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What Makes a City Age Friendly?

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Screen Shot 2015-01-21 at 3.21.56 PMAdrienne Mendenhall, ACCESS Health Singapore Country Manager, brought this very useful report from the Milken Institute to my attention. Cities are central to providing the housing, transportation, health services, and environment and wellness programs necessary for high quality life for the elderly.

The report highlights what features of urban life are important for the health of older citizens. It ranks US cities with respect to these criteria. The Milken Institute has also drafted a Mayor’s Pledge, whereby mayors promise to do all they can to make their cities more age friendly. Below is an excerpt from the introduction to the report.

The full report is available for download here.

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 Ten

With nearly eighty 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 ninety 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 US 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 twenty first century.

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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.

Read more about the Mayor’s Pledge and the Best Cities for Successful Aging initiative here.

William Haseltine

William Haseltine

William A. Haseltine is the Founder, President, and Chairman of the Board of ACCESS Health International. He is well known for his pioneering work on cancer, HIV/AIDS, and genomics. He has authored more than two hundred manuscripts in peer reviewed journals and is the author of several books, including Affordable Excellence: The Singapore Healthcare Story, published in 2013.

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