Aging in Rural Communities

Abstract

Purpose of review: Population aging is occurring worldwide, particularly in developed countries such as the United States (US). However, in the US, the population is aging more rapidly in rural areas than in urban areas. Healthy aging in rural areas presents unique challenges. Understanding and addressing those challenges is essential to ensure healthy aging and promote health equity across the lifespan and all geographies. This review aims to present findings and evaluate recent literature (2019-2022) on rural aging and highlight future directions and opportunities to improve population health in rural communities.

Recent findings: The review first addresses several methodological considerations in measuring rurality, including the choice of measure used, the composition of each measure, and the limitations and drawbacks of each measure. Next, the review considers important concepts and context when describing what it means to be rural, including social, cultural, economic, and environmental conditions. The review assesses several key epidemiologic studies addressing rural-urban differences in population health among older adults. Health and social services in rural areas are then discussed in the context of healthy aging in rural areas. Racial and ethnic minorities, indigenous peoples, and informal caregivers are considered as special populations in the discussion of rural older adults and healthy aging. Lastly, the review provides evidence to support critical longitudinal, place-based research to promote healthy aging across the rural-urban divide is highlighted.

Summary: Policies, programs, and interventions to reduce rural-urban differences in population health and to promote health equity and healthy aging necessitate a context-specific approach. Considering the cultural context and root causes of rural-urban differences in population health and healthy aging is essential to support the real-world effectiveness of such programs, policies, and interventions.

Keywords: Aging; Epidemiology; Rural health; Social determinants.

Fig. 1

Percent of the population aged 65 + by county (source data: US Census 2020)

Fig. 2

Heat map of county-level Spearman correlations between two measures of rural–urban status (population density and Rural–Urban Commuting Area [RUCA]) and measures of social determinants, overall and by US Census region. Red and pink boxes indicate positive associations, and blue areas indicate negative associations. Boldface indicates statistically significant correlation. RUCAs are available from the US Department of Agriculture and are a composite measure of population density, urbanization, and daily commuting time abstracted from the American Community Survey