Rural Older Adults Research Articles

Older Adults' Loneliness and Social Relationships in the Philippines: Comparison Between Rural and Urban Contexts.

This study compared patterns of association between social relationship measures and levels of loneliness for rural and urban older adults in the Philippines. We analyzed social relationship measures and loneliness scores (UCLA Three-Item Loneliness Scale) of a nationally representative sample of Filipino adults 60 years and older in the baseline survey of the 2018 Longitudinal Study of Ageing and Health in the Philippines (LSAHP) (n=4,704). The loneliness score was slightly higher for rural older adults (5.8) than for their urban counterparts (5.1; p=.0001). A significantly larger proportion of older adults in rural areas (12.7%) lived alone than in urban areas (5.4%; p=.0008). The overall pattern of association between social relationship measures and loneliness scores for the two groups was mostly similar. For both groups, living alone, having less active social involvement, and seeing friends less frequently were related to higher levels of loneliness. Poorer subjective financial well-being (e.g., the perception of considerable difficulty in making ends meet) was also significantly associated with higher loneliness scores. These findings suggest that the prevention of loneliness for older adults in countries in the early stages of population aging such as the Philippines requires a broad range of public health initiatives.

Basic mobility, accidental falls, and lifetime physical activity among rural and urban community-dwelling older adults: a population-based study in Northern Iceland

ABSTRACT The objective of this research was to investigate late-life physical functioning and lifetime history of physical activity (PA) among older adults in rural and urban Arctic communities. Data was collected in a cross-sectional, population-based study among 65 to 92-year-old community-dwelling Icelanders (N = 175, 41% ≥75-year-old, 43% women, 40% rural). Late-life physical functioning was operationalised as: basic mobility (Timed Up and Go in seconds, TUG); fall risk (TUG≥12 sec); a fall (≥1 fall/year); and recurrent falls (≥2 falls/year). PA history was based on a self-assessment. Compared to urban participants, rural participants were more likely to have fallen recently, be at fall risk, and describe more PA history. Among urban participants, no fall in the past year was independently associated with more PA in middle adulthood; and worse basic mobility and late-life fall risk were independently associated with being in the ≥75-year-old group. Among rural participants, recurrent falls were independently associated with being a man; and better basic mobility was independently associated with more PA in late adulthood. To conclude, this evidence supports an important association between better late-life physical functioning and more mid- and late-life PA and encourages further research to understand high fall risk among older men in Arctic rural areas.

Non-participation in social activities of rural older adults: Results from the Toyama dementia survey

Objective Social activities play an important role in the maintenance of health and well-being of the older adults. The aim of this study was to identify characteristics of the rural older adults who do not participate by type of social activities.Methods This survey examined 1,537 older adults randomly selected at a sampling rate of 0.5% from among those living in Toyama prefecture of Japan, in 2014. Of the total, 947 ambulatory older adults living in their own homes were analyzed using Poisson regression. Results were presented as prevalence ratio (PR). The level of statistical significance was set at P<0.05 (two-sided test).Results The participants included 426 men (mean age 73.9 ± 6.5 years) and 521 women (mean age 74.8 ± 7.0 years). In terms of work, both men and women did not work at an older age (men PR 1.15 over 75 years old, women PR 1.11 over 70 years old). Men did not work during outpatient treatment (PR 1.09) and the Revised Hasegawa Dementia Scale (HDS-R) 21-25 points (PR 1.09) and 20 points or below. Women who did not drink alcohol did not work (PR 0.93). Both men and women did not participate in residential activities at older ages (men PR 1.12 over 70 years old, women PR 1.11 over 80 years old). Men with 20 points or below on HDS-R (PR 1.16) and with work history of only physical labor (PR 1.12), and women living with family (PR 0.92) were less likely to participate in residential activities. In the hobby group, both men and women with work history of only physical labor were less likely to participate (men PR 1.05, women PR 1.08). Men with education of 9 years or below (PR 1.05) and women living alone (PR 1.07) were less likely to participate. Hobby groups did not relate with age and cognitive decline. In the senior citizens' club, men and women who did not drink alcohol were less likely to participate (men PR 0.91, women PR 0.89). Men who smoked (PR 1.06), men with psychological symptoms (PR 1.09), and women with 20 points or below on HDS-R (PR 1.13) were less likely to participate.Conclusion Factors related to non-participation of older adults in rural cities depended on the type of social activities. In order to promote social activity among the older adults in rural cities, it is important to consider specific measures taking into account the type of social activities.

Cognitive function and cognitive decline among older rural Chinese adults: the roles of social support, pension benefits, and medical insurance

Objectives This study investigated whether social support, pension benefits, and medical insurance coverage are related to cognitive function and decline among older rural Chinese adults and whether depressive symptoms represented a pathway linking these factors with cognitive function. Methods Data are taken from three waves of the China Health and Retirement Longitudinal Study (N = 5,135). Cognitive function is assessed with episodic memory and depressive symptoms are assessed with the 10-item CESD Scale. Social support (intergenerational financial transfers, weekly contact with children, perceived availability of future support, and living arrangements), pension benefits, and medical insurance coverage are self-reported measures. Multilevel linear regression models are employed. Results Intergenerational financial transfers, perceived availability of future support, and pension income are associated with higher levels of cognitive function. Living with others, perceived availability of future support, medical insurance coverage, and pension income are associated with a slower risk of cognitive decline. Depressive symptoms mediated the association between perceived availability of future support, living with others, pension income and level of cognitive function and the link between perceived availability of future support, pension income, and cognitive decline. Conclusion The findings suggested these modifiable factors should be taken into account when screening older adults for possible cognitive impairment and decline. Early interventions may also be helpful by expanding social resources and reducing psychological distress.

Remotely Delivered Exercise to Rural Older Adults With Knee Osteoarthritis: A Pilot Study.

ObjectiveEnhanceFitness (EF) is an evidence‐based exercise program recommended for management of osteoarthritis (OA). However, access to EF is limited in rural areas. Accordingly, we evaluated the feasibility and acceptability of remotely delivered EF (tele‐EF) in rural, community‐dwelling older adults with symptomatic knee OA.MethodsA single‐arm pilot trial of tele‐EF classes was conducted. Videoconferencing was used to livestream the instructor‐led, 1‐hour EF classes 3 days/week for 12 weeks. Outcomes were assessed at baseline and immediately post intervention.ResultsA total of 15 of 27 potential participants (55%) were screen eligible and enrolled into the trial. Participants had a median age of 70 years (interquartile range: 67‐75), and 14 (93%) were women. The median EF class attendance rate was 91% (interquartile range: 85%‐94%). Knee pain, as measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS), improved significantly from baseline to the 12‐week end point (mean difference = −11.4 [95% confidence interval (CI): −20.9 to −2.0]; P = 0.02). In addition, participants’ self‐reported knee function improved significantly (mean difference in KOOS function score = −11.8 [95% CI: −18.4 to −5.2]; P < 0.01) as well as their physical capacity (mean difference in Timed Up and Go test time = 1.8 seconds [95% CI: 0.2‐3.4]; P = 0.03). All participants (100%) were very satisfied with tele‐EF classes, and 12 participants (86%) reported that their condition had much improved or very much improved since beginning the EF exercise program. Lastly, there were no serious adverse events.ConclusionFindings from this pilot trial indicate that tele‐EF is feasible and acceptable in rural older adults with knee OA.

Social Interaction and Physical Activity Among Rural Older Adults: A Scoping Review.

Social interaction and physical activity are critical components in supporting health among older adults, yet rates of activity are low in rural communities. There is significant merit in exploring the relationship between these interrelated concepts. A scoping review was conducted to synthesize existing literature. Search results identified 26 studies meeting inclusion criteria. Findings indicated that social interaction and physical activity were important for many older adults to maintain health; however, not all older adults preferred the social aspect of group-based exercise. Opportunities for physical activity and social interaction were limited based on geographical location and other socioeconomic factors. This was evident in rural communities where populations were lower and education and income levels varied. Differences on the defining role and meaning of physical activity also emerged. Increasing physical activity and social interaction must account for negative associations to address the lower rates of participation among rural older adults.

Pet ownership and cognitive frailty among Chinese rural older adults who experienced a social loss: Is there a sex difference?

BackgroundThe loss of a spouse (widowed or divorced) is one of the most common forms of social loss in older adults. However, evidence is limited regarding whether social loss is associated with cognitive frailty. Maintaining pets has become increasingly popular. Despite its health benefits, little is known about whether pet ownership can buffer cognitive frailty in older adults facing social loss. Here, we examined the role of pet ownership in the relationship between social loss and cognitive frailty among males and females older adults living in rural China. MethodsA total of 2638 rural older adults were analysed. Binary logistic regression analyses were conducted to explore risk or protective factors associated with cognitive frailty. Participants were categorised into four groups according to social loss and pet ownership assessment: (i) no social loss + own pet, (ii) no social loss + no pet, (iii) social loss + own pet, and (iv) social loss + no pet. Binary logistic regression was also performed to examine the interaction effects of social loss and pet ownership on cognitive frailty stratified by sex. ResultsRegardless of pet ownership, spousal loss was associated with cognitive frailty for men and women. Female participants who experienced loss without a pet had a significantly higher risk of cognitive frailty. However, we did not observe a significant association between pet ownership and cognitive frailty among men who experienced loss. ConclusionsOur findings highlight the buffering effect of pet ownership on cognitive frailty in older women experiencing social loss. This implies that targeted support for older adults of different sexes who experienced social losses may be effective in preventing cognitive frailty in rural China.

Association of Cardiovascular Health Metrics with Dementia in Rural Chinese Older Adults: A Population-Based Study

PurposeWe explore the associations of individual and composite cardiovascular health metrics with all-cause dementia, Alzheimer’s disease, and vascular dementia among rural-dwelling older adults and the potential age variations in their associations.Patients and MethodsThis community-based cross-sectional study included 4980 older adults (age ≥65 years; 57.23% women) from the baseline examination of MIND-China. In March–September 2018, data were collected via face-to-face interviews, clinical examinations, and laboratory test. We defined six cardiovascular health metrics according to the modified American Heart Association’s recommendations. We diagnosed dementia and its subtypes following the international criteria. Data were analyzed using logistic regression models.ResultsOf all the participants, 250 were diagnosed with dementia, including 165 with Alzheimer’s disease and 75 with vascular dementia. Ideal composite global cardiovascular health metrics (vs poor composite metrics) were associated with a multi-adjusted odds ratio (95% confidence interval) of 0.62 (0.42–0.93) for dementia, 0.88 (0.52–1.48) for Alzheimer’s disease, and 0.31 (0.16–0.60) for vascular dementia. Moreover, ideal biological cardiovascular health metrics were associated with multi-adjusted odds ratio of 0.52 (0.28–0.95) for dementia and 0.21 (0.06–0.77) for vascular dementia in young–old adults (65–74 years), whereas ideal behavioral cardiovascular health metrics were associated with multi-adjusted odds ratio of 0.48 (0.26–0.89) for dementia and 0.16 (0.06–0.43) for vascular dementia in old–old adults (≥75 years).ConclusionOur results suggest that ideal cardiovascular health metrics are cross-sectionally associated with a low likelihood of dementia and vascular dementia among rural-dwelling older Chinese adults. The associations vary with age, components of cardiovascular health metrics, and dementia subtypes.

Association between Muscle Strength and Anemia in the Rural Middle Age and Older Adults

Association between Muscle Strength and Anemia in the Rural Middle Age and Older Adults

Developing a Comprehensive Multidimensional Wellbeing Index Based on What People Value: An Application to a Middle-Income Country.

We introduce a comprehensive policy-relevant measure of multidimensional wellbeing conceptually rooted in Amartya Sen’s capability approach and applied to a middle-income country: the Multidimensional Wellbeing Index for Peru (MWI-P). We design and collect a specialized survey in Peru in late 2018, which included data on wellbeing achievements across 12 dimensions, on the value that respondents place upon each of these dimensions, and on self-perceived freedom. Then, we utilize this information to set the weighting structure and select a wellbeing sufficiency threshold for the MWI-P, which we estimate using the capability-inspired Alkire–Foster method. Our results show that only 45.9% of the sample population live above the wellbeing threshold, which involves achieving sufficiency in at least seven out of the 12 weighted dimensions of the MWI-P. Subgroup analyses reveal that rural populations, women, and older adults are at a disadvantage compared with urban populations, men, and younger adults, respectively. These subgroups’ disparities hold valid if we introduce changes in the weighting structure or in the wellbeing sufficiency threshold. We argue that the MWI-P can inspire other low- and middle-income countries to reorient post-pandemic recovery policies from a focus on economic growth to a human flourishing approach based on what people value.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11482-022-10064-w.

Social Isolation and Safety Issues among Rural Older Adults Living Alone: Perspectives of Meals on Wheels Programs

ABSTRACT Ensuring the safety and social well-being of rural populations, especially rural older adults living alone with complex medical conditions, is challenging, given large, sparsely populated communities and limited resources. Using qualitative data from surveys with 42 rural Meals on Wheels programs from across the U.S., we highlight particular challenges to meeting the social and safety needs of rural older adults living alone. Respondents described challenges, opportunities, and successes in meeting the needs of their clients. We describe these under four domains: main challenges, what can be done to address social isolation and loneliness, safety issues, improving safety, and current successes. We also identify cross-cutting themes related to programs’ rural environment (long distances, inclement weather), infrastructure (housing quality, access to broadband Internet and technological connectivity, road conditions), funding and resource availability, and service provision (availability of health care and partner organizations.) We describe each of these in more detail and also share policy recommendations for improving health and safety of older adults living alone in rural areas, including funding nutrition programs as a health benefit and addressing aging, poor-quality housing stock.

Association between Self-Medication for Mild Symptoms and Quality of Life among Older Adults in Rural Japan: A Cross-Sectional Study.

Self-medication, a help-seeking behavior to control individual symptoms, can be promoted to prevent the overuse of medical care and improve self-management among older adults. However, evidence regarding the association between self-medication and quality of life (QOL) is lacking. The purpose of this study is to investigate the association between QOL and the usage of self-medication among rural older adults. This cross-sectional study included participants older than 65 years in rural Japanese communities. Data were collected using a questionnaire regarding self-medication trends, the EQ-5D-5L to assess QOL, and a demographics questionnaire. Participants were divided into exposure and control groups based on their tendencies toward self-medication usage. Differences in the demographics between groups were adjusted using propensity score matching. Results: The health status in the exposure group was statistically significantly better than that in the control group in the dimensions of movement, self-care, and usual activities. Conversely, the pain/discomfort and anxiety/depression dimensions were not statistically significantly different. The quality of self-medication behaviors for mild symptoms can be improved with practical knowledge of and access to home remedies and over-the-counter drugs. Educational interventions and system development for better self-medication for mild symptoms and medical care for critical symptoms in rural contexts can be effective in improving QOL among rural older adults.

Approaches to Serving Rural Older Adults in State Plans on Aging: A Policy Content Evaluation.

Every state is required to submit a State Plan on Aging describing how it will use resources from the Older Americans Act (OAA), including a section specific to serving rural older adults. This paper describes a policy content evaluation of all 50 State Plans on Aging, focusing on Section 307(a)(10), which describes how states will serve rural older adults. We identified the most common and innovative approaches to using OAA funds to serve rural older adults across states. The most common information included about using OAA funds to serve rural older adults was describing the funding formula used to allocate resources. However, states varied in their definition of rural and in the details of their funding formulas. A minority of states also described additional approaches to serving rural older adults, including prioritizing Black, Indigenous, or rural residents of color; outreach; and targeted service delivery.

Older black rural South African adults’ perceptions on organ donation: An exploratory study

In this study, we explored older rural South African adults’ perceptions of organ donation. Twelve older Pedi adults (male = 50%; age range 51 to 78 years) completed in-depth interviews on their knowledge of organ donation, cultural views, and influences on their orientation to the medical practice. Four themes emerged from the data synthesis: (i) organ donation regarded as body part harvesting; (ii) organ donation as a taboo practice; (iii) organ donation interfering with closure and spirituality; and (iv) the centrality of family in the decision making on health and life matters. The cultural lens rooted in family and spiritual futures is central to older black Pedi adults’ understanding of organ donation. Organ donation education and awareness campaigns should engage community leaders in bridging the cultural divide that may discourage people from participating in this beneficial practice.

The mediating effect of coping style on the relationship between perceived stress and mental health in Chinese rural older adults living alone: A cross-sectional study.

Older adults living alone is becoming the main family structure in rural China. This study aimed to explore the mediating effect of coping style on the relationship between perceived stress and mental health in rural older adults living alone in China. 356 rural older adults living alone were recruited in Huzhou, China. Subjects were investigated using the Chinese Perceived Stress Scale (CPSS), Chinese Coping Style Questionnaire (CCSQ), and Mental Health Questionnaire (MHQ). Data were analysed using a structural equation. Bootstrapping was used to validate the mediation effects. Mental health showed significant correlations with a sense of nervousness, of uncontrollability, and with positive and negative coping styles (P < 0.05). The results of structural equation modeling showed a good fit for the total sample (χ2 /df=2.684, NFI=0.927, GFI=0.944, RMSEA=0.069). Perceived stress (sense of nervousness and uncontrollability) impacted the mental health of rural older adults living alone mainly through two mediating variables, including positive and negative coping styles. The double mediating contribution rates were 42.11%, and 61.82%. Coping style partially mediated the relationship between perceived stress and mental health of rural older adults living alone in China. Consequently, to improve the mental health of rural older adults living alone, perceived stress and coping styles should be the focus. Geriatr Gerontol Int 2022; 22: 523-528.

A Multilevel Physical Activity Intervention Among Chinese Rural Older Adults (Stay Active While Aging): A Study Protocol for a Clustered Randomized Controlled Trial

BackgroundAlthough a large number of studies have confirmed the benefits of physical activity (PA) in preventing age-related diseases and disabilities, a growing number of older people spent more time in sedentary behavior as opposed to PA. To reverse the alarming trend, numerous studies have corroborated the effectiveness of PA interventions in improving PA among older adults. However, such research is scarce in rural China, where a majority of older adults do not meet the PA recommendation. The Stay Active While Aging (SAWA) aimed to conduct an intervention to improve the PA level among older adults in rural China.MethodsThe SAWA is designed as a single-blind, clustered randomized controlled trial carried out in rural Sichuan, China with an 8-week intervention and a 24-month follow-up. The intervention group will receive a multilevel intervention (individual, interpersonal, and community levels), while the control group will not. The primary outcome is the PA level. Secondary outcome measures include sedentary behavior level, self-efficacy, self-regulation, cognitive function, night-time sleep quality, and anthropometry. The difference-in-differences (DID) will be performed to investigate the between-group differences, adjusted for baseline data and covariates.DiscussionThe SAWA trial will provide a multilevel intervention based on the socio-ecologic model among older adults in rural China. We target the PA level and health status changes while also focus on the maintenance of such intervention during 24 months. If the SAWA produces positive results, it will be possible to recommend similar strategies to be implemented in other Chinese older adults and beyond.Trial registrationChiCTR2100045653 (https://www.chictr.org.cn/index.aspx).

Psychological distress, multimorbidity and health services among older adults in rural South Australia

ObjectivePsychological distress may relate to higher health services use. However, data on psychological distress and health services use among rural older adults are limited. This study investigates psychological distress in older adults (aged ≥60) and evaluates the relationship between psychological distress, multimorbidity and health services utilization. DesignA cross-sectional design was adopted using data on older adults (≥60) (n = 5920) from the South Australia's 2013–2017 population health survey. The Modified Monash Model MM2–7 was used to designate rural areas. The dataset provides information on reported physical health conditions, psychological distress, and patterns of health services use. The Kessler Psychological Distress Scale (K10) was used to compute scores for reported mental health disorders in this population. ResultsThe mean (SD) age of the study participants was 72.1 (8.1) years. Women constituted 58.8% of the sample. The mean (SD) score for psychological distress was 12.5 (3.6). One-fourth (33.7%) report one-chronic condition, 20.4% reported 2 chronic conditions and 13% had more than 3 chronic conditions. High psychological distress was associated with female gender (χ2 = 14.4, p < 0.001), <80 years (χ2 = 11.7, p = 0.019), lower education (χ2 = 10.9, p = 0.027). Similarly, multimorbidity was associated with female gender (χ2 = 51.1, p < 001), increasing age (χ2 = 173.6, p < 0.001) and lower education (χ2 = 28.8 p < 0.001). Psychological distress and multimorbidity were independently associated with health service use. High psychological distress was associated with general practitioner (GP) visit (odds ratio 3.6 (95% CI 2.6–5.1), p < 0.001), emergency department (ED) visit (odds ratio 2.5 (95% CI 1.2–5.0), p < 0.001) and hospital admission (odds ratio 2.3 (95% CI 1.3–4.3), p < 0.001). Multimorbidity was associated with general practitioner (GP) visit (odds ratio 6.8 (95% CI 5.6–8.3), p < 0.001), emergency department (ED) visit (odds ratio 2.5 (95% CI 1.4–4.3), p < 0.001) and hospital admission (odds ratio 3.1 (95% CI 1.9–5.1), p < 0.001). Model included age, gender, education, number of chronic condition and psychological distress. Conclusion/implicationPsychological distress and multimorbidity were independently associated with health services use. Thus, psychological distress, particularly in the presence of multimorbidity, presents an opportunity for intervention by clinicians that may reduce the demand on rural health services.

Decomposing rural–urban differences in successful aging among older Indian adults

The modernization and shift towards urbanized lifestyles have triggered several diseases, and the context of aging varies in urban and rural settings in India. The study aimed to investigate the urban–rural differences in successful ageing among older adults in India and the contributing factors in those differences. The study utilizes data from nationally representative Longitudinal Ageing Study in India (LASI, 2017–18). The analytical sample size for the study was 31,464 older adults aged 60 years and above. Descriptive statistics and bivariate analysis were carried out to present the initial results. Multivariable logistic regression and decomposition analysis was used to find the associations between explanatory variables and successful aging and to identify the contributions of covariates that explain the rural–urban differences in successful ageing. A proportion of 32% and 24% of older adults from rural and urban areas were successful agers with an urban disadvantage. Urban-dwelling older adults had 0.67 times [95% confidence interval (CI): (0.64, 0.71)] lower unadjusted odds of successful ageing than rural older adults. Again, after adjusting for the effect of other explanatory variables, urban older adults had 0.92 times [CI: (0.87, 0.98)] lower odds of being successful agers than their rural counterparts. The major contributors to the rural–urban inequality in successful aging were differences in regional distribution (17% contribution), waist circumference (16%), working status (16%), body mass index (13%) and physical activity (8%) among rural and urban older adults. The urban disadvantage in aging successfully may reflect the higher prevalence of adverse lifestyle behaviours in urban dwellers and under-diagnosis and under-reporting of many diseases in rural areas, particularly non-communicable diseases, suggesting the need for further investigation.

Factors Associated with Preventive Care Utilisation among Chinese Older Adults: Evidence from the 2018 Chinese Longitudinal Healthy Longevity Survey

This research examined the sociodemographic factors associated with preventive care utilisation among Chinese older adults. Using the latest 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), preventive care utilisation was defined as an annual physical examination. In the final study sample, approximately 69 per cent of the older adults had a physical examination annually. Older adults who had received a high level of formal education (eleven years or above) were more likely to use preventive care (all p &lt; 0.01). Participants with a rural social health scheme and residing in rural areas were also more likely to use preventive care (all p &lt; 0.05). For the interaction effect, rural older adults who could not afford healthcare expenses were less likely to use preventive care (AOR = 0.37, 95 per cent CI: 0.16, 0.84). More reforms should be directed toward reducing social disparities regarding preventive care utilisation.

Rooted in earth, rooted in community: Aging in rural houses of northern China

Northern China has experienced unprecedented urbanization over the past several decades, with younger Chinese moving to cities while leaving the lion's share of the older population in rural areas. This study explores how this structural change creates unique opportunities and challenges for older adults living in rural houses, which informs their everyday practices, the meanings of homes, and their subsequent housing choices. We examined the housing experiences of rural older adults through a field study conducted in Heilongjiang province. The study employed qualitative in-depth interviews with thirty-two older adults who live or have lived in rural housing, along with systematic documentation of their houses through photography and hand drawings captured from the field. We analyzed the interview narratives and images using the Glaserian grounded theory method to allow a high level of flexibility and conceptualization. The study identified five core categories of residential experiences: (1) houses as sites of production; (2) the earth/dwelling relationship; (3) social life in interstitial spaces; (4) the house as a means to preserve agency in old age and; (5) the burdensome house. These features were directly linked to the older adults' senses of home and their subsequent housing choices. The rural houses offered a strong sense of agency and belonging to rural older adults, but the city's expansion, the changing household registration system, and their aging bodies forced rural older adults to engage in constant reevaluation of their houses, informing their residential choices. We discuss the study's theoretical contributions and offer insights into policies and future planning for residential areas in both rural and urban areas by comparing the spatial configurations of rural dwellings with their urban apartment counterparts.