Rural Urban Disparities in Geriatric Care Resources and Usage

TL;DR

This study examines differences in geriatric care availability and use between rural and urban areas using data from Medicare and the Veteran Healthcare System.

Contribution

The study introduces a method to map geriatric care resources and needs using RUCA codes and Medicare data to highlight rural-urban disparities.

Findings

Older adults in rural areas show different patterns of geriatric care usage compared to urban residents.

Geriatric care providers are less concentrated in rural compared to urban areas.

Rural older adults face higher risk factors like frailty and dementia but may have limited access to specialized care.

Abstract

Disparities in availability of geriatric care may lead to limited access of geriatric care for older adults, especially those residing in rural areas. Mapping locations of geriatric resources and needs will identify incongruities between supply and demand. Through the use of data from multiple sources including Medicare data and from the Veteran Healthcare System, we used an annual repeated cohort approach of older adults in the Veteran Healthcare system using VA and Medicare data to identify usage of geriatric care services across health systems. Older adults are categorized by their geographic location using RUCA codes matched to their residential zip-code, categorized into urban, rural and highly rural areas. We compare and contrast the characteristics of older adults who utilize geriatric care services using complexity criteria previously established including risk of hospitalization or mortality, high cost utilization, and long term institutionalization, frailty, and specific geriatric conditions including dementia and falls. We also identify the distribution of care providers in geriatric specialties using the National Provider Identifier comparing rates in rural and urban areas.