Technical Information

Fourteen of the fifteen indicators (all except hip fracture hospitalization) in this report use data from the Behavioral Risk Factor Surveillance System (BRFSS). For the past two decades, BRFSS has helped states survey U.S. adults regarding a wide range of health issues and behaviors that affect their health. The crucial information gathered through this state-based telephone surveillance system is used by national, state, and local public health agencies to identify populations that might be most at risk and to monitor the need for and the effectiveness of various public health interventions.

For years 2006-2007, we analyzed data from 134 Metropolitan/Micropolitan Statistical Areas (MMSAs) available through the BRFSS. These were chosen out of the larger set of available MMSAs because they had sample sizes of older adults that were large enough to create stable estimates. For a full description of MMSAs, please visit the FAQs page on the CDC BRFSS website.

While the BRFSS is a useful tool for assessing the health of the older adult population, it has some limitations: It excludes people who don’t have telephones or are in institutions, such as nursing homes; it may under-represent people who are severely impaired because of the functional capacity required to participate in the survey; and responses to BRFSS are self-reported and therefore have not been confirmed by a health care provider. Despite these limitations, the BRFSS is a uniquely powerful tool to provide the prevalence of mental health issues among older community-dwelling U.S. adults, due to its large sample size and proven reliability and validity¹.

Data for the remaining indicator, hip fracture hospitalizations, come from CDC’s National Hospital Discharge Survey (NHDS), which gathers information on characteristics of inpatients discharged from nonfederal short-stay hospitals in the United States. The survey is limited to hospitals with an average length of stay of fewer than 30 days for all patients, general hospitals, and children’s general hospitals. It excludes federal, military, and Department of Veterans Affairs hospitals, as well as hospital units of institutions (such as prison hospitals) and hospitals with fewer than six patient beds.

1. Nelson D, Holtzman D, Bolen J, Stanwyck CA, Mack KA (2001). Reliability and validity of measures for the Behavioral Risk Factor Surveillance System (BRFSS). International Journal of Public Health; 46:S1.