Health Neuroscience 

Alzheimer’s Care Access: City vs Country


Less access to healthcare may be leading to worse outcomes for people with Alzheimer’s in rural areas—but a change due to COVID-19 just might help.

By Alexandra J. Weigand

Imagine living in Paw Paw, Illinois, population 850. It’s quiet, quaint, and neighborly, with one main road running through town. Now imagine living in New York, New York, population 19.2 million. It’s bustling, expansive, and diverse, with a convolution of streets, bridges, buildings, and subway lines. One could name many differences between these two locations. A striking and perhaps less recognized difference, however, is the healthcare and outcomes for individuals living with Alzheimer’s disease and other forms of dementia.

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Alzheimer’s outcomes in rural and urban communities

Dr. Momotazur Rahman and colleagues recently investigated differences in healthcare use and survival time between urban and rural counties across the United States for people diagnosed with Alzheimer’s disease or a related dementia. Findings indicate that those living in rural areas spend more time in nursing homes and less time living in the community and have shorter survival time than those in urban areas.

This study included data from over 500,000 US Medicare beneficiaries with a new diagnosis of Alzheimer’s or a related dementia in 2010 and examined their healthcare outcomes over the following 6 years. Based on county of residence, the vast majority of individuals were classified as urban residents, and the rest as rural. The average age was 82 years, and 62 percent of participants identified as women and 87 percent as White.

Despite having fewer preexisting chronic conditions and being younger on average at the time of diagnosis, rural residents survived about 1.5 months less than their urban counterparts after adjusting for other risk factors. Out of the days studied, rural residents spent 5.7 percentage points more time in nursing homes and 4.6 percentage points less time in the community than the urban group. Further, the rural group spent more time in hospitals by 0.7 percentage points. These gaps became even wider as participants were further along in their diagnosis.

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Healthcare access may improve outcomes

Importantly, these differences may be due to increased access to healthcare (such as hospitals, home health services, community-based care programs, transportation, and caregiver respite) in urban communities. It is considered ideal for those with Alzheimer’s to put off entering nursing homes as long as possible to increase good outcomes, and the opportunities available in urban communities may allow people with Alzheimer’s increased time in community care that could contribute to longer survival.

You may be asking, what can be done in rural communities to help people with Alzheimer’s? One potential solution may lie in the telehealth services that are becoming increasingly available because of the COVID-19 pandemic. With telehealth, providers can deliver services to patients across long distances, which decreases the burdens of transportation, physical distance from hospitals, and other barriers to access. Further, mental health and other services could be provided to caregivers of individuals with Alzheimer’s that would improve outcomes for both parties.

In fact, in a recent report from the Commonwealth Fund, researchers argue that Medicare benefits available during the COVID-19 pandemic to increase telehealth access should continue after the pandemic is over. Such a policy change could help millions of older adults and reduce the differences in access for individuals in rural versus urban communities.

This study was published in the journal JAMA Network Open.


Rahman, M., White, E. M., Thomas, K. S., & Jutkowitz, E. (2020). Assessment of Rural-Urban Differences in Health Care Use and Survival Among Medicare Beneficiaries With Alzheimer Disease and Related Dementia. JAMA Network Open3(10), Article e2022111.

Van Houtven, C. H., and Dawson, W. D. (2020). Medicare and Home Health: Taking Stock in the COVID-19 Era. Commonwealth Fund.

Alex Weigand

About the Author

Alexandra Weigand is a third year PhD student in the San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology. She is also a National Science Foundation Graduate Research Fellow working with Dr. Mark Bondi. Her current research focuses on identifying early brain changes in Alzheimer’s disease and reducing Alzheimer’s risk. Outside of the lab, she works to promote positive mental health among graduate students and to improve science communication with the nonscientific community.


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