

1 to 5 Days 6 to 10 Days 11 to 14 Days 

Only minimal differences existed by sex, age, race/ 

ethnicity or income. However, the proportion of 

older adults experiencing depressive symptoms 

within the week prior to the survey decreased with 

increases in education (see Figure HS28).


Education by Depressive Symptoms at Least 

Once in Past Two Weeks 

27.3% 

19.1% 18.7% 


12.0% 


Fewer than 1 in 10 (7.6%) of Nevada respondents 

65 and older indicated that they had been 

prescribed medication or treatment for a mental 

health or emotional condition (see Table HS16, 

CDC: BRFSS, 2011). 

Only minimal differences were noted by sex, 

education or income. However, a much higher 

percentage of older adults in the 65-74 age 

group (10.8%) reported having been prescribed 

medication and/or treatment than adults in the 

75-84 age cohort (3.1%) or the 85 and older cohort 

(4.9%; see Figure HS29). 

Fig. HS29: Nevada Adults, Age 65 and Older: Age by 

Receiving MH Medication or Treatment 

10.8% 

3.1% 

4.9% 


Health Status 


Suicide 

Between 2008 and 2009, suicide was the only 

leading cause of death in the nation to increase 

(e.g., increase of 1.7%; Kochanek, Xu, Murphy, 

Minino, & Kung, 2011). From 2009 to 2010, suicide 

increased by an age-adjusted 0.8% and ranked 

as the 10th-most-common cause of death (CDC: 

Injury Center, 2012; Murphy, Xu, and Kochanek, 

2012). In 2009, almost 37,000 individuals committed 

suicide (McIntosh, 2012). This translated to one 

suicide death every 14.2 minutes, or just over 100 

deaths per day. In addition, of those who died by 

suicide, almost 6,000 were 65 or older. An older 

adult completed a suicide every 1.5 hours, or 16 

people per day (McIntosh, 2012, p. 1). McIntosh 

noted that although adults 65 and older made 

up only 12.9% of the population in 2009, they 

represented 15.9% of the suicides (2012, p. 1). 

National suicide numbers increased again in 

2010 to 38,364, or 12.4 per 100,000 (McIntosh & 

Drapeau, 2012). This translated to an average of 1 

suicide every 13.7 minutes, or 105.1 deaths per day. 

In 2010, 5,994 U.S. adults 65 or older committed 

suicide, a rate of 14.9 per 100,000, or 16.4 per day. 

Sociological researchers at the University of 

Cambridge noted a correlation between the recent 

economic recession and increases in the U.S. rate 

of suicide (Reeves, Stuckler, McKee, Gunnell, 

Chang, and Basu, 2012). From 1999 to 2007, prior 

to the recession, annual U.S. suicide mortality rates 

increased by an average rate of 0.12 per 100,000 

per year (Reeves et al., 2012, p. 1). After the onset 

of the recent recession (2008-2010), the mortality 

rate climbed to 0.51 per 100,000 per year, which 

translated to approximately 4,750 additional deaths 

by suicide (see Figure HS30). 

Fig. HS30. Time Trend Analysis of U.S. Suicide Rates 

from 1999 to 2020 

(Reeves, Stuckler, McKee, Gunnell, Chang, and Basu, 2012, p. 1) 

65

Health Status 

Researchers for the American Association of 

Suicidology (McIntosh & Drapeau, 2012) examined 

U.S. suicide rates in older adults by age cohort over 

time (see HS31). Results supported the importance 

of analysis by age cohorts 55-64, 65-74, and 85 and 

older. Suicide rates in adults 65-74 dropped between 

2003 and 2007 but increased from 2007 to 2010. 

Suicide rates decreased for adults 75-84 with only 

minor increases in 2005. Rates of suicide increased 

for the youngest baby boomers (age 55-64) from 12.3 

per 100,000 in 2000 to 17.5 per 100,000 in 2010. The 

trend of decreasing suicides among the oldest old (85 

and older) from 2000 to 2009 reversed in 2010. 

20 

19 

18 

17 

16 

15 

14 

13 

12 

11 

10 

Fig. HS31: U.S. Suicide Rates (Per 100,000 Population), 2000- 

2010 

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 

55-64 Years 65-74 Years 75-84 Years 85 and older 

(McIntosh & Drapeau, 2012) 

Since 2008, Nevada has ranked either fourth or 

fifth in the nation for the number of suicide deaths. 

Nevada’s rate has consistently remained above the 

national rate. The only states with a higher suicide 

rate in 2010 were Wyoming, Alaska and Montana. 

Fig. HS33: Nevada, 2010: 10 Leading Causes 

of Death in Adults 65-74* 

Malignant Neoplasms 

Heart Disease 

Chronic Low. Respiratory Disease 

Cerebrovascular 

Nephritis 

Influenza & Pneumonia 

Diabetes Mellitus 

Septicemia 

Unintentional Injury 

Suicide 

All Others 

8.1% 

4.4% 

2.5% 

2.2% 

2.1% 

2.0% 

1.9% 

1.5% 

16.9% 

24.2% 

*Note: Percentages are of the 3098 Total Deaths 

(CDC: WISQARS, 2010) 

34.3% 

Nevada adults 65-85 used two primary methods for 

suicide, firearms (71.6%) and suffocation (10.3%; 

CDC: WISQARS, 2010). This differed from U.S. 

suicide methods for the same age group. Nationally, 

the most common suicide methods were firearms 

(63.1%), poisoning (10%), suffocation (8.7%), cut/ 

pierce (1.3%), fall (1.2%) and drowning (1%). 

In 2011, suicide accounted for an estimated 0.7% 

of the 13,519 Nevada deaths (see Table HS17; 

CDC: BRFSS, 2011). The greatest number of 

Nevada suicides occurred in the Southern Urban/ 

Metropolitan area of the state and among adults 65- 

75 years of age (55%). Eighteen suicides occurred in 

the Northern Urban/Metropolitan region, with 72% 

of those (n = 13) in adults 65-74. Fifty-seven suicides 

occurred in the Southern Urban/Metropolitan region 

with 56% (n = 32) occurring among adults 65-74. 

Sixteen suicides occurred in the Rural/Frontier region 

with 56.3% (n = 9) in adults 75-84. 

Suicide ranked as the sixth-leading cause of death 

for all ages in Nevada in 2008 (Elders Count Nevada, 

2009) and the eighth-leading cause of death in 2009. 

It was the seventh-leading cause of death among 

adults 55-64 that year (CDC: WISQARS, 2010). 

Interestingly, suicide was not one of the 10 leading 

causes of death for Nevada adults 75 and older in 

2010 (CDC: WISQARS, 2010). 

Fig. HS32: Nevada, 2010: 10 Leading Causes 

of Death in Adults 55-64* 

Malignant Neoplasms 

Heart Disease 

Unintentional Injury 

Chronic Low. Respiratory Disease 

Suicide 

Cerebrovascular 

Liver Disease 

Nephritis 

Diabetes Mellitus 

Influenza & Pneumonia 

All Others 

4.8% 

4.3% 

3.8% 

3.3% 

3.0% 

2.5% 

2.1% 

2.0% 

18.7% 

29.6% 

26.0% 

66 

*Note: Percentages are of the 2012 Total Deaths 

(CDC: WISQARS, 2010)

Veterans 

Veterans make up approximately 7% of the U.S. 

population. One out of four seniors is either a 

veteran or a surviving spouse of a veteran (Health 

Policy Explained, n.d.). As of 2010, slightly fewer 

than 26 million veterans were 55 or older (American 

Community Survey, 5-Year Estimates-B21001, 

2006-2010). The oldest group of veterans served 

during World War II (U.S. Department of Veterans 

Affairs, 2012). 

The following veteran data was collected as part of 

the 2011 Behavioral Risk Factor Surveillance System 

survey (BRFSS) with analysis from the Office of 

Public Health Informatics and Epidemiology. 

Approximately 394 Nevada veterans 65 and older 

completed the survey. This represents an estimated 

0.5% of the total veteran population in this age 

range. Due to the small sample size, data was not 

included for any variable for which 50 or fewer 

individuals responded. In addition, caution should 

be taken when interpreting the data as it may 

not be representative of the entire older-Nevadaveteran 

population. 

Trauma 

Veterans 65 and older may have been exposed to 

numerous military-related sources of trauma. For 

example, of the 394 Nevada veterans who completed 

the BRFSS question about military service, 51% 

indicated they had served in a combat or war zone, 

including World War II, the Korean War, Vietnam 

and the Gulf-War (see Table HS18). Peacetime 

veterans, particularly women, also may have been 

exposed to the trauma of sexual assault or rape. Recent 

research suggests that the post-trauma symptoms 

[e.g., Post Traumatic Stress Disorder (PTSD)] may 

continue in these veterans as long as 65 years after 

the exposure (Rintamaki, Weaver, Elbaum, Klama, 

and Miskevics, 2009, p. 2,257). Another recent study 

of 17,250 veterans 65 and older in six Department of 

Veterans Affairs primary care clinics noted a decrease 

in self-reported health ratings and an increase in 

reported PTSD symptoms (Durai et al., 2011). Finally, 

in a national sample of veterans 65 and older, over 

50% rated their health as fair to poor (Villa, Harada, 

Washington, & Damron-Rodriguez, 2003). The study 

reported that ratings differed by race/ethnicity. Older 

Hispanic and Black veterans rated their health worse 

than older White veterans did. 

Traumatic brain injury (TBI) has been called a 

“signature injury” of younger veterans returning from 

the Iraq and Afghanistan wars (Sayer, Scholten, Scott, 

and Carmen, 2012, para. 2). TBIs are blast injuries 

received during combat or while in combat zones. 

These types of brain injuries can result in long-term 

symptoms, including depression, hearing and vision 

difficulties, pain, and other mental health problems. 

Of the Nevada veterans 65 and older who responded 

to the BRFSS item regarding TBI (see Table HS19), 

1.5% indicated that they had been diagnosed 

with TBI (CDC: BRFSS, 2011). Almost 35% of the 

total respondents resided in the Southern Urban/ 

Metropolitan and Northern Urban/Metropolitan area 

of the state, and 30.6% resided in the Rural/Frontier 

region. Regionally, a higher percentage (4.4%) of older 

veterans living in the Rural/Frontier region of the state 

had been diagnosed with TBI (see Figure HS34). This 

should be of concern when considering rural barriers 

to resources and access to treatment. 

1.5% 

Fig. HS34: Nevada Veterans, Age 65 and Older: 

Diagnosed with TBI 

0.3% 


In addition, more Nevada veterans ages 65-74 (2%) 

reported suffering from TBI than those ages 75-84 

(1.2%). Only minimal differences in TBI diagnosis 

were noted across education or income. 

Consequences of trauma may include PTSD, a mental 

health disorder associated with symptoms including 

persistent re-experiencing of the event, continued 

efforts to avoid stimuli associated with the event, and 

symptoms of increased arousal such as irritability, 

hypervigilance, insomnia, exaggerated-startle 

response and difficulty concentrating (Diagnostic 

and Statistical Manual, IV-TM, 1994, p. 428). Other 

consequences of trauma may include depression and 

anxiety. 

2.4% 

4.4% 

Statewide Southern Urban/Metro Northern Urban/Metro Rural/Frontier 

Health Status 

67

Health Status 

Of the Nevada veterans who responded to the BRFSS, 

almost 1 in 10 (9.3%) indicated that a doctor or 

other health professional had diagnosed them with 

depression, anxiety or PTSD (see Table HS20, BRFSS, 

2011). Veteran responses differed only minimally by 

region, age, education or income. Samples sizes were 

too small for veterans 85 and older, female veterans, 

minority respondents, and those with less than a 

high school education. Data for these participants 

were not included in the analysis. The majority of 

veterans responding to the survey were White (n = 

344), male (n = 378) and college graduates (n = 165). 

It is estimated that, of those living in the Southern 

Urban/Metropolitan region of the state, 10.1% had 

been diagnosed with depression, anxiety or PTSD. 

Similar percentages were noted for older veterans in 

the Northern Urban/Metropolitan (9%) region and 

the Rural/Frontier region (6.6%). The percentage 

of veterans ages 65-74 reporting a diagnosis of 

depression, anxiety or PTSD (12.5%) was higher than 

reported by veterans 75-84 (7.3%). 

Mental Health & Suicide 

In addition to issues such as TBI, PTSD, depression 

and anxiety, the most common mental health issues 

facing Nevada veterans include bipolar disorder, 

schizoaffective disorder, and dementia (Nevada 

Veterans Services Commission Quarterly, 2012). 

Untreated mental health problems and poor social 

support sometimes lead to suicide (Sundararaman, 

Panangala, & Lister, 2008). 

Sundararaman et al. (2008) estimated that veterans 

account for approximately 20% of all U.S. suicides. 

However, Bagalman (2012) writes, “no nationwide 

surveillance system exists for suicide among all 

veterans; therefore, the actual prevalence of suicide 

among veterans is not known” (para. 2). What is 

known is that, in 2011, the rate of suicide per 100,000 

among Nevada female veterans (26.7) was three 

times the rate among Nevada non-veteran females 

(8.4), and more than five times higher than the overall 

national rate for females (4.9; Ritch & Thompson, 

2012, p. 2) 5 . Similarly, the suicide rate for Nevada male 

veterans (48.3 per 100,000) is 61.5% higher than the 

rate in Nevada for non-veteran males (29.9%) and 

151% higher than the national rate of male suicide 

(19.2; Ritch & Thompson, 2012, p. 3). 

A preliminary 2011 report indicated that suicide 

accounted for the deaths of 43 Nevada veterans 65 

and older [see Table HS21, Office of Public Health 

Informatics: Electronic Death Registry (OPHIE), 

2011]. These deaths accounted for 0.9% of all veteran 

deaths during the same period. Of the suicides, 

51.1% occurred in the Southern Urban/Metropolitan 

area of the state, 25.6% in the Northern Urban/ 

Metropolitan area, and 23.3% in the Rural/Frontier. 

Finally, the highest number of deaths occurred 

among veterans ages 75-84 (44.2%) followed by 

veterans 65-74 (39.5%) and those 85 and older 

(16.3%). 

The recent CDC: BRFSS survey asked Nevada 

veterans if in the past 12 months they had thought 

of taking their own life (CDC: BRFSS, 2011). Of the 

veterans 65 and older who responded (n = 395), 

4.1% indicated that they had (see Table HS22). 

The majority of respondents were White (n = 343) 

and male (n = 378). Sample sizes were too small to 

measure participants 85 and older, females, or those 

with less than a high school education. Only minimal 

differences were found across education or income. 

Of the veterans who responded, more of those living 

in the Northern Urban/Metropolitan area of the state 

(5.7%) indicated that they had thought of suicide 

at least once in the past year than did those in the 

Southern Urban/Metropolitan area (4.4%) or the 

Rural/Frontier (1.3%; see Figure HS35). 

Fig. HS35: Nevada Veterans, Age 65+: 

Thought of Suicide in Past Year 

4.4% 

Southern Urban/Meto 

5.7% 

Northern 



1.3% 


68 

5 

Source of data for Ritch & Thompson (2012): Office of Vital Records, aggregate 2008-2010

Even though 9.3% of the older Nevada veterans who 

responded to the BRFSS reported previous diagnosis 

of depression, anxiety or PTSD, only 1.5% reported 

a diagnosis of TBI. Slightly more than 4% reported 

thinking of suicide at least once in the year prior 

to the survey. Only 2% of older veterans received 

psychological or psychiatric counseling or treatment 

in the 12 months prior to the survey (see Table 

HS23). By region, 4.1% of veterans in the Northern 

Urban/Metropolitan region, 1.3% in the Southern 

Urban/Metropolitan region, and 2.2% in the Rural/ 

Frontier region reported receiving counseling. 

Differences were minimal across age, education or 

income. 

Health Status 

69

Health Status 

Table HS1 

Nevada Counties, 2009: Life Expectancy by Gender 

Region (Averages) County Male Female 

Southern Urban/Metro 74.1 79.7 

Clark County 74.1 79.7 

Northern Urban/Metro 74.6 80.0 

Washoe County 75.2 80.3 

Carson City 74.0 79.6 

Rural/Frontier 74.5 80.0 

Douglas County 79.1 82.7 

Churchill County 75.1 80.1 

Elko County 75.0 79.7 

Lander County 74.9 80.3 

Eureka County 74.9 80.3 

White Pine County 74.9 80.3 

Pershing County 74.7 80.1 

Humboldt County 74.7 80.1 

Lyon County 74.5 79.9 

Storey County 74.5 79.9 

Lincoln County 74.1 79.7 

Esmeralda County 72.2 78.8 

Nye County 72.2 78.8 

Mineral County 72.2 78.8 

(NevadaLifeExpectancy.com, 2011) 

Table HS2 

United States: Leading Causes of Death by Age Group, 2010* 

Rank 45-64 Years of Age 65 Years and Older 

1 Cancer Heart Disease 

2 Heart Disease Cancer 

3 Accidents (Unintentional Injuries) Chronic Lower Respiratory Diseases 

4 Chronic Lower Respiratory Disease Cerebrovascular Diseases (Stroke) 

5 Chronic Liver Disease and Cirrhosis Alzheimer’s Disease 

6 Diabetes Mellitus Diabetes Mellitus 

7 Cerebrovascular Disease (Stroke) Influenza and Pneumonia 

8 Intentional Self-Harm (Suicide) Nephritis, Nephrotic Syndrome, Nephrosis 

9 Nephritis, Nephrotic Syndrome, Nephrosis Accidents (Unintentional Injuries) 

10 Septicemia Septicemia 

*Note: Data for 2010 is preliminary. (Murphy, Xu, & Kochanek, 2012) 

70

Nevada: Leading Causes of Death, 2009 

Table HS3 

Rank Cause of Death Number Percent 

1 Heart Disease 4,687 24.4% 

2 Cancer 4,461 23.2% 

3 Chronic Lower Respiratory Disease 1,244 6.5% 

4 Accidents (Unintentional Injury) 1,025 5.3% 

5 Cerebrovascular Diseases 859 4.5% 

6 Drug-Induced Causes 555 2.9% 

7 Influenza and Pneumonia 542 2.8% 

8 Intentional Self-Harm (Suicide) 505 2.6% 

9 Nephritis, Nephrotic Syndrome, and Nephrosis 446 2.3% 

10 Injury by Firearms 406 2.1% 

11 Diabetes Mellitus 377 2.0% 

12 Chronic Liver Disease and Cirrhosis 325 1.7% 

13 Alcohol-Induced Causes 319 1.7% 

14 Alzheimer’s Disease 312 1.6% 

15 Motor Vehicle Accidents 254 1.3% 

16 Assault (Homicide) 153 0.8% 

17 Essential Hypertension and Hypertensive Renal Disease 132 0.7% 

18 Parkinson’s Disease 115 0.6% 

19 HIV 63 0.3% 

Total Deaths in 2009 19,224 100.0% 

Health Status 

(Kochanek, Xu, Murphy, Minino, & Kung, 2011) 

Table HS4 

Nevada Behavioral Risk Factor Surveillance System: Survey Responses Regarding Heart Disease 

Has Been Told They Had a Heart Has Been Told They Had Angina 

Attack (Myocardial Infarction) 

or Coronary Heart Disease 

Year: % CI n % CI n 

2005 4.7% (3.7-5.7) 183 4.1% (3.2-5.0) 172 

2006 5.0% (4.1-5.9) 225 5.1% (4.2-6.0) 231 

2007 4.2% (3.2-5.2) 203 4.4% (3.6-5.2) 213 

2008 4.5% (3.7-5.3) 288 4.3% (3.5-5.1) 272 

2009 4.9% (4.1-5.8) 272 3.9% (3.1-4.6) 227 

2010 5.0% (4.0-5.9) 281 4.0% (3.2-4.7) 230 

% = Weighted Percentage, CI = Confidence Interval, n = Cell Size (Numerator), Use caution in interpreting cell sizes less than 50. 


71

Health Status 

Table HS5 

Nevada Residents, Age 65 and Older, 2009: Newly Diagnosed Cancer Cases by Region, Gender, and Age** 

65-74 Years % 75-84 Years % 85+ Years % Total >65 yrs % 

Northern Urban/Metropolitan 

Female 274 44.1% 186 44.5% 73 57.0% 533 45.7% 

Male 347 55.9% 232 55.5% 55 43.0% 634 54.3% 

Total 621 418 128 1167 

Southern Urban/Metropolitan 

Female 986 39.4% 696 42.6% 222 49.0% 1904 41.5% 

Male 1,514 60.6% 939 57.4% 231 51.0% 2,684 58.5% 

Total 2,500 1,635 453 4,588 


Female 174 37.3% 120 39.3% 44 50.0% 338 39.3% 

Male 292 62.7% 185 60.7% 44 50.0% 521 60.7% 

Total 466 13.0% 305 12.9% 88 13.2% 859 13.0% 

Nevada Total 

Female 1,434 40.0% 1,002 42.5% 339 50.7% 2,775 42.0% 

Male 2,153 60.0% 1,356 57.5% 330 49.3% 3,839 58.0% 

Total 3,587 2,358 669 6,614 

** Note: Data are from the Nevada Central Cancer Registry. Invasive cases only. 

(Nevada State Health Division: Central Cancer Registry, 2012) 

72

Table HS6 

Nevada Residents, Age 65 and Older, 2009: Cancer-Related Deaths by Region, Gender, and Age** 

65-74 % 75-84 % 85+ % Total >65 yrs % 

Northern Urban/Metropolitan Area 

Female 97 44.7% 106 46.1% 65 53.7% 268 47.2% 

Male 120 55.3% 124 53.9% 56 46.3% 300 52.8% 

Total 217 230 121 568 

Southern Urban/Metropolitan Area 

Female 391 45.0% 359 45.8% 156 46.7% 906 45.6% 

Male 477 55.0% 424 54.2% 178 53.3% 1,079 54.4% 

Total 868 783 334 1,985 


Female 66 39.8% 78 41.9% 35 43.8% 179 41.4% 

Male 100 60.2% 108 58.1% 45 56.3% 253 58.6% 

Total 166 186 80 432 

Nevada Total 

Female 554 44.3% 543 45.3% 256 47.9% 1,353 45.3% 

Male 697 55.7% 656 54.7% 279 52.1% 1,632 54.7% 

Total 1,251 1,199 535 2,985 

Health Status 

**Note: Nevada Vital Statistics Records - Mortality 

(Nevada State Health Division: Nevada Vital Statistics Records, 2012) 

73

Table HS7 

Health Status 

Nevada Adults Age 65+: Self-Reported Health Status 

Demo- Grouping N* Excellent Very Good Good Fair Poor 

graphic % C.I. % C.I. % C.I. % C.I. % C.I. 

Region Statewide 1,662 14.0% (10.9- 24.0% (20.7- 31.9% (28.1- 21.8% (17.9- 8.4% (6.1- 

17.0) 27.4) 35.7) 25.6) 10.6) 

Southern Urban/Metro 592 14.2% (9.8- 23.5% (18.7- 31.4% (26.0- 22.4% (17.0- 8.6% (5.4- 

18.5) 28.3) 36.7) 27.8) 11.8) 

Northern Urban/Metro 605 13.5% (10.2- 26.4% (21.9- 34.0% (28.5- 18.6% (13.5- 7.6% (4.8- 

16.8) 30.9) 39.4) 23.7) 10.4) 

Rural/Frontier 465 13.7% (9.6- 23.1% (17.9- 31.4% (24.9- 23.5% (15.6- 8.4% (5.1- 

17.8) 28.3) 37.9) 31.3) 11.6) 

Age 65-74 1,024 12.8% (9.8- 24.6% (20.2- 33.5% (28.3- 21.8% (16.7- 7.3% (4.5- 

15.8) 28.9) 38.7) 27.0) 10.1) 

75-84 451 17.6% (9.7- 24.9% (18.0- 29.8% (23.3- 16.5% (11.4- 11.3% (6.4- 

25.4) 31.7) 36.3) 21.6) 16.2) 

85 and Older 129 10.4% (3.2- 15.9% (7.7- 27.5% (16.4- 39.2% (21.8- 7.0% (1.0- 

17.6) 24.1) 38.6) 56.6) 13.0) 

Sex Male 665 11.8% (8.4- 25.3% (20.0- 34.4% (28.5- 20.9% (15.9- 7.7% (4.3- 

15.2) 30.5) 40.4) 25.8) 11.0) 

Female 997 15.9% (11.1- 22.9% (18.6- 29.6% (24.8- 22.6% (16.8- 9.0% (6.0- 

20.7) 27.2) 34.4) 28.4) 12.0) 

Race White 1,436 16.2% (12.5- 25.4% (21.7- 31.2% (27.1- 18.5% (14.9- 8.8% (6.3- 

19.8) 29.1) 35.3) 22.2) 11.3) 

Black 47 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 

Other Race 94 5.0% (0.3- 13.4% (4.2- 35.9% (20.4- 40.0% (21.8- 5.7% (0.0- 

9.7) 22.5) 51.5) 58.2) 12.7) 

Hispanic 58 8.2% (0.0- 22.9% (6.4- 39.1% (20.5- 24.4% (4.7- 5.4% (0.0- 

17.5) 39.4) 57.7) 44.0) 13.6) 

Education Less than H.S. 120 3.6% (0.0- 14.9% (7.6- 39.8% (27.0- 34.5% (21.6- 7.2% (2.1- 

10.5) 22.1) 52.7) 47.5) 12.4) 

H.S. or G.E.D. 509 11.2% (7.5- 23.4% (17.0- 31.5% (25.0- 24.0% (17.2- 9.9% (6.0- 

14.9) 29.8) 37.9) 30.8) 13.8) 

Some Post H.S. 523 19.2% (12.0- 22.2% (17.0- 29.5% (23.6- 18.4% (12.8- 10.6% (5.5- 

26.4) 27.4) 35.5) 24.1) 15.7) 

College Graduate 506 21.3% (16.2- 34.1% (27.7- 30.0% (24.1- 11.3% (7.0- 3.2% (1.1- 

26.5) 40.5) 35.9) 15.7) 5.4) 

Income < $15,000 164 6.4% (2.4- 15.7% (8.3- 29.8% (18.8- 35.2% (22.9- 12.9% (6.2- 

10.4) 23.3) 40.9) 47.5 19.5) 

$15,000 to $24,999 303 15.1% (6.9- 12.8% (8.3- 34.0% (24.8- 24.8% (14.8- 13.4% (6.6- 

23.2) 17.2) 43.2) 34.7) 20.1) 

$25,000 to $34,999 208 3.7% (1.4- 24.8% (14.4- 43.9% (31.5- 22.2% (9.6- 5.3% (1.8- 

6.0) 35.3) 56.3) 34.8) 8.9) 

$35,000 to $49,999 234 17.3% (9.7- 29.5% (20.4- 27.3% (16.2- 19.7% (9.5- 6.3% (2.0- 

24.8) 38.5) 38.4) 29.9) 10.7) 

$50,000 to $74,999 227 15.7% (9.8- 29.1% (20.9- 35.3% (25.8- 16.0% (7.7- 3.9% (0.2- 

21.6) 37.3) 44.8) 24.3) 7.6) 

$75,000+ 209 29.7% (20.2- 27.5% (18.5- 32.1% (21.7- 9.1% (3.9- 1.6% (0.2 

39.1) 36.6) 42.5) 14.4) 3.0) 

74 

*Sample sizes less than 50 are marked with ‘~’. Due to the small samples sizes, responses may not reliably represent the population; therefore, 

are not included. 

(CDC: BRFSS, 2011)

Table HS8 

Nevada Adults, Age 65 and Older: Disability Frequency by Region and Sex 

Nevada Southern Northern Rural, 

Urban/Metro Urban/Metro Frontier 

Total: 2,667,849 1,929,325 472,192 266,332 

Male: 

65 to 74 Years Total 97,265 65,440 17,469 14,356 

Percent with Disability 25.9% 24.3% 26.4% 32.5% 

75 Years & Older Total 56,065 37,655 10,271 8,139 


Female Total: 

65 to 74 years Total 100,869 69,875 17,901 13,093 


75 years & Older Total 69,736 47,223 13,960 8,553 


Health Status 

(American Community Survey, 3-Year Estimates-B18101, 2012) 

75

Health Status 

Table HS9 

Nevada Adults, Age 65 and Older: Reported Limitations in Any Activities 

Demographic Grouping N* Yes No 

% C.I. % C.I. 

Region Statewide 1,519 37.4% (33.1-41.7) 62.6% (58.3-66.9) 

Southern Urban/Metro 531 36.0% (29.9-42.0) 64.0% (58.0-70.1) 

Northern Urban/Metro 560 41.3% (35.4-47.1) 58.7% (52.9-64.6) 

Rural/Frontier 428 38.9% (31.5-46.3) 61.1% (53.7-68.5) 

Age 65-74 947 34.9% (29.4-40.4) 65.1% (59.6-70.6) 

47-84 413 39.2% (31.7-46.8) 60.8% (53.2-68.3) 

85 and Older 106 53.1% (36.0-70.3) 46.9% (29.7-64.0) 

Sex Male 610 35.3% (29.2-41.4) 64.7% (58.6-70.8) 

Female 909 39.3% (33.2-45.4) 60.7% (54.6-66.8) 

Race White 1,313 39.5% (34.9-44.0) 60.5% (56.0-65.1) 

Black 42 ~ ~ ~ ~ 

Other Race 85 44.1% (25.6-62.7) 55.9% (37.3-74.4) 

Hispanic 52 23.2% (8.0-38.5) 76.8% (61.5-92.0) 

Education Less than H.S. 109 33.2% (20.1-46.4) 66.8% (53.6-79.9) 

H.S. or G.E.D. 461 41.1% (33.6-48.5) 58.9% (51.5-66.4) 

Some Post H.S. 479 39.4% (32.0-46.7) 60.6% (53.3-68.0) 

College Graduate 466 34.1% (27.6-40.6) 65.9% (59.4-72.4) 

Income < $15,000 153 41.3% (29.4-53.2) 58.7% (46.8-70.6) 

$15,000 to $24,999 284 47.0% (36.3-57.6) 53.0% (42.4-63.7) 

$25,000 to $34,999 193 28.0% (17.5-38.6) 72.0% (61.4-82.5) 

$35,000 to $49,999 211 40.2% (27.3-53.0) 59.8% (47.0-72.7) 

$50,000 to $74,999 204 39.3% (28.8-49.8) 60.7% (50.2-71.2) 

$75,000+ 200 30.3% (20.0-40.7) 69.7% (59.3-80.0) 

*Sample sizes less than 50 are marked with ‘~’. Due to the small samples sizes, responses may not reliably represent the population; 

therefore, are not included. 


76

Table HS10 

Nevada Adults, Age 65 and Older Requiring Special Equipment 


% C.I. % C.I. 


Southern Urban Metro 539 19.3% (14.3-24.4) 80.7% (75.6-85.7) 

Northern Urban Metro 561 17.7% (13.5-21.9) 82.3% (78.1-86.5) 


Age 65-74 953 16.0% (11.6-20.4) 84.0% (79.6-88.4) 

75-84 417 25.5% (19.0-32.0) 74.5% (68.0-81.0) 

85 and Older 110 27.6% (9.7-45.4) 72.4% (54.6-90.3) 

Sex Male 612 13.2% (9.1-17.3) 86.8% (82.7-90.9) 

Female 920 25.3% (19.8-30.8) 74.7% (69.2-80.2) 

Race White 1,324 19.9% (16.1-23.6) 80.1% (76.4-83.9) 

Black 42 ~ ~ ~ ~ 

Other Race 85 24.6% (6.5-42.8) 75.4% (57.2-93.5) 

Hispanic 54 9.1% (0.3-17.9) 90.9% (82.1-99.7) 


H.S. or G.E.D. 463 21.1% (14.9-27.2) 78.9% (72.8-85.1) 

Some Post H.S. 484 23.1% (16.6-29.7) 76.9% (70.3-83.4) 



$15,000 to $24,999 286 35.8% (25.0-46.7) 64.2% (53.3-75.0) 

$25,000 to $34,999 193 9.7% (4.8-14.6) 90.3% (85.4-95.2) 

$35,000 to $49,999 215 14.3% (7.2-21.3) 85.7% (78.7-92.8) 

$50,000 to $74,999 205 12.4% (4.6-20.3) 87.6% (79.7-95.4) 

$75,000+ 202 9.1% (2.4-15.8) 90.9% (84.2-97.6) 

Health Status 




77

Health Status 

78 

Table HS11 

How Many Days in the Past Month Did Poor Physical or Mental Health, Keep You From Doing Your Usual Activities? 

Demographic Grouping N* 1 to 10 Days 11 to 20 Days 21 to 30 Days None 

% C.I. % C.I. % C.I. % C.I. 

Region Statewide 1,642 8.4% (6.3-10.5) 3.3% (2.0-4.7) 8.2% (5.6-10.8) 80.0% (76.7-83.4) 

Southern Urban/Metro 585 8.5% (5.6-11.4) 3.0% (1.3-4.7) 8.6% (4.9-12.3) 79.9% (75.2-84.6) 

Northern Urban/Metro 594 8.2% (4.7-11.7) 5.3% (2.2-8.5) 8.7% (5.3-12.2) 77.7% (72.5-82.9) 

Rural/Frontier 463 8.2% (4.6-11.8) 2.3% (0.2-4.3) 5.9% (3.3-8.5) 83.6% (78.9-88.3) 

Age 65-74 1,015 10.1% (7.1-13.2) 3.4% (1.7-5.1) 6.9% (3.8-10.0) 79.6% (75.2-83.9) 

75-84 504 7.0% (3.7-10.2) 4.0% (1.3-6.7) 10.1% (5.5-14.7) 78.9% (73.1-84.7) 

85 and Older 123 1.5% (0.0-3.8) 0.0% .-. 10.3% (0.0-23.0) 88.1% (75.3-100) 

Sex Male 654 7.1% (4.0-10.3) 2.0% (0.7-3.3) 7.8% (3.8-11.8) 83.1% (78.1-88.0) 

Female 988 9.5% (6.7-12.4) 4.5% (2.2-6.7) 8.6% (5.3-11.9) 77.4% (72.8-82.0) 

Race White 1,421 8.5% (6.3-10.7) 3.5% (1.9-5.0) 8.2% (5.3-11.0) 79.9% (76.3-83.5) 

Black 46 ~ ~ ~ ~ ~ ~ ~ ~ 

Other Race 91 5.6% (0.0-11.6) 1.0% (0.0-2.5) 19.4% (2.6-36.3) 74.0% (57.0-90.9) 

Hispanic 58 7.1% (0.0-16.3) 5.8% (0.0-12.1) 3.5% (0.0-10.6) 83.5% (70.5-96.6) 

Education Less than H.S. 119 5.8% (0.7-10.9) 2.4% (0.0-5.1) 5.3% (1.2-9.3) 86.5% (79.5-93.5) 

H.S. or G.E.D. 504 12.4% (7.5-17.3) 3.5% (1.5-5.5) 9.6% (4.5-14.7) 74.5% (67.8-81.1) 

Some Post H.S. 515 6.2% (3.8-8.6) 5.1% (1.7-8.6) 11.4% (5.7-17.1) 77.3% (70.8-83.8) 

College Graduate 500 8.1% (4.6-11.7) 1.3% (0.4-2.2) 3.9% (1.1-6.8) 86.6% (82.1-91.1) 

Income < $15,000 157 8.7% (2.7-14.7) 9.8% (4.0-15.6) 12.9% (3.0-22.8) 68.6% (57.2-80.0) 

$15,000 to $24,999 303 9.3% (3.4-15.1) 1.6% (0.4-2.8) 13.3% (6.7-20.0) 75.8% (67.5-84.2) 

$25,000 to $34,999 211 8.9% (3.6-14.2) 5.0% (0.0-10.3) 2.7% (0.6-4.8) 83.4% (75.5-91.3) 

$35,000 to $49,999 229 5.1% (0.0-10.7) 0.3% (0.0-0.6) 8.9% (0.0-18.2) 85.7% (75.4-96.0) 

$50,000 to $74,999 224 11.1% (4.9-17.3) 3.7% (0.0-9.3) 3.7% (0.0-8.0) 81.5% (72.9-90.1) 

$75,000+ 209 8.5% (0.7-16.3) 1.5% (0.0-3.1) 1.5% (0.2-2.9) 88.5% (80.6-96.3) 

*Sample sizes less than 50 are marked with ‘~’. Due to the small samples sizes, responses may not reliably represent the population; therefore, are not included. 

(CDC: BRFSS, 2011)

Table HS12 

Nevada Adults, Age 65 and Older: Visited a Dentist, Dental Hygienist or Dental Clinic within the Past Year 


% C.I. % C.I. 





Age 65-74 767 62.7% (57.8-67.6) 37.3% (32.4-42.2) 

75-84 362 60.3% (53.4-67.3) 39.7% (32.7-46.6) 

85 and Older 100 65.3% (53.4-77.1) 34.7% (22.9-46.6) 

Sex Male 536 63.2% (57.8-68.6) 36.8% (31.4-42.2) 

Female 736 61.1% (55.8-66.4) 38.9% (33.6-44.2) 

Race White 1,090 63.5% (59.4-67.6) 36.5% (32.4-40.6) 

Black 32 ~ ~ ~ ~ 

Other Race 81 46.1% (32.6-59.5) 53.9% (40.5-67.4) 

Hispanic 45 ~ ~ ~ ~ 


H.S. or G.E.D. 428 56.7% (50.2-63.3) 43.3% (36.7-49.8) 

Some Post H.S. 404 63.0% (56.0-70.0) 37.0% (30.0-44.0) 



$15,000 to $24,999 246 47.6% (38.3-56.8) 52.4% (43.2-61.7) 

$25,000 to $34,999 152 59.0% (47.8-70.2) 41.0% (29.8-52.2) 

$35,000 to $49,999 206 68.6% (59.7-77.4) 31.4% (22.6-40.3) 

$50,000 to $74,999 136 67.8% (56.0-79.5) 32.2% (20.5-44.0) 

$75,000+ 147 82.7% (73.9-91.6) 17.3% (8.4-26.1) 

Health Status 




79

Health Status 

Table HS13 

Nevada Adults, Age 65 and Older: Had all Permanent Teeth Removed 


% C.I. % C.I. 





Age 65-74 753 15.4% (11.7-19.0) 84.6% (81.0-88.3) 

75-84 346 20.8% (15.3-26.3) 79.2% (73.7-84.7) 

85 and Older 91 18.7% (8.3-29.0) 81.3% (71.0-91.7) 

Sex Male 524 14.7% (11.0-18.5) 85.3% (81.5-89.0) 

Female 710 19.4% (15.2-23.6) 80.6% (76.4-84.8) 

Race White 1,063 16.8% (13.7-19.8) 83.2% (80.2-86.3) 

Black 31 ~ ~ ~ ~ 

Other Race 72 19.3% (4.9-33.7) 80.7% (66.3-95.1) 

Hispanic 45 17.0% (3.3-30.7) 83.0% (69.3-96.7) 


H.S. or G.E.D. 415 21.8% (16.2-27.4) 78.2% (72.6-83.8) 

Some Post H.S. 392 15.1% (10.6-19.6) 84.9% (80.4-89.4) 



$15,000 to $24,999 241 22.8% (15.1-30.5) 77.2% (69.5-84.9) 

$25,000 to $34,999 148 14.9% (7.2-22.5) 85.1% (77.5-92.8) 

$35,000 to $49,999 201 14.4% (8.3-20.5) 85.6% (79.5-91.7) 

$50,000 to $74,999 130 12.3% (4.0-20.6) 87.7% (79.4-96.0) 

$75,000+ 145 7.7% (1.5-13.9) 92.3% (86.1-98.5) 



(BRFSS, 2010) 

80

Table HS14 

Nevada Adults Age 65 and Older: Number of Poor Mental Health Days in 30 Days 


% C.I. % C.I. % C.I. % C.I. 





Age 65-74 1,008 16.4% (11.3-21.5) 2.5% (1.3-3.6) 6.2% (3.1-9.3) 74.9% (69.4-80.5) 

75-84 444 9.7% (5.4-14.0) 3.9% (0.8-7.0) 7.5% (3.8-11.2) 78.9% (73.0-84.9) 

85 and Older 125 14.4% (1.9-26.8) 8.3% (0.0-18.8) 0.6% (0.0-1.7) 76.8% (61.8-91.9) 

Sex Male 652 7.6% (4.4-10.8) 3.5% (1.0-6.0) 6.0% (2.3-9.7) 82.9% (77.8-88.0) 

Female 980 20.1% (14.4-25.8) 3.2% (1.6-4.8) 6.2% (3.7-8.6) 70.6% (64.7-76.4) 

Race White 1,414 10.6% (8.1-13.0) 3.2% (1.8-4.7) 7.3% (4.6-10.0) 78.9% (75.2-82.5) 

Black 47 ~ ~ ~ ~ ~ ~ ~ ~ 

Other Race 89 18.9% (1.7-36.1) 1.9% (0.0-4.4) 1.3% (0.0-2.8) 77.9% (60.7-95.2) 

Hispanic 57 33.6% (10.9-56.3) 4.6% (0.0-12.2) 0.3% (0.0-0.7) 61.4% (38.9-84.0) 


H.S. or G.E.D. 504 13.4% (8.8-18.1) 2.6% (0.8-4.5) 7.1% (2.0-12.2) 76.8% (70.3-83.3) 

Some Post H.S. 517 15.9% (10.2-21.7) 4.3% (1.3-7.2) 6.5% (3.1-9.8) 73.3% (66.8-79.9) 


Income < $15,000 161 22.3% (10.2-34.4) 5.7% (1.0-10.4) 6.8% (2.0-11.5) 65.2% (53.0-77.4) 

$15,000 to $24,999 298 13.8% (7.7-19.9) 5.3% (0.1-10.4) 7.7% (2.7-12.7) 73.2% (64.9-81.4) 

$25,000 to $34,999 208 18.8% (4.6-33.1) 2.7% (0.7-4.7) 1.2% (0.0-2.4) 77.3% (63.1-91.4) 

$35,000 to $49,999 230 10.3% (1.4-19.2) 1.8% (0.0-4.0) 5.7% (1.5-10.0) 82.2% (72.7-91.7) 

$50,000 to $74,999 223 14.4% (6.7-22.2) 2.1% (0.0-4.5) 1.0% (0.0-2.0) 82.5% (74.5-90.5) 

$75,000+ 205 6.4% (2.4-10.5) 1.2% (0.0-2.4) 2.5% (0.4-4.7) 89.8% (85.0-94.6) 



Health Status 

81

Health Status 

82 

Table HS15 

Nevada Adults Age 65 and Older: Number of Days in Past Two Weeks that Felt Down, Depressed, or Hopeless 


% C.I. % C.I. % C.I. % C.I. 

Region Statewide 1,386 13.9% (10.38-17.44) 3.5% (1.79- 5.24) 1.8% (0.93- 2.62) 80.8% (76.95-84.65) 

Southern Urban/Metro 470 13.6% ( 8.58-18.55) 4.3% (1.79- 6.90) 1.2% (0.19- 2.22) 80.9% (75.43-86.35) 

Northern Urban/Metro 430 18.9% (12.87-24.94) 2.4% (0.60- 4.15) 3.1% (0.70- 5.51) 75.6% (69.37-81.85) 

Rural/Frontier 486 10.4% (6.23-14.54) 1.4% (0.45- 2.32) 2.7% (0.86- 4.60) 85.5% (80.97-90.04) 

Age 65-74 852 14.1% (9.88-18.31) 4.5% (1.89- 7.02) 1.4% (0.67- 2.17) 80.0% (75.25-84.82) 

75-84 434 9.5% (5.10-13.85) 2.6% (0.11- 5.17) 2.8% (0.61- 4.95) 85.1% (79.86-90.35) 

85 and Older 100 31.4% (10.68-52.05) 0.2% (0.00- 0.49) 0.2% (0.00- 0.57) 68.3% (47.65-88.92) 

Sex Male 548 10.8% (6.17-15.46) 2.1% (0.15- 4.03) 1.9% (0.37- 3.43) 85.2% (80.11-90.27) 

Female 838 16.7% (11.41-21.89) 4.8% (2.02- 7.53) 1.7% (0.81- 2.52) 76.9% (71.21-82.60) 

Race White 1,214 14.5% (10.5-18.5) 2.8% (1.3-4.3) 2.2% (1.1-3.2) 80.5% (76.3-84.7) 

Black 34 ~ ~ ~ ~ ~ ~ ~ ~ 

Other Race 75 12.4% (2.1-22.7) 0.8% (0.0-2.0) 0.7% (0.0-1.8) 86.1% (75.5-96.7) 

Hispanic 41 ~ ~ ~ ~ ~ ~ ~ ~ 

Education Less than H.S. 95 22.4% (8.87-35.92) 3.9% (0.00- 9.07) 1.0% (0.00- 2.57) 72.7% (58.63-86.78) 

H.S. or G.E.D. 418 13.9% (8.06-19.81) 3.8% (0.55- 6.98) 1.4% (0.00- 2.74) 81.0% (74.43-87.47) 

Some Post H.S. 445 11.6% (6.57-16.62) 4.5% (1.30- 7.63) 2.6% (0.71- 4.56) 81.3% (75.39-87.21) 

College Graduate 427 9.1% (5.80-12.38) 1.1% (0.07- 2.11) 1.9% (0.20- 3.50) 88.0% (84.20-91.73) 

Income < $15,000 139 16.7% (7.41-26.08) 10.1% (1.06-19.11) 2.9% (0.00- 6.79) 70.3% (58.07-82.48) 

$15,000 to $24,999 261 14.9% (5.21-24.48) 5.0% (0.00-10.10) 3.3% (1.26- 5.34) 76.8% (66.57-87.06) 

$25,000 to $34,999 172 11.8% (5.02-18.51) 1.7% (0.06- 3.31) 0.5% (0.00- 1.11) 86.1% (79.02-93.14) 

$35,000 to $49,999 195 17.7% (4.98-30.32) 1.0% (0.00- 2.51) 0.5% (0.00- 1.39) 80.9% (68.25-93.48) 

$50,000 to $74,999 190 9.6% (2.60-16.57) 2.1% (0.00- 4.75) 0.2% (0.00- 0.49) 88.1% (80.79-95.48) 

$75,000+ 184 11.5% (2.56-20.51) 1.2% (0.00- 3.11) 1.4% (0.00- 4.16) 85.8% (76.41-95.24) 


(CDC: BRFSS, 2011)

Table HS16 

Nevada Adults Age 65 and Older: Currently Receiving Medication or Treatment for Mental Health or 

Emotional Problem 


% C.I. % C.I. 





Age 65-74 854 10.8% (6.8-14.7) 89.2% (85.3-93.2) 

75-84 391 3.1% (1.2-5.0) 96.9% (95.0-98.8) 

85 and Older 100 4.9% (0.0-10.0) 95.1% (90.0-100.0) 

Sex Male 553 5.8% (1.8-9.8) 94.2% (90.2-98.2) 

Female 842 9.2% (6.1-12.3) 90.8% (87.7-93.9) 

Race White 1,223 9.2% (6.1-12.2) 90.8% (87.8-93.9) 

Black 33 ~ ~ ~ ~ 

Other Race 75 3.7% (0.0-8.1) 96.3% (91.9-100.0) 



H.S. or G.E.D. 418 9.8% (4.2-15.4) 90.2% (84.6-95.8) 

Some Post H.S. 447 7.3% (3.7-10.9) 92.7% (89.1-96.3) 



$15,000 to $24,999 262 13.3% (6.1-20.5) 86.7% (79.5-93.9) 

$25,000 to $34,999 174 6.1% (2.0-10.2) 93.9% (89.8-98.0) 

$35,000 to $49,999 198 5.7% (1.4-10.0) 94.3% (90.0-98.6) 

$50,000 to $74,999 191 5.9% (1.8-10.1) 94.1% (89.9-98.2) 

$75,000+ 182 2.7% (0.9-4.4) 97.3% (95.6-99.1) 

Health Status 


83

Health Status 

Table HS17 

Preliminary Report: Death County by Region of Residence, Cause of Death, and Age Group, Nevada 

Residents, 2011* 

Region of Residence Cause of Death Age Group 

65-74 75-84 85+ Total 

Northern Urban/Metropolitan Falls^ 4 12 30 46 

Motor Vehicle Accidents 4 4 0 8 

Suicides 13 4 1 18 

Total Deaths 728 877 1,103 2,708 

Southern Urban/Metropolitan Falls^ 16 46 46 108 



Total Deaths 2,692 3,414 2,884 8,990 

Rural & Frontier Falls^ 4 5 9 18 



Total Deaths 567 657 595 1,819 

Total Falls^ 24 63 85 172 


Suicides 50 31 10 91 

Total Deaths 3,988 4,949 4,582 13,519 

*Data is not final and is subject to changes. 

^Falls includes underlying cause of death as well and included the following ICD-10 codes: W00-W19. 


84

Table HS18 

Nevada Veterans, Age 65 and Older: Served in a Combat or War Zone 


% C.I. % C.I. 

Region Statewide 394 51.0% (42.9-59.0) 49.0% (41.0-57.1) 




Age 65-74 208 52.3% (40.6-63.9) 47.7% (36.1-59.4) 

75-84 154 41.2% (29.8-52.6) 58.8% (47.4-70.2) 

85 and Older 32 ~ ~ ~ ~ 

Sex Male 377 51.3% (43.1-59.4) 48.7% (40.6-56.9) 

Female 17 ~ ~ ~ ~ 

Race White 343 48.7% (39.9-57.5) 51.3% (42.5-60.1) 

Black 11 ~ ~ ~ ~ 

Other Race 16 ~ ~ ~ ~ 


Education Less than H.S. 21 ~ ~ ~ ~ 

H.S. or G.E.D. 96 62.7% (49.3-76.1) 37.3% (23.9-50.7) 

Some Post H.S. 111 47.6% (33.8-61.4) 52.4% (38.6-66.2) 



$25,000 to $34,999 50 58.0% (35.1-81.0) 42.0% (19.0-64.9) 

$35,000 to $49,999 65 65.5% (47.9-83.2) 34.5% (16.8-52.1) 

$50,000 to $74,999 75 48.6% (31.9-65.3) 51.4% (34.7-68.1) 

$75,000+ 70 35.5% (19.3-51.8) 64.5% (48.2-80.7) 

Health Status 

*Sample sizes less than 50 are marked with ‘~’. 

**Percentages are weighted, and may not be a direct reflection of the sample sizes. 


85

Health Status 

Table HS19 

Nevada Veterans, Age 65 and Older: Diagnosed with TBI 


% C.I. % C.I. 





Age 65-74 208 2.0% (0.4-3.5) 98.0% (96.5-99.6) 

75-84 155 1.2% (0.0-2.7) 98.8% (97.3-100.0) 

85 and Older 32 ~ ~ ~ ~ 

Sex Male 378 1.5% (0.5-2.5) 98.5% (97.5-99.5) 

Female 17 ~ ~ ~ ~ 

Race White 344 1.2% (0.2-2.1) 98.8% (97.9-99.8) 

Black 12 ~ ~ ~ ~ 




H.S. or G.E.D. 98 1.1% (0.0-2.4) 98.9% (97.6-100.0) 

Some Post H.S. 110 1.3% (0.0-2.8) 98.7% (97.2-100.0) 



$25,000 to $34,999 50 2.8% (0.0-6.9) 97.2% (93.1-100.0) 

$35,000 to $49,999 65 0.3% (0.0-0.8) 99.7% (99.2-100.0) 

$50,000 to $74,999 75 2.3% (0.0-5.7) 97.7% (94.3-100.0) 

$75,000+ 70 2.1% (0.0-4.7) 97.9% (95.3-100.0) 

*Sample sizes less than 50 are marked with ‘~’. 

**Percentages are weighted, and may not be a direct reflection of the sample size. 


86

Table HS20 

Nevada Veterans, Age 65 and Older: Diagnosed with Depression, Anxiety, or PTSD 


% C.I. % C.I. 

Region Nevada 395 9.3% (4.1-14.4) 90.7% (85.6-95.9) 




Age 65-74 209 12.5% (3.6-21.4) 87.5% (78.6-96.4) 

75-84 155 7.3% (0.8-13.7) 92.7% (86.3-99.2) 

85 and Older 31 ~ ~ ~ ~ 

Sex Male 378 8.6% (3.4-13.8) 91.4% (86.2-96.6) 

Female 17 ~ ~ ~ ~ 

Race White 344 8.9% (3.3-14.5) 91.1% (85.5-96.7) 

Black 12 ~ ~ ~ ~ 




H.S. or G.E.D. 98 8.8% (0.0-17.8) 91.2% (82.2-100.0) 

Some Post H.S. 111 16.8% (4.0-29.6) 83.2% (70.4-96.0) 



$25,000 to $34,999 50 17.6% (0.0-36.3) 82.4% (63.7-100.0) 

$35,000 to $49,999 65 9.5% (0.0-19.5) 90.5% (80.5-100.0) 

$50,000 to $74,999 75 5.9% (1.0-10.8) 94.1% (89.2-99.0) 

$75,000+ 70 3.8% (0.4-7.3) 96.2% (92.7-99.6) 

Health Status 



(CDC: BRFSS, 2011). 

87

Health Status 

Table HS21 

Nevada Veterans, Age 65 and Older, 2011: Death by Suicide* 

Region of Residence Cause of Death Age Group 

65-74 75-84 85+ Total 

Northern Urban/Metropolitan Suicides 6 4 1 11 

Total Deaths 223 340 347 910 

Southern Urban/Metropolitan Suicides 9 8 5 22 

Total Deaths 815 1,242 893 2,950 

Rural/Frontier Suicides 2 7 1 10 

Total Deaths 210 259 206 675 

Total Suicides 17 19 7 43 

Total Deaths 1,249 1,841 1,446 4,536 

*Data is not final and is subject to changes. 

(OPHIE, 2011) 

88

Table HS22 

Nevada Veterans, Age 65 and Older: Thought of Suicide in the Past 12 Months 


% C.I. % C.I. 





Age 65-74 209 5.3% (0.0-11.8) 94.7% (88.2-100.0) 

75-84 154 2.7% (0.0-6.2) 97.3% (93.8-100.0) 

85+ 32 ~ ~ ~ ~ 

Sex Male 378 3.5% (0.1-7.0) 96.5% (93.0-99.9) 

Female 17 ~ ~ ~ ~ 

Race White 343 4.3% (0.1-8.5) 95.7% (91.5-99.9) 

Black 12 ~ ~ ~ ~ 




H.S. or G.E.D. 98 3.2% (0.0-9.3) 96.8% (90.7-100.0) 

Some Post H.S. 111 3.5% (0.0-8.0) 96.5% (92.0-100.0) 



$25,000 to $34,999 50 7.1% (0.0-20.8) 92.9% (79.2-100.0) 

$35,000 to $49,999 65 4.1% (0.0-12.3) 95.9% (87.7-100.0) 

$50,000 to $74,999 74 0.8% (0.0-2.6) 99.2% (97.4-100.0) 

$75,000+ 70 9.4% (0.0-27.3) 90.6% (72.7-100.0) 

Health Status 



89

Health Status 

Table HS23 

Nevada Veterans Age 65 and Older: Received Psychological or Psychiatric Counseling, or Treatment in 

Past 12 Months 


% C.I. % C.I. 





Age 65-74 209 3.4% (1.1-5.7) 96.6% (94.3-98.9) 

75-84 155 0.4% (0.0-0.9) 99.6% (99.1-100.0) 

85 and Older 32 ~ ~ ~ ~ 

Sex Male 379 1.9% (0.7-3.1) 98.1% (96.9-99.3) 

Female 17 ~ ~ ~ ~ 

Race White 344 1.5% (0.5-2.6) 98.5% (97.4-99.5) 

Black 12 ~ ~ ~ ~ 




H.S. or G.E.D. 98 1.0% (0.0-3.1) 99.0% (96.9-100.0) 

Some Post H.S. 111 0.9% (0.0-2.2) 99.1% (97.8-100.0) 



$25,000 to $34,999 50 0.0% 0 100.0% (100.0-100.0) 

$35,000 to $49,999 65 1.1% (0.0-3.0) 98.9% (97.0-100.0) 

$50,000 to $74,999 75 4.9% (0.3-9.5) 95.1% (90.5-99.7) 

$75,000+ 70 2.3% (0.0-4.6) 97.7% (95.4-100.0) 

*Sample sizes less than 50 are marked with ‘~’. Due to the small samples sizes, responses may not reliably represent the population; therefore, 

are not included. 

90

Risk and protective factors 

influence health status and 

choices of behavior. In older 

adults, possible risk factors include 

the experience of loss and isolation, 

changes in self- and social-identity 

due to retirement, declines in physical 

health, changes in self-efficacy, and 

dwindling financial resources. 

Older adults faced with these risks are 

more likely to participate in unhealthy 

behaviors such as substance use or 

abuse, excessive gambling, or other 

risky behaviors. Declines in physical 

health may result in decreased 

physical activity, which reduces 

fitness and raises the risk of falls 

and fall-related injuries. Vision and 

hearing loss may increase the risk of 

motor vehicle accidents. Retirement 

with income reduction may result 

in changes to dietary quality, which 

can lead to unhealthy increases in 

weight. With less disposable income, 

an older adult may opt to skip annual 

medical examinations, vaccinations or 

screening for early detection of cancer. 

Alternatively, protective factors can 

reduce the risk of negative behaviors 

and help older adults age successfully. 

Potential protective factors include 

social and family support, religious or 

spiritual beliefs, and access to health 

care professionals and caregivers 

trained in geriatrics and gerontology. 

Protective factors may also include 

access to transportation and other 

supportive services such as meals-onwheels 

programs, case management, 

personal care, homemaker services 

and adult day care. 

Authors: Angela D. Broadus, Shawna Dale Koehler Larsen, Julie Kilgore 

Content Reviewers: Jay Kvam, Jill Berntson, Betty Dodson, Caleb Cage 

Health Risks & 

Behaviors 

Tobacco Use 

Alcohol Use 

Illicit Drug Use 

Gambling & Other Process Addictions 

Dietary Quality 

Physical Activity 

Overweight & Obesity 

Cholesterol & Blood Pressure 

Influenza & Pneumonia Vaccinations 

Cancer Screenings 

HIV/AIDS & Other Sexually Transmitted Diseases 

Falls & Fall-Related Injuries 

Elder Abuse, Neglect & Exploitation 

Motor Vehicle Accidents 

Veterans

Health Risks & Behaviors 

This section addresses the following health risks 

and behaviors for older adults: 

• tobacco and alcohol use 

• dietary quality 

• physical activity 

• overweight and obesity 

• cholesterol and blood pressure 

• influenza and pneumonia vaccinations 

• cancer screenings 

• HIV/AIDS 

• falls and fall-related injuries 

• elder abuse, neglect and exploitation 

• motor vehicle accidents 

New to the report since the Elders Count Nevada 

(2009) is information about illicit drug use, gambling 

and other process addictions in older adults plus 

a section on health risks and behaviors in older 

Nevada veterans. 

Highlights 1 

Tobacco Use 

• Nevada tobacco use declined from 28.2% in 

1996 to 21.3% in 2010. 

• Nevada continues to rank in the top third of 

states for tobacco use and is the western state 

with the most prevalent use of tobacco. 

Alcohol Use 

• The rate of binge drinking among Nevada older 

adults (6.1%) is lower than the national rate 

(7.6%). 

• The rate of heavy alcohol use among Nevada 

older adults (4.8%) is higher than the national 

rate (1.7%). 


• In 2009, drug-induced death ranked as the 

sixth-leading cause of death in Nevada. 

• In 2010, Nevada ranked fourth from the bottom 

for drug-poisoning deaths. The state’s ageadjusted 

death rate: 20.7 per 100,000. 

• Nevada ranked in the top fifth of states for 

percentage of adults 26 and older who needed 

but did not receive treatment for illicit drug use 

in the past year. 

• The percentage of Nevadans in adults age 26 

and older who reported using marijuana in 

the past year (8.2%) is slightly higher than the 

national average (7.9%). Nevada ranks in the 

top fifth for states with highest use. 


• Nevada has the highest number of adults (an 

estimated 68,000) meeting diagnostic criteria for 

pathological gambling. 


• An estimated 47.2% of Nevadans completing 

the Grants Management Advisory Committee 

(GMAC) survey in early 2012 indicated that they 

had needed assistance in locating or accessing 

food in the 12 months prior to the survey. 

• Service providers reported that 68.1% of their 

clients had needed assistance in locating or 

accessing food during the same time. 

• Fifty-nine percent of service providers cited 

inadequate income as the primary factor 

stopping clients from obtaining adequate food. 

Other factors included cost of food (21.6%) and 

inadequate income (15.2%). 


• Statewide, an estimated 17.8% of older Nevada 

adults met second-level federal guidelines of 

doing either 300 minutes a week of moderateintensity 

exercise or 150 minutes a week of 

vigorous-intensity aerobic exercise and strength 

training two or more days per week. 

• The lowest percentage of survey respondents 

meeting these guidelines for physical activity 

were found in the Rural/Frontier region (10.7%) 

while the largest percentage (21.2%) resided in 

the Northern Urban/Metropolitan area. 

• An estimated 24.8% of older Nevada males met 

the federal guidelines for physical activity, while 

11.6% of older Nevada females met the criteria. 

92 

1 

Percentages for Behavioral Risk Factor Surveillance System (BRFSS) data are based on older adults who responded to the survey and may not be 

representative of the state as a whole.


• In 2011, an estimated 18.1% of Nevada adults 

65 and older met the criteria for obesity; 

41.7% were merely overweight; 2.7% were 

underweight. 

• The Rural/Frontier region had the highest 

percentage of older adults categorized as 

underweight (5.7%) or obese (24.2%). 

• The highest percentage of older adults 

categorized as having a healthy weight (41.3%) 

lived in the Northern Urban/Metropolitan 

region. 

• The highest percentage of merely overweight 

older adults (43.5%) lived in the Southern 

Urban/Metropolitan region. 


• A higher percentage of adults 65 to 74 (61%) 

were told they had high cholesterol than adults 

75 to 84 (45.4%) or those 85 and older (31.7%). 

• Approximately 61% of Nevada adults 65 and 

older have been told they have hypertension. 

• A higher percentage of older adults with less 

than a high school education (76.3%) reported 

having hypertension than did those with a 

college education (54.6%). 


• The immunizations rates for Nevada’s older 

adults are lower than national rates. 

• Nationally and in Nevada, about 70 percent of 

older adults have had a pneumonia vaccination 

at some time in their lives. 


• An estimated 65% of U.S. and 62% of Nevada 

adults age 50 and older indicated that they 

had a sigmoidoscopy or colonoscopy. Among 

Nevadans 65 and older the figure was 67.6%. 

• In 2010, an estimated 53% of U.S. and 52% of 

Nevada males 40 and older reported having had 

a prostate cancer (Prostate Specific Antigen) 

test. Among Nevada adults 65 and older, the 

figure was 75.5%. 

• An estimated 81% of U.S. females and 78% of 

Nevada females 18 and older reported having 

had a Pap test to screen for uterine cancer 

between 2007 and 2010. 

• The percentage of Nevada females having had a 

mammogram differed by education and income. 

Fewer older females with less than a high 

school education (50%) reported having had a 

mammography than did those with a college 

education (80%). 

HIV/AIDS & Other Sexually Transmitted 

Diseases 

• Among adults 55 and older, the rate of AIDS 

diagnoses (6.3 per 100,000) was higher than 

nationally (5.4 per 100,000). 

• The rate of new HIV diagnoses in 2011 was 1.8 

per 100,000 while the rate of those living with 

HIV/AIDS was 98.2 per 100,000. 

• Rates per 100,000 of the following sexually 

transmitted diseases for Nevada adults 65 and 

older in 2011 were chlamydia (3.9), gonorrhea 

(1.8), primary/secondary syphilis (1.2) and early 

latent syphilis (0.3). 


• In 2006, the fall-related fatality rate among U.S. 

adults 65 and older was 38 per 100,000 while 

for Nevada adults 65 and older the rate for the 

Northern and Southern Urban/Metropolitan 

regions of the state was 27.2. The rate for the 

Rural/Frontier region was not available. 

• From 2006 to 2007, the Nevada death rate in 

older adults due to fall-related injuries increased 

from 27.2 to 36.8 per 100,000. In the same 

period, the national fall-related death rate 

among older adults increased from 38 to 48.5 

per 100,000. 


• In FY 2012 (7/1/11 to 6/30/12), Elder Protective 

Services and Nevada law enforcement received 

5,374 allegations of elder abuse statewide. Of 

these: 21.9% (n = 1,176) were for abuse; 21.8% 

(n = 1,173) were for neglect; 31.8% (n = 1,711) 

were for self-neglect; 21.8% (n = 1,171) were 

for exploitation; and 2.7% (n = 143) were for 

isolation. 

• Suspects in the cases closed in FY 2012 included 

the clients themselves (33.2%), the client’s child 

(23.1%), the service provider (13.2%), a relative 

(10.5%), the client’s spouse (9.1%), a friend 

or neighbor of the client (4.9%), and other 

individuals with unknown relationship to the 

client (6%). 


93


• Of all substantiated cases in FY 2012: 38.5% 

were for self-neglect; 22.5% were for abuse; 

20.4% were for neglect; 17.2% were for 

exploitation; and 1.4% were for isolation. 


• For U.S. adults 65 and older: a lower share 

(89.8%) reported that they always use a seatbelt 

when in a motor vehicle; 4.3% reported that 

they nearly always wear one; 2.4% stated that 

they sometimes wear a seatbelt; 0.6% seldom 

wear a seatbelt; 1.6% indicated that they do not 

drive or ride in motor vehicles. 

Veterans 

• In 2008, only 30%-40% of eligible veterans 

actually sought Veterans Administration 

services to address mental health (and possibly 

substance use) issues. 

• 2009-2012 demographics for the Washoe 

County Veteran’s Court indicate that 31% of 

veteran clients were charged with drug and 

alcohol crimes, 24% with crimes against a 

person, 24% with property crimes, and 21% 

with nuisance crimes. 

• Between 2009 and 2012, Washoe County’s 

Veteran’s Court served 99 participants ranging 

in age from 20 to 78 years (M = 45.5 years). 

The majority of clients were White (80%) and 

male (91%). In addition, 12% were Black, 

7% were Hispanic, and 1% were Asian. The 

most common substances at issue in those 

with drug- or alcohol-related crimes included 

poly-substance abuse, alcohol, marijuana, 

methamphetamines, heroin/opiates and cocaine. 

• The age-adjusted rate of motor vehicle fatalities 

among Nevada veterans (27.8 per 100,000) is 

higher than for Nevada’s general population (7.8 

per 100,000). 

94

Tobacco Use 

Tobacco use is associated with “increased 

likelihood of cancer, cardiovascular disease, chronic 

obstructive lung diseases, and other debilitating 

health conditions” (Federal Interagency Forum, 

2012, p. 43). Three of the top 10 leading causes of 

death in the United States (heart disease, cancer 

and chronic lower-respiratory diseases) may be 

directly associated with smoking. In particular, 

the 57% increase from 1981 to 2009 in chronic 

lower-respiratory disease in older adults (Federal 

Interagency Forum, 2012, p. 26) may result from the 

long-term effects of tobacco use. 

Between 1965 and 2010, the percentage of older 

adults nationally who smoked tobacco declined 

(see Figure HR1), and male use declined from 29% 

to 10%. Female use declined only 1% over the 

same period (Federal Interagency Forum, 2012). 

Current tobacco use declined among Nevada 

adults from 28.2% in 1996 to 21.3% in 2010 (see 

Figure HR2, CDC: Smoking & Tobacco Use, n.d.). 

However, Nevada continues to rank in the top third 

nationwide; and is the top state in the western 

region for tobacco use. 

Fig. HR1: Cigarette Use in U.S. Adults 65 and Older: Year and Sex 

34% 

32% 

30% 

28% 

26% 

24% 

22% 

20% 

Fig. HR2: Nevada: Cigarette Use, 1996-2010 

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 

(CDC: BRFSS: Tobacco Use, 1996-2010) 

Nationally, the rate of cigarette smoking in adults 65 

and older is lower than for younger adults (see Table 

HR1). Among these older adults, 52.5% of the males 

and 29.3% of the females were former smokers, 

while 37.8% of males and 61.4% of females were 

non-smokers. Less than 10% percent were current 

smokers or smoked every day. 

The rate of daily smoking in Nevada (10.7%; 

see Table HR2) is lower than nationally (15.1%). 

However, the percentage of former smokers in 

Nevada (51.8%) is more than twice as high (21.7%) 

as nationally. Not surprisingly, the percentage of 

Nevada seniors who have never smoked is lower 

(34.7%) than the percentage nationally (59%, see 

Figure HR3). 


Fig. HR3: Rate of Cigarette Smoking, Adults 

Age 65 and Older: Nevada versus U.S. 

51.8% 

59.0% 

34.7% 

10.7% 

15.1% 

2.8% 

4.2% 

21.7% 

Every Day Some Days Former Smoker Never Smoked 

Nevada U.S. 

(CDC: BRFSS, 2011; CDC: National Health Interview Survey, 2010, in 

Federal Interagency Forum, 2012, p. 128) 

(CDC: National Health Interview Survey, 2010, in Federal Interagency 

Forum, 2012, p. 43) 

95


In 2011, a higher percentage of Nevada adults 65- 

74 reported smoking on a daily basis (14%) than 

adults 75-84 (6.3%) or those 85 and older (4%; CDC: 

BRFSS, 2011). In addition, a much lower percentage 

of Hispanics (2.9%) reported smoking daily than did 

Whites (10.9%) or older adults of other races (13.8%; 

see Figure HR4). Minimal differences were found by 

education or income in the percentage of older adults 

who smoked daily. 

Alcohol Use 

Socially accepted, easy to access, and cheap to 

purchase, alcohol has been the drug of choice for 

many older adults. Even for older adults in nursing 

facilities, alcohol is used to facilitate social contact. 

One study reported that 49.5% of nursing facilities 

surveyed in a northeastern state (N = 111) deemed 

it appropriate to allow residents access to alcohol, 

and 6.9% indicated it was “very appropriate” (Klein 

& Jess, 2002, p. 197). Staff from these facilities 

allowed use upon doctor’s order (26.1%), during 

cocktail hours (18.0%), on special occasions 

(14.4%), at the residents’ discretion (13.5%), outside 

of the facility only (13.5%), when dispensed by staff 

(12.6%), at facility-sponsored outings (10.8%), and 

for sacramental use (0.9%, p. 198). 

Aging is associated with reductions in liver and 

kidney function, muscle mass, and body water and 

with an increase in body fat. These physiological 

changes reduce the older adult’s ability to 

metabolize alcohol, so alcohol remains active longer 

in the body and brain. Alcohol may negatively 

interact with medications, creating a dangerous 

combination. For example, prescription medications 

for insomnia can become lethal if combined with 

alcohol. 

Fig. HR4: Nevada Adults, Age 65 and Older: 

Race/Ethnicity by Smoking Every Day 

10.9% 

13.8% 


2.9% 

White Other Race Hispanic 

Long-term alcohol use or abuse is associated 

with deterioration in overall health and with liver 

disease, stroke, brain damage and dementia, 

internal bleeding, poor nutrition, immune 

dysfunction, falls and injuries, depression, and 

suicide. In Nevada, 1.7% of all deaths in 2009 were 

alcohol induced (Kochanek, Xu, Murphy, Minino, 

& Kung, 2011). That same year, alcohol-induced 

deaths in Nevada ranked 13th in a list of 19 causes 

of death. 

Generally, people drink less alcohol as they grow 

older (SAMHSA, 2011). In the 2010 National Survey 

on Drug Use and Health, the percentage of adults 

who had used alcohol in the month prior to the 

survey decreased from 65.3% among adults 26-29 

to 51.6% in adults 60-64, and to 38.2% in adults 65 

and older. Of those 65 and older who drank alcohol, 

30.7% described themselves as current, non-binge 

and non-heavy drinkers. Another 5.9% described 

themselves as binge drinkers, and 1.6% of drinkers 

were heavy alcohol users 2 . 

Fig. HR5: Of Adults Who Drink: Levels 

of Use 

37.8% 

30.7% 

10.5% 

5.9% 

3.3% 

1.6% 

Current Use (Not Binge Binge Use 

or Heavy Use) 

60-64 Years 65 and Older 

Heavy Use 

(SAMHSA, 2010, Section 3.1) 

96 

2 

“Binge use = five or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least one day in the 

past 30 days. Heavy use = five or more drinks on the same occasion on each of five or more days in the past 30 days” (SAMHSA, 2011, Section 3).

National rates of binge drinking in adults 65 and 

older decreased from 9.8% in 2009 to 7.6% in 2010. 

The rate of heavy alcohol use decreased from 2.2% 

in 2009 to 1.7% in 2010 (SAMHSA, 2010, 2011). The 

rate of reported binge drinking among Nevada older 

adults (6.1%, see Table HR3) was lower than the 

national percentage (7.6%). The rate of heavy alcohol 

use (4.8%, see Table HR4) in Nevada was higher 

than national percentage (1.7%; CDC: BRFSS, 2011). 

Among the older adults, a smaller percentage of 

adults 85 and older (2.1%) met the criteria for binge 

drinking than did adults 65-74 (8.5%; see Figure 

HR6). 


Age by Binge Drinking 

8.5% 

A higher percentage of adults earning $75,000 or 

more per year (69.8%) reported having had at least 

one drink, compared with 33.9% for those making 

less than $15,000 per year and 35.7% for those 

making $15,000 to $24,999 (see Figure HR7). In 

addition, more adults 65 and older with a college 

education (56.2%) reported having a drink than 

those with some college education but no degree 

(41.2%, see HR8). 


Income by Heavy Drinkers Reporting at Least 

One Drink in Past 30 Days 

33.9% 35.7% 

69.8% 


< $15,000 $15,000-$24,999 $75,000 or More 

2.9% 

2.1% 




The percentage of Nevada adults 65 and older who 

described themselves as heavy drinkers (4.8%) did 

not differ significantly by region, age, sex, education 

or income (see Table HR4). 


Education by Heavy Drinkers, One Drink in 

Past 30 Days 

39.3% 

47.2% 

41.2% 


56.2% 


Of the Nevada adults 65 and older who described 

themselves as heavy drinkers, 45.4% reported having 

at least one drink in the 30 days prior to the survey 

(see Table HR5). The percentage of these heavy 

drinkers differed minimally by region, age, sex or 

race/ethnicity. 

97



In 2011, the oldest of the baby boomer population 

(born between 1946 and 1964) reached their 

milestone 65th birthday. Boomers are the first 

population to have grown to adulthood with 

greater lifetime exposure to drug use, greater 

tolerance of substance use, and increasing media 

representation of use as commonplace (Coliver, 

Compton, Gfroerer, and Condon, 2006; Volkow, 

2011). Substance use researchers thus predict an 

increase in illicit drug use, abuse, and dependence 

commensurate with the aging of this population 3 . 

For example, in a trend analysis of National Survey 

of Drug Use and Health (NSDUH), Duncan, 

Nicholson, White, Bradley and Bonaguro (2010) 

noted that the percentage of adults 50 and older 

using illicit drugs increased from 1985 to 2006. 

Specifically, use of marijuana increased from 0.3% 

of the population to 1.6% or 1.27 million older 

adults. Use of cocaine increased from 0.1% to 0.3% 

(140,422 older adults currently using), and use of 

inhalants increased from 0% to 0.1% (56,547 older 

adults; Duncan et al., 2010, p. 239-240). 

National use in 50-59 year old adults from 2002 to 

2010 supports the predicted trends. Past-month 

illicit drug use among adults 50-59 increased from 

2002 to 2010 (SAMHSA, 2011). Past-month use of 

illicit drugs in adults 60-64 decreased from 3.1% in 

2009 to 2.7% in 2010. However, for adults 65 and 

older, past-month use increased from 0.9% in 2009 

to 1.1% in 2010. An estimated 5.2% of adults 50 and 

older (4.8 million) used an illicit drug in the past 

year (see Figure HR9). 

Fig. HR9: NSDUH: Use of Illicit Substances in Adults 50-59 

Unfortunately, we are not prepared nationally or at 

the state level to respond to this emerging public 

health problem. Research into the intersection of 

aging and substance abuse is lacking (Volkow, 

2011). Also lacking is adequate training for 

clinicians, care providers, and primary care 

physicians in screening/assessment and treatment 

of substance abuse in geriatric populations (Klein 

& Jess, 2002; Menninger, 2002). Diagnostic criteria 

found in the current Diagnostic and Statistical 

Manual of Mental Disorders, Fourth Edition (DSM- 

IV, 1994), is inadequate for detecting substance use 

disorders in this age group (Menninger, 2002). 

+ Difference between this estimate and the 2010 estimate is statistically significant at the .05 level. 

+ Difference between this estimate and the 2010 estimate is 

statistically significant at the .05 level. 

(SAMHSA: NSDUH, 2011, Figure 2.8) 

Data from the Drug Abuse Warning Network 

(DAWN) estimated that 118,495 adults 50 and 

older visited hospital emergency departments for 

problems associated with the use of illicit drugs in 

2008 (SAMHSA: Office of Applied Studies, 2010). 

Of these, over half (58.2%) were 50-54 years of age, 

just over a fourth were 55-59, 11.1% were 60-64, 

3.4% were 65-69, and 1.5% were 70 or older. During 

these ER visits, patients 65 and older reported use of 

cocaine (48.3%), heroin (23.3%), marijuana (28.6%), 

and illicit stimulants (5.5%; see Figure HR10). In 

addition, of all visits that included illicit drugs, 31.1% 

also included use of alcohol (SAMHSA: Office of 

Applied Studies, 2010). 

98 

3 

The Substance Abuse and Mental Health Services Administration (SAMHSA) includes the following substances under the category of illicit drugs 

[SAMHSA: National Survey on Drug Use and Health (NSDUH), 2011, Section 2, para. 1]: marijuana (hashish), cocaine (crack), heroin, hallucinogens 

(LSD, PCP, peyote, mescaline, psilocybin mushrooms, and ecstasy/MDMA), inhalants (nitrous oxide, amyl nitrate, cleaning fluids, gasoline, spray 

paint, aerosol sprays, and glue), non-medical use of prescription drugs including pain relievers, tranquilizers, stimulants (methamphetamines) and 

sedatives.

63.8% 

Fig. HR10: DAWN, 2008 : ER Visits and 

Illicit Drug Use in Adults, Age 50 and 

48.3% 

26.6% 

23.3% 

Older 

Aged 50 to 64 

Aged 65 and Older 

28.6% 

18.0% 

5.3% 5.5% 

Cocaine Heroin Marijuana Illicit Stimulants 

(SAMHSA: Office of Applied Studies, 2010) 

Drug-related adverse reactions also are issues of 

importance for older adults. As indicated previously, 

aging is associated with physical changes in 

the ability to distribute, metabolize and excrete 

substances. As such, substances remain in the body 

longer, increasing the chance for an interaction with 

medications, alcohol or illicit substances. Per the 

2010 DAWN report, drug-related adverse reactions 

were highest in ER visits for adults 65 and older 

(SAMHSA: Center for Behavioral Health Statistics 

and Quality, 2012). Of the 1,678.9 ER visits per 

100,000 in 2010, adverse reactions were noted for 

cardiovascular medications, anticoagulants, pain 

relievers, antibiotics, and drugs to treat cancer and 

diabetes. 

State-level data on substance use in older adults is 

minimal. DAWN data is not collected from Nevada, 

and NSDUH and Treatment Episode Data Sets 

(TEDs) state-level data is aggregated for adults 

either age 26 and older (NSDUH) or age 12 and 

older (TEDs) 4 . However, we do know that in 2009, 

drug-induced deaths ranked as the sixth-leading 

cause of death in Nevada (Kochanek, Xu, Murphy, 

Minino, & Kung, 2011). In 2010, Nevada ranked 

fourth in the nation in drug-poisoning deaths with 

an age-adjusted rate of 20.7 per 100,000 (CDC: 

Morbidity and Mortality, Drug Poisonings, 2012). 

We also know that 12,549 Nevada individuals 12 

and older were discharged in 2009 from a hospital 

following substance-related treatment (SAMHSA: 

TEDS, 2012, Chart 1.1a). Treatment services provided 

to the 11,689 admissions included outpatient 

(5,122), detoxification (3,493), intensive outpatient 

(1,114), short-term residential (1,799), long-term 

residential (5), and medically assisted opioid or other 

detoxification (156; SAMHSA: TEDS, 2012, Chart 

1.2a). 

Based on NSDUH 2009-2010 data, the percentage 

of illicit drug dependence in the past year among 

Nevadans 26 and older (1.34%) is higher than the 

U.S. rate (1.25%) for the same age range (SAMHSA: 

NSDUH, 2012). Nevada ranked in the top fifth of all 

states for having the highest percentage of illicit drug 

dependence or abuse in the past year among adults 

26 and older. In addition, Nevada ranked in the top 

fifth for highest percentage of adults 26 and older 

needing, but not receiving, treatment for illicit drug 

use in the past year (SAMHSA: NSDUH, 2012). 

Other state-level data indicate that the percentage 

of Nevadans 26 and older reporting marijuana use 

in the past year (8.19%) is much higher than the 

national average (7.88%). Nevada ranks in the top 

fifth for states with highest use. Nevada also ranks 

higher than the United States in the percentage of 

adults 26 and older reporting cocaine use in the past 

year (1.93% versus 1.41%, respectively), and for the 

nonmedical use of pain relievers in the past year 

(4.62% versus 3.53%, respectively; see Figure HR11). 

1.3% 

1.3% 

Illicit Drug 

Dependence in the 

Past Year 

Fig. HR11: NSDUH, 2009-2010: 

Use in Adults Age 26 and Older 

7.9% 

8.2% 

Marijuana Use in 

Past Year 

1.4% 

(SAMHSA, 2012) 

1.9% 

Cocaine Use in Past 

Year 

3.5% 

U.S. 


4.6% 

Nonmedical Use of 

Pain Relievers 


4 

Nevada facilities providing TEDS data included all facilities that received state/public funding. 

99



Process addictions such as pathological gambling, 

Internet addiction, food addiction, etc., show 

neurobiological, stimulus-reward patterns similar 

to substance addictions. In addition, process 

addictions show similarities in the progression 

from social use to abuse and dependency. And 

just like substance dependence, process addictions 

may result in compulsive behaviors and craving, 

continuing the behavior in spite of adverse 

consequences, and loss of control over the behavior. 

Scientists now acknowledge the similarities 

between substance dependence and pathological 

gambling. 

The National Council on Problem Gambling 

(NCPG, 2012) estimated that 85% of all U.S. 

adults have gambled at least once in their lives 

and 60% have gambled in the past year. Of these, 

approximately 1%, or 2 million adults, met the 

diagnostic criteria for pathological gambling, and 

2-3%, or 4-6 million, were problem gamblers 

(NCPG, 2012). In a nationally representative study 

of U.S. households between 2001 and 2003, 78.4% 

of participants reported gambling at least once in 

their lifetime; the prevalence estimate for lifetime 

problem gambling was 2.3%; and the estimate 

for lifetime pathological gambling was 0.6% 

(Kessler et al, 2008). Age of onset for those who 

eventually became problem gamblers (median age 

= 21) was later than for non-problem gamblers 

(median age = 18; p. 1354). Rank-order popularity 

of different types of gambling did not differ across 

pathological and non-problem gamblers. However, 

the percentage of pathological gamblers who chose 

specific types of gambling was higher than for all 

gamblers (see Figure HR12). 

Fig. HR12: Popularity of Gaming by 

Gambler Type 

Speculating on High Risk Investments 

Internet Gambling 

Sports Betting: Bookie/Parlay Card 

Office Sports Pools 

Gambling at a Casino 

Slot Machines or Bingo 

Numbers/Lotto 

All Gamblers 

8.4% 

26.9% 

1.0% 

7.5% 

5.8% 

45.3% 

44.3% 

85.1% 

44.7% 

78.5% 

48.9% 

77.3% 

62.2% 

86.5% 

Pathological Gamblers 

In addition, the odds of developing a pathological 

gambling disorder increased by type of gaming. 

Games requiring mental skill (card games such 

as poker, bridge, etc.) posed the highest risk of 

association with pathological gambling. Further, 

Kessler et al.’s (2008) study supported previous 

research showing comorbidity between pathological 

gambling and bipolar disorder, substance use 

disorders, and panic disorder. These mental health 

disorders preceded the onset of pathological 

gambling. 

Gambling studies of adults 50 and older also 

indicated an increase in prevalence of lifetime 

gambling, from 35% in 1975 to 80% in 1998 

(National Opinion Research Center, 1999, in Tse, 

Hong, Wang & Cunningham-Williams, 2012, 

p. 639). Prevalence rates of lifetime pathological 

gambling varied widely based on the populations 

selected (e.g., older adults in nursing facilities 

versus those in casinos or bingo establishments), 

the gambling-assessment instruments used, and 

the types of gambling assessed (Tse et al, 2012). 

However, all studies consistently reported lower 

prevalence of problem/pathological gambling 

in older adults than in younger adults, and that 

gambling disorders were more prevalent among 

older males than older females (Tse et al, 2012, p. 

645). 

Stitt, Giacopassi and Nichols’ (2003) study of older 

adults and gambling in casinos suggests that casino 

gambling might not be a major threat to older adults. 

In a survey of 2,768 individuals, these researchers 

found that adults 63 and older were more likely 

to visit casinos than were adults 62 and younger; 

however, there were no age differences in the time 

spent in the casinos. A greater percentage of older 

females (43.7%) indicated they gambled than older 

males (33.3%). Older adults tended to spend less 

money gambling than younger adults, and fewer 

older adults reported losing more money than they 

could afford. 

100 

(Kessler, Hwang, LaBrie, Petukhova, Sampson, Winters, & 

Shaffer, 2008)

In spite of Stitt et al.’s (2003) findings, problem 

or pathological gambling by older adults may be 

particularly problematic. The older adult has fewer 

economic resources and less time than younger 

adults to recoup financial loss (Stitt, Giacopassi, 

& Nichols, 2003). Older adults are more prone to 

suffer health-related consequences from long hours 

spent in casinos and may be less likely to eat well 

or to take their medications while gambling. Older 

adults also may be less likely to understand addiction 

or recognize they have a gambling problem. They 

may hide gambling issues due to stigma and shame 

(Nevada Council on Problem Gambling, 2007). 

The Nevada Department of Health and Human 

Services (DHHS, 2011) indicated that Nevada has 

the highest number of adults (an estimated 68,000) 

meeting diagnostic criteria for pathological gambling 

(p. 2). Volberg (2002) also estimated that in 2000, 

3.5% of Nevadans met the criteria for pathological 

gambling in the past year, and 2.9% met the criteria 

for problem gambling. Bernhard and St. John (2012) 

later suggested that these rates were underestimated 

and that a definitive study of gambling disorders in 

Nevada is warranted. 

In 2010, the Nevada DHHS funded six programs 

with specialized treatment for problem gambling 

(see HR16). The sites were the Las Vegas Problem 

Gambling Center, the Reno Problem Gambling 

Center, Bristlecone, Pathways, New Frontier, and the 

Salvation Army (see Table HR6). 

Between 2006 and 2010, the average annual intake 

for these treatment centers was 429 individuals 

(NVDHHS, 2011, p. 3). However, the Nevada DHHS 

Five-Year Strategic Plan for Problem Gambling 

(2011) suggested that client treatment had declined, 

possibly due to “lack of conformity with key aspects 

of treatment delivery, such as client eligibility, services 

offered, and documentation standards” (p. 8). 



Diet and nutrition are associated with physical 

and cognitive health. Poor diet can result in 

adverse health outcomes, including anemia, 

diabetes, cancer, osteopenia and osteoporosis, 

vision impairment, impaired cognitive function, 

depression, cardiovascular disease, and stroke 

(CDC: Second National Report on Biochemical 

Indicators of Diet, 2012). In 2010, 14.5% of U.S. 

households (17.2 million) were unable to access 

adequate food because of limited funds or resources 

(Coleman-Jensen, Nord, Andrews, & Carlson, 

2011). Limited resources resulted in reduced 

consumption and disrupted eating patterns for 5.4% 

of households (6.4 million; Coleman-Jensen et al., 

2011). 

Even with adequate food availability, some 

individuals suffer from poor nutrition because of the 

types of food selected [e.g., high fat, salt and sugar 

levels; United States Department of Agriculture 

(USDA) Dietary Guidelines, 2010]. The National 

Health and Nutrition Examination Survey (NHNES) 

noted that 23.5% of males and 23.1% of females 60 

and older consumed non-nutritional diet drinks “on 

a given day” from 2009-2010 (Fakhouri, Kit, and 

Ogden, 2012). 

101


The NHNES (2003-2006) assessed biochemical 

indicators of diet and nutrition in a nationally 

representative sample and noted that 10% or less of 

the United States had nutritional deficiencies (CDC: 

Second National Report, Executive Summary, 

2012, p. 4). Specific types of deficiencies found, and 

those more likely to be found deficient, included: 

Vitamin B12 (older adults, 4%); Vitamin C (men, 

7%); and Vitamin D (Non-Hispanic Blacks, 31% 

and Mexican-Americans, 12%). Alternatively, when 

compared with young adults, older adults had the 

highest blood levels of folic acid and higher levels of 

fatty acids. 

With easy access to processed and “fast” foods and 

the myriad of diets promoted through media and 

word of mouth, many Americans today likely have 

no idea what is considered a healthy diet, nor do 

they know the nutritional value of the foods they 

eat (USDA Dietary Guidelines, 2010). However, 

most do know that they should increase their intake 

of fruits and vegetables. 

A meta-analysis of surveys relating to Alzheimer’s 

disease and cognitive health noted that 25.6% 

of adults surveyed agreed that a healthy diet 

was a protective factor against development 

of Alzheimer’s disease (Connell, Roberts, & 

McLaughlin, 2007, in Anderson, Day, Beard, Reed, 

and Wu, 2009, p. S7). However, participants did not 

know what, specifically, constituted a healthy diet. 

The 2010 Health Styles survey of U.S. adults found 

that 75% of participants believed healthy diets were 

essential to maintaining cognitive health (CDC: 

Healthy Brain Initiative, 2011). 

In a statewide survey of Nevadans, 47.2% indicated 

that they needed assistance in locating or accessing 

food in the past year (GMAC Statewide Needs 

Survey, 2012). Social workers and case managers, 

however, indicated that 68.1% of their clients 

needed assistance in locating or accessing food 

during the same time. While 58.8% of service 

providers cited inadequate income as the factor 

stopping clients from obtaining adequate food, 

21.6% of clients stated that it was the cost of food, 

and only 15.2% cited inadequate income as a factor 

(see Figure HR13). 

Fig. HR13: Issues Stopping Clients from 

Obtaining Food 

No school nutrition program 

2.0% 

6.9% 

No community food bank or pantry 

2.4% 

7.7% 

No public assistance 

5.2% 

20.6% 

No access to affordable food 

5.5% 

25.8% 

Did not meet the criteria for public… 

8.7% 

37.7% 

Cost of food 

21.6% 

47.9% 

Inadequate income 

15.2% 

58.8% 

Community Service Provider 

(GMAC Statewide Needs Survey, 2012) 

In the 2011 BRFSS survey, an estimated 14% 

of Nevada adults 65 and older ate five or more 

servings of fruits and vegetables per day (see Table 

HR7). Only minimal differences were noted by 

region of the state, sex, race/ethnicity or education. 

Fewer respondents 85 and older (6.4%) reported 

eating the recommended daily intake (RDI) of fruit 

and vegetables than did adults 75-84 (18.8%; see 

Figure HR14). Fewer adults with less than a high 

school education (6.6%) reported following the 

dietary recommendations than did those with a 

college education (18.5%; see Figure HR15). 


Age by Five or More Fruits and Vegetables per 

Day 

18.8% 



6.4% 

75-84 Years 85 or Older 


Education by Five or More Fruits and 

Vegetables per Day 

6.6% 

Less than H.S. 

18.5% 

College Graduate 

102


In addition to proper nutrition, physical activity 

is essential for maintaining proper weight and 

strength as one ages (DHHS: National Health 

Information Center, 2012). According to the CDC’s 

2008 Physical Activity Guidelines (2012), adults 

65 and older should engage in a combination of 

aerobic and strengthening exercises every week. 

Adults should spend at least 2.5 hours per week 

of moderate-intense aerobic activity, and they 

should spend at least two days a week doing 

muscle-strengthening activity that works all the 

major muscle groups. The National Institute of 

Health/National Institute on Aging (NIH/NIA) also 

recommends a combination of aerobic and musclestrengthening 

activities to improve breathing 

and heart rate, maintain the ability to function 

independently, prevent falls, and help the body to 

stay limber (Go4Life, n.d.). 

The CDC reported that 52.6% of older Nevadans 

participated in aerobic activity at least 2.5 hours per 

week, 30.1% participated in muscle-strengthening 

activities at least twice a week, and 21.3% met the 

2008 U.S. Physical Activity Guidelines (see Figure 

HR16). 

Fig. HR16: Adults, Age 18 and Older: Physical 

Activity, U.S. and Nevada 

51.7% 

52.6% 

U.S. 

NV 


Sex by Participated in Physical Activity in Past 

30 Days 

75.3% 

Male 


62.9% 

Female 

A larger percentage of older adults with a college 

education reported recent physical activity than did 

those with a high school diploma or less (see Figure 

HR18). A larger percentage of older adults with 

an income of $75,000 or greater reported recent 

physical activity than did those with incomes of less 

than $25,000 (see Figure HR19). 


Education by Participated in Physical Activity in 

Past 30 Days 

56.0% 

64.3% 

74.3% 


81.1% 



Aerobic Activity, 2.5 hrs/week 

minimum 

29.6% 

30.1% 

Muscle Strengthening, twice a 

week minimum 


21.0% 

21.3% 

Met 2008 Physical Activity 

Guidelines 


Income by Participated in Physical Activity in 

Past 30 Days 

58.6% 60.2% 

69.8% 70.6% 

77.3% 

88.3% 

Of the older Nevada adults surveyed in 2011, 68.7% 

reported participating in physical activities in the 

past 30 days (see Table HR8; CDC: BRFSS, 2011). 

Only minimal differences were noted by region, age 

or race/ethnicity. 

Differences were noted by sex, education, and 

income. Fewer older adult females in Nevada 

(62.9%) reported physical activity in the past 30 

days than did older adult males (75.3%; see Figure 

HR17). 

< $15,000 $15,000 to 

$24,999 

$25,000 to 

$34,999 

$35,000 to 

$49,999 


$50,000 to 

$74,999 

$75,000+ 

An estimated 17.8% of older Nevada adults 

participated in enough strength training and aerobic 

exercise to meet the second-level federal guidelines 

for physical activity (see Table HR9; CDC: BRFSS, 

2011). The lowest percentage of survey respondents 

meeting these guidelines for physical activity resided 

in the Rural/Frontier region (10.7%), while the largest 

percentage (21.2%) resided in the Northern Urban/ 

Metropolitan area (see Figure HR20). 

103



Region by Met Federal Guidelines for Physical 

Activity 

17.8% 18.4% 

Statewide 

Southern Urban 

Metropolitan 

21.2% 

Northern Urban 

Metropolitan 


10.7% 


An estimated 24.8% of older Nevada males met the 

federal guidelines for physical activity, compared 

with 11.6% of older Nevada females (see Figure 

HR21). 


Sex by Met Federal Guidelines for Physical 

Activity 

24.8% 


Education by Met Federal Guidelines for 


3.8% 

16.1% 

21.7% 



31.2% 



Income by Met Federal Guidelines for Physical 

Activity 

11.3% 10.7% 

< $15,000 $15,000 to 

$24,999 

14.7% 

$25,000 to 

$34,999 

24.9% 

$35,000 to 

$49,999 

27.3% 

$50,000 to 

$74,999 

34.5% 

$75,000+ 

11.6% 

Male 

Female 


The number of older adults meeting the federal 

physical activity guidelines increased with education 

(see Figure HR22) and income (see Figure HR23). 

Less than 5% of older adults with less than a 

high school education met the federal guidelines, 

compared with 31.2% of those with a college 

education. A smaller share adults making $35,000 or 

less (10.7%-14.7%) met the federal guidelines than 

those making $75,000 or more (34.5%). 

104


Body weight, including being overweight or obese, 

is the result of lifestyle choices, genetics, and 

the environment. Health issues associated with 

excessive weight include Type 2 diabetes, cancer, 

hypertension, cardiovascular disease, dyslipidemia, 

stroke, liver or gallbladder disease, osteoarthritis, 

sleep apnea and respiratory problems, and 

gynecological problems (CDC: Overweight and 

Obesity, 2012). Weight-related health problems, in 

addition to those associated with aging, compound 

the cost of health care. This is concerning given the 

projected increase in the older adult population 

(Fakhouri, Ogden, Carroll, Kit and Flegal, 2012). 

The Body Mass Index (BMI), an estimation of 

total body fat calculated by the ratio of height to 

weight, determines weight status (see Table HR10). 

Overweight and obese are “ranges of weight that 

are greater than what is generally considered 

healthy for a given height” (CDC: Overweight and 

Obesity, 2012). 

Between 2007 and 2010, 34.6% of U.S. adults 65 

and older (over 8 million) were obese (Fakhouri, 

Ogden, et al, 2012). Of adults 65-74, 40.8% were 

obese; however, a much smaller percentage of 

adults 75 and older (27.8%) were obese. No 

prevalence differences were noted by sex; however, 

differences were noted across sex by race/ethnicity. 

For example, significantly more non-Hispanic 

Black females 65 to 74 (53.9%) were obese than 

non-Hispanic White females (38.9%). Of females 

75 and older, significantly more non-Hispanic 

Black females (49.4%) were obese than either 

non-Hispanic White females (27.5%) or Hispanic 

females (30.2%; Fakhouri, Ogden, et al, 2012). 

In addition, the prevalence of obesity in females 

decreased with increases in education but only for 

females 65 to 74. 

Odgen, Carroll, Kit and Flegal’s (2012) study noted 

that over a third (35.7%) of U.S. adults and 17% of 

youth in 2010 met the criteria for obesity. Although 

rates of obesity across sex did not differ, adults 

over 60 were more likely to be obese (39.7%) than 

adults 20-39 (32.6%) or 40-59 (36.6%). In addition, 

more women 60 and older (42.3%) were obese than 

women 20-39 (31.9%; Ogden et al., 2012, p. 2). The 

percentage of obesity in men did not differ across 

age; however, rates of obesity did differ across 

race/ethnicity (e.g., Non-Hispanic Blacks, Mexican 

American), income and education (Ogden, Lamb, 

Carroll, and Flegal, 2010) 5 . 

The prevalence of obesity among Nevada adults 

18 and older (24.5%) is less than in the nation as 

a whole (35.7%) but has increased from 22.4% 

in 2010 (CDC: Overweight and Obesity, 2012). 

In 2011, an estimated 18.1% of Nevada adults 65 

and older met the criteria for obesity, 41.7% were 

overweight, and 2.7% were underweight (see Table 

HR11). These percentages differ only minimally 

from 2007 BRFSS data, which showed 18% of older 

Nevadans were obese and 43% were overweight 

(Elders Count Nevada, 2007). 

Although there were minimal differences noted 

among regions, 6% of older adults across all regions 

met the criteria for being underweight and less 

than 25% of older adults across all regions met the 

criteria for being obese. The highest percentages of 

older adults categorized as underweight (5.7%) and 

as obese (24.2%) were found in the Rural/Frontier 

region. The highest percentage of older adults at a 

healthy weight (41.3%) was found in the Northern 

Urban/Metropolitan region (see Figure HR24). 

The highest percentage of overweight older adults 

(43.5%) was found in Southern Urban/Metropolitan 

region (CDC: BRFSS, 2011). 


The prevalence of obesity increased among 

males from 1999 to 2010. Among males 65 to 74, 

prevalence increased from 31.6% in the 1999-2002 

study to 41.5% in the 2007-2010 study. In males 75 

and older, prevalence increased from 17.7% in the 

1999-2002 study to 26.5% in the 2007-2010 study. 

5 

Note that prevalence varied by sex for all three variables. 

105


50% 

40% 

30% 

20% 

10% 

0% 

Fig. HR24: Nevada Adults, Age 65 and 

Older: Region by Weight Category 

Underweight Healthy Weight Overweight Obese 





Interestingly, only minimal differences in weight 

category were associated with education or income. 

However, the percentage of older Nevadans 

categorized as underweight and healthy weight 

did increase with age; the share of those who 

were overweight or obese decreased (see Figure 

HR25). An estimated 2.1% of adults 65-74 were 

underweight, 31.2% were a healthy weight, 

46.5% were overweight, and 20.3% were obese. 

An estimated 3.7% of older adults 75-84 were 

underweight, while 45.9% were a healthy weight, 


Among the oldest Nevadans (85+), a higher 

percentage were categorized as underweight 

(4.6%), while 55.9% were at a healthy weight, 


Weight category differed by sex. An estimated 

49.6% of older males in Nevada were overweight, 

and 16.8% were obese. An estimated 34.5% of 

female respondents were overweight and 19.3% 

were obese (see Figure HR26). A greater percentage 

of older females than males met the criteria for 

being underweight (4.6%) or a healthy weight 

(41.6%). 


Older: Sex by Weight Category 

4.6% 

0.6% 

41.6% 

33.0% 

49.6% 

34.5% 


19.3% 

16.8% 


Male 

Female 

60% 

50% 

40% 

30% 

20% 

10% 

0% 


Older: Age by Weight Category 

65-74 75-84 85 and Older 



106


Hyperlipidemia (high blood cholesterol) and 

hypertension (high blood pressure) are associated 

with heart attack, stroke and cardiovascular disease. 

In 2010, heart disease was the leading cause of 

death, and stroke was the fourth-leading cause 

among U.S. adults 65 and older (Murphy, Xu, & 

Kochanek, 2012). Among Nevada adults in 2009, 

heart disease was the leading cause of death, 

stroke was the fifth-leading cause, and essential 

hypertension or hypertension-related renal disease 

was 17th (Kochanek, Xu, Murphy, Minino, & Kung, 

2011). In 2010, an estimated 5% of Nevadans 18 

and older had been told they had suffered a heart 

attack, 4% had been advised they had angina or 

coronary-artery disease, and 3.1% had suffered 

a stroke (CDC: BRFSS, Prevalence and Trends, 

Cardiovascular, n.d.). 

Among Nevada adults 65 and older, an estimated 

94.7% have had their cholesterol checked at least 

once in their lifetime (see Table HR12), 92.7% have 

had it checked in the past five years (see Table 

HR13), and 54% have been told their cholesterol 

levels are high (see Table HR14). Younger members 

of this population were more likely to have had 

their cholesterol checked than older members. The 

wealthier were also more likely (see Figure HR27 

and HR28). 


Older: Have had Cholesterol Checked in 

96.5% 

Lifetime 

92.0% 

90.4% 


While genetics may predispose individuals to high 

cholesterol and high blood pressure, lifestyle habits 

such as exercise and a healthy diet, coupled with 

medication, may improve health outcomes. The 

American Heart Association (AHA) recommends 

that adults have their cholesterol checked at least 

every five years and more often if 

• Total cholesterol is 200 mg/dL or more 

• Males older than 45 or females older than 50 

• HDL (good) cholesterol is less than 40 mg/dL 

• Other risk factors are present for heart disease 

and stroke (AHA, 2012, para. #7) 

In the United States, 79.2% of adults 18 and older 

said they’d had their cholesterol checked at least 

once, 75.5% said they’d had it checked in the past 

five years. Nearly 40% had been advised that their 

cholesterol was high (CDC BRFSS: Cholesterol 

Awareness, 2011). Fewer Nevada adults 18 and 

older had ever had their cholesterol checked 

(76.5%) or had had it checked in the past five years 

(71.5%). About the same percentage had been told 

that their cholesterol was high. 

93.6% 

65-74 75-84 85 and Older 


Fig. HR28: Nevada Adults 65 and 

Older: Income by Had Cholesterol 

Checked in Lifetime 

92.7% 

< $15K $15K - 

$24,999 

94.2% 

$25K - 

$34,999 

96.2% 96.4% 

$35K - 

$49,999 


$50K - 

$74,999 

99.3% 

$75K and 

Higher 

The percentage of older adults who had a check for 

cholesterol in the past five years also increased along 

with income (see Table HR14 and Figure HR29). 

Fewer older adults earning $15,000 to $24,999 

(89.7%) reported having had a check in the past five 

years than those earning $75,000 or more (98.5%). 

Several factors could explain these differences: 1) 

lack of information and awareness among people 

with lower incomes; 2) lack of access to health 

care; and 3) fewer resources to pay for cholesterol 

screenings. Only minimal differences occurred 

across region, sex, race/ethnicity, or education 

(CDC: BRFSS, 2011). 

107


Fig. HR29: Nevada Adults Age 65 and 

Older: Income by Cholesterol Check in 

Past Five Years 

90.2% 89.7% 

< $15K $15K - 

$24,999 

94.1% 

$25K - 

$34,999 

95.8% 96.1% 

$35K - 

$49,999 


As indicated previously, health professionals 

advised an estimated 54% of Nevada adults 65 

and older that they had high cholesterol (see Table 

HR14). Among older adults having high cholesterol, 

minimal percentage differences existed by region, 

sex, race/ethnicity, education or income. However, 

a higher percentage of adults 65-74 (61.0%) were 

told they had high cholesterol than adults age 75-84 

(45.4%) or those 85 and older (31.7%, see Figure 

HR30). 


$50K - 

$74,999 


Older: Age by Told They Have High 

61.0% Cholesterol 

45.4% 

31.7% 

65-74 75-84 85 and Older 

98.5% 

$75K and 

Higher 

Between 2005 and 2008, more than a third of 

U.S. adults 20 and older (33.5% or approximately 

76 million) had hypertension (National Health 

and Nutrition Examination Survey, 2005-2008, in 

Roger et al, 2012). Of these, approximately 80% 

were aware of their condition, 71% were under 

medication-therapy management, and 48% had 

controlled hypertension (Roger et al, 2012, p. e3). 

By 2011, 30.8% of U.S. and Nevada adults 18 and 

older had learned they had hypertension (CDC 

BRFSS: Hypertension Awareness, 2011). 

An estimated 61.2% of Nevada adults 65 and older 

had been told they had hypertension (see Table 

HR15, CDC: BRFSS, 2011). The percentage of 

respondents reporting hypertension varied only 

minimally by region, age, sex, or race/ethnicity. 

However, a higher percentage of older adults with 

less than a high school education (76.3%) reported 

having hypertension than those with a college 

education (54.6%; see Figure HR31). 


Older: Education by Hypertension 

76.3% 

61.5% 


The prevalence of reported hypertension decreased 

with income (see Figure HR32). For example, the 

lowest percentage of respondents reporting a 

diagnosis of hypertension (43.1%) earned $75,000 

or more per year. Among those earning less than 

$35,000 per year, the rates ranged from 66.5% to 

75.2%. 


56.4% 54.6% 


75.2% 


Older: Income by Hypertension 

66.5% 

< $15K $15K - 

$24,999 

71.7% 

$25K - 

$34,999 

58.7% 58.9% 

$35K - 

$49,999 

$50K - 

$74,999 

43.1% 

$75K to 

Higher 

108


The flu and secondary complications such as 

bacterial pneumonia are more likely to occur in 

adults 65 and older due to typically weaker immune 

systems (CDC: Seasonal Influenza, 2012). At 

particular risk are older adults with other medical 

conditions such as diabetes, cancer, kidney, lung, 

or heart problems (IFPMA, 2012). An estimated 

90% of flu-related deaths and 60% of flu-related 

hospitalizations occur in older adults (CDC: 

Seasonal Influenza, 2012). In 2010, influenza and 

pneumonia ranked as the seventh-most-common 

cause of death among U.S. adults 65 and older 

(Murphy, Xu, & Kochanek, 2012). The same was 

true in Nevada a year earlier (Kochanek, Xu, 

Murphy, Minino, & Kung, 2011). 

Fortunately, the probability of incurring these 

illnesses can be reduced with annual vaccinations. 

The CDC recommends routine annual flu 

vaccinations prior to flu season for all persons 

at least six months of age. In addition, the CDC 

recommends that adults 65 and older receive the 

pneumococcal polysaccharide vaccine (PPSV23) 

for prevention of pneumococcal pneumonia (CDC: 

Vaccines & Immunizations, 2012). In time for 

the 2012-2013 influenza season, Sanofi Pasteur, 

Inc. released Fluzone, a higher-dose flu vaccine 

composed of three flu strains specially formulated 

for older adults’ reduced immune response (CDC: 

Seasonal Flu, 2012). 

Of those who reported having had a flu shot 

in the past year, only minimal differences were 

noted by region, age, sex, race/ethnicity, education 

or income. For example, a slight increase in the 

percentage of adults having had the flu shot 

occurred with increases in age (see HR33). 


Older: Age by Had Flu Shot in Past Year 

52.4% 53.6% 


63.2% 

65-74 Years 75-84 Years 85 and older 

As with flu shots, the percentage of older adults 

who’d had a pneumonia vaccine differed only 

modestly across age, sex, race/ethnicity, education 

or income. The percentage of older adults having 

had the vaccine increased slightly with increases 

in age (see Figure HR34). This is good because 

increased age is associated with increased 

vulnerability to serious pneumonia-related health 

complications. In addition, less than half (49.8%) of 

Hispanic and 70.8% of White respondents reported 

having had the pneumonia vaccine. Nearly 64% of 

older adults with less than a high school education 

reported getting the vaccine. 


In 2011, 61.3%of U.S. adults 65 and older had 

received a flu shot within the past year, and 

70% (median percentage) had had at least one 

pneumonia vaccination (CDC: BRFSS, Prevalence 

and Trends: Immunization, 2011). The percentage 

of immunizations among Nevada’s older adults 

was lower. According to BRFSS 2011 results, an 

estimated 53.7% of adults 65 and older had received 

a flu shot in the year prior to the survey (see Table 

HR16), and an estimated 68.8% had received a 

pneumonia vaccination at some time in their lives 

(see Table HR18, CDC: BRFSS, 2011). 


Older: Had the Pneumonia Vaccine 

74.8% 

64.0% 


83.0% 


109



In 2010 cancer was the second-leading cause of 

death in the United States among adults 65 and 

older (Murphy, Xu, & Kochanek, 2012). The same 

was true among Nevadans 18 and older in 2009 

(Kochanek, Xu, Murphy, Minino, & Kung, 2011). 

In the general population, the following estimates 

exist about the of risk diagnosis with various cancers 

(American Cancer Society, 2012): 

• 1 in 8 women will be diagnosed with invasive 

breast cancer at some point in their lives, and 1 

in 36 will die of the disease (American Cancer 

Society, Breast Cancer, 2012). 

• 1 in 71 women will be diagnosed with invasive 

ovarian cancer in their lifetime, and 1 in 95 will 

die from the disease (American Cancer Society, 

Ovarian Cancer, 2012). 

• 1 in 20 will develop colorectal cancer during 

their lifetime (American Cancer Society, 

Colorectal Cancer, 2012). 

• 1 in 6 men will be diagnosed with prostate 

cancer in their lifetime, and 1 in 36 will die from 

the disease (American Cancer Society, Prostate 

Cancer, 2012). 

An estimated 65.2% of U.S. adults 50 and older 

and 61.5% of Nevada adults in the same age 

range indicated that they had undergone another 

type of colorectal-cancer screening called a 

sigmoidoscopy or colonoscopy (CDC: BRFSS, 

Prevalence and Trends – Colorectal Cancer, 2011). 

Among Nevada adults 65 and older, an estimated 

67.6% had a sigmoidoscopy or colonoscopy (see 

Table HR20, CDC: BRFSS, 2011). Only minor 

differences in percentages were noted across region, 

age, sex, race/ethnicity and education. However, 

the percentage of those having had this type of 

colorectal cancer screening was lower among those 

older adults earning less than $15,000 per year 

(55.2%) than among those earning $75,000 or more 

(77.2%; see Figure HR35). 


Older: Had Sigmoidoscopy or Colonoscopy 

55.2% 56.0% 

< $15,000 $15,000 to 

$24,999 

76.5% 74.4% 74.6% 77.2% 

$25,000 to 

$34,999 

$35,000 to 

$49,999 


$50,000 to 

$74,999 

$75,000+ 

110 

Early detection and treatment of precancerous and 

cancerous cells can help in the prevention and 

treatment of cancer. For example, the 2.3% per 

year decrease in breast-cancer mortality since 1990 

has been partially attributed to mammographic 

screening, particularly among women 60-69 

[U.S. Preventive Services Task Force (USPSTF): 

Breast Cancer Screening, 2012)]. Based on metaanalysis 

of current research the USPSTF provided 

to Congress, the following cancer-screening 

recommendations exist for adults with no current 

signs or symptoms. 

In the 2010 BRFSS survey, an estimated 17.2% 

of U.S. and Nevada adults 50 and older reported 

having had a blood-stool screening for colorectal 

cancer within the past two years (CDC: BRFSS, 

Prevalence and Trends – Colorectal Cancer, 2011). 

Among Nevada adults 65 and older, 21.2% reported 

having had the colorectal screening (see Table 

HR19, CDC: BRFSS, 2010). Only minor differences 

in percentages were noted across region, age, sex, 

race/ethnicity, education or income. 

In 2010, an estimated 53.2% (median percent) 

of U.S. and 51.8% of Nevada males 40 and older 

reported having had a prostate cancer (PSA) test 

(CDC: BRFSS, Prevalence and Trends – Prostate 

Cancer, 2011). Among Nevada adults 65 and 

older, a much higher percentage (75.5%) reported 

having had a PSA test (see Table HR21, CDC: 

BRFSS, 2011). Only minor percentage differences 

were noted across region, age, sex, education or 

income. One issue is that rates of prostate cancer 

vary based on race/ethnicity. For example, in 2008, 

Black men in the United States had the highest 

rates of prostate cancer followed by Whites and 

then Hispanics (CDC: Prostate Cancer, 2012). 

Unfortunately, minority-population samples for this 

item in the 2011 BRFSS for Nevada were insufficient 

to maintain reliability; therefore, no data analysis 

was completed. Given the importance of this 

information and the rising numbers of minorities 

in Nevada, future survey methods should strive 

to increase the response rates among Nevada’s 

minority populations.

An estimated 81.3% (median percent) of U.S. 

females and 78.4% of Nevada females 18 and 

older reported having had a Pap test between 

2007 and 2010 to screen for uterine cancer (CDC: 

BRFSS, Prevalence and Trends – Women’s Health, 

2011). Unfortunately, the 2010 BRFSS did not ask 

a question about Pap tests, specifically, to women 

50 or older, and no data were available regarding 

Pap screening from the 2011 survey. In a recent 

qualitative and quantitative study, Leach and 

Schoenberg (2007) noted that 84.7% of women 

55 and older reporting having had a Pap cervical 

screening test within the past three years. This 

percentage, while high, is lower than the Healthy 

People 2020 goal of 93% for women 21-65. Barriers 

to obtaining Pap examinations included living 

alone, living in a rural area, or being older. These 

considerations may be important for older Nevada 

females residing in the Rural/Frontier regions of the 

state. 

In addition, in 2010 an estimated 77.9% (median 

percent) of U.S. females 50 and older and 69.9% 

of Nevada females in the same age group reported 

having had a mammogram in the past two years. 

Among Nevada females 65 and older, an estimated 

70.4% reported having had a mammogram in the 

two years prior to the 2010 survey (see Table HR22; 

CDC: BRFSS, 2010). 

Fig. HR36: Nevada Females, Age 65 and 

Older: Education by Mammography in 

Past Two Years 

49.7% 

69.3% 72.3% 


In addition to differences associated with education, 

fewer females earning less than $24,999 reported 

having had a mammogram in the past two years 

than those earning $75,000 or more (see Figure 

HR37). These differences (lower percentages 

associated with less education and lower income) 

might be a consequence of differences in access to 

health care, ability to pay for the cancer screening, 

or medical insurance that would cover the cost. 


79.8% 


Fig. HR37: Nevada Females, Age 65 and 

Older: Income by Mammography in 

Past Two Years 

66.6% 

61.5% 

< $15,000 $15,000 to 

$24,999 

56.2% 

$25,000 to 

$34,999 

74.5% 

$35,000 to 

$49,999 

83.1% 

$50,000 to 

$74,999 

87.9% 

$75,000+ 


The percentage of females who’d had a 

mammogram differed by education (see Figure 

HR36) and income (see Figure HR37). Far fewer 

older females with less than a high school education 

reported having had mammography (49.7%) than 

those with a college education (79.8%). 

Again, the minority sample sizes for this BRFSS 

item were too small for reliable analysis. Given 

that breast cancer rates in Black and Hispanic 

women are almost as high as those found in White 

women (CDC: Breast Cancer, 2012), it is imperative 

that future surveys capture data among Nevada’s 

minority female populations. 

111


HIV/AIDS & Other Sexually Transmitted Diseases 

Human Immunodeficiency Virus (HIV), a sexually 

transmitted virus that attacks the immune 

system, was first diagnosed in the United States 

approximately 31 years ago. Initially, progression 

from HIV to Acquired Immunodeficiency Syndrome 

(AIDS) with full immune collapse and death took 

approximately 10 years. However, the recent 

development of HIV medication regimens (e.g., 

Highly Active Antiretroviral Therapy) has mitigated 

the progression, increasing life expectancy to more 

than 30 years [see Figure HR38, Administration on 

Aging (AOA) Positive Aging: HIV Webinar, 2011; 

Karpiak, 2011). 

Fig. HR38: Median Life Years at Age 20 with 

HIV and in Care 

2 

4 

24.3 

27.1 

33.2 

Explanations for the increase in HIV among older 

adults include older adults’ lack of information and 

awareness about HIV risk factors; this may lead to 

unprotected sexual activity (Karpiak, 2011). The 

increase in illicit substance use among adults 50 and 

older also may put them at risk for HIV. The stigma 

associated with HIV infection may result in delayed 

testing in older adults. This might also cause medical 

personal to misinterpret HIV symptoms (e.g., fatigue, 

frequent illnesses, weight loss) as issues related to 

age (CDC: HIV/AIDS among Persons, 2008). 

HIV/AIDS prevention and treatment interventions 

generally are not targeted toward older adults 

because of the biased belief that this population is 

not sexually active and therefore not at risk. Yet HIV 

would leave seniors more susceptible to diseases 

normally associated with aging, such as cancer, 

cardiovascular disease, osteoporosis, liver disease, 

kidney disease and diabetes (Karpiak, 2011). 

112 

1985-87 1990-92 1995-97 2000-2002 2003-2005 

(AOA Webinar, Karpiak, 2011) 

By 2010, more than 1.1 million U.S. individuals 

13 and older had acquired HIV (CDC: HIV/AIDS, 

Statistics, 2012); and by 2015, half of all U.S. adults 

infected with HIV will be 50 or older (Effros, 

Fletcher, Gebo, et al., 2008). In 2010 an estimated 

7,797 new cases of HIV were diagnosed among 

adults 50 and older with 7,908 new diagnoses of 

AIDS (see Figure HR39 and Table HR23; CDC: 

HIV/AIDS, Statistics, 2012). Translated, this means 

that roughly 1 in 6 new diagnoses for HIV annually 

occur in adults 50 and older (Karpiak, 2011). 

Under 13 

13-14 Years 

15-19 Years 

20-24 Years 

25-29 Years 

30-34 Years 

35-39 Years 

40-44 Years 

45-49 Years 

50-54 Years 

55-59 Years 

60-64 Years 

65 or Older 

Fig. HR39: U.S., 2010: Estimated Number of HIV/AIDS 

Diagnoses 

0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 

(CDC: HIV Statistics, 2012) 

AIDS 

HIV 

Another important consequence of HIV/AIDS 

in older adults is the increased risk of isolation 

and loneliness. Karpiak (2011) noted that 70% of 

older adults with HIV live alone and that the most 

frequent co-occurring condition is depression. This 

is significant, considering that depression impacts 

health outcomes and is negatively correlated with 

adherence to medication regimens, including a 

regimen for HIV. 

The rate of AIDS diagnoses among all Nevadans in 

2010 (12.6 per 100,000) was lower than the national 

rate [13 per 100,000; CDC: National Center for HIV/ 

AIDS, Viral Hepatitis, STD, and TB Prevention 

(NCHHSTP) Atlas, 2012). However, among adults 55 

and older, the rate of AIDS diagnoses for Nevadans 

(6.3 per 100,000) was higher than the national rate 

(5.4 per 100,000). 

Among Nevada adults 65 and older, 325 were 

living with HIV/AIDS in 2011 and six were newly 

diagnosed with HIV infection [Nevada State Health 

Division HIV/AIDS Reporting System (eHars), 2012). 

The rate of new HIV diagnoses in 2011 was 1.8 per 

100,000. The rate for those living with HIV/AIDS was 

98.2 per 100,000 (see Table HR25).

Of older Nevada adults living with HIV/AIDS, the 

vast majority (an estimated 80.3%) reside in the 

Southern Urban/Metropolitan region of the state; 

12.3% live in the Northern Urban/Metropolitan 

region; 7.4% live in Rural/Frontier regions (see Table 

HR26, eHars, 2012). In addition, the majority are 

males (85.5%) age 65-74 (86.8%) and White (68.9%). 

The primary method of HIV transmission among 

older males was male-to-male sexual (MSM) contact 

(73.0%), followed by cases with no identifiable or 

reported risk factor (11.2%). An estimated 8.3% 

of transmissions occurred by drug injection and 

4% through heterosexual contact. Alternatively, 

the primary method of transmission among older 

females was heterosexual contact (78.7%) with 

12.8% by drug injection and 8.5% having no 

identifiable or reported risk factor (see Figure HR40). 


Primary Method of HIV Transmission 

No Identified/Reported Risk 8.5% 

11.2% 

Transfusion/Hemophilia 

0.4% 

Heterosexual contact 

4.0% 

78.7% 

MSM+IDU 

3.2% 

Injection Drug use (IDU) 

12.8% 

8.3% 

Male-to-Male Sexual Contact (MSM) 

73.0% 

0% 20% 40% 60% 80% 

Females Males 

(eHars, 2012) 

In addition to HIV/AIDS, sexually transmitted 

diseases (STDs) are a major public health concern 

for adolescents and young adults (CDC: Fact Sheet, 

2011). Diseases such as chlamydia, gonorrhea 

and syphilis may be under-reported and underdiagnosed 

(CDC: Fact Sheet, 2011, para 1). When 

untreated, STDs such as the Human papillomavirus 

(HPV) may be associated with cervical cancer, while 

others (e.g., chlamydia and gonorrhea) may lead 

to infertility or even, in the case of syphilis, death. 

Unfortunately, the same biases surrounding older 

adults and HIV/AIDS also exist with older adults and 

STDs. For example, a meta-analysis of STD-riskreduction 

clinical trials between 1994 and 2005 noted 

the exclusion of older adults (65 and older) from 89% 

of the clinical trials (Levy, Ding, Lakra, Kosteas, & 

Niccolai, 2007). 

Listed below are rates 6 of sexually transmitted 

disease cases among Nevada adults 65 and older 

in 2011 [see Table HR27) Nevada State Health 

Division, Sexually Transmitted Disease Management 

Information Systems (STD*MIS), 2012]. 

• Chlamydia 3.9 

• Gonorrhea 1.8 

• Primary/Secondary Syphilis 1.2 

• Early Latent Syphilis 0.3 

Of the 22 Nevada cases of STDs in adults 65 and 

older diagnosed in 2011, the percentages for all 

were higher for males than for females (see Figure 

HR41). While 22 cases may seem inconsequential, 

this should still be of concern for this particular 

population. In addition, rates of chlamydia, 

gonorrhea and primary and secondary syphilis were 

higher among older Nevada males compared with 

U.S. males (CDC: Division of STD Prevention, 2012). 

The rate of people of gonorrhea in older Nevada 

females (0.6 per 100,000) also was slightly higher 

than found nationally (0.4 per 100,000), but the rate 

of chlamydia nationally (2.1 per 100,000) was higher 

than in older Nevada females (1.7 per 100,000; see 

Figure HR 42). 

76.9% 

23.1% 

Chlamydia 

(n=13) 


STD Cases, 2011 

83.3% 

16.7% 

Gonorrhea 

(n=6) 

100.0% 100.0% 

P&S Syphilis 

(n=2) 

(STD*MIS, 2012) 

0.0% 0.0% 

EL Syphilis 

(n=1) 

Fig. HR42: U.S. and Nevada Adults, Age 65 

and Older: Rates of STD Cases per 100,000, 

2011 

3.3 

2.1 

6.7 

1.7 

2.8 

3.3 

0.4 0.6 

0.8 

(CDC: Division of STD Prevention, 2012) 

Male 

Female 

1.3 

0 0 

U.S Nevada U.S Nevada U.S Nevada 

Chlamydia Gonorrhea P&S Syphilis 

Male 

Female 


6 

Rates are per 100,000. 

113



Aging is associated with physical changes that 

decrease motor stability and increase the chance for 

falls and fall-related injuries. Decreases in muscle 

mass and degeneration in load-bearing joints 

are associated with reductions in overall strength 

and decreased ability to move without assistance. 

Impairments in sensory abilities such as vision and 

hearing decrease an adult’s ability to recognize 

navigation cues. Vision deficits such as cataracts, 

presbyopia, and loss of night vision make it more 

difficult for older adults to recognize and avoid 

objects in their path. Hearing loss can directly affect 

postural balance and awareness of the environment 

or indirectly affect an elder’s ability to attend to 

environmental cues (Lin & Ferrucci, 2012). A recent 

study of adults 40-69 noted an association between 

even mild hearing loss and an increase in reported 

falls (Lin & Ferrucci, 2012). 

Twenty to 30% of falls by older adults are associated 

with moderate-to-severe injuries (CDC: Home 

and Recreational Safety-Falls, 2012). Falls can lead 

to injuries such as head trauma (TBI), lacerations, 

contusions, hip and other fractures, strains/sprains, 

hematomas and early death. In 2006 the annual 

fall-related fatality rate among U.S. adults 65 and 

older was 38.02 per 100,000. For Nevada seniors the 

rate was 27.22 (see Figure HR44 and Figure HR45, 

CDC: WISQARS, Fatal Injury Mapping, 2000-2006). 

As indicated in HR45, fall-related death rates were 

available only for the Northern and Southern Urban 

Metropolitan areas of the state. 

Fig. HR44: 2000-2006, United States, Death Rates per 100,000: 

Falls, Unintentional, Ages 65 and Older, Annualized Crude Rate, 

38.02 per 100,000 

In 2011, unintentional falls were the leading 

cause of nonfatal injury among U.S. adults 65 and 

older. Falls accounted for 62.9% of all nonfatal 

injuries (see Figure HR43 and Table HR28; CDC: 

WISQARS, 10 Leading Causes, 2012). More than 

2 million fall-related injuries led to emergency 

department visits (CDC: WISQARS, Unintentional 

falls, 2012). However, the number of falls among 

older adults may actually be underestimated. Even 

though 1 in 3 older adults fall each year, very few 

incidences are reported to medical providers (CDC: 

Home and Recreational Safety-Falls, 2012). 

Fig. HR43: U.S. Adults, Age 65 and Older: Ten 

Leading Causes of Nonfatal Injury 

(CDC: WISQARS, Fatal Injury Report, 2000-2006) 

Fig. HR45: 2000-2006, Nevada, Death Rates per 100,000: 

Falls, Unintentional, 65 and Older, Annualized Crude Rate, 

27.22 per 100,000 

All Others 

Unintentional Unk/Unspecified 

Unintentional Other Transport 

Unintentional Other Specified 

Unintentional Other Bite/Sting 

Unintentional Poisoning 

Unintentional Cut/Pierce 

Unintentional MV-Occupant 

Unintentional Overexertion 

Unintentional Struck By/Against 

Unintentional Fall 

Overall Injuries 

5.6 

1.5 

1.7 

2.0 

2.5 

2.5 

3.9 

5.1 

5.3 

7.1 

62.9 

100.0 

(CDC: WISQARS, 10 Leading Causes, 2011) 

(CDC: WISQARS, Fatal Injury Report, 2000-2006) 

114

In 2007, 107 Nevada adults 65 and older died from 

injuries related to a fall. Of these, 48 were White 

males and 50 were White females. Also in 2007, the 

Nevada annualized death rate due to fall-related 

injuries was 36.8 per 100,000 older adults (CDC: 

WISQARS, Fatal Injury Mortality Report, 2007). That 

same year, the national fall-related death rate among 

older adults was 48.5 per 100,000 (see Table HR 

29, CDC: WISQARS, Fatal Injury Mortality Report, 

2007). 


According to the U.S. Administration on Aging 

(AoA) National Center on Elder Abuse (NCEA), 

no nationally accepted definition exists for elder 

abuse/mistreatment. All state-law definitions cover 

three basic categories of abuse: “domestic elder 

abuse, institutional elder abuse, self-neglect or 

self-abuse” (AOA: NCEA, 2012, para. #2). Domestic 

elder abuse includes abuse instigated by a person 

in a relationship with the elder and in the elder’s 

home (or the caregiver’s home). Perpetrators of 

domestic elder abuse include family members, 

friends and caregivers. Institutional abuse occurs in 

institutional-care settings such as nursing homes 

or group homes. Instigators of this abuse include 

institutional staff or providers. Self-abuse or neglect 

may occur anywhere and occurs when older adults 

intentionally or unintentionally harm themselves. 

Examples include failure to take medications as 

prescribed, failure to take in adequate nutrition 

or maintain hydration, and failure to maintain 

adequate hygiene. In addition to the three 

categories of elder abuse, there are six types of 

abuse: physical abuse, sexual abuse, emotional/ 

psychological abuse, neglect, financial abuse/ 

exploitation and abandonment. 

An estimated $30 billion in direct and indirect 

health-care costs resulted from fall-related injuries 

among older adults in 2010 (CDC: Home and 

Recreational Safety-Cost, 2012). By 2020, this cost is 

predicted to increase to almost $55 billion annually. 

National statistics on elder abuse/neglect are 

difficult to find because the situation is underidentified 

and under-reported. The 2010 National 

Elder Abuse Mistreatment Study assessed a oneyear 

prevalence of abuse (Acierno, et al., 2010). Of 

adults 60 and older who responded to the survey, 

11.4% described at least one instance of abuse 

in the previous year. Specifically, 4.6% reported 

past-year emotional mistreatment, 1.6% reported 

physical abuse, 0.6% reported sexual mistreatment, 

5.9% reported potential neglect, and 5.2% reported 

financial mistreatment. Low social support was the 

greatest predictor of mistreatment (Acierno, et al., 

2010). 

Of those who described mistreatment in the 

Acierno et al. (2010) study, few reported the 

incidences to authorities. The 1998 National Elder 

Abuse Incidence Study (NCEA, 1998) also noted 

that in 1996 more than 80% of elder-abuse cases 

were not reported. Victims may elect not to report 

abuse because they: 

• Feel ashamed and embarrassed, particularly if a 

family member is the abuser; 

• Are afraid that the abuser will get “in trouble;” 

• Worry that they will be forced to live in a 

nursing home, and this sometimes happens; 

• Feel guilty or somehow to blame; 

• Are in denial that the abuse is occurring, or 

unaware that what they are experiencing is 

abuse or neglect; 

• Are afraid that if they report, the abuse will get 

worse (AOA: NCEA, How to answer the tough 

questions, 2012, p. 2). 


115


Penalties for conviction of elder abuse in Nevada 

include up to a 20-year prison term with additional 

penalties possible under Nevada’s elder-abuse 

statutes, NRS 200.5092-50995. 

The Nevada Aging and Disability Services Division’s 

(ADSD) Elder Protective Services (EPS) and local 

law enforcement investigate allegations of abuse, 

exploitation, isolation, neglect and self-neglect for 

persons 60 and older. ADSD has four offices, in 

Carson City, Elko, Las Vegas and Reno. EPS social 

workers, with an average caseload in FY 2012 of 43 

cases, examine allegations of abuse, exploitation, 

isolation, neglect and self-neglect across all Nevada 

counties (ADSD: EPS Caseload Statistics, 2012). In 

FY 2012 (i.e., between 7/1/11 and 6/30/12), EPS and 

Nevada law enforcement received 5,374 allegations 

of elder abuse. Of these allegations, 21.9% (n = 

1,176) were for abuse, 21.8% (n = 1,173) were for 

neglect, 31.8% (n = 1,711) were for self-neglect, 

21.8% (n = 1,171) were for exploitation, and 2.7% (n 

=143) were for isolation (see Table HR30). 

Fig. HR47: Nevada, Elder Abuse, Age 60 and 

Older, FY2012: Victim Age 

11.6% 12.5% 

14.8% 

17.0% 

(ADSD: EPS, 2012) 

19.0% 

25.2% 

60-65 66-70 71-75 76-80 81-85 86- Plus 

Suspects in the cases closed in FY 2012 included 

the client’s themselves (33.2%, i.e., in self-neglect 

cases), the client’s child (23.1%), the service 

provider (13.2%), a relative (10.5%), the client’s 

spouse (9.1%), a friend or neighbor of the client 

(4.9%), and other individuals with unknown 

relationship to the client [6% (see Figure HR48). 


Older, FY2012: Suspect 

Friend-Neighbor 

Other 

4.9% 

6.0% 

116 

Between FY 2011 and 2012, allegations of abuse, 

neglect, exploitation and isolation increased. 

Allegations of self-neglect decreased (see Figure 

HR46, and Table HR31). 

Fig. HR46: Nevada Elder Abuse, Age 60 and 

Older: FY 2011 verus FY 2012 

1176 1173 

1036 1061 

1859 

(ADSD: EPS, 2012) 

The majority of clients with cases closed (i.e., 

investigation concluded) during FY 2012 were White 

(78.8%), female (62.8%), and living independently 

in their communities (80.4%). Of the remaining, 

7.4% were African American, 5.3% were Hispanic, 

2.3% were Asian, 4.4% were listed as “other,” 0.9% 

were American Indian/Alaskan Natives, and 0.9% 

were Pacific Islander/Hawaiian. In addition, 10.1% 

of the clients resided in nursing facilities, 9.2% lived 

in residential facilities for groups, and 0.3% lived 

in homes for individual residential care. A greater 

percentage of allegations for cases closed in FY 2012 

(25.2%) were for the oldest clients, 86 or older, than 

for clients in younger age groups (see Figure HR47). 

1711 

1139 

1171 

Abuse Neglect Self-Neglect Exploitation Isolation 

FY 2011 FY 2012 

142 

143 

Spouse-Significant Other 

Other relative 

Service Provider 

Child 

Self 

9.1% 

10.5% 

13.2% 

(ADSD: EPS, 2012) 

Of the allegations for cases closed in FY 2012, 

25.9% (n = 1,390) were substantiated, and 72.5% (n 

= 3,894) were unsubstantiated (see Table HR32). Of 

all substantiated cases, 38.5% were for self-neglect, 

22.5% were for abuse, 20.4% were for neglect, 

17.2% were for exploitation, and 1.4% was for 

isolation (Figure HR49). 

(ADSD: EPS, 2012) 

23.1% 


Older, FY2012: Substantiated Cases 

22.5% 

20.4% 

38.5% 

17.2% 

33.2% 

1.4% 

Abuse Neglect Self-Neglect Exploitation Isolation


Older adults have a higher motor vehicle accident 

rate than younger adults (Owsley, 2004), and the 

accident-related fatality rate for adults 80 and older 

is four times the rate for adults 30-59 [National 

Highway Traffic Safety Administration (NHTSA), 

2008, p. 2). In 2010, 6,443 U.S. adults 65 and older 

died in motor vehicle accidents for a crude overall 

death rate of 16 per 100,000 (see Table HR33, 

WISQARS, 2010). For all adults 65 and older, the 

crude death rate per 100,000 was higher for males 

than females (see Table HR34) and increased with 

age (see Figure HR50). In 2010, 54 adults 65 and 

older in Nevada died in motor vehicle accidents for 

a crude death rate of 16.7 per 100,000 (WISQARS, 

2010). In 2011, motor vehicle accidents were the 

fourth-leading cause of nonfatal injuries in U.S. 

adults 65 and older with 194,678 nonfatal injuries 

and a crude injury rate of 470.3 per 100,000 

(WISQARS, 2011). 

Fig. HR50: U.S. Adults, Age 65 and 

Older: Age by Motor Vehicle Death 

Rates per 100,000 

12.05 12.7 

17.31 

(WISQARS, 2010) 

20.74 

23.83 

65-69 Years 70-74 Years 75-79 Years 80-84 Years 85 and Older 

Crude motor vehicle accident mortality rates for U.S. 

adults 65 and older varied by race in 2010 (see Table 

HR35, WISQARS, 2010). For example, the rate for 

older American Indian/Alaskan Natives was 20 per 

100,000, while the rate for older Whites was 16.4 per 

100,000. In addition, mortality rates for both groups 

were higher than the national 65+ rate of 16 per 

100,000. 

Risk factors for motor vehicle accidents in older 

adults include age-related physiological changes. 

Driving skills are impaired by decreases in vision, 

cognition, strength, flexibility and functional 

impairments such as reduced response time to 

stimuli (NHTSA, 2012; Owsley, 2004). A recent 

NHTSA study found nine performance errors in 

older adults involved in motor vehicle accidents, 

including: 

1. Failing to detect potential conflicts, hazards or 

traffic-control information; 

2. Misjudging gaps when crossing or merging into 

traffic; 

3. Failing to predict the development of future 

conflicts based on current traffic and contextual 

information; 

4. Delayed vehicle-control response; 

5. Inadequate visual search; 

6. Slowed decision-making; 

7. Not following the rules of the road; 

8. Not using safe driving practices; 

9. Selecting an inappropriate response (NHTSA, 

2012, p. 1). 

Age-related changes in vision, such as the growth 

of cataracts, are common in older adults. These 

reduce sight by decreasing visual resolution and 

increasing contrast sensitivity and glare (Owsley, 

2004). Glaucoma, another age-related visual disease, 

results in impairment in peripheral vision and may 

reduce awareness of obstacles (Owsley, 2004). Aging 

also is associated with slowed visual-process speed 

and impaired ability to divide attention. These last 

factors are associated with a two-fold increase in 

crash risk (Owsley, 2004, slide #53). Increases in 

fragility among adults 60 and older may also factor 

into motor vehicle fatalities (NHTSA, 2008). 

According to the National Highway Traffic Safety 

Administration (NHTSA), seat belts (correctly used) 

are the most effective means of preventing serious or 

fatal injury in a motor vehicle crash (NHTSA, 2008, 

p. 1). In 2011, 93.3% (median percent) of U.S. adults 

and 94.6% of Nevada adults 18-44 reported that they 

always wear a seat belt (CDC: BRFSS, Injury, 2011). 

A slightly lower share (89.8%) of U.S. adults 65 and 

older reported that they always use a seatbelt, but 

4.3% reported that they nearly always wear one, and 

2.4% stated that they sometimes wear one (see Table 

HR36, CDC: BRFSS, 2011). Of the remaining, 0.6% 

seldom wear a seatbelt, and 1.6% indicated that they 

do not drive or ride in motor vehicles. 


117


Reasons for using or failing to use seatbelts vary. In 

a meta-analysis of 147 studies, NHTSA (2008) noted 

that seatbelt use for drivers of all ages is influenced 

by “socioeconomic status, trip length, seating 

position, physical capabilities, and comfort and 

convenience” (p. 52). For older drivers in particular, 

non-use may result from habits/behaviors developed 

over time, trip length, or physical limitations that 

negatively influence comfort. For example, older 

males were less likely to use seatbelts than older 

females. Physical limitations, such as arthritis, 

inability to twist the neck/torso, or obesity, may also 

lower the use of seatbelts (NHTSA, 2008). 

Veterans 

In this section, we will discuss specific risk 

behaviors in older veterans, including substance 

use, homelessness and motor vehicle fatalities. The 

current focus nationally is on veterans returning 

from the Iraq and Afghanistan combat theaters 

rather than on the older generation of veterans 

who might have served in World War II, Korea or 

the Vietnam War. However, information obtained 

about recent combat veterans may generalize to 

the older veterans. For this reason, recent findings 

about combat veterans will be included in this 

section along with data specific to older veterans. 

A 2004 study of Vietnam (combat) versus Vietnam- 

Era (non-combat) veterans noted a higher 

prevalence of current and past health problems in 

combat veterans, including hearing loss and such 

mental health issues as depression, Post Traumatic 

Stress Disorder (PTSD), and anxiety. In addition, 

the study found higher mortality rates for those 

who had served in combat (CDC: Veterans’ Health 

Activities, 2010). Contributing to these higher 

mortality rates were unintentional poisonings and 

drug-related issues. 

Another study of post-combat veterans, between 

2002 and 2008, found significant increases in 

prescription-drug abuse (NIDA: Topics in Brief, 

2011). In addition, the 2008 Department of Defense 

Health Behavior Study noted an increase in heavy 

alcohol use but reported that tobacco and illicit 

drug use decreased. The Millennium Cohort Study 

2001-2022 reported increased risk of alcohol use 

and abuse and increased smoking initiation among 

combat-deployed reserve and National Guard 

service members (NIDA: Topics in Brief, 2011). 

Combined 2004-2006 data from the National 

Survey on Drug Use and Health (NSDUH) survey 

estimated that 20.9% of veterans 18-25, 11.2% of 

veterans 26-54, and 4.3% of veterans 55 and older 

experienced symptoms of serious psychological 

distress in the year prior to the survey (SAMHSA, 

2007). In addition, an estimated 4.4% of veterans 

55 and older met criteria for substance use disorder, 

and 0.7% met criteria for co-occurring serious 

psychological distress and substance use disorder. 

Nora Volkow, director of the National Institute on 

Drug Abuse (NIDA), noted in 2009 that veterans 

showed 50% higher rates of tobacco use, higher 

rates of binge drinking, and lower rates of illicit 

substance abuse than civilians. She predicted even 

higher rates of substance use in veterans who have 

been in combat and subsequently experienced 

PTSD or mental health issues. 

118

Confounding the issue for many is “service 

members’ reluctance to seek treatment,” for fear 

of military discipline (e.g., discharge) or a belief 

that treatment equals weakness (Volkow, 2009, 

para. #4). For example, Kathryn Power, director of 

the Substance Abuse and Mental Health Services 

Administration’s (SAMHSA) Center for Mental 

Health Services, noted in 2008 that only 30% to 

40% of eligible veterans actually seek Veterans 

Administration services to address mental health 

(and possibly substance use) issues (Benderly, 

2008). Alternatively, Booth and Blow (2008) noted 

either consistency or an increase in baby boomer 

veterans’ utilization of VA inpatient substance 

abuse services between fiscal years 1988, 1991, 

1994 and 1998. They also noted an increase in 

use of other inpatient services where substance 

abuse problems were the secondary diagnosis. 

As these researchers indicated, “there does not 

appear to be an aging-out phenomenon for baby 

boomer veterans,” that is, veterans do not outgrow 

substance use as they age (Booth & Blow, 2008, 

Conclusion Section, para. #2). 

Data on the prevalence of substance-risk behaviors 

among older veterans in Nevada are not available 

for this report. In 2009, per the Nevada Legislature, 

veteran specialty courts were established for 

nonviolent offenders charged with crimes and 

problems related to military service or adjustment 

to civilian life (Nevada Office of Veterans Services, 

2012, Section V). That year, Veteran’s Specialty 

Courts began in Washoe County and Henderson, 

Nevada. In July 2012, the Clark County District 

court system also proposed development of a 

veteran’s court (Jourdan, 2012); however, as of this 

report the court had yet to be established. 

2009-2012 demographics for the Washoe County 

Veteran’s Court indicate that 31% of veteran clients 

were charged with drug and alcohol crimes, 24% 

with crimes against a person, 24% with property 

crimes, and 21% with nuisance crimes (Nevada 

Office of Veterans Services, 2012). Of these, 69% 

were felonies, 25% were misdemeanors, and 6% 

were gross misdemeanors. 

Between 2009 and 2012, Washoe County’s 

Veteran’s Court served 99 participants, ranging in 

age from 20 to 78 (M = 45.5 years). The majority 

of clients were White (80%) males (91%). Twelve 

percent were Black, 7% were Hispanic, and 

1% were Asian. The most common substances 

involved with drug- or alcohol-related crimes 

were poly-substance abuse, alcohol, marijuana, 

methamphetamines, heroin/opiates and cocaine. 

Homelessness in veterans also is a public health 

concern. A 2012 study of homelessness among 

veterans in the seven Continuum of Care (CoC) 

metropolitan areas noted that 8.2% (n = 10,726) of 

the Homeless Management Information System 

homeless population (n = 130,554) were veterans 

(Fargo, et al., 2012). The study also found that … 

“… male veterans were almost 50% as 

likely (adjusted odds ratio [AOR], 1.47; 95% 

confidence interval [CI], 1.19-1.81) and female 

veterans were almost twice as likely (AOR, 

1.97; 95% CI, 1.25-3.12) to be homeless as 

nonveterans in the general population. Among 

the population in poverty, male veterans were 

more than twice as likely (AOR, 2.20; 95% CI, 

1.96-2.48) and female veterans were more than 

three times as likely (AOR, 3.33; 95% CI, 2.17- 

5.13) to be homeless as nonveterans” (Fargo., et 

al., 2012, p. 3). 

Risk factors for homelessness included sex, age, 

race and poverty status. Nearly 7% of the homeless 

veterans were between 18 and 29 years of age, 24% 

were 30-44, 40.8% were 45-54, 23.3% were 55-64, 

and 5.1% were 65 or older. Nearly 90% of homeless 

veterans were male, and 10.2% were female. Fortysix 

percent were Black and 54% were Non-Black. 

Veterans are more vulnerable than are non-veterans 

to homelessness caused by a combination of sex, 

poverty and race. For example, 52.8% of Black male 

veterans 18-29 and 36.3% of Black female veterans 

living in poverty were homeless. Of the Non-Black 

male veterans in poverty, 7.3% were homeless, and 

of the Non-Black female veterans living in poverty, 

11.9% were homeless. In addition, of the Black 

male veterans in the population, only 5.4% were 

homeless. 


119


Among male Black veterans 65+ living in poverty, 

4.8% were homeless, as were 2.1% of Non-Black 

male veterans living in poverty. Of the Black 

older female veterans living in poverty, 1.7% were 

homeless, and of the Non-Black female veterans 

living in poverty, 0.8% were homeless (see Table 

HR37; Fargo et al., 2012). 

The age-adjusted rate of motor vehicle fatalities 

among Nevada veterans (27.8 per 100,000) is higher 

than in the general population (7.8 per 100,000; 

Ritch & Thompson, 2012). However, these data 

did not distinguish between veterans younger than 

or older than age 65. This high rate of death may 

be “reflective of a pattern of risk-taking behaviors 

found in studies of this population (veterans)” (p. 5) 

or may be a consequence of substance use. 

120

Table HR1 

Rate of Cigarette Smoking in U.S. Adults (Civilian, Non-institutionalized, 2010): Age and Sex 

All Current Every Day Some Days Former Non- 

Sex and Age Group Smokers Smokers Smokers Smokers smokers 

Both sexes 19.4% 15.1% 4.2% 21.7% 59.0% 

Males 

18–44 23.9% 17.3% 6.6% 14.9% 61.2% 

45–64 23.2% 19.5% 3.7% 28.9% 47.9% 

65 and older 9.7% 8.4% 1.3% 52.5% 37.8% 

Females 

18–44 19.1% 14.6% 4.5% 10.6% 70.3% 

45–64 19.1% 15.6% 3.6% 22.5% 58.4% 

65 and older 9.3% 7.6% 1.7% 29.3% 61.4% 


(CDC: National Health Interview Survey, 2010, in Federal Interagency Forum, 2012, p. 128) 

121


122 

Table HR2 

Nevada Adults, 65 and Older: Percentage of Smokers by Rate 

Demographic Grouping N* Every Day Some Days Former Smoker Never Smoked 

% C.I. % C.I. % C.I. % C.I. 





Age 65 - 74 1,024 14.0% (10.1-18.0) 3.8% (2.4-5.2) 50.5% (44.8-56.2) 31.7% (26.4-36.9) 

75 - 84 504 6.3% (3.5-9.1) 1.5% (0.3-2.6) 54.1% (46.9-61.4) 38.1% (30.9-45.2) 

85 and Older 129 4.0% (0.0-9.8) 0% (0.0-0.0) 52.7% (36.4-69.0) 43.3% (27.8-58.8) 

Sex Male 663 12.3% (8.2-16.4) 2.0% (0.7-3.3) 60.8% (55.0-66.6) 24.9% (20.1-29.7) 

Female 994 9.4% (6.0-12.8) 3.4% (2.1-4.7) 44.0% (37.9-50.1) 43.2% (37.1-49.2) 

Race White 1,431 10.9% (8.2-13.7) 2.7% (1.7-3.8) 55.8% (51.5-60.2) 30.5% (26.8-34.2) 

Black 47 ~ ~ ~ ~ ~ ~ ~ ~ 

Other Race 92 13.8% (3.0-24.5) 2.5% (0.0-5.4) 33.3% (16.7-49.9) 50.4% (33.2-67.7) 

Hispanic 58 2.9% (0.0-6.2) 1.9% (0.0-4.6) 45.6% (24.4-66.9) 49.6% (28.1-71.1) 


H.S. or G.E.D. 510 14.5% (8.6-20.4) 4.2% (2.3-6.2) 52.4% (45.2-59.6) 28.8% (22.9-34.8) 

Some Post H.S. 521 9.9% (6.0-13.7) 2.9% (1.0-4.9) 51.7% (44.4-58.9) 35.5% (28.6-42.4) 


Income < $15K 161 20.0% (10.6-29.4) 6.7% (2.1-11.2) 36.6% (25.4-47.8) 36.7% (24.8-48.7) 

$15K to $24,999 307 10.5% (3.5-17.4) 2.4% (0.8-4.0) 54.5% (44.6-64.3) 32.7% (23.9-41.5) 

$25K to $34,999 210 13.5% (4.5-22.4) 2.0% (0.3-3.7) 52.9% (38.8-67.1) 31.6% (17.7-45.4) 

$35K to $49,999 231 3.3% (0.9-5.6) 3.3% (0.0-7.1) 66.4% (56.7-76.0) 27.1% (18.4-35.8) 

$50K to $74,999 225 9.3% (2.8-15.9) 1.0% (0.1-2.0) 57.6% (47.7-67.4) 32.1% (22.8-41.4) 

$75,000+ 208 6.9% (0.0-14.4) 2.2% (0.2-4.2) 41.8% (31.8-51.9) 49.0% (38.5-59.6) 


(CDC: BRFSS, 2011)

Table HR3 

Nevada Adults 65 and Older: Binge Drinkers (Adult Men Having Five or More Drinks on One Occasion, 

Females Having Four or More Drinks on One Occasion) 


% C.I. % C.I. 





Age 65-74 912 8.5% (5.6-11.5) 91.5% (88.5-94.4) 

75-84 397 2.9% (0.6-5.3) 97.1% (94.7-99.4) 

85 and Older 105 2.1% (0.0-5.1) 97.9% (94.9-100.0) 

Sex Male 586 8.7% (5.6-11.8) 91.3% (88.2-94.4) 

Female 880 3.9% (1.6-6.2) 96.1% (93.8-98.4) 

Race White 1,274 6.4% (4.3-8.6) 93.6% (91.4-95.7) 

Black 40 ~ ~ ~ ~ 

Other Race 78 12.0% (0.0-26.3) 87.3% (73.7-100.0) 



H.S. or G.E.D. 438 7.3% (3.3-11.4) 92.7% (88.6-96.7) 

Some Post H.S. 465 3.7% (1.7-5.7) 96.3% (94.3-98.3) 



$15,000 to $24,999 278 5.6% (1.4-9.8) 94.4% (90.2-98.6) 

$25,000 to $34,999 180 3.5% (1.0-5.9) 96.5% (94.1-99.0) 

$35,000 to $49,999 209 4.7% (1.5-8.0) 95.3% (92.0-98.5) 

$50,000 to $74,999 196 10.9% (4.3-17.4) 89.1% (82.6-95.7) 

$75,000+ 191 4.8% (1.8-7.7) 95.2% (92.3-98.2) 





123


Table HR4 

Nevada Adults, 65 and Older: Heavy Drinkers (Adult Men Having Two or More Drinks Per Day, Adult 

Women Having One or More Drinks Per Day) 


% C.I. % C.I. 





Age 65-74 905 5.8% (4.0-7.7) 94.2% (92.3-96.0) 

75-84 394 3.7% (1.1-6.4) 96.3% (93.6-98.9) 

85 and Older 105 2.6% (0.3-4.9) 97.4% (95.1-99.7) 

Sex Male 581 6.0% (3.6-8.4) 94.0% (91.6-96.4) 

Female 874 3.8% (2.4-5.2) 96.2% (94.8-97.6) 

Race White 1,264 5.5% (3.9-7.1) 94.5% (92.9-96.1) 

Black 40 ~ ~ ~ ~ 

Other Race 77 2.0% (0.0-5.0) 98.0% (95.0-100.0) 



H.S. or G.E.D. 435 3.9% (1.9-5.9) 96.1% (94.1-98.1) 

Some Post H.S. 461 5.1% (2.9-7.3) 94.9% (92.7-97.1) 



$15,000 to $24,999 276 5.0% (1.6-8.4) 95.0% (91.6-98.4) 

$25,000 to $34,999 178 4.7% (0.3-9.2) 95.3% (90.8-99.7) 

$35,000 to $49,999 206 4.1% (1.1-7.0) 95.9% (93.0-98.9) 

$50,000 to $74,999 193 6.8% (3.0-10.6) 93.2% (89.4-97.0) 

$75,000+ 190 7.8% (3.3-12.3) 92.2% (87.7-96.7) 




124

Table HR5 

Nevada Adults, 65 and Older: Heavy Drinkers Reporting Drinking at Least One Drink of Alcohol in 

Past 30 Days 


% C.I. % C.I. 





Age 65-74 917 50.2% (44.0-56.3) 49.8% (43.7-56.0) 

75-84 399 38.4% (30.6-46.3) 61.6% (53.7-69.4) 

85 and Older 105 41.3% (21.7-61.0) 58.7% (39.0-78.3) 

Sex Male 591 51.5% (45.0-58.1) 48.5% (41.9-55.0) 

Female 882 40.0% (33.7-46.4) 60.0% (53.6-66.3) 

Race White 1,280 47.7% (42.9-52.5) 52.3% (47.5-57.1) 

Black 40 ~ ~ ~ ~ 

Other Race 78 36.5% (18.6-54.3) 63.5% (45.7-81.4) 



H.S. or G.E.D. 439 47.2% (39.4-55.1) 52.8% (44.9-60.6) 

Some Post H.S. 466 41.2% (34.2-48.2) 58.8% (51.8-65.8) 



$15,000 to $24,999 278 35.7% (25.2-46.1) 64.3% (53.9-74.8) 

$25,000 to $34,999 182 49.7% (33.8-65.6) 50.3% (34.4-66.2) 

$35,000 to $49,999 209 53.7% (42.4-65.1) 46.3% (34.9-57.6) 

$50,000 to $74,999 197 59.2% (48.8-69.6) 40.8% (30.4-51.2) 

$75,000+ 191 69.8% (58.5-81.2) 30.2% (18.8-41.5) 





125


Table HR6 

Nevada: State Funded Treatment Centers 

Region Grantee Outpatient Outpatient Intensive Intensive Residential Residential 

Southern Nevada 

Las Vegas X X 

Problem 

Gambling Center 

Pathways X X 

Northern Nevada 

Reno Problem X X 

Gambling Center 

Bristlecone X X 

New Frontier X X X 

Treatment Center 

Salvation Army* X X 

*Although funded from 2006 to 2010, by 2012, this center was no longer funded by the state of Nevada to provide gambling treatment service 

(Bernhard & St. John, 2012). 

(NVDHHS, 2011, p. 3) 

126

Table HR7 

Nevada Adults 65 and Older: Had Five or More Fruits and Vegetables per Day 


% C.I. % C.I. 





Age 65-74 1,031 12.6% (9.3-15.9) 87.4% (84.1-90.7) 

75-84 454 18.8% (12.4-25.3) 81.2% (74.7-87.6) 

85 and Older 130 6.4% (2.4-10.4) 93.6% (89.6-97.6) 

Sex Male 669 13.2% (9.1-17.3) 86.8% (82.7-90.9) 

Female 1,004 14.0% (10.3-17.8) 86.0% (82.2-89.7) 

Race White 1,444 12.2% (9.6-14.7) 87.8% (85.3-90.4) 

Black 47 ~ ~ ~ ~ 

Other Race 94 19.1% (7.8-30.4) 80.9% (69.6-92.2) 

Hispanic 59 23.2% (6.9-39.5) 76.8% (60.5-93.1) 


H.S. or G.E.D. 512 11.7% (7.6-15.9) 88.3% (84.1-92.4) 

Some Post H.S. 526 15.8% (10.5-21.0) 84.2% (79.0-89.5) 


Income < $15K 165 20.2% (10.2-30.1) 79.8% (69.9-89.8) 

$15K to $24,999 307 8.2% (4.0-12.4) 91.8% (87.6-96.0) 

$25K to $34,999 212 11.5% (4.9-18.0) 88.5% (82.0-95.1) 

$35K to $49,999 234 14.3% (8.9-19.6) 85.7% (80.4-91.1) 

$50K to $74,999 227 12.7% (6.9-18.5) 87.3% (81.5-93.1) 

$75K & Higher 209 17.7% (8.8-26.5) 82.3% (73.5-91.2) 





127


Table HR8 

Nevada Adults 65 and Older: Did Physical Activity Other than Current Job in the Past 30 Days? 


% C.I. % C.I. 





Age 65-74 958 70.7% (64.8-76.6) 29.3% (23.4-35.2) 

75-84 420 61.6% (53.5-69.6) 38.4% (30.4-46.5) 

85 and Older 110 73.1% (59.9-86.3) 26.9% (13.7-40.1) 

Gender Male 617 75.3% (69.1-81.5) 24.7% (18.5-30.9) 

Female 924 62.9% (56.7-69.1) 37.1% (30.9-43.3) 

Race White 1,331 70.6% (66.2-74.9) 29.4% (25.1-33.8) 

Black 42 ~ ~ ~ ~ 

Other Race 85 66.8% (49.0-84.6) 33.2% (15.4-51.0) 

Hispanic 54 62.3% (41.1-83.5) 37.7% (16.5-58.9) 


H.S. or G.E.D. 467 64.3% (56.9-71.7) 35.7% (28.3-43.1) 

Some Post H.S. 490 74.3% (67.9-80.6) 25.7% (19.4-32.1) 



$15,000 to $24,999 288 60.2% (49.7-70.8) 39.8% (29.2-50.3) 

$25,000 to $34,999 194 69.8% (55.4-84.3) 30.2% (15.7-44.6) 

$35,000 to $49,999 217 70.6% (58.6-82.6) 29.4% (17.4-41.4) 

$50,000 to $74,999 205 77.3% (68.5-86.1) 22.7% (13.9-31.5) 

$75,000+ 202 88.3% (81.4-95.3) 11.7% (4.7-18.6) 




128

Table HR9 

Nevada Adults 65 and Older: Met Federal Guidelines for Strength Training and Aerobic Exercise 


% C.I. % C.I. 





Age 65-74 909 19.3% (15.2-23.4) 80.7% (76.6-84.8) 

75-84 380 15.5% (10.0-21.0) 84.5% (79.0-90.0) 

85 and Older 95 13.7% (0.0-30.0) 86.3% (70.0-100.0) 

Gender Male 574 24.8% (19.4-30.2) 75.2% (69.8-80.6) 

Female 861 11.6% (8.4-14.8) 88.4% (85.2-91.6) 

Race White 1,250 19.3% (15.7-22.9) 80.7% (77.1-84.3) 

Black 35 ~ ~ ~ ~ 

Other Race 76 20.4% (5.9-34.8) 79.6% (65.2-94.1) 

Hispanic 50 9.5% (0.2-18.7) 90.5% (81.3-99.8) 


H.S. or G.E.D. 443 16.1% (10.2-22.1) 83.9% (77.9-89.8) 

Some Post H.S. 447 21.7% (15.5-27.9) 78.3% (72.1-84.5) 



$15,000 to $24,999 270 10.7% (5.0-16.4) 89.3% (83.6-95.0) 

$25,000 to $34,999 188 14.7% (7.4-21.9) 85.3% (78.1-92.6) 

$35,000 to $49,999 200 24.9% (13.7-36.1) 75.1% (63.9-86.3) 

$50,000 to $74,999 193 27.3% (18.5-36.0) 72.7% (64.0-81.5) 

$75,000+ 192 34.5% (24.1-44.9) 65.5% (55.1-75.9) 




Missing Source. 

Table HR10 

Defining Weight Status by BMI 

BMI 

Considered 

Below 18.5 

Underweight 

18.5-24.9 Healthy Weight 

25.0-29.9 Overweight 

30 or higher Obese 

(CDC: Overweight and Obesity, 2012) 

129


130 

Table HR11 

Nevada Adults 65 and Older: Weight Classification by Body Mass Index (BMI) 

Demographic Grouping N* Underweight Healthy Weight Overweight Obese 

% C.I. % C.I. % C.I. % C.I. 





Age 65-74 988 2.1% (0.3-3.8) 31.2% (26.2-36.2) 46.5% (40.6-52.3) 20.3% (15.5-25.1) 

75-84 443 3.7% (1.0-6.3) 45.9% (37.8-54.0) 32.7% (25.7-39.7) 17.7% (12.0-23.4) 

85 and Older 128 4.6% (0.0-10.8) 55.9% (39.9-71.9) 35.1% (20.1-50.1) 4.4% (1.0-7.9) 

Sex Male 664 0.6% (0.0-1.1) 33.0% (27.3-38.8) 49.6% (43.5-55.8) 16.8% (13.0-20.6) 

Female 949 4.6% (2.1-7.2) 41.6% (35.4-47.7) 34.5% (28.6-40.4) 19.3% (13.9-24.6) 

Race White 1,391 2.7% (1.4-4.0) 40.1% (35.5-44.6) 40.2% (35.7-44.7) 17.0% (14.1-20.0) 

Black 47 ~ ~ ~ ~ ~ ~ ~ ~ 

Other Race 93 2.4% (0.0-6.4) 37.4% (21.6-53.2) 44.8% (27.6-61.9) 15.4% (2.6-28.3) 

Hispanic 56 4.7% (0.0-14.0) 28.0% (11.2-44.7) 45.4% (24.1-66.8) 21.9% (1.2-42.6) 


H.S. or G.E.D. 486 2.8% (0.5-5.1) 38.1% (30.9-45.3) 42.9% (35.5-50.3) 16.2% (11.4-21.1) 

Some Post H.S. 510 2.5% (0.6-4.5) 39.1% (31.7-46.6) 40.6% (33.5-47.8) 17.7% (12.8-22.6) 


Income < $15K 163 1.7% (0.2-3.1) 36.5% (25.3-47.8) 41.9% (29.9-53.9) 19.9% (11.3-28.4) 

$15K to $24,999 294 1.8% (0.0-3.6) 44.4% (34.0-54.8) 36.4% (26.5-46.3) 17.4% (10.2-24.5) 

$25K to $34,999 208 1.6% (0.0-3.3) 35.1% (22.8-47.3) 39.9% (25.9-53.9) 23.4% (9.3-37.6) 

$35K to $49,999 229 6.3% (0.1-12.4) 30.0% (19.3-40.6) 44.6% (32.9-56.4) 19.1% (12.7-25.6) 

$50K to $74,999 222 0.4% (0.0-0.9) 29.1% (20.2-38.0) 49.9% (40.1-59.7) 20.6% (13.1-28.1) 

$75K & Higher 208 0.2% (0.0-0.6) 34.9% (25.5-44.3) 48.0% (37.7-58.3) 17.0% (9.9-24.0) 


(CDC: BRFSS, 2011)

Table HR12 

Nevada Adults 65 and Older: Had Cholesterol Checked in Lifetime 


% C.I. % C.I. 





Age 65-74 1,022 96.5% (94.3-98.7) 3.5% (1.3-5.7) 

75-84 448 92.0% (88.4-95.6) 8.0% (4.4-11.6) 

85 and Older 123 90.4% (80.3-100.0) 9.6% (0.0-19.7) 

Sex Male 661 94.1% (91.1-97.1) 5.9% (2.9-8.9) 

Female 990 95.3% (92.9-97.6) 4.7% (2.4-7.1) 

Race White 1,425 94.9% (92.7-97.1) 5.1% (2.9-7.3) 

Black 46 ~ ~ ~ ~ 

Other Race 94 95.1% (89.9-100.0) 4.9% (0.0-10.1) 

Hispanic 58 97.4% (92.1-100.0) 2.6% (0.0-7.9) 


H.S. or G.E.D. 503 93.6% (89.6-97.6) 6.4% (2.4-10.4) 

Some Post H.S. 517 96.2% (93.6-98.9) 3.8% (1.1-6.4) 



$15,000 to $24,999 304 92.7% (87.1-98.3) 7.3% (1.7-12.9) 

$25,000 to $34,999 210 94.2% (88.9-99.5) 5.8% (0.5-11.1) 

$35,000 to $49,999 230 96.2% (92.2-100.0) 3.8% (0.0-7.8) 

$50,000 to $74,999 224 96.4% (92.5-100.0) 3.6% (0.0-7.5) 

$75,000+ 208 99.3% (98.1-100.0) 0.7% (0.0-1.9) 





131


Table HR13 

Nevada Adults 65 and Older: Had Cholesterol Checked Within Past Five Years 


% C.I. % C.I. 





Age 65-74 1,010 94.2% (91.5-96.8) 5.8% (3.2-8.5) 

75-84 443 90.4% (86.6-94.2) 9.6% (5.8-13.4) 

85 and Older 119 88.5% (78.0-99.0) 11.5% (1.0-22.0) 

Sex Male 655 92.9% (89.6-96.2) 7.1% (3.8-10.4) 

Female 974 92.6% (89.8-95.4) 7.4% (4.6-10.2) 

Race White 1,404 92.9% (90.5-95.3) 7.1% (4.7-9.5) 

Black 46 ~ ~ ~ ~ 

Other Race 93 94.9% (89.7-100.0) 5.1% (0.0-10.3) 

Hispanic 58 95.3% (89.1-100.0) 4.7% (0.0-10.9) 


H.S. or G.E.D. 496 90.8% (86.3-95.3) 9.2% (4.7-13.7) 

Some Post H.S. 508 94.8% (91.8-97.7) 5.2% (2.3-8.2) 



$15,000 to $24,999 300 89.7% (83.7-95.7) 10.3% (4.3-16.3) 

$25,000 to $34,999 206 94.1% (88.8-99.5) 5.9% (0.5-11.2) 

$35,000 to $49,999 227 95.8% (91.8-99.8) 4.2% (0.2-8.2) 

$50,000 to $74,999 223 96.1% (92.2-100.0) 3.9% (0.0-7.8) 

$75,000+ 206 98.5% (96.8-100.0) 1.5% (0.0-3.2) 




132

Table HR14 

Nevada Adults 65 and Older: Advised They Have High Cholesterol 


% C.I. % C.I. 





Age 65-74 985 61.0% (55.4-66.5) 39.0% (33.5-44.6) 

75-84 407 45.4% (37.4-53.5) 54.6% (46.5-62.6) 

85 and Older 114 31.7% (17.6-45.7) 68.3% (54.3-82.4) 

Gender Male 624 55.3% (49.0-61.6) 44.7% (38.4-51.0) 

Female 938 52.8% (46.4-59.2) 47.2% (40.8-53.6) 

Race White 1,356 53.6% (48.9-58.2) 46.4% (41.8-51.1) 

Black 42 ~ ~ ~ ~ 

Other Race 85 60.1% (43.1-77.0) 39.9% (23.0-56.9) 

Hispanic 56 52.6% (31.0-74.2) 47.4% (25.8-69.0) 


H.S. or G.E.D. 467 57.3% (49.9-64.7) 42.7% (35.3-50.1) 

Some Post H.S. 493 58.7% (51.3-66.2) 41.3% (33.8-48.7) 



$15,000 to $24,999 281 51.2% (40.6-61.8) 48.8% (38.2-59.4) 

$25,000 to $34,999 195 57.3% (42.2-72.4) 42.7% (27.6-57.8) 

$35,000 to $49,999 222 59.3% (48.0-70.6) 40.7% (29.4-52.0) 

$50,000 to $74,999 217 59.1% (49.6-68.5) 40.9% (31.5-50.4) 

$75,000+ 206 48.9% (38.2-59.7) 51.1% (40.3-61.8) 





133


Table HR15 

Nevada Adults 65 and Older: Advised They Had Hypertension 


% C.I. % C.I. 





Age 65-74 1,029 59.5% (54.3-64.8) 40.5% (35.2-45.7) 

75-84 451 65.2% (58.2-72.2) 34.8% (27.8-41.8) 

85 and Older 129 58.8% (43.5-74.1) 41.2% (25.9-56.5) 

Gender Male 667 59.0% (53.0-65.0) 41.0% (35.0-47.0) 

Female 1,000 63.2% (58.0-68.4) 36.8% (31.6-42.0) 

Race White 1,442 60.7% (56.4-65.0) 39.3% (35.0-43.6) 

Black 47 ~ ~ ~ ~ 

Other Race 94 63.2% (47.6-78.8) 36.8% (21.2-52.4) 

Hispanic 56 52.2% (31.6-72.8) 47.8% (27.2-68.4) 


H.S. or G.E.D. 511 61.5% (54.5-68.4) 38.5% (31.6-45.5) 

Some Post H.S. 526 56.4% (49.2-63.5) 43.6% (36.5-50.8) 



$15K to $24,999 307 66.5% (57.5-75.4) 33.5% (24.6-42.5) 

$25K to $34,999 211 71.7% (61.8-81.7) 28.3% (18.3-38.2) 

$35K to $49,999 233 58.7% (47.6-69.7) 41.3% (30.3-52.4) 

$50K to $74,999 227 58.9% (49.4-68.5) 41.1% (31.5-50.6) 

$75K and Higher 209 43.1% (32.7-53.6) 56.9% (46.4-67.3) 



(CDC: BRFSS, 2011 

134

Table HR16 

Nevada Adults 65 and Older: Flu Shot within the Past Year 


% C.I. % C.I. 





Age 65-74 936 52.4% (46.3-58.4) 47.6% (41.6-53.7) 

75-84 413 53.6% (45.3-61.9) 46.4% (38.1-54.7) 

85 and older 108 63.2% (46.7-79.7) 36.8% (20.3-53.3) 

Sex Male 600 53.2% (46.7-59.6) 46.8% (40.4-53.3) 

Female 910 54.2% (47.8-60.7) 45.8% (39.3-52.2) 

Race White 1,308 55.0% (50.3-59.7) 45.0% (40.3-49.7) 

Black 42 ~ ~ ~ ~ 

Other Race 84 62.0% (46.0-78.0) 38.0% (22.0-54.0) 

Hispanic 50 45.8% (23.0-68.6) 54.2% (31.4-77.0) 


H.S. or G.E.D. 454 51.9% (44.2-59.7) 48.1% (40.3-55.8) 

Some Post H.S. 480 57.9% (50.7-65.0) 42.1% (35.0-49.3) 



$15,000 to $24,999 284 52.0% (41.4-62.6) 48.0% (37.4-58.6) 

$25,000 to $34,999 192 53.6% (38.3-68.8) 46.4% (31.2-61.7) 

$35,000 to $49,999 209 58.8% (47.9-69.7) 41.2% (30.3-52.1) 

$50,000 to $74,999 201 57.0% (46.7-67.3) 43.0% (32.7-53.3) 

$75,000+ 200 47.5% (36.5-58.5) 52.5% (41.5-63.5) 





135


Table HR17 

Nevada Adults 65 and Older: Had the Pneumonia Vaccine in the Past 


% C.I. % C.I. 





Age 65-74 897 64.0% (57.7-70.4) 36.0% (29.6-42.3) 

75-84 402 74.8% (67.2-82.3) 25.2% (17.7-32.8) 

85 and Older 104 83.0% (70.6-95.4) 17.0% (4.6-29.4) 

Sex Male 572 69.2% (62.8-75.6) 30.8% (24.4-37.2) 

Female 881 68.6% (62.0-75.2) 31.4% (24.8-38.0) 

Race White 1,262 70.8% (66.3-75.2) 29.2% (24.8-33.7) 

Black 39 ~ ~ ~ ~ 

Other Race 77 72.1% (57.8-86.3) 27.9% (13.7-42.2) 

Hispanic 50 49.8% (26.8-72.8) 50.2% (27.2-73.2) 


H.S. or G.E.D. 442 71.3% (64.3-78.2) 28.7% (21.8-35.7) 

Some Post H.S. 457 70.9% (64.1-77.7) 29.1% (22.3-35.9) 



$15,000 to $24,999 274 75.5% (67.3-83.6) 24.5% (16.4-32.7) 

$25,000 to $34,999 181 54.5% (38.1-70.9) 45.5% (29.1-61.9) 

$35,000 to $49,999 209 75.0% (66.6-83.4) 25.0% (16.6-33.4) 

$50,000 to $74,999 190 72.7% (63.2-82.2) 27.3% (17.8-36.8) 

$75,000+ 191 69.1% (59.4-78.8) 30.9% (21.2-40.6) 




136

Table HR18 

U.S. Preventive Services Task Force Recommendations for Cancer Screening in Adults 

Type of Cancer Year Recommendations 

Breast/Ovarian 2005 Recommends genetic counseling, screening, and a consideration of 

prophylactic treatment for women with a family history of breast or 

ovarian cancer related to mutations in the BRCA1 or BRCA2 genes 

2009 Recommends biennial mammography for women 50-74 but 

concluded that there was insufficient evidence for mammography 

screening after the age of 75 

2012 Recommends against screening for ovarian cancer in women 

Cervical 2012 Women 21-65, recommends cytology (Pap) cervical screening every 

three years 

Women 30-65, recommends cytology (Pap) and Human 

Papillomarvirus (HPV) screening every five years 

Women 66 and older, no screening recommended in women who 

have had adequate prior screening and are not at high risk 

Colorectal 2008 Age 50-75, recommends screening using fecal occult blood testing, 

sigmoidoscopy or colonoscopy. Recommends against routine 

screening for adults 76-85 and recommends against any screening for 

adults 85 and older. 

Prostate 2012 Recommends against prostate-specific antigen (PSA) screening for 

prostate cancer due to over-diagnosis rates of 17-50% 


(USPSTF: Breast Cancer Screening, 2012) 

137


Table HR19 

Nevada Adults 65 and Older: Had a Blood Stool Test Within the Past Two Years 


% C.I. % C.I. 





Age 65-74 732 20.5% (16.3-24.6) 79.5% (75.4-83.7) 

75-84 338 21.4% (15.8-27.0) 78.6% (73.0-84.2) 

85 and Older 93 19.0% (6.6-31.3) 81.0% (68.7-93.4) 

Sex Male 510 22.2% (17.3-27.0) 77.8% (73.0-82.7) 

Female 695 20.4% (16.3-24.6) 79.6% (75.4-83.7) 

Race White 1,035 21.4% (18.0-24.7) 78.6% (75.3-82.0) 

Black 29 ~ ~ ~ ~ 

Other Race 76 19.9% (7.2-32.6) 80.1% (67.4-92.8) 



H.S. or G.E.D. 403 19.6% (14.6-24.7) 80.4% (75.3-85.4) 

Some Post H.S. 386 23.4% (17.1-29.7) 76.6% (70.3-82.9) 



$15,000 to $24,999 236 20.3% (13.8-26.7) 79.7% (73.3-86.2) 

$25,000 to $34,999 143 28.8% (17.4-40.3) 71.2% (59.7-82.6) 

$35,000 to $49,999 199 25.5% (16.7-34.3) 74.5% (65.7-83.3) 

$50,000 to $74,999 127 15.6% (7.7-23.5) 84.4% (76.5-92.3) 

$75,000+ 143 16.1% (8.5-23.7) 83.9% (76.3-91.5) 




138

Table HR20 

Nevada Adults 65 and Older: Had Sigmoidoscopy or Colonoscopy 


% C.I. % C.I. 





Age 65-74 744 68.6% (63.8-73.4) 31.4% (26.6-36.2) 

75-84 346 68.9% (62.3-75.5) 31.1% (24.5-37.7) 

85 and Older 92 59.3% (46.1-72.5) 40.7% (27.5-53.9) 

Sex Male 515 72.0% (67.0-77.1) 28.0% (22.9-33.0) 

Female 709 63.7% (58.4-69.0) 36.3% (31.0-41.6) 

Race White 1,052 68.6% (64.5-72.6) 31.4% (27.4-35.5) 

Black 28 ~ ~ ~ ~ 

Other Race 79 55.2% (39.1-71.3) 44.8% (28.7-60.9) 



H.S. or G.E.D. 411 62.3% (55.6-69.0) 37.7% (31.0-44.4) 

Some Post H.S. 394 70.8% (64.2-77.4) 29.2% (22.6-35.8) 



$15,000 to $24,999 239 56.0% (46.3-65.6) 44.0% (34.4-53.7) 

$25,000 to $34,999 147 76.5% (67.0-86.0) 23.5% (14.0-33.0) 

$35,000 to $49,999 202 74.4% (66.2-82.6) 25.6% (17.4-33.8) 

$50,000 to $74,999 131 74.6% (63.8-85.5) 25.4% (14.5-36.2) 

$75,000+ 147 77.2% (67.9-86.5) 22.8% (13.5-32.1) 





139


Table HR21 

Nevada Adults 65 and Older: Had a PSA Test Within the Past Two Years 


% C.I. % C.I. 





Age 65-74 300 73.4% (66.6-80.3) 26.6% (19.7-33.4) 

75-84 148 80.7% (72.4-89.0) 19.3% (11.0-27.6) 

85 and Older 33 62.5% (38.8-86.3) 37.5% (13.7-61.2) 

Race White 427 74.7% (68.9-80.4) 25.3% (19.6-31.1) 

Black 9 ~ ~ ~ ~ 




H.S. or G.E.D. 137 66.0% (54.5-77.6) 34.0% (22.4-45.5) 

Some Post H.S. 145 79.9% (71.5-88.4) 20.1% (11.6-28.5) 



$15,000 to $24,999 92 69.9% (57.7-82.1) 30.1% (17.9-42.3) 

$25,000 to $34,999 61 87.2% (78.9-95.5) 12.8% (4.5-21.1) 

$35,000 to $49,999 91 72.5% (59.3-85.7) 27.5% (14.3-40.7) 

$50,000 to $74,999 73 81.1% (68.0-94.2) 18.9% (5.8-32.0) 

$75,000+ 89 76.8% (64.7-88.9) 23.2% (11.1-35.3) 




140

Table HR22 

Nevada Adults 65 and Older: Had a Mammogram in the Past Two Years 


% C.I. % C.I. 





Age 65-74 434 77.0% (70.6-83.3) 23.0% (16.7-29.4) 

75-84 194 65.5% (56.1-74.8) 34.5% (25.2-43.9) 

85 and Older 60 54.7% (37.8-71.6) 45.3% (28.4-62.2) 

Race White 614 70.9% (65.1-76.6) 29.1% (23.4-34.9) 

Black 20 ~ ~ ~ ~ 




H.S. or G.E.D. 269 69.3% (61.3-77.4) 30.7% (22.6-38.7) 

Some Post H.S. 242 72.3% (63.0-81.7) 27.7% (18.3-37.0) 



$15,000 to $24,999 143 61.5% (47.0-76.1) 38.5% (23.9-53.0) 

$25,000 to $34,999 86 56.2% (38.8-73.5) 43.8% (26.5-61.2) 

$35,000 to $49,999 106 74.5% (63.0-86.0) 25.5% (14.0-37.0) 

$50,000 to $74,999 55 83.1% (67.9-98.4) 16.9% (1.6-32.1) 

$75,000+ 58 87.9% (78.1-97.7) 12.1% (2.3-21.9) 





141


Table HR23 

U.S., 2010: Estimated Number of HIV/AIDS Diagnoses by Age 

HIV 

AIDS 

Under 13 217 23 

13-14 Years 34 52 

15-19 Years 2,200 529 

20-24 Years 7,565 2,262 

25-29 Years 6,823 3,379 

30-34 Years 5,954 4,009 

35-39 Years 5,523 4,464 

40-44 Years 5,720 5,198 

45-49 Years 5,296 5,194 

50-54 Years 3,671 3,825 

55-59 Years 2,154 2,100 

60-64 Years 1,119 1,094 

65 or Older 853 889 

(CDC: HIV/AIDS, Statistics, 2012) 

142

Table HR24 

U.S. and Nevada, 2010: Rate of New AIDS Diagnoses 

Demographic Grouping Rate per 100,000 

U.S. 


Year 2000 17.3 16.9 

2001 16.6 13.3 

2002 16.5 16.2 

2003 16.6 13.9 

2004 15.9 15.1 

2005 15 15.6 

2006 14.2 13 

2007 13.7 13.8 

2008 13.3 13.9 

2009 13 11.9 

2010 13 12.6 

Sex Male 19.9 20.8 

Female 6.3 4.1 

Age 55 and Older 5.4 6.3 

Race White 5.1 8.8 

Black 53.3 42.1 

Asian 4.2 8.9 

Multi 21.3 11.4 

Hispanic 18.5 14.2 


(CDC: NCHHSTP Atlas, 2012) 

Table HR25 

New HIV Infections and Persons Living with HIV/AIDS in Nevada, 2011 

New HIV Infections 

Living with HIV/AIDS 

N Rate* N Rate* 

65+ 6 1.8 325 98.2 

Total 378 14.1 7,284 271.8 

[ Nevada State Health Division HIV/AIDS Reporting System (eHARS), 2012] 

*Rate per 100,000 population is based on 2012 interim population estimates from NV Demographics. 

143


Table HR26 

Persons 65 and Older Living with HIV/AIDS* in Nevada, 2011 

Demographic Grouping 2011 

n % Rate** 

Region Southern Urban/Metro 261 80.3% 112.8 

(at Diagnosis) Northern Urban/Metro 40 12.3% 73.0 

Rural/Frontier 24 7.4% 53.6 

Age 65 to 74 282 86.8% 144.0 

75 to 84 41 12.6% 39.8 

85 and Older 2 0.6% 6.2 

Sex Male 278 85.5% 185.0 

Female 47 14.5% 26.0 

Race White, non-Hispanic 224 68.9% 114.4 

Black, non-Hispanic 50 15.4% 48.6 

Other*** 11 3.4% N/A 

Hispanic 40 12.3% 124.4 

Transmission Males 

Category Male-to-Male Sexual Contact (MSM) 203 73.0% N/A 

Injection Drug use (IDU) 23 8.3% N/A 

MSM+IDU 9 3.2% N/A 

Heterosexual contact 11 4.0% N/A 

Perinatal Exposure 0 0.0% N/A 

Transfusion/Hemophilia 1 0.4% N/A 

Risk Factor Not Identified or Reported 31 11.2% N/A 

Subtotal 278 100.0% 185.0 

Females 

Injection Drug Use 6 12.8% N/A 

Heterosexual contact 37 78.7% N/A 

Perinatal Exposure 0 0.0% N/A 

Transfusion/Hemophilia 0 0.0% N/A 

Risk Factor Not Identified or Reported 4 8.5% N/A 

Subtotal 47 100.0% 26.0 

Total 325 100.0% 98.2 

[Nevada State Health Division HIV/AIDS Reporting System (eHARS), 2012] 

*Persons living with HIV/AIDS data include data on persons living in Nevada with HIV (not yet AIDS) and AIDS based on the current address listed 

in the HIV/AIDS Reporting System (eHARS). These persons may or may not have been diagnosed with HIV or AIDS in Nevada. 

**Rate per 100,000 population is based on 2012 interim population estimates from NV Demographics. 

*** Includes persons who identified as Asian/Hawaiian/Pacific Islander, American Indian/Alaska Native, or multi-race/other. 

144

Table HR27 

Nevada Adults 65 and Older: STD Cases, 2011 

Chlamydia Gonorrhea Primary & Secondary (P&S) Early Latent (EL) 

Syphilis** Syphilis** 

N % Rate* N % Rate* N % Rate* N % Rate* 

Region at Diagnosis 

Southern 

Urban/Metro 8 61.5% 3.5 4 66.7% 1.7 2 50.0% 0.9 1 100% 0.4 

Northern 

Urban/Metro 3 23.1% 5.5 1 16.7% 1.8 0 0.0% 0.0 0 0.0% 0.0 

Rural/Frontier 2 15.4% 4.5 1 16.7% 2.2 2 50.0% 4.5 0 0.0% 0.0 

Total 13 100% 3.9 6 100% 1.8 4 100% 1.2 1 100% 0.3 

Sex 

Male 10 76.9% 6.7 5 83.3% 3.3 2 100% 1.3 1 100% 0.7 

Female 3 23.1% 1.7 1 16.7% 0.6 0 0.0% 0.0 0 0.0% 0.0 

Total 13 100% 3.9 6 100% 1.8 2 100% 0.6 1 100% 0.3 

*Rate per 100,000 population is based on 2012 interim population estimates from NV Demographics. 

** Primary/Secondary Syphilis: Primary stage is highly contagious, lasts 1-5 weeks, secondary lasts 4-6 weeks. Early Latent Syphilis - Less than one-year’s duration. 

(Nevada State Health Division Sexually Transmitted Disease Management Information Systems (STD*MIS), data as of August 2012) 


145


146 

Table HR28 

U.S. Adults 65 and Older, 2011: Ten Leading Causes of Nonfatal Injury 

CV 

(SE/National Lower 95% Upper 95% 

Rank Cause of Injury Injuries % Std Error Estimate) CI CI 

0 Overall Injuries 3,821,222 100% 356,693.4 9.3% 3,122,102.9 4,520,341.2 

1 Unintentional Fall 2,403,146 62.9% 197,916.0 8.2% 2,015,230.2 2,791,061.0 

2 Unintentional Struck By/Against 269,421 7.1% 23,184.6 8.6% 223,978.7 314,862.5 

3 Unintentional Overexertion 203,047 5.3% 18,102.8 8.9% 167,565.5 238,528.5 

4 Unintentional MV-Occupant 194,678 5.1% 22,819.8 11.7% 149,951.5 239,405.1 

5 Unintentional Cut/Pierce 148,065 3.9% 12,831.3 8.7% 122,916.1 173,214.7 

6 Unintentional Poisoning 95,841 2.5% 12,372.6 12.9% 71,591.0 120,091.6 

7 Unintentional Other Bite/Sting 93,856 2.5% 10,847.7 11.6% 72,594.4 115,117.3 

8 Unintentional Other Specified 74,873 2.0% 11,388.7 15.2% 52,550.8 97,194.6 

9 Unintentional Other Transport 66,445 1.7% 6,592.9 9.9% 53,522.6 79,366.8 

10 Unintentional Unknown/Unspecified 56,754 1.5% 8,165.7 14.4% 40,749.5 72,759.1 

11 All Others* 215,096 5.6% . . . . . 

(CDC: WISQARS, 2011)

Table HR29 

U.S. Adults 65 and Older, 2007: Unintentional Fall Deaths and Rates per 100,000 

Sex Race Number of Crude 

Deaths Population Rate 

Males White 7,895 14,155,959 55.77 

Black 289 1,278,555 22.6 

American Indian/Alaskan Native 46 95,980 47.93 

Asian/Pacific Islander 178 558,615 31.86 

8,408 16,089,109 52.26 

Females White 9,417 18,870,496 49.9 

Black 311 2,006,642 15.5 


Asian/Pacific Islander 169 736,812 22.94 

9,926 21,736,602 45.66 

Total 18,334 37,825,711 48.47 


(CDC: WISQARS, Fatal Injury Mortality Report, 2007) 

147


148 

Table HR30 

Nevada Elder Abuse Reporting System: FY 2012 Allegations for Cases Closed Between 7/1/11 and 6/30/12 

Region Abuse Neglect Self-Neglect Exploitation Isolation Total 

Southern Urban Metropolitan 

ADSD 699 690 849 672 87 2997 

Law Enforcement 40 26 3 29 0 98 

Northern Urban Metropolitan 

ADSD 299 292 584 328 48 1551 



ADSD 127 160 273 138 8 706 


Statewide Total 1176 1173 1711 1171 143 5374 

(ADSD: EPS Caseload Statistics, 2012)

Table HR31 

Nevada, FY 2011 – FY 2012: Percent Change in EPS Cases 

Number of Cases 

% Change 

FY11 

FY12 

Abuse 1,036 1,176 13.5% 

Exploitation 1,139 1,171 2.8% 

Isolation 142 143 0.7% 

Neglect 1,061 1,173 10.6% 

Self-Neglect 1,859 1,711 (8%) 

(ADSD: EPS Caseload Statistics, 2012) 


149


150 

Table HR32 

Nevada Elder Abuse Reporting System: FY 2012, Substantiated and Unsubstantiated Allegations for Cases Closed Between 7/1/11 and 6/30/12* 

Region Abuse Neglect Self-Neglect Exploitation Isolation Total 

Southern Urban Metropolitan 

Substantiated 

ADSD 141 135 146 99 8 529 


Unsubstantiated 

ADSD 558 555 703 574 79 2469 

Law Enforcement (LE) 4 5 0 7 0 15 

Northern Urban Metropolitan 

Substantiated 

ADSD 127 101 284 100 11 623 



ADSD 172 190 300 228 37 927 



Substantiated 

ADSD 37 47 104 37 0 225 

LE 1 1 0 1 0 3 


ADSD 90 113 169 101 8 481 

LE 1 0 0 1 0 2 

Substantiated Statewide Total 313 284 535 239 19 1390 

Unsubstantiated Statewide Total 825 863 1172 911 124 3895 

*Note: The LE reports received by ADSD do not always show that a case is substantiated or unsubstantiated; the status of an LE case may be unknown. 

(ADSD: EPS, 2012)

Table HR33 

U.S. Adults 65 and Older: Age by Motor Vehicle Deaths and Rates per 100,000 

Age Group Number of Deaths Population Crude Rate 

65-69 1,498 12,435,263 12.1 

70-74 1,178 9,278,166 12.7 

75-79 1,267 7,317,795 17.3 

80-84 1,191 5,743,327 20.7 

85+ 1,309 5,493,433 23.8 

Total 6,443 40,267,984 16.0 


Table HR34 


U.S. Adults 65 and Older: Sex and Age by Motor Vehicle Deaths and Rates per 100,000 

Age Group Sex Number of Deaths Population Crude Rate 

65-69 Males 978 5,852,547 16.7 

Females 520 6,582,716 7.9 

1,498 12,435,263 12.1 

70-74 Males 745 4,243,972 17.6 

Females 433 5,034,194 8.6 

1,178 9,278,166 12.7 

75-79 Males 767 3,182,388 24.1 

Females 500 4,135,407 12.1 

1,267 7,317,795 17.3 

80-84 Males 653 2,294,374 28.5 

Females 538 3,448,953 15.6 

1,191 5,743,327 20.7 

85+ Males 719 1,789,679 40.2 

Females 590 3,703,754 15.9 

1,309 5,493,433 23.8 

Total 6,443 40,267,984 16.0 


151


Table HR35 

U.S. Adults 65 and Older, 2010: Race by Motor Vehicle Fatalities 

Race Deaths Population Crude Rate 

White 5,731 34,971,197 16.4 

Black 462 3,541,901 13.0 


Asian/Pacific Islander 199 1,499,672 13.3 

Total 6,443 40,267,984 16.0 


152

Table HR36 

U.S. Adults 65 and Older, 2011: Frequency of Seatbelt Use in Motor Vehicles 

Frequency* Weighted Std Dev 95% Confidence Limits Percent Std Err 95% 

Frequency of for Weighted Frequency of Confidence 

Weighted Percent Limits for 

Frequency Percent 

Always 1,386 267,785 10,087 248,000.0 287,570.0 89.8% 1.3 87.2% 92.4% 

Nearly Always 65 12,885 2,412 8,154.0 17,616.0 4.3% 0.8 2.7% 5.9% 

Sometimes 21 7,132 2,648 1,937.0 12,327.0 2.4% 0.9 0.7% 4.1% 

Seldom 10 1,708 782 174.0 3,242.0 0.6% 0.3 0.1% 1.1% 

Never 32 4,631 1,142 2,390.0 6,872.0 1.6% 0.4 0.8% 2.3% 

Never drive or ride in a car 11 4,009 1,545 979.1 7,040.0 1.3% 0.5 0.3% 2.4% 

Total 1,525 298,151 10,183 278,177.0 318,126.0 100% 

*Frequency Missing = 144 (CDC: BRFSS, 2011) 


153


154 

Table HR37 

Prevalence and Risk of Homelessness Among Veterans and Nonveterans in Poverty and General Populations in 7 U.S. Metropolitan Areas 

Age Race % Homelessness Poverty % Homelessness Poverty 

Population RR* Population RR** 

Veterans Nonveterans Veterans Nonveterans 

M F M F M F M F M F M F 

18-29 Black 52.8 36.3 11.8 15.7 4.5 2.3 5.4 7.9 2.6 4.6 2.1 1.7 

Non-Black 7.3 11.9 3.3 3.9 2.2 3.1 0.7 1.6 0.5 0.8 1.4 2.1 

30-44 Black 33.8 35.4 23.7 13.8 1.4 2.6 4.7 6.3 4.1 3.2 1.1 2.0 

Non-Black 17.2 12.1 7.7 4.4 2.2 2.8 1.0 0.9 0.7 0.6 1.3 1.5 

45-54 Black 38.0 29.1 24.6 10.7 1.5 2.7 7.3 3.2 4.8 2.0 1.5 1.6 

Non-Black 21.0 12.3 8.7 4.1 2.4 3.0 1.9 1.1 0.9 0.4 2.2 2.7 

55-64 Black 24.2 9.1 13.6 3.7 1.8 2.4 3.8 1.4 2.4 0.7 1.6 2.1 

Non-Black 10.5 9.3 5.6 1.8 1.9 5.2 0.6 0.6 0.6 0.2 1.1 3.3 

65+ Black 4.8 1.7 3.6 0.6 1.3 2.8 0.6 0.4 0.6 0.1 1.0 3.2 

Non-Black 2.1 0.8 1.2 0.3 1.8 2.9 0.1 0.1 0.1 0.0 0.7 2.3 

All Ages Black 26.8 29.7 17.7 11.6 2.5 2.5 4.0 4.9 3.4 2.7 1.5 2.1 

Non-Black 10.6 9.2 5.5 3.3 2.2 3.2 0.6 0.8 0.7 0.5 1.4 2.3 

All Ages All Races 14.6 15.0 7.9 5.1 2.2 3.0 1.0 1.6 1.0 0.8 1.4 2.3 

*Prevalence of homelessness among veterans/Prevalence of homelessness among nonveterans in poverty population. 

**Prevalence of homelessness among veterans/Prevalence of homelessness among nonveterans in general population. 

(Fargo, et al., 2012, p. 8)

In the final section of the Elder’s 

Count Nevada (2013) report, we 

will examine health care among 

Nevada’s older adults. Sections within 

this chapter include discussions about 

health care utilization and coverage, 

health-policy reform and its impact on 

older adults in Nevada, Medicare and 

Medicaid enrollment, staff resources, 

caregivers, prescriptions drugs, 

expenditures, nursing home facilities 

and residents, and health care issues 

among older Nevada veterans. 

New to the Health Care chapter in the 

Elder’s Count Nevada (2013) report 

is a section on health care reform as 

it applies to older adults. In 2010, the 

Patient Protection and Affordable Care 

Act (PPACA) was signed into law. It 

was designed to improve access to 

health care through various reform 

provisions (Garner et al., 2012). On 

January 3, 2013, President Obama also 

approved Nevada’s plan to create an 

online health insurance exchange. 

Under law, this exchange will assist 

individuals and companies with 

finding health insurance by allowing 

them to search insurance options. 

The exchanges are scheduled to 

launch open enrollment by October 1, 

2013, and by January 1, 2014, federal 

subsidies are scheduled to be available 

for purchases through the exchanges 

(Kliff, 2013). 

Health Care 

Medical Services Use & Health Insurance Coverage 

Health Policy Reform 

Medicare & Medicaid Enrollment 

Workforce Resources 

Caregivers 

Prescription Drugs 

Expenditures 

Nursing Home Facilities 

Nursing Home Residents 

Veterans 

Authors: Angela D. Broadus, Julie Kilgore, Shawna Dale Koehler Larson 

Content Reviewers: Caleb Cage, Tina Gerber-Winn

Health Care 

156 

Highlights 

Medical Services Use & Health Insurance 

Coverage 

• Inpatient Medicare admissions in Nevada stayed 

relatively constant between 2007 and 2010, 

while the number of admissions nationally 

decreased. 

• Although the number of outpatient Medicare 

hospital visits increased nationally between 2007 

and 2010, they remained relatively constant in 

Nevada. 

• Of Nevadans 65 and older, an estimated 96.6% 

indicated that they have health care coverage. 

• Just over a fifth (22.1%) of Nevada adults and 

3.4% of Nevadans 65 and older are either 

uninsured or under-insured. 

Health Policy Reform 

• Title I Quality, Affordable Health Care for All 

Americans will be an important improvement 

for older adults with chronic conditions such 

as hypertension and diabetes, or with previous 

conditions such as cancer. 

• Older adults will benefit from the 2010 Patient 

Protection and Affordable Care Act’s (PPACA) 

geriatric and rural-physician workforce 

development and training. 

• The PPACA lowered the cost of prescription 

drugs for Nevadans reaching the Medicare Part 

D coverage gap for out-of-pocket expenses. This 

saved Nevadans an average of $585 in 2012. 


• In 2012, an estimated 13.9% (379,860) of the 

Nevada population and 16% (over 49 million) of 

the U.S. population were Medicare beneficiaries. 

• Between 2010 and 2011, an estimated 13% 

(39.9 million) of the U.S. population and 13% 

(341,800) of Nevadans received Medicare. 

• Between 2010 and 2011, 16% (50.6 million) 

of the U.S. population and 10% (261,200) of 

Nevadans received Medicaid health insurance. 

• Nevada is one of 17 states that do not 

provide a “medically needy program” to cover 

possible gaps in coverage for those above the 

“categorically needy income levels.” 

• When compared with the United States as a 

whole, Nevada spent a larger share on acute 

care (68.1% vs. 64%) and hospital payments 

(6.3% vs. 4.5%). 


• From 2000 to 2010, the number of new students 

enrolled in Nevada medical schools grew by 

273.7%, while nationally enrollment grew by 

22.9%. In spite of this encouraging news, the 

current number of active physicians in Nevada is 

discouraging. 

• In 2010, Nevada’s rate of student enrollment in 

medical or osteopathic school (29.4 per 100,000) 

was lower than the national enrollment rate of 

31.4 per 100,000. 

• Between 2000 and 2010, the rate for Nevada 

residents/fellows in ACGME programs increased 

by 77.8%, compared with a 15.3% increase 

nationally. 

• The percentage of physicians retained in Nevada 

upon graduation (39.2%) was slightly higher in 

2010 than found nationally (38.6%). 

• The percentage retained from a graduate 

medical education program in Nevada (57.8%) 

was higher than found nationally (47.8%). 

• In spite of the encouraging news, the current 

number of active physicians in Nevada is 

discouraging. In 2010, Nevada ranked 45th in 

the nation for the number of active physicians 

per 100,000 in population (198.3). 

Caregivers 

• The number of caregivers in Nevada during 

2009 ranged from a snapshot of 364,000 (in last 

month) to a total 532,000 annually. 

• These caregivers provided 348 million hours of 

care at an average of $11.48 per hour. 

• The total value of care provided by Nevada 

caregivers in 2009 was an estimated $4 billion. 


• In 2009, drug-induced deaths ranked as 

Nevada’s sixth-leading cause of death. 

• In 2010, Nevada ranked fourth in the nation in 

drug-poisoning deaths with an age-adjusted 

rate of 20.7 per 100,000. 

• Between 2009 and 2010, nonmedical use and 

abuse of prescription pain relievers by Nevada 

adults 26 and older was higher (4.6%) than 

found nationally (3.5%).

Expenditures 

• Nevada was in the fastest-increasing quarter of 

states for health care expenditures and in 2009 

posted a higher annual rate of growth (9.2%) 

than the national rate (6.5%). 

• Nevada health expenditures in 2009 consisted 

of: hospital care (34%), physician and other 

professional services (33.1%), prescription drugs 

and other medical nondurables (15.6%), nursing 

home care (3.2%), dental services (5.8%), home 

health care (3.1%), medical durables (2.5%), 

and other health, residential and personal-care 

expenditures (2.8%). 

• Nevada devoted a smaller share of its health 

expenditures to hospital care, nursing home 

care, home health care, and other health, 

residential and personal care than was the case 

nationally. 


• Contrary to the national trend, the number of 

nursing home facilities in Nevada increased 

from 44 in 2003 to 51 in 2011. 

• In 2011, Nevada’s certified nursing homes had a 

total of 5,984 beds, 4,717 residents, and a 78.8% 

occupancy rate (CDC: Health United States, 

2012). This occupancy rate was lower than 

found nationally (81.6 per 100 beds). 

• In 2009, 11 Nevada nursing homes had fewer 

than 50 beds, 10 had 50-99 beds, 22 had 100- 

199 beds, and six had 200 or more beds. 

• In 2009, Nevada had 45 dually certified 

(Medicare and Medicaid) facilities, and two 

facilities with single certification. 

• In 2009, 2.1% of nursing homes in Nevada were 

found to be without deficiencies, 27.1% had 

severe deficiencies resulting in actual harm or 

causing immediate jeopardy to residents, and 

6.3% had substandard quality of care. 


• In 2009, 7.1% of U.S. adults 65 and older and 

21.5% of adults 85 and older had experienced 

at least one nursing home stay. In Nevada the 

corresponding figures were 3.7% and 12.4%. 

• In 2010, there were 7,823 nursing facility 

residents in Nevada with a per-facility low of 2 

and a high of 426. The average was 160. 

• Of Nevada’s nursing home residents in 2009, 

58.9% were female, 20.3% were 65-74, 32.8% 

were 75-84, and 29.3% were 85 and older. The 

majority were White (86.5%); 28.7% had no 

Activities of Daily Living (ADL) impairments; 

19.9% had five ADL impairments; and 43.2% 

did not have any cognitive impairments. 

• The percentage of residents with no 

impairments in ADL decreased from 31.5% 

to 28.7% between 2005 and 2009, and the 

percentage of those with four ADL impairments 

increased from 27% to 32.5%. 

Veterans 

• The Veterans Health Administration pays $8,800 

per veteran treated at VA clinics. 

• By 2020, VA health care costs are projected to 

increase to between $69 billion and $83 billion 

depending on the number of soldiers deployed 

in overseas conflicts and the income thresholds 

for eligibility. 

• In 2010, Nevada spent $527 million for veteran 

health care, with 57,869 veterans (unique 

patients) receiving treatment at a VA health care 

facility. By 2011, the total had increased to $533 

million for 59,643 patients. 

• Of these patients, 60.5% (36,077) resided 

in the Southern Urban/Metropolitan region 

of the state, 23.3% in the Northern Urban/ 

Metropolitan region, and 16.2% in the Rural/ 

Frontier region. 

Health Care 

157

Health Care 

Medical Services Use & Health Insurance Coverage 

Older adult use of medical services increased 

between 1998 and 2008. For example, although 

adults 65 and older continued to represent 

approximately 12% of the U.S. population, their 

share of physician office visits rose from 24% to 

27% (Cherry, Lucas, & Decker, 2010), their share 

of medication prescriptions (new or renewed) 

increased from 33% to 38%, and their share of 

diagnostic and imaging orders (e.g., CT scan, 

MRI, X-ray, or ultrasound) increased from 26% to 

30%. The average number of minutes they spent 

during a physician office visit increased from 24 

to 28 minutes. The annual number of doctor’s 

appointments per person 65 or older increased from 

6.1 in 1998 to 6.9 in 2008. The number of doctor 

appointments resulting in a prescription (new or 

renewed) increased from 4.2 per person in 1998 to 

5.5 per person in 2008 (Cherry et al., 2010). 

According to the Centers for Medicare & Medicaid 

Services (CMS), the number of hospital inpatient 

Medicare admissions nationally increased between 

2007 and 2010, while admissions decreased in 

Nevada (see Figure HC1 and Table HC1, CDC: 

National Center for Health Statistics, n.d.). In 

addition, while the number of outpatient Medicare 

hospital visits increased nationally during the same 

period, they remained relatively constant in Nevada 

(see Figure HC2). 

Fig. HC1: U.S. and Nevada: Hospital 

Inpatient Medicare Admissions (per 1,000 

Beneficiaries) by Year 

343.5 340.9 330.8 324.6 

280.0 290.8 286.5 283.5 

2007 2008 2009 2010 

(CDC: National Center for Health Statistics, n.d.) 

Fig. HC2: U.S. and Nevada: Hospital 

Outpatient Medicare Admissions (per 1,000 

Beneficiaries) by Year 

3838.6 3881.5 3972.5 4014.7 

2369 2360.3 2411.2 2391.7 

2007 2008 2009 2010 

U.S. 

NV 

U.S. 

NV 

Between 1978 and 2008, the use of specialists 

increased for adults 65 and older. In 1978, 

approximately 62% used primary care physicians, 

and approximately 37% used medical or surgical 

specialists (Cherry et al., 2010). By 2008, fewer older 

adults (45%) were using primary care physicians, 

and more used medical (25%) or surgical (30%) 

specialists. In addition, between 1998 and 2008 the 

number of medical visits for adults 65 and older 

increased for chronic conditions such as essential 

hypertension, cardiac dysrhythmias and diabetes, 

and for conditions such as lipid metabolism 

disorders, urinary-system issues and hypothyroidism 

(Cherry et al., 2010). 

A major factor in accessing health care was whether 

the individual had health insurance. In 2011, the 

3-Year American Community Survey found that an 

estimated 66.2% of the U.S. population had some 

type of private health insurance, 29.5% had public 

health insurance, and 15.2% had no health insurance 

(ACS, 3-Year Survey, S0201, 2011). In Nevada, 

an estimated 64.3% had private health insurance, 

23.2% had public coverage, and 22.1% had no health 

insurance (ACS, 3-Year Survey, S0201, 2011; Garner, 

Wakefield, Tyler, Samuels, & Cleveland, 2012). 

In the 2011 Behavioral Risk Factor Surveillance 

System (BRFSS), 82.1% of U.S. adults 18 and older 

and 72.7% of adult Nevadans indicated that they 

had health care coverage. However, an estimated 

96.6% of Nevadans 65 and older indicated they 

had coverage. This was most likely in the form of 

Medicare (see Table HC2, CDC: BRFSS, 2011). 

Health care coverage rates did not differ significantly 

by region, age, race/ethnicity, sex, education or 


Cost is a major factor in health care utilization, 

and over the past decade, health care costs have 

increased dramatically. In 2010, Medicare charges 

per hospital stay for adults 65 and older ranged from 

zero dollars to over $2 million (see Table HC3; CDC: 

BRFSS, 2010). Additionally, the average charges per 

hospital stay were lower for adults over age 85 ($50, 

706) than for those age 65-84 years old ($63,670). 

158 

(CDC: National Center for Health Statistics, n.d.)

In 2011, an estimated 4.6% of U.S. adults 65 and 

older said they either did not get care or delayed 

care due to cost (CDC: Publication and Information: 

2011). When examined by age group, the share 

of adults 65-74 who did not get or who delayed 

medical care increased slightly between 1997 and 

2011 (5% to 5.8%). Among adults 75 and older, the 

share deferring care decreased, from 4.1% to 3.1% 

(see Figure HC3). In 2011 an estimated 4.3% of U.S. 

adults 65 and older did not get prescription drugs 

due to cost, and 7% did not get dental care (see Table 

HC4). 

Percent 

7.0 

6.0 

5.0 

4.0 

3.0 

2.0 

1.0 

0.0 

Fig. HC3: U.S. Adults, Age 65 and Older: Did Not Get 

or Delayed Medical Care due to Cost 

5.8 

5.0 

4.6 4.6 

4.1 

3.1 

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 

65 Years and Older 65-74 Years 75 Years and Older 

(CDC: Publication & Information, 2011) 

Health Care 

Health Care Reform 

Nearly every hospital with an emergency 

department is required to provide emergency 

services to anyone, regardless of ability to pay. And 

even when an uninsured patient arrives planning to 

pay his or her own way, that patient may struggle 

to pay for an extended stay. The upshot: Hospitals 

treat tens of millions of uninsured individuals 

each year, and most of that care is uncompensated. 

Indeed, in the last decade, hospitals provided more 

than $300 billion in uncompensated care to the 

uninsured and under-insured…. And although 

hospitals do what they can to assist patients, 

burdens on uninsured individuals remain heavy. 

Millions of families are just one major injury or 

illness from financial ruin. 

(Brief for the American Hospital Association as 

Amici Curiae, 2012, p. 3) 

New to the Elder’s Count Nevada (2013) report is a 

section on health care reform as it applies to older 

adults. In 2010, the Patient Protection and Affordable 

Care Act (PPACA) was signed into law. It was 

designed to improve access to health care through 

various reform provisions (Garner et al., 2012). On 

January 3, 2013, President Obama also approved 

Nevada’s plan to create an online health insurance 

exchange. Under law, this exchange will assist 

individuals and companies with finding health 

insurance by allowing them to search insurance 

options. The exchanges are scheduled to launch 

open enrollment by October 1, 2013. By January 1, 

2014, federal subsidies are scheduled to be available 

for purchases through the exchanges (Kliff, 2013). 

As indicated previously, 22.1% of Nevada adults 

and 3.4% of Nevadans 65 and older are either 

uninsured or under-insured. The first reform, 

Title I Quality, Affordable Health Care for All 

Americans, eliminates the pre-existing conditions 

limitation for children and is designed to ensure 

that all Americans have access to affordable 

health insurance. This would be an important 

improvement for older adults with chronic 

conditions such as hypertension and diabetes, or 

with previous conditions such as cancer. 

Another reform, Title IX Revenue Provisions, 

specifically helps older adults in two ways: It levies 

an excise tax on insurance companies or plans that 

have annual premiums over $1,350 for individuals 

or $3,000 for families or retired individuals 55 and 

older (Garner et al., 2012, p. 24). Also, adults 65 

and older will be able to claim itemized deductions 

on medical expenses in excess of 7.5% of adjusted 

gross income through 2016. After that, the 

threshold will increase to 10% of adjusted gross 


159

Health Care 

The PPACA includes workforce provisions designed 

to: “improve access by increasing the supply of 

needed health workers, particularly primary care 

practitioners; increase efficiency and effectiveness 

by encouraging systems redesign; address problems 

of mal- distribution; and improve the quality of care 

through improved education and training” (AAMC, 

2010, p. 1). The PPACA also addresses workforce 

issues through development of workforce-grant 

programs, effective methods for financing health 

care education, and loan-repayment programs. 

Students agreeing to practice in specific areas of 

need, such as geriatrics, for a minimum of two years 

post-graduation will receive tuition assistance. 

Eligible primary care practitioners and surgeons will 

receive Medicare incentive bonuses (10%), while 

Medicaid payments to primary care practitioners 

will be set at 100% of the Medicare rate in 

2013 and 2014. Older adults will benefit from 

PPACA’s geriatric and rural- physician workforce 

development and training. Specifically, the PPACA: 

• Amends Title VII of PHSA to award grants to 

Geriatric Education Centers (GECs) to develop 

Continuing Medical Education fellowships, with 

$10.8 million authorized for period between FYs 

2011-2014; 

• Establishes Geriatric Career Incentive Awards 

for non-physician providers with $10 million/ 

year authorized for FYs 2011-2013 

• Expands eligibility beyond physicians for 

Geriatric Academic Career Awards 

• Amends the Title VIII Comprehensive Geriatric 

Education program 

• Amends Title VII to establish a grant program 

for medical schools to establish, improve, or 

expand “rural-focused” education and training 

meeting certain criteria, including recruiting 

students likely to practice in rural communities 

(AAMC, 2010, p. 6). 

Finally, the PPACA lowered the out-of-pocket cost 

of prescription drugs for Nevadans reaching the 

Medicare Part D coverage gap (Healthcare.gov, 

2012). The health care law provided a 50% discount 

for brand-name prescription drugs and a smaller 

discount for already lower-priced generic drugs. In 

2012, this saved Nevadans an average of $585 per 

person (Healthcare.gov, 2012). 


160 

Medicare is “the federal insurance program for people 

who are 65 or older, certain younger people with 

disabilities, and people with end-Stage Renal Disease” 

(www.medicare.gov). Medicaid is a state-level 

program that “provides health coverage for lowerincome 

people, families and children, the elderly, and 

people with disabilities” (www.healthcare.gov). 

Medicare consists of four specific programs: hospital 

insurance (Medicare Part A), medical insurance 

(Medicare Part B), a combined hospital and medical 

private-insurance program (Medicare Part C), and 

prescription-drug insurance (Medicare Part D). 

Beginning in 2014, the PPACA is scheduled to 

expand Medicare eligibility to include those younger 

than 65 and those with higher incomes. Eligibility 

also will expand to include low-income adults with 

disabilities who fail to meet Supplemental Security 

Income (SSI) requirements. 

In 2012, an estimated 13.9% (379,860 individuals) 

of the Nevada population and 16% (over 49 million) 

of the U.S. population were Medicare beneficiaries 

[see Table HC5, Henry J. Kaiser Family Foundation 

(HJKFF), 2012]. 

The average age of Medicare beneficiaries in 

Nevada was slightly lower than found nationally 

(see Table HC6).

Between 2010 and 2011, an estimated 13% (39.9 

million) of the U.S. population received Medicare 

and 16% (50.6 million) received Medicaid health 

insurance (HJKFF, 2012). During this same time, 

13% (341,800) of Nevada’s population received 

Medicare and 10% (261,200) received Medicaid 

health insurance. Of Nevadans receiving Medicare, 

48% (184,400) were 65-74, and 26% (101,600) 

were 75-84 (see Figure HC4). In addition, 51% 

were female, 73.7% were White, and 56.5% were 

at 200% or more of the Federal Poverty Level (see 

Table HC7; HJKFF, 2012). When compared with the 

nation as a whole, a greater percentage of Nevada 

Hispanics (10.8% vs. 7.6%) and those designated 

as “Other” (9.5% vs. 4.7%) were Medicare 

beneficiaries. 

Fig. HC4: U.S. & Nevada Adults Age 65 & 

Older, 2010-2011: Age by Distribution of 

Medicare Beneficiaries 

48.0% 

(HJKFF, 2012) 

44.8% 

26.3% 27.0% 

15.7% 17.0% 

10.3% 

0.0% 


United States 

19-64 Years 65-74 Years 75-84 Years 85 and Older 

In 2009, estimated spending for Medicare in Nevada 

was $3.3 million. Enrollees each spent an estimated 

$9,692 (HJKFF, 2012). In comparison, the estimated 

per-enrollee spending nationally was $10,365. From 

1991-2009, Nevada was the fastest-growing state 

in terms of average annual growth in Medicare 

spending. Its average annual growth rate was 

11.1%, while the national average growth rate was 

8% (HJKFF, 2012). However, from 1991 to 2009, 

Nevada was only the 12th-fastest-growing in terms 

of Medicare spending with an annual rate of 6.1%. 

During that period the national growth rate averaged 

6.3%. 

The 2009 distribution of Medicare spending by 

service type in Nevada is comparable to that 

nationally. The largest percentage of money was 

spent on hospital care (see Table HC8) with the 

lowest share spent on dental services. This is likely 

because Medicare covers only necessary dental 

procedures related to a covered medical service. 

(HJKFF, 2012). 

Medicaid provides health care coverage for the poor, 

the aged, and people with disabilities. In Nevada, 

older adults are eligible for Medicaid if they are at 

76%-99% of the federal poverty level (FPL), have 

no more than $2,000 in assets if single, and have 

a monthly income between $710.40 and $1,085.46 

(Kaiser Commission on Key Facts, 2010). Nevada 

is one of 17 states that do not provide a “medically 

needy program” to cover possible gaps in coverage 

for those above the “categorically needy income 

levels” (Kaiser Commission, 2010, p. 2). However, 

Nevada does provide a special income standard of 

300% of Supplemental Security Income (SSI) for 

nursing home Medicaid. 

In 2009, more than half (58%) of Medicaid enrollees 

in Nevada were children (HJKFF, 2012). Of the 

remaining, 19% were adults 19-64, 14% were 

disabled Nevadans under the age of 65, and 9% were 

adults 65 and older. Medicaid enrollment for 2009 

was 290,435, 11% of the state’s total population and 

much lower than the national rate, 20%. As of July 1, 

2011, Nevada ranked 16th in the nation in Medicaid 

Managed Care enrollment with 248,819 enrollees 

(HJKFF, 2012). An annual snapshot of Medicaid 

enrollment for all enrollee categories (see Figure 

HC5) shows that enrollment dropped from June 2004 

to December 2006 and then began to rise in 2007 at 

the start of the national recession. 

Fig. HC5: Medicaid, Nevada: Point-in-Time 

Monthly Enrollments by Year (in Thousands) 

June 2004 

December 2004 

June 2005 

December 2005 

June 2006 

December 2006 

June 2007 

December 2007 

June 2008 

December 2008 

June 2009 

December 2009 

June 2010 

December 2010 

June 2011 

(HJKFF, 2012) 

176.6 

174.2 

171.7 

172.8 

171.8 

166.5 

170.2 

180.0 

188.9 

195.0 

213.5 

238.6 

263.6 

280.3 

290.9 

In June 2011, the monthly Medicaid enrollment 

for Nevada adults 19 and older was 105,400 (see 

Figure HC6). Between June 2009 and 2011, Nevada 

experienced a 22.4% increase in monthly enrollment 

for adults, compared with a 12.7% increase nationally 

(HJKFF, 2012). Additional data specifically for older 

adults were not available. 

Health Care 

161

Health Care 

Fig. HC6: Medicaid, Nevada Adults: Point-in- 

Time Monthly Enrollments by Year (in 

Thousands) 

86.1 

107.1 105.4 

June 2009 June 2010 June 2011 

(HJKFF, 2012) 

Nevada ranked in the lowest quartile nationally 

in Medicaid state and federal spending in FY 2010 

with expenditures of $1.5 billion (HJKFF, 2012). The 

payments went for acute care (68.1%), long-term 

care (25.6%), and disproportionate share hospital 

programs for hospitals that treat indigent patients 

(6.3%, see Table HC9). Compared to the United 

States as a whole, Nevada spent more on acute care 

(68.1% vs. 64%) and a disproportionate share of 

hospital payments (6.3% vs. 4.5%). 


To meet the growing and changing demand for 

medical care, the United States and Nevada must 

have sufficient medical providers. In 2003, the 

Association of American Medical Colleges (AAMC) 

predicted a national shortage of almost 91,000 

physicians by 2020 due to the rising U.S. population, 

the aging of America, and the aging of the medicalprovider 

community (p. 2). Following enactment 

of the Patient Protection and Accountable Care 

Act (PPACA), the medical colleges revised their 

prediction to a “shortage of 91,500 and 130,600 

active-patient care physicians in 2020 and 2025, 

respectively, and a primary care shortage of 45,400 

and 65,800 physicians in 2020 and 2025” (AAMC: 

The impact of health care reform, 2011, p. 1). 

With medical-school training averaging 14 years 

(AAMC, 2003), the predicted shortfall must be 

addressed before the demand seriously outweighs 

the supply. Per the AAMC (2003), a 30% increase 

in medical-school enrollment by 2015 is essential to 

meet the growing demand. Between 1980 and 2005, 

U.S. first-year medical-school enrollment declined 

from a rate of 7.3 per 100,000 of population to 5.6 

per 100,000 (AAMC, 2003). However, a more recent 

AAMC report (Ward, 2012) indicated that national 

enrollment rates increased between 2002 and 

2012 by 18.4% (see Table HC10). If these increases 

continue, medical-school enrollment will reach the 

suggested 30% increase by 2016 (Ward, 2012). 

At the state level, Nevada has shown significant 

increases in enrollment rates for medical or 

osteopathic schools (AAMC, 2011). In 2010, 

Nevada’s rate of student enrollment in medical or 

osteopathic school (29.4 per 100,000) was lower 

than found nationally (31.4 per 100,000). However, 

between 2000 and 2010, Nevada increased the 

number of students by 273.7%, while enrollment 

grew nationally by 22.9%. 

In 2010, Nevada ranked in the bottom quintile 

with the fewest residents/fellows in Accreditation 

Council for Graduate Medical Education (ACGME) 

programs. Its rate was 10.5 per 100,000, compared 

with a national rate of 35.8 per 100,000 (AAMC, 

2011). However, between 2000 and 2010, the rate 

for Nevada residents/fellows in ACGME programs 

increased by 77.8%, compared with a 15.3% increase 

nationally. The percentage of physicians retained in 

Nevada upon graduation (39.2%) was higher than 

found nationally (38.6%), as was the percentage 

retained from a graduate-medical-education 

program (57.8% versus 47.8%). 

162

In spite of this encouraging news, the current 

number of active physicians in Nevada is 

discouraging. In 2010 Nevada ranked in the bottom 

quintile nationally for: number of active physicians 

per 100,000 in population (198.3, 45th in the nation); 

active primary care physicians (71.2, 46th in the 

nation); active patient-care physicians (178.1, 44th); 

active patient-care, primary care physicians (63.7, 

46th); and percentage of female physicians (25%, 

44th). Nevada ranked below the state median (25%) 

and national level (26.2%) for physicians 60 and 

older (24.5%) and above the state median (23.1%) for 

percentage of physicians who had graduated from 

an international medical school (27.9%; see Table 

HC11; AAMC, 2011). In 2010, Nevada had 5,264 

active physicians, of whom 4,771 were active M.D.s 

and 493 were active D.O.s (Doctors of Osteopathic 

Medicine). 

In addition to the need for physicians, Nevada falls 

behind other states nationally in other health care 

professions. For example, from 2006 to 2011, Nevada 

fell from 49th to last in the nation in the number of 

registered nurses (RNs) with 605 nurses per 100,000 

population compared with 874 per 100,000 nationally 

(HJKFF, 2012). In the same time frame, Nevada 

moved from 47th to last in the nation in the number 

of nurse practitioners with 26 per 100,000 compared 

with 58 per 100,000 nationally (HJKFF, 2012). Also 

in 2011, Nevada ranked 44th in the nation with 

5 dentists per 10,000 compared with 6 per 10,000 

nationally, and 39th in the nation with 23 Physician 

Assistants per 100,000 compared with 27 per 100,000 

nationally (HJKFF, 2012). 

Health Care 

Caregivers 

Family caregivers provide unpaid care to adults and 

special-needs children through a variety of means: 

assisting with tasks of daily living (56%); transferring 

in and out of beds and chairs (40%); dressing 

(32%); bathing, showering or other hygiene-related 

activities (26%); using the toilet (24%); feeding 

(19%); and incontinence-related issues [18%, 

National Alliance on Caregiving (NAC), 2009, p. 

5]. Feinberg, Reinhard, Houser, and Choula (2011) 

generated a more comprehensive list of tasks in the 

“new normal” for caregiver roles: 

• Providing companionship and emotional support 

• Helping with household tasks, such as preparing 

meals 

• Handling bills and dealing with insurance claims 

• Carrying out personal care, such as bathing and 

dressing 

• Being responsible for nursing procedures in the 

home 

• Administering and managing multiple 

medications, including injections 

• Identifying, arranging, and coordinating services 

and supports 

• Hiring and supervising direct care workers 

• Arranging for or providing transportation to 

medical appointments and community services 

• Communicating with health professionals 

• Serving as “advocate” for their loved one during 

medical appointments or hospitalizations 

• Implementing care plans 

• Playing a key role of “care coordinator” during 

transitions, especially from hospital to home 

(Feinberg et al., 2011, p. 5). 

Estimates of caregiving prevalence within the United 

States vary. One national survey estimated that 

65.7 million individuals have worked at least once 

in their lives as an unpaid caregiver (NAC, 2009). 

Another survey estimated that 61.6 million worked 

as caregivers in 2009 (Feinberg et al., 2011). Per NAC 

(2009), 31.2% of U.S. households (an estimated 36.5 

million) used a caregiver in the past year with an 

average caregiver burden of 18.9 hours per week. For 

those living with the care recipient, the caregiving 

burden was as high as 39.3 hours per week. 

The economic value of caregiving increased from 

$350 billion in 2006 to $375 billion in 2007 and to 

$450 billion in 2009 (Feinberg et al., 2011). Value 

increases between 2007 and 2009 reflected a 57% 

increase in the number of caregivers. An additional 

43% of the increase followed an increase in the wage 

value from $10.10 per hour in 2007 to $11.16 in 2009 

(Feinberg et al., 2011, p. 3). 

163

Health Care 

The majority of caregivers are female (66% in the 

NAC survey, 65% in the Feinberg et al. survey), and 

the average age is 49.2 years (NAC, 2009, p. 4). In 

2004, the average age of a caregiver was 46.4. NAC 

(2009) attributed the change in caregiver age to the 

growing number of caregivers between 50 and 64 

years of age. 

The majority of caregivers (86%) cared for relatives, 

36% cared for a spouse, and 14% for a child. In 

addition, the majority of caregivers (70%) provided 

care to adults 50 and older. An estimated 62% of 

care recipients were female, the mean age being 69.3 

(NAC, 2009). Similar to the increase in caregiver age, 

the share of care recipients 75 and older increased 

from 43% in 2004 to 51% in 2009 (NAC, 2009, p. 4). 

Almost half (47%) of caregivers 65 and older and 

49% of co-resident caregivers provide care on their 

own. More than a third (35%) of caregivers had 

paid assistants (NAC, 2009). Of course, use of paid 

caregivers or assistants depends upon household 

income. For example, the 2008 recession may have 

been a factor in the decline of paid help from 41% in 

2004 to 35% in 2009 (NAC, 2009, p. 7). 

In a study of North Carolina caregivers, Winder, 

Bouldin and Andresen (2010) assessed the perception 

of choice in caregiving. Those who believed they 

had no choice in caregiving were more likely to 

be an adult child of the recipient. Those believing 

they had a choice were more likely to be a family 

member other than a parent or child. In addition, 

caregivers who believed that they had no choice 

were 3.1 times more likely to report stress and a 

higher level of burden than those who felt they had 

a choice (p. 3). The Rosalynn Carter Institute for 

Caregiving (RCI, 2010) estimates that 20%-30% of 

caregivers suffer adverse health effects related to the 

stress of caregiving. These caregivers tend to neglect 

themselves, putting the needs of the care recipient 

ahead of their own (p. 5). Health issues included 

depression, grief, lack of sleep or exercise, poor diet, 

physical issues, and increased use of alcohol, nicotine 

or other drugs. 

The number of caregivers in Nevada during 2009 

ranged from a snapshot of 364,000 (in the last 

month) to 532,000 annually (Feinberg et al., 2011). 

These caregivers provided 348 million hours of 

care at $11.48 per hour. Thus, the total value of 

care provided by Nevada caregivers in 2009 was an 

estimated $4 billion. 

Between 2006 and 2009, the number of caregivers 

in the preceding month increased by 40%. The 

number of caregiving hours increased by 24.3%. The 

total economic value of Nevada caregiving activities 

increased by 33.3% (see Table HC12, Feinberg et al., 

2011; Houser & Gibson, 2007, 2008). 

In some states, care recipients may be eligible for 

paid caregiving. In Nevada, home and communitybased 

waivers for paid caregiving services are 

available for older adults with: 

• Physical or cognitive disabilities [Home and 

Community Based Waiver (HCBW)]; 

• Eligible adults in 24-hour residential care facilities 

(Assisted Living Waiver); 

• Adults needing non-medical services in order 

to maintain independence in their own homes 

(COPE and HCBW); 

• Home-based care for those with severe 

disabilities who do not qualify for Medicaid or 

other resources [Personal Assistance Services 

(PAS); National Resource Center for Participant- 

Directed Services, 2012]. 

164


As indicated in the chapter Health Risks and 

Behaviors, aging is associated with changes in 

pharmacokinetics (ability to absorb, distribute, 

metabolize and excrete substances) and 

pharmacodynamics (the physiological effects of the 

substance). Two potentially negative outcomes may 

result from these age-related changes. 

Substances may remain active longer in an 

older adult’s body or brain, rising to toxic levels 

or resulting in paradoxical unintended effects. 

Common adverse drug events among seniors 

include: 

• Gastrointestinal tract events (nausea, vomiting, 

constipation/diarrhea) 

• Hemorrhagic events 

• Dry mouth 

• Urinary retention 

• Dizziness/lightheadedness 

• Toxicity from anticholinergic medication due 

to age-related declines in metabolism and 

elimination 

• Central Nervous Side (CNS) effects (e.g., 

confusion or hallucinations) from pain 

medications such as Pentazocine 

• Impaired psychomotor functioning in those 

with a history of falls when prescribed 

Benzodiazepines (Campanelli, 2012). 

In a national study of adults 57-85, researchers 

found that 81% used at least one prescription 

medication, 42% used at least one over-the-counter 

medication, and 49% used a dietary supplement 

(see Figure HC7; Qato, Alexander, Conti, Johnson, 

Schumm, & Tessler, 2008, p. 2,867). Almost a third 

of adults (29%) used at least five prescriptions, 

46% used over-the-counter medications, and 

52% used dietary supplements concurrent with 

prescriptions medications. At least 4% were at risk 

for an adverse drug reaction due to concomitant 

use of nonprescription medications [over-thecounter 

medications (OTCs)] such as aspirin with 

prescription anticoagulants, or the use of niacin (a 

B-vitamin) with Atorvastatin (a cholesterol lowering 

medication; p. 2,872). 

Fig. HC7: U.S. Adults, Age 57-85: Prescription Drugs, 

OTC and Dietary Supplements 

At Least 1 Prescription Medication 

At Least 5 Prescription Medications 

At Least 1 OTC 

Concurrent OTC Use with Prescriptions 

At Least 1 Dietary Supplement 

Concurrent Dietary Supplements with 

Prescription 

29.0% 

(Qato, et al., 2008) 

42.0% 

46.0% 

49.0% 

52.0% 

81.0% 

Health Care 

Second, drugs that remain active longer in the body 

are more likely to interact with other substances 

or medications. This would result in adverse drug 

events and other medication-related problems 

such as drug-drug interactions or drug-disease 

interactions (Campanelli, 2012). Examples include: 

increased fluid retention or exacerbation of heart 

failure in seniors with a history of congestive 

heart failure who are taking Nonsteroidal Anti- 

Inflammatory Drugs (NSAIDs); lowered seizure 

threshold in epileptic adults prescribed Bupropion 

for depression or addiction-related issues; and 

exacerbation of Parkinson’s symptoms in older 

adults taking antipsychotics or antiemetics 

(Campanelli, 2012). Adverse drug reactions due 

to cardiovascular medications, anticoagulants, 

pain relievers, antibiotics and drugs to treat cancer 

and diabetes were noted in 1,678.9 (per 100,000) 

emergency department visits by U.S. adults 65 and 

older in 2010 (SAMHSA: Center for Behavioral 

Health Statistics and Quality, 2012). 

165

Health Care 

Evidence-based interventions, such as medication 

therapy management (MTM), have proven effective 

if in optimizing outcomes and lowering risks 

associated with medication use in older adults. 

The Sanford Center for Aging at the University 

of Nevada, Reno, offers such a program. With 

funding from the Nevada Aging and Disability 

Services Division (ADSD) and The Marion G. 

Thompson Charitable Trust, the program offers 

free medication reviews to low-income, vulnerable 

seniors 60 and older who are taking five or more 

prescription drugs. A Certified Geriatric Pharmacist 

(CGP) reviews an older adult’s entire drug regimen 

(prescription drugs, OTCs, dietary supplements) for 

safety and effectiveness. During FY 2011-2012, the 

program assisted 104 elder Nevadans with chronic 

health conditions and complex drug regimens. The 

MTM evaluations completed for this sample of 

clients revealed that 85% were at risk for adverse 

side effects; 63% were at risk for a prescriptionprescription 

interaction; 54% had potentially 

untreated medical conditions; 46% were taking 15 

or more medications (Rx and OTCs); 14% were 

taking 15 or more prescription drugs; 21% were 

prescribed an inappropriate dosage; and 18% were 

on an inappropriate medication schedule. 

In 2009, drug-induced death ranked as Nevada’s 

sixth-leading cause of death (Kochanek, Xu, 

Murphy, Minino, & Kung, 2011). In 2010, Nevada 

ranked fourth in the nation in drug-poisoning 

deaths with an age-adjusted rate of 20.7 per 100,000 

(CDC: Morbidity and Mortality, Drug Poisonings, 

2012). Between 2009 and 2010, nonmedical use 

and abuse of prescription pain relievers by Nevada 

adults 26 and older was higher (4.6%) than found 

nationally (3.5%, SAMHSA: Center for Behavioral 

Health, 2013). This same trend occurred between 

2010 and 2011 (see Figure HC8). Between 2010 and 

2011, Nevada ranked seventh-worst in the nation 

for nonmedical use and abuse of prescription pain 

relievers among individuals 12 and older (5.6%, 

C.I. 4.57-6.89). However, use among adults 26 and 

older decreased from 4.6% in 2009-2010 to 4.3% in 

2010-2011 (SAMHSA: Center for Behavioral Health, 

2013). 

Fig. HC8: U.S. and Nevada, Adults Age 26 and 

Older: Nonmedical Use of Prescription Pain 

Relievers 

4.6% 

3.5% 3.4% 

4.3% 

U.S. 


In addition to issues related to potential 

inappropriate medication use, nonmedical use and 

abuse of prescription drugs is a growing public 

health concern, particularly in Nevada (SAMHSA: 

Center for Behavioral Health, 2013). 

2009-2010 2010-2011 

(SAMHSA: Center for Behavioral Health, 2012) 

166

Expenditures 

In 2009, U.S. health care expenditures grew at a 

lower rate (4%) than in the previous 50 years of 

National Health Expenditure monitoring (Martin 

et al., 2011, Martin et al., 2012, p. 208). In 2010, 

health care expenditure rates decreased further to 

3.9%. Martin, et al (2011) attributed the stall in 

annual spending growth to the recession and lower 

consumer private-health insurance spending (p. 11). 

In spite of the slower health care expenditure 

growth, U.S. health care spending as a share of the 

Gross Domestic Product (Martin et al., 2011, p. 11) 

increased from 16.2% of the Gross Domestic Product 

($7,483 per capita) in 2007 to 17.6% ($8,233 per 

capita) in 2010 [see Figure HC9; Organization for 

Economic Cooperation and Development (OECD): 

Health Data, 2012). Although U.S. health spending 

is 2.5 times the average spending of other nations 

and twice that of even other “rich” nations such 

as the United Kingdom and France, only 48.2% in 

2010 was financed through taxes and Social Security 

contributions (OECD: Briefing Note, 2012). The 

remaining portion came from private insurance and 

out-of-pocket consumer contributions. Interestingly, 

even though U.S. health care spending far outpaces 

the global community, the United States has only 

2.4 practicing physicians per 1,000 in population, 

compared with an average of 3.1 physicians per 1,000 

in other OECD countries (OECD: Briefing Note, 

2012). 

Fig. HC9: U.S., 2007-2010: Percent Health 

Spending per GDP 

16.2 

16.6 

17.7 

17.6 

Total national health care expenditures for 2010 

($2.59 billion) consisted of health-consumption 

expenditures (94.3%) and investments (5.7%). The 

health-consumption expenditures budget can be 

further divided into personal health care (89.4%), 

government administration (1.2%), net cost of health 

insurance (6%), and government health activities 

(3.4%; see Figure HC10). Personal health care 

expenditures consisted of payments for: hospital care 

(37.2%); physician and other professional services 

(31.5%); medical product retail outlet sales (15.6%); 

nursing-care facilities and continuing-care retirement 

communities (6.5%), other health, residential and 

personal care (5.9%), and home health care (3.2%; 

see Figure HC11). Of the investment expenditures, 

spending on structures and equipment made up the 

majority (67%) of the cost, while research accounted 

for 33.1% of the budget. 

3.2% 

6.5% 

5.9% 

Fig. HC10: National Health Expenditures, 

2010: Health Consumption Expenditure 

Details 

6.0% 3.4% 

1.2% 

89.4% 

Personal Health Care 

Government Administration 

Net Cost of Health Insurance 

Government Public Health 

Activities 

(Martin, Lassman, Washington, Catlin, et al., 2012) 

Fig. HC11: National Health Expenditures, 2010: 

Personal Health Care Details 

15.6% 

31.5% 

37.2% 

Hospital Care 

Physician and Other Professional Services 

Other Health, Residential, and Personal 

Care 

Home Health Care 

Nursing Care Facilities, Continuing Care 

Retirement Communities 

Medical Product Retail Outlet Sales 

Health Care 

2007 2008 2009 2010 

(OECD, 2012) 

(Martin, Lassman, Washington, Catlin, et al., 2012) 

167

Health Care 

Nevada’s total health expenditure for 2009 was 12.1% 

($15.1 billion) of the Gross State Product (CMS, 

2012) and 0.7% of total U.S. health care expenditures 

(Henry J. Kaiser, State Health Facts, Nevada Health, 

2012). Nevada was in the fastest-increasing quarter 

of states for health care expenditures and posted 

a higher annual rate of growth (9.2%) than the 

national rate (6.5%). However, per-capita spending 

for Nevadans was lower ($5,735) than nationally 

($6,815), and the average annual percentage growth 

for the state (4.9%) was lower than the national rate 

(5.3%). 

3.2% 

2.5% 

5.8% 3.1% 

15.6% 

Fig. HC12: Nevada Health Expenditures, 2009 

33.1% 

2.8% 

34.0% 

Hospital Care 

Physician and Other Professional 

Services 

Prescription Drugs and Other 

Medical Nondurables 

Nursing Home Care 

Dental Services 

Home Health Care 

Medical Durables 

Other Health, Residential, and 

Personal Care 

(Henry J. Kaiser: State Health Facts: Nevada Health Expenditures, 2012) 

Nevada health expenditures in 2009 consisted of: 

hospital care (34%); physician and other professional 

services (33.1%); prescription drugs and other 

medical nondurables (15.6%); nursing home care 

(3.2%); dental services (5.8%); home health care 

(3.1%); medical durables (2.5%); and other health, 

residential and personal-care expenditures (2.8%, 

see Figure HS12). In 2009, Nevada spent a lower 

percentage than the nation as a whole on hospital 

care, nursing home care, home health care, and 

other health, residential and personal care (see Table 

HC13). 


The number of nursing homes in the United States 

decreased by 8.5% between 2000 and 2009 (17,378 

to 15,884, see Figure HC13). This was due partially 

to a decline in nonprofit and government-sponsored 

facilities (see Table HC14; CMS: Nursing Homes, 

2010). 2 In 2009, for-profit nursing homes accounted 

for 67.5% of all nursing facilities. 

Fig. HC13: U.S., 2000-2009: Number of 

Medicare/Medicaid Certified Nursing 

17,378 

17,142 

Facilities 

16,982 

16,774 

16,482 

16,310 

16,117 16,051 

15,954 15,884 

Contrary to the national trend, the number of nursing 

home facilities in Nevada increased from 44 in 2003 

to 51 in 2011 (CDC: Health, United States, 2012) 3 . 

In 2011, the state’s certified nursing homes included 

a total of 5,984 beds, 4,717 residents, and a 78.8 

occupancy rate per 100 beds (CDC: Health United 

States, 2012). The Nevada occupancy rate was lower 

than found nationally (81.6 per 100 beds). 

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 

(CMS: Nursing Homes, 2010) 

168 

2 

Note: Numbers of nursing facilities in 2003, 2004, and 2007 differ between the 2008 and 2010 CMS Nursing Home Data Compendium. In addition, the 

2007 data differed across sections within the 2010 CMS Nursing Home Data Compendium. Attempts at verification through alternative sources did not 

corroborate with either set of data. Therefore, the latest data was use and results should be interpreted with caution. 

3 

Note: Detailed CDC nursing home information by state is not yet available for 2010-2012.

In 2009, 11 Nevada nursing homes had fewer than 

50 beds, 10 had 50-99 beds, 22 had 100-199 beds, 

and six had 200 or more beds. The number of dually 

(Medicare and Medicaid) certified facilities increased 

marginally in the United States and Nevada between 

2005 and 2009 (see Table HC15). In the same years, 

the percentage of sites nationally with singlecertification 

decreased from 5.3% to 5.2% for those 

with just Medicare certification and from 7% to 

4.4% for those with just Medicaid certification. In 

2009, Nevada had 45 dually certified programs and 2 

facilities with single certification. 

The mean number of nursing home deficiencies 

decreased nationally between 2000 and 2009, while 

the number in Nevada remained relatively constant 

(see Figure HC14). 

9.9 

Fig. HC14: U.S. and Nevada: Mean Number 

of Nursing Home Deficiencies 

6.5 

10.3 

7.2 

6.9 

8.6 8.9 

7.2 7.0 6.7 

2005 2006 2007 2008 2009 


U.S. 


30% 

25% 

20% 

15% 

10% 

5% 

0% 

Fig. HC15: U.S. and Nevada, 2007-2009: 

Nursing Home Deficiencies Details 

U.S. NV U.S. NV U.S. NV 

2007 2008 2009 

No Deficiencies 

Severe Deficiences: Actual Harm or Immediate Jeopardy 

Substandard Quality of Care 


In 2009, more Nevada nursing home facilities 

(27.1%) than found nationally (13.9%) reported 

health deficiencies resulting in actual harm or 

immediate resident jeopardy (CMS: Nursing Homes: 

2010). Of the deficiencies causing actual harm, 3.3% 

were isolated incidences and 1.2% represented a 

pattern of actual harm. Of the deficiencies causing 

immediate jeopardy to residents, 0.2% were isolated 

incidences and 0.2% represented a pattern of 

behavior. More severe deficiencies both nationally 

and in Nevada occurred in facilities with 100 or more 

beds (CMS: Nursing Homes: 2009). Nationally, 

for-profit facilities were found to have the highest 

percentage of severe deficiencies (14.6%). In Nevada 

that distinction belonged to non-profit facilities 

(50%). 

Health Care 

Of all U.S. nursing facilities, 8% were found to have 

no deficiencies in 2009, 13.9% had severe deficiencies 

resulting in actual harm or causing immediate 

jeopardy to residents, and 3.7% had substandard 

quality of care. (CMS: Nursing Homes, 2010). In the 

same year, 2.1% of nursing homes in Nevada were 

found to be without deficiencies, 27.1% had severe 

deficiencies resulting in actual harm or causing 

immediate jeopardy to residents, and 6.3% had 

substandard quality of care (see Figure HC15). The 

percentage of zero-deficiency facilities in Nevada 

declined from 14.5% in 2007 to none in 2008 with 

slight improvement, to 2.1%, in 2009. (see Table 

HC16). 

The cost of nursing home care may be prohibitive for 

many older adults. In 2011, rates for private rooms 

in nursing facilities varied from a low of $141 per day 

in Louisiana to $655 per day in Alaska. The average 

rate was $239 daily or $87,235 annually (MetLife, 

2011, p. 4). The average rate for a semi-private room 

was $214 daily or $78,110 annually. In Nevada, the 

average rates were slightly lower. Rates for a private 

room ranged from $170 to $436 with an average of 

$237. For a semi-private room the range was $110 to 

$244 with an average of $206 (MetLife, 2011, p. 2). 

The cost of living in an assisted-living community 

is lower compared with nursing facility care but still 

may be prohibitive. The 2011 average national rate 

for assisted living communities was $3,477 monthly 

or $41,724 annually (MetLife, 2011, pg. 4). Base rates 

for assisted living in Nevada were slightly lower, 

ranging from $1,800 to $4,850 monthly or an average 

of $3,151. 

169

Health Care 

Home health care and adult day services provide 

lower level of care options. The national hourly 

rate for home care services varied from a low of $13 

in Louisiana to a high of $29 in Minnesota for a 

homemaker/companion. The national average was 

$19 per hour. Home health aides are slightly more 

expensive with an average cost of $21 per hour. The 

average daily rate for adult day services ranged from 

$29 per day in Alabama to $148 per day in Vermont 

with an average of $70 per day (see Table HC17). 

Fig. HC16: U.S. and Nevada, 2011: Cost of Care 

Adult Day Services Daily Rate 

$17,940.00 

$18,200.00 

Home Care: Homemaker Hourly Rate 

$20,800.00 

$19,760.00 

Home Care: Home Health Aide Hourly Rate 

$22,880.00 

$21,840.00 

Assisted Living Monthly Base Rate 

$37,812.00 

$41,724.00 

Semi-Private Room Daily Rate 

$75,190.00 

$78,110.00 

Private Room Daily Rate 

$86,505.00 

$87,235.00 

Nevada U.S. 

(MetLife, 2011) 

The annual cost for care of older adults is slightly 

lower in Nevada than in the United States, with 

the exception of the costs for home health care (see 

Figure HC16). 


Between 2007 and 2009, the number of Americans 

residing in nursing homes increased from an 

estimated 3.2 million (CMS: Nursing Homes, 2008) 

to an estimated 3.3 million (CMS: Nursing Homes, 

2010). In 2009, 7.1% of U.S. adults 65 and older and 

21.5% of adults 85 and older had experienced at 

least one nursing home stay (see Figure HC14, CMS: 

Nursing Homes, 2010, p. i-ii). In Nevada during the 

same year, 3.7% of adults 65 and older and 12.4% of 

adults 85 and older had been nursing home residents 

at least once. In 2010, there were 7,823 nursing 

facility residents in Nevada with a per-facility low of 

two and a high of 426. The average was 160. (BRFSS, 

2011). 

Fig. HC17: U.S. and Nevada: Percent of 

Residents with at Least One Nursing Home 

Stay 

65 and Older 

7.1% 

21.5% 

3.7% 

12.4% 

85 and Older 

A comparison of national and Nevada nursing home 

residents from 2009 revealed that fewer Nevada 

residents were female (58.9%) than found nationally 

(65.4%; CMS: Nursing Homes, 2010). In addition, 

a higher percentage were ages 65-74 (20.3%) and 

75-84 (32.8%) than found nationally. Fewer were 

85 or older (see Table HC18). A higher percentage 

of Nevada nursing home residents were White 

(86.5%) and had either no Activities of Daily Living 

(ADL) impairments (28.7%) or had the maximum 

of five impairments (19.9%) than did nursing home 

residents nationally. Finally, a higher percentage of 

Nevada nursing home residents had no cognitive 

impairment (43.2%) or had lower levels of cognitive 

impairment than found nationally. 

The share of residents 65-74 increased from 17.8% 

in 2005 to 20.3% in 2009, while the percentage of all 

other age groups decreased (see Figure HC18). 

Fig. HC18: Nevada, 2005-2009: Percent of 

Nursing Home Residents by Age 

U.S. 



35.3% 34.7% 33.7% 

32.8% 

27.4% 27.5% 26.9% 26.7% 

17.8% 

17.7% 18.4% 19.2% 

32.8% 

26.1% 

20.3% 

65-74 Years 

75-84 Years 

85-95 Years 

95 and Older 

3.4% 3.3% 3.2% 3.3% 

3.2% 

2005 2006 2007 2008 2009 

(CMS: Nursing Homes: 2010) 

170

Between 2005 and 2009, the Nevada nursing homeresident 

population became slightly more diverse. 

The share of White residents decreased from 

88.6% to 86.5%. The percentage Black, Asian and 

Hispanic residents increased, while the percentage 

of American Indian/Alaskan Natives remained stable 

(see Table HC19). In addition, the percentage of 

residents with no impairments in ADL decreased 

from 31.5% to 28.7% between 2005 and 2009, and 

the percentage of those with four ADL impairments 

increased from 27% to 32.5%. Finally, even though 

the percentage of Nevada nursing home residents 

with ADL impairment increased from 2005 to 

2009, the level of cognitive impairment did not. 

The percentage of residents with no impairment 

increased from 35% in 2005 to 43.2% in 2009. In 

addition, the decline in impairment ranged from 

5.3% (e.g., 13.5% in 2005 to 12.4% in 2009) for mild 

impairment to 53.1% (6.4% in 2005 to 3% in 2009) 

for very severe impairment. 

Health Care 

Veterans 

The Department of Veterans Affairs (VA) ensures 

health care services for all honorably discharged 

veterans who actively served in the U.S. Armed 

Forces. Twenty-four months of continuous service is 

required from veterans who enlisted after September 

7, 1980, or entered active duty after October 16, 

1981 (U.S. Department of Veterans Affairs: Health 

Benefits, 2012, Chapter 1). In addition, serviceconnected 

disabilities and income levels determine 

eligibility. Priority is given to those with servicerelated 

disabilities (see Table HC20; U.S. Department 

of Veterans Affairs: Health Benefits, 2012). 

For the majority of veterans, enrollment is required. 

Exceptions to this rule include: 

• Veterans with a service-connected disability of 50 

percent or more 

• Veterans seeking care for a disability the military 

determined was incurred or aggravated in the 

line of duty, but which VA has not yet rated, 

within 12 months of discharge 

• Veterans seeking care for a service-connected 

disability only 

• Veterans seeking registry examinations (Ionizing 

Radiation, Agent Orange, Gulf War/Operation 

Iraqi Freedom and Depleted Uranium 

(U.S. Department of Veterans Affairs: Health 

Benefits, 2012, Chapter 1, p. 2). 

In addition to the VA’s general and specialized 

medical care, the Veterans Health Administration 

(VHA) provides health care to veterans whose 

needs are not fully covered by Medicare [Federal 

Interagency Forum on Aging-Related Statistics 

(2012). Such needs include long-term nursing home 

and community-based care, and specialized care for 

a variety of acute-care issues like depression, PTSD 

and suicidal ideations (Federal Interagency Forum, 

2012, p. 59). 

171

Health Care 

In 2011, the population of veterans 65 and older 

was estimated at 9.4 million with 3.8 million 

veterans enrolled to receive health care from the 

VHA (Federal Interagency Forum, 2012, p. 147). 

Of these, 2.6 million patients received health care. 

VHA also estimated that 38% of enrolled veterans 

have Medicare Part D coverage, 23% have private 

insurance, 15% have TRICARE® for Life medical 

coverage, 14% are eligible for Medicaid, and 5% have 

no health insurance (Federal Interagency Forum, 

2012, p. 59). 

Fig. Fig. HC19: Nevada, 2011: Distribution of of 

Health Care Monies by Region 

60.1% 

Southern Urban Metro 

60.1% 

Southern Urban Metro 

Northern Urban Metro 

Northern Urban Metro 



25.7% 

25.7% 

14.2% 

14.2% 

Southern Urban Metro Northern Urban Metro Rural/Frontier 

Southern Urban Metro Northern Urban Metro Rural/Frontier 

(U.S. Dept. of Veterans Affairs: Expenditures, 2012) 

In 2011, Heidi Golding, principal analyst for the 

Military and Veterans’ Compensation, presented cost 

estimates for 2011-2020 before the Committee on 

Veterans’ Affairs and the U.S. Senate. Per Golding 

(2011), the VHA pays $8,800 per veteran treated 

at VA clinics, and FY 2011 VA health care and 

research appropriations totaled $52 billion. These 

appropriations increased from the $44 billion in 2009 

and $48 billion in 2010 (Potential Costs of Veterans, 

2010). By 2020, VA health care costs are projected to 

increase to $69 billion to $83 billion depending on 

the number of soldiers deployed in overseas conflicts 

and the income thresholds for eligibility (Potential 

Costs of Veterans, 2010). Veterans returning from 

combat are more likely to be young with less than 

1% older than 60. Therefore, projected cost increases 

are more likely to be war-related for injuries such as 

amputations, PTSD and Traumatic Brain Injury rather 

than because of age. 

In 2010, Nevada spent $527.3 million for veteran 

health care with 57,869 veterans (unique patients) 

receiving treatment at a VA health care facility. By 

2011, the total had increased to $533.1 million for 

59,643 patients (see Table HC21; U.S. Department 

of Veteran Affairs: Expenditures, 2012). Of these 

patients, 60.5% (36,077) resided in the Southern 

Urban/Metropolitan region of the state, 23.3% in the 

Northern Urban/Metropolitan region, and 16.2% in 

the Rural/Frontier region. 

By region, 60.1% ($320 million) of VA health care 

expenditures in 2011 went to the Southern Urban/ 

Metropolitan region of the state, 25.7% ($137 million) 

went to the Northern Urban/Metropolitan region, 

and 14.2% ($75.5 million) went to the Rural/Frontier 

regions (see Figure HC19). 

Nevada has one regional VA office, in Reno; one 

Benefits Office, in Las Vegas; and VA Medical 

Centers in Las Vegas and Reno. Health Care clinics 

are located in Elko (1), Ely (1), Fallon (1), Henderson 

(1), Las Vegas (4), Minden (1), Pahrump (1) and 

Winnemucca (1). The Elko clinic offers virtual 

medical appointments to rural, hard-to-reach older 

veterans through telehealth (Juretic, Hill, Luptak, et 

al., 2010) 4 . Services include medication management 

and prescription refills, routine lab tests, health 

education and specialty services. Finally, the state 

has three veteran service centers (“Vet Centers”) in 

Henderson, Las Vegas and Reno. 

172 

4 

Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care (http://www.hrsa. 

gov/ruralhealth/about/telehealth/)

Table HC1 

Centers for Medicare & Medicaid Services Report: U.S. and Nevada, Utilization Report by Year 

2007 2008 2009 2010 

U.S. NV U.S. NV U.S. NV U.S. NV 

Hospital inpatient Medicare admissions 343.5 280.0 340.9 290.8 330.8 286.5 324.6 283.5 

(per 1,000 beneficiaries) 

Imaging Medicare service events (per 1,000 beneficiaries) 3.8 9.5 3.9 8.5 3.9 8.4 3.9 8.4 

Hospice Medicare admissions (per 1,000 beneficiaries) 30.2 25.1 31.3 25.3 32.0 25.2 33.1 27.6 

Skilled nursing facility Medicare admissions 87.2 47.8 89.3 51.7 87.9 53.2 87.8 55.2 


Home health Medicare episodes (per 1,000 beneficiaries) 182.7 160.5 196.5 179.6 210.4 184.5 217.2 195.1 

Hospital outpatient Medicare visits (per 1,000 beneficiaries) 3838.6 2369.0 3881.5 2360.3 3972.5 2411.2 4014.7 2391.7 

Ambulatory surgical center Medicare service events 181.5 230.8 197.6 234.3 207.3 251.7 209.3 258.0 


Physician evaluation and management Medicare 13493.3 13363.3 13697.9 13611.6 13840.1 13835.4 13866.0 13723.0 

service events (per 1,000 beneficiaries) 

Physician procedures Medicare service events 4198.5 4220.2 4349.4 4301.0 4534.9 4636.5 4577.0 4724.4 


Imaging Medicare service events (per 1,000 beneficiaries) 4322.0 4399.8 4432.6 4533.2 4496.2 4645.6 4448.6 4603.7 


Health Care 

173

Health Care 

Table HC2 

Nevada Adults 65 and Older, 2011: Have Health Care Coverage 


% C.I. % C.I. 





Age 65-74 Years 1,030 96.7% (94.4-98.9) 3.3% (1.1-5.6) 

47-84 Years 454 97.0% (94.4-99.7) 3.0% (0.3-5.6) 

85 and Older 128 93.1% (84.0-100) 6.9% (0.0-16.0) 

Race White 1,442 96.9% (95.1-98.7) 3.1% (1.3-4.9) 

Black 47 ~ ~ ~ ~ 

Other Race 93 100% (100-100) 0% (0.0-0.0) 

Hispanic 59 92.5% (83.5-100) 7.5% (0.0-16.5) 

Sex Male 668 95.0% (91.8-98.2) 5.0% (1.8-8.2) 

Female 1,002 98.0% (96.4-99.6) 2.0% (0.4-3.6) 

Education Less than H.S. 121 95.3% (90.4-100) 4.7% (0.0-9.6) 

H.S. or G.E.D. 511 96.1% (93.0-99.2) 3.9% (0.8-7.0) 

Some Post H.S. 525 96.2% (92.9-99.6) 3.8% (0.4-7.1) 

College Graduate 509 99.4% (98.8-100) 0.6% (0.0-1.2) 

Income < $15K 165 94.7% (88.2-100) 5.3% (0.0-11.8) 

$15K to $24,999 307 96.7% (92.5-100) 3.3% (0.0-7.5) 

$25K to $34,999 212 97.3% (94.0-100) 2.7% (0.0-6.0) 

$35K to $49,999 234 99.3% (98.5-100) 0.7% (0.0-1.5) 

$50K to $74,999 227 98.9% (97.8-99.9) 1.1% (0.1-2.2) 

$75K or Higher 208 94.9% (88.4-100) 5.1% (0.0-11.6) 




Table HC3 

Medicare Health Insurance Benefits (HIB), 2010: Age by Costs per Hospital Stay 

Age Minimum Charge Maximum Charge Average Charge 

65-84 $0 $2,029,985 $63,670 

85+ $4 $1,670,011 $50,706 


174

Table HC4 

U.S. Adults 65 and Older: Did not Get or Delayed Medical Care, Prescription Drugs or Dental Care Due to Cost 

Did Not get or delayed medical care due to cost 

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 

65 Years and Older 4.6% 4.0% 4.2% 4.5% 4.0% 4.2% 4.5% 4.7% 4.6% 4.2% 4.3% 4.5% 5.1% 5.0% 4.6% 

65-74 Years 5.0% 4.3% 4.7% 5.1% 4.4% 5.0% 5.1% 5.5% 5.4% 5.0% 5.3% 5.1% 6.0% 6.3% 5.8% 


Did not get prescription drugs due to cost 

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 


65-74 Years 3.4% 2.9% 2.8% 4.4% 4.6% 6.3% 5.5% 6.2% 6.4% 3.8% 4.5% 4.8% 5.0% 6.3% 5.7% 


Did not get dental care due to cost 

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 


65-74 Years 4.2% 3.4% 3.5% 4.6% 4.4% 4.5% 5.3% 6.7% 6.2% 4.9% 6.4% 7.4% 8.0% 9.0% 9.0% 


(CDC: Publication & Information, 2011) 

Health Care 

175

Health Care 

Table HC5 

U.S. and Nevada Medicare Beneficiaries 

Year United States Nevada 

1999 39,224,343 232,617 

2000 39,480,028 241,806 

2001 40,028,458 254,341 

2002 40,963,671 266,974 

2003 42,121,333 278,785 

2004 42,359,734 291,959 

2005 43,404,885 302,537 

2006 44,067,816 308,802 

2007 44,132,245 316,606 

2008 44,831,390 327,629 

2009 45,484,782 336,383 

2010 46,589,141 348,168 

2011 47,672,971 359,968 

2012 49,435,610 379,860 

(HJKFF, 2012) 

Table HC6 

Mean Age of Medicare Beneficiaries in Adults 65 and Older: U.S. and Nevada 

Year United States Nevada 

2007 76.49 74.95 

2008 76.46 74.91 

2009 76.43 74.84 

2010 76.42 74.81 


176

Table HC7 

U.S. & Nevada, 2010-2011: Distribution of Medicare Beneficiaries 


Age 19-64 Years 17.0% 15.7% 

65-74 Years 44.8% 48.0% 

75-84 Years 27.0% 26.3% 

85 and Older 10.3% ~ 

Sex Female 55.0% 51.3% 

Male 44.6% 48.7% 

Race White 77.0% 73.7% 

Black 10.4% 6.1% 

Hispanic 7.6% 10.8% 

Other 4.7% 9.5% 

Federal Poverty Level (FPL) Under 100% 16.0% 14.1% 

100-149% 16.7% 14.7% 

150-199% 13.8% 14.8% 

200% or Higher 54.0% 56.5% 

Health Care 

(HJKFF, 2012) 

177

Health Care 

Table HC8 

U.S. and Nevada Distribution of Medicare Spending by Service Type, 2009 

Medicare Spending by Residence Medicare Spending 

(in millions) 

Per Enrollee by 

State of Residence 

United 

United States Nevada States Nevada 

% $ % $ $ $ 

Hospital Care 46.8% $220,382 45.5% $1,511 $4,847 $4,405 

Physician & Clinical Services 23.2% $109,434 25.4% $843 $2,407 $2,458 

Other Professional Services 2.9% $13,667 2.7% $90 $301 $263 

Dental Services 0.1% $290 0.0% $1 $6 $3 

Home Health Care 1 6.3% $29,835 7.2% $240 $656 $698 

Prescription Drugs and 12.2% $57,627 11.0% $365 $1,267 $1,064 

Other Medical Nondurables 

Durable Medical Products 1.6% $7,446 2.2% $74 $164 $215 

Nursing Home Care 5.9% $27,991 5.3% $177 $616 $515 

Other Health, Residential, 1.0% $4,588 0.7% $24 $101 $69 

and Personal Care 

Total 100% $471,260 100% $3,324 $10,365 $9,692 

(HJKFF, 2012) 

178 

1 

Home Health care covers medical care provided in the home by freestanding home health agencies (HHAs). Medical equipment sales or rentals not 

billed through HHAs and non-medical types of home care (Meals on Wheels, chore-worker services, friendly visits, or other custodial services) are 

excluded (http://www.statehealthfacts.org/profileind.jsp?ind=626&cat=6&rgn=30&cmprgn=1).

Table HC9 

U.S. and Nevada, FY 2010: Distribution of Medicaid Spending by Service 

Acute Care Long Term Care Disproportionate Share 

Hospital Payments 

Nevada 68.1% 25.6% 6.3% 

United States 64.0% 31.5% 4.5% 

Health Care 

(HJKFF, 2012) 

Table HC10 

U.S. Medical School Applicants and Enrollment, 2002-2012 

% % % 

Change Total U.S. Change Change % Change 

Total from Medical from Total First- from in 

First-time Prior School Prior Time Prior Enrollment 

Year Applicants Year Applicants Year Enrollment Year from 2002 

2002 24,884 -0.1% 33,624 -3.5% 16,488 0.8% ~ 

2003 26,160 5.1% 34,791 3.5% 16,541 0.3% 0.3% 

2004 27,190 3.9% 35,735 2.7% 16,648 0.6% 1.0% 

2005 28,291 4.0% 37,372 4.6% 17,003 2.1% 3.1% 

2006 29,583 4.6% 39,108 4.6% 17,361 2.1% 5.3% 

2007 31,946 8.0% 42,315 8.2% 17,759 2.3% 7.7% 

2008 31,019 -2.9% 42,231 -0.2% 18,036 1.6% 9.4% 

2009 31,062 0.1% 42,268 0.1% 18,390 2.0% 11.5% 

2010 31,832 2.5% 42,741 1.1% 18,665 1.5% 13.2% 

2011 32,654 2.6% 43,919 2.8% 19,230 3.0% 16.6% 

2012 33,772 3.4% 45,266 3.1% 19,517 1.5% 18.4% 

(Ward, 2012) 

179

Health Care 

Table HC11 

AAMC, 2010: U.S. and State Physician Workforce 

U.S. 


Rate Per % Rate Per % 

100,000 100,000 

Total Active Physicians 258.7 198.3 

Primary Care Physicians 90.5 71.2 

Physicians Active in Patient Care 219.5 178.1 

Active Patient Care Primary Care Physicians 79.4 63.7 

Female Physicians 30.4% 25.0% 

Physicians, International Medical Graduates 24.0% 27.9% 

Physicians Age 60 or Older 26.2% 24.5% 

Medical and Osteopathic School Enrollment 31.4 29.4 

(AAMC, 2011) 

Table HC12 

Nevada Caregiving Data: 2006, 2009 

% Change: 

2006 2007 2009 2006, 2009 

Number of Caregivers 260,000 280,000 364,000 40.0% 

(In Last Month) 

Estimated Hours of Caregiving 280,000,000 305,000,000 348,000,000 24.3% 

Rate per Hour $10.47 $10.81 $11.48 9.6% 

Total Economic Value $3 billion $3.3 billion $4 billion 33.3% 

(Feinberg et al., 2011; Houser & Gibson, 2007, 2008) 

180

Table HC13 

U.S. and Nevada, 2009: Distribution of Health Care Expenditures by Service 

NV NV US US 

% $ % $ 

Hospital Care 34.0% $5,142 36.3% $759,074 

Physician and Other Professional Services 33.1% $5,010 27.4% $572,668 

Prescription Drugs and Other Medical Nondurables 15.6% $2,357 14.0% $293,163 

Nursing Home Care 3.2% $490 6.6% $136,971 

Dental Services 5.8% $874 4.9% $102,222 

Home Health Care 3.1% $463 3.3% $68,264 

Medical Durables 2.5% $375 1.7% $34,878 

Other Health, Residential, and Personal Care 2.8% $421 5.9% $122,623 

Total 100% $15,133 100% $2,089,862 

Health Care 

(Henry J. Kaiser: State Health Facts: Nevada Health Expenditures, 2012) 

Table HC14 

U.S. and Nevada, 2003-2009: Nursing Homes 

Total For Profit Non-Profit Government 

U.S. Nevada U.S. Nevada U.S. Nevada U.S. Nevada 

2003 16,774 44 10,978 35 4,762 4 1,039 5 

2004 16,482 44 10,810 33 4,648 5 1,029 6 

2005 16,310 47 10,748 36 4,562 5 1,000 6 

2006 16,117 47 10,681 36 4,457 5 980 6 

2007 16,051 48 10,756 34 4,324 8 971 6 

2008 15,954 48 10,733 34 4,287 8 934 6 

2009 15,884 49 10,726 36 4,226 7 932 6 

(CMS: Nursing Homes, 2008, 2010) 

181

Health Care 

Table HC15 

U.S. and Nevada: Nursing Home Certification Type 

2005 2006 2007 2008 2009 

U.S. NV U.S. NV U.S. NV U.S. NV U.S. NV 

Dually Certified 14,301 44 14,300 44 14,326 45 14,350 44 14,360 45 

Medicare only 871 1 863 1 857 1 823 2 819 2 

Medicaid only 1,138 2 955 2 867 2 781 2 705 2 

Total Facilities 16,310 47 15,118 47 16,051 48 15,954 48 15,884 49 


Table HC16 

U.S. and Nevada, 2007-2009: Nursing Home Deficiencies Details 

2007 2008 2009 

U.S. NV U.S. NV U.S. NV 

No Deficiencies 8.0% 14.5% 7.5% 0.0% 8.0% 2.1% 

Severe Deficiencies: Actual Harm or 17.1% 12.7% 16.5% 14.3% 13.9% 27.1% 

Immediate Jeopardy 

Substandard Quality of Care 3.6% 1.8% 4.4% 2.0% 3.7% 6.3% 

Mean Number of Deficiencies 7.2 6.9 7.0 8.6 6.7 8.9 


Table HC17 

U.S. and Nevada, 2011: Cost of Care 

U.S. 


Daily, 

Daily, 

Hourly, 

Hourly, 

Monthly Annual Monthly Annual 

Private Room Daily Rate $239.00 $ 87,235.00 $237.00 $ 86,505.00 

Semi-Private Room Daily Rate $214.00 $ 78,110.00 $206.00 $ 75,190.00 

Assisted Living Communities Monthly Base Rate $3,477.00 $ 41,724.00 $3,151.00 $ 37,812.00 

Home Care: Home Health Aide Hourly Rate $21.00 $ 21,840.00 $22.00 $ 22,880.00 

Home Care: Homemaker Hourly Rate $19.00 $ 19,760.00 $20.00 $ 20,800.00 

Adult Day Services Daily Rate $70.00 $ 18,200.00 $69.00 $ 17,940.00 

(MetLife, 2011) 

182

Table HC18 

U.S. and Nevada, 2009: Nursing Home Resident Characteristics 

U.S. 


Sex Male 34.6% 41.1% 

Female 65.4% 58.9% 

Age 0-21 Years 0.2% 0.2% 

22-30 Years 0.3% 0.3% 

31-64 Years 13.7% 17.2% 

65-74 Years 16.7% 20.3% 

75-84 Years 32.2% 32.8% 

85-95 Years 31.7% 26.1% 

95 and Older 5.2% 3.2% 

Race White 82.6% 86.5% 

Black 11.4% 6.3% 

Asian 1.5% 2.5% 

American Indian, Alaskan Native 0.4% 0.7% 

Hispanic 4.1% 4.1% 

Number of ADL Impairments 0 26.0% 28.7% 

1 7.5% 6.2% 

2 6.6% 5.8% 

3 8.2% 6.8% 

4 33.2% 32.5% 

5 18.4% 19.9% 

Cognitive Impairment Score 0 (No Impairment) 32.3% 43.2% 

1 (Very Mild Impairment) 12.0% 13.8% 

2 (Mild Impairment) 14.8% 12.4% 

3 (Moderate Impairment) 23.7% 18.6% 

4 (Moderate Severe Impairment) 7.0% 4.6% 

5 (Severe Impairment) 5.1% 4.5% 

6 (Very Severe Impairment) 5.1% 3.0% 

Health Care 


183

Health Care 

Table HC19 

Nevada, 2005-2009: Nursing Home Resident Characteristics 

2005 2006 2007 2008 2009 

Sex Male 38.5% 39.2% 39.6% 41.1% 41.1% 

Female 61.5% 60.8% 60.4% 58.9% 58.9% 

Age 0-21 Years 0.5% 0.4% 0.2% 0.2% 0.2% 

22-30 Years 0.5% 0.5% 0.5% 0.4% 0.3% 

31-64 Years 15.2% 15.9% 17.1% 17.4% 17.2% 

65-74 Years 17.8% 17.7% 18.4% 19.2% 20.3% 

75-84 Years 35.3% 34.7% 33.7% 32.8% 32.8% 

85-95 Years 27.4% 27.5% 26.9% 26.7% 26.1% 

95 and Older 3.4% 3.3% 3.2% 3.3% 3.2% 

Race White 88.6% 88.0% 87.5% 87.0% 86.5% 

Black 5.6% 5.7% 6.1% 6.4% 6.3% 

Asian 1.8% 2.0% 2.0% 2.2% 2.5% 

American Indian, Alaskan Native 0.6% 0.7% 0.7% 0.6% 0.7% 

Hispanic 3.4% 3.5% 3.7% 3.7% 4.1% 

Number of 0 31.5% 31.1% 29.5% 28.3% 28.7% 

ADL Impairments 1 6.7% 6.6% 6.6% 6.7% 6.2% 

2 5.9% 5.7% 5.8% 5.7% 5.8% 

3 7.9% 7.3% 7.5% 7.6% 6.8% 

4 27.0% 29.4% 29.6% 31.5% 32.5% 

5 21.1% 19.9% 21.0% 20.3% 19.9% 

Cognitive 0 (No Impairment) 35.0% 38.3% 39.1% 41.5% 43.2% 

Impairment Score 1 (Very Mild Impairment) 11.2% 13.1% 13.0% 13.7% 13.8% 

2 (Mild Impairment) 13.1% 11.5% 12.3% 12.2% 12.4% 

3 (Moderate Impairment) 22.3% 20.9% 20.7% 19.5% 18.6% 

4 (Moderate Severe Impairment) 6.9% 6.3% 5.5% 4.4% 4.6% 

5 (Severe Impairment) 5.3% 5.1% 5.5% 5.5% 4.5% 

6 (Very Severe Impairment) 6.4% 4.8% 3.9% 3.4% 3.0% 


184

Veteran Priority Groups for Health Care Benefits* 

Table HC20 

Group 1 • Veterans with service-connected disabilities rated 50% or more and/or Veterans 

determined by VA to be unemployable due to service-connected conditions. 

Group 2 • Veterans with service-connected disabilities rated 30% or 40%. 

Health Care 

Group 3 • Veterans who are former POWs. 

• Veterans awarded the Purple Heart Medal. 

• Veterans awarded the Medal of Honor. 

• Veterans whose discharge was for a disability incurred or aggravated in the line of duty. 

• Veterans with VA service-connected disabilities rated 10% or 20%. 

• Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151, “benefits 

for individuals disabled by treatment or vocational rehabilitation.” 

Group 4 • Veterans receiving increased compensation or pension based on their need for regular aid 

and attendance or by being permanently housebound. 

• Veterans determined by VA to be catastrophically disabled. 

Group 5 • Non-service-connected veterans and non-compensable service-connected Veterans 

rated 0%, whose annual income and/or net worth are not greater than the VA financial 

thresholds. 

• Veterans receiving VA pension benefits. 

• Veterans eligible for Medicaid benefits. 

Group 6 • Compensable 0% service-connected veterans. Veterans exposed to ionizing radiation 

during atmospheric testing or during the occupation of Hiroshima and Nagasaki. Project 

112/SHAD participants. 

• Veterans who served in the Republic of Vietnam between Jan. 9, 1962, and May 7, 1975. 

• Veterans who served in the Southwest Asia Theater of Combat Operations from Aug. 2, 

1990, through the present. 

• Veterans who served in a Theater of Combat Operations after Nov. 11, 1998, as follows: 

• Veterans discharged from active duty on or after Jan. 28, 2003, for five years post 

discharge. 

Group 7 • Veterans with incomes below the geographic means test income thresholds and who 

agree to pay the applicable copayment. 

185

Health Care 

Group 8 • Veterans with gross household incomes above the VA national income threshold and the 

geographically adjusted income threshold for their resident location and who agrees to 

pay copays. 

• Veterans eligible for enrollment: Non-compensable 0% service-connected and: 

—Subpriority a: Enrolled as of Jan. 16, 2003, and who have remained enrolled since that 

date and/ or placed in this subpriority due to changed eligibility status. 

—Subpriority b: Enrolled on or after June 15, 2009, whose income exceeds the current VA 

National Income Thresholds or VA National Geographic Income Thresholds by 10% or 

less. 

• Veterans eligible for enrollment: Non-services-connected and: 

—Subpriority c: Enrolled as January 16, 2003, and who remained enrolled since that date 

and/or placed in this subpriority due to changed eligibility status 

—Subpriority d: Enrolled on or after June 15, 2009, whose incomes exceeds the current VA 

National Income Thresholds or VA National Geographic Income Thresholds by 10% or l 

less. 

• Veterans not eligible for enrollment: Veterans not meeting the criteria above: 

—Subpriority e: Non-compensable 0% service-connected 

—Subpriority g: Non-service-connected 

*Note: Table taken directly from Health Benefits booklet and the VA website. 

(U.S. Department of Veterans Affairs: Health Benefits, 2012, Chapter 1, p. 2-4) 

186

Data Limitations, Challenges & Cautions 

All reports have inherent limitations that could 

influence the reliability and validity of the 

information presented. While citing all data 

limitations is not possible, key limitations, challenges 

and cautions are included in this section. 

Data cited in this report are from nationally 

recognized, reliable sources. The data also are 

secondary, which means that we did not develop 

the surveys, collect the information, or analyze 

the data. As such, we cannot account for the datacollection 

processes, the possibility of response 

bias, problems due to small sample size, conflicting 

data, or error. In addition, the dates of available data 

varied from 2008-2012 across (and even within) 

sources. Differences in years of data collection 

complicated efforts to make comparisons. Therefore, 

we reported some of the information by year without 

comparison. Finally, even with efforts to crossvalidate 

information over multiple sources, it is still a 

possibility that results were misinterpreted. 

Other challenges related to the lack of national and 

state-level data specific to the senior population. 

This was particularly apparent when researching 

information about illicit substance use and gambling 

among older Nevadans, researching data on older 

Nevada veterans, and getting adequate sample 

sizes in surveys completed by underrepresented 

populations. National sources such as the Substance 

Abuse and Mental Health Services Administration 

(SAMSHA), National Survey on Drug Use 

and Health (NSDUH) surveys report use and 

dependence data only through age 59. This makes 

it difficult to capture a good picture of substance use 

issues among the nation’s older adults. 

With gambling prevalence, we found a lack of 

reliable data regarding issues relating specifically to 

Nevada’s older adults. Researchers in 2012 refuted 

a well-cited study due to methodological issues 

and suggested that the earlier data underestimated 

gambling disorders among older Nevadans. 

It was challenging to find information specifically 

about older veterans in Nevada because this 

population has not been on the radar of researchers. 

Finally, BRFSS samples sizes from underrepresented 

groups such as Blacks, Asians, etc., were too small 

to ensure reliability. We chose not to use these 

data, even though this left gaps in the available 

information. As a result, interpretations of the 

existing data must be made with caution. 

It is important to consider that participant bias 

may have skewed survey results, demographics 

and prevalence rates. A respondent may inflate 

measures related to education and income while 

understating other measures such as weight and 

number of alcoholic drinks consumed. Although 

retrospective accounts are understandably inaccurate 

and unreliable, trend data is not as sensitive to 

respondent bias because individuals are less likely 

to report with systematic bias over time. In addition, 

if some respondents choose not to answer specific 

questions, nonresponse bias may occur. 

In addition to respondent bias, data collection 

is susceptible to an array of errors, such as 

misinterpretations of responses by interviewers, 

data entry errors, and missed questions. Errors can 

occur during data analysis, such as computer coding, 

scanning and processing. 

Resources such as time for research and development 

and funding for design and printing limited the 

scope of this project. In the future, as more data are 

collected about the older adult population, baselines 

and/or benchmarks could be established to measure 

and evaluate Nevada’s performance in meeting the 

needs of its older adults. 

Specific Data Source Information 

The secondary data contained in this report was 

collected from a variety of federal, state and private 

resources, chiefly the U.S. Census Bureau, Centers 

for Disease Control and Prevention (CDC), Henry 

J. Kaiser Family Foundation, Centers for Medicare 

and Medicaid Services (CMS), Nevada State 

Demographer and the Nevada State Health Division. 

APPENDIX 

187

APPENDIX 

CDC Behavior Risk Factor Surveillance 

System (BRFSS) 

Due to sampling and weighting procedures, the CDC 

recommends that caution be taken when interpreting 

prevalence rates if the unweighted sample size for 

the denominator is less than 50. Sample sizes of less 

than 50 were considered unreliable and were not 

used in this report. The result was that responses 

for certain underrepresented groups were not 

captured at all. Thus, caution is encouraged in the 

interpretation of data. 

The Nevada State Health Division is federally 

funded to collect annual BRFSS data via random 

phone surveys of Nevada residents and to analyze 

the results. Although BRFSS data were collected 

across the state of Nevada, the percentage of older 

adults within each county ranged from 8.7% of Elko 

County to 26.2% of Esmeralda County. Older adults 

constituted less than a fifth of the population in every 

Nevada county, except Esmeralda. In addition, the 

percentage of older adult participants was small; 

therefore, the responses received from older adults 

may not be reflected adequately in this report. 

CDC National Center for Injury 

Prevention and Control 

This organization, which obtains much of its data 

from the National Center for Health 

Statistics, recommends caution with sample sizes of 

less than 20. The majority of health data on Nevada 

older adults were not analyzed for prevalence and 

trends across races or older age groups because 

sample sizes were too small. 

U.S. Census Bureau 

The Census Bureau collects data through the mail, 

over the phone, and in person for its decennial 

census. The American Community Survey (ACS), 

an ongoing nationwide survey designed to provide 

communities with a fresh look at how they are 

changing, is based on a sample of the community. 

The survey is administered every year to a small 

percentage of the population. Where possible, fiveyear 

ACS aggregate data were used as this provided 

the most comprehensive data. However, in cases 

where information was unavailable through this 

method, the one- or three-year ACS data sets were 

used. These data sets may not adequately reflect 

the smaller populations living in the rural/frontier 

regions of the state. 

188

References 

Acierno, R., Hernandez, M. A., Amstadter, A. B., 

Resnick, H. S., Steve, K., Muzzy, W., & Kilpatrick, 

D. G. (2010). Prevalence and correlates 

of emotional, physical, sexual, and 

financial abuse and potential neglect in the 

United States: The national elder mistreatment 

study. Research and Practice, 100(2), 292- 

297. 

Administration on Aging (AOA). (2011). Positive 

aging: HIV turns 30 webinar. Retrieved from 

AOA: http://www.aoa.gov/AoARoot/ 

AoA_Programs/HPW/HIV_AIDS/Webinar. 

aspx 

Administration on Aging (AOA): National Center 

on Elder Abuse (NCEA). (2012). Elder abuse/ 

mistreatment defined. Retrieved from AOA 

website: http://www.ncea.aoa.gov/Main_ 

Site/FAQ/Basics/Definition.aspx 

American Cancer Society (ACS). (2012). How many 

women get ovarian cancer? Retrieved from the 

ACS website: http://www.cancer.org/cancer/ovariancancer/overviewguide/ovariancancer-overview-key-statistics 

American Foundation for Suicide Prevention 

(AFSP). (2012). Facts and figures: State statistics. 

Retrieved from AFSP website: https:// 

www.afsp.org/index.cfm?fuseaction=home. 

viewpage&page_id=05114FBE-E445- 

7831-F0C1494E2FADB8EA 

American Heart Association (AHA). (2012). How 

to get your cholesterol tested. Retrieved from 

AHA website: http://www.heart.org/ 

HEARTORG/Conditions/Cholesterol/ 

SymptomsDiagnosisMonitoringofHighCholesterol/How-To-Get-Your-Cholesterol-Tested_UCM_305595_Article.jsp 

APPENDIX 

Alzheimer’s Association (2012). Alzheimer’s disease 

facts and figures. Alzheimer’s & Dementia, 

8(2), 1-72. 

American Association of Retired Persons (AARP). 

(2012). Grandfacts: National fact sheet for 

grandparents and other relatives raising children. 

Retrieved from the AARP website: 

http://www.aarp.org/content/dam/aarp/ 

relationships/friends-family/grandfacts/ 

grandfacts-national.pdf 


men get prostate cancer? Retrieved from the 

ACS website: http://www.cancer.org/cancer/prostatecancer/overviewguide/prostate-cancer-overview-key-statistics 


people get colorectal cancer? Retrieved from 

the ACS website: http://www.cancer.org/ 

cancer/colonandrectumcancer/overviewguide/colorectal-cancer-overview-key-statistics 


women get breast cancer? Retrieved from the 

ACS website: http://www.cancer.org/cancer/breastcancer/overviewguide/breastcancer-overview-key-statistics 

American Geriatrics Society (AGS). (2012, June). 

Current geriatrician shortfall. Retrieved from 

the AGS website: http://www.americangeriatrics.org/files/documents/Adv_Resources/GeriShortageCurrentNumbers2012.pdf 

American Psychiatric Association. Diagnostic criteria 

for 309.81: Posttraumatic stress disorder. 

(1994). In Diagnostic and statistical manual of 

mental disorders (4th ed., TM., pp. 427-428). 

Washington, DC: American Psychiatric Association. 

American Society of Civil Engineers (ASCE). (2009- 

2012). Report card for America’s infrastructure: 

Nevada. Retrieved from ASCE website: 

http://www.infrastructurereportcard.org/ 

state-page/nevada 

American Society of Civil Engineers (ASCE). (2010). 

2009 Report card for America’s infrastructure. 

Retrieved from ASCE website: http://www. 

infrastructurereportcard.org/sites/default/ 

files/RC2009_roads.pdf 

American with Disabilities Act of 1990, as amended 

(ADA). (2009). The United States Department 

of Justice. Retrieved from ADA website: 

http://www.ada.gov/pubs/adastatute08. 

htm#12102 

189

APPENDIX 

190 

Anderson, L. A., Day, K. L., Beard, R. L., Reed, P. 

S., & Wu, B. (2009). The public’s perceptions 

about cognitive health and Alzheimer’s disease 

among the U.S. population: A national 

review. The Gerontologist, 49(S1), S3-S11. 

Association of American Medical Colleges 

(AAMC). (2003). Help wanted: More U.S. 

doctors. Retrieved from AAMC website: 

https://www.aamc.org/download/82874/ 

data/helpwanted.pdf 


(AAMC). (2011). 2011 State physician workforce 

data book: Center for workforce studies. 

Retrieved from the AAMC website: https:// 

www.aamc.org/download/263512/data/ 

statedata2011.pdf 


(AAMC). (2011). The impact of health care 

reform on the future supply and demand for 

physicians updated. Retrieved from the 

AAMC website: https://www.aamc.org/ 

download/158076/data/updated_projections_through_2025.pdf 


(AAMC). (2012). Spotlight on specialties: geriatric 

medicine. Retrieved from the AAMC 

website: https://www.aamc.org/students/ 

medstudents/cim/choicesnewsletter/ 

spring12/278804/path_geriatricmedicine. 

html 

Bagalman, E. (2012, February 3). Suicide prevention 

efforts of the veterans health administration. 

Congressional Research Service, 7-5700/R42340: 

Report for Congress. Retrieved from Fetal Alcohol 

Syndrome website: http://www.fas. 

org/sgp/crs/misc/R42340.pdf 

Benderly, B. L. (2008, January/February). Veterans 

& their families: A SAMHSA priority. SAM- 

HSA News, 16(1), 1-5. Retrieved from SAM- 

HSA website: http://www.samhsa.gov/ 

samhsa_news/volumexvi_1/article1.htm 

Bernhard, B. and St. John, S. (2012). Problem 

gambling and treatment in Nevada. 

Reports. Paper 49. http://digitalscholarship.unlv.edu/cgi/viewcontent. 

cgi?article=1048&context=social_health_nevada_reports 

Booth, B. M., & Blow, F. C. (2008). Chapter 9. Utilization 

of veteran’s health services for substance 

abuse: A study of aging baby boomer 

veterans. Substance Abuse and Mental Health 

Services Administration: Office of Applied Studies. 

Retrieved from the SAMHSA website: 

http://oas.samhsa.gov/aging/chap9.htm 

Bosworth, H. B., Hays, J. C., George, L. K., and Steffens, 

D. C. (2002). Psychosocial and clinical 

predictors of unipolar depression outcome 

in older adults. International Journal of Geriatric 

Psychiatry, 17, 238-246. 

Bragg, E. J., Warshaw, G. A., Meganathan, K., & 

Brewer, D. E. (2012). The development of 

academic geriatric medicine in the United 

States 2005 to 2010: An essential resource for 

improving the medical care of older adults. 

Journal of the American Geriatrics Society, 

60(8), 1540-1545. 

Bricker, J., Kennickell, A. B., Moore, K. B., and Sabelhaus, 

J. (2012, June). Changes in U.S. 

family finances from 2007 to 2010: Evidence 

from the survey of consumer finances. Federal 

Reserve Bulletin, 98(22). Retrieved from 

the Federal Reserve website: http://www. 

federalreserve.gov/pubs/bulletin/2012/ 

pdf/scf12.pdf 

Brief for the American Hospital Association as Amici 

Curiae, Department of Health and Human 

Services, et al., v Florida, et al, 11-398 (2012). 

Retrieved from the AAMC website: https:// 

www.aamc.org/download/286584/data/ 

amicusbrief2.pdf 

Bureau of Labor Statistics. (2012). Employment 

projections. Table 3.3. Civilian labor force participation 

rates by age, sex, race, and ethnicity. 

Retrieved from Bureau of Labor Statistics 

website: http://www.bls.gov/emp/ep_table_303.htm 

Campanelli, C. M. (2012). American geriatrics society 

updated Beers criteria for potential inappropriate 

medication use in older adults. 

Journal of the American Geriatrics Society, 1-16. 

DOI: 10.1111/j.1532-5415.2012.03923.x. Retrieved 

from www.americangeriatrics.org: 

http://www.americangeriatrics.org/files/ 

documents/beers/2012BeersCriteria_JAGS. 

pdf

Campbell, P. R. (1996). Population projections for 

states by age, sex, race, and Hispanic origin: 

1995-2025. Washington, D.C.: U.S. Census 

Bureau. 

Centers for Disease Control and Prevention (CDC). 

(2011). The CDC Healthy Brain Initiative: Progress 

2006‒2011, Atlanta, GA: CDC. Retrieved 

from CDC website: http://www.cdc.gov/ 

aging//pdf/HBIBook_508.pdf 

Centers for Disease Control and Prevention (CDC): 

Behavioral risk Factor Surveillance System 

Survey Data (BRFSS). (2011). Data analysis 

by: Office of Public Health Informatics and 

Epidemiology, Nevada State Health Division 

[unpublished data]. Carson City, NV: 

Department of Health and Humans Services. 



Survey Data (BRFSS). (2011). All states – 

2011: Cholesterol awareness. Retrieved from 

CDC website: http://apps.nccd.cdc.gov/ 

BRFSS/page.asp?yr=2011&state=All&cat=C 

A#CA 



Survey Data (BRFSS). (2011). Prevalence and 

trends data: Nationwide – 2010 Colorectal Cancer 

Screening. Retrieved from CDC website: 

http://apps.nccd.cdc.gov/brfss/display.asp 

?cat=CC&yr=2010&qkey=4424&state=UB 




trends data: Nationwide – 2011 Health status. 

Retrieved from CDC website: http://apps. 

nccd.cdc.gov/BRFSS/display.asp?state=US 

&cat=HS&yr=2011&qkey=8001&grp=0&SU 

BMIT4=Go 



Survey Data (BRFSS). (2011). Prevalence 

and trends data: Nationwide – 2011 Immunization. 

Retrieved from CDC website: 

http://apps.nccd.cdc.gov/brfss/page. 

asp?cat=IM&yr=2011&state=UB#IM 




trends data: Nationwide – 2011 Injury. Retrieved 

from CDC website: http://apps. 

nccd.cdc.gov/brfss/display.asp?cat=IN&yr= 

2011&qkey=8331&state=UB 




trends data: Nationwide – 2010 Prostate cancer. 

Retrieved from CDC website: http://apps. 

nccd.cdc.gov/brfss/display.asp?state=UB& 

cat=PC&yr=2010&qkey=4423&grp=0&SUB 

MIT4=Go 




trends data: Nationwide – 2010 – Women’s 

health. Retrieved from CDC website: http:// 

apps.nccd.cdc.gov/brfss/display.asp?state= 

UB&cat=WH&yr=2010&qkey=4426&grp=0 

&SUBMIT4=Go 



Survey Data (BRFSS). (n.d.). Prevalence and 

trends data: Nevada – 2010 – Cardiovascular 

disease. Retrieved from CDC website: http:// 

apps.nccd.cdc.gov/BRFSS/display.asp?cat= 

CV&yr=2010&qkey=5001&state=NV 



Survey Data (BRFSS). (n.d.). Prevalence 

and trends data: Nevada-1996-2011-Tobacco 

use. Retrieved from CDC website: 

http://apps.nccd.cdc.gov/BRFSS/page. 

asp?cat=TU&yr=2011&state=NV#TU 

Centers for Disease Control and Prevention 

(CDC): Behavioral risk Factor Surveillance 

System Survey Data (BRFSS). 

(2011). Prevalence and trends data: Physical 

activity. Retrieved from CDC website: 

http://apps.nccd.cdc.gov/BRFSS/page. 

asp?cat=PA&yr=2011&state=UB#PA 


Breast Cancer. (2012). Breast cancer rates by 

race and ethnicity. Retrieved from the CDC 

website: http://www.cdc.gov/cancer/ 

breast/statistics/race.htm 

APPENDIX 

191

APPENDIX 

192 


Division of STD Prevention. (2012, December). 

Sexually transmitted disease surveillance, 

2011. Retrieved from the CDC website: 

http://www.cdc.gov/std/stats11/Surv2011. 

pdf 


Fact Sheet. (2011). STD trends in the United 

States: 2011 National data for Chlamydia, gonorrhea, 

and syphilis. Retrieved from the CDC 

website: http://www.cdc.gov/std/stats11/ 

trends-2011.pdf 


Health, United States, 2011. (2012). Table 

120: Nursing homes, beds, residents, and occupancy 

rates, by state: United States, selected 

years, 1995-2011. Retrieved from CDC website: 

http://www.cdc.gov/nchs/hus/contents2011.htm#120 


Healthy Aging Report. (2009). The state of 

aging and health in America report, 2008-2009: 

Compare indicators by location. Retrieved 

from CDC website: http://apps.nccd.cdc. 

gov/SAHA/Default/CompareReports. 

aspx?Compare=US&Parent=US 


HIV/AIDS among Persons Age 50 and Older. 

(2008). CDC HIV/AIDS facts. Retrieved 


hiv/topics/over50/resources/factsheets/ 

pdf/over50.pdf 


Home & Recreational Safety. (2012). Costs of 

falls among older adults. Retrieved from CDC 

website: http://www.cdc.gov/HomeandRecreationalSafety/Falls/fallcost.html 


Home & Recreational Safety. (2012). Falls 

among older adults: An overview. Retrieved 


HomeandRecreationalSafety/Falls/adultfalls.html 


Home & Recreational Safety. (2012). Falls in 

nursing homes. Retrieved from CDC website: 

http://www.cdc.gov/HomeandRecreationalSafety/Falls/nursing.html 


Home & Recreational Safety. (2012). Hip fractures 

among older adults. Retrieved from CDC 

website: http://www.cdc.gov/HomeandRecreationalSafety/Falls/adulthipfx.html 


Morbidity and Mortality Weekly Report 

(MMWR). (2012, January 27). Cancer screening 

– United States, 2010. Retrieved from 

CDC website: http://www.cdc.gov/ 

mmwr/PDF/wk/mm6103.pdf 



(MMWR). (2012, August 17). Prevention and 

control of influenza with vaccines: Recommendations 

of the advisory committee on immunization 

practices (ACIP) – United States, 2012- 

2013 influenza season. Retrieved from CDC 

website: http://www.cdc.gov/mmwr/ 

preview/mmwrhtml/mm6132a3.htm?s_ 

cid=mm6132a3 

Center for Disease Control and Prevention (CDC): 


(MMWR). (2012, December 7). Quickstats: 

Drug-poisoning death rates – National vital 

statistics sytem, United States, 2010. Retrieved 


mmwr/preview/mmwrhtml/mm6148a6. 

htm?s_cid=mm6148a6_e 

Centers for Disease Control and Prevention: National 

Center for Health Statistics. (n.d.). 

Health Indicators Warehouse. Retrieved from 

www.healthindicators.gov [1/7/13]. 

Center for Disease Control and Prevention (CDC): 

National Center for HIV/AIDS, Viral Hepatitis, 

STDs, and TB Prevention. (2012). AIDS 

diagnoses. Retrieved from CDC website: 

http://gis.cdc.gov/GRASP/NCHHSTPAtlas/main.html 


Overweight and Obesity. (2012). Defining 

overweight and obesity. Retrieved from CDC 

website: http://www.cdc.gov/obesity/ 

adult/defining.html


Physical Activity. (2011). How much physical 

activity do you older adults need? Retrieved 


physicalactivity/everyone/guidelines/olderadults.html 


Physical Activity. (2012). Facts about physical 

activity. Retrieved from CDC website: 

http://www.cdc.gov/physicalactivity/ 

data/facts.html 


Prostate Cancer. (2012). Prostate cancer rates 

by race and ethnicity. Retrieved from CDC 

website: http://www.cdc.gov/cancer/prostate/statistics/race.htm 


Publications and Information Products. 

(2011). Health, United States, 2011: Updated, 

Table 79. Retrieved from CDC website: 

http://www.cdc.gov/nchs/hus/contents2011.htm#079 


Seasonal Influenza (Flu). (2012). Fluzone 

high-dose seasonal influenza vaccine. Retrieved 


flu/protect/vaccine/qa_fluzone.htm 


Seasonal Influenza (Flu). (2012). What you 

should know and do this flu season if you are 

65 years and older. Retrieved from CDC 

website: http://www.cdc.gov/flu/about/ 

disease/65over.htm 


Smoking & Tobacco Use. (n.d.). State tobacco 

activities tracking and evaluation (STATE) system. 

Retrieved from CDC website: http:// 

apps.nccd.cdc.gov/statesystem/InteractiveReport/InteractiveReports.aspx 


Vaccines & Immunizations. (2012). Pneumococcal 

disease in-short. Retrieved from the 

CDC website: http://www.cdc.gov/vaccines/vpd-vac/pneumo/in-short-both.htm 


Veterans’ Health Activities. (2010). Environmental 

health. Retrieved from the CDC website: 

http://www.cdc.gov/nceh/veterans/ 

vet_hlth_actvy.pdf 


Web-based Injury Statistics Query and Reporting 

System (WISQARS) [Online]. (2012). 

Fatal injury mapping. Retrieved from CDC 

website: http://wisqars.cdc.gov:8080/cdc- 

MapFramework/mapModuleInterface.jsp 

[2012, December, 23]. 




Fatal injury mortality report, Nevada. Retrieved 

from CDC website: www.cdc.gov/ 

ncipc/wisqars [2012, December, 23]. 




10 Leading causes of death, Nevada: 2010, all 

races, both sexes. Retrieved from CDC website: 

www.cdc.gov/ncipc/wisqars [2012, 

December, 23]. 




National suicide statistics at a glance. Retrieved 


ViolencePrevention/suicide/statistics/leading_causes.html 

[2012, December, 23]. 




United States, unintentional overall motor vehicle 

deaths and rates per 100,000. Retrieved 

from CDC website: www.cdc.gov/ncipc/ 

wisqars [2012, December, 27]. 

Centers for Medicare & Medicaid Services (CMS): 

Nursing Homes. (2010). Nursing home data 

compendium: 2010 Edition. Retrieved from 

the CMS website: http://www.cms.gov/ 

Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/nursinghomedatacompendium_508. 

pdf 

APPENDIX 

193

APPENDIX 

Centers for Medicare & Medicaid Services (CMS): 

Health Expenditures. (2012). State provider: 

Health expenditures by state of provider, 1980- 

2009. Retrieved from CMS website: http:// 

www.cms.gov/Research-Statistics-Dataand-Systems/Statistics-Trends-and-Reports/ 

NationalHealthExpendData/Downloads/ 

prov-tables.pdf 

Cherry, D., Lucas, C., and Decker, S. L. (2010, August). 

Population aging and the use of officebased 

physician services. CDC: National 

Center for Health Statistics, Data Brief #41. Retrieved 

from CDC website: http://www.cdc. 

gov/nchs/data/databriefs/db41.htm 

Coleman-Jensen, A., Nord, M., Andrews, M., and 

Carlson, S. (2011, September). Household 

food security in the United States in 2010. 

U.S. Department of Agriculture: Economic 

Research Service, Report Summary. Retrieved 

from U.S. Department o f Agriculture website: 

http://www.ers.usda.gov/publications/err-economic-research-report/err125. 

aspx 

Cropp, I. (2011, May 5). Why do hearing aids cost 

so much? American Association of Retired Persons 

(AARP). Retrieved from AARP website: 

http://www.aarp.org/health/conditionstreatments/info-05-2011/hearing-aids-cost. 

html 

Cullinane, P. (2006). Late-life civic engagement enhances 

health for individuals and communities. 

The Journal on Active Aging, 66-73. 

Cutler, D. M., & Lleras-Muney, A. (2007, March). 

Education and health. National Poverty Center: 

Policy Brief, #9. Retrieved from National 

Poverty Center website: http://www.npc. 

umich.edu/publications/policy_briefs/ 

brief9/policy_brief9.pdf 

Dickinson, W. J., Potter, G. G., Hybels, C. F., Mc- 

Quoid, D. R., & Steffens, D. C. (2011). 

Change in stress and social support as predictors 

of cognitive decline in older adults 

with and without depression. International 

Journal of Geriatric Psychiatry, 26(12), 1267- 

1274. 

194 

Colliver, J. D., Compton, W. M., Gfroerer, J. C., 

& Condon, T. (2006). Projecting drug use 

among aging baby boomers in 2030. Annals 

of Epidemiology. 16(4), 257–265. 

Congressional Budget Office (CBO). (2010, Oct). 

Potential costs of veterans’ health care. Retrieved 

from the CBO website: http:// 

www.cbo.gov/sites/default/files/cbofiles/ 

ftpdocs/118xx/doc11811/2010_10_7_vahealthcare.pdf 

Cornwell, E. Y., and Waite, L. J. (2012). Social network 

resources and management of hypertension. 

Journal of Health and Social Behavior. 

53, 215-231. 

Corporation for National & Community Service. 

(2011). Volunteering in Nevada. Retrieved from 

Volunteering in America website: http:// 

www.volunteeringinamerica.gov/NV 

Crescioni, M., Gorina, Y., Bilheimer, L., & Gillum, 

R. F. (2010, April 21). Trends in health status 

and health care use among older men. 

Center for Disease Control: National Health 

Statistics Reports. Retrieved from CDC website: 

http://www.cdc.gov/nchs/data/nhsr/ 

nhsr024.pdf 

Duncan, D. F., Nicholson, T., White, J. B., Bradley, 

D. B., and Bonaguro, J. (2010). The baby 

boomer effect: Changing patterns of substance 

abuse among adults age 55 and older. 

Journal of Aging & Social Policy, 22(3), 237- 

258. 

Durai, U. N. B., Chopra, M. P., Coakley, E., Llorente, 

M. D., Krichner, J. E., Cook, J. M., & Levkoff, 

S. E. (2011). Journal of the American Geriatrics 

Society, 59, 1087-1092. 

Dye, B. A., Li, X., and Thornton-Evans, G. (2012, 

August). Oral health disparities as determined 

by selected healthy people 2020 oral 

health objectives for the United States, 2009- 

2010. NCHS Data Brief, 104, Hyattsville, MD: 

National 

Center for Health Statistics. Retrieved from 

the CDC website: http://www.cdc.gov/ 

nchs/data/databriefs/db104.pdf 

Echt, K. V. (2009). Presentation 4. Health literacy in 

aging: Processing health information (pp. 11- 

12). In C. Baur (Ed.). Improving health literacy 

for older adults: Expert panel report, 2009, U.S. 

Department of Health and Human Services. Retrieved 


gov/healthliteracy/pdf/olderadults.pdf

Effros, R., B., Fletcher, C. V., Gebo, K., et al. (2008). 

Workshop on HIV infection and aging: What 

is known and future research directions. 

Clinical Infectious Diseases, 47, 542-53. 

Fakhouri, T. H. I., Kit, B. K., & Ogden, C. L. (2012, 

October), Consumption of diet drinks in the 

United States, 2009-2010. U.S. Department of 

Health and Human Services: National Center for 

Health Statistics, Brief No. 109. Retrieved from 

CDC website: http://www.cdc.gov/nchs/ 

data/databriefs/db109.pdf 

Fakhouri, T. H. I., Ogden, C. L., Carroll, M. D., Kit, 

Brian K., & Flegal, K. M. (2012, September). 

Prevalence of obesity among older adults in 

the United States, 2007-2010. U.S. Department 

of Health and Human Services: National Center 

for Health Statistics, Brief No. 106. Retrieved 



Fargo, J., Metraux, S., Byrne, T., Munley, E., Montgomery, 

A. E., Jones, H., Sheldon, G., Kane, 

V., & Culhane, D. (2012). Prevalence and 

risk of homelessness among U.S. veterans. 

Preventing Chronic Disease: Public Health Research, 

Practice, and Policy, 9(110112), 1-9. Retrieved 

from the CDC website: http://www. 

cdc.gov/pcd/issues/2012/pdf/11_0112.pdf 

Federal Interagency Forum on Aging-Related Statistics. 

(2010, July). Older Americans 2010: Key 

indicators of well-being. Washington, D.C.: 

U.S. Government Printing Office. 

Federal Interagency Forum on Aging-Related Statistics. 

(2012, June). Older Americans 2012: 

Key indicators of well-being. Washington, D.C.: 

U.S. Government Printing Office. 

Feinberg, L., Reinhard, S. C., Houser, A., & Choula, 

R. (2011). Valuing the invaluable: 2011 Update, 

the growing contributions and costs of 

family caregiving. AARP Public Policy Institute: 

Insight on the Issues. Retrieved from the 

AARP website: http://www.aarp.org/relationships/caregiving/info-07-2011/valuingthe-invaluable.html 

Garner, D. L., Wakefield, M. A., Tyler, T. G., Samuels, 

A. D., & Cleveland, R. (2012). Healthcare 

access and insurance availability in Nevada. 

In D. Shalin (Ed.), The social health of Nevada: 

Leading indicators and quality of life in the silver 

state. Las Vegas, NV: UNLV Center for 

Democratic Culture. Retrieved from CDCLV 

website: http://cdclv.unlv.edu/healthnv_2012/healthaccess.pdf 

Geyer, S., Hemstrom, O., Peter, R., & Vagero, D. 

(2006). Education, income, and occupational 

class cannot be used interchangeably in 

social epidemiology. Empirical evidence 

against a common practice. Journal of Epidemiology 

and Community Health, 60, 804-810. 

Golding, H. L. (2011, July 27). Testimony: Potential 

costs of health care for veterans of reent and 

ongoing U.S. Military operations. Congressional 

Budget Office (CBO). Retrieved from 

the CBO website: http://www.cbo.gov/ 

sites/default/files/cbofiles/ftpdocs/123xx/ 

doc12315/07-27-va_healthcare.pdf 

Gould, E. (2008). Growing disparities in life expectancy. 

Economic policy institute: Research and 

ideas for shared prosperity. Retrieved from 

Economic Policy Institute website: http:// 

www.epi.org/content.cfm/webfeatures_ 

snapshots_20080716 

Grants Management Unit. (2012, May). Statewide 

needs survey. Nevada Department of Health 

and Human Services (NVDHHS). Retrieved 

from NVDHHS website: http://dhhs. 

nv.gov/grants/Documents/2012Statewid 

eNeedsAssessment/GMACNeedsAssessment2012.pdf 

Griffin, L. I. (2004). Older driver involvement in 

injury crashes in Texas, 1975-1999. AAA 

Foundation for Traffic Safety. Retrieved from 

AAA website: http://www.aaafoundation. 

org/pdf/OlderDriverInvolvementInInjury- 

Crashes.pdf 

Griswold, M. T., & Packham, J. (2011, February). Nevada 

rural and frontier health data book – 2011 

edition. Reno, NV: Nevada State Office of 

Rural Health. 

APPENDIX 

195

APPENDIX 

Hardcastle, J. (2010, October 11). 2010 Population 

projections. University of Nevada, Reno: The 

Business Services Group, Nevada State Demographer. 

Retrieved from http://nvdemography.org/featured-articles/235/ 

Hardcastle, J. (2011). Nevada county population 

projections 2010 to 2030. Retrieved from 

http://nvdemography.org/wp-content/ 

uploads/2010/10/2010-to-2030-Population- 

Projections-Report-REVISED-102610.pdf 

HealthCare.gov. (2012). How the health care law is 

making a difference for the people of Nevada. 

Retrieved from www.healthcare.gov/law/ 

resources/nv.html 

Hoefer, M., Rytina, N., & Baker, B. C. (2010, January). 

Estimates of the unauthorized immigrant 

population residing in the United 

States: January 2009. Homeland Security: Office 

of Immigration Statistics Policy Directorate. 

Retrieved from DHS website: http://www. 

dhs.gov/xlibrary/assets/statistics/publications/ois_ill_pe_2009.pdf 

Houser, A., & Gibson, M. J. (2007, Nov). Valuing 

the invaluable: A new look at state estimates 

of the economic value of family caregiving 

(Data update). AARP Public Policy Institute: 

Insight on the Issues, 1-8. Retrieved from the 

AARP website: http://assets.aarp.org/rgcenter/il/dd158r_caregiving.pdf 

196 

Health Policy Explained. (n.d.) Military and veteran’s 

healthcare. www.kaiseredu.org. Retrieved 

from Kaiser Education website: 

http://www.kaiseredu.org/Issue-Modules/ 

Military-and-Veterans-Health-Care/Background-Brief.aspx 

HealthyPeople.gov. (2012). Cancer: Objectives. 

Retrieved from the Healthy People 2020 

website: http://healthypeople.gov/2020/ 

topicsobjectives2020/objectiveslist. 

aspx?topicId=5 

HealthyPeople.gov. (2012). Nutrition, physical activity, 

and obesity: Latest data – obesity in adults. 

Retrieved from Healthy People website: 

http://healthypeople.gov/2020/LHI/nutrition.aspx?tab=data 

Hearing Loss Association of America. (2012). Medicaid 

regulations. Retrieved from http://www. 

hearingloss.org/content/medicaid-regulations 

Henry J. Kaiser Family Foundation: State Health 

Facts. (2012). Nevada: Health expenditures by 

state of residence. Retrieved from www.statehealthfacts.org: 

http://www.statehealthfacts.org/profileind.jsp?cat=5&sub=143&rgn 

=30&cmprgn=1 

Henry J. Kaiser Family Foundation: State Health 

Facts. (2012). Nevada health insurance status. 

Retrieved from www.statehealthfacts.org: 

http://www.statehealthfacts.org/profileind. 

jsp?cat=3&sub=39&rgn=30 

Houser, A., & Gibson, M. J. (2008, Nov). Valuing the 

invaluable: The economic value of family 

caregiving, 2008 Update. AARP Public Policy 

Institute: Insight on the Issues, 1-8. Retrieved 

from the AARP website: http://assets.aarp. 

org/rgcenter/il/i13_caregiving.pdf 

Hoyert, D. L., & Xu, J. (2012, October). Deaths: Preliminary 

data for 2011. National Vital Statistics 

Reports, 61(6). Retrieved from CDC website: 

http://www.cdc.gov/nchs/data/nvsr/ 

nvsr61/nvsr61_06.pdf 

Ihrke, D. K., Faber, C. S., & Koerber, W. K. (2011). 

Geographical mobility: 2008 to 2009. U.S. 

Census Bureau. Retrieved from Census Bureau 

website: http://www.census.gov/ 

prod/2011pubs/p20-565.pdf 

Institute of Medicine of the National Academies. 

(2012, July). The mental health and substance 

use workforce for older adults: In whose hands? 

Retrieved from Institute of Medicine website: 

http://www.iom.edu/Reports/2012/ 

The-Mental-Health-and-Substance-Use- 

Workforce-for-Older-Adults.aspx 

International Federation of Pharmaceutical Manufacturers 

& Associations (IFPMA). (2012). 

Morbidity and mortality. Retrieved from 

IFPMA website: http://www.ifpma.org/ 

resources/influenza-vaccines/seasonal-influenza/morbidity-and-mortality.html

Jourdan, K. (2012, July 17). Clark county moves 

forward on creating veterans court. Las 

Vegas Review-Journal. Retrieved from LVRJ 

website: http://www.lvrj.com/news/clarkcounty-moves-forward-to-create-veteranscourt-162793086.html 

Juretic, M., Hill, R., Luptak, M., Rupper, R., Bair, B. 

Floyd, J., Westfield, B., & Daily, N. K. (2010). 

Reaching out to older veterans in need: the 

Elko clinic demonstration project. The Journal 

of Rural Health, 26(4), 325-332. 

Kaiser commission on Key Facts: Medicaid and the 

Uninsured. (2010, February). Medicaid financial 

eligibility: Primary pathways for the elderly 

and people with disabilities. Retrieved from the 

H. J. Kaiser website: http://www.kff.org/ 

medicaid/upload/8048.pdf 

Karpiak, S. (2011, June). The complications of success: 

The aging of HIV population. In D. Nelson, 

Positive aging: HIV turns 30. Webinar conducted 

by the Administration on Aging’s 

Health, Prevention, and Wellness Program. 

Retrieved from AOA website: http://www. 

aoa.gov/AoARoot/AoA_Programs/HPW/ 

HIV_AIDS/Webinar.aspx 

Kessler, R. C., Hwang, I., LaBrie, R., Petukhova, M., 

Sampson, N. A., Winters, K. C., & Shaffer, H. 

J. (2008). DSM-IV pathological gambling in 

the national comorbidity survey replication. 

Psychological Medicine, 38(9), 1351-1360. 

Klein, W. C., & Jess, C. (2002). One last pleasure? Alcohol 

use among elderly people in nursing 

homes. Health & Social Work, 27(3), 193-203. 

Kliff, S. (2013, Jan. 3). Plans for health insurance 

exchanges approved by White House for 

seven more states. Washington Post Online. 

Retrieved from www.washingtonpost. 

com: http://www.washingtonpost.com/ 

national/health-science/plans-for-healthinsurance-exchanges-approved-by-whitehouse-for-seven-more-states/2013/01/03/2 

eb43128-55e9-11e2-8b9e-dd8773594efc_story. 

html?wpisrc=nl_headlines 

Leach, C. R., Schoenbery, N. E. (2007, October). The 

vicious cycle of inadequate early detection: 

A complementary study on barriers to cervical 

cancer screening among middle-aged 

and older women. Preventing Chronic Disease: 

Public Health Research, Practice, and Policy, 

4(4), 1-12. Retrieved from the CDC website: 

http://www.cdc.gov/pcd/issues/2007/ 

oct/pdf/06_0189.pdf 

Levy, B. R., Ding, L., Lakra, D., Kosteas, J., and 

Niccolai, L. (2007). Older persons’ exclusion 

from sexually transmitted disease riskreduction 

clinical trials. Sexually Transmitted 

Diseases, 34(8), 541-544. DOI: 10.1097/01. 

olq.0000253342.75908.05. 

Lin, F. R., & Ferrucci, L. (2012). Hearing loss and 

falls among older adults in the United 

States. Archives of Internal Medicine, 172(4), 

369-370. Retrieved from The JAMA Network: 

http://0-archinte.jamanetwork.com. 

innopac.library.unr.edu/Issue.aspx?journali 

d=71&issueID=22609&direction=P 

Mackun, P., Wilson, S., Fischetti, T., & Goworowska, 

J. (2011, March). Population distribution and 

change: 2000 to 2010: 2010 census briefs. 

U.S. Census Bureau. Retrieved from Census 

Bureau website: http://www.census.gov/ 

prod/cen2010/briefs/c2010br-01.pdf 

Martin, A. B., Lassman, D., Washington, B., Catlin, 

A., & the National Health Expenditure Accounts 

Team. (2012). Growth in U.S. health 

spending remained slow in 2010: Health 

share of gross domestic product was unchanged 

from 2009. Health Affairs, 31(1), 

208-219. Retrieved from the Kaiseredu. 

org: http://content.healthaffairs.org/content/31/1/208.full.pdf+html 

Martinez, I. L., Crooks, D., Kim, K. S., & Tanner, E. 

(2011). Invisible civic engagement among 

older adults: Valuing the contributions of informal 

volunteering. Journal of Cross Cultural 

Gerontology, 26, 23-37. 

McDonald, M. (2011). United States election project: 

2008 General election turnout rates. Retrieved 

from http://elections.gmu.edu/ 

Turnout_2008G.html 

APPENDIX 

197

APPENDIX 

198 

McDonald, M. (2011). United States election project: 

2010 General election turnout rates. Retrieved 

from http://elections.gmu.edu/ 

Turnout_2010G.html 

McIntosh, J. L. (for the American Association of 

Suicidology). (2012). U.S.A. suicide: 2009 official 

final data. Washington, DC: American 

Association of Suicidology, dated January 

12, 2012. Retrieved from http://www.suicidology.org. 

McIntosh, J. L., & Drapeau, C. W. (for the American 

Association of Suicidology). (2012). U.S.A. 

suicide 2010: Official final data. Washington, 

DC: American Association of Suicidology, 

dated September 20, 2012. Retrieved from 

http://www.suicidology.org 

Menninger, J. A. (2002). Assessment and treatment 

of alcoholism and substance-related disorders 

in the elderly. Bulletin of the Menninger 

Clinic, 66(2), 166–183. 

MetLife Mature Market Institute. (2011, Oct). Market 

survey of long-term care costs: The 2011 metlife 

market survey of nursing home, assisted living, 

adult day services, and home care costs. Retrieved 

from MetLife website: https://www.metlife. 

com/assets/cao/mmi/publications/studies/2011/mmi-market-survey-nursing-homeassisted-living-adult-day-services-costs.pdf 

Miller, R. (2012). Voter registration statistics. Nevada 

Secretary of State: Ross Miller. Retrieved 

from http://www.nvsos.gov/index. 

aspx?page=1190 

Mykyta, L., & Macartney, S. (2012, June). Sharing a 

household: Household composition and economic 

well-being: 2007-2010. Current Population 

Report, P60-242. 

National Alliance for Caregiving & AARP. (2009, 

Nov). Caregiving in the U.S. 2009. Retrieved 

from the NAC website: http://www.caregiving.org/pdf/research/Caregiving_in_ 

the_US_2009_full_report.pdf 

National Alliance on Mental Illness (NAMI). 

(2011, November). State mental health 

cuts: The continuing crisis. Retrieved from 

NAMI website: http://www.nami.org/ 

ContentManagement/ContentDisplay. 

cfm?ContentFileID=147763 

National Center for Education Statistics (NCES): 

Institute of Education Sciences. (2011, July). 

Table 12: Percentage of persons age 25 and over 

with high school completion or higher and a 

bachelor’s or higher degree, by race/ethnicity and 

state: 2007-2009. Retrieved from NCES website: 

http://nces.ed.gov/programs/digest/ 

d11/tables/dt11_012.asp 

National Center for Environmental Health: Division 

of Laboratory Sciences. (2012). Second 

national report on biochemical indicators 

of diet and nutrition in the U.S. population. 

Centers for Disease Control and Prevention. Retrieved 


gov/nutritionreport/ 

National Center for Environmental Health: Division 

of Laboratory Sciences. (2012). Second 

national report on biochemical indicators of 

diet and nutrition in the U.S. population: Executive 

summary. Centers for Disease Control 

and Prevention. Retrieved from CDC website: 

http://www.cdc.gov/nutritionreport/pdf/ 

ExeSummary_Web_032612.pdf#zoom=100 

National Center for Frontier Communities (NCFC). 

(2012). Retrieved from http://www.frontierus.org/defining.php 

National Center for Responsible Gaming: Advancing 

Research, Education and Awareness 

(NCRG). (2009-2011). Gambling disorders 

360°: Exploring the latest news, issues and 

research relating to gambling disorders and responsible 

gaming. Retrieved from NCRG website: 

http://blog.ncrg.org/issues-insights/ 

redefining-pathological-gambling-ne-research-highlights 

National Conference on Citizenship. (2011). 2011 Issue 

brief: Civic health and unemployment – Can 

engagement strengthen the economy? Retrieved 

from http://ncoc.net/unemployment 

National Council on Aging (NCOA). (2012). United 

states of aging. Retrieved from NCOA website: 

http://www.ncoa.org/assets/files/ 

pdf/united-states-of-aging/2012-survey/8- 

3-12-US-of-Aging-Survey-Fact-Sheet-National-FINAL.pdf

National Highway Traffic Safety Administration 

(NHTSA). (2008). Occupant protection 

issues among older drivers and passengers: 

Volume II appendices. Retrieved from 

NHTSA website: http://www.nhtsa.gov/ 

search?q=older+adults&x=0&y=0 

National Highway Traffic Safety Administration 

(NHTSA): Traffic Tech. (2012, March). Agerelated 

functional limitations, countermeasures, 

and crash risks. Retrieved from NTHSA 

website: www.nhtsa.gov/staticfiles/traffic_tech/811596.pdf 

National Institute on Drug Abuse (NIDA): Topics in 

Brief. (2011, April). Substance abuse among the 

military, veterans, and their families: A research 

update form the national institute on drug abuse. 

Retrieved from the NIDA website: http:// 

www.drugabuse.gov/sites/default/files/ 

veterans.pdf 

National Institute of Health (NIH): National Eye 

Institute. (2012). Prevalence of adult vision impairment 

and age-related eye diseases in America: 

Estimated number of cases by vision problem 

age >/= 40. Retrieved from NIH website: 

http://www.nei.nih.gov/eyedata/adultvision_usa.asp 

National Institute of Health (NIH): National Institute 

on Aging (NIA). (n.d.). Go4Life: Get 

started. Retrieved from NIH website: http:// 

go4life.nia.nih.gov/get-started 


(ADSD). (2012). SB129 elder abuse training 

presentation. Retrieved from ADSD website: 

http://nvaging.net/ 


(ADSD): Elder Protective Services (EPS). 

(2012). Caseload statistics. Retrieved from 

ADSD website: http://nvaging.net/CaseloadStatistics-EPS.pdf 


(ADSD): Appendix J: 2011 Survey of seniors 

and citizens with disabilities. Retrieved from 

the ADSD website: http://nvaging.net/ 

sp/2012-2016/AppendixJ2011SurveyofSeniorsandPersonswithDisabilities.pdf 

Nevada Council on Problem Gambling (NCPG). 

(2007). Seniors and gambling. Retrieved from 

NCPG website: http://www.nevadacouncil. 

org/seniors.php?bi=1182880971 

Nevada Council on Problem Gambling. (2012). 

FAQ: Problem Gamblers. Retrieved 

from NCGP website: http://www. 

ncpgambling.org/i4a/pages/index. 

cfm?pageid=3390#widespread 

Nevada Department of Health and Human Services 

(2011). Five Year Strategic Plan for Problem 

Gambling Treatment Services Within the State 

of Nevada: Fiscal Years 2012 - 2016. Carson 

City, NV: Nevada DHHS. 

APPENDIX 

National Institute of Health: National Institute on 

Deafness and Other Communication Disorders. 

(2012). Hearing loss and older adults. 

Retrieved from NIH website: http://www. 

nidcd.nih.gov/health/hearing/pages/older. 

aspx 

National Institute of Mental Health (NIMH). (n.d.). 

Older adults and mental health: Depression. Retrieved 

from NIMH website: http://www. 

nimh.nih.gov/health/topics/older-adultsand-mental-health/index.shtml 

National Resource Center for Participant-Directed 

Services. (n.d.). Find a program: Nevada. Retrieved 

from Boston College website: http:// 

web.bc.edu/libtools/insights-publications. 

php?state=38 

Nevada Department of Health and Human Services: 

Grants Management Advisory Committee 

(GMAC). (2012, May). Statewide needs 

survey. Retrieved from NVDHHS website: 

http://dhhs.nv.gov/Grants/ 

Nevada Department of Public Safety (NVDPS): Office 

of Traffic Safety. (2011). Highway safety 

plan: Fiscal year 2012. Retrieved from NVDPS 

website: http://ots.state.nv.us/Docs/HSP_ 

FINAL.pdf 

Nevada Department of Transportation (NDOT): 

Projects and Programs. (2012). American 

recovery and reinvestment act – Overview. 

Retrieved from NDOT website: 

http://www.nevadadot.com/Content. 

aspx?id=1922&terms=American%20Recovery%20Act 

199

APPENDIX 

Nevada Legislature: The People’s Branch of Government. 

(2012). Nevada facts and state emblems. 

Retrieved from the NV Legislature 

website: http://leg.state.nv.us/General/ 

NVFacts/index.cfm 

Nevada Office of Veterans Services. (2012). NSVH 

admissions. Retrieved from NV Office of 

Veterans website: http://www.veterans. 

nv.gov/NSVH_admissions.html 

Nevada Office of Veterans Services. (2012, June 21). 

Nevada veterans services commission quarterly 

meeting, June 21, 2012 at 0930 hours. 

Nevada State Health Division. (2012). Central Cancer 

Registry. Data and analysis provided by the 

Bureau of Health Statistics, Planning, Epidemiology 

and Response. 

Nevada Veterans Services Commission Quarterly 

Report (Section V). (2012, June). Veterans 

court: Legislative committee on senior citizens, 

veterans, and adults with special needs. 

Office of Management and Budget. (n.d.). Table 

4.1 – Outlays by agency: 1962-2017. Retrieved 

from OMB website: http://www.whitehouse.gov/omb/budget/Historicals 

Office of Management and Budget (OMB): 2010 

Standards for delineating metropolitan and 

micropolitan statistical areas; Notice. (2010, 

June 28). Federal Register, 75(123), 37245- 

29052 

Office of Management and Budget (OMB). (2012). 

Budget of the U.S. government: FY 2013 Summary 

tables. Retrieved from OMB website: 

http://www.whitehouse.gov/sites/default/files/omb/budget/fy2013/assets/ 

budget.pdf 

Office of National Drug Control Policy (ONDCP). 

(2012). Nevada drug control update. Retrieved 

from ONDCP website: http://www.whitehouse.gov/sites/default/files/docs/state_ 

profile_-_nevada.pdf 

Office of Public Health Informatics and Epidemiology. 

Nevada State Health Division. (2011). 

Electronic death registry system. [unpublished 

data.]. Carson City Nevada: Department of 

Health and Human Services. 

Ogden, C. L., Lamb, M. M., Carroll, M. D., & Flegal, 

K. M. (2010, December). Obesity and socioeconomic 

status in adults: United States, 

2005-2008. U.S. Department of Health and 

Human Services: National Center for Health 

Statistics, Brief No. 50. Retrieved from CDC 

website: http://www.cdc.gov/nchs/data/ 

databriefs/db50.pdf 

Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. 

M. (2012, January). Prevalence of obesity in 

the United States, 2009-2010. U.S. Department 

of Health and Human Services: National Center 

for Health Statistics, Brief No. 82. Retrieved 



Organization for Economic Co-operation and Development 

(OECD): Briefing Note. (2012). 

OECD health data 2012: How does the United 

States compare? Retrieved from the OECD 

website: http://www.oecd.org/unitedstates/BriefingNoteUSA2012.pdf 

Organization for Economic Co-operation and Development 

(OECD): Health Policies and 

Data. (2012). OECD health data 2012: Frequently 

requested data. Retrieved from the 

OECD website: http://www.oecd.org/els/ 

healthpoliciesanddata/oecdhealthdata2012- 

frequentlyrequesteddata.htm 

Organization for Economic Co-operation and 

Development (OECD): Health Statistics 

(database). (2012). OECD health data: 

Health status. 

doi: 10.1787/data-00540-en. Retrieved on 

July 16, 2012 from OECD website: http:// 

stats.oecd.org/BrandedView.aspx?oecd_bv_ 

id=health-data-en&doi=data-00540-en 

Ortiz Gustafson, C., & Ouellette, J. (2011). Nevada 

early intervention services: Rural and frontier 

regional rate study. Retrieved from http:// 

health.nv.gov/PDFs/New/EI_RuralFrontier_v5.pdf 

Owsley, C. (2004). Visual information capabilities of 

older drivers. NHTSA workshop on headlamp 

safety metrics: Balancing visibility and 

glare, Birmingham, Alabama. 

200

Passel, J., & Cohn, D. (2011, February 1). Unauthorized 

immigrant population: National and 

state trends, 2010. Pew Research Center: Pew 

Hispanic Center. Retrieved from PEW website: 

http://www.pewhispanic.org/files/ 

reports/133.pdf 

Passel, J., Cohn, D., & Gonzalez-Barrera, A. (2012, 

April 23). Net migration from Mexico falls to 

zero – and perhaps less. Pew Research Center: 

Pew Hispanic Center. Retrieved from PEW 

website: http://www.pewhispanic.org/ 

files/2012/04/Mexican-migrants-report_final.pdf 

Ritch, L. J., & Thompson, J. L. (2012). Suicide 

mortality in Nevada’s military veterans, 

2008-2010. Nevada State Health Division. 

Retrieved from NV State Health Division 

website: http://health.nv.gov/Publications/2008-2010_Suicide_Nevada_Veterans. 

pdf 

Roger, V. L., et al. (2012). Heart disease and stroke 

statistics: 2012 Update, A report from the 

American Heart Association. Circulation, 125, 

e2-e220. doi: 10.1161/CIR.0b013e31823ac046. 

Retrieved from http://circ.ahajournals.org/ 

content/125/1/e2.full.pdf+html 

APPENDIX 

Performance Analysis Division. (2011). State of Nevada 

transportation: 2011 Facts and figures. Retrieved 

from NDOT website: http://www. 

nevadadot.com/uploadedFiles/NDOT/ 

About_NDOT/NDOT_Divisions/Planning/ 

Performance_Analysis/Fact%20Book%20 

2011%20Final(1).pdf 

Perry, M. J., Mackun, P. J., Baker, J. D., Joyce, C. D., 

Lollock, L. R., & Pearson, L. S. (2001). Population 

change and distribution: Census 2000 

brief. U.S. Census Bureau. Retrieved from 

Census Bureau website: http://www.census.gov/prod/2001pubs/c2kbr01-2.pdf 

Pew Research Center: The Databank. (2012). 10,000 

– Baby boomers retire. Retrieved from PEW 

website: http://pewresearch.org/databank/ 

dailynumber/?NumberID=1150 

Qato, D. M., Alexander, G. C., Conti, R. M., Johnson, 

M., Schumm, P., and Tessler, S. (2008). Use of 

prescription and over-the-counter medications 

and dietary supplements among older 

adults in the United States. Journal of the 

American Medical Association, 300(24), 2867- 

2878. Doi: 10.1001/jama.2008.892. Retrieved 

from the NIH website: http://www.ncbi. 

nlm.nih.gov/pmc/articles/PMC2702513/ 

pdf/nihms84868.pdf 

Reid, H. (n.d.). Issues. United States Senator for Nevada: 

Harry Reid. Retrieved from http://www.reid. 

senate.gov/issues/transportation.cfm/ 

Rintamaki, L. S., Weaver, F. M., Elbaum, P. L., 

Klama, E. N., & Miskevics, S. A. (2009). 

Persistence of traumatic memories in World 

War II prisoners of war. Journal of the American 

Geriatrics Society, 57(12), 2257-2262. 

Rosalynn Carter Institute (RCI). (2010). Averting the 

caregiving crisis: Why we must act now. Retrieved 

from the RCI website: http://www. 

rosalynncarter.org/UserFiles/File/RCI_Position_Paper100310_Final.pdf 

Sandoval, B., Willden, M.J., & O’Mara, L. G. (2011, 

May 23). Nevada’s state health information 

technology strategic and operational plan. 

Office of the national coordinator for health information 

technology. 

Sanford Center for Aging. (2009). Elders count Nevada: 

Key health indicators for Nevada’s elders. 

University of Nevada, Reno. 

Sayer, N., Scholten, J., Scott, S., & Hall, C. (2012, 

April). Polytrauma & blast-related injuries. 

VA Office of Research and Development, Health 

Services Research and Development Service: 

QUERI Fact Sheet. Retrieved from VA website: 

http://www.queri.research.va.gov/ 

about/factsheets/polytrauma_factsheet.pdf 

Schrank, D., Lomax, T., and Eisele, B. (2011, September). 

TTI’s 2011 urban mobility report: 

Powered by INRIX traffic data. Texas Transportation 

Institute: The Texas A&M University 

System. Retrieved from http://tti.tamu.edu/ 

documents/mobility-report-2011.pdf 

Smith (2011). Assembly concurrent resolution no. 

10. Legislative Committee on Health Care. 

Smith, S. K., & Ahmed, B. (1990). A demographic 

analysis of the population growth of states, 

1950-1980. Journal of Regional Science, 30(2), 

209-227. 

201

APPENDIX 

Staplin, L., Lococo, K. H., Stewart, J., & Decina, 

L. E. (1999). Safe mobility for older people 

notebook. Office of Research and Traffic Records, 

National Highway Traffic Safety Administration, 

DOT HS 808853. Retrieved from 

National Highway Traffic Safety website: 

http://www.nhtsa.gov/people/injury/olddrive/safe/tech-doc.htm 

State of Nevada Official Website: Cooperative libraries 

automated network. (2008). A history 

of Nevada. Retrieved from http://www.clan. 

lib.nv.us/content.asp?id=1. 

Stitt, B. G., Giacopassi, D., & Nichols, M. (2003). 

Gambling among older adults: A comparative 

analysis. Experimental Aging Research, 29, 

189-203. 

Substance Abuse and Mental Health Services Administration 

(SAMHSA). (n.d.). Co-occurring 

disorder-related quick facts: Gambling. Retrieved 

from SAMHSA website: http:// 

www.samhsa.gov/co-occurring/topics/ 

data/GamblingQuickFacts.pdf 


(SAMHSA). (2010). Results from 

the 2009 national survey on drug use and health: 

Volume I. Summary of national findings. Office 

of Applied Studies, NSDUH Series H-38A, 

HHS Publication No. SMA 10-4856 Findings. 

Rockville, MD: Substance Abuse and Mental 

Health Services Administration. Retrieved 

from SAMHSA website: http://oas.samhsa. 

gov/NSDUH/2k9NSDUH/2k9Results. 

htm#3.1 


(SAMHSA). (2011). Results 

from the 2010 national survey on drug use 

and health: Summary of national Findings. 

NSDUH Series H-41, HHS Publication 

No. (SMA) 11-4658. Rockville, MD: Substance 

Abuse and Mental Health Services 

Administration. Retrieved from SAM- 


data/NSDUH/2k10NSDUH/2k10Results. 

htm#2.4 


(SAMHSA). (2012). State estimates 

of substance use and mental disorders 

from the 2009-2010 national surveys on drug 

use and health, NSDUH Series H-43, HHS Publication 

No. (SMA) 12-4703. Rockville, MD: 

Substance Abuse and Mental Health Services 

Administration. 


(SAMHSA): Center for Behavioral 

Health Statistics and Quality. (2012, 

July 2). The DAWN report: Highlights of the 

2010 drug abuse warning network (DAWN) 

findings on drug-related emergency department 

visits. Rockville, MD. Retrieved from 

SAMHSA website: http://www.samhsa. 

gov/data/2k12/DAWN096/SR096EDHighlights2010.htm 


(SAMHSA): Center for Behavioral 

Health Statistics and Quality. (2013, 

Jan 8). The NSDUH report: State estimates of 

nonmedical use of prescription pain relievers. 

Rockville, MD. Retrieved from the SAM- 


data/2k12/NSDUH115/sr115-nonmedicaluse-pain-relievers.htm 


(SAMHSA): Office of Applied 

Studies. (2007, Nov 1). The NSDUH report: 

Serious psychological distress and substance use 

disorder among veterans. Rockville, MD. Retrieved 

from the SAMHSA website: http:// 

www.samhsa.gov/data/2k7/veteransDual/ 

veteransDual.htm 



Studies. (2009, Nov 11). The N-SSATS report: 

Substance abuse treatment facilities operated by 

the department of veterans affairs. Rockville, 

MD. Retrieved from the SAMHSA website: 

http://oas.samhsa.gov/2k9/213/213VAfaci 

lities2k9Web.pdf 

202



Studies. (2010, Sept 9). The DAWN report: 

Emergency department visits involving illicit 

drug use by older adults: 2008. Rockville, MD. 

Retrieved from SAMHSA website: http:// 

oas.samhsa.gov/2k10/DAWN015/IllicitAbuseHTML.pdf 


(SAMHSA): Treatment Episode 

Data Set (TEDS), 2009. (2012). Discharges 

from substance abuse treatment services, DA- 

SIS series: S-60, HHS Publication No. (SMA) 

12-4704. Rockville, MD; Substance Abuse 

and Mental Health Services Administration. 

Retrieved from SAMHSA website: http:// 

www.samhsa.gov/data/2k12/TEDS2009N/ 

TEDS09DAck.htm 

Sundararaman, R., Panangala, S. V., & Lister, S. A. 

(2008, May 5). Suicide prevention among 

veterans. CRS Report for Congress, RL34471. 

Retrieved from FAS website: http://www. 

fas.org/sgp/crs/misc/RL34471.pdf 

U.S. Census Bureau. (2011). Poverty thresholds by size 

of family and number of children. Retrieved from 

Census Bureau website: http://www.census. 

gov/hhes/www/poverty/data/threshld/ 

U.S. Census Bureau: American Factfinder. (2010). 

American community survey: Poverty status in 

the past 12 months by household type by age of 

householder, ACS 1 Year estimates. Retrieved 

from Census Bureau website: http://factfinder2.census.gov 


American community survey: Poverty status in 

the past 12 months by household type by age of 

householder, ACS 5 Year average 2006-2010. 

Retrieved from Census Bureau website: 

http://factfinder2.census.gov 


American community survey: Selected population 

profile in the United States, 2009-2011 

American community survey 3-year estimates, 

S0201. Retrieved from Census Bureau website: 


APPENDIX 

The Council of State Governments. (2010). Capitol 

facts and figures, extension of enhanced medicaid 

benefits to states (FMAP) [Data file]. Retrieved 

from http://knowledgecenter.csg.org/drupal/system/files/FMAP_9-22_1.pdf 

The National Center on Elder Abuse (NCEA). 

(1998, September). The national elder abuse 

incidence study: Final report. Retrieved from 

AOA website: http://www.aoa.gov/AoA- 

Root/AoA_Programs/Elder_Rights/Elder_ 

Abuse/docs/ABuseReport_Full.pdf 

Tse, S., Hong, S., Wang, C., & Cunningham-Williams, 

R. M. (2012). Gambling behavior and 

problems among older adults: A systematic 

review of empirical studies. Journals of Gerontology 

Series B: Psychological Sciences and 

Social Sciences, 67(5), 639-652. 

U.S. Census Bureau. (2010). 2010 Census urban and 

rural classification and urban area criteria. 


http://www.census.gov/geo/www/ 

ua/2010urbanruralclass.html 


American community survey: Sex by age by employment 

status for the population 16 years and 

over, ACS 1 Year estimates. Retrieved from 

Census Bureau website: http://factfinder2. 

census.gov 


American community survey: Sex by age by employment 

status for the population 16 years and 

over, ACS 5 Year average 2006-2010. Retrieved 

from Census Bureau website: http://factfinder2.census.gov 


American factfinder glossary. Retrieved from 


census.gov 


American community survey: 2006-2010– 

B10051-Grandparents living with own grandchildren 

under 18 years by responsibility for own 

grandchildren by presence of parent of grandchildren 

and age of grandparent. Retrieved from 


census.gov/faces/tableservices/jsf/pages/ 

productview.xhtml?pid=ACS_10_5YR_ 

B10051&prodType=table 

203

APPENDIX 



B10001-Grandchildren under 18 years living 

with a grandparent householder by age 

of grandchild. Retrieved from Census 

Bureau website: http://factfinder2.census.gov/faces/tableservices/jsf/pages/ 



U.S. Census Bureau: American Factfinder. 

(2012). American community survey: 2006- 

2010–B21001-Sex by age by veteran status 

for the civilian population 18 years and 

over. Retrieved from Census Bureau 

website: http://factfinder2.census. 

gov/faces/tableservices/jsf/pages/ 




(2012). American community survey: 

2006-2010–B07401-Migration by age and 

county. Retrieved from Census Bureau 







2006-2010–B01001-Population by sex, age 

and county. Retrieved from Census Bureau 







B09017-Relationship by household type (including 

living alone) for the population 65 

years and over. Retrieved from Census 





(2012). American community survey: 2006- 

2010–B15001-Sex by age by educational attainment 

for the population 18 years and 

over. Retrieved from Census Bureau 







B12002-Sex by marital status by age for the 

population 15 years and over. Retrieved from 


census.gov/faces/tableservices/jsf/pages/ 





2006-2010–DP05-Demographic and housing 

estimates. Retrieved from Census Bureau 




DP05&prodType=table 



S0103 - Population 65 years and over in 

the United States. Retrieved from Census 



S0103&prodType=table 


American community survey: 5-Year public use 

microdata sample (PUMS): Nevada 2006-2010. 


http://factfinder.census.gov 


American community survey: Median household 

income in the past 12 months (In 2010 inflationadjusted 

dollars) by age of householder. U.S., 

1-Year average 2006, 2007, 2008, 2009, 2010. 



204


American community survey: Median household 

income in the past 12 months (In 2010 inflationadjusted 

dollars) by age of householder. U.S., 

5-Year average 2006-2010. Retrieved from 

Census Bureau website: http://factfinder. 

census.gov 

U.S. Census Bureau: Current Population Survey. 

(2011). Educational attainment: Current population 

survey data on educational attainment: CPS 

2011 detailed tables – Table 3. Retrieved from 

Census Bureau website: http://www.census.gov/hhes/socdemo/education/data/ 

cps/2011/tables.html 

U.S. Census Bureau: Newsroom. (2011, December 

21). Texas gains the most in population since the 

census. Retrieved from Census Bureau website: 

http://www.census.gov/newsroom/ 

releases/archives/population/cb11-215. 

html 

U.S. Census Bureau: Population Estimates. (2008). 

Vintage 2009 – National tables: Table 2. Cumulative 

Estimates of Resident Population Change 

for the United States, Regions, States, and Puerto 

Rico and Region and State Rankings: April 

1, 2000 to July 1, 2009 (NST-EST2009-02). 


http://www.census.gov/popest/data/ 

historical/2000s/vintage_2009/index.html 

U.S. Census Bureau: Social Explorer. (2010). 

American community survey: ACS 2010 (1- 

year estimates). Retrieved from Census 

Bureau website: http://www.socialexplorer.com/pub/reportdata/htmlresults. 

aspx?ReportId=R10283930 

U.S. Census Bureau: State and County Quickfacts. 

(2012). Nevada. Retrieved from Census Bureau 

website: http://quickfacts.census.gov/ 

qfd/states/32000.html 

U.S. Department of Agriculture (USDA) and U.S. 

Department of Health and Human Services. 

(2010, December). Dietary guidelines for 

Americans, 2010, 7th Edition, Washington, 

DC: U.S. Government Printing Office. Retrieved 

from USDA website: http://www. 

cnpp.usda.gov/publications/dietaryguidelines/2010/policydoc/policydoc.pdf 

U.S. Department of Defense. (n.d.). Defense finance 

and accounting service. Retrieved from U.S. 

Department of Defense website: http:// 

www.dfas.mil/retiredmilitary/about/contact-who.html 

U.S. Department of Health & Human Services 

(USDHHS). (2012). Get active. www.healthfinder.gov. 

Retrieved from USDHHS website: 

http://www.healthfinder.gov/prevention/ 

PrintTopic.aspx?topicID=22&catId= 

APPENDIX 


Vintage 2009 – National tables: Table 1. Annual 

estimates of the resident population by sex 

and five-year age groups for the United States: 

April 1, 2000 to July 1, 2009 (NC-EST2009-01). 


http://www.census.gov/popest/data/ 

historical/2000s/vintage_2009/index.html 


State population estimates and demographic 

components of change – 1900 to 1960 total 

population estimates. Retrieved from Census 

Bureau website: http://www.census.gov/ 

popest/data/state/asrh/1980s/tables/ 

st5060ts.txt 


State totals: Vintage 2011. Retrieved from 

Census Bureau website: http://www.census.gov/popest/data/state/totals/2011/ 

index.html 

U.S. Department of Health & Human Services (US- 

DHHS): Administration on Aging. (2011). 

Positive aging: HIV turns 30 webinar. Retrieved 

from AOA website: http://www. 

aoa.gov/AoARoot/AoA_Programs/HPW/ 

HIV_AIDS/Webinar.aspx 

U.S. Department of Homeland Security. (2011). 

Yearbook of immigration statistics: 2010. Washington, 

D.C.: U.S. Department of Homeland 

Security, Office of Immigration Statistics. 

U.S. Department of Justice: District of Nevada. 

(2012). Tribal matters: A snapshot of Nevada’s 

Indian country. Retrieved from U.S. Department 

of Justice website: http://www.justice. 

gov/usao/nv/tribal_matters/index.html 

205

APPENDIX 

U.S. Department of Labor, Bureau of Labor Statistics. 

(2012). Consumer expenditure survey, 

Table 3850. Age of reference person: Average annual 

expenditures and characteristics. Retrieved 

from Bureau of Labor and Statistics website: 

http://www.bls.gov/cex/tables.htm 

U.S. Department of Veterans Affairs (n.d.) Retrieved 

from VA website: http://www.vba.va.gov/ 

U.S. Department of Veterans Affairs. (2012). Expenditures: 

National center for veterans analysis 

and statistics. Retrieved from the VA website: 

http://www.va.gov/vetdata/Expenditures. 

asp 

U.S. Department of Veterans Affairs. (2012). Federal 

benefits for veterans: Dependents and survivors. 

Retrieved from the VA.gov website: http:// 

www.va.gov/opa/publications/benefits_ 

book/2012_Federal_benefits_ebook_final.pdf 

U.S. Department of Veterans Affairs. (2012). Veteran 

population: National center for veterans analysis 

and statistics. Retrieved from VA website: 

http://www.va.gov/vetdata/Veteran_Population.asp 

U.S. Preventive Services Task Force (USPSTF). 

(2005). Genetic risk assessment and BRCA 

mutation testing for breast and ovarian cancer 

susceptibility: Recommendation statement. 

Annals of Internal Medicine, 143, 355-61. 

Retrieved from USPSTF website: http:// 

www.uspreventiveservicestaskforce.org/ 

uspstf05/brcagen/brcagenrs.htm#copyright 


(2005). Screening for breast cancer: Recommendation 

statement. Annals of Internal 

Medicine, 151,716-726. Retrieved from USP- 

STF website: http://www.uspreventiveservicestaskforce.org/uspstf09/breastcancer/ 

brcanrs.htm 


(2005). Screening for cervical cancer: Recommendation 

statement. AHRQ Publication No. 

11-05156-EF-2. Retrieved from USPSTF 

website: http://www.uspreventiveservicestaskforce.org/uspstf11/cervcancer/cervcancerrs.htm 


(2008). Screening for colorectal cancer: Recommendation 

statement. AHRQ Publication 08- 

05124-EF-3. Retrieved from USPSTF website: 

http://www.uspreventiveservicestaskforce. 

org/uspstf08/colocancer/colors.htm 


(2012). Screening for ovarian cancer: Recommendation 

statement. AHRQ Publication No. 

12-05165-EF-2. Retrieved from USPSTF website: 

http://www.uspreventiveservicestaskforce.org/uspstf12/ovarian/ovarcancerrs. 

htm 


(2012). Screening for prostate cancer: Final 

recommendation statement. AHRQ Publication 

No. 12-05160-EF-2. Retrieved from USPSTF 

website: http://www.uspreventiveservicestaskforce.org/prostatecancerscreening/ 

prostatefinalrs.htm 

U.S. Social Security Administration, Office of Retirement 

and Disability Policy, Office of 

Research, Evaluation, and Statistics. (2012). 

Annual Statistical Supplement, 2011. Retrieved 

from Social Security website: http://www. 

socialsecurity.gov/policy 

U.S. Social Security Administration, Office of Retirement 

and Disability Policy, Office of 

Research, Evaluation, and Statistics. (2012). 

OASDI Beneficiaries by State and County, December 

2010. Retrieved from Social Security 

website: http://www.socialsecurity.gov/ 

policy/docs/statcomps/ssi_sc/2010/index. 

html 

Villa, V. M., Harada, N. D., Washington, D., & 

Damron-Rodriguez, J. (2003, May-Jun). The 

health and functional status of U.S. veterans 

aged 65+: Implications for VA health programs 

serving an elderly, diverse veteran 

population. American Journal of Medical Quality, 

18(3), 108-116. 

Volberg, R. A. (2002). Gambling and problem gambling 

in Nevada: Report to the Nevada department of 

human resources. Retrieved from NCPG website: 

http://www.ncpgambling.org/i4a/ 

pages/index.cfm?pageid=3390#widespread 

206

Volkow, N. D. (2009, Nov 1). Substance abuse 

among troops, veterans, and their families. 

National Institute on Drug Abuse: NIDA Notes. 

Retrieved from NIDA website: http:// 

www.drugabuse.gov/news-events/nidanotes/2009/11/substance-abuse-amongtroops-veterans-their-families 

Volkow, N. D. (2011, Dec 19). Substance abuse 

among older adults. National Institute on 

Drug Abuse. Retrieved from NIDA website: 

http://www.drugabuse.gov/news-events/ 

nida-notes/2011/12/substance-abuseamong-older-adults 

Ward, L. (2012, Oct 23). Medical school enrollment 

continues to climb with new diversity gains. 

AAMC.org. Retrieved from the AAMC website: 

https://www.aamc.org/newsroom/ 

newsreleases/310002/121023.html 

World Health Organization (WHO). (2008). Closing 

the gap in a generation: Health equity through 

action on the social determinants of health. 

Retrieved from WHO website: http:// 

whqlibdoc.who.int/hq/2008/WHO_IER_ 

CSDH_08.1_eng.pdf 

Wysocki, A., Butler, M., Kane, R. L., Kane, R. A., 

Shippee, T., and Sainfort, F. (2012, Nov.). 

Long term care for older adults: A review of 

home and community-based services versus 

institutional care. Effective Health Care Program: 

Comparative Effectiveness Review No. 81. 

(Prepared by the Minnesota Evidence-based 

Practice Center under Contract No. 290- 

2007-10064-I.) AHRQ Publication No.12(13)- 

EHC134-EF. Rockville, MD: Agency for 

Healthcare Research and Quality. Retrieved 

from www.effectivehealthcare.ahrq.gov/ 

reports/final.cfm 

APPENDIX 

Wentworth, S. G. and Pattison, D. (2001/2002). Income 

growth and future poverty rates of the 

aged. Social Security Bulletin, 64(3). 

Werner, C. A. (2011). The older population: 2010 

– 2010 Census briefs. U.S. Census bureau: 

Census briefs. Retrieved from Census Bureau 

website: http://www.census.gov/prod/ 

cen2010/briefs/c2010br-09.pdf 

Wharton, C. (2012, March 12). Nevada state demographer 

releases population estimates. 

University of Nevada, Reno: Media newsroom. 

Retrieved from http://newsroom.unr. 

edu/2012/03/12/nevada-state-demographer-releases-population-estimates/ 

Whitley, P. (2008). American cultural history, 1900- 

1909. The Decades. Retrieved from http:// 

kclibrary.lonestar.edu/decade00.html 

Winter, K. H., Bouldin, E. D., & Andresen, E. M. 

(2010, March). Lack of choice in caregiving 

decision and caregiver risk of stress, North 

Carolina, 2005. Preventing Chronic Disease: 

Public Health Research, Practice, and Policy, 

7(2, A41), 1-11. Retrieved from the CDC 

website: http://www.cdc.gov/pcd/issues/2010/mar/09_0037.htm 

Ziliak, J. P., & Gundersen, C. (2012). Senior hunger 

in America 2010: An annual report. Meals on 

Wheels Research Foundation. Retrieved from 

Meals on Wheels website: http://mealsonwheelserie.org/2012/08/07/the-meals-onwheels-research-foundation/ 

207

Notes 

“The success of a report card depends on nesting messages and finding how to balance 

a simple and elegant presentation that will spark interest among individuals and organizations 

with information and translates that information into action.” 

—Center for Advancement of Health


Mail Stop 146 


Reno, NV 89557-0146 

(775) 784-4774 phone • (775) 784-1814 fax 

email address: sanford@unr.edu 

website: www.unr.edu/sanford

S ongquan D eng / Shutterstock .com - University of Nevada School ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?