ž In the rural sample, widowed elders, stroke history, and problems with toileting and shopping were significantly associated with a higher risk of depressive disorders. For rural elderly with a stroke history, there was a 7.39 increase in likelihood of suffering from depression.

Friedman B. et al., 2007

To determine whether factors associated with depression differ between elderly residents of rural and urban areas.

Cross-sectional observational study with

multiple logistic regression analysis.

ž Urban: MSA

ž Rural: Non-MSA (Based on the U.S. Office of Management and Budget)

ž 926 elderly people (age ≥ 65 years); 650 in urban areas and 276 in rural areas.

ž Sociodemographic characteristics: age, gender, education, annual household income, financial strain, and site.

ž Social support: marital status, living arrangement, number of friends, and number of relatives.

ž Supplemental health insurance

ž Prior health services use

ž Health status: self-related health status, number of 13 chronic conditions, SF-36 Physical Component Summary (PCS) score, anxiety, body mass index (BMI), number of ADL dependencies, number of IADL dependencies

ž Major depression (SF-36 PCS score >30) significantly differed between urban and rural areas (p = 0.007); urban elderly had major depression significantly more often than rural elderly.

ž For urban elderly, major depression was associated with dependence in five or six ADLs (OR: 2.33) and in three or more instrumental ADLs (OR: 8.85).

ž Having very few close friends (OR: 6.86, 95% confidence interval [Cl]: 2.18 - 21.58), 2+ emergency room visits in the past 6 months (OR: 4.00, 95% Cl: 1.19 - 13.43), and more financial strain (OR: 1.50, 95% Cl: 1.01 - 2.23) were associated with a significantly higher likelihood of major depression in rural areas as compared with urban areas.

Lee C. et al., 2009

To identify and compare Health Promotion Behaviors (HPBs) of older rural and urban community-dwelling female spousal caregivers.

Exploratory, descriptive survey design.

ž Urban: Centralized area with a population density of 1000 per square mile and at least 10,000 total.

ž Rural: Outside the urbanized cluster or areas with rural status designation.

ž 72 female elderly people (age ≥60 years) who are provided with care for at least 6 months at home; 39 in urban areas and 33 in rural areas.

ž HPLP-II: 52 health-related behaviors and six subscales; health responsibility, nutrition, physical activity, spiritual growth, interpersonal relations, and stress management.

ž PI-developed questionnaire: demographics, caregiving responsibilities, length of time in caregiving role, and amount of personal time.

ž No significant differences existed in mean scores of the six subscales and overall HPLP-II between rural and urban sample populations.

Apidechkul T., 2011

To assess quality of life and mental and physical health among people aged 60 years and over in urban and rural areas of northern Thailand.

Cross-sectional study.

(Not written clearly)

ž Urban: 11 villages in the Pa Kaw Dum sub-district, and the Mae Lao district were used as suburban areas.

225 elderly people (age ≥ 60 years); 116 in urban areas and 109 in rural areas.

ž WHOQOL-BREF-THAI: 26 questions/ physical health, mental health, social relationships, and environment health.

ž Subjects who lived in suburban areas had a higher quality of life than those who lived in rural areas in terms of physical health (p = 0.011), mental health (p = 0.025), and social relationships (p = 0.012).