Characteristics of and Survivorship among the Very Old: Implications for Rural Families and Service Delivery

Abstract

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. …