As the population of older adults in the United States increases, state public health agencies are confronted with new opportunities and challenges (1). These agencies recognize the need to form new partnerships and develop effective and innovative approaches for addressing the needs of older adults (2). Public health initiatives to promote healthy aging and reduce the burden of chronic conditions are currently underway and include partnership efforts by public health organizations and aging services agencies to implement evidence-based health promotion programs, disseminate information about aging issues, and strengthen their ability to expand these efforts (3). To ensure that informed decisions are being made and to measure progress toward health goals related to older adults, state health agencies interpret and disseminate data on the health of older adults (4). These agencies rely on surveillance — the continuous, systematic collection and analysis of health data — a core tool of public health practice (5). However, previous work to develop indicators that measure whether a community promotes health and well-being among older adults (6) and to create a picture of older adult health has not focused on public health issues (7) or included state-level data (8). Similarly, the development of indicators for chronic diseases (9,10) has not focused on older adults. To fully understand the breadth and depth of older adult health from a public health perspective, these efforts must be combined to produce a core set of public-health–related indicators to measure older adult health at the state level.

As the first step toward our ultimate goal of creating a core set of indicators, the Centers for Disease Control and Prevention (CDC) and the Association of State and Territorial Chronic Disease Program Directors (CDD), a national public health association of the chronic disease program directors in each state, began to explore indicators that are particularly relevant to healthy-aging activities within state health agencies. The CDD established the Aging Surveillance Advisory Committee to assess state public health agencies' needs, preferences, and priorities for data to monitor older adult health and develop recommendations for potential core indicators.

In this article, we describe the process for exploring the state perspective on surveillance of older adult health, the results of our research, the way in which the findings helped shape the indicators selected for The State of Aging and Health in America 2004 report (11), and potential next steps for creating a core set of indicators.

The CDD Aging Surveillance Advisory Committee convened an expert panel via teleconference in January 2003. Panel members were selected on the basis of their affiliation with federal, state, and local public health agencies; academic institutions; clinical care; national public health organizations, aging services organizations, or both; and philanthropic organizations, as well as their knowledge of surveillance, epidemiology, quality-of-life issues, aging issues, and public health programming. The panel was asked to focus on four broad areas: 1) appropriate age groups for older adult health surveillance, 2) criteria for including indicators, 3) essential subject areas for aging surveillance, and 4) audience needs and composition. The minutes of the conference call meeting were subsequently shared with panel members to ensure accuracy and solicit additional feedback.

We used the information from the expert panel to develop a survey of state health agencies. All 50 states and 8 territories (collectively referred to hereafter as states) were invited to participate. The survey asked for information about the following: 1) the characteristics or indicators of older adult health that currently are being monitored in the state, 2) the ways in which data are being reported and used (with examples of reports, if available), and 3) the indicators of older adult health that most need to be assessed. If a state did not submit a completed survey, up to three follow-up e-mails were sent.

Concurrently, we scanned the relevant literature to identify data sources and methodological approaches, current uses of surveillance data, and other aspects of surveillance that may have affected the ability of state health agencies to collect and use information about older adult health. The scan included published literature, conference abstracts, key informant resources, and reports from state health agencies and other organizations.

The expert panel and survey findings resulted in the following four domains for organizing healthy-aging indicators that are relevant to public health:

These findings were presented in May 2003 at the Making Health Count for Older Americans summit, which was convened by the CDC and the Center for the Advancement of Health. This summit brought together stakeholders representing public health, aging services agencies, academia, health care, the news media, and the government. The discussion centered on currently available reports on the health of older adults (7,8), critical health indicators for older adults at the national and state levels, the feasibility of regularly producing a report on older adult health, and appropriate formats for such a report. Subsequently, the CDC, the Merck Institute of Aging & Health, and The Gerontological Society of America collaborated to compare the recommendations from the CDD and the summit with available data and the nation's Healthy People goals (13,14).

The results of the collaboration were synthesized into The State of Aging and Health in America 2004 report, which includes an analysis of 15 key indicators related to older adult health for the 50 states and the District of Columbia (Table) (11). Using data from the BRFSS, the report provides information about the number of states that met the Healthy People 2000 (13) targets and includes current data for each indicator; state data (rank and grade) are listed alphabetically. The report also includes examples of state activities, including Maine's report on older women's health. As a result, The State of Aging and Health in America 2004 is more than a compilation of data — it is a reference tool and blueprint for public health and aging services professionals to use as they address the health needs of older adults in their own communities. The State of Aging and Health in America 2004 has been well received by its intended audience. This positive response is a testament to the need for such information.

In addition to being shared at the national summit, our findings were distributed to stakeholders in a report (15) and presented at the 17^th National Conference on Chronic Disease Prevention and Control in 2003. The findings are an important step in creating a core set of indicators related to older adult health. Overall, the results of the expert panel and state survey revealed that states were interested in a broad range of indicators on health and aging. Although many indicators are available in current data systems, some measures (such as measures of social connectedness and hip fractures) are not yet available at the national and state levels.

Several factors should be considered when reviewing our findings. First, the survey data are not generalizable. Furthermore, as with any survey method, the information obtained from state public health agencies may have been biased because of the collection method used, the type of follow-up performed, and the timing of the request.

We have not yet reached our goal of developing a set of core indicators, and our findings highlight the need for more explicit criteria for selecting them. They also suggest that the best approach for meeting the needs of state health agencies and their partners may be to develop a menu of indicators within the various domains identified in this pilot work. Future work should also involve a larger, more diverse set of stakeholders to identify such a menu. In addition, future work may benefit from a conceptual framework such as the ecological model of health (16).

Our experiences during this process have shown us that state public health agencies and other stakeholders believe that surveillance on the health of older adults is a critical public health issue. We hope that the findings and issues raised in this article will stimulate additional work and move this important agenda forward.