Rural Population - Age 65+ in North Dakota

North Dakota

Residents of rural areas are older than their urban counterparts — more than 20% of the rural population is 65 years or older — and are at greater risk for poor health outcomes. Rural areas are often under-resourced and face unique challenges regarding the social determinants of health. These challenges are associated with a preventable hospitalization rate 40% higher than that of urban populations and a mortality rate 23% higher. Rural residents also have higher rates of cigarette smoking, high blood pressure and obesity. 

The demographics of the older adult population are shifting. Historically, women have lived longer than men; at last count, 52% of the older rural population was female. While this trend will probably continue, the age gap between men and women is expected to shrink. Rural areas are less ethnically diverse, with the white population accounting for 92.7% of rural adults age 65 and older. Older Black and Hispanic adults make up less than half the proportion they do in urban populations, accounting for 4.5% and 2.3% of rural older adult demographics, respectively. 

Older adults living in rural areas face unique challenges to staying healthy. The health of rural populations is impacted by a complex mix of economic, social, racial, ethnic and geographic factors. Financial insecurity, remote location, lower socioeconomic status and higher rates of unhealthy behaviors contribute to the significant health disparities between rural and urban populations. Furthermore, geographic isolation and shortages in the health care workforce make access to care a very serious challenge for rural populations. As rural residents age and their health needs increase, their already-limited access to necessary services may further decrease if they have mobility impairments or rely on caregivers for transportation. In 2020, there were about 53 million caregivers in the United States, about half of whom were taking care of a parent or a parent-in-law. Most caregivers of older adults are spouses or adult children, but decreasing fertility and marriage rates and increasing divorce rates mean that many baby boomers will not have partners or children who can help them age independently. This will put new and unique stresses on the health care system and challenge how our society currently cares for older adults.

Addressing rural health disparities requires special policy considerations at all levels of the government and community. 

To reduce health disparities in rural areas, the Centers for Disease Control and Prevention (CDC) recommends that health care providers focus on the following areas for improvement: 

• High blood pressure screening and management.
• Encouraging smoking cessation, physical activity and healthy eating.
• Safer prescribing of opioids for pain. The CDC updated its Clinical Practice Guideline for Prescribing Opioids in 2022.

Older adults can use the National Council on Aging’s BenefitsCheckUp tool to find out more about what kind of assistance they may be eligible for and the Administration on Aging’s Eldercare Locator to find programs near them.

AARP and National Alliance for Caregiving. “Caregiving in the United States 2020.” Washington, D.C.: AARP, May 14, 2020. https://doi.org/10.26419/ppi.00103.001.

Davis, James C., Anil Rupasingha, John Cromartie, and Austin Sanders. “Rural America at a Glance: 2022 Edition.” Economic Information Bulletin. U.S. Department of Agriculture, November 2022. https://www.ers.usda.gov/webdocs/publications/105155/eib-246.pdf.

Dowell, Deborah, Kathleen R. Ragan, Christopher M. Jones, Grant T. Baldwin, and Roger Chou. “CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022.” MMWR. Recommendations and Reports 71, no. 3 (November 4, 2022): 1–95. https://doi.org/10.15585/mmwr.rr7103a1.

Johnston, Kenton J., Hefei Wen, and Karen E. Joynt Maddox. “Lack Of Access To Specialists Associated With Mortality And Preventable Hospitalizations Of Rural Medicare Beneficiaries.” Health Affairs 38, no. 12 (December 1, 2019): 1993–2002. https://doi.org/10.1377/hlthaff.2019.00838.

Vespa, Jonathan, Lauren Medina, and David M. Armstrong. “Demographic Turning Points for the United States: Population Projections for 2020 to 2060.” Current Population Reports. Washington, D.C.: U.S. Census Bureau, February 2020. https://www.census.gov/library/publications/2020/demo/p25-1144.html.