Abstract
Objective:This review aimed to explore and analyze the social determinants that impact rural women’s aged 60 years and older healthcare access in low or middle income and high income countries.Methods:Major healthcare databases including MEDLINE and MEDLINE In-Process, PsycINFO, PubMed, ProQuest, Web of Science, CINAHL and ERIC were searched from April 2016 to August 2016 and a manual search was also conducted. A rigorous selection process focusing on the inclusion of rural elderly women in study population and the social determinants of their healthcare access resulted in 38 quantitative articles for inclusion. Data were extracted and summarized from these studies, and grouped into seven categories under upstream and downstream social determinants.Results:Prevailing healthcare systems in combination with personal beliefs and ideas about ageing and healthcare were identified as significant determinants. Socioeconomic and cultural determinants also had a statistically significant negative impact on the access to healthcare services, especially in developing countries.Conclusion:Potentially, improvements to healthcare access can be achieved through consideration of rural elderly women’s overall status including healthcare needs, socioeconomic determinants and cultural issues rather than simply establishing healthcare centers.
Highlights
The prevalence of morbidity, comorbidities and premature deaths associated with rural elderly women (REW) is related to access to modern healthcare services (MHS) [1, 2]
Synthesizing the evidence based on the social determinants of health (SDoH) model resulted in an identification of seven categories and included the downstream SDoH category such as health literacy and education, passive healthcare seeking behaviour and lack of healthcare support, and the upstream SDoH category comprising financial constraints, transportation difficulties, relationship matters and a culture of restriction as represented in the diagrammatic model seen in Fig. (2)
Living with depression increased a sense of helplessness for REW in seeking MHS even in high income countries such as Switzerland [p = 0.008
Summary
The prevalence of morbidity, comorbidities and premature deaths associated with rural elderly women (REW) is related to access to modern healthcare services (MHS) [1, 2]. Elderly women accounted for 54% of the total elderly population worldwide in 2015 and 52% of these women live in rural areas [2, 3]. Many REW lack access to MHS and underutilization of MHS is identified as a major reason for premature and preventable deaths [4, 5]. This underutilization is skewed toward a lower rate of hospitalzation is skewed toward a lower rate of hospital visits, diagnosis, hospitalizations and complete treatment [2]. Inadequate healthcare access for REW presents a challenge to all countries that value good health outcomes for REW, especially low and middle income countries as defined by World Bank
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