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The population of those 65 years of age and older in the United States continues to grow, with the country seeing faster growth in rural areas. In a report from the US Census Bureau on “The Older Population in Rural America” (Smith & Trevelyan, 2019), older adults comprise 17.5% of the rural population, while in urban areas it is 13.8%. In 1980, older adults only comprised 10.9% of the rural population (Smith & Trevelyan). As baby boomers started turning 65 in the last decade, it is expected that these numbers will continue to rise over the next few decades at a rate faster than what has been seen since 1980. Given the increase in older adults living in the rural US, it is imperative that the country proactively address the health and wellness of this growing population, understanding the impacts of social determinants of health that have led to rural health disparities, and supporting innovative solutions to improving rural older adult health.
In the 1980s, the rural older adult population had similar health outcomes to their urban older adult counterparts, but since then the gap in health outcomes has widened (Harrington et al., 2020). Rural adults see a 20% higher all-cause mortality rate, life expectancy more than 3 years below their urban counterparts, 11% higher rate of hypertension, 40% higher rate of diabetes, 40% higher rate of heart disease, 30% higher rate of stroke, and a 100% higher rate of chronic obstructive pulmonary disease (Harrington et al., 2020; Croft et al., 2018). They also experience higher rates of depression, suicide, and drug-related deaths (Harrington et al., 2020).
These disparities can be attributed to several risk and social determinant factors. Tobacco use is higher in rural populations, residents are less physically active, and more obese (Harrington et al., 2020). Rural residents tend to have lower incomes, a lower education level, are less insured, poorer housing options, and limited access to supermarkets and healthy food options. They also have fewer healthcare and mental health providers, critical specialty provider shortages (e.g., oncologists, cardiologists, pulmonologists), less emergency medicine and hospital options, and fewer skilled nursing facilities. This lack of access is compounded by transportation issues, often including no available public transportation options (CDC).
So how do we reverse these trends, including addressing social determinants of health, to improve the health of rural older adults? One current target area has been critical access and provider shortages. The Human Resources and Services Administration, Department of Labor, and other government entities have increased funding aimed at improving the pipeline of the healthcare and public health workforce in rural communities (addressing nursing, mental health, primary care, oral care, and others). While these funding opportunities are a start, it will be essential that these agencies review outcomes to develop proven solutions to continue to grow the rural health workforce.
In addition to addressing access and provider shortages, it is imperative that we look to develop team-based care models focused on rural populations. Such models can address not only rural delivery sites, but an increase in telehealth and digital health options that can impact health promotion, disease prevention, and chronic disease management.
Finally, a major focus also needs to be on the economic development of rural communities. Many see the federal government’s recent $1.5 trillion infrastructure bill as a start, but this will not necessarily address some of the general transportation and physical environment issues that impact the health of rural older adults. A multi-pronged approach requiring innovative solutions will be required to address the health of rural older adults over the next several decades.
We must see collaboration from the interprofessional health, mental health, and public health workforce, communities, businesses, and government, who together can build a happier, healthier future for our rural older adults.
Sources:
Centers for Disease Control and Prevention (2019). Rural health. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/rural-health.htm
Croft, J. B., Wheaton, A. G., Liu, Y., Xu, F., Lu, H., Matthews, K. A., Cunningham, T. J., Wang, Y, & Holt, J. B. (2018). Urban-rural county and state differences in chronic obstructive pulmonary disease: United States, 2015. Morbidity and Mortality Weekly Report, 67(7), 205-211. doi: 10.15585/mmwr.mm6707a1
Harrington, R. A., Califf, R. M., Baslamurugan, A., Brown, N., Benjamin, R. M., Braund, W. E., Hipp, J., Konig, M. Sanchez, E., & Joynt Maddox, K. E. (2020). Call to action: Rural health: A presidential advisory from the American Heart Association and American Stroke Association. Circulation, 141(10), e615-e644. doi: 10.1161/CIR.0000000000000753
Smith, A. S., & Trevelyan, E. (2019). The older adult population in rural America: 2012-2016. United States Census Bureau. https://www.census.gov/content/dam/Census/library/publications/2019/acs/acs-41.pdf
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