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

Abstract

Expansion of the world's elderly populations has increased concerns about aging-related medical disorders like Alzheimer's disease and other dementias. In the United States, one fourth of those older than age 65 and at greatest risk for developing dementia live in rural environments that may influence its manifestation. The objectives of this study were to determine the need for and potential benefits of further epidemiological research concerning dementia and similar disorders in rural U.S. populations and to identify pertinent methodological issues related to rural dementia research. This study employed a National Library of Medicine (MEDLINE) document search based on the key words "cognitive disorders," "dementia," "Alzheimer's disease," and "rural," followed by recovery of literature resources references in the bibliographies of selected articles. Nineteen studies focusing on dementia or related disorders in rural settings have been reported from around the world. While four of these were conducted in the United States, only one rural dementia prevalence study has been undertaken in this country. Because of methodological variability, comparisons of prevalence estimates between these rural studies, as well as with those from urban investigations, is difficult. Nonetheless, there is reason to believe that certain potentially dementing illnesses are more common in rural populations. There is also evidence to suggest that the screening instruments commonly used in such studies tend to misclassify rural elders as "false positive" dementia cases. Information regarding dementing disorders, particularly Alzheimer's disease, in rural populations is scarce. Preliminary observations that dementia may be more common in rural settings and that rural families are more likely to maintain their dementing elders in the community imply that further rural dementia research could yield important insights into the risk factors for these illnesses, the variables influencing their course, and the methods by which they can be more effectively managed. A determination of the reliability and validity of commonly used dementia screening instruments in rural populations would represent an important advancement in this area of research.

Screening for dementia using picture memory impairment screen among older adults in an urban underprivileged area of Bangalore city, India

“…1 Very few community based studies have been done to explore this problem in developing countries like India especially in urban underprivileged areas. [11][12][13] A major limiting factor in identifying dementia is the lack of cognitive screens that account for cultural differences and variable literacy rates. Also, many cognitive screens are lengthy and not designed for non-specialist use.…”

Prevalence of dementia in a rural nursing home population in Southern Germany

“…Furthermore, our determination of a 48 percent prevalence rate of dementia may be much lower than the actual rate, as in rural families it is more common to maintain demented elders in the community and deliver care and social support in the home 6 .…”

“…The average age of 81 years in our population reflects the approximate age of 80 years in a cross-sectional study with 1,387 nursing home residents in Baden, Germany 6 . This age is not representative of dementia prevalence in the general population: it can be assumed that at the beginning of the disease most individuals are supported by caregivers at home and that the need for admission to nursing homes arises in the much more advanced stages of the disease.…”

“…47% of the German population live in non-urban areas where disease screening and diagnosis and delivery of medical care are comparatively more difficult than in urban settings. Globally, dementia may be more common in rural settings compared to non-urban settings 6 . An epidemiological study in Japan found a higher rate of dementia in a rural area compared to an urban area 7 .…”

“…Only nineteen studies focusing on dementia in rural settings are reported globally 6 . None of these studies reports on the rural population with dementia in Germany.…”