Healthiest states for seniors

Written by:
November 4, 2020
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Healthiest states for seniors

Hawaii tops the list as the state with the healthiest seniors, while Mississippi is last, facing challenges of poverty and early deaths. This ranking of states is based on the health of their seniors, across a range of measures, from obesity to excessive drinking to smoking habits and rates of poverty.

Services to make it easier for older Americans to stay in their homes have improved across the country. The reach of SNAP—the Supplemental Nutrition Assistance Program—has increased and the number of home health care workers rose. But problems remain, including an increased incidence of depression and such unhealthy behavior as heavy drinking. Too many seniors are deferring visits to the doctor because of cost. Differences between men and women are apparent too. Older women are more likely to be physically inactive. Men are more likely to die by suicide and to smoke and drink too much.

The number of young seniors, those 65 to 74, is growing. They are more racially and ethnically diverse, with more Black and Hispanic seniors in the group. Compared to 15 years ago, fewer young seniors are dying early and they smoke less. They also are more obese and have higher rates of diabetes.

To determine which U.S. states are the most and least healthy for their senior populations, Stacker consulted America’s Health Rankings’ 2019 Senior Report. The public health researchers behind this report analyzed 34 metrics of senior health for every state, ranging from nursing home quality to preventable hospitalizations. The metrics are split into five categories: behaviors, community and environment, policy, clinical care, and health outcomes.

Stacker included each state’s overall score and its rank in all five categories in this story. See where your state falls on this important measure.

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#50. Mississippi

- Overall score (relative to U.S. average): -0.989
- Senior behaviors rank: #48
- Community & environment rank: #50
- Policy rank: #41
- Clinical care rank: #49
- Health outcomes rank: #50

Mississippi faces serious challenges, with many of its seniors living in poverty, and a high early death rate. On the plus side is its low rate of excessive drinking among older adults. Many more adults die in hospice care than hospital ICUs.

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#49. Kentucky

- Overall score (relative to U.S. average): -0.88
- Senior behaviors rank: #49
- Community & environment rank: #47
- Policy rank: #32
- Clinical care rank: #44
- Health outcomes rank: #49

Kentucky has a low percentage of nursing home residents needing care in the category of "only with everyday tasks" and conversely a high percentage of those with a personal doctor. Poverty rates have fallen, but food insecurity has grown.

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#48. Louisiana

- Overall score (relative to U.S. average): -0.857
- Senior behaviors rank: #50
- Community & environment rank: #49
- Policy rank: #34
- Clinical care rank: #38
- Health outcomes rank: #43

For Louisiana’s seniors, there is a high rate of home health care workers. A large number of seniors have a personal doctor and they increasingly make use of hospice care. On the minus side, obesity and food insecurity are common and excessive drinking has increased.

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#47. Oklahoma

- Overall score (relative to U.S. average): -0.784
- Senior behaviors rank: #46
- Community & environment rank: #40
- Policy rank: #48
- Clinical care rank: #42
- Health outcomes rank: #45

More than two-thirds of Oklahoma seniors get their flu shots. And they have a low prevalence of excessive drinking. They are smoking less, but obesity rates have increased by over 20%. 

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#46. West Virginia

- Overall score (relative to U.S. average): -0.687
- Senior behaviors rank: #47
- Community & environment rank: #43
- Policy rank: #18
- Clinical care rank: #37
- Health outcomes rank: #47

West Virginia is seeing more than a 20% rise in obesity among seniors. Food insecurity is also increasing. The state faces a low percentage of able-bodied seniors and a high early death rate. On the plus side, few seniors drink to excess and many get flu shots.

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#45. Arkansas

- Overall score (relative to U.S. average): -0.652
- Senior behaviors rank: #42
- Community & environment rank: #39
- Policy rank: #36
- Clinical care rank: #43
- Health outcomes rank: #48

Few seniors in Arkansas drink to excess, but they also are not active and have a high early death rate. Obesity recently rose more than 10%, and the incidence of depression among seniors increased, but food insecurity decreased.

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#44. Alabama

- Overall score (relative to U.S. average): -0.594
- Senior behaviors rank: #43
- Community & environment rank: #37
- Policy rank: #28
- Clinical care rank: #31
- Health outcomes rank: #46

Obesity and poverty rates have dropped in the state, but food insecurity recently rose by over 10%. Few seniors in Alabama drink excessively, but they also are not physically active.

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#43. Tennessee

- Overall score (relative to U.S. average): -0.528
- Senior behaviors rank: #41
- Community & environment rank: #42
- Policy rank: #13
- Clinical care rank: #45
- Health outcomes rank: #44

Tennessee has a low prevalence of excessive drinking and a high percentage of seniors who are managing their diabetes. On the minus side, fewer that half of residents get their flu shots, with vaccination coverage falling in recent years, and there is a high prevalence of smoking, though rates are on a downward trend.

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#42. New Mexico

- Overall score (relative to U.S. average): -0.454
- Senior behaviors rank: #31
- Community & environment rank: #45
- Policy rank: #43
- Clinical care rank: #35
- Health outcomes rank: #42

A high percentage of New Mexico’s seniors are poor, with a high prevalence of food insecurity and a low number with a personal doctor. Smoking increased 31% from 2018 to 2019. Seniors also have a low prevalence of obesity.

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#41. Georgia

- Overall score (relative to U.S. average): -0.416
- Senior behaviors rank: #40
- Community & environment rank: #48
- Policy rank: #23
- Clinical care rank: #26
- Health outcomes rank: #39

Georgia has low numbers of seniors who drink excessively, however, the prevalence increased 19% from 2017 to 2019. Physical inactivity also rose 17% in the same period. On the other hand, poverty decreased 10% in the six-year period ending in 2019.

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#40. Texas

- Overall score (relative to U.S. average): -0.318
- Senior behaviors rank: #36
- Community & environment rank: #46
- Policy rank: #21
- Clinical care rank: #19
- Health outcomes rank: #38

Texas has a high percentage of seniors living in poverty. Obesity rose 16% in the six-year period ending in 2019, as did physical inactivity, up 11% from 2016 to 2019. The good news is that Texan seniors have a low prevalence of smoking, and food insecurity has fallen.

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#39. Missouri

- Overall score (relative to U.S. average): -0.3
- Senior behaviors rank: #30
- Community & environment rank: #31
- Policy rank: #45
- Clinical care rank: #29
- Health outcomes rank: #40

Missouri’s seniors get their flu shots and are cutting back on their smoking, which fell 19% in the five-year period ending in 2019. However, poverty rates have risen, and seniors have a high early death rate.

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#38. Nevada

- Overall score (relative to U.S. average): -0.298
- Senior behaviors rank: #37
- Community & environment rank: #35
- Policy rank: #35
- Clinical care rank: #48
- Health outcomes rank: #32

In Nevada, there are a high number of smokers, and the problem worsened from 2018 to 2019, when smoking increased 22%. More depression was reported from 2013 to 2019, and residents reported being less physically active in the years from 2016 to 2019. The number of seniors with a personal doctor is low. 

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#37. North Carolina

- Overall score (relative to U.S. average): -0.272
- Senior behaviors rank: #44
- Community & environment rank: #44
- Policy rank: #8
- Clinical care rank: #10
- Health outcomes rank: #41

A large number of seniors get flu shots in North Carolina and have a personal doctor. But a high number of the state’s seniors report frequent mental distress, and the state’s obesity rate is on the rise, up 17% in the years from 2016 to 2019.

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#36. Indiana

- Overall score (relative to U.S. average): -0.24
- Senior behaviors rank: #39
- Community & environment rank: #32
- Policy rank: #27
- Clinical care rank: #39
- Health outcomes rank: #36

Indiana’s seniors manage their arthritis successfully, and a low percentage of them live in poverty. But too few seniors get their flu shots and there is a high percentage of obesity. One bad habit is on the rise—drinking to excess, up 33% in the years from 2016 to 2019. Another is decreasing—smoking fell 10% in the same period.

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#35. Wyoming

- Overall score (relative to U.S. average): -0.166
- Senior behaviors rank: #32
- Community & environment rank: #5
- Policy rank: #50
- Clinical care rank: #50
- Health outcomes rank: #30

Wyoming has a high number of meals delivered to seniors’ homes, though the number fell 18% from 2017 to 2019. There is a low level of frequent mental distress, but also a low level of seniors with personal doctors. Obesity is on the rise, increasing 40% in the years from 2013 to 2019.

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#34. South Carolina

- Overall score (relative to U.S. average): -0.102
- Senior behaviors rank: #25
- Community & environment rank: #33
- Policy rank: #19
- Clinical care rank: #13
- Health outcomes rank: #37

Few South Carolinian seniors drink to excess. Deaths in hospitals fell 42% in the years from 2013 to 2019, while seniors made use of hospice care. Food insecurity is high, though it dropped 12% from 2017 to 2019. There is a high prevalence of frequent mental distress, and smoking increased 15% in the years from 2015 to 2019.

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#33. Alaska

- Overall score (relative to U.S. average): -0.082
- Senior behaviors rank: #45
- Community & environment rank: #4
- Policy rank: #40
- Clinical care rank: #47
- Health outcomes rank: #24

Alaska has its challenges: a high prevalence of obesity that rose 19% in the years from 2013 to 2019; low numbers of seniors who get vaccinated against the flu; and a 20% rise in smoking from 2017 to 2019. Poverty is also up among seniors. Early deaths dropped and there is a low prevalence of frequent mental distress.

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#31. Arizona

(tie)
- Overall score (relative to U.S. average): -0.077
- Senior behaviors rank: #24
- Community & environment rank: #41
- Policy rank: #37
- Clinical care rank: #21
- Health outcomes rank: #25

Arizona has a low percentage of obesity, though it increased 16% in the years from 2013 to 2019. Physical inactivity also increased, up 16% in the three years ending in 2019. Food insecurity rose by more than half in recent years, and its prevalence is high.

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#31. Illinois

(tie)
- Overall score (relative to U.S. average): -0.077
- Senior behaviors rank: #29
- Community & environment rank: #34
- Policy rank: #16
- Clinical care rank: #41
- Health outcomes rank: #29

Illinois has a high number of able-bodied seniors, with a low prevalence of frequent mental distress. But too many do not get their flu shots, and smoking has risen 20% in the six-year period ending in 2019. The reach of SNAP—the Supplemental Nutrition Assistance Program, more colloquially known as food stamps—increased 15% from 2015 to 2019.

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#30. Ohio

- Overall score (relative to U.S. average): -0.063
- Senior behaviors rank: #34
- Community & environment rank: #27
- Policy rank: #25
- Clinical care rank: #15
- Health outcomes rank: #35

A high number of Ohio’s seniors have a personal doctor and they manage their arthritis successfully. But physical inactivity, smoking, and early deaths are also high. Excessive drinking rose 11% in the three years ending in 2019, and smoking increased 14% from 2013 to 2019.

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#29. Florida

- Overall score (relative to U.S. average): -0.02
- Senior behaviors rank: #34
- Community & environment rank: #29
- Policy rank: #28
- Clinical care rank: #22
- Health outcomes rank: #28

Florida has a low prevalence of obesity and a high percentage of four- and five-star nursing home beds. Food insecurity dropped 32% from 2013 to 2019. But smoking increased 20% in the four-year period ending in 2019, and the number of people with a personal doctor also fell.

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#28. Kansas

- Overall score (relative to U.S. average): -0.019
- Senior behaviors rank: #20
- Community & environment rank: #16
- Policy rank: #47
- Clinical care rank: #32
- Health outcomes rank: #33

Kansas has a low number of seniors living in poverty and a low prevalence of food insecurity. But it also saw excessive drinking increase 27% in the three-year period ending in 2019. The number of home-delivered meals fell by 12% from 2017 to 2019.

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#27. Montana

- Overall score (relative to U.S. average): -0.001
- Senior behaviors rank: #23
- Community & environment rank: #6
- Policy rank: #49
- Clinical care rank: #40
- Health outcomes rank: #26

Montana’s strengths include its low level of obesity, its high expenditures for community support, and a high percentage of home-delivered meals. On the down side: a low prevalence of seniors with a personal doctor and a high (and increasing) prevalence of excessive drinking.

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#26. Michigan

- Overall score (relative to U.S. average): 0.058
- Senior behaviors rank: #27
- Community & environment rank: #23
- Policy rank: #15
- Clinical care rank: #25
- Health outcomes rank: #31

Michigan has a high prevalence of obesity, though physical inactivity has decreased in recent years. Poverty rose  and SNAP’s reach shrunk in the same period. But the state has a high percentage of seniors with personal doctors and seniors who get home-delivered meals.

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#25. Virginia

- Overall score (relative to U.S. average): 0.075
- Senior behaviors rank: #15
- Community & environment rank: #26
- Policy rank: #39
- Clinical care rank: #22
- Health outcomes rank: #27

Virginia has a low percentage of seniors living in poverty and high flu vaccination coverage. On the down side, the state saw an increase in excessive drinking, by 31%, in the two-year period ending in 2019, and community support for meals, personal care, and other expenses has dropped.

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#24. Idaho

- Overall score (relative to U.S. average): 0.115
- Senior behaviors rank: #12
- Community & environment rank: #17
- Policy rank: #46
- Clinical care rank: #27
- Health outcomes rank: #22

Idaho’s seniors are active and obesity dropped 13% in recent years. Community support increased 9% from 2017 to 2019. But few seniors have a personal doctor, and few get their flu shots.

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#23. Nebraska

- Overall score (relative to U.S. average): 0.146
- Senior behaviors rank: #21
- Community & environment rank: #10
- Policy rank: #44
- Clinical care rank: #28
- Health outcomes rank: #18

Nebraska’s seniors get their flu shots and few are living in poverty. But there is a high prevalence of obesity, and it increased 17% from 2013 to 2019. Also on the minus side, excessive drinking rose 27% in the three years ending in 2019.

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#22. South Dakota

- Overall score (relative to U.S. average): 0.162
- Senior behaviors rank: #18
- Community & environment rank: #13
- Policy rank: #42
- Clinical care rank: #36
- Health outcomes rank: #17

South Dakota has a low prevalence of excessive drinking, but poverty decreased and physical activity rose 27% from 2018 to 2019. Obesity is also on the rise, up 28% in the six years ending in 2019.

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#21. New Jersey

- Overall score (relative to U.S. average): 0.178
- Senior behaviors rank: #11
- Community & environment rank: #30
- Policy rank: #11
- Clinical care rank: #33
- Health outcomes rank: #23

New Jersey has a high percentage of able-bodied seniors and a low early death rate. It has high levels of physical inactivity, which rose in the two years ending in 2019, but obesity decreased 5% from 2018 to 2019.

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#19. Oregon

- Overall score (relative to U.S. average): 0.194
- Senior behaviors rank: #33
- Community & environment rank: #19
- Policy rank: #9
- Clinical care rank: #24
- Health outcomes rank: #18

Oregon seniors are active, but in the six years ending in 2019, obesity rates rose 23%. For adults 60 and older with some difficulty living on their own, deliveries of meals increased 6% from 2018 to 2019, and there is a high level of enrollment in SNAP aka food stamps.

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#19. Pennsylvania

- Overall score (relative to U.S. average): 0.194
- Senior behaviors rank: #22
- Community & environment rank: #28
- Policy rank: #2
- Clinical care rank: #11
- Health outcomes rank: #34

Pennsylvania has a high prevalence of obesity, and in the three years ending in 2019, food insecurity increased 40%. Poverty rose by 9% from 2018 to 2019, but excessive drinking dropped 17%. Two other promising signs include the increasing percentage of those getting flu shots and a reduction in early deaths.

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#18. North Dakota

- Overall score (relative to U.S. average): 0.233
- Senior behaviors rank: #38
- Community & environment rank: #1
- Policy rank: #31
- Clinical care rank: #46
- Health outcomes rank: #5

North Dakota saw smoking increase 28% in the two years ending in 2019, and incidents of depression rose by 43% from 2018 to 2019. The state has a low prevalence of food insecurity, but also few seniors with a personal doctor. Enrollment in SNAP is low, too.

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#17. California

- Overall score (relative to U.S. average): 0.256
- Senior behaviors rank: #5
- Community & environment rank: #38
- Policy rank: #14
- Clinical care rank: #12
- Health outcomes rank: #20

California’s seniors are physically active and have a low smoking rate. Home health care workers are available: The numbers increased 24% per adult 75 and older from 2018 to 2019. But excessive drinking is also prevalent, and increased 26% in that same timeframe.

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#16. New York

- Overall score (relative to U.S. average): 0.28
- Senior behaviors rank: #19
- Community & environment rank: #36
- Policy rank: #1
- Clinical care rank: #34
- Health outcomes rank: #12

New York seniors have stepped up their physical exercise, with inactivity falling 10% in the six years ending in 2019. SNAP enrollment is high, home health care workers are available, and the early death rate is low. On the other hand, excessive drinking rose 17% from 2016 to 2019.

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#15. Delaware

- Overall score (relative to U.S. average): 0.284
- Senior behaviors rank: #27
- Community & environment rank: #14
- Policy rank: #20
- Clinical care rank: #1
- Health outcomes rank: #21

Delaware has a large percentage of able-bodied seniors, but it also has a problem with obesity that rose 12% from 2018 to 2019, and a high prevalence of physical inactivity. Poverty also increased 37% in that period.

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#14. Washington

- Overall score (relative to U.S. average): 0.396
- Senior behaviors rank: #7
- Community & environment rank: #18
- Policy rank: #12
- Clinical care rank: #19
- Health outcomes rank: #16

Smoking is on the decline in Washington, dropping 16% in the two years ending in 2019, and the state's seniors are active. They enroll in SNAP—its reach rose 12% in that same timeframe. The number of home health care workers available for those 75 and older increased 70% from 2018 to 2019.

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#13. Iowa

- Overall score (relative to U.S. average): 0.401
- Senior behaviors rank: #12
- Community & environment rank: #8
- Policy rank: #33
- Clinical care rank: #9
- Health outcomes rank: #12

Iowa has a low percentage of poor seniors, and poverty fell 13% from 2015 to 2019. Excessive drinking has decreased. But the number of seniors getting flu shots also fell and obesity increased.

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#12. Maryland

- Overall score (relative to U.S. average): 0.406
- Senior behaviors rank: #12
- Community & environment rank: #22
- Policy rank: #7
- Clinical care rank: #17
- Health outcomes rank: #11

Large numbers of Maryland seniors get flu shots and have a personal doctor. The number of poor adults 60 and older who enroll in SNAP rose 11% from 2018 to 2019. On the other hand, the percentage of adults who have some difficulty living independently and who have meals delivered to their homes is low. Obesity rose 19% in five years ending in 2019.

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#11. Massachusetts

- Overall score (relative to U.S. average): 0.411
- Senior behaviors rank: #26
- Community & environment rank: #11
- Policy rank: #5
- Clinical care rank: #18
- Health outcomes rank: #15

Excessive drinking is high in Massachusetts, rising 24% from 2017 to 2019. The number of flu vaccinations fell, with coverage decreasing 13% in the four years ending in 2019, and the incidents of depression rose 27% from 2013 to 2019. On the plus side, high numbers of seniors enroll in SNAP and spending for community support is high, too.

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#10. Wisconsin

- Overall score (relative to U.S. average): 0.444
- Senior behaviors rank: #17
- Community & environment rank: #15
- Policy rank: #24
- Clinical care rank: #7
- Health outcomes rank: #6

Excessive drinking is rising in Wisconsin, up 15% in the two years ending in 2019. Poverty also rose 10% in that timeframe, and incidents of depression were up 29% from 2013 to 2019. Obesity is a problem, but it decreased 16% from 2018 to 2019. SNAP reach has increased in recent years.

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#8. Maine

- Overall score (relative to U.S. average): 0.448
- Senior behaviors rank: #16
- Community & environment rank: #19
- Policy rank: #6
- Clinical care rank: #5
- Health outcomes rank: #12

Drinking to excess is on the rise in Maine, up 15% in the two years ending in 2019. Obesity is a problem too, though it decreased 16% from 2018 to 2019, and there is a high percentage of able-bodied seniors. SNAP reach rose 19% in the four years leading up to 2019.

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#8. Vermont

- Overall score (relative to U.S. average): 0.448
- Senior behaviors rank: #10
- Community & environment rank: #3
- Policy rank: #22
- Clinical care rank: #30
- Health outcomes rank: #10

The number of early deaths fell 6% from 2014 to 2019, there is a low percentage of ICU use among seniors, and the number of four- or five-star nursing home beds rose 16% in the three years ending in 2019. Smoking increased 16% from 2018 to 2019, and the number of home health care workers decreased 12% in that period.

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#7. Rhode Island

- Overall score (relative to U.S. average): 0.456
- Senior behaviors rank: #8
- Community & environment rank: #25
- Policy rank: #10
- Clinical care rank: #2
- Health outcomes rank: #9

The number of seniors in this New England state who have a personal doctor is high; poverty decreased by 13% from 2017 to 2019; and food insecurity dropped 19% over the five years ending in 2019. But heavy drinking increased 23% over the two years ending in 2019, and early deaths increased 9% from 2018 to 2019.

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#6. New Hampshire

- Overall score (relative to U.S. average): 0.552
- Senior behaviors rank: #6
- Community & environment rank: #2
- Policy rank: #38
- Clinical care rank: #14
- Health outcomes rank: #4

New Hampshire has a small number of seniors living in poverty and a high percentage of seniors who get home-delivered meals. It also has a high prevalence of heavy drinking, which increased 23% in the three years leading up to 2019. The number of four- or five-star nursing home beds fell by 15% from 2015 to 2019.

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#5. Colorado

- Overall score (relative to U.S. average): 0.631
- Senior behaviors rank: #3
- Community & environment rank: #12
- Policy rank: #25
- Clinical care rank: #4
- Health outcomes rank: #8

Colorado’s seniors are physically active, have a low rate of early deaths and a low prevalence of food insecurity, which fell 60% in the three years ending in 2019. On the downside, poverty increased 11% from 2017 to 2019 and heavy drinking rates rose 23% in the three years leading up to 2019.

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#4. Minnesota

- Overall score (relative to U.S. average): 0.655
- Senior behaviors rank: #9
- Community & environment rank: #8
- Policy rank: #17
- Clinical care rank: #6
- Health outcomes rank: #1

Minnesota has large numbers of home health care workers relative to the population, poverty decreased from 2013 to 2019, and SNAP reach increased in the four years ending in 2019. Heavy drinking is high, and the prevalence of smoking is rising.

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#3. Connecticut

- Overall score (relative to U.S. average): 0.661
- Senior behaviors rank: #4
- Community & environment rank: #21
- Policy rank: #3
- Clinical care rank: #16
- Health outcomes rank: #3

Connecticut has high numbers of able-bodied seniors, a high SNAP enrollment, and a low early death rate. Food insecurity fell 21% in the three years leading up to 2019. Obesity increased 6% from 2018 to 2019, however, and the state has a high percentage of hospital deaths, though hospice care did increase 70% in the six years ending in 2019.

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#2. Utah

- Overall score (relative to U.S. average): 0.71
- Senior behaviors rank: #2
- Community & environment rank: #7
- Policy rank: #28
- Clinical care rank: #3
- Health outcomes rank: #7

Utah has a low prevalence of smoking, which increased from 2018 to 2019, but only among a small number of seniors. The same is true for excessive drinking. The state has a low percentage of hospital deaths, and food insecurity fell in the five years ending in 2019. Flu vaccination coverage is low, however.

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#1. Hawaii

- Overall score (relative to U.S. average): 0.778
- Senior behaviors rank: #1
- Community & environment rank: #23
- Policy rank: #3
- Clinical care rank: #8
- Health outcomes rank: #2

Hawaii has a low level of obesity, a low early death rate, and a high quality of nursing homes as measured by the percentage of four- and five-star beds. But obesity is increasing, the prevalence of heavy drinking is high, and SNAP reach fell.

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