Rural Older Adults with Cognitive Impairment and Chronic Disease: A Mixed Methods Study of Social and Health Factors in Their Care
Investigators: Christine Cigolle
Funding: Michigan Center on the Demography of Aging, 2016-2017
Geriatric conditions, such as dementia, fall outside the traditional disease model of medicine and are often overlooked in the care of older adults. Dementia represents a special case as a geriatric condition. It frequently co-occurs with the other geriatric conditions and chronic diseases, and it is the condition most strongly associated with disability. Its prevalence in the United States is estimated to be 14% among those 71 years and older, affecting nearly 4.2 million adults. Dementia has pervasive effects on the health and well-being of older adults. It influences all aspects of their relationships with their primary care providers. It affects their ability to self-manage all of their chronic diseases. It frequently leads to difficult and varied burdens for their caregivers in supporting them in non-institutional settings. The medical, caregiving, and social challenges of dementia patients are particularly germane in rural areas. Rural primary care providers are more often faced with limited office support staff and decreased ability to refer to specialists. Rural communities have fewer social support resources for older adults with dementia. Older adults represent a larger share of the population in rural areas, and in those rural areas have increases in multimorbidity prevalence and severity. Yet, much remains unknown about the demographic and health characteristics of rural older adults with dementia, the communities in which they live, their needs, and their long term outcomes.
The proposed pilot will perform a mixed methods study of older adults with dementia in rural Michigan. The pilot will address how rural older adults with dementia are cared for in their communities, as viewed by primary care physicians in those communities. Specifically, the pilot will seek qualitative and quantitative information about rural older adults with dementia, their caregivers, and clinicians as to the challenges in addressing dementia and comorbid chronic disease in rural populations. The research will test the hypothesis that rural older adults with dementia have barriers to care and support that are unique to the rural setting. Semi-structured qualitative interviews will be conducted with rural primary care physicians in Michigan. These interviews will be supplemented with an exploratory secondary data analysis of older adults with dementia in rural settings, using data from the Health and Retirement Study.