Residential differences in attitudes about barriers to using community-based services among older adults.

Despite poorer health, rural elders tend to use fewer community-based services than their urban or suburban counterparts. Researchers have speculated that residential differences in the receipt of community-based services may be attributable to, among other factors, the attitudes of older adults toward such services. Twelve focus groups were conducted to explore residential variation in the attitudes of older adults toward the use of community-based services, specifically emphasizing perceived barriers to the use of services. While both rural and urban residents expressed overall satisfaction with the services that they had received in the past or currently receive and both groups noted insufficient community-based services, residential differences emerged in both the nature of the perceived barriers and the frequency in which they were mentioned. Rural elders more frequently highlighted barriers that diminished their use of community-based services. Such barriers included a lack of awareness of services, inadequate transportation, and perceived rigid program eligibility standards. Urban older adults mentioned far fewer and different barriers to the receipt of services, but those barriers seemed to be consistent with the community context in which they lived. While these findings support speculations that differences in attitudes may account for some of the residential variation in the use of community-based services that has been observed, the conclusion also can be drawn that, regardless of residence, older adults face substantial barriers to services, resulting in unmet needs.