Nutrition and health for older persons in rural America: a managed care model.

In 1994, 1 in 8 Americans, 33.2 million persons, were 65 years old or over (1). The US Census Bureau (1) estimates that by the year 2050, 1 in 5 Americans, or 80 million persons, will be aged 65 years or older, and those aged 85 and over are expected to number 19 million. In 1993, the US Department of Health and Human Services reported that 28% of persons aged 65 and older characterized their health as fair or poor, whereas only 8% of persons under the age of 65 considered themselves in fair or poor health (2). According to the same report, most older persons suffer from at least one chronic condition and many experience multiple health problems. This article describes the growing challenge to provide health services to older Americans and presents an innovative program that provides nutrition risk screening and intervention to older Americans living in rural Pennsylvania.

OLDER AMERICANS IN RURAL AREAS

According to the US Senate Special Committee on Aging, in 1992 nearly two thirds of all community-dwelling non-metropolitan older persons resided in rural (any area with a population of 2,499 or fewer [3]) areas (4). Older persons in rural areas are often isolated, both socially and geographically. Older persons may not have access to private or public transportation, which may generate additional feelings of isolation and separation and limit access to health care (5). In addition to limited education and finances and the presence of chronic disease, many rural elderly experience poor dentition, depression, disability, and substance abuse. They may also take multiple medications. All of these situations challenge the resources of the local health care system (6). Available services and resources may be highly variable (3), and the opportunity for positive intervention may be doomed by lack of critical resource components and/or integrated delivery.

Coward et al (4), used data from the 1984 National Health Interview Survey and the accompanying Supplement on Aging to determine if place of residence significantly affected the need for health service funding through the Older Americans Act. After controlling for age, race, and income, the authors found that older persons residing outside of a metropolitan area had more hospital admissions, functional limitations, chronic health conditions, and falls and increased confusion and forgetfulness.

Gillanders and Buss (5) conducted …