Participation of metropolitan, urban and rural community-dwelling older adults

Abstract

Environmental factors are important in maintaining a high level of participation. This cross-sectional study aimed at comparing the level of participation of older adults living in rural, urban and metropolitan environments and exploring sociodemographic factors associated with participation according to each type of environment. A total of 350 community-dwelling participants showing a normal aging process were randomly recruited. Participation in daily activities and social roles was measured with the Assessment of Life Habits. Sociodemographic and environmental data were gathered using a questionnaire. Participants from the rural region reported less schooling, a lower income, no access to public transportation and less access to stores than others. Participants from the metropolitan region differed in terms of less use of a car, less satisfaction with their social support and feeling less secure in their neighborhood. However, no significant difference was found between the metropolitan, urban and rural groups for participation in daily activities and social roles. Furthermore, the variables most associated with participation were similar for all three regions. This suggests that although the environment of older adults living in metropolitan, urban and rural region differs, their level of engagement in daily activities and social roles is similar.

Introduction

The normal aging process is associated with changes in some physical, social and cognitive abilities (Fülöp, 2007) and a change in participation (Desrosiers et al., 2004b, Wilkie et al., 2006). With the publication of the International Classification of Functioning, Disability and Health (ICF), the World Health Organization (WHO) defined participation as a person's involvement in a life situation (WHO, 2001). Participation has become a subject of interest since it goes beyond functional independence and considers additional domains that are essential or important in a person's life, such as leisure and community life. Fougeyrollas et al. (1998) made an important contribution to the concept of participation with the Disability Creation Process (DCP) model. In this model, participation is operationalized via the concept of life habits, which are defined as social roles valued by the person or his/her social environment but also as daily activities that need to be performed before interacting with others. Participation, defined as the engagement in daily activities and social roles, is the result of an interactive process between personal characteristics (organic systems and capabilities) and the environmental context in which people live. The environmental context includes the social environment, such as friends and family, government and public services, as well as the physical environment, such as accessibility to and within the house, local roads and the weather. People living in rural areas have different environments, both social and physical, than people living in cities. Healthcare facilities and stores might be further from home, public transportation is not available everywhere, road conditions differ, and social interaction and support might differ as well. Therefore, the level of urbanization of the area in which people live could have a significant impact on their level of participation.

Many studies have demonstrated that people living in rural regions differ from those living in urban areas on many health and socioeconomic conditions. Self-perceived health is similar across types of regions (Martinez et al., 2004, St-John et al., 2006) but people living in rural regions present differences in many diseases, namely more cardiovascular diseases (Mitura and Bollman, 2003, DesMeules and Pong, 2006), more stomach and lung cancers (Martinez et al., 2004) and a higher prevalence of arthritis/rheumatism (Mitura and Bollman, 2003). People living in rural areas are also disadvantaged on health determinants, with more smoking and obesity (Mitura and Bollman, 2003, Martinez et al., 2004). On the other hand, studies show that people living in rural areas have less breast cancer (Martinez et al., 2004), less depression (Wang, 2004), lower stress levels and a stronger feeling of belonging to a community (DesMeules and Pong, 2006). On socioeconomic factors, rural residents report less schooling and a lower income (Mitura and Bollman, 2003, DesMeules and Pong, 2006). Finally, transportation is more difficult for people living in rural areas with less or no access to public transportation (Turcotte, 2006).

Most studies on participation have been carried out in urban areas or without considering the type of environment (urban or rural). Harvey and Noreau (2003) wanted to know whether people perceived their environment differently when living in a metropolitan, urban, semi-urban or rural area. They observed that people perceived more facilitators for participation in urban areas, especially with regard to public and government services and physical accessibility. Even though this study did not evaluate participation itself, it demonstrated that the perception of environmental factors influencing participation differed according to the participants’ living environment. To our knowledge, no study has evaluated the impact of living in a rural, urban or metropolitan area on participation.

The objectives of this study were (1) to compare participation of older adults according to the level of urbanization of their home environment, and (2) to explore sociodemographic factors associated with participation in relation to the urbanization level of their environment.