Nearly 22 percent of the nation’s elderly reside in the rural and the suburban areas. They prefer to live far away from the crowds in the rural settings despite access to a fewer and a narrower range of health care and long-term care services. Health in old age is generally assessed on the basis of sensory impairments, oral health, obesity, smoking, air quality, prescription drugs, access to health insurance, access to health care services, and opportunities for access to disease prevention and health promotion.
Even though they are growing in numbers, older people living in the rural areas by almost all economic, health and social indicators are poorer and less healthier as compared to their non-rural counterparts. They have poorer housing, fewer options in personal and public transportation, and significantly more limited access to the health professionals and the community-based programs and services.
Life in many small towns is quite different from that of the big cities. It usually is full of friendly neighbors, fresh air, spectacular sunsets, close-knit communities and endless horizons. But at the same time people also have to deal with a lack of competent healthcare professionals and facilities that are easily accessible to the urban elderly. There are a fewer adult day-care centers and in-home health services, such as respite care or meals on wheels than in the urban and the suburban areas. The list of inequities between the rural and the urban elderly may be surprising for many who are unfamiliar with the real-life circumstances of the former. Many of these discrepancies contribute to their vulnerability to physical and mental health problems, as well as to a lack of access to services.
Programs such as The Eldercare Locator and The National Adult Day Care Services Association offer several ways to the caregivers to seek help for their elderly loved ones. People living in the rural areas are constantly marred with lower incomes higher unemployment rates making them more vulnerable to the physical and mental health problems, as well as to a lack of access to services. Some of the major problems that the rural elderly face are:
- Access to care – In addition to a lack of mental health agencies and programs, the rural communities struggle to recruit and retain mental health professionals. As such many small rural hospitals have closed, while other healthcare facilities are in financial straits. Around 40 percent of rural residents live in the areas with no public transportation system and about 57 percent of rural residents do not own a car and as a result the elderly are dependent on their family members, friends and neighbors for transportation that certainly become a barrier for access to care. Approximately around 15% of the US elderly have to face several barriers to access healthcare.
- Scarcity of primary care physicians and healthcare providers – The number of healthcare providers and the hospitals and nursing homes are gradually on the verge of dissipating from the rural areas. Most of the staff is looking for options to join the managed-care organizations elsewhere. Medicare also pays lesser to the rural hospitals and the rural physicians.
- Alcoholism and drug abuse – According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the American Geriatrics Society, risky drinking among those 65 years and older occurs when a person consumes more than seven drinks per week or more than three drinks on a single day. More often than not the elderly are not aware that the recommended limits are lower than for the younger adults. They are more sensitive to alcohol and are less able to metabolize it, both of which can contribute to adverse effects. With a scarcity of mental health professionals in the rural areas fewer than one in five rural hospitals have treatment services for these conditions.
- Geographical isolation – Apart from the usual challenges of chronic diseases and functional decline, the rural elderly also have to face geographical isolation that leads to ecological threat, financial distress and economic downturn. All these can erode employment opportunities and the sense of community. People living away from the metropolitan areas are constantly marred with lower incomes, higher unemployment rates, higher poverty rates, less health insurance and more substandard housing.
- Healthcare technology – Technologies such as telemedicine and other modern high-level medical machines offered to improve access to healthcare. Their most effective and efficient applications can be accessed only in the urban healthcare settings.
- Rural residents tend to be poorer – On an average per capita income of the rural Americans is $7417.00 less than their urban counterparts. The disparity in incomes is even greater for minorities living in the rural areas.
Usually the people living in the rural areas are prone to several health risks because of their occupations like farming, fishing and acquisition of the natural resources like coal, lumber and natural gas. Other health risks associated with these occupations are – farm-accidents that can cause loss of limb, black lungs etc. The behavioral factors also have an adverse effect on the rural residents especially the elderly. Most of the seniors indulge in alcohol and tobacco consumption, lead sedentary lifestyles and become prone to several health issues. They also have to deal with the environmental factors like the weather conditions, natural terrain, wild animals in addition to lack of adequate housing, clean water and healthy food that are beyond the individual’s choice. All these are major health risk factors that can potentially contribute to chronic health conditions.
For many seniors aging healthy and gracefully can be too overwhelming because they have to adjust to a new role in the society, lose their independence and face social isolation. Besides this, the access to medical care and mental health services can be too daunting. If there is anything that the society can do is to start giving some emotional support and access to healthcare to the seniors.