health in terms of functional abilities, health, or health perception between urban and rural communities, whereas one article [13] found no significant difference in the above three categories.

3.1. Functional Abilities

Functional abilities included the following three elements: social function, physical function, and role function in daily life. Three articles [11] [14] [16] noted significant differences in social function between urban and rural communities. Mainous et al. [11] reported that urban residents aged ≥65 years had better social functioning compared to their rural counterparts (p = 0.02), and Wang et al. [14] reported that social class was positively associated with perceived health and self-care in urban areas. Apidechkul [16] reported that social dysfunction significantly differed between rural and suburban areas (p < 0.001), and that social relationships in urban areas were higher than those in rural areas (p = 0.012). Moreover, Friedman et al. [12] found that the social aspect (e.g., social relationships, having very few close friends) was a significant factor associated with mental health or depression when comparing urban versus rural communities. For instance, having very few close friends (odds ratio [OR]: 6.86; 95% confidence interval [Cl]: 2.18 - 21.58) was associated with a significantly higher likelihood of major depression in rural areas compared to urban areas. The other two elements, physical function (p = 0.0009) and role function in daily life (p = 0.02), were reported to be significantly better in urban areas compared to rural areas in one article [11] .

3.2. Health

The health category included the following two elements: mental health or depression and physical health. Four articles [11] [12] [15] [16] noted significant differences for mental health or depression. Among those, two articles [11] [16] found that mental health or depression in elderly people was significantly better in urban areas than in rural areas. The other two articles [12] [15] reported that mental health or depression in elderly people significantly differed between urban and rural areas. Chiu et al. [15] showed significant differences between urban and rural populations (p = 0.005), and depression was significantly associated with living urban area (odds ratio [OR]: 0.59; 95% confidence interval [Cl]: 0.40 - 0.85). Friedman et al. [12] found a significant difference in the incidence of major depression between urban and rural areas (p = 0.007), with those living in urban areas being significantly more prone to major depression.

Two articles [11] [16] noted significant differences between urban and rural settings for physical health. One article [11] found that physical health differed significantly (p = 0.0009) according to the SF-20 subscale, and another article [16] found that physical health in urban areas was higher compared to rural areas (p = 0.011).

3.3. Health Perception

Two articles [11] [14] reported on health perception with a focus on urban and rural settings. Mainous et al. [11] found a significant difference (p = 0.007) between urban and rural communities, and Wang et al. [14] showed a positive association between perceived health and self-care and well-being in urban and rural communities.

4. Discussion

The population composition in Japan continues to change with the increasing elderly population and decreasing birth rates. Under such social circumstances, the characteristics of a community will continue to change; like humans, the community is alive.

The Japanese government is currently promoting the construction of integrated community care systems tailored to the characteristics of each residential community by 2025. “Community” is diverse [6] , and while it has been suggested to strongly influence older adults’ well-being and QOL [7] , the definition of “community” in a research setting is still unclear. Therefore, the present study used “urban” and “rural” settings as characteristics of residential communities according to the literature [8] [9] [10] . And then, through a literature review of six studies including the four articles [11] [12] [14] [15] of the correlation research design with multivariate procedure, was carried out, and significant differences identified in elderly health between urban and rural communities were classified into three categories (functional abilities, health, and health perception). Five [11] [12] [14] [15] [16] of the six studies identified significant differences in elderly health relating to functional abilities and health.

Among functional abilities, social function was described in five articles [11] [12] [13] [14] [16] . In one article [16] , the social aspect (e.g., social relationships, having very few close friends) was a significant factor associated with mental health or depression when comparing urban and rural areas. In particular, having very few close friends was associated with a significantly higher likelihood of major depression among rural residents compared to urban residents. It is suggested that the important issues might be what the whole community (ie, urban or rural) understands about the life of the people, rather than the views of the actual communities that the people live in [17] . The findings in the current study suggest that social function might be a more important outcome measure of elderly health, particularly regarding mental health or depression, when considering outcome measures for effective integrated community care that takes into account the characteristics of each community.

In the health category, mental health was described in five articles [11] [12] [13] [15] [16] . Among these, four articles [11] [12] [15] [16] reported that mental health or depression in elderly people significantly differed between urban and rural communities. However, the results regarding the mental state of elderly people in urban versus rural communities were not consistent among these articles; two articles [11] [16] reported that urban elderly people had better mental health compared to rural elderly people, whereas other two articles [12] [15] found mental health in rural elderly people to be better. Thus, whether a significant difference exists in elderly mental health between urban and rural communities remains unclear. Yet, mental health or depression might be a more important measure of elderly health in effective integrated community care based on community characteristics.

Overall, the definitions of urban and rural areas in the respective countries seemed not to be enough provided. And then, through a literature review, the present study revealed that significant differences between urban and rural communities relate to aspects of social function and mental health or depression, although only a few studies reported on elderly health from the perspective of differences in environment between urban and rural communities. One article [16] showed that urban elderly people had higher QOL compared to their rural counterparts, in terms of mental health and social function. When developing an effective person-centered integrated community care system that aims to promote the QOL of residents while taking into consideration the characteristics of each community (i.e., urban or rural), it will be important to recognize social aspects as well as mental health or depression as more important outcome measures. In addition to it, on this article, Chiu et al. [15] showed that depression was significantly associated with living urban area. One possibility is that the residential community itself such as urban and rural may be one of the factors influencing the mental health or depression.

In order to carry out further studies regarding effective integrated community elderly care that considers community characteristics in the future, the definition of the characteristics of community (e.g., urban and rural) in research settings should be clarified. And then, further studies will be needed that focus on not only elderly health but also the environmental aspects surrounding community residents (urban/rural) with intervention research design, in order to explore outcome measures for effective person-centered integrated community care systems. In addition, it will be more important to pile the research data globally and perform a meta-analysis.

Acknowledgements

A part of manuscript was accepted as Peer-Reviewed Poster Presentation at the 30th International Nursing Research Congress, Calgary, Alberta, Canada, in Sigma Theta Tau International, 25-29 July, 2019.

Cite this paper
Imaiso, J. (2019) Significant Differences in Elderly Health between Urban and Rural Communities: A Literature Review. Health, 11, 567-577. doi: 10.4236/health.2019.115048.
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