Adults In Rural Areas Research Articles

Cognitive Function Among Rural People in Nineveh: A Cross-Sectional Survey

Background: Early identification of cognitive weakening in previously undetected cases could help deal by starting programs for rehabilitation. Aim: The aim of this survey was to evaluate the prevalence and degree of cognitive impairment among adults of rural area in Nineveh, Iraq. Method: A cross-sectional study with convenient sampling technique was conducted to enroll subjects from a rural area in Nineveh. Cognitive function was examined in all the patients by the Saint Louis University Mental Status (SLUMS) is a screening tool for the cognitive state. A total of 213 agreed to participate in the survey with a mean age of 52.1 ± 11.8 years and higher percentage of participants were with primary level of education 125 (58.7%). Results: The mean score for the cognitive function examination was 18.85 ± 4.55 with significant differences were found between cognitive function and educational level, employment, and monthly income. Cognitive score was negatively correlated with age of participants (r= - 0.128, p value = 0.031). Although it was not significantly associated with level of education but around 43% of the study population suffered from mild cognitive impairment to dementia. Conclusion: The study concludes that there have been strong calls for program from the Ministry of Health to improve dementia care and support for societies with dementia and their occupations that will stay a life of that means and dignity. Efforts to make societies greater cognitively functioned, as well as, actively attractive patients will improve cost, the sustainable, treatment and care methods for diseases and quality of life.

Cognitive screening among older afro‐caribbean adults in rural areas of South Florida

AbstractBackgroundAlzheimer’s disease and related dementias (ADRD) disproportionately affects communities of color with older black Americans performing worse than Whites on cognitive tests and facing higher ADRD risks.1,2 Contributors to low diagnostic rates include inadequate knowledge, cultural norms, low health literacy, and an unwillingness to discuss early signs of disease. 1,3‐5 Older Afro‐Caribbeans are a growing subset of the population, particularly in rural South Florida, but best practices to screen for ADRD are unknown.6 Many instruments, including the Montreal Cognitive Assessment (MoCA) have not been assessed within this population. We report on the use of the MoCA 5‐minute test/telephone (Mini‐MoCA) as a screening tool in older, rural‐dwelling Afro‐Caribbeans.7 MethodWe conducted survey interviews with 53 Afro‐Caribbean participants. Participants were assessed with the 5‐minute Mini‐MoCA, which included tests of language fluency, orientation and recall. Linear regression models were used to investigate the association between different components of the Mini‐MoCA its effects on age, sex, and education.ResultA total of 53 Afro‐Caribbean participants (67.2 +10.8y (Mean ± SD), 68% with 10y or less of education) residing in rural South Florida within the last 20 years were included. Participants were largely from Haiti (66%) with 34% from other Caribbean countries including Cuba, Jamaica, Puerto Rico, and Barbados. About 80% of participants reported not having their memory tested prior to the study. The Mini‐MoCA demonstrated good reliability in this sample (α = 0.734). We found that 53% had a total score of 11 or lower on the Mini‐MoCA. Linear regression suggested a significant association between Mini‐MoCA score and education (p = .001).ConclusionWhile the Mini‐MoCA showed good reliability in low‐educated older Afro‐Caribbeans, scores were strongly dependent on years of education. Disparities in educational attainment may contribute to disparities in performance and affect true detection on cognitive impairment in these communities. Social and cultural factors must be considered when interpreting the Mini‐MoCA, given the high error rates on items that depend on the ability to read and write. Study results highlight the need to use a language‐neutral test to accurately measures cognitive impairment among this specific population.

How older adults fulfill their retirement plans relates to positive mental health: a path model analysis of social activity and self-esteem

Retirement planning fulfillment is necessary for older adults to adapt to later life and maintain their quality of life. This study investigates the internal mechanisms between retirement planning fulfillment and positive mental health among older adults. 1200 Chinese older adults (Mage = 68.49, SD = 7.27; 57% female) completed a questionnaire package measuring retirement planning fulfillment, positive mental health, post-retirement social activities, and self-esteem. Results indicated that older adults in rural areas had significantly lower retirement planning fulfillment than those in urban areas. Retirement planning fulfillment was positively associated with social activity, self-esteem, and positive mental health. Social activities and self-esteem mediated the relationship between retirement planning fulfillment and positive mental health. This study suggests the need for further investigation of retirement planning fulfillment, which helps improve older adults’ ability to cope with later life.

Level of malnutrition and associated factors among community-dwelling rural older adults in Fogera Zuriya district, Northwest Ethiopia

ObjectivesMalnutrition is very common among older adults. In rural Ethiopia, around 25% of women and 34% of men ≥65 y of age are malnourished. However, the risk factors for malnutrition among older adults in rural areas are not well understood. The aim of this study was to assess the level of malnutrition and associated factors among community-dwelling rural older adults in Fogera Zuriya district, Northwest Ethiopia. MaterialsThis was a community-based, cross-sectional study among randomly selected (N = 634) adults ≥65 y of age in Fogera Zuriya rural district. Participants were selected using a multistage sampling technique. A pretested full Mini-Nutritional Assessment (MNA) tool was used to classify as malnourished (MNA score <17), at risk for malnutrition (MNA score 17–23.5), or otherwise normal. A validated Geriatric Depression Scale form (15 items) was used to assess depression. Ordinal logistic regression was employed to identify factors of malnutrition and the PLUM procedure was used to produce an odds ratio (OR). P < 0.05 was considered statistically significant with the dependent variable. Both crude and adjusted ORs (COR and AOR, respectively) with a corresponding 95% confidence interval were computed. ResultsThis study included 634 older adults. According to the results of the study, the risk for malnutrition was 383 (60%), and being malnourished was 166 (268%). The following factors were significantly associated with the risk for malnutrition and malnutrition:• Age ≥85 y (AOR, 3.47; 95% CI, 1.270–9.465);• Skipping two meals daily (AOR, 6.36; 95% CI, 2.11–19.16);• Skipping 1 meal a day (AOR, 3.05; 95% CI, 1.82–5.12);• Having a poor appetite (AOR, 6.2; 95% CI, 2.50–15.36);• Being depressed (AOR, 4.04; 95% CI, 2.37–6.89);• Low physical activity (AOR, 3.81; 95% CI, 1.50–9.72);• Family size of three of less members (AOR, 1.9; 95% CI, 1.14–3.24); and• Low dietary diversity score (AOR, 1.91; 95% CI, 1.11–3.31) ConclusionsIn this study, the prevalence of malnourished (26%) was almost higher than the national average in Ethiopia (21%). Older age, skipping a meal, poor appetite, depression, low physical activity, and low dietary diversity score were factors significantly associated with the risk for malnutrition and malnutrition. Along with this, improving diet and exercise should be a top priority. Maintaining continuing psychological support, social support, and a balanced family size within the community should be additional interventions.

Rural age-friendly ecosystems for older adults: An international scoping review with recommendations to support age-friendly communities.

The population of older adults in rural areas is rising, and they experience higher rates of poverty and chronic illness, have poorer health behaviors, and experience different challenges than those in urban areas. This scoping review seeks to (1) map the state of the science of age-friendly systems in rural areas regarding structural characteristics, processes for delivering age-friendly practices, and outcomes of age-friendly systems, (2) analyze strengths, weakness, opportunities, and threats of age-friendly system implementation, and (3) make person, practice, and policy-level recommendations to support active aging and development of age-friendly communities. An international scoping review was conducted of articles that used age-friendly framing, had a sample age of 45 years of age or older, self-identified as rural, and reported empiric data. Searches were conducted in PubMed, CINAHL, AgeLine, PsychINFO, EMBASE, Scopus, and Academic Search Elite on October 26, 2021, and rerun March 10, 2023. Data were charted across three analytic layers: socioecological model, Donabedian's framework, and SWOT analysis. Results reveal limited data on outcomes relevant to organizations, such as return on investment or healthcare utilization. While the SWOT analysis revealed many strengths of age-friendly systems, including their impact on persons' outcomes, it also revealed several weaknesses, threats, and gaps. Namely, age-friendly systems have weaknesses due to reliance on trained volunteers and staff, communication, and teamwork. System-level threats include community and health system barriers, and challenges in poor/developing areas. While age-friendly systems in this review were heterogeneous, there is an opportunity to focus on unifying elements including the World Health Organization age-friendly cities framework or 4Ms framework for age-friendly care. Despite the many benefits of age-friendly systems, we must acknowledge limitations of the evidence base, pursue opportunities to examine organizational metrics to support implementation and sustainability of age-friendly systems, and leverage improvements in age-friendliness at a community level.

Rural disparities in use of family and formal caregiving for older adults with disabilities.

As federal and state policies rebalance long-term care from institutional settings to home- and community-based settings, reliance on formal (paid) and family (unpaid) caregivers for support at home nationally has increased in recent years. Yet, it is unknown if use of formal and family care varies by rurality. Using the Health and Retirement Study, we describe patterns in receipt of combinations of formal and family home care and self-reported expectation of nursing home use by rurality among community-dwelling adults aged 65+ with functional limitations from 2004 to 2016. Older adults residing in rural areas are more likely to receive any family care than those in urban areas. From 2004 to 2016, a higher proportion of older adults in rural areas receive care from family caregivers exclusively while a lower proportion receive care from formal caregivers exclusively. When examining older adults in urban areas, we find the opposite - a higher proportion of urban adults rely exclusively on formal care and a lower proportion rely exclusively on family care in 2016 compared to 2004. We find that national estimates of sources of caregiving and their changes over time mask significant heterogeneity in uptake by rurality. Understanding how older adults in rural areas are, or are not, receiving home-based care compared to their urban peers and how these patterns are changing over time is the first step to informing supports for family and formal caregivers.

Effect of car use on social frailty among community-dwelling older adults in rural areas

IntroductionCars are essential for the mobility of older adults in rural areas, and driving a car is likely to contribute to the maintenance of a socially active lifestyle. The purpose of this study was to investigate the effect of car use on the onset of social frailty among older adults in rural areas and verify whether the effect differed with the level of locomotive function. MethodsThis longitudinal study included 1160 older adults in rural areas. The onset of social frailty was defined as giving two or more negative responses to the five questions asked during the follow-up assessment and no social frailty at baseline. Car use was assessed by determining whether participants drove a car at least once a week. Locomotive function was measured using the Geriatric Locomotive Function Scale-25; a total score of ≥7 was defined as a low locomotive function. Logistic regression analysis was used to investigate the effect of car use on the onset of social frailty. Furthermore, subgroup analysis by locomotive function was also performed. ResultsIn the follow-up assessment, 11.1% of older adults developed social frailty after 1 year. Participants who drove a car had lower odds of onset of social frailty (adjusted odds ratio [aOR] = 0.50, 95% confidence interval [CI] = 0.30–0.83). Subgroup analysis showed the same relationship only among those with a low locomotive function (aOR = 0.49, 95% CI, 0.31–0.91). ConclusionThe findings of this study may helpful for policy-makers to discuss transportation among older adults in a rural area from the point of preventing social frailty.

Social isolation and intrinsic capacity among left-behind older adults in rural China: The chain mediating effect of perceived stress and health-promoting behavior.

Strengthening and maintaining the intrinsic capacity (IC) of the older adults is the key to preventing and delaying disability and promoting healthy aging. This study explores the relationship between social isolation, perceived stress, health promotion behavior, and IC of the left-behind older adults in rural areas and analyzes the chain mediating effect of perceived stress and health promotion behavior among social isolation and IC. From March 2021 to May 2022, a multi-stage sampling method was used to recruit participants from rural areas in Heilongjiang Province, China. The data were collected by the simplified version of the Lubben Social Network Scale, the Chinese Perceived Stress Scale, the Health-Promoting Lifestyle Profile-Chinese, and the Integrated Care for Older People (ICOPE) screening tool. We used the PROCESS macro for SPSS to determine the mediating effect of perceived stress and health-promoting behavior between social isolation and IC. Social isolation score was positively correlated with health-promoting behavior (r = 0.78, p < 0.01) and IC (r = 0.67, p < 0.01), whereas it was negatively correlated with perceived stress (r = -0.63, p < 0.01). Perceived stress was negatively correlated with health-promoting behavior (r = -0.62, p < 0.01) and IC (r = -0.43, p < 0.01). The health-promoting behavior and IC were positively correlated (r = 0.56, p < 0.01). Bootstrapping values indicated that the chain-mediating effect of perceived stress and health-promoting behavior was statistically significant. Consequently, to improve the IC of the left-behind older adults, we should focus more on reducing the degree of social isolation of the left-behind older adults and improving their perceived stress and health-promoting behavior.

A Sero-Epidemiological Study on Visceral Leishmaniasis among Volunteer Children and Adults in Rural Areas of Shahroud, Iran 2018-2019.

Visceral leishmaniasis (VL) also known as Kala-azar is considered as one of the zoonotic infections in Mediterranean countries. The disease reservoir and vectors are dogs and sandflies respectively. Due to reported sporadic cases of Kala-azar in the past five years in Shahroud County, Semnan Province, Iran, this study aimed to investigate the status of this infection in this area and to determine its seroepidemiology to take required measurements for infection control and treatment. This study was conducted on 504 subjects residing in seven villages in Shahroud County. Blood samples were randomly selected using the cluster sampling method and were collected from subjects aged up to 13 years old (90%) and adults over 13 years old (10%) from September to May 2019. After separating sera from whole blood, samples were subjected to direct agglutination test (DAT) to detect anti-Leishmania infantum antibodies. A range of 1:10 to 1:800 dilutions were prepared from the samples. Results of 1:800 titration indicated that no sample was positive for antibodies against L. infantum. After the secondary screening, 10 cases (1.98%) showed the antibody titer of 1:100, while four cases (0.79%) showed the antibody titer of 1:400. Of 14 cases with the L. infantum antibodies, all were detected from the children <13 years old. According to clinical findings, no patient was suffering from fever, weight loss, splenomegaly, hepatomegaly, and cachexia and therefore did not show the Kala-azar symptoms. The results of the current study indicate that Kala-azar is not prevalent in Shahroud County.

COVID-19 Bivalent Booster Vaccination Coverage and Intent to Receive Booster Vaccination Among Adolescents and Adults — United States, November–December 2022

COVID-19 vaccine booster doses are safe and maintain protection after receipt of a primary vaccination series and reduce the risk for serious COVID-19-related outcomes, including emergency department visits, hospitalization, and death (1,2). CDC recommended an updated (bivalent) booster for adolescents aged 12-17 years and adults aged ≥18 years on September 1, 2022 (3). The bivalent booster is formulated to protect against the Omicron BA.4 and BA.5 subvariants of SARS-CoV-2 as well as the original (ancestral) strain (3). Based on data collected during October 30-December 31, 2022, from the National Immunization Survey-Child COVID Module (NIS-CCM) (4), among all adolescents aged 12-17 years who completed a primary series, 18.5% had received a bivalent booster dose, 52.0% had not yet received a bivalent booster but had parents open to booster vaccination for their child, 15.1% had not received a bivalent booster and had parents who were unsure about getting a booster vaccination for their child, and 14.4% had parents who were reluctant to seek booster vaccination for their child. Based on data collected during October 30-December 31, 2022, from the National Immunization Survey-Adult COVID Module (NIS-ACM) (4), 27.1% of adults who had completed a COVID-19 primary series had received a bivalent booster, 39.4% had not yet received a bivalent booster but were open to receiving booster vaccination, 12.4% had not yet received a bivalent booster and were unsure about getting a booster vaccination, and 21.1% were reluctant to receive a booster. Adolescents and adults in rural areas had a much lower primary series completion rate and up-to-date vaccination coverage. Bivalent booster coverage was lower among non-Hispanic Black or African American (Black) and Hispanic or Latino (Hispanic) adolescents and adults compared with non-Hispanic White (White) adolescents and adults. Among adults who were open to receiving booster vaccination, 58.9% reported not having received a provider recommendation for booster vaccination, 16.9% had safety concerns, and 4.4% reported difficulty getting a booster vaccine. Among adolescents with parents who were open to getting a booster vaccination for their child, 32.4% had not received a provider recommendation for any COVID-19 vaccination, and 11.8% had parents who reported safety concerns. Although bivalent booster vaccination coverage among adults differed by factors such as income, health insurance status, and social vulnerability index (SVI), these factors were not associated with differences in reluctance to seek booster vaccination. Health care provider recommendations for COVID-19 vaccination; dissemination of information by trusted messengers about the continued risk for COVID-19-related illness and the benefits and safety of bivalent booster vaccination; and reducing barriers to vaccination could improve COVID-19 bivalent booster coverage among adolescents and adults.

Who Will Care for Rural Older Adults? Measuring the Direct Care Workforce in Rural Areas.

Using the 2021 Occupational Employment and Wage Statistics (OEWS) dataset, we calculate the ratio of direct care workers relative to the population of older adults (ages 65+) across rural and urban areas in the US. We find that there are, on average, 32.9 home health aides per 1000 older adults (age 65+) in rural areas and 50.4 home health aides per 1000 older adults in urban areas. There are, on average, 20.9 nursing assistants per 1000 older adults in rural areas and 25.3 nursing assistants per 1000 older adults in urban areas. There is substantial regional variation. Greater investment needs to be made in improving wages and job quality for direct care workers to attract workers to these critical occupations, especially in rural areas where the need for direct care is greater.

Development of a Digital Behavioral Intervention to Reduce the Consumption of Sugar-Sweetened Beverages Among Rural Appalachian Adults: Multiphased, Human-Centered Design Approach

To avoid the low engagement and limited efficacy of digital behavioral health interventions, robust human-centered design (HCD) processes are needed. The primary objective of this study was to describe a flexible, step-by-step HCD process to develop digital behavioral health interventions by illustrating iSIPsmarter as an example. iSIPsmarter is a digital intervention for reducing the consumption of sugar-sweetened beverages (SSBs) that comprises 6 internet-based cores metered out over time to deliver the program content, an integrated SMS text message strategy to engage users in reporting SSB behaviors, and an electronic cellular-enabled scale for in-home weighing. The secondary objective is to illustrate the key components and characteristics of iSIPsmarter that resulted from the HCD process. The methods were guided by the Model for Internet Interventions and by best practices in HCD and instructional design processes (eg, rapid prototype development and think-aloud protocol). The 3-phased (ie, contextual, prototype testing, end user testing phases) process followed in this study included a series of 13 semistructured one-on-one interviews with 7 advisory team participants from the targeted Appalachian user group. The interviews were content coded by 2 researchers and then deductively coded to the suggested areas of digital behavioral health interventions. The participants provided rich perspectives pertaining to iSIPsmarter's appearance, behavioral prescriptions, burdens, content, delivery, message, participation, and assessment. These inputs included requests for built-in flexibility to account for varying internet and SMS text message accessibility among users; ideas to resolve the issues and problems encountered when using the prototypes, including those related to navigation and comprehension of content; ideas to enhance personalized feedback to support motivation and goal setting for SSB consumption and weight; and feedback to refine the development of realistic and relatable vignettes. The participants were able to interact with multiple prototype drafts, allowing researchers to capture and incorporate feedback related to the iSIPsmarter dashboard, daily SSB and weight diaries, action planning, core content, interactions, and vignettes. Using scientific models and established processes is critical for building robust and efficacious interventions. By applying an existing model and HCD and instructional design processes, we were able to identify assumptions and address the key areas of the iSIPsmarter intervention that were hypothesized to support users' engagement and promote behavior change. As evidenced by the rich feedback received from the advisory team members and the resulting iSIPsmarter product, the HCD methodology was instrumental in the development process. Although the final iSIPsmarter content is specific to improving SSB consumption behaviors among adults in rural areas, the intent is that this HCD process will have wide applications in the development of digital behavioral health interventions across multiple geographic and behavioral contexts.

Oral Health Literacy and Health Seeking Behavior of Older Adults in Rural Community

Objectives: This community-based cross-sectional study aimed to examine health information seeking behavior regarding oral health and oral health literacy and their relationship in older adults. Methods: The research was conducted with 432 participants from the rural area of, Noen Maprang District, Phitsanulok province, Northern Thailand. To measure oral health literacy, modified Short Test of Functional Health Literacy in Dentistry for Older Adults was used. The adapted questionnaire was used to collect health information seeking behavior in the past 3 months. Results: Only 12.3% demonstrated adequate oral health literacy. Some 27.1% presented active health information seeking behavior, 57.3% presented passive health information seeking behavior and 15.6% had never obtained or sought any oral health information. The association between health information seeking behavior and oral health literacy could not be observed. Television, health personnel, family members/relatives and village health volunteers were the most popular information sources. Conclusions: By adding oral health information and improving skills of oral health information for village health volunteers, it is possible to develop oral health literacy in older adults in rural areas.

Association Between Sleep and Cognition of Older Adults in Rural Areas: A Cross-Sectional Study.

Sleep is an essential physiological function for everyone. Limited evidence existed on the associations between multi-factor sleep patterns and cognition among older adults in rural areas. Aimed to assess that, We conducted a cross-sectional study on the living habits and cognitive status in rural areas of Qingdao and 1167 participants aged 65 to 96 years answered the questionnaire. The result showed that poor sleep quality, high sleep disturbance, daytime dysfunction, and hypnotic drug-dominated sleep patterns were related to the cognitive function, and there was no obviously associations between good sleep duration and cognition. In order to solve the sleep problems and preserve cognitive function, support and protection of physical and mental health should be the priority of government policies in helping older adults' group in rural areas.

Knowledge on prevention and management of snake bite among adults in rural area of West Bengal

Background: Snake bite and its consequences may be largely prevented with adequate knowledge. Better knowledge can lead to positive attitude and subsequently good practices. Hence, it is of utmost need that people should have adequate knowledge regarding snake bite and its management. Aims and Objectives: The aims of this study were to assess the knowledge regarding prevention and management of snake bite among adults in a rural area of West Bengal and to find out any association between sociodemographic profile and knowledge on prevention as well as management of snake bite among the study participants. Materials and Methods: A community-based and observational descriptive study was conducted in the rural field practice area of Medial College, Kolkata, West Bengal for of 2 months. The study participants who were willing to participate in the study and gave written informed consent were included in the study. A pre-designed, pre-tested, and semi-structured data collection form was used. It was developed based on similar type of previous studies and was modified according to the local culture. The data collection form comprised sociodemographic profile of the study participants, their knowledge regarding snake bite, and its prevention and availability of first aid management. Results: A total of 134 participants were included in the study. The mean age was 45.81 ± 8.00 years. It was observed that majority of the study subjects believed in the knowledge that all types of snakes are poisonous (93.2%) and leads to death (90.3%). First aid measures such as application of tourniquet that was seen in only 4.4% of the cases. However, more than half of the study subjects (71.6%) believed in sucking the venom out of the wound. It was noted that higher education status, improved social class had better knowledge score of snake bite prevention and management as compared to their counterparts and this association was found to be statistically significant (P &lt; 0.001). Conclusion: Knowledge of the study subjects on snake bite and its prevention is good, but still a large number of participants have inadequate knowledge on snake bite and its prevention. Community-based awareness program on prevention and management of snake bite, use of personal protective measures, and training of peripheral health workers ware specifically recommended.

A Pilot Study to Explore the Improvements in Pulmonary and Cognitive Functions With a Kazoo Intervention Among Middle-Aged and Older Adults in a Rural Community.

Dementia is a leading cause of disability and dependence in older adults worldwide. The aim of this pilot study was to explore the effect of using a kazoo instrument to improve pulmonary function and cognitive reserve in middle-aged and older adults in rural areas. This quasi-experimental study was conducted at two community care stations selected using cluster sampling from a rural district in southern Taiwan. We enrolled 85 middle-aged and older adults who were randomly assigned into self-learner and in-class groups. Both groups received a 6-month kazoo program. Cognitive and pulmonary function were compared before and after the intervention between the two groups. Significantly improved pulmonary function with regards to forced vital capacity (p < .05) was found in the self-learner group, and significantly improved maximum expiratory flow 75% (p < .001) was found in both groups. Mini-Mental State Examination scores significantly improved in the self-learner group (p < .01), but there was no significant change in the in-class group. Our results suggest that community care stations could consider implementing wind instrument programs such as a kazoo to enhance pulmonary function and cognitive reserve in middle-aged and older adults residing in rural areas.

Need and Potential Use of Telemedicine in Two Rural Areas

ABSTRACT Using technology as a way to ensure Home and Community-Based Services (HCBS) as an option for older adults in rural areas is of increasing interest as a result of the pandemic. Literature suggests older adults do not adopt telehealth and/or medicine practices due to barriers and do not use telemedicine as a form of communication with medical staff. This study evaluates the potential for telehealth/medicine use in rural communities through two case studies of older persons (N = 176) age 65+ aging in place in the Eastern Plains of Colorado (n = 88) and rural Western Nebraska (n = 88). Demographic data collection is followed by nominal data collection (yes/no) for telehealth exposure, use, and potential. Two separate open-ended, qualitative questions seeking further details are subsequently asked. Results from the convenience sample indicate that the main themes emanating from older persons responding to telehealth/medicine interview questions include support for its potential use with some using teleconferencing, health portals, along with the expectation that telehealth/medicine would be part of new health care systems. These findings provide evidence that older adults residing in rural areas need to be trained with a certain set of technology skills, which allows for the breaking of barriers toward the use and recognized value of telemedicine. Agencies supporting rural older adults must emphasize this form of training within the framework of service offerings especially for the older adult who has poor technological capacity. Lack of awareness for such services inhibits service use, thereby impacting overall well-being.

RURAL AGE-FRIENDLY ECOSYSTEMS: A SCOPING REVIEW WITH RECOMMENDATIONS FOR AGE-FRIENDLY COMMUNITIES

Abstract The population of older adults in rural areas is rising, and they experience higher rates of poverty and chronic illness, have poorer health behaviors, and experience different challenges than those in metropolitan areas. Promoting age-friendly rural communities and healthcare is key to improving outcomes and addressing disparities. This international scoping review seeks to 1) map the state of the science of age-friendly systems in rural areas regarding structural characteristics, processes for delivering age-friendly practices, and outcomes of age-friendly systems, 2) analyze strengths, weakness, opportunities, and threats of age-friendly system implementation, and 3) make person, practice, and policy-level recommendations to support active aging. Articles were retrieved from PubMed, CINAHL, AgeLine, PsychINFO, EMBASE, Scopus, and Academic Search Elite on 10/26/21 and included if they used age-friendly framing, self-identified as rural, and reported empiric data. Data were charted across three analytic layers: socioecological model, Donabedian’s framework, and SWOT analysis. While age-friendly systems in this review were heterogeneous, many utilized the World Health Organization age-friendly cities framework. Results reveal limited data on outcomes relevant to organizations. While the SWOT analysis revealed many strengths of age-friendly systems, it also revealed several weaknesses, threats, and gaps. Weaknesses included over-reliance on trained volunteers and staff, communication, and teamwork. Threats included community and health system barriers and challenges in developing regions. Despite the benefits of age-friendly systems, we must acknowledge limitations of the evidence base, pursue opportunities to examine organizational metrics to support implementation and sustainability of age-friendly systems, and leverage improvements in age-friendliness at a community level.

Identifying the suicidal ideation risk group among older adults in rural areas: Developing a predictive model using machine learning methods.

The aim of this study was to develop a predictive model that can identify the suicidal ideation risk group among older adults in rural areas using machine learning methods. This study applied an exploratory, descriptive and cross-sectional design. The participants were older adults (N=650) aged over 65 living in rural areas of South Korea. Self-report questionnaires were used to collect the demographics, suicidal ideation, depression, socioeconomic information and basic health information from September to October 2020. The collected data were analysed using machine learning methods with R statistical software 4.1.0. The predictive models indicated that depression, pain, age and loneliness were significant factors of suicidal ideation. Good performance was observed based on the area under the receiver operating characteristic curve in the decision tree, random forest and logistic regression. Finally, the evaluation of model performance indicated moderate to high sensitivity and specificity. The predictive models using machine learning methods may be useful to predict the risk of suicidal ideation. Furthermore, depression with pain, age and feelings of loneliness should be included in the initial screening to assess suicide risk among older adults in rural areas. Identifying suicidal risk among older adults is challenging. Thus, employing predictive models that can assess depression, pain, age and loneliness can enable public healthcare providers to detect suicidal risk groups. Particularly, the presented models from this study can facilitate healthcare providers with initiating early interventions to prevent suicide among older adults in clinical and community nursing care settings. The reporting of this study (Observational, cross-sectional study) conforms to the STROBE statement. No patient or public contribution. This study did not involve patients, service users, caregivers or members of the public. Applying this model may help to prevent geriatric suicide because the nursing staff will have a greater awareness regarding the suicide ideation risk of older adults, thereby reducing the possibility of their suicide.

Acceptance of technology related to healthcare among older Korean adults in rural areas: A mixed-method study

Many older adults find it difficult to accept new forms of information and communication technology (ICT), despite its advantages such as convenience and efficiency. It is necessary to identify the reasons for low ICT use among older people—even among those with positive attitudes toward ICT—to help older adults cope with social changes and bridge the digital divide. This study explored technology acceptance and related factors among older Korean adults living in rural areas. Based on an existing model (the senior technology acceptance model), a new conceptual framework for technology acceptance was proposed, and the framework was tested using pathway analysis. Semi-structured interviews were conducted in three focus groups (n = 15), and a survey questionnaire was administered to older Korean adults living in a rural area (n = 233) from 17 January 2021 to 18 February 2021. Qualitative data were analyzed using directed content analysis, and quantitative data were analyzed using pathway analysis. Four categories, 11 subcategories, and 18 codes were identified, and a new conceptual framework was proposed based on the qualitative findings. The results of the model revealed significant positive direct paths from external controls (β = 0.45, p < .001), attitudinal beliefs (β = 0.33, p < .001), and cognitive health (β = 0.10, p = .040) to internal abilities. It is necessary to develop and apply a targeted and tailored ICT education program to improve self-efficacy and reduce anxiety regarding technology use among older Korean adults living in rural areas.