health equity among older rural adults

At Monday's "Rural Health and Aging" session, presenters underscored the need to expand prevention and health programs to seniors living in rural areas and very rural areas — those not adjacent to cities — particularly beyond the eastern half of the U.S. In addition, the programs that have been successful need to consider the populations they aren't serving, such as minority groups.

A primary risk for older adults across the country are falls. One in four adults ages 65 and older falls every year. In fact, every 11 seconds, an older adult is treated in an emergency room for a fall-related injury. Serious falls can lead to fractures and head trauma, which can result in death, reduced mobility, loss of independence and premature death.

"These injures and incidents cause so many different types of problems for individuals that can really be the start of a negative downward trajectory,” said Matthew Smith, associate professor and associate director of the Center for Population Health and Aging at Texas A&M University. "They're very common, but they are largely preventable, and we do know that we can identify different risk factors so that we can intervene. It's never too late to intervene and try to increase protective behaviors among older adults."

Smith's center is working to expand evidence-based fall prevention programs across the country. During the Annual Meeting session, he presented research that examined the national dissemination of eight evidence-based fall prevention programs. Over a three-year period, 39 grantees in 22 states held 3,755 workshops for 45,812 people. Of the 3,221 U.S. counties, 17 percent were served by one of these workshops, "which is actually pretty great,&"Smith said.

Of the eight programs, the top four — A Matter of Balance, Stepping On, Tai Ji Quan and Tai Chi for Arthritis — accounted for 80 percent of the workshops. In fact, A Matter of Balance represented 65 percent of the workshops. However, programs that had a better rural penetration were Stepping On, Tai Ji Quan, FallScape and Stay Safe, Stay Active.

The average age of the participant was 76 years old, and 81 percent were women, Smith reported. Rural areas were more likely to hold programs at faith-based organizations and community centers.

"It's really about identifying the partners who can deliver this infrastructure, reduce the number of miles and the travel time, so that individuals can access so many of these programs," Smith told attendees.

Session presenter Steven Cohen, assistant professor at the University of Rhode Island, illustrated the complexity of income inequality and obesity in older adults, as his research showed that lower income levels were not always associated with higher obesity rates.

His study linked 2012 data from the Behavioral Risk Factor Surveillance System to 2010 Census data to categorize 134,536 adults age 65 and older by county of residence. The obesity data was based on self-reported height and weight. The data was then stratified into 16 categories by income and population density.

Overall, as income increased, obesity rates decreased, as expected. However, the rates didn't go down as much in rural areas when compared to urban areas. In addition, after adjusting for gender, age and other confounders, higher income inequality was associated with a reduced likelihood of obesity in some categories.

"There's not really a clear pattern of what’s going on, but what we're finding is that higher income inequality is actually protective against obesity in some categories," he said. "There's wide discrepancies in terms of income and rural or urban status, and there was actually negative associations that tended to be stronger in the higher income areas in the more rural areas.

“All that information we have about income inequalities [being] bad for your health, well it turns out that — at least when measuring at the county level — that may not be the case,” Cohen told session attendees. "We'e not quite sure why that is."

The findings merit further research to be able to create policies and programs that will effectively reduce obesity in rural communities, he said.

The studies presented during Monday's session helped illustrate which programs work, said Elaine Jurkowski, professor at Southern Illinois University. She pointed out that senior centers are prevalent across the country and often make good prevention partners.

"But we're not reaching [enough people],"; she said. "So what are we doing that we're not reaching them? That's maybe the next generation of what we need to start to look at in terms of rural health. How can we begin to create some sort of equity and access?"