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15 Best Small Cities for Successful Aging

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As boomers age, their retirement ambitions are likely to include more than just trading in their winter snow shovels for a fair-weathered community in a low-tax state. That is why the Milken Institute has created its new Best Cities for Successful Aging Index.

Far from a list of Florida cities with cheap, and early, eats, the Milken Institute rankings (which are actually dominated by cold-weather places) take into account a wide number of variables—78 in fact—that point to a community’s health care resources, safety, affordability, comfort, ease of transportation, second-career opportunities, cultural offerings and community connectedness.

The study’s authors—Anusuya Chatterjee, Ross DeVol and Paul Irving—drilled deeply. In the area of heath care, for example, they looked at the number of doctors, hospital beds, dialysis centers and more; the number of hospitals with Alzheimer’s units and hospice centers; hospital expenses per inpatient day; the percentage of hospitals with medical school affiliations; and more than a dozen other factors.

They did the same for wellness indicators, financial indicators, employment and education indicators as well; they did all this for large metro areas and small metro areas, and they did this for two age cohorts—65 to 79 and 80 and older. The result is a multivariate ranking on steroids.

“This index is a first research of its kind in the United States using public-use data that determine the overall quality of life for seniors,” Milken Institute scholar Anusuya Chatterjee said, commenting on the study for ThinkAdvisor. “Ninety percent of seniors want to age in [the same] place, and this index looks directly at how cities are meeting these needs.”

Chatterjee said the Milken Institute’s Successful Aging data site can be used as a tool for Americans to assess where each metro area stands. “Personal preference is of course the ultimate deciding guide,” she adds.

The big study examined two cohorts: one that included the 100 largest cities and regions and the other 259 smaller metropolitan areas. ThinkAdvisor first looked at the 20 Best Big Cities for Successful Aging. Read on for the 15 Best Small Cities for Successful Aging.

Hattiesburg, Miss., visitor center.

15.  Hattiesburg, Miss.

Overall Score: 88.46

Age 65-79 Rank and Score: 18; 87.37

Age 80+ Rank and Score: 7; 93.19

TAKEAWAY: Located between Jackson, Miss., and New Orleans, Hattiesburg has many job opportunities in industries likely to hire seniors. The metro has a relatively low cost of living and the lowest crime rate. But it has high rates of obesity, diabetes and Alzheimer’s disease. Since the senior population is small, volunteer rates are low.

Julien Dubuque's grave in Dubuque, Iowa.

14.  Dubuque, Iowa

Overall Score: 88.47

Age 65-79 Rank and Score: 25; 86.56

Age 80+ Rank and Score: 17; 88.94

TAKEAWAY: The metro’s unique architecture and river location attract many tourists, and it is highly connected to nearby Chicago. It offers quality hospitals and specialized care for seniors. The 65+ population is large, and seniors actively volunteer. Many points of cultural enrichment also make this metro desirable for seniors.

Fans at a West Virginia University football game. (Photo: AP)

13.  Morgantown, W.Va.

Overall Score: 89.05

Age 65-79 Rank and Score: 13; 88.87

Age 80+ Rank and Score: 18; 88.74

TAKEAWAY: Home to the University of West Virginia, Morgantown has employment, art and culture, education and access to health care services. Rentals are inexpensive, and homes are moderately priced. However, it ranks toward the bottom in living arrangements due largely to the expense and lack of facilities for the oldest, sickest population.

Sign post in Anchorage.

12.  Anchorage, Alaska

Overall Score: 89.68

Age 65-79 Rank and Score: 8; 91.02

Age 80+ Rank and Score: 67; 85.11

TAKEAWAY: Anchorage’s older residents enjoy the benefits of senior-friendly employment opportunities and public policies. However, it ranks near the bottom in most of the indicators involving living arrangements, and it goes without saying that the severe weather is a bummer.

Iowa cornfield

11.  Ames, Iowa

Overall Score: 90.67

Age 65-79 Rank and Score: 6; 91.51

Age 80+ Rank and Score: 10; 91.31

TAKEAWAY: Ames has an educated workforce, low unemployment, a strong fiscal base and the amenities of a university town. Although it has high ridership in public transport, the commute time is long. Housing and rental prices are above the median, and residents need more continuing-care facilities and better-quality hospitals and nursing homes.

Mt. Rushmore is near Rapid City.

10.  Rapid City, S.D.

Overall Score: 90.71

Age 65-79 Rank and Score: 10; 89.71

Age 80+ Rank and Score: 12; 89.72

TAKEAWAY: Rapid City has a thriving economy with a major health care center that serves the five-state region and an influx of tourism due to nearby Mount Rushmore. However, home health care providers, continuing care facilities and quality nursing homes are in short supply.

Duke fans cheering basketball team. (Photo: AP)

9.  Durham-Chapel Hill, N.C.

Overall Score: 90.74

Age 65-79 Rank and Score: 11; 89.21

Age 80+ Rank and Score: 8; 92.01

TAKEAWAY: Home to Duke University and part of the famed Research Triangle, Durham is an excellent choice for overall access to health care and medical innovation and for enjoying all the benefits top-notch educational institutions have to offer. While home prices are expensive, rentals are not. However, the high crime rate makes safety a big concern.

Fishing in a Montana river.

8.  Missoula, Mont.

Overall Score: 91.44

Age 65-79 Rank and Score: 9; 90.49

Age 80+ Rank and Score: 16; 88.98

TAKEAWAY: Missoula enjoys the cultural, educational and financial benefits of being a university town. It has quality health care and many recreational facilities. However, it ranks near the bottom in income growth and inequality, weather, cost of living and housing prices among the small metros.

Downtown Ann Arbor.

7.  Ann Arbor, Mich.

Overall Score: 91.82

Age 65-79 Rank and Score: 7; 91.23

Age 80+ Rank and Score: 9; 92.00

TAKEAWAY: The University of Michigan at Ann Arbor is one of the best in the nation and offers a raft of cultural and educational opportunities for residents. But living arrangements are expensive, and the economic environment makes it less than ideal for seniors in the market for a second career.

Retirement housing built by University of Florida. (Photo: AP)

6.  Gainesville, Fla.

Overall Score: 92.26

Age 65-79 Rank and Score: 5; 91.86

Age 80+ Rank and Score: 6; 93.25

TAKEAWAY: Home of the University of Florida, Gainesville is a vibrant town with great weather and a strong fiscal base. The university-affiliated Shands HealthCare system is one of the best in the nation. However, a slow economy and a small senior population in the metro might prevent seniors from relocating here.

Mayo clinic

5.  Rochester, Minn.

Overall Score: 92.49

Age 65-79 Rank and Score: 12; 89.06

Age 80+ Rank and Score: 4; 94.34

TAKEAWAY: The Mayo Clinic, one of the best hospitals in the nation, is located here. Needless to say, this has attracted many health care providers. Safe and secure neighborhoods offer a superior quality of life. But the sluggish economy and low college enrollment are definite weaknesses.

University of Missouri campus. (Photo: AP)

4.  Columbia, Mo.

Overall Score: 94.43

Age 65-79 Rank and Score: 4; 93.26

Age 80+ Rank and Score: 5; 94.00

TAKEAWAY: Thanks in part to a strong tax base, Columbia offers excellent educational facilities and health care. University-sponsored research is an incubator for innovation and new businesses, which gives seniors access to cutting-edge technology in health care and supports entrepreneurial activities. However, the metro is short on recreation and culture.

Capitol in Bismarck, N.D.

3.  Bismarck, N.D.

Overall Score: 95.44

Age 65-79 Rank and Score: 3; 93.30

Age 80+ Rank and Score: 3; 96.26

TAKEAWAY: The capital city is reaping the benefits of North Dakota’s oil and gas boom. It ranks high in senior employment, and the large service sector increases the chances of finding a job. If weather is not a high priority, Bismarck offers excellent opportunities for working seniors.

University of Iowa in Iowa City.

2.  Iowa City, Iowa

Overall Score: 98.63

Age 65-79 Rank and Score: 2; 97.07

Age 80+ Rank and Score: 1; 100.00

TAKEAWAY: Home to the University of Iowa and its medical school, Iowa City has excellent health care, little crime and relatively few seniors below the poverty line. On the flip side, housing and rentals are pricier than the median for small metros. Although its population skews younger, the presence of a young working-age population implies a solid fiscal base.

Falls Park in Sioux Falls.

1.  Sioux Falls, S.D.

Overall Score: 100.00

Age 65-79 Rank and Score: 1; 100.00

Age 80+ Rank and Score: 2; 97.58

TAKEAWAY: With a booming economy, low unemployment, and a rapidly growing financial infrastructure, Sioux Falls is a good place for seniors who want to work or start a second career. Its hospitals specialize in geriatric services, hospice and rehabilitation, and the metro has recreation and an active lifestyle. But seniors might be turned off by the inclement weather and lack of contemporaries.


Check out the full Milken Institute report on Best Cities for Successful Aging.

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