The U.S. elderly population has grown exponentially in recent decades. The number of Americans 65 and older grew from 35 million in 2000 to 41.4 million in 2011 and to an estimated 44.7 million in 2013. This trend is expected to continue as members of the baby boomer generation reach retirement age.

While it can be difficult to grow old in some U.S. states, life for seniors is often far worse in many other countries. Still, the United States will face increasingly large challenges. In the coming years, state officials, families, and individuals will need to pay more attention to the needs of the elderly — to improve medical care, access to services, infrastructure, or other amenities that become more necessary late in life.

Click here to see the worst states to grow old in

Click here to see the best states to grow old in

HelpAge International evaluates each year the social and economic well-being of elderly country residents in its Global AgeWatch Index. Last year, the United States was among the better places to grow old in the world, at eighth place. However, domestically, each state offers a very different quality of life for its older residents. Based on an independent analysis by 24/7 Wall St., which incorporated a range of income, health, labor, and environmental indicators, Utah is the best state in which to grow old, while Mississippi is the worst.

To be considered among the worst states to grow old, senior citizens in the states had to have relatively weak income security, as measured by several indicators. The 2013 median income among families with a head of household 65 and older, for example, did not exceed the comparable national figure of $37,847 in nine of the worst states to grow old. A typical elderly household in Mississippi earned less than $30,000, the least nationwide.

Retirees often have fixed income as they begin to tap into their savings and collect social security. Kate Bunting, CEO of AgeWatch USA, explained that, “It’s really important for older people to have reliable access to a guaranteed income.” More than 90% of Americans 65 and older in the vast majority of states received social security income in 2013. Yet, the average monthly social security benefit of $1,294 was likely not enough for many seniors.

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Many older Americans also had non-social security income, such as withdrawals from 401Ks and savings as a supplement. In 2013, 47.9% of Americans 65 and older had such supplemental retirement incomes. Comparable figures in a majority of the worst states to grow old actually exceeded the national figure. Even with the supplemental retirement income many elderly residents had, it was frequently not enough to offset their financial burdens. At stake, according to Bunting, is the elderly’s “ability to eat nutritious foods, which impacts their health, and their ability to access other critical services.”

With lower, and often fixed, incomes, elderly Americans are vulnerable financially. In addition, age often brings a host of health problems, causing greater reliance on medical and accessibility services. To determine how the states fared when it comes to health care, we examined health services and outcomes. Among the worst states, for example, life expectancy was relatively low. In all of the 10 worst states, it was less than 80 years. Life expectancy at birth in 2011 did not exceed 76 years in four of the states.

A good education, which can lead to employment opportunities and higher incomes, is also an indication of well-being. More than 24% of Americans 65 and older had at least a bachelor’s degree as of 2013. In seven of the 10 worst states to grow old, however, less than 20% of elderly residents had attained at least a bachelor’s degree. In Mississippi, just 14.2% did, the lowest rate nationwide.

Safety often becomes a greater concern for aging Americans, as older people are often targeted by criminals. Residents of any age in the worst states to grow old also did not feel particularly safe. On a recent survey, less than 70% of residents in nine of the 10 states told Gallup they felt safe walking home alone at night. The violent crime rate in four of the worst states was also greater than 500 violent crimes reported per 100,000 residents, all among the higher violent crime rates in the nation.

In addition, policies often shape the quality of life of a state’s elderly population, particularly in terms of accessibility to services. Based on an OECD survey, all of the worst states for old people had worse accessibility to services than the majority of states. Bunting said that the aging population is growing, and it will become increasingly “important that [states] have the right kinds of policies in place that help support a quality old age.” Adapting to these demographic patterns through age-friendly policy, Bunting continued, is “important and worthwhile to do, no matter what age you are.”

These are the worst states to grow old in.

See our full methodology here.

The Worst States to Grow Old In

10. South Carolina
> Median household income (65+): $35,042 (14th lowest)
> Pct. with a disability (65+): 37.2% (18th highest)
> Pct. with a bachelor’s degree or higher (65+): 22.9% (23rd lowest)
> Violent crime rate: 494.8 per 100,000 residents (6th highest)

Based on a range of factors, including income, health, labor, and environmental indicators, South Carolina is the 10th worst state in which to grow old. Older Americans are often targets of scams, financial crimes, and violence. With nearly 500 violent crimes reported per 100,000 people in the state in 2013 — one of the highest rates — South Carolina is not especially safe. Based on a recent Gallup poll, just 63% of all state residents felt safe walking alone at night, the lowest percentage nationwide. As in most of the worst states in which to grow old, South Carolina’s elderly population is also poor relative to elderly populations in other states. More than one in 10 residents 65 and older lived in poverty in 2013, one of the highest rates.

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9. Kentucky
> Median household income (65+): $32,964 (5th lowest)
> Pct. with a disability (65+): 42.0% (5th highest)
> Pct. with a bachelor’s degree or higher (65+): 16.7% (2nd lowest)
> Violent crime rate: 198.8 per 100,000 residents (5th lowest)

Less than 17% of Kentucky’s elderly population had at least a bachelor’s degree as of 2013, the second worst rate nationwide. Perhaps as a result, older Kentuckians have relatively poor income security. Older households had a median income of less than $33,000 in 2013, one of the lowest figures in the country. The vast majority of seniors received social security benefits. In addition, 48.5% of older residents had other forms of retirement income, larger than the comparable national figure of 47.9%. However, these supplemental incomes were not enough to keep 11.2% of Kentucky’s elderly population out of poverty, one of the highest poverty rates among state elderly populations.

8. Alabama
> Median household income (65+): $33,469 (6th lowest)
> Pct. with a disability (65+): 41.4% (8th highest)
> Pct. with a bachelor’s degree or higher (65+): 19.6% (12th lowest)
> Violent crime rate: 418.1 per 100,000 residents (14th highest)

At 75.4 years, Alabama’s life expectancy at birth in 2011 was lower than that of all but two states. Low life expectancy may result from not eating healthy foods. In 2011, 11.2% of senior citizens in the state did not have easy access to nutritious foods, the fifth highest share in the country. The high degree of food insecurity may also be related to low incomes. The poverty rate of state residents 65 and over was 10.6% in 2013, and the median household income of the same age group was less than $34,000 that year — both among the worst levels in the country. Additionally, more than 41% of Alabama’s elderly residents were disabled in 2013, well above the national figure of 36.4%.

7. New Mexico
> Median household income (65+): $35,785 (19th lowest)
> Pct. with a disability (65+): 41.9% (6th highest)
> Pct. with a bachelor’s degree or higher (65+): 27.3% (14th highest)
> Violent crime rate: 596.7 per 100,000 residents (2nd highest)

More than 27% of older New Mexico residents had a bachelor’s degree or higher in 2013, the only one among the worst states for older people that exceeded the comparable national rate of 24.1%. Yet, the state’s elderly population was among the most likely to live in poverty in 2013. Nearly 12% of residents 65 and older lived in poverty, the third highest nationwide. Poor income insecurity likely contributed to similarly poor health outcomes. Nearly 42% of residents 65 and older had a disability in 2013, one of the highest rates. In addition, the OECD evaluated access to services in New Mexico worse than access in nearly every other state.

6. Tennessee
> Median household income (65+): $34,462 (9th lowest)
> Pct. with a disability (65+): 40.0% (9th highest)
> Pct. with a bachelor’s degree or higher (65+): 19.2% (9th lowest)
> Violent crime rate: 579.7 per 100,000 residents (4th highest)

In 2011, nearly 12% of Tennessee seniors did not have adequate access to nutritious and affordable food, the second-highest percentage in the nation. Low educational attainment rates likely explain in part the poor income security among older state residents. Less than 20% of Tennessee residents 65 and older had at least a bachelor’s degree, one of the lowest figures in the country. Relatively poor nutrition, as well as the low incomes, contributed to poor health outcomes among the state’s older population. As in a majority of the worst states in which to grow old, older Tennesseans were more likely to have a disability than other older Americans in general, and the life expectancy at birth in 2011 was 76.3 years, one of the lowest figures. In addition, Tennessee was not especially safe, with roughly 580 violent crimes reported per 100,000 people in 2013, the fourth highest rate among all states.

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5. Nevada
> Median household income (65+): $41,491 (13th highest)
> Pct. with a disability (65+): 36.2% (23rd highest)
> Pct. with a bachelor’s degree or higher (65+): 22.5% (20th lowest)
> Violent crime rate: 591.2 per 100,000 residents (3rd highest)

The collapse of Nevada’s economy as a result of the housing crisis in 2009 is likely still having an effect on the state’s residents, including its elderly population. Only 91% of Nevadans aged 55 to 64 were employed in 2013, the lowest rate in the country. Additionally, Nevada had the country’s highest rate of residents 65 and older who did not have health insurance, which may have contributed to only 66.1% of all residents having a personal doctor, the lowest rate in the country. Senior citizens in Nevada were also among the country’s least likely to have access to healthy and affordable food, with food insecurity identified among 10.4% of older residents. Food insecurity was far from Nevada residents’ only problem, as the state also had one of the highest violent crime rates in the country in 2013.

4. Arkansas
> Median household income (65+): $31,959 (4th lowest)
> Pct. with a disability (65+): 42.4% (4th highest)
> Pct. with a bachelor’s degree or higher (65+): 16.8% (3rd lowest)
> Violent crime rate: 445.7 per 100,000 residents (10th highest)

More than 94% of elderly Arkansas residents received social security benefits in 2013, the highest rate among all states. Yet, this income frequently did not meet the financial needs of many older Arkansans, as nearly 13% did not have adequate access to nutritious and affordable food in 2011, the highest rate in the nation. While it is often expected that Americans entering retirement have savings of some kind, just 41.5% of the age group in the state had any retirement income to supplement social security, nearly the lowest figure. As a result, the state had among the higher poverty rates among its elderly population, at 10.5%. In addition, older state residents had low educational attainment rates. Less than 17% had at least a bachelor’s degree in 2013, the third lowest rate nationally.

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3. West Virginia
> Median household income (65+): $31,542 (3rd lowest)
> Pct. with a disability (65+): 45.5% (the highest)
> Pct. with a bachelor’s degree or higher (65+): 14.2% (the lowest)
> Violent crime rate: 289.7 per 100,000 residents (23rd lowest)

Just over 14% of West Virginia’s elderly population had at least a bachelor’s degree in 2013, 10 percentage points below the national figure and the lowest in the country. Poor educational outcomes often lead to low incomes. Among the state’s senior citizens, a typical household earned $31,542 in 2013, the third lowest figure in the country. Additionally, West Virginia’s elderlies were the most likely in the country to have some kind of disability in 2013, with nearly half indicating they were disabled. Low incomes and a high share of disabled residents may prohibit some older residents from taking advantage of services. According to a 2013 OECD report, services in West Virginia were less accessible than all but a few other states.

2. Louisiana
> Median household income (65+): $31,230 (2nd lowest)
> Pct. with a disability (65+): 41.7% (7th highest)
> Pct. with a bachelor’s degree or higher (65+): 18.8% (8th lowest)
> Violent crime rate: 510.4 per 100,000 residents (5th highest)

Older Louisiana residents are among the nation’s most financially insecure. A typical household with older occupants had an income of $31,230 in 2013, second only to Mississippi. Compared to seniors in other states, seniors in Louisiana were also some of the least likely to receive social security benefits or other forms of retirement income. Perhaps as a result, nearly 13% of the age group in the state lived in poverty in 2013, the second highest rate in the country. Older Louisiana residents also fared poorly in terms of health. For example, life expectancy at birth was less than 76 years as of 2011, one of the lowest figures. A 2013 assessment of city infrastructure design found that policies implemented in Louisiana in recent years better considered the needs of elderly people and others requiring greater access than most states, which bodes well for the state’s future elderly populations.

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1. Mississippi
> Median household income (65+): $29,511 (the lowest)
> Pct. with a disability (65+): 45.1% (2nd highest)
> Pct. with a bachelor’s degree or higher (65+): 18.2% (6th lowest)
> Violent crime rate: 267.4 per 100,000 residents (18th lowest)

Mississippi’s older population fares poorly based on a wide range of measures, making it the worst state in the nation in which to grow old. Mississippi’s elderly population had by many measures the worst income security nationwide. The median income among elderly households was less than $30,000 in 2013, the lowest in the country. Nearly 15% of residents 65 and older lived in poverty that year, also the worst rate. Perhaps as a result of financial burdens, elderly residents had worse health outcomes. More than 45% had a disability, the second highest rate in the country. In addition, accessibility to services in Mississippi was rated worse than in any other state by the OECD.

Methodology

To determine the best and worst states in which to grow old, 24/7 Wall St. compiled data from a variety of sources and grouped them into four broad categories: income, health, labor, and environment and access.

To construct our index we used the min-max normalization method. A similar methodology was used in constructing HelpAge International’s Global AgeWatch Index and the United Nation’s Human Development Index. First, all indicators were modified so that higher values indicated better outcomes. For example, rather than use the percentage of the population with a disability, our index used the percentage of people 65 and over without a disability. Second, each indicator was normalized to fall between 0 and 1 using the indicator’s minimum and maximum values. Third, we calculated the geometric mean of the indicators in each category to obtain an index of each category. Geometric means were used to account for relationships between indicators that may be causal. Our final index was calculated as a geometric mean of the category-specific indices.

Included in the income category are data from the U.S. Census Bureau’s 2013 American Community Survey (ACS) regarding the 65 and older population with retirement income, poverty rates, and median household income. The health category includes data from the Census Bureau on the percent of people 65 and over with a disability. Also included are data on the percentage of seniors insecure about food from Feeding America’s 2013 report, Spotlight on Senior Hunger. We also included 2011 life expectancy at birth from the Organization for Economic Cooperation and Development (OECD), the OECD’s health index, and a survey from Gallup on whether people have a personal doctor. The labor category incorporated data from the Census on the share of people 65 and over with a bachelor’s degree or higher, as well as employment rates for people aged 55-64 from the Bureau of Labor Statistics. The environment and access category included data from the OECD on how accessible a variety of services are in each state. From Gallup, we considered how safe people feel walking alone at night and how satisfied people are with the places they live. FInally, we included data on violent crime rates from the Federal Bureau of Investigation.

These are the best states in which to grow old.

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