Older Adults In Rural Communities Research Articles

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.

Health and Nutritional Beliefs and Practices among Rural Elderly Population: An Ethnographic Study in Western Spain.

Background: Demographic transition is causing an increasingly aged society, which has a significant impact on public health strategies. Increases in the size of the elderly cohort create a wider stratification and pose specific challenges. Nutrition and diet are one key issue. This study aims to describe food-related practices, beliefs, and representations of non-institutionalized older adults in rural communities in Extremadura (Western Spain). Method: The ethnographic-based fieldwork was conducted from January to July 2019. Empirical material was collected through different research relationships (semi-structured interviews and informal conversations) and direct observation in various locations in Extremadura―involving a variety of agents associated with different aspects of the nutritional process. Results: Data analysis revealed four major themes: (1) Limitations on choice and quality of food available; (2) food preferences and cooking methods; (3) the role of nostalgia in the construction of taste preferences; and (4) perceptions of what “healthy” food is and how respondents relate to the advice provided by health professionals. Conclusions: Nutritional choices among the group studied presented significant differences from medical advice―which was seen as a series of “bans” that did not carry enough authority to alter the symbolic value attached to their traditions.

A Triple-Difference Approach to Re-Evaluating the Impact of China's New Cooperative Medical Scheme on Incidences of Chronic Diseases Among Older Adults in Rural Communities.

BackgroundThis paper re-evaluates the impacts of China’s New Cooperative Medicine Scheme (NCMS), a social health insurance program targeting China’s rural population, on the incidences of chronic diseases among its enrollees. Although coverage under the NCMS expanded rapidly following its implementation in 2003, previous studies have failed to reach a consensus on its health impacts. Existing conflicting results may be due to methodological problems such as implausible identification assumptions and the failure to focus on the most relevant beneficiaries.MethodsDrawing on data from a longitudinal sample from the China Health and Nutrition Survey (CHNS), we focus on a subgroup of patients over the age of 55 years to re-estimate the NCMS’s impact on incidences of chronic disease among enrollees. We adopt a triple-difference (difference-in-difference-in-differences) method, relaxing the parallel-trend assumption commonly invoked in the previous double-difference (difference-in-differences) studies.ResultsOur triple-difference estimates suggest that the NCMS has significantly reduced the incidences of apoplexy and diabetes among rural residents aged 55 years or older. The impacts of the NCMS on chronic disease are underestimated by the commonly adopted double-difference method. The triple-difference method allows evaluations to focus on the most relevant subgroups for detecting program impacts.ConclusionOur findings that the NCMS has significantly positive impacts on elderly enrollees’ incidences of chronic diseases also suggest the need for examining its impacts on other vulnerable groups, such as low-income individuals, young children, and individuals with poor health conditions.

Rural America's Hospitals are Not Prepared to Protect Older Adults From a Surge in COVID-19 Cases.

Rural communities with predominantly older adult populations could be especially vulnerable to poor outcomes from COVID-19 due to lacking intensive care unit (ICU) capacity. Our objective is to describe the scope of the problem by summarizing population totals of older adults in rural America and their community’s ICU bed availability. We performed a review of peer-reviewed literature, in addition to hand searching non–peer-reviewed and governmental/non-governmental agency reports, using the Kaiser Health News data report to assess the number of ICU beds in 10 predominantly rural states with the highest older adult populations. We found that while 19% of the U.S. population lives in rural counties, these counties contain only 1% of the ICU beds in the United States. Counties particularly at risk for inadequate ICU capacity include Crittenden, Arkansas; Cass, Minnesota; and Sagadahoc, Maine. Solutions include building new delivery systems, reopening previously closed rural hospitals, and calling on local businesses to create medical supplies. In summary, the 10 million older adults in rural communities in the United States may face challenges with obtaining critical care treatment due to the increased need of ICU beds during the COVID-19 pandemic.

THE IMPACT OF PARTICIPATION IN SOCIAL HEALTH NETWORKS

Stress and compassionate fatigue are common among graduate level students working in healthcare professions, however, few studies focus on preventative self-care and its’ impact on these learners. As part the University of Louisville’s Behavioral Health Workforce Enhancement Training Program (BHWET), graduate students are trained to work with older adults in rural communities. The focus of our BHWET program is to provide holistic, behavioral health care through our FlourishCare Network. As part of the student’s weekly curriculum, an interdisciplinary group of learners from counseling psychology, social work and psychiatric nursing were invited to the attend the sessions were invited to participate in a 2-semester Microclinics and Health Matters course that was designed to promote self-care and harness the power of social networks to promote health. A total of 15 students completed the program. Biomarkers including BMI, Cholesterol, A1C, Blood Pressure were taken every week time the course was offered. Cortisol levels were taken every 4 months to measure stress levels. Across the initial 12 weeks of programming, there were positive outcomes for the participants in terms of either maintenance of healthy goals or biomarkers. Additionally, the program had an impact on the older adult clients that were being served by the students compared to students that did not participant. In a review of the plan of care items, which is central to our work with FlourishCare clients, plan of care items showed a stronger focus on connecting clients to social health interventions and a stronger connection to education about health-related content.

Leveraging a contextually sensitive approach to rural geriatric interprofessional education.

Interprofessional Education (IPE) has been recognized on an international and national level as an effective method of preparing health professionals for practice while also improving health system outcomes. In particular, recent research highlights that geriatric IPE initiatives can be mutually beneficial both to learners and older adults in rural communities. Despite this trend, IPE initiatives continue to produce mixed results. Although some scholars have acknowledged that IPE initiatives need to consider the complexity of healthcare contexts, there is a dearth of research that considers the diversity of rural communities or rural older adult health. This paper proposes that leveraging contextually sensitive rural gerontological health research marks a next step in IPE development.

The Association between Public Transportation and Social Isolation in Older Adults: A Scoping Review of the Literature.

Inadequate public transportation was recognized as a barrier to social participation, especially for older adults in rural communities and with mobility issues. Older adults will not benefit from opportunities to engage with their community and maintain social networks if they are unable to access them. The purpose of this scoping review was to make recommendations for further research and to summarize areas for improvement identified in the literature that will aid in the development of public transportation initiatives that can better address social isolation for older adults (≥ 55 years of age). Nineteen articles met the inclusion criteria, identifying themes of access to rural public transportation, issues with public transportation, and mobility. In practice, older adults need to prepare for driving cessation and mobility transitions; sound policy requires input to tailor transportation initiatives to an aging population, and future research should explore older adults' transportation needs and potential solutions in urban and rural communities.

Supporting older adults’ engagement in health-care programs and policies: Findings from a rural cognitive health study

ABSTRACTAlthough rural seniors are important users of health-care services, their perspectives and input remain largely absent from health programs and policies. This article explores rural seniors’ perspectives to support their engagement in patient-oriented research. Guided by lay theory and cultural schema theory, participant observation, concept maps, and semi-structured interviews were conducted with 42 rural seniors in Saskatchewan, Canada. Three themes were identified: community outreach through trust and partnership-building; using flexible data collection methods such as moving to open-ended interviews rather than closed-ended surveys; and developing community-relevant dissemination strategies such as local newspaper articles, posters, and community workshops. In moving forward, collaborative research with seniors is essential to improving health programs and policies for older adults in rural communities and beyond.

Taking ‘Steps to Connect’ to later life: Exploring leisure program participation among older adults in rural communities

Steps to Connect is a leisure education program that facilitates participation in leisure activities to enable individuals to connect to themselves, to others around them, and to their communities. The authors’ previous program development efforts were focused on individuals with chronic conditions in rural settings, and now there is interest in adapting it for older adults. As such, the authors explored the perceptions and constraints associated with tailoring leisure activities and programs to older adults living in rural Nova Scotia, Canada. They conducted five focus groups in four rural communities, including 33 participants aged 60+ years. Thematic analysis of focus group transcripts revealed participants’ awareness of how leisure programs promote physical and mental health, social participation, as well as meaningful personal and community experiences. Participants also identified several leisure constraint themes that warrant consideration when implementing leisure programs to promote active aging among older adults living in rural communities, such as Steps to Connect.

A multicomponent frailty intervention for socioeconomically vulnerable older adults: a designed-delay study.

PurposeThe primary aim of this study was to evaluate the effectiveness of a 6-month multicomponent intervention on physical function in socioeconomically vulnerable older adults in rural communities. As secondary aims, we evaluated the effectiveness of the intervention on frailty and other geriatric syndromes, sustained benefit at 12 months, and baseline characteristics associated with poor response.Patients and methodsThis designed-delay study was conducted in 187 adults (mean age: 77 years; 75% women) who were living alone or on a low income in three rural regions of Korea. A 24-week multicomponent program that consisted of group exercise, nutritional supplementation, depression management, deprescribing medications, and home hazard reduction was implemented with a planned 6-month interval from August 2015 through January 2017. The primary outcome was physical function, measured using the Short Physical Performance Battery (SPPB) score (range: 0–12; minimum clinically important difference ≥1) at 6 months. Secondary outcomes included frailty phenotype, sarcopenia, Mini Nutritional Assessment-Short Form score (range: 0–14), Center for Epidemiologic Studies-Depression Scale score (range: 0–60), and falls.ResultsAt 6 months, the SPPB score increased by 3.18 points (95% CI: 2.89, 3.48) from baseline. The program improved frailty (odds ratio: 0.06; 95% CI: 0.02, 0.16), sarcopenia (odds ratio: 0.32; 95% CI: 0.15, 0.68), Mini Nutritional Assessment-Short Form score by 1.67 points (95% CI: 1.28, 2.06), and Center for Epidemiologic Studies-Depression Scale score by −3.83 points (95% CI: −5.26, −2.39), except for fall (rate ratio: 0.99; 95% CI: 0.69, 1.43). These beneficial effects were sustained at 12 months. Body mass index ≥27 kg/m2 and instrumental activities of daily living disability at baseline were associated with poor improvement in the SPPB score.ConclusionThis 24-week multicomponent program had sustained beneficial effects up to 1 year on physical function, frailty, sarcopenia, depressive symptoms, and nutritional status in socioeconomically vulnerable older adults in rural communities. (ClinicalTrials.gov, NCT 02554994)

Bringing Healthy Aging to Scale: A Randomized Trial of a Quality Improvement Intervention to Increase Adoption of Evidence-Based Health Promotion Programs by Community Partners.

To evaluate the effectiveness of a quality improvement intervention to increase delivery of 2 evidence-based health promotion workshops, Stepping On and Chronic Disease Self-Management Program (CDSMP), in rural communities. A cluster-randomized wait-list control group design. Rural Wisconsin counties with trained workshop leaders but no workshops in the prior year were eligible to participate. Sixteen counties were randomized to receive the NIATx intervention or wait-list control. The 1-year intervention consisted of training and coaching county aging unit staff to apply NIATx methods to increase and sustain the number of Stepping On or CDSMP workshops in their community. Mann-Whitney tests examined effect on workshops held, participants, and workshop completers. The paired Wilcoxon signed rank test explored change in participants' health behaviors and health care utilization. Counties receiving the NIATx intervention significantly increased the number of workshops per county per year as compared with baseline (1.5 vs 0.19, P < .001) and sustained improvements during the year following the intervention. Stepping On participants, during the 6 months postintervention, had reduced falls risk behaviors (P < .001), 0.43 fewer falls (P < .01), and 0.028 fewer medical record-verified emergency department visits for falls-related injuries (P < .05) compared with the 6 months before the intervention. CDSMP participants had reduced social isolation (P = .018) and improved physician communication skills (P = .005). Our study demonstrates that coaching rural service organizations in use of the quality improvement process, NIATx, may increase implementation reach of evidence-based health promotion/disease prevention programs. Initiative findings indicate that this approach may be a new and potentially important strategy to increase reach of health promotion programs for older adults in community settings. A quality improvement approach effectively increases and sustains delivery of evidence-based health promotion/workshops for older adults in rural communities. Counties or states struggling to engage older adults in evidence-based health promotion workshops could integrate quality improvement into policies and practices to increase workshop availability. Once engaged, older adults experience improved health behaviors from both programs and reduced falls and emergency department utilization from Stepping On.

Rural Older Adult Readiness to Adopt Mobile Health Technology: A Descriptive Study

Purpose: The purpose of this study was to gain insight into the readiness of rural older adults to accept mobile health technology. Results will be useful in the design and delivery of mobile health technology to assist with health management, wellness interventions, and aging in place. Sample: Convenience sampling was used to recruit 30 participants from two rural Northern California multipurpose senior centers. Methods: Participants attended a demonstration and participated in a blood pressure screening using a mobile health device followed by a survey. Mixed methods of data collection were used to capture categorical data as well as contextual, socio-cultural, and experiential factors for understanding the potential for future use of mobile health technology by older adults in rural communities. Results: Participants indicated they wanted control over their health data by choosing when and where to share the information, with the exception of alerts sent in a crisis situation. Results were evenly split on the importance of using technology to connect with patient education and support groups on-line. Important facilitators that would promote adoption of mobile health technology include ease of use, convenience, and affordability. Barriers to adoption include moderate concern with risk to the privacy and security of their health information, and high cost. Conclusion: Mobile health technologies that are easy and convenient to use, affordable, and a good fit for each individual have the potential to facilitate patient engagement, patient empowerment, and individual responsibility for health and wellness. Additional nursing research on innovative models of care is needed to validate and promote mobile health technology for the health and aging in place needs of rural older adults. Rural nurse leaders can take the lead to innovatively leverage mHealth technology solutions that impact rural health and wellness. Keywords : mHealth, Rural, Older Adults, Age in Place DOI : http://dx.doi.org/ 10.14574/ojrnhc.v15i1.346

Barriers to primary care hospital follow-up among older adults in rural or semi-rural communities

BackgroundFailure to follow-up with a primary care provider (PCP) following discharge from an acute care setting is strongly associated with readmission within 90days among elderly patients. AimThe purpose of this study was to identify barriers to primary care follow-up among older adults in rural communities. MethodsThis was an explanatory mixed methods study which included scaled survey and interview techniques. Descriptive and inferential statistics were calculated for scaled concepts. Standard content analysis was performed on the qualitative items. ResultsCorrelation between intention to follow-up with a PCP and actual follow-up was poor (r=0.20). Patients encountered substantial obstacles to the PCP follow-up visit. Obstacles clustered into two groups: 1) healthcare or social system barriers and 2) personal characteristics of patients. ConclusionsIndividualized discharge planning that reflects the complexities of post-hospitalization adaptation for elders is most likely to be useful for ensuring PCP follow-up.

The Experience of Nursing Students Visiting Older Adults Living in Rural Communities

The expanding population of older adults living in rural communities presents a rich opportunity for new clinical experiences for nursing students. The purpose of this research study was to explore the experiences of nursing students working with older adults in rural communities, the experiences of older adults, and the development of relationships. The sample included 96 nursing students and 16 older adults. Using the phenomenological method, we solicited comprehensive descriptions through open-ended questions. The following themes describe the experience of nursing students and the older adults they visited in their homes: (a) Welcoming Presence, (b) Developing a Trusting Relationship, (c) Spending Time Together, (d) Sharing and Listening to Stories, (e) Learning about Growing Old, and (f) Growing Nursing Students. Students believed that this experience was a vital component of their nursing education and it taught them how to develop a therapeutic relationship, learn how to listen, and how to be comfortable with themselves in the role of the student nurse. Students felt that the home setting was a safe environment to learn how to listen, carry out assessments, and receive feedback from older adults. This clinical experience can be easily implemented in a nursing curriculum to better prepare nurses for the challenges of the future.

ACP FOR HEALTHY OLDER ADULTS: STRATEGIES AND TOOLS FOR A PUBLIC HEALTH APPROACH

BackgroundEngaging older community-dwelling healthy adults in ACP discussions is an international public health challenge that requires social strategies to ensure uptake of ACP in non clinical settings.AimThe entrust-u study developed...

Dental care utilization among North Carolina rural older adults

This analysis delineates the predisposing, need, and enabling factors that are associated with regular and recent dental care in a multiethnic sample of rural older adults. A cross-sectional, comprehensive, oral-health survey conducted with a random, multiethnic (African American, American Indian, white) sample of 635 community-dwelling adults aged 60 years and older was completed in two rural southern counties. Logistic regression models assessed the simultaneous associations of dental care with predisposing, enabling, and need factors. Almost no edentulous rural older adults received dental care; 27.1 percent of dentate rural older adults had received regular dental care, and 36.7 percent had received recent dental care. Predisposing (less than high-school education, dental anxiety), enabling (no regular place for dental care), and need factors (no filled teeth) reduced the odds of regular dental, while predisposing (dental anxiety), enabling (no regular place for dental care), and need factors (no filled teeth) reduced the odds of recent dental care. Having excellent, very good, or good self-rated oral health increased the odds of receiving regular and recent dental care. Regular and recent dental care are infrequent among rural older adults. Contrary to expectations, those not receiving dental care are those who most need care; this has been referred to as the Paradox of Dental Need. Community access to dental care and the ability of older adults to pay for dental care must be addressed by public-health policy to improve the health and quality of life of older adults in rural communities.

Patterns of subjective quality of life among older adults in rural Vietnam and Indonesia

This paper aims to assess the subjective quality of life (SQOL) and its correlates among older adults in rural communities of Vietnam and Indonesia. The paper uses the data from the INDEPTH/WHO Study on global aging and adult health (SAGE). The study was carried out in the FilaBavi Health and Demographic Surveillance System (HDSS) site in Vietnam and in Purworejo HDSS in Indonesia. All people aged 50 years and over who lived in these two HDSS areas were surveyed. Face-to-face household interviews were carried out by trained surveyors using the standardized summary version of the INDEPTH/WHO SAGE questionnaire. The SQOL was assessed by asking the respondents "How would you rate your overall quality of life?" The response set was a five-point scale where 1 = Very good, 2 = Good, 3 = Moderate, 4 = Bad, 5 = Very bad. In both countries, the SQOL was reported to be higher among (i) men; (ii) people with higher education; (iii) people who were in a marital partnership; (iv) people who lived with other family members; and (v) those with higher economic status, compared with that in those of other category(ies) of the same characteristic. In Vietnam, people who belonged to the second to fifth economic quintiles and had more than 6 years of education were sevenfold more likely to report very good/good quality of life compared with those who belonged to the first economic quintile (poorest) and had no formal education. The corresponding figure was 2.7 for Indonesia. The patterns of sociodemographic determinants of SQOL show that inequality in quality of life exists among older adults in the two study settings.