Transportation of Rural Elders and Access to Health Care

Abstract

Demographic data show that the rural Midwest is becoming less populous and older. As a population gets older, its need for health care servi ces increases, a fact that makes access to health care a growing concer n. One of the many dimensions of access to health care is the a b i l i ty to physically travel to a doctor's office, hospital, or other health care faci l ity. While th is study addresses general issues surrounding rural elders' access to transportation, we pay special attention to their travel to obtai n health care. Rural elders use a variety of means to travel to obtain health care. Some are able to drive their own veh icles, others r ide with family members, fr iends, or neighbors, and others require the services of public transportation. Our r eport focuses on public transportation. We examine how rural Iowans age 75 and over use public transit and discuss the nature and magn i tude of their transit needs. We also assess the capac ity of Iowa's public transit system to meet the needs of rural elders.

Access to Transportation and Health Care Utilization in a Rural Region

“…While access to transportation for routine care has been ignored, access to transportation for emergency care in rural communities, whether on the ground or in the air, is a major theme for rural health. 14 The need for access to transportation for health care utilization among older adults in rural communities has been the focus of several studies and reviews, 7,8,13,[15][16][17][18][19][20] with the need to provide alternatives to the private automobile if older adults are to independently access care being a major theme.…”

Dementing Illnesses in Rural Populations: The Need for Research and Challenges Confronting Investigators

“…Selecting a Representative Sample. Because rurality is generally associated with geographic isolation, small population, and sparse settlement (Hewitt, 1989), investigators in the United States often define their rural target populations with reference to criteria such as those applied by the Bureau of the Census when defining rural communities (e.g., towns with fewer than 2,500 residents) or those used by the Office of Management and Budget (i.e., not included in any metropolitan statistical area) (Damiano, Momany, Foster, & McLeran, 1994;Hewitt, 1989). However, many of the factors discussed above as having a potential influence on the occurrance, course, and management of dementia (i.e., lower economic status, less formal education, and limited access to medical providers) are aIso among those tending to distinguish rural from urban residents (Bureau of the Census, 1991).…”

“…If participants are required to travel to an interview or examination facility, investigators have to take into account the relatively longer trips that rural residents have to make with only limited access to public transportation (Damiano, et al, 1994;Kihl, 1993). With regard to private conveyence, one study found that approximately 26 percent of rural elders living alone had no private automobile and that nearly 40 percent of all automobile trips taken by rural elders to visit a physician involved a driver other than the patient.…”

“…With regard to private conveyence, one study found that approximately 26 percent of rural elders living alone had no private automobile and that nearly 40 percent of all automobile trips taken by rural elders to visit a physician involved a driver other than the patient. Further, very elderly rural women (important subjects in dementia studies) were the least likely to hold a driver's license (Damiano, et al, 1994). Others have reported that even licensed rural elders with access to a private automobile may prefer not to drive themselves (Kihl, 1993).…”

Oral health: perceptions of need in a rural Iowa county

“…is not representative of the state, as the elderly are not distributed equally across Iowa's counties. 36 Also, as there was no visual dental e~amination,~~.~' the study relied on the subjects to give information about their own oral health. It generally has been assumed that valid measures of oral health status only can be obtained from direct clinical observation by a dentist.…”