What To Know About Accessibility Of Dementia Care In Rural Vs. Urban Settings

When you think about your options for managing dementia, do you consider where you live? Dementia, a set of symptoms typically affecting memory and thinking, can impact people in both urban and rural areas, and where you’re located can play a role in your treatment options. In general, research shows that individuals who live in rural areas tend to have less access to dementia care than those in urban areas. Accessible care options like online therapy may be helpful for people with dementia in rural locations who may not have many local mental health professionals.

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What is dementia?

Dementia is not its own illness. Rather, it can be seen as a cluster of symptoms that can be caused by several different illnesses affecting brain function. These dementia causes include the following:

• Alzheimer’s disease: Alzheimer’s tends to be the most common type of dementia. It is usually caused by a buildup of plaque in the brain. 
• Lewy body dementia: Lewy body dementia can be caused by abnormal protein deposits called “Lewy bodies” in the brain. 
• Frontotemporal dementia: Like Lewy body dementia, this form of dementia can also be caused by a buildup of protein, specifically in the brain’s frontal and temporal lobes. 
• Vascular dementia: Vascular dementia can be caused by conditions affecting the brain’s blood supply, like strokes and blood clots. 

Despite their differences, each of these types of dementia can affect a person’s memory and thinking abilities. Although these effects might start out mild, they often worsen as time passes. Some common examples include those listed below:

• Memory loss
• Trouble completing daily tasks
• Problems with communication
• Poor judgment and decision-making
• Changes in mood and personality
• Depression
• Anxiety
• Loss of interest in activities and relationships
• Trouble with movement and balance

The World Health Organization reports that dementia is the seventh leading cause of death worldwide, as well as one of the main causes of disability among older people. 

Even though dementia usually affects older adults, people under age 65 can have it, too. This is known as “young-onset dementia” or “early-onset dementia.”

What does dementia care look like?

Before exploring how dementia care differs between rural and urban areas, it may help to understand what dementia treatment involves. 

Although it currently has no cure, dementia can often be managed. People with dementia tend to need more care as their illness progresses, with later-stage patients often requiring ongoing help with daily tasks. Some may live on their own with in-home help, while others may need to move into an assisted living home. According to the CDC, people with dementia usually receive care from family members or friends.

Dementia management options

• Medication: Several medications may slow the progress of dementia and make its symptoms less severe. The right medication can depend on the person, their type of dementia, and how far along they are in the illness. 
• Therapy: Treatments aimed at improving mental health and thinking abilities may also be helpful. Therapies like cognitive rehabilitation and cognitive stimulation therapy may sharpen memory, attention, and communication skills. They may also help people with memory loss improve their relationships and self-esteem. 
• Daily assistance: Because dementia can involve challenges with movement, communication, and decision-making, having assistance with daily tasks may help patients maintain their health and independence. 
• Lifestyle changes: People with dementia may be able to improve their brain health by making lifestyle changes. These can include focusing on nutritious eating habits, getting plenty of exercise, and limiting alcohol intake. 

With proper treatment and support, it is often possible for people with dementia to reduce their symptoms while maintaining their mental health and quality of life. But what does this look like for rural and urban patients? 

Accessibility of dementia care and Alzheimer’s disease care

It might not seem like there would be much of a difference between rural and urban residents when it comes to managing dementia. However, research has found that people living in rural communities may face bigger barriers to dementia diagnosis and care. 

How accessibility of dementia care impacts diagnosis and treatment

There may be multiple reasons for this, but lower access to healthcare services might be one of the biggest. In a study from 2024, researchers looked at data on nearly 95,000 Washington state residents. They found that people in urban areas typically lived an average of nine miles from a neurologist. On the other hand, people in rural populations usually lived an average of 100 miles from the nearest neurologist. This lack of dementia specialists may make it harder to get the proper diagnosis and treatment. 

In a different study from 2022, researchers analyzed data on over 70,000 patients with early-onset dementia. They found that those in rural areas generally had fewer neurological tests and visits to clinical psychologists. Instead, they normally relied on primary care providers (PCPs) for diagnosis and treatment.

However, according to a 2020 Alzheimer’s Association survey: 

• 39% of PCPs reported that they were “never comfortable” or only “sometimes comfortable” diagnosing dementia. 
• 22% of PCPs didn’t have specialized training in dementia care and diagnosis. 
• 71% of PCPs in rural areas reported that there weren’t enough dementia specialists to meet the needs of patients in their area. 

Challenges in accessing dementia care for rural patients

Rural dementia patients may also have a harder time getting access to other types of care. In the 2020 Medicare study mentioned above, researchers found that rural patients usually received less home healthcare than urban residents with Alzheimer’s disease.

They also spent less time in the community than their urban counterparts. Because research shows that being socially active may improve cognitive function, this potential isolation may also contribute to worse outcomes. 

Get access to mental health support for dementia

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Getting help and assuring mental health care

Inequalities in rural healthcare access can pose unique challenges. Having ongoing mental health support may help people with dementia maintain their well-being and quality of life, but if you’re in a rural area, finding that support may be difficult. Online therapy may be a more accessible option. Platforms like BetterHelp empower you to work with a wide range of therapists without having to leave your home. You also have the option to change therapists as needed until you find the right fit. 

The role of online therapy

Research shows that online therapy may relieve symptoms of depression, which can be common among people with dementia. 

In a 2017 study, researchers looked at data from 373 studies of internet-based therapy. They found that online therapy could be effective at treating depression, anxiety, and multiple other mental health concerns.