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Learn the skills you need to work with geriatric populations in rural areas! Gerontological Social Work in Rural Towns and Communities provides a range of intervention and community skills aimed precisely at the needs of rural elders. This book fills a gap in the literature by focusing on the specific practice concerns for social workers assisting older adults in rural areas, including the aging experience, social worker skills, professional functions, working with special populations, and health and long-term care concerns. This valuable resource will benefit social workers, gerontologists, allied health professionals in rural areas, health and human services administrators and managers. Gerontological Social Work in Rural Towns and Communities explores the challenges social workers need to overcome when working with the elder community in rural areas. This book's significance to social workers will only increase as more adults choose to live and grow old away from the cities. Experts in the field suggest strategies to overcome barriers in planning and providing services such as: a longer distance for the elderly to travel to use social service centers a narrower range of available services in the local area increased poverty levels for the elderly a stronger dependency by elderly on family rather than public assistance This book is divided into five sections: Rurality and Aging—introduces the concept of rurality and examines the demographics of aging from a rural perspective Practice Dimensions of Social Work with Rural Elders—includes clinical practice models, intervention and advocacy techniques, program planning, and marketing approaches Special Populations—gives attention to four special population groups: indigenous elders, African-American older adults, elderly Latinos, and disabled elders Special Issues Pertaining to Rural Elders—covers five essential issues for rural gerontological social workers: health promotion, older workers and retirement preparation, aging in place, specialized housing, and ethical practice Training and Policy Recommendations—future training and education recommendations for social workers are explored, as well as service capacity building, the aging network, and the future of long-term care While a variety of theoretical perspectives are explored in Gerontological Social Work in Rural Towns and Communities, the book's empowerment orientation and strengths-based approach will enhance your abilities to improve quality of life for elderly individuals in rural communities. Each chapter contains a comprehensive review of the literature on the subject it addresses, and several chapters include tables and graphs to further establish their revealing empirical findings. An appendix provides additional sources to turn to for more information. About the Contributors Acknowledgments Preface PART I SECTION I. INTRODUCTORY CONCEPTS OF RURALALITY AND AGING Chapter 1. Rurality, Aging and Social Work: Setting the Context (Sandra S. Butler and Lenard W. Kaye) Chapter 2. The Demographics of Aging in Rural Perspective (Lucinda L. Roff and David L. Klemmack) SECTION II. PRACTICE DIMENSIONS OF SOCIAL WORK WITH RURAL ELDERS Chapter 3. Rural Aging: Social Work Practice Models and Intervention Dynamics (Cynthia D. Bisman) Chapter 4. Advocacy Techniques with Older Adults in Rural Environments (Sandra S. Butler and Nancy M. Webster) Chapter 5. Rural Program Planning and Development for Older Adults (Hong Li and C. Jean Blaser) Chapter 6. A Rural Perspective on Marketing Services to Older Adults (Kim K. R. McKeage and Lenard W. Kaye) SECTION III. SPECIAL POPULATIONS Chapter 7. Indigenous Elders in Rural America (Amanda Barusch and Christine TenBarge) Chapter 8. Rural African American Older Adults and the Black Helping Tradition (Mikal N. Rasheed and Janice Matthews Rasheed) Chapter 9. Rural Elderly Latinos (Steven Lozano Applewhite and Cruz Torres) Chapter 10. Rural Disabled Elders (Elizabeth DePoy and Stephen French Gilson) PART II SECTION IV. SPECIAL ISSUES AND PROGRAMS Chapter 11. Older Adult Health Promotion in Rural Settings (Stephanie J. FallCreek) Chapter 12. Older Rural Workers and Retirement Preparation (Lorraine T. Dorfman) Chapter 13. Rural Older Adults at Home (Whitney Cassity-Caywood and Ruth Huber) Chapter 14. Specialized Housing and Rural Elders (Sandra S. Butler and Donald W. Sharland) Chapter 15. Ethical Practice Issues in Rural Perspective (Tara C. Healy) SECTION V. LOOKING AHEAD: TRAINING AND POLICY RECOMMENDATIONS Chapter 16. Future Training and Education Recommendations for Rural Gerontological Social Workers (Nancy P. Kropf) Chapter 17. Rural Mental Health: A Discussion of Service Capacity Building for Rural Elders (Eloise Rathbone-McCuan and Share Bane) Chapter 18. The Aging Network and the Future of Long-Term Care (Josefina Carbonell and Larry Polivka) Appendix: Sources for More Information on Social Work with Rural Older Adults (Elizabeth Johns and Jane Harris-Bartley) Index Reference Notes Included

The proportion of older people in Poland is higher in rural areas than in urban areas. Thus, we aimed to evaluate treatment rate and factors associated with outcome and safety of intravenous thrombolysis (IVT) in rural residents aged ≥80 years admitted to primary stroke centers. This study was a retrospective, observational cohort study of 873 patients treated with recombinant tissue plasminogen activator (rt-PA) in primary stroke centers between February 1, 2009 and December 31, 2017. Among them were 527 rural residents and 231 (26.5%) were ≥80 years of age. The analyses between rural and urban patients aged ≥80 and between rural patients aged <80 and aged ≥80 were performed. The proportion of patients aged ≥80 treated with rt-PA was comparable in rural and urban residents (27.9% vs 24.3% = 0.24). Rural patients aged ≥80 were also characterized by lower incidence of cardiovascular risk factors and better patients' conditions on admission to hospital. Symptomatic intracerebral hemorrhage rate among ≥80-year-old stroke patients was lower in those living in rural areas than in those living in urban areas (5.4% vs 14.3%, = 0.02); there were no differences regarding mortality and 3-month functional outcome between both populations. The older group of rural patients was characterized by a higher 3-month mortality (28.5% vs 12.6%, < 0.001) and lower functional independence rate (34.0% vs 50.5%, < 0.001) than rural younger patients. Antiplatelet (OR 2.43, 95% CI 1.04-5.66, = 0.04) and anticoagulant therapy before stroke (OR 3.64, 95% CI 1.21-10.99, = 0.022), early ischemic changes in baseline computerized tomograprpahy (OR 2.65, 95% CI 1.03-6.82, = 0.043) were associated with unfavorable outcome; and higher National Institute of Health Stroke Scale score on admission (OR 1.01, 95% CI 1.01-1.20, = 0.039), higher baseline count of white blood cells (OR 1.33, 95% CI 1.10-0.62, = 0.003) were associated with mortality in rural patients over 80. We suggest that rural patients aged ≥80 may be safely treated with IVT in routine practice. However, lower efficacy and a higher mortality must be considered in former use of Vitamin K antagonist and antiplatelet or high white blood cells count.

Background The rural–urban gap in socioeconomic and morbidity status among older adults is prevalent in India. These disparities may impact the levels and factors of self-rated health (SRH). The objective of the study is to compare the levels and determinants of SRH between rural and urban areas by considering the moderating effects of marital status and living arrangements. Subjects and methods The present study used data from the Longitudinal Ageing Study in India (LASI) wave 1 (2017–18). A total sample of 30,633 older adults aged 60 years and above were selected for the study. Descriptive statistics, bivariate chi-square test, the interaction effect of living arrangements and marital status, and logistic estimation were applied to accomplish the study objectives. Results The prevalence of poor SRH was found 7% higher in rural areas compared to urban counterparts. A substantial rural–urban disparity in the patterns of poor SRH was also observed. The interaction effect of marital status and living arrangement on self-rated health suggested that older adults who were currently unmarried and living alone were 38% more likely to report poor SRH than those who were currently married and co-residing in rural India. In addition to marital status and living situation, other factors that significantly influenced SRH include age, socio-cultural background (educational attainment and religion), economic background (employment status), health status (ADLs, IADLs, multi-morbidities), and geographic background (region). Conclusion The present study's findings demonstrated that, notwithstanding local variations, marital status and living circumstances significantly influenced SRH in India. In the present study, unmarried older people living alone were more susceptible to poor SRH in rural areas. The present study supports the importance of reinforcing the concepts of care and support for older individuals. There is a need for special policy attention to older individuals, particularly those unmarried and living alone. Although older individuals had difficulty performing ADLs and IADLs and had multi-morbidities, they reported poorer health. Therefore, offering them social support and top-notch medical assistance is crucial.

Physical Activity (PA) is essential for enhancing the physical function of pre-frail and frail older adults. However, among this group, PA-levels vary significantly. Identifying the factors contributing to these differences could support tailored PA interventions. This study aims to examine factors associated with physical activity levels among pre-frail and frail older adults in rural China. This is a cross-sectional study. A total of 284 (pre)frail older adults (aged ≥60 years) were included from ten rural healthcare centers in Northeast China. Participants were categorized into low-moderate and high physical activity groups assessed using the Short Form International Physical Activity Questionnaire. Four-dimensional data were collected, including demographics, health behaviors, objective physical performance measures, and self-reported perceived health profiles. Extreme Gradient Boosting (XGBoost), a machine learning algorithm, was employed for binary classification (low-moderate vs. high physical activity). Model performance was assessed using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, precision, and F1-score. To enhance interpretability, SHapley Additive exPlanations (SHAP) were utilized to identify key predictive variables. Mean age of participants was 70 years (59% female, 86% farmers). The low-moderate group averaged 1,187 MET/week, while the high physical activity group reached 8,162 MET/week. Physical performance tests showed significantly better scores in the high PA group. The XGBoost model achieved 82.4% accuracy (AUC: 0.769, specificity: 90%, sensitivity: 63%). SHAP analysis revealed that self-reported social support, general health, ambulation, and physical performance measures were the most important factors. The high physical activity group demonstrated better physical function than the low-moderate physical activity group; though, both groups showed poorer physical function compared to the general older population. Self-reported health perceptions and social support significantly correlated with physical activity levels. Addressing these factors through targeted interventions-including community-based social support programs and structured mobility-enhancing exercises-may contribute to improved health outcomes and enhanced quality of life in this population.

Physical Activity (PA) is essential for enhancing the physical function of pre-frail and frail older adults. However, among this group, PA-levels vary significantly. Identifying the factors contributing to these differences could support tailored PA interventions. This study aims to examine factors associated with physical activity levels among pre-frail and frail older adults in rural China. This is a cross-sectional study. A total of 284 (pre)frail older adults (aged [greater than or equal to]60 years) were included from ten rural healthcare centers in Northeast China. Participants were categorized into low-moderate and high physical activity groups assessed using the Short Form International Physical Activity Questionnaire. Four-dimensional data were collected, including demographics, health behaviors, objective physical performance measures, and self-reported perceived health profiles. Extreme Gradient Boosting (XGBoost), a machine learning algorithm, was employed for binary classification (low-moderate vs. high physical activity). Model performance was assessed using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, precision, and F1-score. To enhance interpretability, SHapley Additive exPlanations (SHAP) were utilized to identify key predictive variables. Mean age of participants was 70 years (59% female, 86% farmers). The low-moderate group averaged 1,187 MET/week, while the high physical activity group reached 8,162 MET/week. Physical performance tests showed significantly better scores in the high PA group. The XGBoost model achieved 82.4% accuracy (AUC: 0.769, specificity: 90%, sensitivity: 63%). SHAP analysis revealed that self-reported social support, general health, ambulation, and physical performance measures were the most important factors. The high physical activity group demonstrated better physical function than the low-moderate physical activity group; though, both groups showed poorer physical function compared to the general older population. Self-reported health perceptions and social support significantly correlated with physical activity levels. Addressing these factors through targeted interventions-including community-based social support programs and structured mobility-enhancing exercises-may contribute to improved health outcomes and enhanced quality of life in this population.

This study explored the patterns of comorbidities and their impact on health-related quality of life (HRQoL) among elderly individuals living in rural communities in Vietnam. A cross-sectional study was conducted across four communes in Thai Binh province. The demographic characteristics and comorbidities of the participants were evaluated, along with their Euroqol-5 dimensions-5 levels (EQ-5D-5L), using a structured questionnaire supplemented by clinical examinations. A multivariate Tobit regression model was applied to assess the relationship between comorbidities and HRQoL. Results showed that a minority of participants (9.5%) were free of comorbidities. Cataracts were the most common condition (61.0%), followed by osteoarthritis (55.4%), rheumatoid arthritis (46.1%), and dementia (39.0%). The average EQ-5D index was 0.806 (SD =  0.184). Pain/discomfort, difficulties with usual activities, and anxiety/depression contributed most to the reduction in the EQ-5D-5L index. Participants with rheumatoid arthritis (β =  − 0.10; 95% CI =  − 0.13, − 0.07) and postural hypotension (β =  − 0.08; 95% CI =  − 0.14, − 0.02) experienced the greatest decrease in EQ-5D index, followed by those with urinary diseases (β =  − 0.05; 95% CI =  − 0.09, − 0.02) and stroke (β =  − 0.05; 95% CI =  − 0.09, − 0.01). This study highlights the high prevalence of comorbidities among the elderly in rural Vietnam, with arthritis, postural hypotension, urinary diseases, and stroke being most strongly associated with reduced HRQoL. Regular screening and monitoring of comorbidities are vital to identify individuals who would benefit most from healthcare interventions to enhance HRQoL.

Prior research has identified that older rural patients and their families view preparation for detecting and responding to worsening health after a hospital stay as their most pressing unmet need, and perceive an evidence-based warning signs intervention that prepares them to do so as highly likely to meet this need. Yet, little is known about healthcare professionals' perspectives about potential barriers and facilitators to implementing warning signs interventions, especially in rural communities. This study aimed to identify potential barriers and facilitators to healthcare professionals' provision of a warning signs intervention in rural communities. In this qualitative descriptive study, we examined healthcare professionals' perspectives on potential barriers and facilitators to providing a warning signs intervention. A purposive, criterion-based sample of healthcare professionals, stratified by professional designation (three strata - nurses, physicians, and allied healthcare professionals) who provide health care to rural dwellers in Ontario, Canada participated in semi-structured telephone focus-group discussions or 1:1 interviews on barriers and facilitators to delivering the intervention. Data were analyzed using conventional qualitative content analysis. Twenty-seven healthcare professionals participated in focus groups and 15 in 1:1 interviews for a total of 42 healthcare professionals. Analysis by healthcare professional stratum revealed nine categories of barriers and facilitators: material resources; human resources; healthcare professional communication; healthcare professional knowledge and skill; healthcare professional buy-in; context of rural practice; patient- and family-specific characteristics; risks and liabilities; and timing of intervention delivery. Seven of these categories converged across healthcare professional strata. However, the reasons why different healthcare professional strata perceived the categories as important, and the ways in which they saw them functioning as barriers and facilitators, varied. Our findings shed light on barriers and facilitators that should be considered to ensure successful implementation of the intervention in rural communities. This study adds to the limited research on rural healthcare professionals' perspectives on barriers and facilitators to delivering a warning signs intervention.

The global population of older adults has steadily increased in recent decades. Little is known about the gender difference in the quality of life (QoL) of older adults in the general population. This study aimed to identify factors associated with QoL among older adults by gender. Data on QoL using the World Health Organization Quality of Life (WHOQoL-BREF) questionnaire and socio-demographic characteristics, including living status and sources of income, were collected from 1147 older adults. The WHOQoL-BREF has four domains: physical, psychological, social and environmental. Rasch analysis was used to compute a combined score from Likert-type data to a continuous scale ranging from 0% satisfaction to 100% satisfaction in terms of QoL for each domain. We used a generalized linear model to compare the mean rate of QoL for different factors, and logistic regression analysis was used to quantify the associations of factors with below-average QoL measured as 50% or less in QoL. The domain-specific QoL mean (standard error), minimum-maximum values were physical 48.9 (0.41), 7-86, psychological 38.9 (0.51), 4-71, social 50.5 (0.49), 8-92, and environmental domains 47.8 (0.37), 6-91 in the total sample with significant gender difference in all but social domain. The proportion of below average QoL for females vs. males was physical 47.6% vs. 42.6%, psychological 74.4% vs.66.7%; social 34.8% vs. 30.1% and environmental domains 56.1% vs. 49.0%. In females, participants living alone were associated with a higher proportion of below average QoL in physical OR 30.2, 95% CI 2.47, 370, psychological OR 9.54, 95% CI1.09,83.27 and social domains OR 5.94, 95% CI 1.25,28.34. In males, participants' sources of income from relatives were associated with a higher proportion of below average QoL in physical OR 3.6, 95% CI 2.01,6.44, psychological 30.2, 95% CI 2.47, 370, psychological OR 4.63 95% CI 2.56, 8.38, social domains OR 1.81, 95% CI 1.04, 3.16 and environmental domains OR 2.53 95% CI 1.44, 4.43 than those who had own income. Females engaged in income generation activities had better QoL in social and environmental domains than those with house duties, irrespective of their education or socioeconomic status. Males in retired life had the highest QoL in the social and environmental domains if they had better SES. The study's findings reveal that more than 50% of people had below-average QoL in each domain, which is significant. The study also highlighted that females living alone and males without their own income had the poorest QoL. On a positive note, it was found that females engaged in any income generation activities had better QoL in social and environmental domains. These results provide valuable insights for policymakers and healthcare professionals. They underscore the importance of implementing appropriate intervention programs to enhance the QoL of older adults, reiterating the urgency and necessity of their work to improve the health and well-being of older adults.

The life satisfaction of older adults in rural China has aroused widespread attention from policymakers and in academia. In this study we examined whether sense of self-worth and consumption mediate the association between stress and life satisfaction among rural older adults in China. We analyzed data from 586 surveys completed by people aged 60 years and over living in Zhejiang Province. The results showed that stress had a significant negative effect on life satisfaction, and sense of self-worth and consumption partially mediated this relationship. Our findings have implications for improving the life satisfaction of older adults who live in rural areas in China.

This study aims to assess the intrinsic links between physical exercise and multidimensional poverty among rural older people, focusing on the mediating mechanisms of social and cultural capital, to inform responses to active ageing. This study utilized the adult and household databases of the China Household Tracking Survey (CFPS) in 2018 and 2022. Stata17.0 was used to screen and process the data, and the A-F double critical value method was adopted to measure and structurally decompose the multi-dimensional poverty among the elderly of Chinese household farmers. The association between physical exercise participation and multi-dimensional poverty among rural elderly people was estimated using the ordinary Least squares (OLS) method. The mediating effects of social capital and cultural capital were explored by using the stepwise regression method. Finally, the heterogeneous manifestations of the impact of physical exercise participation on multi-dimensional poverty among rural elderly people were investigated by using the grouped regression method. This study found that physical exercise participation has a significant role in reducing multidimensional poverty in old age among family farmers (β = -0.0149, p < 0.001), and this finding remains valid after a series of robustness tests such as full model estimation (β = -0.009, p < 0.001), propensity score matching test (ATT value of -0.017, -0.015, and -0.017, respectively) and other series of robustness tests, the conclusion still holds. The results of the mediating effect showed that social capital and cultural capital mediated the effect of physical exercise on multidimensional poverty. Heterogeneity analyses showed that the effects of physical exercise participation on multidimensional poverty were more pronounced among females, unmarried, in the eastern region, and among the elderly with a high life expectancy. Participation in physical exercise can effectively alleviate multidimensional poverty, which is reflected in the enhancement of health level, economic status, living standard, and subjective perception sub-dimensions. Engaging in physical exercise can alleviate poverty through two channels: accumulating social capital and enhancing cultural capital. The construction and maintenance of rural sports facilities should be strengthened, a 'healthy labour model' combining physical exercise and agricultural production should be constructed, special sports poverty-alleviation initiatives should be implemented for \"vulnerable\" elderly people, and a 'Healthy Villages' project should be launched to promote the participation of all people in poverty alleviation. The 'Healthy Villages' programme has been launched to promote the participation of the entire population in physical exercise.