Aging, Healthcare and Dementia in Missouri
Missouri is a rural State in terms of geography and population distribution. According to the Office of Social and Economic Data Analysis (OSEDA), University of Missouri , 91 of Missouri 's 113 counties are considered rural/non-metropolitan by US Census criteria. A meaningful portion of Missouri 's population in 2000 (32%) resided in these 91 rural counties. Four metropolitan areas (St. Louis, Kansas City, Columbia, Springfield-where our four Alzheimer's Association chapters are based) and nearby areas accounted for the majority of state residents (68%).
Missouri 's total population of older adults in 2000 was 13.5%, higher than the national average of 12.4%. A substantial number of households in rural counties included one or more older adults. As shown in Figure 1, the rural counties of north central and south central Missouri had particularly high percentages (dark blue, up to 41%) of elder households in 2000.
Why is this? According to OSEDA, overall population in many rural counties declined over the past 20 years. One explanation is that older adults are “aging in place” whereas younger adults are moving elsewhere and fewer children are born to remaining residents. Adults aged 85 and over, in fact, represented the second highest growing population group in Missouri (next to baby boomers aged 35-54) between 1990 and 2000. The number of older adults in this 85+ cohort rose 21.4% during this period.
Although a substantial number of older adults reside in rural counties, relatively few physicians practice in these counties. Only 16% of all licensed physicians in Missouri practiced in rural counties in 2000. Rural Knox County in northeastern Missouri, for example, had a total population of 4,300 when the census was taken in 2000, with 21% of residents over the age of 65 years. Only five licensed physicians practiced in Knox County at that time!
In Knox County , as in probably most rural counties across the US , older adults must often travel many miles to other counties or metropolitan areas to access healthcare services. This situation is likely to complicate care for older adults with Alzheimer's disease (AD) who must rely on others (family, friends, social service organizations) to facilitate and otherwise follow-up on medical appointments and general care needs.
Approximately one third of Missouri 's estimated 125,000 persons with AD reside in rural counties. Changing demographics suggest that a substantial portion of these live alone, and thus may face even greater healthcare challenges. Read Understanding Obstacles to Alzheimer's Care in Rural Missouri for more information.
What's being done?
Community service organizations, such as the Alzheimer's Association and Area Agencies on Aging, are doing a lot to serve the needs of rural elders. Rural hospitals, such as Audrain Medical Center in Mexico, Missouri, serve as important hubs for dementia care, drawing patients from many miles.
The Washington University Knight ADRC supports rural dementia care through educational outreach. Our Clinician Partners Program (CPP) seeks to improve dementia care in rural areas by enhancing the knowledge base of the physicians and other healthcare professionals that practice there.
The RCPP uses a “mini-residency” educational model, involving select groups of clinicians in 3-day intensive training experiences in St. Louis . Many Knight ADRC faculty and staff volunteer their time and expertise to participate in RCPP sessions-provided to small groups of 4-5 trainees up to six times per year.
Primary care physicians, advanced practice nurses, and physician assistants are the primary targets for the program. Clinicians may apply for entry, or individuals may be nominated by a colleague, local organization, or even a patient.
Since 2000, the RCPP has trained over 85 clinicians from across Missouri . As shown in the figure to the left, trainees have come from rural counties across the state (red stars). Counties in cream have just 8-102 persons per square mile. For comparison, St. Louis County has over 2,000 persons per square mile. The counties of far northwest and west central Missouri are important RCPP targets for the next few years.
Initial planning is underway for the Knight ADRC to co-sponsor a Rural Dementia Care conference in the Spring of 2008. The goal of the conference will be to document the challenges associated with providing quality dementia care in rural areas and to propose practical improvements. Monitor the Knight ADRC homepage and future issues of HORIZONS newsletter for more information.