Rural Older Adults Research Articles

Behavioral change in fruit and vegetable consumption and associated cognitive impairment among Chinese older adults.

Previous research has examined how fruit and vegetable consumption may affect cognitive impairment among older adults. However, knowledge regarding the behavioral change in fruit and vegetable consumption remains limited in the Chinese older adult population. This research aimed to fill the literature gap. We used data from five waves of the Chinese Longitudinal Healthy Longevity Study (2005-2018, observations = 18,856 from 11,388 participants) and selected older adult participants (65 years old or above). A behavioral change was defined as a consumption change in the study sample. Cognitive impairment was measured based on the mini-mental state examination. We used the Cox multi-state model as the major statistical analysis. Chinese older adults who transitioned from non-daily to daily consumption of vegetables had lower odds of reporting cognitive impairment deteriorating from normal cognitive function to severe, compared with those who did not change their consumption behavior (HR [hazard ratio] = 0.88, 95% CI 0.80, 0.97; p < 0.05). All transitions in fruit consumption were negatively associated with cognitive changes from normal cognitive function to mild-moderate cognitive impairment. In our additional stratified analysis examining rural-urban disparity, we observed similar significant findings among rural older adults (Vegetable consumption change:HR = 0.83, 95% CI 0.75, 0.93; p < 0.01) but not urban older adults. Behavioral change in consumption of vegetables may affect Chinese older adults' cognitive health. Future interventions should focus on the critical role of behavioral change in vegetable consumption in reducing older adults' cognitive impairment. However, the contradictory findings of fruit consumption warrant further investigation to draw a conclusive claim regarding its benefits for cognitive health.

Health-seeking behaviours of the families with older adults during the COVID-19 epidemic in rural China: a qualitative inquiry from the perspective of migration and social support networks

IntroductionHealth behaviours during a public health crisis for families with vulnerable ageing relatives are worth studying. After the Chinese government’s zero-tolerance policy on COVID-19 ended at the close of 2022,...

Development and validation of Social Support Needs Questionnaire (SSNQ) for the left-behind older adults in rural China.

Objectives: This study compiled a Social Support Needs Questionnaire (SSNQ) for the left-behind older adults in rural China and assessed its psychometric properties. Methods: The formation of the SSNQ included three stages. First, item pool was established based on literature analysis. Second, through expert consultation, the 1-version questionnaire items were determined. Third, pre-survey with 901 cases of rural left-behind older adults was used to develop and test final-version of the Social Support Needs Questionnaire (SSNQ). Results: The Cronbach's α of the SSNQ was 0.914, ranging from 0.815 to 0.886 for each factor. The item-content validity index ranged from 0.875 to 1.00, and the scale-content validity index was 0.969. Conclusions: The SSNQ prepared by this study can be used as an evaluation tool for the social support needs of left-behind older adults in rural China, providing a basis for further establishment of the social support system.

The mediating effect of sleep quality on solid cooking fuel use and psychological distress among rural older adults: evidence from Shandong, China

BackgroundExposure to indoor air pollution from solid cooking fuel use may increase mental disorders risk through pathways such as oroxidative stress, neuroinflammation, or cerebrovascular damage. However, few studies have explored the underlying mechanism between solid cooking fuel use and psychological distress. The present study aims to investigate the mediating role of sleep quality on the relationship between solid cooking fuel use and psychological distress among older adults in rural Shandong, China.MethodsThis study used the cross-sectional data from the second follow-up survey of the Shandong Rural Elderly Health Cohort (SREHC). A total of 3,240 rural older adults were included in the analysis. Logistic regression and the Karlson, Holm, and Breen (KHB) mediation analyses were performed to investigate the relationship between solid cooking fuel use and psychological distress, as well as the mediating role of sleep quality in this association.ResultsThis study found that solid cooking fuel use was significantly and positively associated with psychological distress among older adults in rural Shandong, China (OR = 1.38, 95% CI: 1.12,1.70). Mediation analysis revealed that sleep quality mediated the association between solid cooking fuel use and psychological distress among older adults (β = 0.06, P = 0.011). The mediation effect accounted for 16.18% of the total effect.ConclusionsOur study showed that solid cooking fuel use was associated with psychological distress among rural older adults, and sleep quality mediated this association. Interventions should focus on addressing cooking fuel types and poor sleep quality to reduce psychological distress. In the future, more aggressive environmental protection policies would be needed to lessen the adverse effects of indoor air pollution on the health of older adults in rural China.

Facilitators and barriers of technology adoption and social connectedness among rural older adults: a qualitative study

ABSTRACT Background Social disconnection is a public health concern among rural Australian older adults. While research suggests technology can enhance social wellbeing and protect against social disconnection, many older adults are not digitally literate, and little is known as to why and how technology adoption could be promoted in rural contexts. This study aimed to (1) explore the barriers and facilitators of technology adoption among rural older adults and (2) determine the potential utility of technology to promote social connectedness in the aged population. The Theoretical Domains Framework and the Behaviour Change Wheel (BCW) were employed to gain a comprehensive understanding of the digital and social behaviours of rural Australian older adults. Methods Semi-structured interviews were conducted with a convenience sample of 33 rural older adults aged between 65 and 87 years. Interviews were conducted over the phone, audio-recorded, and transcribed. Interview transcripts were coded and analysed using thematic analysis and the BCW. Results Numerous barriers and facilitators of technology adoption were identified, with the most prominent being knowledge, perceived value, perceived self-efficacy, and social support. Findings suggest that older adults’ technology adoption is not simply a technical matter, but influenced by various individual, social, and environmental contexts. Consideration of these factors during development, marketing, training and implementation may facilitate technology adoption among older adults. With regard to social connectedness, several rural barriers emerged, including low population density, geographic isolation, limited community opportunities and poor public transport infrastructure. Conclusion Technology was consistently identified as a facilitator of the social experience, indicating that technology is a promising tool to enhance social connectedness among older adults, particularly those living in rural areas. Future research should focus on enhancing the capability, opportunity and motivation of older adults in technology adoption, with reference to the rural contexts.

“I Figured It Might Be Because We Are Rural”: A Qualitative Study of Barriers and Opportunities Related to Home-Based Personal Assistance Services

Personal care assistance (PCA) provides vital support so rural disabled people and older adults can live in their communities. Currently, the state of home and community-based services in the United States is dire, with major shortfalls in access and utilization of these services. Moreover, little is known about the experiences of people living in rural areas who need paid, in-home assistance with activities of daily living. Because rural areas are often underserved and under-resourced, this study aimed to understand the experiences of rural users of personal care assistance services to inform the development of a training for rural people. Between February and November of 2021, 38 semi-structured qualitative interviews were conducted with 40 self-identified rural-dwelling people across the United States who use paid PCAs. Interview topics included finding, hiring, and training workers; worker qualities; and how living in a rural place impacted PCA services. Using thematic coding, results highlight how rurality intersected with participants’ daily experiences. Respondents identified 3 barriers to getting PCA services: (1) lack of transportation and travel distance, (2) worker shortages, and (3) fewer local community services; and one facilitator of obtaining PCA services: strong community connection. Additionally, some aspects of rural culture—such as valuing a slower pace of life, independence, and rugged individualism—presented both barriers and opportunities for rural PCA recipients. As the home care worker shortage crisis in the United States is expected to worsen in coming decades, rural people needing PCA services face unique circumstances related to place and culture.

Can cultural capital, cognitive ability, and economic capacity help rural older adults bridge the digital divide? Evidence from an empirical study.

The digital divide is the difference between individuals who use the Internet and those who do not. Under the triple social environment of urban-rural dichotomy, population aging, and the digital era in China, the existence of digital divide among rural older adults has seriously affected their access to health information through the Internet, so it is urgent to bridge the digital divide problem they face. Based on Maslow's Hierarchy of Needs Theory and Stress Coping Theory, the impact of cultural capital on the digital divide among rural older adults was systematically analyzed using hierarchical regression and Chained Mediation Effect Tests using data from the Chinese Family Panel Studies (CFPS). Cultural capital has a significant positive effect on the digital divide among rural older adults (β = 0.178, p < 0.01). Cognitive ability and economic capacity both play independent intermediary effects between cultural capital and digital divide among rural older adults, and the intermediary chain formed by the two plays a chain intermediary effect. The increase in the cultural capital of rural older adults has led to an increase in their cognitive ability and economic capacity, which ultimately has a favorable effect on the bridging of the digital divide. Heterogeneity results suggest that cultural capital is more effective in bridging the digital divide among male rural older adults aged 60-69. Cultural capital is able to bridge the digital divide faced by rural older adults and is age and gender heterogeneous. At the same time, improved cognitive ability and economic capacity can also help rural older adults bridge the digital divide. Therefore, it is proposed that we increase the construction of public cultural service infrastructure in rural areas, liaise with community neighborhood committees and village committees to do a good job of publicity, improve training measures for key groups, and maintain the enthusiasm of rural older adults for learning, so as to provide references for the rural older adults in China and developing countries in general to bridge the digital divide.

Prevalence and factors associated with probable sarcopenia in southern Brazil: a population-based study.

There are few studies on probable sarcopenia in rural areas. This study aims to assess prevalence of probable sarcopenia and its associated factors in older adults living in the rural area of a municipality in southern Brazil. This cross-sectional study assessed data from the second wave of the EpiRural Cohort Study. Structured questionnaires, handgrip strength, gait speed, and anthropometric measurements were collected from 651 older adults. The criteria from the European Working Group on Sarcopenia in Older People 2 were used in this study. Chi-square test and logistic regression with robust variance were performed. Prevalence of probable sarcopenia was 19.2% (95% confidence interval (CI): 16.3-25.2%). Male sex (prevalence ratio (PR) 1.61; 95%CI 1.17-2.21), age &ge;80 years (PR 4.15; 95%CI 2.65-6.50), underweight (PR 1.90; 95%CI 1.23-2.93), diabetes mellitus (PR 1.80; 95%CI 1.20-2.73), and hospitalization in the past year (PR 2.00; 95%CI 1.36-2.91) were significantly associated with probable sarcopenia. One in five rural older adults have probable sarcopenia. Older adults living in rural areas need frequent measurements of muscle strength, and greater investments should be made to minimize the physical disability caused by sarcopenia among this population.

Association between Dietary Patterns and Cardiometabolic Multimorbidity among Chinese Rural Older Adults.

The global population is aging rapidly, leading to an increase in the prevalence of cardiometabolic multimorbidity (CMM). This study aims to investigate the association between dietary patterns and CMM among Chinese rural older adults. The sample was selected using a multi-stage cluster random sampling method and a total of 3331 rural older adults were ultimately included. Multivariate logistic regression analysis was used to examine the association between the latent dietary patterns and CMM. The prevalence of CMM among rural older adults was 44.64%. This study identified four potential categories: "Low Consumption of All Foods Dietary Pattern (C1)", "High Dairy, Egg, and Red Meat Consumption, Low Vegetable and High-Salt Consumption Dietary Pattern (C2)", "High Egg, Vegetable, and Grain Consumption, Low Dairy and White Meat Consumption Dietary Pattern (C3)" and "High Meat and Fish Consumption, Low Dairy and High-Salt Consumption Dietary Pattern (C4)". Individuals with a C3 dietary pattern (OR, 0.80; 95% CI, 0.66-0.98; p = 0.028) and a C4 dietary pattern (OR, 0.70; 95% CI, 0.51-0.97; p = 0.034) significantly reduced the prevalence of CMM compared with the C1 dietary pattern. Rural older adults have diverse dietary patterns, and healthy dietary patterns may reduce the risk of CMM.

Associations between social isolation, perceived ageism and subjective well-being among rural Chinese older adults: A cross-sectional study

ObjectiveThis study aimed to investigate the relationship between social isolation, perceived ageism and subjective well-being among rural Chinese older adults and its mechanisms of action. MethodsA total of 403 rural resident older adults were surveyed from March to April 2024. Data were collected using the General Information Questionnaire, the General Alienation Scale (GAS), the Perceived Ageism Questionnaire (PAQ), and the Memorial University of Newfoundland Scale of Happiness (MUNSH). SPSS 27.0 and PROCESS macro were used to analyze the data. ResultsPearson correlation analysis revealed a significant negative correlation (p<0.01) between subjective well-being and social isolation (r = -0.720) and perceived ageism (r = -0.661) among rural older adults. Perceived ageism partially mediated the effect between social isolation and subjective well-being in rural older adults, and the mediating effect accounted for 29.9 % of the total effect (p<0.001). ConclusionSocial isolation can reduce the subjective well-being of rural older adults through perceived ageism.

Home-based motivational interviewing for late-life rural hoarding disorder: a pilot study

Objectives The primary purpose of this pilot study was to determine the feasibility and acceptability of a novel brief (six-session) motivational interviewing home-based intervention for hoarding disorder designed for rural older adults. The secondary aims were to examine the engagement of proposed mechanisms of change and the preliminary efficacy of symptom reduction. Method Fifteen rural-dwelling older adults were enrolled in the pilot trial for Project RECLAIM (Reduce Clutter and Increase Meaning). Engagement of proposed mechanisms of change was assessed weekly for reported engagement in sorting/discarding behaviors and from baseline to post-treatment on readiness for change and motivation. Symptom reduction was assessed from baseline to post-treatment on hoarding symptoms and general psychological functioning. Results Sixty percent of participants completed all six sessions of RECLAIM. Over the course of treatment, participants reported significant decreases in household clutter (d = −0.85) and object attachment (d = −1.01) and increases in positive affect (d = 0.71), readiness for change (d = 0.40) and motivation (d = 0.52), and sorting between sessions (ß = 3.82). Conclusion The significant reductions in hoarding symptoms after only six sessions of treatment suggest that a brief, in-home, intervention may be a viable option for symptom reduction, particularly for rural-dwelling older adults.

Prevalence of mild cognitive impairment and modifiable risk factors: A cross-sectional study in rural older adults with diabetes

To determine the prevalence and modifiable risk factors for MCI in older adults with T2DM in rural China. This cross-sectional study encompassed 96 villages, employing a cluster sampling approach to recruit eligible older adults with T2DM as study participants. Logistic regression analysis was utilized to identify modifiable risk factors associated with MCI. Average marginal effects were calculated. The discriminatory performance of these risk factors in identifying MCI was evaluated by plotting the receiver operating curve and calculating the value of the area under the curve. A total of 898 older adults with T2DM in our study. The overall prevalence of MCI was 50.22 %. Independent associations with MCI were found in poor self-management ability of diabetes (OR = 0.808, 95 % CI: 0.808, 0.766), depressive symptoms (OR = 3.500, 95 % CI: 1.933, 6.337), moderate (OR = 0.936, 95 % CI: 0.017, 0.075) and high (OR = 0.939, 95 % CI: 0.016, 0.100) levels of physical activity, poorer oral health (OR = 2.660, 95 % CI: 2.226, 3.179), and lower grip strength (OR = 0.913, 95 % CI: 0.870, 0.958). The AUC was 0.967 (95 % CI 0.508–0.470). The prevalence of MCI was high among older adults with T2DM in rural areas of China. The self-management ability of diabetes, depressive symptoms, physical activity, oral health and grip strength were modifiable risk factors of MCI. Targeted interventions should be developed and implemented to address these modifiable risk factors, aiming to enhance cognitive function and mitigate the incidence of MCI in older adults with T2DM.

Tailoring age-friendly technology-enabled transportation service solutions in rural communities

Rural older adults requiring transportation assistance represent an historically underserved demographic, who often have greater needs for transportation services but may face challenges in benefiting from the latest transportation technological developments. This paper presents one of the first studies that aims to investigate the effective technology-enabled solutions that can cater to the diverse needs of rural older adults throughout the entire service process. The study first uses latent class analysis (LCA) structure model to identify three distinct groups of older adults with varying attitudes toward information and transportation technologies: (1) Class 1 – tech-challenged, moderate transportation tech adopters, (2) Class 2 – tech-savvy, modest transportation tech adopters, and (3) Class 3 – tech-savvy, enthusiastic transportation tech adopters. The estimated results from the LCA membership model demonstrated that Class 1 appear to constitute a more vulnerable population compared to their counterparts in Class 2 and Class 3, as they tend to be characterized by older age, lower household income, living alone, and more dependence on mobility aids. The study then delves into qualitative insights through focus group discussions with individuals balanced from these identified groups, revealing ten critical elements that encompass the entirety of service reservation, recommendation, scheduling, and reception. The findings suggest several tech-based solutions, including: (1) the establishment of a regional “one call does it all” center, (2) the implementation of a centralized ride matching and recommendation system, (3) the introduction of an automated scheduling system aligned with healthcare services, and (4) the development of a user-friendly portable device for service reception. These solutions aim to empower both technology and transportation service professionals in delivering age-friendly rural transportation services customized to the unique needs and limitations of older adults.

Self-Employment Transitions and Health Outcomes in Later Life: Evidence From China.

Self-employment is a vital alternative to waged employment for older workers. Recent research has shown that employment transitions frequently occur when individuals approach retirement. However, evidence of how older people's health changes when they switch between self and waged employment is lacking, particularly outside Western contexts. To address this research gap, we explored the health impact of employment transitions for the older working population in China by hukou (urban or rural household registration status), region, and education. We employed fixed effect models to examine the impact of employment transitions on cognitive, mental, and physical health and life satisfaction drawing on data from four waves (2011, 2013, 2015, and 2018) of the China Health and Retirement Longitudinal Study (N = 4,606). Given China's unique context, we analyzed the results of agricultural and nonagricultural work separately. Individuals transitioning into or remaining in self-employment had lower self-rated health and life satisfaction than those remaining in waged employment. There was no significant difference in cognitive functioning or depressive symptoms. Additionally, those who transitioned from self-employment into waged employment rated their health worse than those who remained in waged employment. The health impacts were more apparent for agricultural than nonagricultural self-employment, particularly for older workers living in urban regions with rural hukou and lower education levels. Most older Chinese transitioning into or staying self-employed are or were pushed into self-employment due to their low human capital and socioeconomic status, which affects their subsequent health. Pension reform and policies supporting older adults to stay in the workforce could help close the economic and health gaps between rural and urban older adults.

Associations of 24-hour movement behaviors with depressive symptoms in rural-dwelling older adults: a compositional data analysis

BackgroundWe aimed to explore the association of sleep duration with depressive symptoms among rural-dwelling older adults in China, and to estimate the impact of substituting sleep with sedentary behavior (SB) and physical activity (PA) on the association with depressive symptoms.MethodsThis population-based cross-sectional study included 2001 rural-dwelling older adults (age ≥ 60 years, 59.2% female). Sleep duration was assessed using the Pittsburgh Sleep Quality Index. We used accelerometers to assess SB and PA, and the 15-item Geriatric Depression Scale to assess depressive symptoms. Data were analyzed using restricted cubic splines, compositional logistic regression, and isotemporal substitution models.ResultsRestricted cubic spline curves showed a U-shaped association between daily sleep duration and the likelihood of depressive symptoms (P-nonlinear < 0.001). Among older adults with sleep duration < 7 h/day, reallocating 60 min/day spent on SB and PA to sleep were associated with multivariable-adjusted odds ratio (OR) of 0.81 (95% confidence interval [CI] = 0.78–0.84) and 0.79 (0.76–0.82), respectively, for depressive symptoms. Among older adults with sleep duration ≥ 7 h/day, reallocating 60 min/day spent in sleep to SB and PA, and reallocating 60 min/day spent on SB to PA were associated with multivariable-adjusted OR of 0.78 (0.74–0.84), 0.73 (0.69–0.78), and 0.94 (0.92–0.96), respectively, for depressive symptoms.ConclusionsOur study reveals a U-shaped association of sleep duration with depressive symptoms in rural older adults and further shows that replacing SB and PA with sleep or vice versa is associated with reduced likelihoods of depressive symptoms depending on sleep duration.

Shared decision making in rural general practices: a qualitative exploration of older rural South Australians’ perceived involvement in clinical consultations with doctors

BackgroundShared decision-making (SDM) implementation is a priority for Australian health systems, including general practices but it remains complex for specific groups like older rural Australians. We initiated a qualitative study with older rural Australians to explore barriers to and facilitators of SDM in local general practices. MethodsWe conducted a patient-oriented research, partnering with older rural Australians, families, and health service providers in research design. Participants who visited general practices were purposively sampled from five small rural towns in South Australia. A semi-structured interview guide was used for interviews and reflexive thematic coding was conducted. ResultsTelephone interviews were held with 27 participants. Four themes were identified around older rural adults’ involvement in SDM: (1) Understanding of “patient involvement”; (2) Positive and negative outcomes; (3) Barriers to SDM; and (4) Facilitators to SDM. Understanding of patient involvement in SDM considerably varied among participants, with some reporting their involvement was contingent on the “opportunity to ask questions” and the “treatment choices” offered to them. Alongside the opportunity for involvement, barriers such as avoidance of cultural care and a lack of continuity of care are new findings. Challenges encountered in SDM implementation also included resource constraints and time limitations in general practices. Rural knowledge of general practitioners and technology integration in consultations were viewed as potential enablers. ConclusionAdequate resources and well-defined guidelines about the process should accompany the implementation of SDM in rural general practices of South Australia. Innovative strategies by general practitioners promoting health literacy and culturally-tailored communication approaches could increase older rural Australians’ involvement in general.

The impact of widowhood on the quality of life of older adults: the mediating role of intergenerational support from children

BackgroundChina’s transition into an aging society is accelerated by the simultaneous decline in fertility rates and the prolonged life expectancy of older adults. The impact of widowhood, a significant stressor in old age, has emerged as a crucial factor affecting the quality of life among the elderly.MethodsThis study is based on data from the 2018 China Health and Aging Tracking Survey. Multiple linear regression models were employed to investigate the influence of widowhood on the quality of life of older adults in China. Additionally, Bootstrap mediation effects were utilized to assess the mediating role of intergenerational support, considering both financial and emotional support from children.ResultsThe findings indicate a substantial reduction in the quality of life index among older adults following widowhood. Moreover, the impact is more pronounced among older men compared to older women. Rural older adults experience a significant decline in quality of life post-widowhood, while the effect on urban counterparts is not statistically significant.ConclusionsIntergenerational financial support was identified as a partial mediator between widowhood and the quality of life among older adults. This underscores the importance of familial financial assistance in mitigating the adverse effects of widowhood on the well-being of the elderly. These results offer valuable insights into the nuanced impact of widowhood on the quality of life among older adults in China, emphasizing the need for targeted interventions, especially in rural areas.Clinical trialNot applicable.

Influencing Perception of Frailty Risk in Urban &amp; Rural Older Adults

Abstract Date Presented 03/23/24 Frailty affects rates of hospital readmission, transition to assisted care, decreased life satisfaction, and decreased life span. Participation in an OT frailty risk reduction program can influence perception of frailty for rural and urban older adults. Primary Author and Speaker: Susan B. Blair

Enjoying the golden years: social participation and life satisfaction among Chinese older adults.

Older adults commonly face the risk of social isolation, which poses a significant threat to their quality of life. This study explores the association between social participation and life satisfaction among older Chinese adults. Data were sourced from the 2018 China Health and Retirement Longitudinal Study. Regression analysis and mediation analysis were employed to examine the relationship between social participation and life satisfaction, with a focus on the roles of loneliness and self-rated health. The results indicate that social participation is significantly positively associated with older adults' life satisfaction. Furthermore, the positive association is more pronounced with increased diversity in social activities. Mediation analysis reveals that reductions in feelings of loneliness and improvements in health levels mediate the relationship between social participation and life satisfaction. Further analysis showed that social participation had a greater positive association among rural older adults and those lacking family companionship. This study provides evidence for enhancing life satisfaction among older adults and highlights the importance of diversity in social participation.

Perception on health and exercise among indonesian older adults: a sequential exploratory study in javanese rural communities

This study aims to investigate the perceptions of health and exercise among older adults in rural Javanese communities in Indonesia. Through a sequential exploratory approach, the research uncovers diverse levels of knowledge regarding health and exercise among the rural population. There are 40 older adults from three different regency in Central Java Province participated in filling out the Global Physical Activity Questionnaire (GPAQ). Further qualitative analysis used 25 samples out of 40 through convenient method. Semi-structured interview is conducted to confirm results of questionnaire and explore their perception on health and exercise. Despite variations, a predominant belief emerges among participants regarding the significant health benefits associated with exercise. Analysis reveals that a considerable majority (87.5%) of participants meet the World Health Organization's recommended standards of &gt;600 METs/week, primarily through work-related physical activities. However, there remains a notable disparity in the prevalence of physical activity during leisure time, particularly in engaging in sport-related physical activities. The accumulated METs score dominantly comes from work and travel-related activities. Qualitative study reveals that there are still few initiatives among older adults to adopt a healthy living through sports and exercise. Some believe that sports were never part of their culture. To address these findings, we urge for strategic interventions from stakeholders to enhance awareness among rural older adults about the importance of sports and exercise to enhance the overall well-being. This entails the implementation of health education programs and the facilitation of collective exercise activities at the village level. Keywords: health, exercise, older adults, rural communities, GPAQ