5 must-do's as age wave bears down on the USA

• Number of Americans 65 and older is likely to more than double by 2060
• In exclusive survey%2C 1 in 3 older Americans say their town isn%27t preparing for booming population
• The costs of adapting America to this very different demographic will be daunting

AUSTIN — As a city that prides itself on being young and hip, Austin didn't seem to notice that its residents were aging.

That is, until a report by the Brookings Institution pointed out that this city's metro area has the nation's fastest-growing percentage of "pre-seniors," ages 55 to 64, with a 110% increase from 2000 to 2010. Among those 65-plus, Austin is the second-fastest growing, after Raleigh-Cary, N.C.

"Being a creative community, we're going to work to find creative solutions," says Bobbie Barker, 61, co-chair of a task force charged with getting the city up to speed.

This demographic tidal wave that has awakened city planners here is washing across the USA, raising concerns about health challenges, adequate housing, mobility for seniors and simply ensuring that this swelling population can live fulfilling lives. The number of Americans 65 and older is likely to more than double in the next 50 years, and experts say that in some ways, we need to begin remaking America to meet the challenges of future generations.

As fiscal issues strain budgets at every level of government, the trick will be finding the dollars necessary to not just meet the growing entitlement needs of Social Security and Medicare — which in fiscal 2012 alone cost more than $1.2 trillion, just over a third of the entire federal budget — but also the untold billions that will be required in other areas of seniors' lives. Despite some pockets of progress, demographers and aging experts say the USA is "hugely behind" in readying for the onslaught of aging adults, fueled by the 76.4 million-member Baby Boom generation, born from 1946 to 1964.

"We haven't faced up to the significance of aging of the population as a society, and it has huge implications," both socially and financially, says Henry Cisneros, a former U.S. secretary of Housing and Urban Development and four-term mayor of San Antonio. Cisneros has focused on elder housing options for years.

As the country prepares for this age wave, USA TODAY has identified five areas in which the nation needs to do better, based on interviews with those who have been studying aging issues and on findings from a new nationally representative survey, exclusive to USA TODAY. Getting Americans to focus on these five areas — health care, housing, transportation, keeping seniors productive and engaged, and caregiving — is a tall order in a nation that hasn't wanted to dwell on getting old and is already hobbled by fiscal challenges at federal, state and local levels.

"We live in a society that is incredibly youth-oriented, and we tend to deny that old age happens," says Lilliam Barrios-Paoli, commissioner of New York City's Department for the Aging. "Because of that, we don't address issues of aging as forcefully as we should."

The survey finds communities are indeed having mixed success. Part of a joint effort by the National Council on Aging, UnitedHealthcare and USA TODAY, it included interviews with 1,007 adults 60 and older and a comparison group of 1,000 ages 18-59. It found:

•33% of older Americans surveyed say their city or town is not preparing for the future needs of a growing senior population; interestingly, even more of the younger group (45%) say that.

•18% of seniors say their community is not responsive to senior needs; among those younger, 29% say that.

•Almost a third of seniors rate public transportation and job opportunities in their communities as poor. But three-quarters say health care services are good to excellent.

•Transportation and affordable housing are the two top areas seniors say their city should invest more in (both 26%); followed by affordable health care and home-delivered meals, both 23%.

"Communities need to think about how they integrate generations because one of the things that keeps a senior young is interacting with younger people. Whether it's reading to preschool kids or counseling and mentoring teenagers, people feel better when they're helping others and feel like their life is of value. It's very easy as you get older to feel like you're just a taker and you're not a contributor," says Bill Reed, 77, of Upland, Calif., a retired research physicist.

Demographer William Frey, whose 2011 analysis spurred Austin into action, says Baby Boomers are driving the move to stay in their hometowns — and homes — rather than flocking to traditional retirement meccas such as Arizona and Florida, as many of their grandparents and parents did.

Cities haven't noticed because "these are not people rushing into their communities. They've been there all along, but they're aging in place," he says. "This is a hidden demographic trend that is just going to bite some communities at some point."

According to Census projections, the number of Americans 65 and older is expected to more than double, from 43.1 million in 2012 to 92 million in 2060. As longevity increases, the issues aren't just about keeping elders safe and healthy; they also need to remain productive and engaged.

John Rowe, chairman of the MacArthur Research Network on an Aging Society, says, "The discussion about preparing has focused obsessively on entitlement programs, including Medicare and Social Security and especially the solvency of the trust funds for those programs. If we fix those problems and we do not re-engineer the core institutions of our society, we will fail."

These core institutions — "education, work, retirement, the family, the design of cities, transportation and the like — are not designed to support a population with the age distribution of the future United States," says Rowe, a professor of health policy at Columbia University and former CEO of Aetna.

As communities attempt a restructuring, here's a closer look at what needs to be done in these key areas.

HEALTH CARE — AND COSTS

"There aren't enough individuals trained in how to care for older adults," says Cathy Alessi, president of the American Geriatrics Society. Besides a general shortage of physicians and health care workers, "we need to ensure that (geriatric) training is incorporated for everyone involved in health care."

Affordability is another real concern. A report released this year found that future health care needs for a retiree will cost about $146,400 out-of-pocket (not paid through Medicare) for someone currently age 65 with an average life expectancy of 20 more years. It's $292,800 for a couple the same age, says the report, sponsored by the Society of Actuaries using data from the Health Care Cost Institute.

Though Americans are living longer, many have chronic conditions, which also will affect health costs. The Alzheimer's Association says one in three seniors die with Alzheimer's or another dementia; it projects that in 2013, Alzheimer's will cost the nation $203 billion. This number is likely to rise to $1.2 trillion by 2050. That's just one disease. Of those 60 and older in the survey, 47% had been diagnosed with high blood pressure; 35% arthritis; 34% high cholesterol; 21% diabetes and 20% vision loss.

SENIOR-FRIENDLY HOUSING

As more seniors opt to age in place, they may seek affordable apartments or modify homes to address safety and mobility needs, from grab bars in bathrooms to ramps, chairlifts on stairs and other accommodations.

"One of the big things is to figure out how to retrofit existing homes," says Cisneros, 66, executive chairman of CityView, a San Antonio company that specializes in urban real estate. He edited a 2012 book Independent for Life, which outlines a variety of tactics.

Zoning changes may also be needed. Cisneros says age-appropriate housing options may be "smaller-scale, less expensive, closer together," or "with another generation of their family," such as "granny flats," where a small secondary residence is built on the same site as a larger home.

THE TRANSPORTATION CHALLENGE

"Every survey ever done of older adults shows that transportation is a problem. It's the No. 1 unmet need," says Sandy Atkins of the San Fernando, Calif., non-profit Partners in Care. Seniors need "reliable, affordable transportation that does not require long waits."

Although cities have buses that seniors could take, it's not a good option for them, Atkins says, noting that bus routes often require long walks and bus stops often have no benches to sit on while waiting. Special buses or disability vans aren't the answer either, she says. "They do use them but complain they don't show up on time or have to arrange it so much ahead. It winds up being a four-hour trip. It drains their stamina."

One trend that appears to be catching on, Atkins says, is volunteer transportation programs, often with senior volunteers driving.

STAYING ENGAGED, PRODUCTIVE

Because of increased longevity, many older workers will be able to stay on the job longer, work part-time or volunteer, experts say. They may have as many as 20 to 25 years after the typical retirement age — too long to lie around on the couch.

"People in their 60s now, that grew up in the '60s, are much more politically active, much more savvy and will continue to participate. We need to look at age not only as receiving but providing new roles and role models for participating," Barrios-Paoli says.

"Too much leisure time leads to lack of purpose," says Graham McDougall, 63, a professor of nursing at the University of Alabama-Tuscaloosa.

Nick Monreal, 66, of San Antonio says older adults want to be "appreciated and respected. I'm outworking younger people every day. I'm not looking to retire for at least another seven or eight years."

LONGER LIVES MEANS CAREGIVING

"We have to accept the fact that a very large number of individuals are becoming caregivers, and caregivers need support," says Barker, who works for a non-profit group.

The percentage of U.S. adults who are family caregivers jumped from 30% in 2010 to 39% in 2012, according to a June report by the Pew Research Center and the California HealthCare Foundation; about two-thirds support a parent or in-law. Almost half of U.S. adults expect to care for an elderly family member at some point, Pew says.

Longer lifespans mean that many adults 60 and older will be caring for parents in their 80s, 90s and beyond. Census projections suggest the number of Americans 85 and older will more than triple, from 5.9 million in 2012 to 18.2 million by 2060.

Becoming a caregiver themselves wasn't the biggest concern in the new survey. When asked what worries them most, 34% of respondents said "not being able to care for myself" or "being a burden."

Across the country, all the identified needs of seniors will take money.

"There's vast potential for intergenerational conflict," Cisneros says. He notes that seniors on fixed incomes may be less supportive of school bond issues and young workers may balk at funding benefits for older populations. "They may feel some resentment."

Frey says the older adults have an edge on clout.

"There's going to be so many people in this age group, it will be impossible to disregard their needs — most of all because they're going to be voting in such large numbers, and they'll have a lot more time to do it," he says.

Barker, whose Austin task force will present recommendations to the mayor in a few weeks, will be among those reaping the benefits.

About 18 months ago, she and her husband moved to a condo downtown, where she enjoys urban "walkability" and bikes the trails on weekends.

"Downtown living increases the probability that we will be able to age in place," she says.