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This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #24, #25, #35, #38, #45, #47


Learning Objectives

  • Describe the demographics of the rural aging population.

  • Describe three common problems that affect rural elders in ways different from their urban counterparts.

  • Describe the special health service programs designed to improve care to rural elders.

Key Clinical Points

  1. Rural elders have high rates of disability and poverty, thereby increasing their risk for adverse health outcomes.

  2. The need for geriatric health care providers in rural areas is very great. This is especially true for those with multiple chronic conditions.

  3. The federal government, to increase access to care for rural elders, has created a number of special programs. Geriatric care providers should make use of these programs.

Approximately 60 million Americans of all ages live in areas classified by the US Office of Management and Budget (OMB) as nonmetropolitan, or “rural.” They comprise one-fifth of the US population. The “rural life” holds great value in the history of the United States, though there are many stereotypes about rural elders (Table 22-1). For most of our country’s history, rural living was practically the only way of life. The majority of Americans lived in rural areas up until the early 1900s. Throughout the years, rural living has been seen as a noble and pure form of existence. Getting “back to the land” has long been viewed as a dream for many city dwellers.


Rural life is also connected to prominent American values—the dual values of self-reliance and interdependence with one’s neighbors, freedom from governmental control, a slower pace of living, and the back to nature philosophy. As will be discussed, a significant movement, or “in-migration” of older people back to rural areas is occurring in part because of these values. However, the long trend of younger people moving away or “out-migration” from rural areas and the poorer and sicker older people remaining also continues. What society may be facing in the next few decades is a population of primarily older people living in large portions of the country—a population made of two subgroups, healthy active and politically motivated baby boomers who have returned to the ...

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