Rural Health
Research Gateway

Aging

Research Products & Journal Articles

Browse the full list of research publications on this topic completed by the Rural Health Research Centers.

Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.

Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.

2024

2023

  • Medicare Advantage Enrollment Update 2023
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
    Date: 11/2023
    This policy brief continues RUPRI Center's annual update of Medicare Advantage (MA) enrollment including the changes in enrollment in types of MA plans, and health policy changes that may have had an impact.
  • Unmet Needs for Help With Mobility Limitations Among Older Adults Aging in Place: The Role of Rurality
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 10/2023
    This study identifies differences in unmet mobility needs among older adults by rurality. It uses data from the National Health and Aging Trends Study, limiting analyses to respondents who had not moved since baseline (average housing tenure of 27 years; n = 3343).
  • Multi-Sector Collaboration to Support Rural Aging
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 08/2023
    In this paper, researchers examine the lessons rural areas present for supporting aging, including the role that aging and social services, public health systems, and health care have to play.
  • Advancing the Age-Friendly Movement in Rural Communities
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 02/2023
    The research team looked at the role of Aging Life Care Managers® to help support the age-friendly movement in rural areas. The team explored ways in which Aging Life Care Managers® could advocate for the needs and interests of their clients, help them access care and support, and involve rural communities in the age-friendly movement.
  • Who Will Care for Rural Older Adults? Measuring the Direct Care Workforce in Rural Areas (journal article)
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 02/2023
    In this manuscript, the research team used data from the 2021 Occupational Employment and Wage Statistics dataset to calculate the ratio of direct care workers relative to the population of older adults (ages 65+) across rural and urban areas in the US.

2022

2021

2020

  • Acuity Differences Among Newly Admitted Older Residents in Rural and Urban Nursing Homes
    Journal Article
    Maine Rural Health Research Center
    Date: 11/2020
    This study found newly admitted residents of rural nursing homes were more likely to have cognitive issues/problem behaviors than those in urban facilities. Yet rural facilities admitted less complex older (age 75+) residents than urban, raising questions about the rural long-term services and supports system and capacity of rural nursing homes.
  • Comparing the Health Workforce Provider Mix and the Distance Travelled for Mental Health Services by Rural and Urban Medicare Beneficiaries
    Journal Article
    WWAMI Rural Health Research Center
    Date: 08/2020
    This study used 2014 administrative Medicare claims data to describe the mix of health professionals who care for rural and urban patients with mood and/or anxiety disorders. It further describes where these beneficiaries received care and the one-way distance (miles) and time (minutes) they travelled to receive it.
  • Rural-Urban Differences Among Older Adults
    Chartbook
    University of Minnesota Rural Health Research Center
    Date: 08/2020
    This chartbook presents the characteristics of older adults in rural counties, as well as rural-urban differences among older adults, across four domains: demographics, socioeconomic characteristics, healthcare access and use, and health characteristics.
  • The Unique Impact of COVID-19 on Older Adults in Rural Areas
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 06/2020
    Older adults in rural areas of the U.S. face unique risks related to COVID-19, which puts them at risk of not only the virus, but of not being able to meet their healthcare, social, and basic needs. Rural/urban inequities, combined with within-rural inequities in health, healthcare, and financial resources cause particular challenges.
  • Characteristics of Counties With the Highest Proportion of the Oldest Old
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2020
    The "oldest old," or individuals age 85 and older, are one of the fastest-growing segments of the U.S. population, yet little is known about where those individuals tend to live and what their communities are like. This information is important for planning how to best respond to and support this growing population.
  • Differences by Rurality in Satisfaction With Care Among Medicare Beneficiaries
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 05/2020
    There are stark differences between rural and urban areas in demographic characteristics, health status, and healthcare. Yet less is known about rural‐urban differences in Medicare beneficiaries' satisfaction with care. We seek to understand rural‐urban differences in satisfaction with care for Medicare beneficiaries.
  • Rates of Living Alone by Rurality and Age
    University of Minnesota Rural Health Research Center
    Date: 04/2020
    In this infographic, we identify rates of living alone for all adults and within specific age groups using two classifications of rurality.

2019

  • Access and Capacity to Care for Medicare Beneficiaries in Rural Health Clinics
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 12/2019
    Access to timely, high-quality healthcare is essential for health, but rural areas face particular barriers to access, including for primary care. We present findings from an online survey of RHCs describing clinic characteristics related to healthcare access for rural Medicare beneficiaries.
  • Access to Specialty Care for Medicare Beneficiaries in Rural Communities
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 12/2019
    Access to care is a challenge in many rural communities for both primary care services and specialty care services. We present findings from an online survey of Rural Health Clinics describing access issues for rural Medicare beneficiaries in seeking care from specialty care providers.
  • Rural-Urban Differences in Access to and Attitudes Toward Care for Medicare Beneficiaries
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 12/2019
    Access to healthcare is important to health outcomes and well-being. Even among Medicare beneficiaries, access to care may differ by rural-urban location due to differences in the healthcare and socio-demographic landscape. We describe rural-urban differences in access to care for Medicare beneficiaries.
  • Hospital Closures and Short-Run Change in Ambulance Call Times
    Journal Article
    Rural and Underserved Health Research Center
    Date: 11/2019
    Hospital closures affect the availability of emergency department services. This paper examines changes in ambulance ride times in areas with hospital closures compared to those in similar areas without hospital closures and separately analyzes changes in ambulance ride times between urban and rural areas and among Medicare-eligible patients.
  • Unmet Need for Personal Care Assistance Among Rural and Urban Older Adults
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 06/2019
    This brief presents data on rural-urban differences in unmet need for personal care among older adults with functional limitations.
  • Long-Term Services and Supports Use Among Older Medicare Beneficiaries in Rural and Urban Areas
    Journal Article
    Maine Rural Health Research Center
    Date: 01/2019
    Analyzing the Medicare Current Beneficiary Survey, authors from the Maine Rural Health Research Center found that compared to their urban counterparts, rural Medicare beneficiaries had higher odds of nursing home use after controlling for beneficiary characteristics and contextual factors including nursing home bed supply.

2018

2017

  • Barriers to Nursing Home Care for Nonelderly Rural Residents
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 12/2017
    This study uses data from 23 semi-structured interviews with rural hospital discharge planners in five states to identify specific barriers to finding nursing home care for nonelderly rural residents. We found three primary themes—payment status, fit, and medical complexity—as well as two minor themes—caregivers and bureaucratic processes.
  • Gender and Geographic Differences in Medicare Service Utilization During the Last Six Months of Life
    Journal Article
    Rural and Minority Health Research Center
    Date: 11/2017
    End-of-life issues are important for senior women, particularly rural women, who are more likely than their urban counterparts to live alone. The role of residence has yet to be investigated. The purpose of this study is to examine whether service utilization in the last six months of life differs across gender and rurality.
  • Rural Long-Term Services and Supports: A Primer
    RUPRI Health Panel: Rural Policy Analysis and Applications
    Date: 11/2017
    This paper provides policymakers and other interested stakeholders a primer on the fundamentals of the rural LTSS system, rural access to and use of LTSS, and the opportunities and limitations of current federal and state LTSS policy for advancing rural health system transformation toward a high-performing rural health delivery system.
  • Rural Transportation: Challenges and Opportunities
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2017
    This policy brief uses survey data from 113 key informants across all 50 states to describe challenges and opportunities related to rural transportation.
  • Supply-Side Differences Only Modestly Associated With Inpatient Hospitalizations Among Medicare Beneficiaries in the Last Six Months of Life
    Journal Article
    Rural and Minority Health Research Center
    Date: 11/2017
    This study examined rural and urban Medicare beneficiaries and inpatient hospitalizations during their last six months of life. The study concluded that care at the end of life is much the same for rural and urban Medicare decedents.
  • Differences in Medicare Service Use in the Last Six Months of Life Among Rural and Urban Dual – Eligible Beneficiaries
    Report
    Rural and Minority Health Research Center
    Date: 08/2017
    In this brief, we compare rural and urban dual-eligible beneficiaries to Medicare-only beneficiaries in their service utilization in the last six months of life. Within rural beneficiaries, we further explore differences associated with race/ethnicity.
  • Rural-Urban Differences in Medicare Service Use in the Last Six Months of Life
    Report
    Rural and Minority Health Research Center
    Date: 08/2017
    This brief focuses on the current status of healthcare use during the last six months of life among Medicare beneficiaries. We used data from a sample of Medicare beneficiary claims to assess whether service utilization differed between rural and urban decedents and across decedents of different race/ethnicity categories.
  • Medical Barriers to Nursing Home Care for Rural Residents
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2017
    This policy brief describes barriers rural residents with complex medical care needs may face when seeking placement in a nursing home and identifies potential policy strategies to overcome them.

2016

2015

2014

2013

2009

  • The Aging of the Primary Care Physician Workforce: Are Rural Locations Vulnerable?
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 06/2009
    Large numbers of primary care physicians are nearing retirement as fewer new U.S. medical graduates are choosing primary care careers. This policy brief describes the rural areas of the U.S. where impending retirements threaten access to primary care and offers potential solutions to the problem.

2007

2006

  • Health Risks Factors Among American Indians and Alaska Native Elders
    Journal Article
    Upper Midwest Rural Health Research Center
    Date: 2006
    Chronic disease rates are higher among American Indian and Alaska Native elders although they exercise more and have higher rates of participation in multiple exercise activities. Research concerning the relationship between chronic disease and health risk factors is limited for American Indian and Alaska Native elder populations. This paper indicated results of an analysis of the effect of risk factors on chronic disease from a survey of 9,296 Native elders, representing 171 tribes from 88 sites. The sampling design employed systematic random sampling for larger tribes, with smaller tribes (fewer than 200) interviewing all or the majority of their elders. The data suggest that smokers, drinkers, and non-exercisers are at increase risk for chronic disease.

2005

  • Prevalence of Chronic Disease Among American Indian and Alaska Native Elders
    Upper Midwest Rural Health Research Center
    Date: 10/2005
    This report examines chronic disease prevalence and functional limitations among American Indian/Alaska Natives by rurality, gender, age, healthcare access, and health behaviors. It includes policy recommendations.
  • Disability Burdens Among Older Americans Associated With Gender and Race/Ethnicity in Rural and Urban Areas
    Rural and Minority Health Research Center
    Date: 09/2005
    No prior research has investigated differences in disability-free and disabled life expectancy associated with rural or urban residence. This report addresses this gap and identifies differences in healthy life expectancy that may signal important policy needs.
  • Geographic Access to Health Care for Rural Medicare Beneficiaries
    WWAMI Rural Health Research Center
    Date: 04/2005
    This study looked at where Medicare beneficiaries from five states obtain their care, how far they travel for that care, and the mix of physician specialties from whom they obtain their ambulatory care.
  • Assisted Living in Rural America: Results From a National Survey
    Southwest Rural Health Research Center
    Date: 03/2005
    This article examines the assisted living industry in metropolitan and rural areas. Results indicate that assisted living was largely a private-pay form of long-term care and was more common in metropolitan than rural areas. Findings suggest that assisted living will make only a marginal contribution to meeting the needs in rural areas.
  • Rural Health Research in Progress in the Rural Health Research Centers Program, 9th Edition
    Maine Rural Health Research Center
    Date: 02/2005
    This book provides policymakers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy. It provides a context for legislation current that affects rural health services and populations.
  • Chronic Disease and Functional Limitation Among American Indian and Alaska Native Elders
    Journal Article
    Upper Midwest Rural Health Research Center
    Date: 2005
    Reports the results of an analysis of chronic disease's effect on functional limitation from a survey of 7,107 Native elders representing 143 tribes from 77 sites.
  • Chronic Disease in American Indian/Alaska Native Elders
    Journal Article
    Upper Midwest Rural Health Research Center
    Date: 2005
    This journal article describes the prevalence of chronic diseases among Native American elders.
  • Disability Burdens Among Older Americans in Rural and Urban Area
    Fact Sheet
    Rural and Minority Health Research Center
    Date: 2005
    This fact sheet examines differences in disability-free and disabled life expectancy among rural or urban residents, using an indicator called "health expectancy."
  • Providing Hospice Care in Rural Areas: Challenges and Strategies to Address Them
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 2005

    Hospices in rural settings face challenges in the provision of hospice care as a result of their location and the size of their service area population. To ascertain the challenges that hospices face in serving rural communities, researchers conducted in-depth case studies of four different models of hospice care in rural areas. The authors describe strategies used by the case study hospices and recommend policies that could increase access to hospice care for rural Medicare beneficiaries and other rural residents. National initiatives to improve end-of-life care need to consider the special challenges faced by rural hospices.

2004

  • Rurality and Nursing Home Quality: Results From a National Sample of Nursing Home Admissions
    Journal Article
    Southwest Rural Health Research Center
    Date: 10/2004
    There are higher percentages of elderly population in and the utilization rates of nursing homes are higher in rural areas. Overall, problems in rural nursing homes are at a much higher risk for poor outcomes, but it is most apparent in extremely isolated rural areas.
  • Do Rural Elders Have Limited Access to Medicare Hospice Services?
    Journal Article
    University of Minnesota Rural Health Research Center, Upper Midwest Rural Health Research Center
    Date: 05/2004
    Examines whether there are urban-rural differences in use of the Medicare hospice benefit before death and whether those differences suggest that there is a problem with access to hospice care for rural Medicare beneficiaries.
  • Rural-Urban Issues in the Wage Index Adjustment for Prospective Payment in Skilled Nursing Facilities (Brief Report)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2004
    Hourly wage data from Medicare-participating nursing homes were used to examine urban/rural patterns in average hourly nursing home wages and wage variation within the statewide rural labor markets defined by CMS. The data were also used to examine the adequacy of the hospital wage index as an adjuster for skilled nursing facility rates.

2003

  • Rural-Urban Issues in the Wage Index Adjustment for Prospective Payment in Skilled Nursing Facilities (Full Report)
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 11/2003
    Hourly wage data collected were used to examine urban/rural patterns in average hourly nursing home wages and pattern variation within the statewide rural labor markets. The data were also used to examine the adequacy of the hospital wage index as an adjuster for skilled nursing facility rates.
  • Health Insurance Coverage of The Rural and Urban Near Elderly
    Maine Rural Health Research Center
    Date: 10/2003
    This paper reports the results of a study that used data from the 1996-1998 Medical Expenditure Panel Survey to address two principal research questions related to health insurance coverage for the rural near elderly.
  • Nursing Homes in Rural America
    Southwest Rural Health Research Center
    Date: 2003
    This policy brief discusses the main findings of a 2000 survey of 17,000 nursing homes related to rural elderly.
  • Rural Minority Elders
    Fact Sheet
    Rural and Minority Health Research Center
    Date: 2003
    This fact sheet provides data on health status, health insurance coverage, education, and income of rural elders.

2002

2001

2000

  • The Effect of the Doctor-Patient Relationship on Emergency Department Use Among the Elderly
    Journal Article
    WWAMI Rural Health Research Center
    Date: 01/2000
    OBJECTIVES: This study sought to determine the rate of emergency department use among the elderly and examined whether that use is reduced if the patient has a principal-care physician.
    METHODS: The Health Care Financing Administration's National Claims History File was used to study emergency department use by Medicare patients older than 65 years in Washington State during 1994. RESULTS: A total of 18.1% of patients had 1 or more emergency department visits during the study year; the rate increased with age and illness severity. Patients with principal-care physicians were much less likely to use the emergency department for every category of disease severity. After case mix, Medicaid eligibility, and rural/urban residence were controlled for, the odds ratio for having any emergency department visit was 0.47 for patients with a generalist principal-care physician and 0.58 for patients with a specialist principal-care physician.
    CONCLUSIONS: The rate of emergency department use among the elderly is substantial, and most visits are for serious medical problems. The presence of a continuous relationship with a physician--regardless of specialty--may reduce emergency department use.
  • Emergency Department Use by the Rural Elderly
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2000
    This study uses Medicare data to compare emergency department (ED) use by rural and urban elderly beneficiaries. Given the similarity of diagnostic conditions associated with ED visits, rural EDs must be capable of dealing with the same range of emergency conditions as urban EDs.

1999

  • Rural and Urban Physicians: Does the Content of Their Medicare Practices Differ?
    Journal Article
    WWAMI Rural Health Research Center
    Date: 1999
    Rural and urban areas have significant differences in the availability of medical technology, medical practice structures and patient populations. This study uses 1994 Medicare claims data to examine whether these differences are associated with variation in the content of practice between physicians practicing in rural and urban areas.