Understanding the Experiences and Psychological Wellbeing of Adults Living with Dementia in Rural, Age in Place Communities

Helal, Melinda (2025) Understanding the Experiences and Psychological Wellbeing of Adults Living with Dementia in Rural, Age in Place Communities. PhD thesis, Lancaster University.

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Abstract

Background and Purpose. As the global population ages, understanding the experiences and psychological wellbeing of older adults becomes increasingly important, particularly for those living with dementia in rural communities. This study explores the challenges and lived- experiences of older adults with dementia who choose to age in place (remain in one’s home until the end of life) within rural settings. Focusing on the United States, where an estimated 46 million older adults live in rural areas, this research addresses a significant gap in the literature regarding the social and environmental factors that influence psychological wellbeing in these populations. Method. Using three approaches to data collection, comprising semi-structured interviews, social network mapping, and visual documentation, the study examines how the built and social environments of rural communities impact the psychological wellbeing, life satisfaction, and sense of purpose among older adults with dementia. Findings. The study revealed three key findings regarding the psychological wellbeing of older adults with dementia in rural, age-in-place communities. First, participants demonstrated a strong attachment to their rural communities, which fostered feelings of support, safety, and belonging. This connection helped maintain a positive outlook and reinforced a sense of stability. Second, social relationships, whether among lifelong residents or newcomers, were vital to participants' life satisfaction and mental health. Engaging with family, friends, and community members provided a significant boost to wellbeing, especially for those who had relocated to smaller towns. Third, the study challenged the notion that support networks diminish as people age. Many participants showed creativity and resourcefulness in seeking support, utilizing compensatory strategies like relying on friends, family, or community members for transportation or other needs. These actions allowed them to maintain autonomy and stay connected, despite limited resources. Despite challenges like fewer healthcare services in rural areas, participants exhibited resilience, demonstrating that strong community ties can effectively support psychological wellbeing and autonomy, even in underserved environments. Conclusion. This study highlights how strong community attachment, social relationships, and personal resilience contribute to the psychological wellbeing of adults living with dementia in rural, age in place communities. It challenges prevailing assumptions that rural settings are less suitable for ageing in place and demonstrates how, with the appropriate social and environmental supports, these environments can effectively foster autonomy and psychological wellbeing for individuals living with dementia.