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Peer-reviewedCC BYThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association

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.

  • Romil R Parikh1,2
  • Eric Jutkowitz2
  • Jack M Wolf3
  • Benjamin W Langworthy4
  • Chanee D Fabius5,6
  • Stephanie Giordano7
  • Tetyana P Shippee2
7 affiliations
  1. 1Evidence-Based Practice & Impact Center, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Kansas, USA.
  2. 2Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.
  3. 3Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
  4. 4Division of Biostatistics and Health Data Science, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.
  5. 5Center on Aging, University of Connecticut School of Social Work, Hartford, Connecticut, USA.
  6. 6Division of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
  7. 7Human Services Research Institute, Cambridge, Massachusetts, USA.
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Abstract

Purpose

Most 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

We 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

Among 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

Among 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.

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Cite

BibTeXRIS
BibTeX
@article{parikh2026people,
  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.}},
  author = {Romil R Parikh and Eric Jutkowitz and Jack M Wolf and Benjamin W Langworthy and Chanee D Fabius and Stephanie Giordano and Tetyana P Shippee},
  journal = {The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association},
  year = {2026},
  month = sep,
  doi = {10.1111/jrh.70230},
  url = {https://europepmc.org/article/MED/42924567},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - 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.
AU  - Romil R Parikh
AU  - Eric Jutkowitz
AU  - Jack M Wolf
AU  - Benjamin W Langworthy
AU  - Chanee D Fabius
AU  - Stephanie Giordano
AU  - Tetyana P Shippee
PY  - 2026
DA  - 2026/09/01
JO  - The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
DO  - 10.1111/jrh.70230
UR  - https://europepmc.org/article/MED/42924567
AB  - Purpose  Most 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  We 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  Among 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  Among 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.
SN  - 0890-765X
SN  - 1748-0361
ER  -