A scoping review of the healthcare needs of older community-dwelling adults living in rural areas

The aim of this review was to explore the unmet healthcare needs of community-dwelling older adults living in rural areas, to identify barriers and facilitators in accessing services and examine the supply and demand of community-based care. A scoping review was conducted following the Arksey and O'Malley framework and adhering to PRISMA-ScR guidelines. A systematic search and selection process identified peer-reviewed articles and grey literature published from 2014 to 2025. Data were extracted, organised and analysed using Covidence to map key findings and identify thematic patterns. Ovid MEDLINE, CINAHL Plus with Full Text, Scopus, Informit, and ProQuest Health and Medicine databases were searched for primary research studies. A search specifically for grey literature focusing on the current Australian context was undertaken separately. The 23 resources included in the review highlight significant rural healthcare disparities, including workforce shortages, high service costs and limited availability of aged care resources. While family and community networks remain vital sources of support, they are increasingly strained due to demographic shifts, such as the outmigration of younger populations. Older people consistently expressed a strong preference for home-based care; however, environmental and systemic barriers, such as inadequate transportation and service fragmentation, hinder their ability to age in place. Social participation was found to be linked to wellbeing, yet many older adults in rural communities experience isolation due to geographic, infrastructure and service-related constraints. This review identified persistent and multifaceted inequities in healthcare services available to community-dwelling older adults. Rural health workforce shortages, limited community support service availability, transport barriers, fragmented care systems and reliance on informal caregiving were key factors influencing the capacity to age in place. These findings highlight the need for more coordinated, context and culturally responsive rural health services and support systems.