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What does getting older in America really look like? For some, later life brings activity, connection, and independence. For others, it means more time managing illness or disability, often with support such as specialist equipment or hospital beds for their homes, which makes daily life easier.
Our new study explores the reality of aging across the country and how it differs depending on where you live. We analyzed national and state-level data on people aged 65 and over, including:
● National trends in chronic conditions such as heart disease, diabetes, obesity, and high cholesterol
● Changes since 2015, showing which conditions are rising and which are falling
● State-by-state comparisons of chronic illness, life expectancy, physical inactivity, disability, and mental distress
So, where are people living the healthiest lives into their later years?
What is the ‘Expansion of Morbidity’ theory?
The Expansion of Morbidity theory states that while modern medicine helps people live longer, it doesn’t always mean those extra years are spent in good health. Instead of adding healthy decades, advances in treatment may be extending the period in which people live with chronic conditions.
For example, someone may survive a heart attack thanks to better care but then live for many years with heart disease or other complications. These discrepancies raise a crucial question: as life expectancy climbs, are we also improving the quality of those extra years, or simply prolonging the time spent in poor health?
The best and worst states for aging well
Getting older looks very different depending on where you live. In some states, older adults are living longer, more active lives. In others, chronic conditions, disability, and mental distress are far more common, making later life much harder to navigate.
The states with the best quality of life for seniors
|
|
|
Prevalence (65+) |
|
|
|||||||
|
Rank |
State |
High cholesterol |
Obesity |
Cardiovascular diseases |
Diabetes |
Cancer |
Physical inactivity |
Functional disability |
Frequent mental distress |
Life expectancy at 65 (years) |
Score /10 |
|
1 |
Vermont |
48.6% |
24.4% |
17.4% |
16.7% |
22.1% |
25.9% |
27.7% |
7.6% |
19.4 |
8.36 |
|
2 |
Hawaii |
51.1% |
20.5% |
17.0% |
20.7% |
15.9% |
28.4% |
32.4% |
8.1% |
20.6 |
8.17 |
|
3 |
Colorado |
51.4% |
23.8% |
16.8% |
18.0% |
21.5% |
23.0% |
29.1% |
7.9% |
19.1 |
8.05 |
|
4 |
Connecticut |
55.0% |
27.1% |
18.0% |
19.2% |
19.7% |
29.9% |
29.0% |
7.0% |
19.9 |
7.82 |
|
5 |
New Jersey |
55.1% |
27.8% |
17.4% |
21.5% |
19.2% |
30.2% |
28.8% |
6.9% |
19.4 |
7.48 |
|
6 |
District of Columbia |
51.6% |
25.9% |
16.0% |
21.2% |
16.5% |
25.2% |
33.7% |
7.7% |
18.3 |
7.34 |
|
7 |
New Hampshire |
51.3% |
28.0% |
18.6% |
18.2% |
22.4% |
29.1% |
26.9% |
7.6% |
19.0 |
7.24 |
|
8 |
Minnesota |
51.9% |
32.5% |
20.9% |
19.5% |
20.3% |
28.9% |
27.9% |
7.6% |
19.4 |
6.94 |
|
9 |
Utah |
52.4% |
27.9% |
18.5% |
19.0% |
22.2% |
22.4% |
31.1% |
8.3% |
18.8 |
6.78 |
|
10 |
Massachusetts |
52.8% |
26.1% |
18.4% |
21.0% |
22.3% |
30.4% |
30.3% |
7.8% |
19.6 |
6.71 |
1. Vermont | Score of 8.31 out of 10
Vermont leads the nation in healthy aging. Around one in six (16.7%) of over-65s have diabetes, the lowest in the country, and obesity affects just 24.4%. Functional disability is also less common, with under a third (27.7%) of older adults reporting serious limitations, well below many other states.
Even though it is already the healthiest places for seniors, policies in Vermont are looking to go one step further. For example, Age Strong Vermont is a 10-year plan that aims to make it an age-friendly state through holistic initiatives.3
2. Hawaii | Score of 8.17 out of 10
Hawaii’s older adults live longer than anywhere else in America. Life expectancy after 65 reaches 20.6 years, over four years longer than in West Virginia. Obesity affects a fifth (20.5%) of older adults, and cardiovascular disease is relatively rare at 17.0%.
Seniors in Hawaii have plenty of support to age well, while still being able to stay at home. The Hawai‘i Community Foundation runs a multi-year grant program, called Kūpuna Aging in Place (KAP), which funds organizations that help older adults with services like community programs, adult day care and health, and caregiver support.
3. Colorado | Score of 7.96 out of 10
Older adults in Colorado fare better than most of the nation, particularly when it comes to staying active and avoiding obesity. Almost a quarter (23.8%) of over 65s are obese, and only 23.0% are inactive – the third-lowest rate in the nation.
The state’s culture of outdoor recreation supports habits that carry into older age and could have impacted these numbers. Studies show that 72% of Coloradans spend recreational time outdoors once or more per week, which helps build lifelong activity patterns that benefit health well beyond 65.4
The states with the worst quality of life for seniors
|
|
|
Prevalence (65+) |
|
|
|||||||
|
Rank |
State |
High cholesterol |
Obesity |
Cardiovascular diseases |
Diabetes |
Cancer |
Physical inactivity |
Functional disability |
Frequent mental distress |
Life expectancy at 65 (years) |
Score /10 |
|
1 |
West Virginia |
61.1% |
34.7% |
29.3% |
30.8% |
20.2% |
41.7% |
39.4% |
12.7% |
16.1 |
0.86 |
|
2 |
Alabama |
61.9% |
33.6% |
26.1% |
28.4% |
22.1% |
41.0% |
38.0% |
7.5% |
16.4 |
1.67 |
|
3 |
Louisiana |
56.4% |
36.1% |
25.3% |
29.4% |
18.0% |
40.4% |
38.7% |
10.9% |
16.8 |
1.78 |
|
4 |
Mississippi |
58.2% |
32.2% |
23.5% |
31.4% |
19.0% |
42.2% |
40.9% |
9.2% |
16.1 |
2.06 |
|
5 |
Indiana |
58.3% |
35.3% |
23.2% |
25.8% |
21.7% |
32.2% |
33.4% |
9.1% |
17.3 |
2.15 |
|
5 |
Tennessee |
57.7% |
33.4% |
26.1% |
27.3% |
19.7% |
36.9% |
34.8% |
9.7% |
16.6 |
2.15 |
|
7 |
Arkansas |
55.6% |
34.2% |
25.5% |
24.4% |
19.9% |
40.2% |
38.8% |
8.1% |
16.6 |
2.54 |
|
8 |
Georgia |
59.2% |
32.1% |
20.8% |
27.9% |
20.0% |
36.3% |
34.2% |
10.0% |
17.1 |
2.75 |
|
9 |
Oklahoma |
56.8% |
32.8% |
25.4% |
23.7% |
18.2% |
39.0% |
40.1% |
8.6% |
16.4 |
2.80 |
|
10 |
Virginia |
57.9% |
33.6% |
24.2% |
25.4% |
21.2% |
33.9% |
30.5% |
10.0% |
18.2 |
2.82 |
1. West Virginia | Score of 0.86 out of 10
No state struggles more with aging well than West Virginia. More than a third of older adults live with obesity (34.7%), almost the same share have diabetes (30.8%), and two in five (39.4%) over-65s report serious limitations in daily life.
Life expectancy at 65 is just over 16 years, the joint lowest in the country with Mississippi. However, programs like Try This West Virginia, which back community-led health projects to increase movement and healthy living, are a positive step.1
2. Alabama | Score of 1.67 out of 10
High cholesterol affects almost 61.9% of over-65s in Alabama, and obesity and diabetes are also widespread. The state’s older adults are among the least active in the country, with two in five (41.0%) reporting little regular physical activity.
This combination can take a toll. Almost two-fifths (38.0%) of people over 65 live with functional disabilities, and life expectancy after 65 is only 16.4 years.
3. Louisiana | Score of 1.78 out of 10
Obesity is a big challenge for Louisiana’s older adults. Over a third (36.1%) of over-65s are affected, the highest share in the US. Inactivity is also widespread, with 40.4% reporting little or no exercise. Together, these factors could contribute to the high rates of diabetes (29.4%) and cardiovascular disease (25.3%).
While the state promotes programs encouraging healthier eating and more activity, barriers remain. Sixty of Louisiana’s 64 parishes are officially designated as Health Professional Shortage Areas for primary care, limiting access to doctors, which could reduce opportunities for prevention and treatment.2
How many older Americans live with chronic conditions?
Across the United States, almost every older adult is now living with at least one chronic condition. In 2023, over nine in 10 (93.0%) adults aged 65 and over reported managing one or more long-term health problems, a slight increase of 0.5% since 2015.
These conditions often include things like:
● Heart disease
● Diabetes
● Arthritis
● Chronic respiratory problems
For many people, that can mean reduced independence, difficulty staying active, and a higher risk of further complications with age.
Which health conditions are rising among older adults?
To understand the picture in more detail, we’ve looked at how the prevalence of specific chronic conditions has shifted over time.
|
|
Prevalence (65+) |
||||
|
Year |
Obesity |
Diabetes |
High cholesterol |
Heart disease |
Cancer diagnoses* |
|
2015 |
27.6% |
22.7% |
54.5% |
22.3% |
27.2% |
|
2016 |
28.0% |
23.2% |
|
22.4% |
27.5% |
|
2017 |
28.5% |
22.6% |
51.7% |
21.7% |
27.9% |
|
2018 |
28.9% |
23.9% |
|
22.3% |
28.3% |
|
2019 |
29.3% |
23.0% |
51.2% |
21.3% |
28.6% |
|
2020 |
29.3% |
22.5% |
|
21.5% |
28.9% |
|
2021 |
29.5% |
22.6% |
53.7% |
20.6% |
29.2% |
|
2022 |
30.6% |
23.9% |
|
22.4% |
29.5% |
|
2023 |
30.2% |
23.5% |
55.2% |
20.5% |
|
|
Difference |
9.4% |
3.5% |
1.3% |
-8.1% |
9.5% |
*Excludes skin cancer
Focusing on specific conditions shows both progress and new challenges for older adults. Since 2015, obesity rates in people aged 65 and over have risen from 27.6% to 30.2%, and diabetes has also become more common (from 22.7% to 23.5%). High cholesterol remains one of the most widespread issues, affecting more than half (55.2%) of older adults in 2023.
There are areas of improvement, too. Fewer older adults are now living with heart disease, which may be linked to advances in medical treatment and lifestyle changes, such as falling smoking rates.5 But at the same time, the share of people with a cancer diagnosis has increased from 27.2% to 29.5%.
Expert advice for living well in later life
Dr Weiss gives advice on how people can take charge of their health and quality of life in their later years:
“Living longer does not always mean living better, but there are steps you can take to protect your health and independence as you age. Small, consistent choices add up over time.
“Staying active is one of the most powerful tools you have. Aim for daily movement, whether that is walking, gardening, or gentle strength exercises that keep muscles and joints strong.
“Pay attention to your diet, focusing on balanced meals with plenty of fruit, vegetables, and lean protein.
“Preventive care also matters. Keep up with screenings, manage conditions like high blood pressure or diabetes early, and do not hesitate to ask for support.
“Sleep is a pillar of healthy aging that often gets overlooked. Quality sleep supports everything from heart health to mental well-being. The right sleep environment can make all the difference, which is why adjustable beds and specialist mattresses are so valuable. They can relieve pressure, improve circulation, and provide comfort for those managing chronic conditions or reduced mobility.
“Just as important is looking after your mental health and social connections. Join community groups, volunteer, or make time for hobbies you enjoy. A strong support network and sense of purpose can make a real difference to wellbeing in later life.”
Methodology
Opera Beds has designed and supplied home-hospital beds that combine advanced clinical features with a homelike style for over 20 years. Our mission is to improve comfort, mobility, and independence for people across the United States through thoughtful, high-quality bed solutions.
Keen to understand how well America is aging, we wanted to explore chronic health conditions, disability, and well-being in adults aged 65 and over by gathering the following data:
- National insights
We used Americas Health Rankings to find the most recent national rates of the following conditions among adults (for adults 65+):
● High cholesterol
● Obesity
● Heart disease
● Diabetes
We then found the rates for each condition in 2015 (the oldest date for which data was available for each condition) and calculated the percentage change in prevalence.
- State comparisons
We then collected the rates of each of these chronic conditions among people aged 65+, as well as the following data for each state:
● Physical inactivity: https://www.americashealthrankings.org/explore/measures/Sedentary
● Functional disability: https://www.americashealthrankings.org/explore/measures/functional_disability_sr
● Frequent mental distress 65+: https://www.americashealthrankings.org/explore/measures/mental_distress_sr
● Life expectancy at 65: https://www.cdc.gov/nchs/data/nvsr/nvsr73/nvsr73-07.pdf
We combined this state-level data for all factors into a single score to reveal the states where older adults can expect the best quality of life.
Note: Kentucky and Pennsylvania were removed from this section due to a lack of data.
All data was collected in September 2025 and is correct as of then.
Sources
- Try This West Virginia
- American Medical Association
- Vermont Department of Health
- Colorado Parks & Wildlife
- American Lung Association
