Access to Health Care for the Rural Elderly

IN ADDITION TO THE USUAL CHALlenges of chronic disease and functional decline, the rural elderly also face geographic isolation. Sixty-one million people live in the rural United States, a number that exceeds the entire population of the United Kingdom, Spain, Italy, or France. Nearly 15% of the US rural population is aged 65 years or older. As they age, the rural elderly confront several barriers to obtaining medical care. To a far greater degree than their urban counterparts, rural primary care physicians are expected to provide urgent care, rehabilitation, outreach, and specialty care (in collaboration with distant urban specialists) for their patients. Health care outcomes for the rural elderly, as with other groups in the United States, are influenced more by social position, insurance status, clinician access, and economic status than by geography. When differences in outcomes between rural and urban health care have been demonstrated, they generally relate to an imbalance of volume, staff support, equipment, and choice. In this article, we examine practice patterns and describe social, policy, and research issues influencing care for the rural elderly.