The age distribution and level of rurality of a county influence the health status and health care needs of its population (Gamm et al., 2002; NCHS, 2001). Since the 1960s, the age structure of the population in a geographic area has tended to become older as urbanization has decreased (Beale and Cromartie, 2004; CMS, 2004). This upward urban–rural gradient for those aged 65+ is present in all regions (but steepest in the Midwest and South) and is due to changes in migration patterns—that is, retired persons migrating into rural areas, coupled with a half-century of younger persons migrating out of rural areas.3 According to the ERS, 315 rural counties experienced a rise in their older population (aged 60+) by 15 percent or more as a result of net migration alone during the 1990s (NCHS, 2001). By 2000, this amounted to 24+ percent of the population seeking rural counties as retirement destinations (see Figure B-3). Aside from migration, the overall growth in the older population from 1990 to 2000 was 7.4 percent (Personal communication, C. Beale, June 1, 2004). The growth rate of the older rural population is expected to be quite high over the next 20 years as the baby boomers move into retirement age.4

This increasing age trend has significant implications for health care needs. As noted in this report, older people have a higher incidence of chronic conditions, and many have multiple such conditions (Anderson and Horvath, 2002). Residents in rural areas experience higher rates of limitations in daily activities5 as a result of their chronic conditions—activity limitation levels are about 20 percent in rural individuals compared with 13 percent for their urban counterparts (NCHS, 2001). Effective management of chronic conditions requires ongoing access to a multidisciplinary team of providers, including primary care providers, specialists, pharmacists, health educators, and social workers. As discussed in Chapter 4, many rural communities struggle to attract and retain an adequate health professions workforce to meet the needs of their population.


In particular, the large older populations of the Plains and the Corn Belt reflect the prolonged outbound movement of young people to urban areas over more than a generation.


Nationally, the population of those aged 60+ is expected to grow by 23 percent from 2000 to 2010, and then by 33 percent from 2010 to 2020—far higher than the growth rate of the rest of the population (Personal communication, C. Beale, June 1, 2004).


Activities reflected in this measure may include, but are not limited to, working independently performing routine tasks such as household chores or shopping, and independently performing personal care activities such as bathing or eating (NCHS, 2001).

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