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.1
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.2
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.
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