Barriers to Health Care Increase Disease, Death Risk for Rural Elderly
The findings were published in The Journal of Rural Health by researchers from Oregon State University and the Oregon Health & Science University.
The research confirms some of the special challenges facing older populations in rural or remote areas, who often have less access to physicians, long distances to travel for care, sometimes a lower socioeconomic and educational level, and other issues. It also reflects health problems that might have been reduced if they were treated earlier or more aggressively, researchers say.
Data from several different study groups found that rural residents measured significantly higher on the Modified Cumulative Illness Rating Scale, with about an 18% higher disease burden.
"It's been known for some time that health care is harder to access in rural areas, and this helps us better understand the extent of the problem," says Leah Goeres, a postdoctoral scholar who led the research at the Oregon State University/Oregon Health & Science University College of Pharmacy.
"Many physicians do the best they can in rural areas given the challenges they face," Goeres says. "But there are fewer physicians, fewer specialists, a higher caseload. Doctors have less support staff and patients have less public transportation. A patient sometimes might need to wait months to see a doctor, and have to drive significant distances. Adverse effects can increase from taking multiple medications. "These are real barriers to choice and access, and they affect the quality of care that's available."
Also worth noting, Goeres says, is that especially in very old populations, illness can lead to more illness and quickly spiral out of control. A patient in an urban setting might receive prompt treatment for a mild ulcer, whereas the same person in a rural setting might have to wait while the condition worsens and may even lead to cancer.
"It's of particular concern that rural older adults start with more disease burden, which significantly increased over the next five years, but the average number of medications they used decreased over the same time period," says David Lee, an assistant professor in the OSU College of Pharmacy who oversaw the research.
This research was done in Oregon with three cohorts of older adults, one rural and two urban, and 296 people altogether. It was supported by the Oregon Alzheimer's Disease Tax Checkoff Fund and the National Institutes of Health.
The findings of the new study include:
Increased access to health care, health education, increased supervision from clinicians, and better management of both prescription and over-the-counter medications could all be of value in helping rural residents to live longer and healthier livers, the researchers said in their conclusion.