Hawaii’s senior citizens are among the nation’s healthiest, but the state slipped to fourth place in the America’s Health Rankings Senior Report 2015.

The rankings were issued by United Health Foundation based on 35 measures of well-being and are intended as a call to action for communities. Hawaii had placed second overall last year in the senior rankings.

Among Hawaii’s strengths were its low prevalence of obesity, low rate of preventable hospitalizations, low hip fracture rate, low rate of premature deaths and ample supply of geriatricians. It placed first in all those categories.

Seniors in Hawaii were also more physically active than the rest of the nation and more received the flu vaccine.

On the other hand, more seniors in Hawaii reported joint pain than any other state, more elderly are underweight here, and more end up dying in the hospital rather than at home.

While hospice care is rarer in Hawaii than nationally, it is on the upswing in the islands. About 42 percent of elderly who died in 2014 in Hawaii used hospice care, which is usually provided at home, up from 36 percent the year before. The national average is 51 percent.

Vermont was ranked as the healthiest state for seniors, followed by New Hampshire and Minnesota. Louisiana was the least healthy, according to the report, released Tuesday.

"With America’s senior population poised to double by 2050, we must continue to invest in programs and solutions that address our seniors’ health needs and help them live the best lives they possibly can," said Ron Fujimoto, chief medical officer for UnitedHealthcare’s Community Plan for Hawaii.

Hawaii has placed first for two years in a row in the United Health Foundation’s America’s Health Rankings that gauge the health of the entire population, not only seniors, and are issued in December. The full report is available at americashealth rankings.org.