Rural ageing refers to the implications of ageing, patterns, processes, and outcomes, in rural contexts. Rural ageing research considers the experiences of those who age in rural environments (and should include the perspectives of older adults themselves) and the implications of rural ageing for rural communities and stakeholders such as service providers.
Ageing is often cast in a negative light, with older adults portrayed as a burden and a financial drain upon society. However, older adults are often assets to their communities. Studies of rural ageing can cast a critical eye on burden and asset perspectives. Use of a geographical lens allows place-based elements of ageing to highlight unique spatial contexts; for example, population sparsity, distance and remoteness from key service centers, and characteristics of many remote and rural places raise different challenges for older people living in rural areas in comparison with those who live in more densely populated and urban contexts. “Rural” is a heterogenous spatial context, and individuals can experience rural ageing in myriad ways. Studies of rural ageing thus encompass research that highlights the diversity of experiences between, for example, different types of rural areas and for different subgroups and different individuals within the older population.
Demographic ageing, increased absolute numbers of older people and higher proportions of older people in the population, brings both challenges and opportunities for society. Worldwide, people are living longer than ever before, and the global population aged 60 and over is now growing faster than all younger age cohorts (United Nations 2017). This can be attributed to decreased fertility and increased longevity (Glasgow and Brown 2012; Philip and Williams 2019). Demographic ageing in the Global North is leading to both higher absolute numbers of adults aged 60 and over and a reconfiguration of the profile of national populations. By 2030, every 4th person in Europe and 5th person in the United States will be aged over 65 (Jauhiainen 2009). Higher proportions of older adults than children are now found in many countries, for example, the United Kingdom and Canada and are expected in, for example, the United States by 2035 (Vespa 2018).
Older people should not be viewed as a homogenous group. Individuals in their 60s and 70s are, on the whole, more likely to live healthy and independent lives than were previous generations of the same age group (Stones and Gullifer 2014). Frailty and a high incidence of limiting, long-term illness are increasingly associated with the oldest old; thus, compiling statistics using subgroups within the older population is now common. Such figures show that the oldest old (those over 80) are the fastest growing cohort of older people globally.
Spatial patterns of ageing are unequal, at world region, national, and sub-national scales. The United Nation’s 2017 publication World Population Ageing reported that the highest percentage of population aged 60 and over was to be found in Europe, North America, and Australia/New Zealand. In 2017, 19.6% of the European Union population was aged 65 and over (Eurostat 2017), but the Europe-wide figure obscures large variations at the national level (e.g., 13.25% of the Irish population were aged 65+ in 2016 compared to 22% of the Italian population). Likewise, statistics published by the US Census Bureau and reports from the Canadian Census of 2016 show differences between these two North American countries.
Rural Contexts of Ageing
A pattern whereby rural areas have older populations than urban areas is common across the Global North. Remote rural areas commonly have the oldest demographic profiles, a pattern expected to continue for the foreseeable future (cf. Davis et al. 2012; Glasgow and Brown 2012; Philip et al. 2012). Demographic ageing in rural areas is largely the outcome of the following processes: long-term outmigration of young adults, the in-migration of mid-life individuals who then age in place, and the in-migration of pre-retired and retired adults (Philip and MacLeod 2018; Plane and Jurjevich 2009; Woods 2012). Mid- and later-life adults are attracted to rural areas for reasons including proximity to attractive countryside and scenic areas (Kipeläinen and Seppänen 2014), lower housing costs, a perception of increased security and peacefulness (Jauhiainen 2009), and assumptions that rural areas support better social networks than those found in urban areas (Milbourne 2012; Wirth et al. 2016). Rural demographic ageing often occurs within a broader context of rural populations continuing to decline. For example, Europe’s rural population is expected to decline by 25% between 2000 and 2030, but the proportion of older people living within rural areas will increase (Burholt and Dobbs 2012).
Distinguishing between accessible and remote rural areas can be one useful way of highlighting the varied demographic fortunes of rural areas within a single national context. For example, 2016 population estimates for Scotland report that 25% of the remote rural population was aged 65, compared with 21% in accessible rural areas (Scottish Government 2018). A further refinement to illuminating sub-national demographic ageing is offered in recent work by Copus and Hopkins (2018) which has mapped Scotland’s Sparsely Populated Areas (SPAs), defined as the areas of Scotland where there are fewer than 10,000 people living within a 30-minute drive or ferry journey from a person’s home. In Scotland, the population of rural areas and small towns grew by 9% between 1991 and 2011, but a 2% decline over the same period occurred in the SPAs. A further loss of a quarter of the SPA population by 2046 is projected. Copus and Hopkins (2018) found that, between 1991 and 2016, the proportion of individuals aged 65 and over grew less rapidly in the SPAs (+23%) than in other non-urban areas of Scotland (+32%). Dependency ratios in the SPAs, however, were higher, with implications for service demands, supplying a local a workforce to staff key services, and the ability of local government serving SPAs to raise sufficient revenue to continue providing public services at current levels. The SPA research illustrates how refinements to standard rural definitions can provide insights useful to those studying patterns and processes associated with rural ageing.
Ageing in rural areas poses many of the same challenges that are found in urban contexts including, for example, increased demands on and associated costs of delivering health and social care services, accessibility challenges arising from service restructuring, and isolation or loneliness. A-spatial challenges can be magnified and others introduced in rural contexts associated with sparse populations, inhospitable terrain, difficulties in providing key services to small numbers scattered over large areas, and difficulties recruiting staff to health and social care and other professional positions (Philip and Williams 2019). Decades of youth outmigration often means many older rural adults do not have family members living nearby. Changes brought about by sociodemographic and wide cultural change can also bring challenges. Newcomers arriving into some, but not all, rural areas can result in older residents not knowing their neighbors and not being offered the informal care and support they may once have been offered. In many rural communities, the social cohesion typified and reproduced in narratives of “problem-free” rural areas where a “rural idyll” or rural utopia is to be found (Elshof et al. 2017) no longer exists, if it ever did, yet this social construction of rural areas remains a strong pull for in-migrants who subsequently struggle to develop the social networks that can help individuals to age well.
Key Research Findings
As noted above, population ageing is spatially uneven and has place-embedded implications “with ageing now an axiomatic backdrop for much research and policy on 21st century populations” (Skinner et al. 2015, p. 777). How individuals, communities, and stakeholders respond to rural ageing now has the potential to inform future responses in rural areas and in urban areas as ageing becomes more pronounced expected in this context. Addressing the challenges of ageing in rural areas and exploiting the opportunities offered by an increasingly healthy and independent older population need an awareness of how place matters and how place-based solutions and approaches have an important role to play in supporting ageing well, irrespective of where an older adult lives. Individual and community experiences of ageing are not homogenous, and the attributes and responses of rural places will be many and varied (Elshof et al. 2017). In other words, ageing in rural contexts can be different to ageing in an urban context, those who grow older in different types of rural area can have quite different experiences, and the personal characteristics of members of rural communities can present unique challenges and opportunities in later life (Davis et al. 2012). This complexity, and interplay between place-based and person-based attributes, has been referred to by Skinner and Hanlon (2016) as the “neglected contexts of ageing.” In what follows in this entry, we draw upon examples from published research that speaks to neglected contexts of rural ageing and frame the discussion around the desire of national governments and supranational organizations such as the World Health Organization to promote “active ageing” or “healthy ageing” and to encourage older adults to remain living independently in their own homes (ageing in place) for as long as possible. Below we consider interrelated issues which could support ageing in place, namely, (i) service provision, (ii) developments in ICT and the “smart” revolution, and (iii) community inclusion and capacity. We also consider the positive contributions older adults make within rural society, highlighting how volunteering, providing informal care and support, and participation in civic life are elements of active ageing that run counter to the dominant narrative of rural ageing as being burdensome.
As observed by Doheny and Milbourne (2017), the nature and level of services available at the local level are often unequal, resulting in inequalities between different places which could have a deleterious impact on older people living in rural areas. Typically, debates about health and social care provision for older people in rural areas in the research literature focus on increasing numbers of frail elderly and the burden they place on services that are already stretched (cf. Martin et al. 2005; Comas-Herrera et al. 2010; Copus and Hopkins 2018) due to, for example, difficulties in recruiting and retaining professional staff to positions serving rural communities; public sector budget cuts reducing levels of provision in areas characterized by small, dispersed populations; and little interest from the private sector to have a presence in areas with small populations where the opportunities to turn a profit are limited. Demand for seniors housing such as supported accommodation and residential care facilities outstrips provision in many rural areas: these services tend to be clustered in the population centers that serve rural hinterlands and in large urban areas (Keeling 2012). Residential care is older peoples’ “choice of last resort” (Stones and Gullifer 2014, p. 450). In rural areas where there are few or no local options, a move into residential accommodation means having to leave one’s community. This can have profound implications for well-being, with the older rural adult having to adapt to both losing their autonomy and relocating to live somewhere unfamiliar and where their friends may find it difficult to visit (Kipeläinen and Seppänen 2014).
Older people should not just be seen as a burden on stretched public services. Older people use a variety of services in rural areas, helping retain demand for and ensuring the viability of services that are important to rural residents of all ages such as shops, banks, post offices, libraries, and public transport. If support is available to allow older rural adults to age in place, the consumer base is retained, and this may halt the decline of core services and thus help to sustain community resilience.
Woods (2006, p. 587) observed that “the ideal rural community is defined by the presence of certain facilities and services, and the disappearance of these can be perceived as undermining a traditional way of life.” Being able to access a range of services locally is also crucial for allowing older rural adults to age in place. Many private sector outlets have closed in recent decades, public sector services have been centralized to cut costs and promote more efficient delivery, and the voluntary sector is relied upon in some national contexts to deliver services previously delivered by the state. Milbourne (2012; p. 315) noted that rural service provision can be “fraught with difficulties” in national contexts where neoliberal political perspectives prevail; these difficulties have been compounded by more than a decade of austerity. The unprofitability of private sector services has been a factor behind a long-term trend of decreasing numbers of rural shops, banks, post offices, transport, petrol stations, etc. in small and dispersed rural communities. Loss of locally available key services is particularly detrimental for those on low incomes, those who for whatever reason do not use online alternatives, and those with accessibility constraints: all three categories commonly include a large proportion of the older population. The higher costs of service delivery in rural areas and, for the private sector, limited opportunities to turn a profit if the potential customer base is small mean that rural areas are increasingly vulnerable to further cuts in services. In contexts where governments provide a publicly funded health service, there are practical and moral questions at stake when it comes to determining what level of service should be readily accessible to all citizens, within a reasonable distance, regardless of place of residence. In countries where broadly social-democratic political ideologies prevail, such as in Finland, objectives of state-led regional policies include retaining a population in every area of the country that is currently inhabited. Meeting this objective requires nationwide opportunities to access health and social care and other key services required to satisfy basic needs (Jauhiainen 2009). In contexts where the market, rather than the state, delivers services, the private sector will not operate within rural areas unless there is a sufficient consumer base to allow providers to make a profit.
Recent developments in ICT and community inclusion and capacity have offered solutions to some of the challenges to delivering core services in rural communities (see below). Also of note is that older adults are often central to the design, development, and operation of innovative local solutions to service delivery, such as voluntary services and social enterprises, for example, designing community transport solutions to meet unmet demands and providing locally led health and social care to provide jobs for local people and buying over and turning around community assets. Here we see older people’s actions as being of direct benefit to their community; they are assets, not burdens.
Development in ICT and the Smart Revolution
Developments in information and communications technologies (ICTs), digital devices, and applications have already transformed many domains of life. Digitization in rural communities has a considerable potential to further revolutionize personal, social, cultural, and economic aspects of life and to offer cost-effective solutions to some challenges associated with rural ageing. Within advanced economies older adults remain the least likely age group to be users of ICT, but age-related differences in digital engagement are much less pronounced than a decade ago (e.g., as observed for the United Kingdom by the Office for National Statistics). In the medium term, the number of older adults with no experience of using digital technologies is expected to reduce further. ICT can help to support ageing in place providing that an individual is amenable to digital devices and applications being incorporated into their care package and that health and care professionals consider these to be appropriate interventions for individuals to use (Currie et al. 2015). Although still in the early stages, there is huge potential for more technology to be integrated into domestic environments, creating “smart homes” which can offer varying degrees of intervention designed to help support autonomy and independent living. Health smart homes enable residents to remain independent and safe in their own homes by utilizing technology for healthcare assistance (e.g., motion sensors, fall detection alarms, remote blood pressure monitors) (Creaney 2019). Online applications that facilitate social interaction are already playing a role in mitigating isolation (e.g., video calls between older rural adults and family living elsewhere) and make it possible for older adults to remotely participate in social and community events (e.g., real-time streaming of local events). Proxy Internet use can help enable an older adult to live independently. For example, a trusted third party such as an older adult’s child can pay bills, book appointments, or order grocery shopping on behalf of an elderly rural resident.
Digital solutions are, however, not a panacea for all the challenges of ageing, least of all in rural contexts. There is a need to better understand how people can use technology in the places where they live (Kipeläinen and Seppänen 2014). For example, to function effectively, digital solutions must be deployed in contexts where potential users have the skills and ability to do so, the means of purchasing and maintaining digital devices, and access to appropriate technical platforms and digital infrastructure (Philip and Williams 2019). Territorial digital divides, whereby the digital telecommunications infrastructure serving rural areas frequently lags behind urban infrastructure (cf. Philip et al. 2017), can make it impossible to deploy home-based digital technologies that assist independent living among the older rural population. Largely housebound individuals and older adults living alone and/or in sparsely populated areas where there are limited opportunities for in-person interaction with others are the most vulnerable to possible negative effects of “going digital.” For example, older adults and health and social care professionals have expressed concern that a move from in-person service delivery to the deployment of digital health and care technologies could reduce opportunities for social interaction, increasing loneliness and compromising well-being (Currie et al. 2015; Philip et al. 2015). Furthermore, digital devices are often not designed with the older user in mind: for example, conditions such as arthritis can make it difficult to use a mouse or small buttons/controls (Dowds et al. 2018). Digital devices and charges for Internet connectivity in the home can be too expensive for older consumers on low incomes.
Community Inclusion and Capacity Building
Retirement is a major stage in a person’s life, and a common stereotypical view is to associate retirement with a person losing economic and social value and becoming increasingly vulnerable. In rural areas, where demographic ageing is already pronounced, a discourse that older people are a burden to society commonly prevails, often framed around dependency ratio arguments. Retired adults are no longer productive net contributors to a national economy; thus, they are a drain on resources such as health and social care services (however, many older adults pay income tax on their pension and other sources of income). Aligned with dependency ratio arguments is the fact that areas that have experienced pronounced demographic ageing will have a smaller working age population which struggles to meet the demands of the older population (Moffat and Heaven 2017). Researcher are, however, beginning to question stereotypically negative views (Burholt and Dobbs 2012; Davis et al. 2012). There have been calls to move beyond economic framings of ageing and dependency to perspectives which highlight the opportunities many older people bring to rural communities (Glasgow and Brown 2012: Burholt et al. 2013; Munoz et al. 2014), including the most peripheral areas (Jauhiainen 2009). Seeing older people in this way employs a “productive ageing” discourse whereby the contributions made by older rural adults to enhance the viability and thus the long-term resilience of their communities are foregrounded (Davis et al. 2012). This perspective creates analytical space within which both sides of an “assets and burdens” perspective on rural ageing are acknowledged.
Isolation and loneliness are known to affect many older people, regardless of where they live. Social networks contract with age (Lansford et al. 1998), and the oldest of older rural adults have few visits from friends and neighbors (Kivett et al. 2000). Reduced personal mobility and ill health can create further barriers to getting out and about and participating in activities that promote social interaction with others. There is a commonly held assumption that rural areas are close-knit, supportive, friendly, and neighborly, but this is not always the case. Isolation and loneliness are thus not considered serious problems in rural areas, but, in fact, loneliness may be hidden (Burholt and Dobbs 2012). Despite more than 90% of older people having raised children, they are more likely to live alone than other age groups (Glasgow and Brown 2012). In the Global North, the likelihood of an older adult living within a multi-generational family household is small and is most likely within minority ethnic groups (Keeling 2012). Ashida et al. (2019) stress the importance of non-family local social networks for developing new and active relationships and promoting well-being for older people in rural areas. Factors thought to influence loneliness, such as retirement resulting in individuals having fewer opportunities to interact on a regular basis with other people and geographical separation from friends and family, may be more pronounced in rural areas, where opportunities for social interaction may already be limited, than elsewhere (cf. Burholt and Dobbs 2012). The geographical attributes of remote, sparsely populated places may magnify the risk of isolation and compound difficulties in maintaining face-to-face social interaction. Active participation in social activities is known to be important for the well-being of older adults, and it is important to understand what activities older adults would like to participate in and how engagement can be facilitated (Skinner and Hanlon 2016; Dowds et al. 2018).
If older people are active in their local communities, loneliness and isolation can be combatted and a process of productive ageing facilitated (Davis et al. 2012). Those who volunteer feel more satisfied and are better connected to and within their local communities than those who do not (Davies et al. 2018). Older ex-urban incomers to rural areas with professional and managerial backgrounds bring with them social capital that may be exploited to the benefit of their new community; many have “been able to inject news ideas into rural communities” (Milbourne 2012, p. 316). Civic activities and engagement strategies are often led by energized, skilled local older people (Munoz et al. 2014; Burholt and Dobbs 2012). Healthy, active, and engaged older people – long-term residents and more recent incomers – may thus be regarded as an untapped and underemployed resource (Munoz et al. 2014). In some, but not all, national contexts, volunteers are essential for the viability and resilience of rural communities. Neoliberal approaches by some nations in the Global North have led to the voluntary sector taking over responsibility for the delivery of services that were once the preserve of the state (ibid.). In Australia, for example, volunteering underpins the delivery of many essential services and volunteering rates in rural areas exceed those found in urban areas (Davies et al. 2018). A vibrant voluntary sector is, however, not without problems. In many rural areas, there is a limited pool of potential volunteers, and individuals may feel overburdened and obliged to retain roles in voluntary organizations for longer than they would like because they know that if they step down, the continued delivery of essential and nonessential services could be compromised. Davies et al. (2018) argue that better support is needed for rural volunteers, and Munoz et al. (2014) note that this is especially the case when volunteers are responsible for service delivery.
Future Directions of Research
Skinner et al.’s (2015) call to interrogate “hidden geographies of ageing,” i.e., to investigate under-researched rural ageing topics, offers a springboard to develop future research that focuses on rural dimensions of ageing. There is considerable scope for new studies of rural ageing, including empirical research and the development of theory and concepts. We suggest that future work should balance interrogating “problems” of ageing in rural contexts with developing a deeper appreciation of the positive contributions older rural people make to rural communities. We also argue that both mono- and interdisciplinary perspectives are required. Work undertaken in collaboration with diverse stakeholders such as government, third sector organizations, and rural communities themselves should be encouraged to include different perspectives in our understandings of rural ageing. Cross-national comparative research will further elucidate diversity of experiences of rural ageing and identify lessons learnt or flag interventions that could be deployed in other places. ICT offers solutions to ageing in place for the rural old, and more needs to be understood and the implications of these solutions to individuals, communities, and society. Finally, much of the understanding of rural ageing has been from the Global North. There is need to understand rural ageing in other countries. This entry has highlighted the need to reflect both place and person-centered approaches in considering rural ageing in future research.
With demographic ageing projected to continue throughout the twenty-first century, there is much scope for research on patterns, processes, and implications of ageing in the foreseeable future. Scholars are already undertaking research that seeks to uncover what Skinner et al. (2015) described as the “hidden geographies of ageing.” As outlined above, work with an explicit focus on rural ageing has already highlighted geographically mediated dimensions of ageing that are often overlooked in a research area dominated by urban perspectives. Further studies will enhance understandings of how place matters in ageing research and contribute to wide research agendas about the futures of rural communities.
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