Community Context and Rural Strategies to Support the Oldest Old

Research center:
Project funded:
September 2019
Project completed:
August 2020

Rural areas are older, on average, than urban areas, and they are getting older more quickly, due to declining birth rates and migration patterns among younger adults. Meanwhile, the demographics of rural areas are changing, as immigration and socio-economic forces influence who lives in rural areas. As a result, there is a need for a broad characterization of older adults in rural areas and how they differ from older adults in urban areas, including where they live (non-core, micropolitan, FAR codes, etc.), gender, marital status, race and ethnicity, income, health status, and living arrangements.

Meanwhile, one of the fastest-growing segments of the entire U.S. population is adults age 85 and older, sometimes referred to as the "oldest old." By 2050, an estimated 19 million Americans will be 85 or older; comprising approximately 20% of the total population of older adults, age 65 and older. The oldest old are more likely than their younger counterparts to have chronic conditions and resource-intensive healthcare needs. Thus, with the growth of this population comes unique needs for healthcare and long-term care services, along with a wealth of experience and value to communities and society.

The Maine Rural Health Research Center completed a project to illuminate rural-urban differences in the characteristics of the oldest-old, finding significant differences across health, functional status, living arrangements, and socio-demographic characteristics. However, given documented differences in rural-urban locations in long-term care availability and caregiver supports, more information is needed on where the oldest old reside and how rural communities are currently responding to, and planning for, the needs of the oldest-old among them.

We used U.S. census data and other relevant data sources (e.g., Social Security Administration data) to systematically characterize older adults in rural areas and rural-urban differences between older adults. We also used U.S. census data dating back to 1950 to identify the changes in the prevalence of the oldest old by county, including in both rural and urban counties. We then identified the counties with the greatest concentration of the oldest old today and conducted key informant interviews of individuals living and working in the rural counties with the greatest concentration of the oldest old in order to identify rural-relevant strategies to support that population.