Having coped with aging parents in various state and local settings, Charles Lockhart and Jean Giles-Sims learned through both personal experience and vigorous research which key economic, sociological, cultural, and policy variables should inform older Americans' decisions in choosing where to live during retirement and old age. In a well-written book that is useful to both the general public and scholars alike, Lockhart and Giles-Sims pose five basic issues that seniors must consider: 1) Where can retirees best find a life of companionship and active recreation? 2) Where can retirees best find a meaningful life and supportive communities? 3) Where can retirees best afford to live (and be safe)? (4) Where will retirees have the greatest opportunity for being healthy and finding the best medical care? And 5) where can retirees find accessible, affordable, high-quality long-term care?
The authors attempt to synthesize a massive amount of demographic data that address these questions. They understand that older Americans are a very diverse population and that the nation's 50 states often contain major internal variations (urban vs. rural areas, for example). Still, they produce several intriguing, recurring patterns of opportunities and services available by state. Much of this book is a plainly written description of a variety of factors (income inequality, cost of living, Robert Putnam's “social capital index,” and several indices of political culture, health spending, and health outcomes) and how they produce differing types of “Senior State Friendliness” (SFF) as displayed on dozens of national maps. A concluding chapter is more complex, as the authors use regression analyses to try to identify key variables that explain these interstate differences.
One reader-friendly heuristic device employed by the authors is profiles of hypothetical older couples (and a few singles) who make (or do not make) geographical moves at various stages in the aging cycle. Indeed, this is an important point of the book: Seniors (and their adult children, if any) must be aware of the progressive stages of aging. States that rank well on measures of interest to “active seniors” (recreation, climate, leisure activities) may not be well matched to the more intensive medical needs (availability of medical specialists, hospitals, and long-term-care services) and community support (and proximity of family members) required in late old age. Few states, the authors find, “have it all.”
As Lockhart and Giles-Sims demographically map and analyze factors related to Senior State Friendliness, definite geopolitical and sociocultural patterns emerge. They eventually conclude that “with some exceptions, different southern regions lead the recreational lifestyle dimension of SSF. Various northern regions tend to lead on the meaningful contributions and supportive communities; the health and high quality medical care; and the accessible high quality long-term care dimensions. Northwestern/north-central and south-central southeastern regions provide greater affordability” (p. 124). Indeed, it is hard not to notice that the nation's poorest, often racially divided “Deep South” states (Louisiana, Mississippi, Alabama) fare worst on most indexes (except climate and affordability) and “hold a near monopoly on the bottom ranks of health and high quality medical care” (p. 124). Conversely, the more ethnically and economically homogeneous northern “heartland” states, from the Rockies (Idaho, Montana, Wyoming, Utah) into the Great Plains (North and South Dakota, Minnesota, Iowa), generally fare very well on Lockhart and Giles-Sims's five key senior questions—with the exception, of course, of long and cold winters, which negatively impact “recreation.”
Why do some states have more SSF than others? In the concluding chapter, Lockhart and Giles-Sims calculate regression coefficients to explain variations in the five SSF issues as dependent variables using seven independent variables: state political culture, political (party) competition, state tax capacity, median income of seniors, proportion of seniors, proportion of minority seniors, and average senior property tax.
As might be expected, strong civic culture (“meaningful contributions and supportive communities”) is correlated with a solid middle class (median senior income) and active, participatory politics (political culture and party competition). And the authors glumly acknowledge their replication of Robert Putnam's famously controversial correlation, that “greater ethnic diversity depresses supportive community feelings” (p. 136). They are also puzzled by a regression coefficient indicating that rising proportions of minority seniors drives up the cost-of-living indexes (though this might have something to do with concentration of immigrant minority seniors in large cities).
Although climate and recreational factors might be largely beyond human control, Lockhart and Giles-Sims conclude that quality of life for aging Americans is largely dependent upon variables relating to culture, economic resources, politics, and public policy: “a cultural orientation towards using public policy to improve the lives of a large proportion of the population as possible coupled with the material capacity to support this inclination explain a good deal of the variation in SSF across the American states” (p. 139).
Of course, age differences are increasingly intertwined with other sociological factors, especially class and race. Indeed, the stark demographic differences among states presented throughout the book provide ample temptation to digress into these related factors. The regional differences in poverty, high inequality ratios, class, race/ethnicity, and public and private health insurance coverage (or lack thereof) fairly shout at social science readers familiar with health-care statistics and with demographic change. (The multivariate analyses of the prolific Brookings Institution demographer William Frey come to mind.) Lockhart and Giles-Sims might have paid a bit more attention to race/ethnicity and, perhaps, to gender: Women usually outlive men by several years, are more independent, and tend to have stronger social networks. But, by and large, the authors are to be commended for keeping a tight focus on the topic at hand: matching citizens' needs at various stages of aging to the ways in which states provide services and opportunities appropriate to those stages.
The tidal wave of 78 million baby boomers is rolling into the choices and dilemmas outlined in Aging Across the United States. (Indeed, many boomers—like the authors—may already be grappling with these matters as they care for older parents.) Lockhart and Giles-Sims provide a sophisticated road map for the changing terrain of retirement and aging. Their book combines scholarship with very useful information for a general audience and deserves wide notice. The editors at Penn State Press have wisely recognized this and Aging Across the United States will shortly appear in a more reasonably priced paperback edition.
