Premature institutionalization among the rural elderly in Arizona

Rural areas of the United States, compared with urban areas, exhibit a scarcity of resources and programs designed to provide health and supportive services to impaired elderly persons living in the community. Furthermore, recent research has indicated that informal, familial support for the rural elderly has become increasingly attenuated because of such factors as outmigration of younger family members. Under these circumstances, there is reason for concern that a lack of available supportive services to help impaired rural elderly persons remain in the community may in effect drive them prematurely into nursing homes. In Arizona we have found that, consistent with such a process, elderly nursing home patients in rural areas tend on the average to be significantly less impaired in most areas of functional capacity, and younger at time of entry, than elderly nursing home patients in urban areas. This pattern remains when various possible confounding effects are statistically controlled.