Whether you crave big-city life or small-town bliss as you age, one thing your home should be able to do is support you in whichever stage of life you happen to be, without you having to pick up stakes and move elsewhere.

And that’s exactly what’s happening. “Cities are on the front lines of the largest demographic shift in history,” Paul Irving, chairman of the Milken Institute Center for the Future of Aging, says in a statement. “Lifespans are extending into eight, nine, and ten decades, and older adults increasingly are seeking lifelong engagement and purpose. They expect their cities and communities to support their changing needs.”

To that end, the Center, in collaboration with the Institute’s Research Department, have released the third edition of their “Best Cities for Successful Aging” report and index. The report, which covers metro areas both large and small, evaluates the amenities and benefits each offers to its population, with particular attention to a city’s ability to support a resident through all stages of life.

(Related: 12 Best Small Cities for Successful Aging: 2017)

After all, even when aging in place, not everyone is ready to give up the peace and quiet of smaller surroundings for the excitement delivered by the fast pulse of big-city living—or prepared to face the constant hustle and bustle that would be their lot if they gave up small metro areas for a major metropolitan area.

In seeking to uncover the best cities in which people can age in place, Milken ranked 381 metropolitan areas, “using refined methodology and updated data in nine categories,” as well as 83 indicators of livability. Rank and score, to find which are the most livable, not only for older adults but of other ages, too

ThinkAdvisor previously reviewed Milken’s top 12 choices among small metro areas; now we turn our attention to the top 12 big metro areas where residents can successfully age.

Denver Brocons Fans. (Photo: AP)

12. Denver/Aurora/Lakewood, Colorado

  • Age 65–79 Rank: 12
  • Age 80+ Rank: 13
  • General Livability: 55
  • Health Care: 18
  • Wellness: 4
  • Financial Security: 20

Takeaway: The area’s active population doesn’t let a little cold stop them from taking advantage of all the outdoor activities on offer in this metro area. In fact, it has a No. 1 ranking for physical activity. It also has a strong economy and a lively arts and culture scene, offering professional opportunities as well as community engagement. Strong income and employment growth keep older people in the low-poverty range, and there are plenty of older workers as a result. Good infrastructure makes everything from getting around to getting health care easier, but of course there is a catch: it’s expensive—from health care to transit fares to the cost of living overall. 

Yellow cabs in New York. (Photo: AP)

11. New York/Newark/Jersey City, NJ/Pennsylvania

  • Age 65–79 Rank: 11
  • Age 80+ Rank: 11
  • General Livability: 49
  • Health Care: 56
  • Wellness: 35
  • Financial Security: 64

Takeaway: For transit, access to health care and convenience, this metro area is tough to beat. There are plenty of activities and cultural resources for older people, too—but be prepared. You’ll be spending a lot to live here and take advantage of all that. Commutes are bad, as are waits for the emergency room, but on the other hand, neighborhoods are walkable and there are strong Medicare signups capturing 90 percent of those eligible. The bad news is that there’s high unemployment and high poverty among older people here, and there’s not much of a spirit of volunteerism in the region.

 Cable Cars riding down the streets of San Francisco.

10. San Francisco/Oakland/Hayward, California

  • Age 65–79 Rank: 9
  • Age 80+ Rank: 10
  • General Livability: 3
  • Health Care: 68
  • Wellness: 5
  • Financial Security: 28

Takeaway: You’ll find plenty to do here, whether it’s cultural, educational, or tech-oriented, and plenty of jobs, as well as ample resources for older adults—but jobs tend to go to younger people, with significant unemployment among older adults. In addition, the cost of living is prohibitive and most people don’t have the sort of income or assets to allow them to live in the area where they work, so they’re consigned to long and unlikable commutes. Fortunately, however, drivers are good, with few car accidents per capita, and neighborhoods themselves are walkable. The weather is a real attraction here, and the quality of available health care is good.

Beacon Hill in Boston.

9. Boston/Cambridge/Newton; Massachusetts/New Hampshire

  • Age 65–79 Rank: 10
  • Age 80+ Rank: 9
  • General Livability: 27
  • Health Care: 13
  • Wellness: 17
  • Financial Security: 46

Takeaway: It’ll cost you to live here, whether you’re healthy or not; home prices are high, as are the price tags on assisted living and nursing homes. But the quality of care is excellent, with medical school affiliations for most hospitals, lots of doctors, and plenty of home care options. Then there are the area’s education options, with top universities, as well as employment options, with lots of 65+ workers on the job. There’s also special-needs transportation, strong transit funding and walkability to consider. But on the negative side, there are high levels of depression in the Medicare population, as well as numerous older-adult injury falls and few caregivers.

Mississippi State Capitol in Jackson.

8. Jackson, Mississippi

  • Age 65–79 Rank: 8
  • Age 80+ Rank: 8
  • General Livability: 77
  • Health Care: 3
  • Wellness: 71
  • Financial Security: 8

Takeaway: Jackson does well on median home and rental prices, and even on the cost of hospital stays. In fact the cost of living as a whole is pretty welcoming, as is the employment atmosphere for older people. However, there’s low employment growth and a “struggling economy.” Still, access to good health care—plenty of nurses, nurse practitioners and orthopedic surgeons, as well as plenty of caregiving options—can make this an attractive place for older people whose physical health isn’t keeping up with their mental stamina.

Omaha skyline.

7. Omaha, Nebraska / Council Bluffs, Iowa

  • Age 65–79 Rank: 7
  • Age 80+ Rank: 7
  • General Livability: 43
  • Health Care: 4
  • Wellness: 62
  • Financial Security: 32

Takeaway: Affordability, quality health care, recreational amenities and employment opportunities all serve as attractions for the educated population of Omaha/Council Bluffs. There’s a low poverty rate among older people, as well as affordable medical care and plenty of jobs; in addition, there’s strong funding for older-adult programs. But it’s not a walkable area, and mass transit is definitely a weak point. In addition, there aren’t that many hospitals, which could be a concern despite the health care sector’s strengths in other areas such as geriatrics, hospice and orthopedics.

Austin skyline.

6. Austin/Round Rock, Texas

  • Age 65–79 Rank: 6
  • Age 80+ Rank: 5
  • General Livability: 13
  • Health Care: 17
  • Wellness: 12
  • Financial Security: 2

Takeaway: Those in search of creativity can thrive in Austin/Round Rock, with a youthful population but plenty to enjoy for older people as well. The South by Southwest music and film festival lives here, of course, but there are also plenty of opportunities for more mundane pursuits—say, in tech. There’s a high older-worker employment rate here, as well as a healthy small business atmosphere with a tax-friendly approach. And health care is a solid positive—although the area isn’t cheap to live in, and grocery stores are few and far between. Plus, you’ll spend a lot of time in your car on your way to and from various destinations.

Bikers in Des Moines. (Photo: AP)

5. Des Moines/West Des Moines, Iowa

  • Age 65–79 Rank: 5
  • Age 80+ Rank: 6
  • General Livability: 29
  • Health Care: 5
  • Wellness: 43
  • Financial Security: 33

Takeaway: It’s not so expensive to live here, which gives it an edge over other top metro areas. In addition, it has a strong business environment and good health services—which are also reasonably priced, even for long-term care. It also has emerged as a leader in the U.S. in geriatric services, with a good number of rehab and Alzheimer’s facilities. There are also many older workers here, as well as older volunteers and funding for programs targeting older adults. But you’ll have to drive to get from place to place, since there’s little public transportation. And there aren’t all that many grocery stores—yet another place to drive to.

Mormon Temple in Salt Lake City. (Photo: AP)

4. Salt Lake City, Utah

  • Age 65–79 Rank: 3
  • Age 80+ Rank: 4
  • General Livability: 82
  • Health Care: 10
  • Wellness: 16
  • Financial Security: 3

Takeaway: Medical care here for older people is ample, including geriatric, rehabilitation, physical therapy and Alzheimer’s care, and there’s low older adult poverty and income inequality—as well as strong 65+ employment levels and community colleges that teach new skills. Housing is costly, though, and while there’s an educated population, a diverse job market and a volunteer-minded older population, there’s also a high crime rate and more fast food than fitness locations that contribute to less-healthy lifestyles.

Duke fans cheering basketball team. (Photo: AP)

3. Durham/Chapel Hill, North Carolina

  • Age 65–79 Rank: 4
  • Age 80+ Rank: 3
  • General Livability: 81
  • Health Care: 1
  • Wellness: 32
  • Financial Security: 24

Takeaway: Population growth has pushed Durham/Chapel Hill into the large metro category, as part of the Research Triangle area. Health care and economic benefits emanating from the University of North Carolina and Duke University research activities means that the area has some of the country’s best hospitals, as well as excellent access to geriatric, Alzheimer’s, hospice and physical therapy services. Not only is there a strong volunteerism ethic, but there’s employment growth in health, education, hospitality and leisure—as well as a low unemployment rate among older workers and a strong small business environment.

Wisconsin State Capitol.

2. Madison, Wisconsin

  • Age 65–79 Rank: 2
  • Age 80+ Rank: 2
  • General Livability: 39
  • Health Care: 2
  • Wellness: 7
  • Financial Security: 27

Takeaway: An educated population, a healthy environment and a broad array of health care services all combine to provide a good environment not just for older people, but for the young as well. It’s expensive to live here, however, and being a college town brings along some of the woes attendant on a young and still-learning population, such as binge drinking. But commutes are short, with many of them walkable, and there’s plenty to do here besides work.

Provo Utah Temple.

1. Provo/Orem, Utah.

  • Age 65–79 Rank: 1
  • Age 80+ Rank: 1
  • General Livability: 1
  • Health Care: 26
  • Wellness: 1
  • Financial Security: 9

Takeaway: It’s not the first time Provo/Orem has claimed the top spot in Milken’s study; in 2012 it was also at the top of the heap for large metro areas. What brought it back to the top of the heap is the strength of the services and support systems that make it an ideal home for older adults amid a youthful, family-oriented population. Outdoor recreation, caregivers for older people living at home and strong volunteerism are some of the elements contributing to its wellness score, while a strong economy, a growing small business sector, high employment and low income inequality also contribute to a stable and supportive atmosphere for people of all ages.

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