Best Cities for Successful Aging

July 10, 2017

Two important, unassailable facts underpin our 2014 "Best Cities for Successful Aging"™ report: Our nation is aging at an unprecedented rate, in a titanic shift that is creating the largest older population in history; and these mature adults live predominantly in urban settings. A product of lower birth rates and increasing longevity, this phenomenon is changing the landscape of the United States and the world.


As a growing population of older adults emerges, timeworn notions of aging no longer fit. Older adults are staying in the workforce longer and anticipating more meaningful "golden years." New attitudes about work, health, housing, education, transportation, and other needs are evident. Millions of aging adults are upending convention, seeking to remain active and contributing members of their communities. A revolution in the "culture of aging" is underway.

Cities are on the frontlines of the challenges and opportunities that accompany this revolution. How U.S. cities and their leaders deal with these realities will affect not just the course of millions of individual lives, but more broadly our ability to build a better America.

With this second edition of the Milken Institute's "Best Cities for Successful Aging" report, we examine how metropolitan areas are stepping up to the challenge, and we rate and rank their capacity to enable people to age independently and productively, with security and good health.

Not Just Another Top 10

With nearly 80 million American baby boomers facing the fulfillments and stresses of aging, there's no shortage of lists heralding "best" locations for older adults. There's a veritable universe of eye-catching honor rolls often based on some combination of factors such as mild weather and affordable living. However, they tend to include only subsets of the many factors that actually define such locations.

There is little question about where we want to age. The vast majority of older people—up to 90 percent, according to AARP's research—want to age in place and at home. The crucial question is how we want to spend those later years. To age in place successfully, older adults must enjoy environments that support health and productivity and the ability to live purposeful, contributing lives. With other challenges dominating policymaking at the national and state levels, urban leaders may offer America's best opportunity for positive change to facilitate vitality and engagement as we age.

The Milken Institute is proud to present our 2014 "Best Cities for Successful Aging," which updates and expands on our groundbreaking 2012 report. The report measures, compares, and ranks 352 U.S. metropolitan areas based on how well they enable older people to fulfill their potential, in their own lives as well as in their contributions to society and to others across the age spectrum.

Measuring Success

We know that physical and social surroundings can support or inhibit health, engagement, productivity, and purpose as people age. "Best Cities" identifies age-friendly living environments that foster well-being, which in turn can mitigate age-associated decline.






Our methodology uses publicly available data on health care, wellness, living arrangements, transportation, financial characteristics, employment and educational opportunities, community engagement, and overall livability. The aim is to highlight and encourage best practices that enhance the lives of older people and the cities in which they live, and by extension improve the nation as a whole.

The report differs from other "best" rankings that tend to be based on opinion polls or narrow aspects of aging. Our data-driven, detailed approach provides a deeper level of analysis. Developed by our research staff with input from our "Best Cities for Successful Aging" Advisory Committee, the report's rankings are based on a weighted, multidimensional methodology that examines a broad range of quality-of-life factors for older Americans.

To produce these evaluations, we looked at broad criteria that we believe define successful aging in the 21st century. Such criteria are commonly cited by academics and institutions that promote age-friendly communities:

  • Safe, affordable and convenient environments. We compiled statistics on cost of living, employment growth, jobless rates, income distribution, crime rates, alcoholism, and weather.

  • Health and happiness. We looked at a range of factors, including the number of health professionals, hospital beds, long-term hospitals, and facilities with geriatric, Alzheimer's, dialysis, hospice, and rehabilitation services. We also examined hospital quality and affiliation with medical schools. To determine the general wellness of a community, we studied the rates of obesity, diabetes, Alzheimer's, smoking, and mental illness and looked at the availability of recreation and other healthy pursuits.

  • Financial security, including opportunities for work and entrepreneurship. We examined each area's tax burden, small-business growth, poverty levels, and employment rates for those 65-plus, and the data on reverse mortgages. We reviewed employment opportunities and factors tied to encore careers.

  • Living options for mature residents. We compiled statistics on the costs of homeownership and rental housing, nursing homes and quality nursing care, assisted living facilities, and home health-care providers.

  • Mobility and access to convenient transportation systems. We studied commute times, fares, the use of and investment in transit for the public and for older residents specifically, and the number of grocery stores and other key retailers.

  • Beneficial engagement with families and communities and physical, intellectual and cultural enrichment. We compiled statistics on volunteerism, and we reviewed indicators reflecting access to fitness and recreational facilities, training and education, enrichment programs focused on older adults, museums, cultural institutions, libraries, and YMCAs, as well as the proportion of the population that is 65 and older.







Best Cities for Successful Aging Data

Using this framework, our report ranks the 100 largest and 252 smaller metropolitan areas. The overall rankings are based on eight subcomponents: general indicators, health care, wellness, living arrangements, transportation/convenience, financial well-being, employment/education, and community engagement. Each subcomponent is based on multiple individual indicators— 84 indicators in all.

The findings include three main rankings for each city: one for the aging population overall, one for people 65 to 79, and one for those 80 and older. The subindexes reflect the reality that people over 80 generally have different needs and priorities from their 65-year-old counterparts. These differences are factored into weighting the data for the two subgroups. For example, for those 80-plus, we give more weight to factors such as health care, while the subindex for those 65 to 79 focuses more on active lifestyles and economic opportunities.

Emerging Solutions

Urban leaders know well the growth of "naturally occurring retirement communities," or NORCs, in their cities. In these neighborhoods, residents are aging in emerging communities that were not designed for the unique needs of older adults. The NORC phenomenon gives forward-thinking metropolitan leaders a ready-made opportunity to employ creative thinking—not patchwork efforts, but integrated approaches that encompass a range of services and infrastructure that can improve the lives of older residents.

Leaders across the country are actively developing exciting solutions and civic projects tailored to their aging populations. They are demonstrating that the narrative of aging doesn't simply have to be about the strains on social safety nets and health-care systems. Many of their approaches are outlined in this report, and we trust that other cities will take note of both successes and areas for improvement.
















Policymakers also realize that cities benefit from the new longevity economy as businesses lean into the economic possibilities presented by the rapidly growing older cohort. The mature market has sparked countless innovations—from new approaches to financial services and wellness to health-care delivery and age-friendly housing and transportation systems; from lifelong learning and new work opportunities to aging-centered technologies and social networks, fashion, travel, and leisure.

Importantly, older adults have a depth of talent and experience to contribute in the workforce and intergenerational settings. Their perspective and purposeful engagement can enhance the lives of all through encore careers, civic engagement, and volunteer activities.

Programs with Purpose

The rankings in our "Best Cities for Successful Aging" report are based on measureable data that apply across metropolitan areas. But not all innovations lend themselves to broad, data-based measurement. So our rankings may miss important programs that are making a difference, through creative nonprofit efforts or business models that promote successful aging. Because they are not widespread enough to be included in our measurable data, our methodology does not include pilot and experimental programs that mayors may be spearheading in their own cities.

To take note of these successes, we have compiled a sampling of beneficial programs, highlighting examples of initiatives already in place. These efforts can be replicated in other cities, expanded for regional or national impact, or in the case of nationwide programs, supported and deepened for even greater effect. These Programs with Purpose represent just a fraction of the successful aging efforts being advanced nationwide.

We congratulate those involved in all such programs and the mayors who are fostering age-friendly policies and practices. Despite this momentum, however, we cannot ignore the fact that overall progress remains too slow. By 2040, 80 million Americans will be 65 and over, nearly double the number in 2010. Although the 21st century finds older people healthier and more vibrant than in generations past, outdated notions of aging still permeate our society. Dramatic culture change is needed. While we do not discount the challenges of aging, we must retire anachronistic expectations of decline and disengagement and recognize the potential for healthy, productive, and purposeful aging. The Milken Institute hopes this edition of "Best Cities" will spur action and a sense of urgency.

Mayor's Pledge

This urgency hands the nation's mayors a profound leadership opportunity. Cities are testing labs for social innovations, and mayors can launch ground-level programs in ways that states and the federal government often cannot.

Those actions will be relevant not just to today's demography. The age wave sweeping America and the world is no transitory trend. It will continue into the future and permanently shape and change cities. Older people will continue to expand their presence within the population, their longevity fueled by medical advances, improved nutrition, and better standards of living. The number and proportion of urban dwellers will rise in tandem. The World Health Organization projects that by 2030, about three of every five global inhabitants will live in cities, and a growing segment will be over age 60.

In this panorama, American mayors can lead the world. That is why we have issued a Best Cities for Successful Aging Mayor's Pledge in conjunction with this report. The age wave has no bias or boundaries, and this nonpartisan Pledge reaches across the political spectrum. With the Pledge, the Milken Institute and its Best Cities for Successful Aging Advisory Committee challenge mayors to unite in a commitment to make our cities better for older residents and in the process ensure a brighter future for all ages.

Mayors who sign the Pledge agree to make the well-being of older residents a priority of all municipal departments. They will work to improve safety, affordability, and access to health resources, employment, and educational opportunities, as well as housing and mobility options. Also of vital importance, they commit to enabling and promoting purposeful engagement by older residents in volunteerism, encore careers, and civic work that will strengthen cities overall and improve lives old and young.

We acknowledge and honor the forward-thinking mayors who have signed the Pledge. More are signing every day. We look forward to their achievements. Their ideas will open the door to solutions that can be scaled and replicated at the state, national, and global levels. And their leadership will inspire other policymakers to act.

Encouraging Change

The 2012 edition of "Best Cities for Successful Aging" received extraordinary attention from national and local media, city leaders and planners, and a wide range of stakeholders. This resonance demonstrated an awakening and a hunger for ideas and approaches to the challenges and opportunities posed by the world's largest-ever population of older adults. While "Best Cities" focuses on the United States, the imperative to address the issues around aging is evident in consequential efforts across many borders, including the World Health Organization's Global Network of Age-Friendly Cities initiative. Recognizing the power of cities across the world to transform the landscape of aging, the WHO is encouraging them to tackle the demographic shift. We applaud the WHO and other organizations working to build global awareness and encourage action.

The publication of our inaugural "Best Cities for Successful Aging" report sparked many calls for a follow-up release. The Milken Institute's purpose in this second edition is to update and amplify that analysis and continue to spotlight the importance of local leadership in the drive for successful aging.

We hope that our rankings generate virtuous competition among cities and encourage improvement in the social structures that serve aging Americans. We seek to promote best practices and innovations that enable engagement. We intend to spark solutions-oriented dialogue among thought leaders, decision-makers, and stakeholders. We want to spread successful aging across America and the world. The humane values inherent in age-friendly communities afford people of all ages the chance to work, learn, prosper, and live with dignity and purpose. Guided by those values, we aspire to shape the future.

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Paul Irving
Santa Monica, Calif.

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