Aging in rural areas: balancing land, care, and connection of family caregivers of persons with dementia: a qualitative analysis

Research examining the life situations of the general population of very old adults has increased during the past decade (e.g., Manton, 1986; Rosenwaike, 1985). Very old adults, for example, are found to have longer recovery time from acute health conditions; to have increased limitations of activities, length of hospitalization, institutionalization, and need for assistance; and more limitations in activities of daily living than other older adults (Rosenwaike, 1985). Relatively little research, however, has examined the characteristics and needs of adults surviving to very old age in rural areas. Information on the very old is important because of their distinct vulnerability to inadequate health and related care, especially in rural under-served areas. Approximately 25% of adults 65 years of age or older, or over 7.6 million persons, reside in rural areas (U.S. Bureau of the Census, 1992). In addition, 25% of elders 85 years of age and older live in rural areas (U.S. Bureau of the Census, 1992). Nationally, it is estimated that between 1980 and 2030, the number of adults in this very old age group will triple and by 2050 the number will have increased sevenfold (U.S. Senate Special Committee on Aging, 1991). Although the majority of very old adults will continue to reside in urban locations, a substantial number will be located in rural areas. Additionally, many of these very old rural elders, and the families caring for them, can be expected to have inadequate resources for the maintenance of their well-being. AGING IN RURAL CONTEXT For the purposes of this review, issues related to aging in rural areas have been divided into two major sections. First, information is provided regarding environmental and individual characteristics of very old persons aging in a rural context. Second, information pertinent to the prediction of very old age survival in rural areas is presented. Characteristics of Very Old Persons Elders in rural areas have been described as disadvantaged, both in terms of community and individual resources, when compared with older adults residing in metropolitan areas (e.g., Coward, 1987; Glasgow, 1988; Glasgow, Holden, McLaughlin, & Rowles, 1993; Lee & Lassey, 1980; McLaughlin & Jensen, 1993). Several community-level characteristics, including small community size, population dispersion, geographic isolation, limited public sector resources, and the concentration of economic resources in a small number of business and industry sectors, have contributed to economic hardships and inadequate social and supportive resources available for elders in rural areas (Glasgow, 1993). Glasgow (1993) noted two ways these limitations affected well-being: (a) by reducing the effective social and economic responses possible from the public sector, including adequate access to proximate health care, public transportation, and formal social services; and b) by frequently limiting older adults' access to helpers within their informal network. The life situations of older adults in rural areas have been further affected by individual-level social and economic changes during the last decade. For example, older adults residing in rural areas have become more diverse. This increased diversity has complicated the creation of viable service models. Rowles and Johansson (1993) described four types of rural elderly residents in terms of their community integration: (a) lifelong community residents who have maintained large kinship and informal networks; (b) lifelong community residents whose informal support resources have been reduced as family members have moved from the area; (c) return migrant elders who, because of their limited recent history in the area, have minimal access to informal support networks; and (d) retirees who have moved from urban areas with little or no previous social history in the area and, as a result, have limited informal social support. An individual-level economic change affecting many older rural adults is the increasing number of very old rural adults living in poverty. …

When the demographic transition started in the 1970s in Thailand, internal migration of this country also manifested a turning point. Newly reclaimable vacant land almost vanished in the 1980s, although surplus populations in rural areas were being absorbed by other rural areas with lower population densities until the 1970s. This study analyzed population and internal migration changes in Thailand from 1980 to 2030. Analysis of populations by age group in urban areas (central region and Bangkok metropolis) and rural areas (northeast region and Surin province) indicated that decreased growth of younger populations in urban areas caused a marked increase in migration of young generations as the labor force moved from rural to urban areas, especially after the 1990s. Statistics of the inter-regional migration census from the northeast to central regions also indicated that this population flow began to increase around the year 1990. The present trends of population aging and various socioeconomic situations in rural and urban areas in Thailand will result in acceleration of population aging in rural areas through deprivation of rural young populations by urban areas.

This paper underlines that ageing in rural areas is a very complex and multilevel interdependent process which is based on networks—the later is being created by interrelations among a mentally constructed (individual perception of person aged 65+), the formalized (involvement of different relevant stakeholders) and the material (rural areas) environments. We argue that these networks are crucial for the creation of age-friendly rural areas. However, the networks—their establishment, the functioning, the form—are less frequent in research on ageing in rural areas. Therefore, we focus on the hidden geographies of these networks: where are the networks placed, who is included, what kind of relationships is performed, how they are addressing the actual needs and expectations of ageing populations in rural areas. For the further analysis of the significance of these networks, a wide longitudinal research is needed. The hidden needs and expectations, hidden information, hidden knowledge, hidden skills, hidden networks of actors are all creating the contemporary landscape of ageing that is not a win–win situation for ageing in rural areas. We would like to underline that ageing in rural areas becomes friendlier when these networks become visible and operational—since this would open up the field for the creation of new job opportunities in rural areas, also for the fine-tuning of existing and the future development of essential social and economic infrastructure, which is relevant for age-friendly rural communities. Re-organization of public care for elderly on national as well as on the local level is expected, new forms of health and social services need to be developed aiming at more efficiency and financial sustainability.

Migration, population aging, and income inequality in China

Technology generation in Latin American manufacturing industries: Jorge M. Katz, ed., (Macmillan Press, London, 1987) pp. xi + 549, £30

Aging is a complex multifaceted policy problem that is compounded by a growing and potentially frail elderly population. Existing policy approaches are embedded in a medical conception of aging and modernist forms of political economy. The multifaceted nature of aging as a policy problem challenges this approach, and in rural areas many aspects of the problem are magnified. If aging is approached in cultural terms, a deeper understanding of aging can be developed, and the dimensions of the problem exposed, and it is shown that collaborative approaches may offer a way forward. The new public governance offers a way of incorporating collaborative approaches into public decision-making to address complex problems. The chapter concludes by making some policy recommendations as to how the problems highlighted can be addressed within the framework of the new public governance.

Access to clean and efficient cooking fuel is crucial for promoting good health, safeguarding the environment, and driving economic growth. Despite efforts to promote the adoption of cleaner alternatives, traditional solid fuels such as charcoal and firewood remain prevalent in Ghana. In this study, we utilized a statistical mechanical model as a framework to explore the statistical relationship between socio-economic factors such as educational attainment, wealth status, place of residence, and cooking fuel choices. We analysed data from the Ghana Malaria Indicator Survey (GMIS) conducted in 2019, involving a total of 2,942 women of reproductive age. The findings revealed that 13.77% of participants preferred using LPG fuels for cooking, while 86.23% preferred non-LPG fuels for their cooking needs. The data indicated that among LPG users, 96.54% are educated women of reproductive age, and 3.46% are non-educated women of reproductive age. Among these, 95.31% are non-poor, and 4.69% are poor. Additionally, 21.73% reside in rural areas, while 78.27% live in urban areas. The data also showed that among non-LPG fuel users, 68.70% are educated women of reproductive age, and 31.30% are non-educated women of reproductive age. Among this group, 16.04% are non-poor, and 83.96% are poor. Furthermore, 67.24% reside in rural areas, and 32.76% live in urban areas. Our findings showed that in the absence of social interaction, a woman's wealth status has a relationship to her choice of fuel for cooking. Additionally, women of reproductive age in rural areas with some education demonstrated a significant private incentive (40.12%) to use LPG, implying a positive correlation between education and the use of LPG for cooking. However, when social interactions are considered, factors such as education, wealth status, and place of residence have significant relationships with a woman's decision about fuel choice. The interaction strength among women of reproductive age in urban areas with some education shows a negative estimate (-4.06%), suggesting that there is no significant imitative effect. The study further suggests that urban women of reproductive age who are poor exert a greater influence on their urban counterparts who are not poor when social interaction is incorporated. Women of reproductive age in rural areas with some form of education exert a greater influence on women of reproductive age in rural areas with no form of education. We recommend that the government of Ghana and its stakeholders focus on leveraging the influence of urban poor women and educated rural women through community-led programs and educational campaigns. Financial support mechanisms like microfinance and subsidies, alongside reliable LPG infrastructure, can make access easier for these target groups. Tailored communication strategies, peer-to-peer learning, and collaboration with local institutions are crucial for spreading awareness and encouraging the adoption of LPG.

Contraceptive use is one of the essential influential factors to the birth rate of Indonesia. This article aims to identify the profile of contraceptive use in rural and urban areas based on the socio-economic and demographic characteristics as well as the influential factors. This study conducted a further analysis of Performance Monitoring and Accountability 2020 (PMA2020) survey in 2015, by applying univariate, bivariate, and multivariate analysis. Th e results of the analysis show a similar average number of children for both rural and urban areas; this situation is in accordance with the program of National Population and Family Planning ( BKKBN). In addition, the educational and economic status of women in union of childbearing age in rural areas has improved along with the increasing number of women graduated from senior high school as well as the improvement of their wealth. However, many women in rural and urban areas never have been visited by family planning officers as well as do not have health insurance, such as BPJS. The finding of the study also shows that the higher the economic status of women in rural areas, the higher their chances to use contraception. Conversely, the higher the economic status of women in urban areas, the lower their participation in family planning program. Therefore, specific, intensive and equal interventions to IEC and advocacy programs are needed for both rural and urban areas .

Aging in rural areas is challenging and has very specific characteristics in the way these elderly people live their old age, from the perspectives of cognition, functionality and life purpose. There is a lack of information and data in the literature on how people age in rural areas around the world. The aim of this study was to identify and describe how people age in rural areas, focusing on the following domains: cognition, physical function/functionality and life purpose. We included cross-sectional studies published up to April 2023 found in six databases: PubMed, LILACS, PsycINFO, Scopus, SciELO and Web of Science. The Rayyan software was used for the first selection of studies and the Observational Study Quality Evaluation was used to assess methodological quality and risk of bias. For the primary analysis, the titles and abstracts available in the search engine were analyzed using the following MeSH descriptors: "physical functioning"; "cognition"; "cognitive function"; "life purpose"; 'personal satisfaction'; 'subjective well-being'; "aged"; "elderly"; "old"; "rural aging"; "rural population"; "communities, rural"; "distribution, rural spatial"; "medium communities"; "rural settlement"; "small community". In the secondary selection, the selected articles were fully read by two independent reviewers and confirmed by a third reviewer when necessary. From 22 studies methodologically evaluated it was seen that rural aging in the world is female and mostly in elderly women farmers; mental evaluation together with activities of daily living and instrumental activities were the most evaluated; the studies did not mention the evaluation of life purpose. The world ages very differently in rural areas, and the way we age is directly linked to where this process takes place. Cognition, followed by functionality, are the most researched outcomes in cross-sectional studies with this population and the assessment of life purpose has not been investigated to date.

This study aimed to describe and compare urban and rural family caregivers' reactions to caring for a relative with dementia and to examine the associations between caregiving and socio-demographic factors. Most studies on family caregivers' experiences caring for older people with dementia have been conducted in urban areas, and little is known about the experiences of family caregivers living in rural areas. A cross-sectional study design was used. A total of 102 caregivers (response rate 85%) from urban (n=57) and rural (n=46) areas completed the Caregiver Reaction Assessment (CRA) Scale and demographic information. Data were analysed using descriptive and inferential statistics and linear regression models. Overall, family caregivers reported high satisfaction even if they also reported high impact on finances and daily living. Rural caregivers experienced a higher negative impact on finances but reported more support from family members than urban caregivers. Age, gender and relationship were significantly associated with four of the five CRA subscales. Educational level and geographical setting were not associated with any of the CRA subscales. The results of the study raise questions about the financial situation of older female caregivers and on the expectations of built-in family structures in urban and rural areas. Further studies focusing on the meaning and constitution of a family would help us to understand how these factors influence family caregiving both in rural and urban areas. To provide person-centred care and to avoid stereotyped caregiving, a better picture of traditions in family caregiving can improve a more differentiated and appropriate professional caregiving pliable with the cultural context in which it is carried out.

Although approximately one-fourth of the population of the United States lives in rural areas, relatively little research has focused on the experiences of children in rural families (Coleman, Ganong, Clark, & Madsen, 1989; Hennon & Brubaker, 1988; Scanzoni & Arnett, 1987; Schumm & Bollman, 1981). Specifically, little information is available concerning child care in rural areas, although rural and urban parents may differ in family resources, the structure of families, the kind of child care used, how care is selected and, as a result, the kind of services needed (Boyd & Shoffner, 1983; Scanzoni & Arnett, 1987; Sherman, 1992; Shoffner, 1986). Although some dimensions of the problems in rural child care are known, little information is available to help professionals develop services that fit the needs of rural families (Clinton & Bean, 1989; Hawk, Donham, & Gay, in press; Moore, 1989; Warnock, 1992). As defined by the United States Bureau of the Census, rural population areas include the open countryside and places with fewer than 2,500 inhabitants that lie outside urbanized areas. In 1989, 66.2 million Americans were classified by the Census Bureau as living in rural areas. The South, with 28.9 million people, has the largest rural population (43.6%), followed by the Midwest, with 17.7 million rural residents or 26.7% of the rural population. About 4.8 million persons (7.25%) of the rural population now live on farms, and the percentage has steadily dropped during this century (Pins, 1992; U.S. Bureau of the Census, 1990, 1992). RURAL AND URBAN FAMILIES Variables of race, ethnicity, family income, mothers' income, and children's ages have been shown to influence the use of child care in general, but information about the influence of these variables on rural families is limited, with even less data available to compare rural and urban families (Dawson & Cain, 1990). Although rural-urban differences are found, many differences appear to be decreasing. Most rural families are comprised of married couples (79.2%), and 23% have children under the age of 6. The median annual income for rural families is $34,213, with 56.8% of the rural women over the age of 15 in the labor force (U.S. Bureau of the Census, 1992). A similar proportion of urban women (57.2%) is employed, although families living within metropolitan areas have a higher median annual income of $38,370 (U.S. Bureau of Census, 1993). Racial differences have been found, with Caucasians comprising a larger percentage of rural (92%) than urban (81.4%) areas, and African American and Hispanics making up a smaller percentage of rural (6.3% black and 2.7% Hispanic) than urban areas (14.5% black and 10.4% Hispanic; U.S. Bureau of the Census, 1990). Many families indicate that maternal employment is a major reason for using supplemental child care. In the past, rural women have been less likely to be in the paid labor force than urban women (Dawson & Cain, 1990). However, this difference appears to have narrowed, although mothers' work experiences may differ (Bescher-Donnelly & Smith, 1981; Brown, 1981; Hennon & Brubaker, 1988; Lichter & Eggebeen, 1992; Ollenburger, Grana, & Moore, 1989). Women living in nonmetropolitan areas are more likely to be employed in marginal or low-paying jobs and to be employed part-time when they would prefer full-time employment (Lichter, 1989; Lichter & Eggebeen, 1992). Significant rural/urban differences in maternal education levels have also been found, with rural women having a lower level of education and fewer advantages (Scanzoni & Arnett, 1987). An increasing percentage of rural families are poor, with nearly 23% of nonmetropolitan children estimated to live in poverty (Lichter & Eggebeen, 1992). Some of the reasons for rural poverty are due to changes in employment, but about 60% of the increase in rural child poverty during the 1980s is estimated to be due to changes in family structure (Lichter & Eggebeen, 1992). …

This study examined awareness and utilization of maternal and child health services among women of reproductive age in rural areas in Akwa Ibom State. Three objectives and three research questions were raise to guide this study. A descriptive survey research design was adopted and the population of this study was 303,768 females of reproductive age in the study area and a sample size of 246 women of reproductive age drawn through purposive sampling technique was used for the study. A researcher-developed questionnaire titled Awareness and Utilization of Maternal and Child Health Care Services Questionnaire with reliability coefficient of 0.73 was the instrument for data collection. The data were analyzed using frequency and percentage. The findings of the study indicated that there was a great awareness of maternal and child health services among women of reproductive age; utilization of maternal and child health services among women of reproductive age was good; there was a great level of utilization of maternal and child health services among women of reproductive age. Based on these findings, it was concluded that there was optimal awareness and utilization of maternal and child health services among women of reproductive age in rural areas in Akwa Ibom State. Based on the findings, recommendations were made that federal, states and local government areas should still need to reach out to other people who do not utilize maternal and child health care services; educating women and men about the importance of maternal and child health care services would make them to utilize the services and efforts should be made to fill health service gaps with substantial success through more community-based facilities and financial subsidies.

Palliative care policies worldwide support people’s wishes to spend their final days at home with family caregivers playing a vital role. In Norway, 16% of the population lives in rural areas where palliative end-of-life care is especially challenging due to geographical barriers and limited access to healthcare resources. Research on rural family end-of-life care for people with cancer is sparse. Therefore, the purpose of this study was to investigate what resources are needed for rural family caregivers when providing end-of-life care and preparing for home death for a person with cancer. Thirteen semi-structured in-depth interviews with family caregivers in seven rural municipalities in Northern Norway were conducted from February to April 2023. The thematic analysis revealed three key themes supporting caregivers’ resilience: end-of-life care and home death require available resources in family caregivers; the availability of reliable professional follow-up services for end-of-life care; support from family and social networks compensate for lacking healthcare resources. Holistic healthcare for rural populations should consider aspects like distance and cost while involving the entire family and their social network. Local palliative care beds and telehealth services should be available to support rural family caregivers.

Population aging is occurring worldwide, particularly in developed countries such as the United States (US). However, in the US, the population is aging more rapidly in rural areas than in urban areas. Healthy aging in rural areas presents unique challenges. Understanding and addressing those challenges is essential to ensure healthy aging and promote health equity across the lifespan and all geographies. This review aims to present findings and evaluate recent literature (2019-2022) on rural aging and highlight future directions and opportunities to improve population health in rural communities. The review first addresses several methodological considerations in measuring rurality, including the choice of measure used, the composition of each measure, and the limitations and drawbacks of each measure. Next, the review considers important concepts and context when describing what it means to be rural, including social, cultural, economic, and environmental conditions. The review assesses several key epidemiologic studies addressing rural-urban differences in population health among older adults. Health and social services in rural areas are then discussed in the context of healthy aging in rural areas. Racial and ethnic minorities, indigenous peoples, and informal caregivers are considered as special populations in the discussion of rural older adults and healthy aging. Lastly, the review provides evidence to support critical longitudinal, place-based research to promote healthy aging across the rural-urban divide is highlighted. Policies, programs, and interventions to reduce rural-urban differences in population health and to promote health equity and healthy aging necessitate a context-specific approach. Considering the cultural context and root causes of rural-urban differences in population health and healthy aging is essential to support the real-world effectiveness of such programs, policies, and interventions.

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