UF Study: Rural Elders More Likely To Enter Nursing Homes

September 4, 1996

GAINESVILLE—Older adults who live in rural America are more likely to enter a nursing home than their urban counterparts, report University of Florida researchers in the September issue of the Journal of Gerontology.

The findings are the first to document that where elderly people live increases their risk of entering a long-term care facility — even after other factors, such as health and family support, are taken into account, say researchers from UF and the University of New England.

The news is of particular interest amid the ongoing national debate about health-care reform and the growing public cost of long-term care services, set to increase dramatically as Baby Boomers reach old age.

“A better understanding of rural-urban differences in admission rates to nursing homes is important because they represent thousands of admissions and millions of dollars of expenditures,” said Russell Mullens, an associate professor at the University of New England and a study team member.

Researchers examined differences in nursing home admissions during a six-year period among a national sample of 7,527 adults older than 70, in four different types of rural and urban communities. Those living in the most sparsely populated and geographically remote settings were 25 percent more likely to enter a nursing home.

“In earlier work we had documented that rural communities had more nursing home beds per 1,000 elders than did more urban settings,” said Raymond T. Coward, director of UF’s Institute for Gerontology and the study’s principal investigator. “But what had not been previously established was the direct link between place of residence and a greater risk of admission.”

This higher risk cannot be explained by other factors that are known to influence an admission, said Julie Netzer, a member of the research team from the department of health policy and epidemiology at UF’s College of Medicine. Researchers took into account differences between rural and urban elders in their personal characteristics, their physical and mental health and the family support available to them.

“Once these other factors were accounted for, then the remaining difference could be attributed to the place of residence or community context in which the elder lived,” Netzer said. “In theory, we know that the ability of an older person to remain living independently in the community is a combination of their physical and mental abilities and the demands placed on them by the environment in which they live.”

Researchers speculate that the rural elderly are more likely to enter a nursing home because rural areas often have a smaller number and narrower range of community-based and in-home services available for older residents, Coward said.

“As a consequence, rural elders may conclude that they have few alternatives but to enter a nursing home,” he said. “Rural elders also may be more favorably inclined toward entering their local nursing home than people in more urban settings. For one thing, they are more likely to have visited the place, more likely to have had a friend or family member who was cared for there, and more likely to know people who work there.”

Ultimately, these differences in admission rates between rural and urban communities are a concern to both public officials and rural families. “We must be sure that rural elders are given every opportunity to maintain their life in the community and that they are not prematurely entering nursing homes because of the absence of viable community-based service alternatives,” Coward said.