Background
In 2004, St. Luke’s Episcopal Health Charities (SLEHC) and Care for Elders began identifying critical indicators that would comprise a Harris County elder report card. Care for Elders is a large Robert Wood Johnson funded partnership, whose goal is to develop a seamless continuum of care for elders in Harris County. The report card would enable service planners, policy makers, and funders to enhance the continuum of care for elders. This research group is now comprised of over 15 members who represent local universities, healthcare providers, health systems, non-profit and governmental agencies. The group is primarily interested in elders who are most vulnerable due to conditions such as poverty, disability, and isolation. In a county that is prone to severe weather events, at-risk elders are likely to require additional attention from first responders and disaster relief planners. This may be particularly critical for those with special needs such as lack of English proficiency, lack of personal transportation or phone, those in poverty, and elders who live alone, who are likely to require additional attention.

Phase I
Demographic information is the first group of indicators developed and published. Contributors included Karl Eschbach, PhD from University of Texas Medical Branch in Galveston who gathered US Census-based indicators. Tom Reynolds of The University of Texas School of Public Health at Houston and SLEHC, used the data to develop the following maps.

Phase II
Targeted for mid 2007, an additional set of maps will display indicators delineated by gender and three age groupings: those in ages 65-74, ages 75-84, and those over age 85. Future features may also include an interactive section displaying local resources by Harris County zip code and within specific legislative and jurisdictional boundaries.

Overview of Mapped Indicators
The overlap of concentrations of several indicators such as poverty, living alone, lack of vehicle and greater than 1/3 of income spent on housing, may be useful for those who provide services to communities with greatest concentration of underserved elders. By locating services within these communities, elders will gain another level of independence and support.

The demographic indicators are on static maps that are based on US Census 2000 data for all people in Harris County who are 65 years of age or older. Calculations were made by quintiles and are displayed at zip code level. Map indicators will be updated periodically to illustrate trends regarding the wellbeing of elders in Harris County through the decades.

Maps

Percent of People Over 65 Living in Crowded Conditions
According to census 2000, Harris County has 7.4 percent of its population in elders age 65 and older, as compared to the State of Texas with 9.9 percent. They live throughout the county. Pockets of high concentration of elders of 5.5- 14 percent of the population of zip codes are located in The Near Northside and Fifth Ward neighborhoods, both within the Loop-610 in Houston. Other concentrations are seen north of town on both sides of north State Highway 45, and in the East End and southeast neighborhoods between east I-10 and Highway 45 south, and within Loop-610. Areas with equal density of elders can be found scattered throughout the county south of Loop-610 and east of Highway 288, along Highway 59 north outside of Loop-610, and southwest of the loop Highway 59 south and Beltway 8.

Percent of People Over Age 65 Who Are Disabled
Identification of disability is by self-report, and includes all people who report one or more disability. No distinction is made between sensory disabilities such as the loss of hearing or sight, and mobility related disabilities. Given this lack of specificity, it is not surprising to find larger concentrations of disability everywhere older people reside in larger numbers. It is perhaps more useful to identify areas where the two indicators, age and disability, do not overlap. The far northeast, and far northwest, more rural areas of the county, appear to have higher concentration of reported disabilities ranging between 50 to 77 percent. These concentrations also appear in the southern portion of the county along Route 288, and in the west and east of town in neighborhoods that are located on both sides of Beltway 8.

Percent of People Over Age 65 Who Live Alone
An indicator often related to increased vulnerability of elders is that of living alone. Elders who are over age 65, and live alone, may not constitute a group at risk if they are economically stable and their health is good. The largest concentration of elders living alone, 30-48 percent of the population by zip code, appear to be in older neighborhoods, encircling downtown Houston, just west and southwest of downtown, on both sides of Loop-610 west, and extending to Beltway 8 on the west side. This level of concentration is also found inside Loop-610 in the northwest quadrant, outside the loop on the north side of town, and in the northeast of town. Smaller pockets of concentration of elders living alone are located outside the south of Loop-610, in the Pearland area, and in neighborhoods in Pasadena in the southeast portion of the map.

Percent of People Over Age 65 Living in Poverty
The weighted average poverty threshold for a single older person age 65 or older was $8,259 in census 2000 (www.census.gov ). The income sources for people in lowest level of poverty are generally largely dependent on Social Security and public assistance programs. Living in poverty constitutes a serious risk factor for elders and correlates with increased morbidity and mortality. The highest concentration of elders in poverty, those that comprise 20-43 percent of the population within the zip code, are found in a characteristic pattern that corresponds with the location of minority neighborhoods in Houston and Harris County. A large area east, north and south of downtown Houston contain these neighborhoods and extends south to the edge of the County and north and northeast within Beltway 8.

Percent of People Over Age 65 Who Spend More Than 30% of Their Income on Housing
This indicator is likely to relate to poverty in that many elders are likely to live on fixed incomes. The highest concentrations of elders in this category are 35-60 percent of the population of the zip code in which they live and appear to be scattered over the county. Large concentrations of people in this category are found just north Interstate 10 between Beltway 8 and the county boundary, and in the northeast edge of the county on both sides of Highway 290, as well as in the older neighborhoods of Houston.

Percent of People Over Age 65 Who Do Not Speak English Well
This category indicative of immigrant status does not comprise large numbers of elders, as most immigrants tend to be young. Pockets of highest concentrations of elders lacking English proficiency represent only 14-36% of the population per zip code, and are found in neighborhoods where immigrants particularly Spanish speaking and those from Asian countries live. The largest region of concentration of this category is in the Alief area in the southwest portion of the county, near and far southeast neighborhoods, areas north of downtown Houston and along Beltway 8 in the northwestern sector.

Percent of People Over Age 65 with No Available Vehicles
In Harris County, use of a vehicle is vital to many activities related to wellbeing and social integration for elders. Often, a car is also a necessity in order to access healthcare services, especially if these are required to be frequent trips beyond the immediate neighborhood. Elders who must rely on others or on public transportation are at greater risk of reducing their contacts with care providers who are help them engaged in prevention of disease or life enrichment opportunities. At highest concentrations, 20-46 percent of zip code population, elders in this category are located mostly in neighborhoods that encircle downtown Houston within Loop-610, and extend out to the northeast and southwest along Highway 59.

Percent of People Over Age 65 with No Home Telephone
This category along with the lack of vehicle can be proxies for isolation of elders. While the proportion of people without telephone is small, concentrations of 2.5 to 15 percent can be found in larger numbers in more rural areas along the far northeastern and far northwestern edges of the county. Small pockets are also located throughout the county and are likely to be found in household where poverty is severe.

More Mapping Resources
Additional SLEHC online mapping tools are available for total community populations at www.slehc.org and for Harris County safety net clinics at www.projectsafetynet.net.