By Monica E. Oss, Chief Executive Officer, OPEN MINDS
A new Census Bureau report—Older Adults Outnumber Children In 11 States, Nearly Half Of Counties—should have every executive thinking. Older adults now outnumber children in 11 states—up from just three states in 2020. Nearly half of all counties across the country are now home to more adults 65 and older than kids under the age of 18. The share of older adults in the population has risen from 12.4% in 2004 to 18% in 2024, while the share of children has dropped from 25% to 21.5%.
The problem with demographic changes is that they are gradual and don’t make headlines like wars or stock market blips. They quietly reshape everything from politics to labor markets and housing. Like tectonic plates, demographic forces shift slowly beneath our feet, while profoundly redefining everything above.
The demographics are telling. In 2020, there were only three states where older adults outnumbered children: Maine, Vermont, and Florida. By 2024, the number of those states had increased from three to 11 to include Delaware, Hawaii, Montana, New Hampshire, Oregon, Pennsylvania, Rhode Island, and West Virginia. Perhaps even more striking, in 2024, 1,411 counties—45% of all counties—had more older adults than children. That’s an increase from 983 counties (31%) just four years ago.
The regional variations in the Census Bureau data are telling. Regionally, the West (38.4) and South (38.8) had the lowest median ages in 2024; the Northeast had the highest (40.6), followed by the Midwest (39.3). Maine’s population in 2024 was the oldest, with a median age of 44.8; Utah’s was the youngest (32.4).
The metro area with the highest median age in 2024 (68.1) was Wildwood-The Villages, Florida, where 57% of the population was 65 and older. Two other Florida metro areas—Punta Gorda and Homosassa Springs—followed closely with the second-highest (60.1) and third-highest (56.8) median ages. More than 35% of both populations were 65 and older. Metro areas with the youngest median age were in Provo-Orem-Lehi (26.4 years) and in Logan (27) both located in Utah. Both metro areas have a large university.
The mental health statistics of the aging population are also telling. About 16% of older adults (12.7 million) received mental health treatment in the past year. Older adult females were more likely than older adult males to have received treatment, 19.6% versus. 11.9%, respectively.
And 12.8% of older adults (10 million) engaged in binge drinking in the past month, including 2.5 million (3.2%) who engaged in heavy drinking. In both cases, older adult males were more likely to engage in binge drinking and heavy drinking—ten times more and twice as likely, respectively.
This demographic shift—and the shift in demand—is going to have an effect on health care and caregiving. An older population will present with more chronic conditions, more caregiving needs, and higher long-term care costs. Provider organizations will need a reimagined care infrastructure that blends technology, new service models, and family and community support. And in many regions, declining school-age populations will spark debates about what were once routine resource allocations. Infrastructure built for children, such as local schools, will compete for funding with services facing increasing demands to support an aging population, including transportation, housing, home services, community hospitals, and next-generation senior centers.
For most community-based provider organizations, to navigate the decade ahead—their strategies need to move from age-aware to age-ready. This means developing a service strategy for older adults, including service lines specifically developed for this demographic.
And the current snapshot of the population demographics is only the start of the trend. The number of Americans ages 65 and older is projected to increase from 58 million in 2022 to 82 million by 2050 (a 47% increase), and the 65-and-older age group’s share of the total population is projected to rise from 17% to 23%. What we see now in this demographic shift is only the tip of the iceberg.