Rural depopulation and the rural‐urban gap in cognitive functioning among older adults

Abstract

Purpose:As the population ages, the number of people with cognitive impairment will rapidly increase. Although previous research has explored the rural-urban gap in physical health, few studies have analyzed cognitive health. The purpose of this study was to examine rural-urban differences in cognitive health, with a focus on the moderating effect of population decline. Methods: The study used individual-level nationally representative data from the 2000-2016 waves of the Health and Retirement Study (N = 152,444) merged to county-level contextual characteristics. Hierarchical linear models were used to predict the cognitive functioning of US adults aged 50 and over by rural-urban residence, county depopulation, and their interactions while controlling for individual-level and county-level demographic and contextual factors.Findings: Older adults living in rural counties had lower cognitive functioning than urban adults. The interaction between living in a rural and depopulated county was statistically significant (P < .001). The rural penalty in cognitive functioning was 40% larger for those who lived in counties that lost population between 1980 and 2010 compared to those who lived in stable or growing rural counties. These results were independent of race-ethnicity, gender, age, education, income, region, employment status, marital status, physical health, and depression as well as the county's racial-ethnic composition, age structure, economic and educational disadvantage, and health care shortages. Conclusions:The results have important implications for those seeking to reduce health disparities both between rural and urban older adults and among different groups of rural people. Interventions targeting those living in rural depopulating areas are particularly warranted. K E Y W O R D Scognitive health, depopulation, health disparities, population loss, rural health One in 9 US adults over the age of 45 has experienced subjective cognitive decline. 1 Over a third say that it has interfered with their daily activities, and over 40% indicate that they need help with basic household tasks. Subjective cognitive decline is also an early warning sign of Alzheimer's disease. About 15%-20% of the US population aged 65 and older has mild cognitive impairment due to Alzheimer's disease. 1 Dementia is the single largest contributor to disability, 2 and its total cost burden is similar to that of heart disease and cancer. 3 In the past 20 years, while the number of deaths from heart disease has decreased, the number of deaths from Alzheimer's has more than doubled. 1,4 As 696

Rural–urban differences in personality traits and well‐being in adulthood

“…To the extent that personality and well‐being changes are rooted in universal, developmental milestones common to all humans, as is suggested by biological and social role models of psychological development (e.g., Atherton et al, 2020), then the null effects of rurality–urbanicity on personality and well‐being change may not be all that surprising. Relatedly, although the effects of rurality–urbanicity on personality and well‐being change may be null, prior work has shown evidence for the opposite pathway: personality traits and well‐being needs predict where people migrate to (see Ciani & Capiluppi, 2011; Glauber, 2022; Hoogerbrugge & Burger, 2022; Jokela, 2020; Yoshino & Oshio, 2022). This pattern of findings highlights an important delineation of socialization (rurality–urbanicity → personality/well‐being) and selective migration effects (personality/well‐being → living in rural or urban place) that are worth attending to when interpreting the complex and dynamic associations among macro‐level contexts and personality traits and well‐being (see Götz et al, 2021 for an example).…”

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Urbanicity and cognitive functioning in later life

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