Community determinants of health for rural elderly

Although community health nursing practice supports community-level interventions, the influence of communities on the health of older members is not well known. Ethnographic design and methods were employed to study the health of older residents in a western plains farming community. Relationship was a key component for understanding life in this town. Reciprocal relationships in which older people and the community were mutual benefactors were crucial to the acceptability of help and support. Stressors were lack of privacy and isolation for those who did not conform to prevailing norms. Nurses in rural areas have to foster a sense of relationship and reciprocity within a community, since assistance is accepted most easily when older people can repay in kind. Advocating the use of government supports and programs may not be successful if the programs do not require such contributions. Close relationships can be stressful as well as supportive, and increasing social support and monitoring for an older person may inadvertently decrease privacy and promote stress.