Study: Injury, Food Insecurity and Inadequate Social Supports Put Older Rural Adults at Risk

A research paper found that significant gaps in access to healthcare can compound risks to the well being of older rural residents stemming from social isolation, injuries, or inadequate nutrition.

by Liz CareyJuly 29, 2024  || THE DAILY YONDER – KEEP IT RURAL

While rural older adults are statistically just as likely as their urban counterparts to suffer from injuries, food insecurity and social isolation, their lack of access to healthcare puts them at greater risk for negative health outcomes as a result, a new study found.

In a new policy brief from the University of Minnesota’s Rural Health Research Center, researchers found that one in every three rural and urban older adults experience either physical injury, food insecurity or a lack of social and emotional support. Ingrid Jacobson, lead researcher on the study, said those three risk factors raise serious public health concerns.

“Injury, food insecurity, and social isolation are known to influence the risk of each other,” Jacobson said in an email interview. “Experiencing one can lead to a greater risk of experiencing the other two. Combining these things with the known lack of access to healthcare and other important resources, such as affordable grocery stores, it does spiral into a greater problem in rural areas.” Rural areas also have larger proportions of older adults than urban areas, the research found, and are the fastest growing age group in those areas.

Of the three risk factors, lack of social and emotional support was the most common, according to the study. About 18.5% of rural older adults said they had inadequate social and emotional support, while 19.9% of urban older adults did. Rural older adults were more likely to report injury as a risk factor, with 10.8% of rural adults saying they had experienced some form of injury compared to 9.2% of urban older adults. Rural and urban adults reported similar rates of food insecurity at 4.9% and 4.4% respectively.

Falls are the leading cause of injury among older adults, with one in three falling every year, according to the Centers for Disease Control and Prevention. Studies have shown rural residents have higher rates of motor vehicle injuries and death rates from unintentional falls. And, the CDC said, injuries caused by falls and motor vehicle accidents can lead to more serious issues like traumatic brain injury and long-term disability among older adults.

Low food security among older adults can lead to decreased mental abilities and multiple chronic diseases. A 2021 survey by Feeding America estimates one in 14 U.S. adults over the age of 60 is food insecure, with rural residents, younger older adults and Black and Hispanic older adults more likely to be food insecure. According to a Feeding America survey, 19% of rural respondents reported having high or marginal food security, while 49% had low food security, and 28% very low food security. Researchers at the Rural Health Research Center said those numbers are likely to have increased recently due to high inflation.

Many older rural adults have strong social networks, the study found, but they also lack access to health care and support networks. Older adults in rural areas may also be at increased risk for maltreatment and neglect because of social and geographic isolation. Older adults are more likely to live alone, have chronic disease, physical impairment and loss of close relations compared to other age groups which can add to loneliness and decreased levels of social and emotional support, the Rural Research Center study found.

Carrie Henning-Smith, associate professor with the University of Minnesota School of Public Health and part of the research team, said the research shows that as much attention should be paid to risk factors like injury and social isolation as is paid to larger health issues like diabetes or heart disease.

“It was also striking that nearly one-third of older adults in both rural and urban areas experienced at least one of the risk factors we were examining,” Henning-Smith said. “We spend considerable resources and policy attention on addressing chronic disease and other medical conditions for older adults. Our results show that we should focus as much on other adverse outcomes.”

Jacobson said social well-being is an important driver of health and well-being for rural adults.

“The most striking thing for me from this study was that nearly one in five older adults in both rural and urban areas reported a lack of social and emotional support,” Jacobson said. “That’s a lot of people. We know that loneliness and social isolation has been an issue for everyone, especially during the pandemic, and this study shows that lack of social support remains a pervasive issue for older adults post-pandemic.”

The Rural Health Research Center researchers said policy makers should take a more holistic approach to the health of older adults in rural areas.

“In continued moves toward value-based care, attention should be paid to health outcomes beyond the diagnoses we typically focus on for older adults,” Henning-Smith said. “Incentivizing healthcare providers to address broader social drivers of health, and promoting multisectoral collaboration is key to supporting older adults in rural and urban areas alike.”

Each risk factor, the researchers said, represents opportunities to prevent adverse health outcomes.

“By tailoring policy to promote less injury, less food insecurity, and increased social and emotional support among older adults, especially in rural settings and among marginalized older adult subpopulations, policy can potentially decrease health inequities and future adverse health outcomes among older adults,” the researchers wrote.