Everyone has a list of the best places to retire; Florida, Arizona and other warmer climes usually dominate. But weather might not be the best way to judge which cities are the best to age “successfully.”

The Milken Institute recently released its biannual list of cities for successful aging. The top of the list is dominated by places whose residents must endure real winters.

Milken looked at a number of metrics — 84 in all — that measured financial security, safety, affordability, cultural amenities, health and happiness, among other things. The idea was to dig beyond weather and look at services and lifestyle amenities available in large cities and smaller metro areas across the country.

That’s important, Milken noted, citing the AARP finding that 90% of older people want to age in their own homes.

“We need to start looking at what facilities people need to successfully age,” said Anusuya Chatterjee, co-author of the report and senior economist at the Milken Institute. “One of the things we wanted to say is that most people want to age at home and in place. This survey shows how well equipped these cities and metro areas are to help” them do so.

What follows are the ranking for the 12 Best Cities for Successful Aging — six from Small Metro Areas and six from Big Metro Areas. 

Top 6 Small Metro Areas for Successful Aging

6. Ames, Iowa

Age 65-79 Rank: 6

Age 80+ Rank: 3

TAKEAWAY: Hosting the Big 12 campus of Iowa State University, Ames residents enjoy a strong town-gown connection. Learning opportunities, low unemployment and an expanding economy characterize this Hawkeye State metro. But growing demand requires more specialty health care.

5. Rapid City, South Dakota

Age 65-79 Rank: 8

Age 80+ Rank and Score: 33

TAKEAWAY: A stable economy and low jobless rate among the older population make this an attractive place to live for the elderly. In addition, there are recreational opportunities, and older residents are active as volunteers. Long distances to grocery stores and low ridership on public transportation are negatives. Even worse is a high rate of Alzheimer’s disease, but no hospitals with a unit to care for such patients.

4. Bismarck, North Dakota

Age 65-79 Rank: 4

Age 80+ Rank: 7

TAKEAWAY: The lowest unemployment rate in the category with a strong economy bolstered by growth in the hospitality and leisure industries make this a good place to age. Adding to mix are high income growth and quality health care and nursing homes. The state funds public transportation, but the system has low ridership. The biggest negatives to the metro area are expensive housing and a lack of home health care workers.

3. Columbia, Missouri

Age 65-79 Rank and Score: 3

Age 80+ Rank and Score: 4

TAKEAWAY: Top hospitals and rehab centers along with an abundance of doctors, surgeons and nurses make this a good place to grow old. A stable economy with jobs for older workers and a young work force that provides a solid tax base adds to the allure. Problems include a lack of recreational and cultural services for older adults and few grocery stores near neighborhoods, as well a high cost of living and high crime rate.

2. Sioux Falls, South Dakota

Age 65-79 Rank: 2

Age 80+ Rank: 2

TAKEAWAY: Among the pluses are the highest rate of bank deposits per capita in the group, low cost in-patient care, short emergency room waits and plenty of doctors and nurses. In addition, there are cultural and entertainment venues and abundant public funding for services to keep the elderly engaged. On the negative side, housing is expensive, as are adult day services, and there are not enough grocery stores and other conveniences.

1. Iowa City, Iowa

Age 65-79 Rank: 1

Age 80+ Rank: 1

TAKEAWAY: An outstanding, low-priced health care system, plenty of public transportation, a high employment rate and healthier living with relatively few fast-food outlets are the positives. Negatives include a high cost of living, lack of banks, high taxes and a high rate of fatal car accidents.

Top 6 Big Metro Areas for Successful Aging

6. Jackson, Mississippi

Age 65-79 Rank: 8

Age 80+ Rank: 11

TAKEAWAY: Plenty of health care is available including dialysis centers, nursing home beds and all types of caregivers and doctors. Job opportunities, retraining and low taxes are pluses. Negatives include low quality of health care, long ER wait times and a high rate of car accidents.

5. Salt Lake City, Utah

Age 65-79 Rank: 5

Age 80+ Rank: 6

TAKEAWAY: High employment among the elderly, retraining programs and access to banks and stores combine with active lifestyles for the older population to boost this metro area. In addition, there are plenty of doctors, nurses and affordable assisted-living facilities. Negatives include lack of transportation for those with special needs and few community programs for the elderly. The study found little evidence of housing that meets the need of the older population and too many dollars in reverse mortgages, suggesting financial vulnerability. 

4. Boston-Cambridge-Newton, Massachusetts-New Hampshire

Age 65-79 Rank: 4

Age 80+ Rank: 2

TAKEAWAY: Good health care, quality nursing homes and employment opportunities are positives. In addition, universities help make the area intellectually stimulating. Negatives include a high cost of living and commuting times. Expensive health care, a high rate of falls and long emergency room times add to the downside.

3. Provo-Orem, Utah

Age 65-79 Rank: 2

Age 80+ Rank: 1

TAKEAWAY: The health of older citizens is a big positive with the lowest rate of diabetes among large metros, low smoking and binge-drinking rates and few injuries caused by falls. A low crime rate and high volunteerism add to the attractiveness of the community. Negatives include high cost of living and a shortage of doctors, nurse and MRI and dialysis clinics, as well as Alzheimer’s care.

2. Omaha-Council Bluffs, Iowa-Nebraska

Overall Score:

Age 65-79 Rank: 3

Age 80+ Rank: 5

TAKEAWAY: A good job picture for all ages, short commutes and access to grocery stores, as well state-of-the-art medical facilities and recreational opportunities boost this metro area. Areas of concern include a high rate of binge drinking that causes safety risks and overconsumption of sugary beverages that cause chronic disease. There are also insufficient MRI and dialysis clinics and not enough transportation for those with special needs.

1. Madison, Wisconsin

Age 65-79 Rank: 1

Age 80+ Rank: 3

TAKEAWAY: Excellent health care, combined with a high employment rate and low poverty among older adults help make Madison the top city for successful aging. In addition, abundant cultural and recreation choices bolster Wisconsin’s capital city. The downside is a lack of MRI and dialysis clinics, too many fast-food restaurants and too few grocery stores for the convenience of the elderly.