Older Adults In Rural Communities Research Articles

Predictors of fall protection motivation among older adults in rural communities in a middle-income country: A cross-sectional study using the Protection Motivation Theory.

To evaluate factors associated with fall protection motivation to engage in fall preventive behaviour among rural community-dwelling older adults aged 55 and above using the protection motivation theory scale. A cross-sectional study. The study was conducted in a healthcare clinic in Malaysia, using multistage random sampling from November 2021 to January 2022. Three hundred seventy-five older adults aged 55 and older were included in the final analysis. There were 31 items in the final PMT scale. The analysis was performed within the whole population and grouped into 'faller' and 'non-faller', employing IBM SPSS version 26.0 for descriptive, independent t-test, chi-square, bivariate correlation and linear regressions. A total of 375 older participants were included in the study. Fallers (n = 82) and non-fallers (n = 293) show statistically significant differences in the characteristics of ethnicity, assistive device users, self-rating of intention and participation in previous fall prevention programmes. The multiple linear regression model revealed fear, coping appraisal and an interaction effect of fear with coping appraisal predicting fall protection motivation among older adults in rural communities. Findings from this study demonstrated that coping appraisal and fear predict the protection motivation of older adults in rural communities. Older adults without a history of falls and attaining higher education had better responses in coping appraisal, contributing to a reduction in perceived rewards and improving protection motivation. Conversely, older adults from lower education backgrounds tend to have higher non-preventive behaviours, leading to a decline in fall protection motivation. These results contribute important information to nurses working with older adults with inadequate health literacy in rural communities, especially when planning and designing fall prevention interventions. The findings would benefit all nurses, healthcare providers, researchers and academicians who provide care for older adults. Participants were briefed about the study, and their consent was obtained. They were only required to answer the questionnaire through interviews. Older individuals aged fifty-five and above in rural communities at the healthcare clinic who could read, write or understand Malay or English were included. Those who were suffering from mental health problems and refused to participate in the study were excluded from the study. Their personal information remained classified and not recorded in the database during the data entry or analysis.

Individual and Community-Contextual Level Factors Associated With Wellbeing Among Older Adults in Rural Zambia.

Objective: This article aims to identify individual and community-contextual level factors associated with the wellbeing of older adults (50years and older) in rural Zambia. Methods: Data from the nationally representative 2015 Living Conditions Monitoring Survey (LCMS) was used. Employing multilevel mixed effects, the individual and community-contextual factors on wellbeing were determined. Results: Overall, 31.7% of rural older adults perceived their wellbeing as good. Both individual and community-contextual level factors are associated with the wellbeing of older adults in rural communities. At the individual level, wellbeing was associated with higher education attainment. Community-contextual factors significantly associated with wellbeing included improved housing, access to piped tap water within the premises, own charcoal or income to purchase firewood. Conclusion: The findings foreground the imperative to analyse both individual and community-contextual level factors of wellbeing to generate and present evidence for investments in education across the life course and for the development of infrastructure towards increasing the wellbeing of rural older adults. Additionally, the results provide a basis for planning by devising policies and programmes for older people to thrive and for no one to be left behind regardless the setting.

The impact of income level on skeletal muscle health in rural Chinese older residents: a study of mediating effects based on dietary knowledge.

China's rural residents have basically solved the problem of subsistence, but due to aging, the prevalence of sarcopenia (abbreviated as sarcopenia) has been increasing year by year, especially the skeletal muscle health of the rural older residents has not been sufficiently paid attention to, so analyses of the impact of income level on the skeletal muscle health of the older people in rural areas of China are of great practical significance. Based on the annual data of the China Health and Nutrition Survey (CHNS) in 2006, 2009, and 2011, we introduced the mediator variable of dietary knowledge and used the Probit model regression, mediation effect model, and instrumental variable regression to assess the skeletal muscle health status of the rural older people in China and explore the mechanism of the influence of the income level on the skeletal muscle health of the rural older residents in China. The primary objectives of this study were to evaluate the impact of income level on the skeletal muscle health status of older adults living in rural areas of China and to investigate the underlying mechanisms. By analyzing the findings of this study, our aim is to establish a correlation between the economic status and skeletal muscle health of older adults in rural communities, as well as elucidate the influence of income level and dietary knowledge on their skeletal muscle health. Through the attainment of these objectives, we hope to provide valuable insights and recommendations for enhancing skeletal muscle health among the rural older population in China. Based on our research findings, it can be inferred that there was a significant association between the financial status of rural older adults and their skeletal muscle health. Additionally, the prevalence of sarcopenia was lower among individuals with higher income levels, and there was a negative correlation between the prevalence of sarcopenia and the level of dietary knowledge among rural older individuals. The knowledge of dietary knowledge level of rural older people plays a mediating role in the income level and the prevalence of sarcopenia. Moreover, with the change in income level and the increase in age, the change in skeletal muscle health status showed obvious heterogeneity, in which the effect on the relatively younger (65-70 years old) samples was greater. Therefore, sustained income growth remains an effective way to improve the skeletal muscle health of older rural residents. At the same time, improving dietary knowledge and dietary quality among the older people is important in preventing a decline in muscle strength and physical function and in preventing the onset of sarcopenia.

Associations between frailty and mild cognitive impairment in older adults: Evidence from rural Chiang Mai Province.

Thailand entered an aged society phase in 2000, with mild cognitive impairment (MCI) and frailty becoming prevalent among the older adult population. However, no studies have yet examined these issues specifically within rural communities. This study aims to explore the relationship between frailty and MCI among older adults in rural Thailand. It was a cross-sectional study conducted between December 2022 and June 2023. A questionnaire was administered by trained village health volunteers. The survey targeted older adults aged 60 years and above, residing in rural Chiang Mai, Thailand, with those having a history of dementia, depression, and brain injury being excluded from participation. Nine hundred eighty-four participants among the older adults were available for analysis. The mean age was 69.8 (SD 7.9) with 62.2% females (n = 612). The median frequency of exercise was three days (0-7). The prevalence of MCI and frailty among rural older adults in the community was 35.6% (n = 350) and 8% (n = 79), respectively. There were four factors associated with an increased risk of MCI, including age (aOR = 1.07, 95% CI 1.04-1.09, p < 0.001), smoking cigarettes (aOR 1.95, 95% CI 1.27-2.98, p = 0.002), feelings of loneliness (aOR 1.43, 95% CI 1.01-2.03, p = 0.043), and the presence of frailty (aOR 1.92, 95% CI 1.10-3.35, p = 0.022). There were two factors associated with a lower risk of MCI: a higher education level (aOR 0.90, 95% CI 0.86-0.94, p <0.001) and engaging in frequent exercise (aOR 0.9, 95% CI 0.86-0.95, p < 0.001). Frailty exhibited an association with an elevated risk of MCI among older adults in rural communities. Enhancing screening through health volunteers and primary healthcare professionals, coupled with bolstering community-driven health promotion initiatives, becomes imperative.

Rural-urban difference in meeting the need for healthcare and food among older adults: evidence from India

BackgroundDue to changes in demographic and epidemiological scenarios, and the gradual increase in the older population, India is yet to prepare for rising nutrition and health-related issues among older adults in the coming decades. While the process of ageing and its associated aspect has been found to have an urban-rural divide. Thus, this study examines rural/urban differences in unmet needs for food and healthcare among Indian older adults.MethodsA sample of 31,464 older adults aged 60 years and above were considered in the study from the Longitudinal and Ageing Survey of India (LASI). The bivariate analysis was done using the sampling weights. Logistic regression and decomposition analysis was used to explain the rural-urban gap in the unmet needs for food and healthcare among Indian older adults.ResultsRural older adults were more vulnerable to meeting the need for health and food than their urban counterparts. While factors that contributed majorly to the difference in unmet need for food between urban and rural were education (34.98%), social group (6.58%), living arrangements (3.34%) and monthly per capita expenditure (MPCE) (2.84%). Similarly, for the unmet need for health, the factors that contributed the most to the rural-urban gap are education (28.2%), household size (2.32%), and MPCE (1.27%).ConclusionThe study indicates more vulnerability among rural older adults than compared to urban older individuals. The targeted policy-level efforts should be initiated considering the economic and residential vulnerability identified in the study. There is a need for primary care services that can provide targeted help to older adults in rural communities.

226 The Feasibility and Acceptability of Perturbation-Based Balance to Older Adults in Rural Communities

OBJECTIVES/GOALS: Older adults in rural communities are at an elevated risk of falling. Perturbation-Based Balance Training (PBT) is a highly effective fall prevention paradigm but its feasibility in the community is unknown. The purpose of this study was to determine the feasibility and acceptability of PBT to older adults and local clinicians in rural communities. METHODS/STUDY POPULATION: 19 older adults (60+ years) were recruited from communities in rural Montana to take part in a PBT program. The PBT program was implemented using a bespoke portable PBT treadmill developed by our research team and validated against commercial PBT treadmills. To increase ecological validity, the program was implemented by local clinicians. The PBT program lasted 6 weeks, with 1 session per week, participants received up to 35 trip perturbations per session. The feasibility and acceptability of PBT to participants and clinicians was assessed within the Theoretical Framework of Acceptability, prospectively and retrospectively via interviews and surveys, and concurrently via field notes. RESULTS/ANTICIPATED RESULTS: Data analysis is ongoing and will be complete by the time of presentation. Preliminary results suggest the portable PBT program was generally acceptable to older adults and local clinicians. Perceived effectiveness was generally positive and increased balance awareness and low burden are emerging as common themes. Local clinicians indicated the burden of implementing PBT was low, PBT fit within their views on fall prevention, and had a high level of perceived effectiveness. There appear to be a few limitations to feasibility, which are primarily related to the weight and transportation of the treadmill. We are currently working to refine the treadmill and lower its weight and are developing a grant with local clinicians and extension agents that would facilitate transportation to a broader network of communities. DISCUSSION/SIGNIFICANCE: Our preliminary findings suggest PBT is feasible in rural communities and accepted by older adults. Increased balance and fall awareness and low burden are emerging as important factors in the feasibility and acceptability of PBT. This study provides a foundation for future studies to translate other PBT modalities from the lab to the community.

The effect of a multimodal intervention program on cognitive and daily function of older persons residing in rural communities: A pilot study.

This pilot study aimed to explore the effects of a 12-week multimodal intervention program, comprising cognitive training and cognitive-stimulation, on cognitive performance and daily function of older adults in rural communities. Fifty-one participants were equally assigned to the multimodal intervention, cognitive-stimulation, and no-intervention control groups. Cognition and daily function were assessed using the Korean version of neuropsychological test battery and instrumental activities of daily living at baseline and at the 12-week follow-up assessment, respectively. Compared with the two other groups, the multimodal intervention group showed significant improvement in global cognitive function, attention, and executive function. A significant group-by-time interaction in instrumental activities of daily living was observed among the groups, with a greater improvement observed in the multimodal intervention group and little changes or decreases over time in the other groups. This study suggested the beneficial effects of a multimodal intervention on cognitive and behavioral improvement in older adults.

Enabling Rural Telehealth for Older Adults in Underserved Rural Communities: Focus Group Study

Telehealth is often suggested to improve access to health care and has had significant publicity worldwide during the COVID-19 pandemic. However, limited studies have examined the telehealth needs of underserved populations such as rural communities. This study aims to investigate enablers for telehealth use in underserved rural populations to improve access to health care for rural older adults. In total, 7 focus group discussions and 13 individual interviews were held across 4 diverse underserved rural communities. A total of 98 adults aged ≥55 years participated. The participants were asked whether they had used telehealth, how they saw their community's health service needs evolving, how telehealth might help provide these services, and how they perceived barriers to and enablers of telehealth for older adults in rural communities. Focus group transcripts were thematically analyzed. The term telehealth was not initially understood by many participants and required an explanation. Those who had used telehealth reported positive experiences (time and cost savings) and were likely to use telehealth again. A total of 2 main themes were identified through an equity lens. The first theme was trust, with 3 subthemes-trust in the telehealth technology, trust in the user (consumer and health provider), and trust in the health system. Having access to reliable and affordable internet connectivity and digital devices was a key enabler for telehealth use. Most rural areas had intermittent and unreliable internet connectivity. Another key enabler is easy access to user support. Trust in the health system focused on waiting times, lack of and/or delayed communication and coordination, and cost. The second theme was choice, with 3 subthemes-health service access, consultation type, and telehealth deployment. Access to health services through telehealth needs to be culturally appropriate and enable access to currently limited or absent services such as mental health and specialist services. Accessing specialist care through telehealth was extremely popular, although some participants preferred to be seen in person. A major enabler for telehealth was telehealth deployment by a fixed community hub or on a mobile bus, with support available, particularly when combined with non-health-related services such as internet banking. Overall, participants were keen on the idea of telehealth. Several barriers and enablers were identified, particularly trust and choice. The term telehealth is not well understood. The unreliable and expensive connectivity options available to rural communities have limited telehealth experience to phone or patient portal use for those with connectivity. Having the opportunity to try telehealth, particularly by using video, would increase the understanding and acceptance of telehealth. This study highlights that local rural communities need to be involved in designing telehealth services within their communities.

Protective and high-risk social activities associated with homebound status among older adults in rural Japan

Becoming homebound can be devastating for older adults in rural communities. This study aimed to identify protective or high-risk social activities associated with homebound status among the rural young old (ages 65–74) and the oldest old (ages ≥ 75). We used data from a survey of older adults in a rural community of Japan in 2014. Questions covered sociodemographic characteristics, homebound status (i.e., going out less than once a week), physical and psychological status, and social activities. Using survey data, we conducted logistic regression analysis to identify protective and high-risk social activities associated with homebound status. Of the 1,564 participants, 51.0 % were the oldest old, and the mean age was 75.2 (±7.0) years. The prevalence of homebound status was 10.5 % total: 5.2 % among the young old and 15.7 % among the oldest old and highest among the female oldest old (19.4 %). The main protective social activity for the young and the oldest old was visiting friends’ houses (adjusted odds ratio [AOR] 5.38, 95 % confidence interval [CI] 1.64–17.64 and AOR 3.49, 95 % CI 1.07–11.42, respectively). For the young old, specific high-risk social activities were advising family and friends (AOR 0.07, 95 % CI 0.01–0.62) and activities to support older adults (AOR 0.17, 95 % CI 0.03–0.84). For the oldest old, a protective social activity was participating in long-term care prevention programs (AOR 28.94, 95 % CI 1.90–441.63). To prevent rural older adults from becoming homebound, support should be provided according to protective and high-risk social activities for age groups, with particular attention to safe socialization amid the threat of COVID-19.

The complex nature of transportation as a key determinant of health in primary and community care restructuring initiatives in rural Canada

It is well recognized that transportation is a barrier to healthcare access for rural-dwelling residents, particularly older adults. Healthcare restructuring initiatives seldom take into consideration the complexity of transportation, which acts as a barrier to appropriate and timely access to healthcare services for older adults in rural communities. This article presents findings of a qualitative research study that explored the complex nature of transportation challenges that rural-dwelling older adults experience in Western Canada when trying to access primary and community care services. Data were derived from a larger study of service user views on a healthcare restructuring initiative intended to facilitate aging-in-place. We conducted 15 focus groups and 9 interviews with a diverse sample of 83 older adults living in one urban centre and nine rural and small rural towns in British Columbia (BC)’s interior. We used content analysis to determine codes and derive themes. Study findings showed that transportation was a top priority for improving primary and community care. Older adult participants identified a range of transportation challenges in trying to get to healthcare services and care providers getting to them. Transportation was a social determinant of health (SDOH) for all participants, regardless of whether they lived in the urban centre or in a rural or small rural town. Our study provides more evidence to support that transportation is a key SDOH for rural-dwelling older adults. As such, transportation should be specifically addressed in healthcare restructuring initiatives that aim to support aging-in-place. Service providers need to advocate for system-wide solutions such as integrating transportation into the healthcare system, while it is imperative that decision-makers act on these solutions.

Reaching Out to Older Adults in Rural Communities by Utilizing Community Health Workers During a Pandemic

Older adults in rural communities have access, isolation, and technology barriers to healthcare that are exacerbated by the COVID- 19 pandemic. A shortage of healthcare professionals combined with limited resources and poor broadband access have limited their ability to benefit from telehealth. The pandemic has further worsened isolation in rural communities. This Age-Friendly Care, PA pilot study uses community health workers (CHW) as a bridge to connect isolated and underserved older adults with their healthcare team. The CHWs facilitate access to telehealth provided by a Federally Qualified Health Center (FQHC), and also provide “check-ins’ to housebound patients. The focus of the intervention is CHW delivered facilitation of telehealth and other supports to better manage their healthcare needs. We will describe the co-design of the project and discuss lessons learned in attempting to bridge the digital divide for rural older adults during and after the pandemic.

Navigating Food Insecurity as a Rural Older Adult: The Importance of Congregate Meal Sites, Social Networks and Transportation Services

ABSTRACT To explore how older adults in rural communities navigate food insecurity, ten focus groups were held in Indiana, USA with 65 discussants. Recordings underwent inductive qualitative data analysis. Driving and transport remain a barrier to rural food access. Living alone is another contributor to food insecurity, while older adults’ social networks are protective. Congregate meal sites are critical to maintaining nutrition and are underfunded; one-third of this region’s meal sites closed in 2019. These must be maintained and expanded. Transportation to food outlets is needed. Mechanisms that reinforce older adults’ social networks can build upon an existing asset.

Factors That Influence Physical Activity Among Older Adults Living in Rural Community in Wangthong District, Phitsanulok, Thailand

This study aimed to assess the individual, interpersonal, and environmental factors that relate to physical activity (PA) among older adults in rural communities in Wangthong district, Phitsanulok, Thailand. A cross-sectional study was conducted on 545 elders by multi-stage sampling. The data were collected via a validated questionnaire. Multiple logistic regression analysis was performed to identify potential determinants of PA. Factors including youngest-old (adjusted OR 1.55, 95% CI [1.05–2.28]), high level of income (adjusted OR 1.89, 95% CI [1.17–3.19]), being a member of the elders’ club (adjusted OR 1.68, 95% CI [1.15–2.46]), and high level of perceived self-efficacy (adjusted OR 1.79, 95% CI [1.23–2.61]) indicated higher likelihood of PA ( p &lt; .05). Interventions to improve PA among older people should include improving physical environmental attributes, creating more inexpensive and less time-consuming alternatives for PA, promoting peer support networks and activities to enhance self-efficacy.

Functional status and its associated factors among community-dwelling older adults in rural Nepal: findings from a cross-sectional study

BackgroundThe high burden of chronic conditions, coupled with various physical, mental, and psychosocial changes that accompany the phenomenon of aging, may limit the functional ability of older adults. This study aims to assess the prevalence of poor functional status and investigate factors associated with poor functional status among community-dwelling older adults in rural communities of eastern Nepal.MethodsData on 794 older adults aged ≥ 60 years from a previous community-based cross-sectional study was used. Participants were recruited from rural municipalities of Morang and Sunsari districts of eastern Nepal using multi-stage cluster sampling. Functional status was assessed in terms of participants’ ability to perform activities of daily living using the Barthel Index. Covariates included sociodemographic characteristics, lifestyle factors, and self-reported chronic conditions. A binary logistic regression model was used to investigate factors associated with poor functional status.ResultsThe overall prevalence of poor functional status was 8.3 % (male: 7.0 % and female: 9.6 %), with most dependence noted for using stairs (17.3 %), followed by dressing (21.9 %) on Barthel Index. In the adjusted model, oldest age group (odds ratio [OR] = 2.83, 95 %CI: 1.46, 5.50), those unemployed (OR = 2.41, 95 %CI: 1.26, 4.65), having memory/concentration problems (OR = 2.32, 95 %CI: 1.30, 4.13), depressive symptoms (OR = 2.52, 95 %CI: 1.28, 4.95), and hypertension (OR = 1.78, 95 %CI: 1.03, 3.06) had almost or more than two times poor functioning.ConclusionsOne in 12 older adults had poor functional status as indicated by their dependency on the items of the Barthel Index; those in the oldest age bracket were more likely to exhibit poor functional status. We suggest future studies from other geographies of the country to supplement our study from the rural setting for comprehensive identification of the problem, which could guide the development of prevention strategies and comprehensive interventions for addressing the unmet needs of the older adults for improving functional status.

Moderated mediation roles of social connectedness and optimism on emotional intelligence and life satisfaction

The processes and circumstances underlying the association between emotional intelligence and life satisfaction were investigated among rural older adults. The factor structure of the measures was also assessed to determine their capacity and suitability for use. Participants were 1053 (639 males and 414 females) older adults with a mean age of 71.34 (SD of 7.15) recruited from selected rural communities in southwestern Nigeria. Results of the factor analysis show that the measures are appropriate for use in the study settings. Emotional intelligence significantly predicts life satisfaction as a result of social connectedness among the samples used. Also, the effect holds better among older adults with higher dispositional optimism than those with lower dispositional optimism. The study outcomes underscore the importance of social connectedness and optimism on life satisfaction among older adults in rural communities.

Rural-urban differences in diagnostic incidence and prevalence of Alzheimer's disease and related dementias.

Understanding rural-urban variation in the diagnostic incidence and prevalence of Alzheimer's disease and related dementias (ADRD) will inform policies to improve timely diagnosis and access to supportive services for older adults in rural communities. Using 2008 to 2015 national claims data for fee-for-service Medicare beneficiaries (roughly 170 million person-years), we computed unadjusted and adjusted diagnostic incidence and prevalence estimates for ADRD in metropolitan, micropolitan, and rural counties, and examined differences in survival rates. Risk-adjusted ADRD diagnostic incidence was higher in rural versus metropolitan counties despite lower prevalence. Among beneficiaries diagnosed with ADRD in 2008, metropolitan county residents experienced longer survival compared to residents in rural and micropolitan counties. These data suggest that older adults in rural communities may be underdiagnosed with ADRD, and/or diagnosed at later stages of dementia. Further work is needed to develop strategies to reduce this disparity.

Preventive health care services utilization and its associated factors among older adults in rural communities in Anambra State, Nigeria.

Introductionquality of life and life expectancy of people are improved when preventive health care services are utilized because these identify treatable health problems and puts life-threatening diseases in check. Morbidity and mortality associated with age-related chronic disease among the older adults is on the increase, therefore, this study aims at determining preventive health care services utilization among older adults in rural communities in Anambra State.Methodsa cross sectional design adopted for this study was carried out on older adults from the ages of 65 years and above in rural communities in Anambra State from October 2019 to January 2020. Data were collected through researcher-administered structured questionnaire. Data were analysed using univariable and multivariable regression analysis.Resultsa total of 1944 older adults participated with an overall cluster percentage of 40.6% older adults utilizing investigated preventive health care services. The results of the multivariable analysis indicates that the following factors were associated with utilization of preventive healthcare services: male gender (aOR: 0.443, 95%CI: 0.281 - 5.472, p=0.47), level of education; primary (aOR: 1.536, 95%CI: 1.201 - 5.261, p=0.00), secondary (aOR: 4.516, 95%CI: 3.192 - 6.242, p=0.00), and tertiary (aOR: 3.407, 95%CI: 3.199 - 5.666, p=0.00)], income of N50,000-N100,000 (aOR: 2.754, 95%CI: 1.066 - 10.766, p=0.01), and N100,000 and above (aOR: 4.233, 95%CI: 1.846 - 12.811, p=0.00)], and health insurance [aOR: 0.691, 95%CI: 0.422 - 1.945, p=0.03].Conclusionpreventive health care services were under-utilized. Creating awareness on the importance of utilizing preventive health care services is highly recommended since most age-related chronic diseases once established may last a lifetime and affect quality of life and wellbeing.

Significant Association between Physical Performance and Inflammatory Biomarkers in Older Adults with Frailty in Rural Thailand

Background: The etiology of frailty is complex and incompletely understood, and is associated with alterations in the immune system, resulting in chronic low-grade inflammation. However, few studies have explored the inflammatory biomarkers related to physical performance in the elderly. Methods: We evaluated the prevalence of frailty with a cross-sectional study among older adults in rural communities in Thailand (n = 457, mean age of 71.4 ± 5.8 years) with Fried’s frailty phenotype including five criteria: weight loss, exhaustion, slowness, weakness, and inactivity. The association between inflammatory biomarkers (serum interleukin-6, IL-6 and C-reactive protein, CRP levels) and physical performance (grip strength, walk times and VO2Max) was examined in frail participants (n=64). Results: The prevalence of frailty and pre-frailty in this population was 37.4% (95% CI, 32.9-42.0) and 54% (95% CI, 49.4-58.7). Multiple linear regression analysis found that serum IL-6 level was significantly elevated in frail older adults with low grip strength (beta = -0.348, SE= 0.155, p = 0.029). Serum CRP level was also elevated significantly in frail older adults with low grip strength (beta = -0.049, SE= 0.023, p = 0.04) and low VO2Max (beta = -0.047, SE= 0.019, p = 0.016) after adjustment for sex, age, hypertension, diabetes, osteoporosis, heart disease, and BMI. Conclusion: Our findings support a low level of grip strength as predictor of inflammatory biomarkers in older adults with frailty. Primary care practitioners could use frailty indicators and performance combined with serum biomarkers for early health risk detection in older adults.

The Impact of the COVID-19 Epidemic on Older Adults in Rural and Urban Areas in Mexico.

ObjectivesMexico is among the countries in Latin America hit hardest by coronavirus disease 2019 (COVID-19). A large proportion of older adults in Mexico have high prevalence of multimorbidity and live in poverty with limited access to health care services. These statistics are even higher among adults living in rural areas, which suggest that older adults in rural communities may be more susceptible to COVID-19. The objectives of the article were to compare clinical and demographic characteristics for people diagnosed with COVID-19 by age group, and to describe cases and mortality in rural and urban communities.MethodWe linked publicly available data from the Mexican Ministry of Health and the Census. Municipalities were classified based on population as rural (<2,500), semirural (≥2,500 and <15,000), semiurban (≥15,000 and <100,000), and urban (≥100,000). Zero-inflated negative binomial models were performed to calculate the total number of COVID-19 cases, and deaths per 1,000,000 persons using the population of each municipality as a denominator.ResultsOlder adults were more likely to be hospitalized and reported severe cases, with higher mortality rates. In addition, rural municipalities reported a higher number of COVID-19 cases and mortality related to COVID-19 per million than urban municipalities. The adjusted absolute difference in COVID-19 cases was 912.7 per million (95% confidence interval [CI]: 79.0–1746.4) and mortality related to COVID-19 was 390.6 per million (95% CI: 204.5–576.7).DiscussionUrgent policy efforts are needed to mandate the use of face masks, encourage handwashing, and improve specialty care for Mexicans in rural areas.

Exploring Daily Activity Patterns on the Typical Day of Older Adults for Supporting Aging-in-Place in China's Rural Environment.

Severe aging in rural China is prompting communities to promote support for older people to age in place. The study of the daily life of older adults in rural areas is conducive to understanding their real life and demands, as well as the way they interact with their environment, to develop feasible strategies. In this study, 171 older adults over 60 years old in two different types of villages in Northern Zhejiang Province were investigated and analyzed in terms of the temporal and spatial features of daily activities, as well as their relationship with population attributes, personal competence, and subjective demands. The results show that: (1) significant association can be seen between working hours and the demand for health services, housework hours and gender and age, as well as leisure hours and ADL and the demand for recreational services. (2) The older adults appear to have inter-group homogeneity in some aspects: basic living activities, leisure hours, the gender difference in housework hours, and recreational preference, while they have higher average paid work hours and fewer leisure alternatives than their urban counterparts. Their definitions of paid work, housework, and leisure activities are vague. (3) The definition of home by the older adults in rural places sometimes seems to go beyond the scope of their own house, and the extensive definition of home may change their recognitions of some activities. They also inclined to assign meaning to a place through frequent use rather than through external definitions. (4) The weak consciousness on buying services and deteriorated financial situation hinders the older adults in rural communities from expressing their real demands. Unspoken demands include economic security, recreational choices, and assistance in housework. The results will help to provide references for the improvement of eldercare services and the community environment.