{
  "abstract": "Purpose\n\nMost older adults prefer aging in place, for which home- and community-based services (HCBS) play an essential role. However, it is unknown whether rural-urban differences in unmet HCBS needs differ by dementia status, which is an important evidence gap to develop targeted interventions to improve HCBS access. Therefore, we evaluated associations of rural-urban continuum (RUCA classification) with consumer-reported unmet HCBS needs by dementia status.Methods\n\nWe analyzed data from the National Core Indicators- Aging & Disability survey (2016-2019; 14,645 community-dwelling consumers; age, ≥65years; 23 states) using logistic regression, comparing adjusted odds ratios (OR) of consumer-reported unmet HCBS needs across rural-urban continuum, stratified by dementia.Findings\n\nAmong people living with dementia (PLWD, n = 2438), compared to metropolitan areas, prevalence of unmet HCBS needs was greater in micropolitan areas (35.4% versus 30.7% consumers; OR, 1.32, 95% CI, 0.98-1.77), small towns (36.3% consumers; OR, 1.44, 95% CI, 0.97-2.13), and rural areas (44.8% consumers; OR, 1.83, 95% CI, 1.11-3.04). These associations were reversed in those without dementia (n = 12,207). Compared with metropolitan areas, prevalence of unmet HCBS needs was lower among those in micropolitan areas (28.7% vs 31.4% consumers; OR, 0.82; 95% CI 0.72-0.93), small towns (29.3%; OR 0.85; 95% CI 0.73-1.00) and rural areas (25.4%; OR, 0.73, 95% CI, 0.58-0.90).Conclusion\n\nAmong PLWD, unmet HCBS needs are significantly greater in rural areas. These findings highlight the critical need for dementia-capable HCBS in rural areas to improve equitable access to these essential services among PLWD.",
  "abstract_shown": true,
  "affiliations": [
    "Evidence-Based Practice & Impact Center, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Kansas, USA.",
    "Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.",
    "Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.",
    "Division of Biostatistics and Health Data Science, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.",
    "Center on Aging, University of Connecticut School of Social Work, Hartford, Connecticut, USA.",
    "Division of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.",
    "Human Services Research Institute, Cambridge, Massachusetts, USA."
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Romil R Parikh",
      "orcid": "0000-0001-6087-0583"
    },
    {
      "affs": [
        1
      ],
      "name": "Eric Jutkowitz",
      "orcid": "0000-0002-1735-8434"
    },
    {
      "affs": [
        2
      ],
      "name": "Jack M Wolf",
      "orcid": "0000-0002-8919-8740"
    },
    {
      "affs": [
        3
      ],
      "name": "Benjamin W Langworthy",
      "orcid": "0000-0001-6735-3853"
    },
    {
      "affs": [
        4,
        5
      ],
      "name": "Chanee D Fabius",
      "orcid": "0009-0004-5786-5774"
    },
    {
      "affs": [
        6
      ],
      "name": "Stephanie Giordano"
    },
    {
      "affs": [
        1
      ],
      "name": "Tetyana P Shippee",
      "orcid": "0000-0003-1804-2527"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/bcqj9cw5hpfa4.bib",
  "cited_by": 0,
  "doi": "10.1111/jrh.70230",
  "fulltext_url": "https://europepmc.org/articles/PMC13692696",
  "id": "bcqj9cw5hpfa4",
  "issns": [
    "0890-765X",
    "1748-0361"
  ],
  "landing_url": "https://europepmc.org/article/MED/42924567",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2738|Dementia and Cognitive Impairment Research"
    ]
  ],
  "openalex": "W7223336674",
  "pdf_url": "https://europepmc.org/articles/PMC13692696?pdf=render",
  "pmcid": "PMC13692696",
  "pmid": "42924567",
  "published": "2026-09-01",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/bcqj9cw5hpfa4.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:02Z",
      "native_id": "MED:42924567",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42924567"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2738|Dementia and Cognitive Impairment Research",
      "subfield": "psychiatry"
    }
  ],
  "title": "People Living With Dementia in Rural Areas are Most Likely to Report Unmet Service Needs in Home- and Community-Based Services in the United States.",
  "title_text": "People Living With Dementia in Rural Areas are Most Likely to Report Unmet Service Needs in Home- and Community-Based Services in the United States.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:02Z",
  "url": "https://research.draconitic.com/paper/bcqj9cw5hpfa4",
  "venue": "The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association",
  "versions": []
}