People Living With Dementia in Rural Areas are Most Likely to Report Unmet Service Needs in Home‐ and Community‐Based Services in the United States
Romil R. Parikh, Eric Jutkowitz, Jack M. Wolf, Benjamin W. Langworthy, Chanee D. Fabius, Stephanie Giordano, Tetyana P. ShippeeABSTRACT
Purpose
Most older adults prefer aging in place, for which home‐ and community‐based services (HCBS) play an essential role. However, it is unknown whether rural‐urban differences in unmet HCBS needs differ by dementia status, which is an important evidence gap to develop targeted interventions to improve HCBS access. Therefore, we evaluated associations of rural‐urban continuum (RUCA classification) with consumer‐reported unmet HCBS needs by dementia status.
Methods
We analyzed data from the National Core Indicators‐ Aging & Disability survey (2016‐2019; 14,645 community‐dwelling consumers; age, ≥65years; 23 states) using logistic regression, comparing adjusted odds ratios (OR) of consumer‐reported unmet HCBS needs across rural‐urban continuum, stratified by dementia.
Findings
Among people living with dementia (PLWD, n = 2438), compared to metropolitan areas, prevalence of unmet HCBS needs was greater in micropolitan areas (35.4% versus 30.7% consumers; OR, 1.32, 95% CI, 0.98–1.77), small towns (36.3% consumers; OR, 1.44, 95% CI, 0.97–2.13), and rural areas (44.8% consumers; OR, 1.83, 95% CI, 1.11–3.04). These associations were reversed in those without dementia (n = 12,207). Compared with metropolitan areas, prevalence of unmet HCBS needs was lower among those in micropolitan areas (28.7% vs 31.4% consumers; OR, 0.82; 95% CI 0.72–0.93), small towns (29.3%; OR 0.85; 95% CI 0.73–1.00) and rural areas (25.4%; OR, 0.73, 95% CI, 0.58‐0.90).
Conclusion
Among PLWD, unmet HCBS needs are significantly greater in rural areas. These findings highlight the critical need for dementia‐capable HCBS in rural areas to improve equitable access to these essential services among PLWD.