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V May 1961
I LEXINGTON I { I} or
Health Problems of y
    Older Persons in Selected  
  Rural and Urban Areas
of Kentucky   {
By E. GRANT youmms T   R
Department of Rural Sociology
R UNIVERSITY OF KENTUCKY
xmmucxv Acmcuvrmm. mxvmmmr smuow
V LEXINGTON

 Progress Report 104 May 1961
HEALTH PROBLEMS OF OLDER PERSONS IN SELECTED
RURAL AND URBAN AREAS OF KENTUCKY
E. Grant Youmans
University of Kentucky
Kentucky Agricultural Experiment Station
Lexington
In cooperation with
Farm Population and Rural Life Branch, Economic and Statistical
Analysis Division, Economic Research Service
U. S. Department of Agriculture

 ACKNOWLEDGMENTS
This is one of several reports based on a survey of older persons
made jointly by the Department of Rural Sociology, University of.
Kentucky, and the Farm Population and Rural Life Branch, Economlc and
Statistical Analysis Division, U. S. Department of Agriculture. Assist-
ance was provided by a number pf persons: S. C. Bohanan, James S. >
_ Brown, A. Lee Coleman, C. Milton Coughenour, Thomas R. Ford, Earl
Mayhew, Ralph Ramsey, and Robert Straus, all of the University of
Kentucky; Gladys K. Bowles, James D. Cowhig, Margaret Jarman Hagood,
and Donald G. Hay, all of the Economic and Statistical Analysis Divi- ·
sion, U. S. Department of Agriculture; Sara C. Stice, Director of _
Public Health Education, Kentucky Department of Health; and Daniel E.
Allegar, John E. Dunkelberger, Harold F. Kaufman, Ben T. Lanham, and .
,E. V. Smith, all of Technical Committee $-44. V 4
Acknowledgment is made to John W. Hamblen, Director of the Com-
puting Center, and to David A. Sheets, Director of the Office of ·
Machine Statistics, University of Kentucky, for use of data processing
equipment.
The survey on which this report is based is a contributing study
to the Cooperative Southern Regional Sociological Research Project S—44.

 CONTENTS
LIST OF TABLES ..,............. . . ....... 4
INTRODUCTION ......................... 5
Objectives and Procedures ................ 6
Sample .......................... 8
HEALTH STATUS .................. . ...... 9
Health Ailments ..................... 12
Role Impairments ..................... 18
_ Perceptions ....................... 29
HEALTH SERVICES, NEEDS, AND COSTS ............... 38
Health Services ..................... 38
Health Needs ................ . ...... 4O
Health Insurance ..................... 45
Other Medical Costs ................... 47
SUMMARY ...... . ..................... 49
APPENDIX ........................... 51
Field Procedures ....,................ 51
-3..

 LIST OF TABLES
Table No, Page
1, Selected Characteristics of Persons Aged 60 and Older,
Casey County and Lexington, Kentucky, 1959 .,....... l0
2, Reported Health Ailments of Persons Aged 60 and Older,
Casey County and Lexington, Kentucky, 1959, by Sex
and Residence , ...,... ., ..... , ...,. . , . 13
3, Ability to Get Around of Persons Aged 60 and Older,
Casey County and Lexington, Kentucky, 1959 ,...,. , , . 20
4, Retirement Status of Men Aged 60 and Older, Casey
County and Lexington, Kentucky, 1959 . .,........ . 23
5, Reasons for Retiring Given by Men Aged 60 and Older,
Casey County and Lexington, Kentucky, 1959 ,,...,... 24
6. Most Important Problems of Persons Aged 60 and Older,
Casey County and Lexington, Kentucky, 1959 ..,,..... 31
7. Advantage of Aging to Persons Aged 60 and Older, Casey
County and Lexington, Kentucky, 1959 .,.......... 33
8, Disadvantages of Aging to Persons Aged 60 and Older,
Casey County and Lexington, Kentucky, 1959 ......... 34
9, Kinds of Health Services Needed by Persons Aged 60 and
Older, Casey County and Lexington, Kentucky, 1959 ,.... 43
10, Persons Aged 60 and Older Covered by Health Insurance,
Casey County and Lexington, Kentucky, 1959, by Sex ,.,,. 46
ll, Cooperation of Persons Aged 60 and Older in Being
Interviewed, Casey County and Lexington, Kentucky, 1959 . . 55
-4-

 HEALTH PROBLEMS OF OLDER PERSONS IN SELECTED
RURAL AND URBAN AREAS OF KENTUCKY
E. Grant Youmans
INTRODUCTION
One of the more recent developments in health investigations
is the attempt to describe the interrelationships between health
status and other aspects of human life. It is generally recognized
that health is not an isolated phenomenon, but is associated with
` many factors.
Health behavior, as all human behavior, takes place in an
environmental setting, and it is a fruitful research task to attempt
to trace the impact of the social environment upon such behavior.
Among older persons the problem of health is of particular signifi-
cance, At a time when more and more resources are directed to
remedying health difficulties of older persons, it is vitally impor-
tant to discover the role of socio-environmental factors in these
health problems. Having access to such information should aid action
agencies in developing more realistic health programs for older persons.
A second and related research task is to focus attention more
directly upon the behavior of the ailing person. The life history of
a person attests to the recurrent process of organizing one"s daily
-5-

 -5-
life, of cutting down or withdrawing from certain social roles, of I
selecting and taking on new or different activities in keeping with
one's interests and abilities, and of adapting and adjusting psycho- A
logically to these changes. Among older persons this process is
intensified and aggravated by declining physical vigor and the develop-
ment of infirmities. In what ways do physical health status and socio-
environmental factors influence the social and psychological behavior
of older persons? Data relevant to this question may contribute to
understanding the behavior.
A third and somewhat different health problem, of especial concern
among older persons, is that of obtaining adequate health services in
keeping with the 1ndiv1dual's needs and ability to pay. Many areas
of the United States, particularly some rural areas, have inadequate
health facilities. Medical costs have risen markedly in recent years.
Many older persons with limited financial resources are confronted
with heavy medical costs, and probably many more fail to obtain nec-
essary health services because they hesitate to go into debt. In-
formation ls needed for appraising the health services available to
older persons, for assessing their health needs, and for estimating
the health costs to them.
Objectives and Procedures
This report has four objectives: (1) to assess the impact of I
selected socio-environmental factors upon the physical health

 -7-
status of older persons; (2) to appraise the effect of physical
health upon the social and psychological behavior of older persons;
(3) to examine the impact of selected socio-environmental factors
upon the role impairments and perceptions of older persons; and
(A) to present information on the health services available to,
and the health needs and costs of, older persons.
Data relevant to these objectives are taken from a larger survey
of problems of older persons.1 Older persons responded to questions
put to them in personal interviews, No medical verification was
made of reported health ailments. Socio-environmental factors in
the survey were limited to those of residence, sex, age, and socio-
economic status. The social behavior of the respondents is assessed
A under the concept "role impairment," and psychological behavior is
limited to certain perceptions of the older persons.
( The factor of socio-economic status probably requires elaboration.
Indices of socio·economic status——such as education, occupation, income,
housing, and residential area and others-have been used extensively
with adult subjects (or their spouses) who are engaged full time in
the labor force, It is questionable whether such indices are applicable
to older persons who have reduced their work activities or withdrawn
completely from the labor market, In this study, the aim was to find
an index which reflected the past style of life of a sample of older
persons who had lived almost all their adult lives in their present
communities. V
lField procedures are described in the Appendix.

 -8-
The index of socio-economic status used consists of 14 items of ~
equipment commonly owned by or accessible to American families.2 Those
owning or having access to fewer than 9 items were classified as having
low socio-economic status, and those owning or having access to 9 to
14 items were classified as having high socio-economic status. A
degree of verification of the indices of socio-economic status was
provided, since the interviewers observed and recorded the presence
or absence of many of the items of equipment. The level of economic
living as assessed by items of equipment was closely associated with
level of income. The median annual income of the older men and women
of low socio-economic status was $704, and for those of high socio-
economic status, $1,843.
The 0.05 level of probability was used in testing the significance
of differences. Differences that are not statistically significant
but supply supporting evidence are referred to as slight or negligible.
It is recognized that the analyses of the health data omit many
variables. Family and community relationships, for example, probably
have an important bearing on self-assessed health responses, and these
are not included.
Sample
In 1959, men and women aged 60 and older in an area probability
sample of households in a rural Kentucky county and a random sample of
 
zltems of eguipment: '
1. automobile 8. radio
2. gas or electric range 9. television
3. central heating l0. mechanical refrigerator
4. piped water ll. home freezer
5. running hot water 12. automatic clothes washer
6. electricity 13. inside flush toilet
7. telephone 14. bath or shower

 -g-
persons of comparable age in a Kentucky metropolitan area were interviewed
in their homes. No institutionalized older persons were included.
Casey county, with a total population of slightly over 14,000 persons
in 1960, is a 100-percent rural county located in the Southern Appala-
chian Region and relatively isolated from any large urban center. The
greater Lexington com unity had a total population of about 120,000
persons in 1958.
Detailed characteristics of the samples are presented in Table 1.
The age range was 60 to 97 years, with a median of 69 years. The sample
included more women than men, a difference due to the greater proportion
of female respondents in the urban sample. Three—fifths of the respon-
dents were married, and rural persons exceeded urban persons in this respect.
One-fifth of the urban sample was nonwhite, compared with less than one
percent for the rural sample. The sample was predominantly Protestant.
Urban respondents, compared with rural persons, had slightly more
formal education, substantially higher incomes, and were of markedly
higher socio-economic status. Almost 7 out of 10 older persons owned
their homes. Rural persons had lived for an average of 60 years in
their present com unity, while urban persons had lived for an average
of 45 years in theirs.
HEALTH STATUS
The physical, social, and psychological health status of the
respondents is assessed from three sets of data: (l) their reported
physical health ailments, (2) their self-evaluation of their role
impairments, and (3) their responses to certain questions about their
perceptions and outlook.

 -1g-
Table 1. Selected Characteristics of Persons Aged 60 and Older,
Casey County and Lexington, Kentucky, 1959
 
Characteristic Rural Urban Total
 
No. Pct. N0. Pct. No. Pct.
Number of cases 627 100 609 100 1,236 100
@2;
Male 312 50 220 36 532 43
Female 315 50 389 64 704 57
Age
60-64 166 27 152 25 318 26
65-69 159 25 145 24 304 24
70-74 124 20 143 23 267 22
75 and over 178 28 169 28 347 28
(Median) (69) (70) (69)
Marital Status
Married 429 68 308 51 737 60
Widowed 161 26 252 41 413 33
Never married 23 4 37 6 60 5
Divorced or separated 14 2 12 2 26 2
Residence
Farm 439 70 -— -- 439 36
Village or town 131 21 -- -· 131 10
Open country, not farm 57 9 —· -— 57 5
Large city -- -· 609 100 609 49
Color ·
white 627 100 482 79 1,109 90
Nonwhite * * 127 21 127 10

   (
. Table 1 (cont'd) -11-
 
Characteristic Rural Urban Total
;
_ gg; Pct. gg; Pct. gg; Pct.
j Religion
v Protestant 494 79 521 86 1,015 82
‘ Catholic 14 2 26 4 40 3
( Jewish 1 - 10 2 11 1
1 Other 25 4 13 2 38 3
No response 93 15 39 6 132 11
Formal Education
1
0-4 grades 222 35 103 17 325 26
5-8 grades 329 52 206 34 535 43
9-12 grades 35 6 142 23 177 14
13-16 grades 21 3 109 18 130 11
17 or more grades 4 1 20 3 24 2
y No response 16 3 29 5 45 4
_ (Median) (5.5) (8.1) (6.5)
Annual Money Income Per Person
_ None 36 6 16 3 52 4
$1 - 499 164 26 59 10 223 18
$500 - 999 201 32 134 22 335 27
$1,000 - 2,999 169 27 203 33 372 30
$3,000 - 4,999 23 4 69 11 92 8
$5,000 and over 18 3 80 13 98 8
No response 16 2 48 8 64 5
· (Median) ($762) ($1,704) ($964)
Socio-Economic Status**
( Low (8 items or less) 517 82 89 15 606 49
I High (9-14 items) 110 18 520 85 630 51
_ Home Ownership
Own home 475 75 363 60 838 68
Rent 68 11 166 27 234 19
Live free 73 12 67 11 140 11
` Other 11 2 13 2 24 2
 
*Less than 0.5 percent.
**See Objectives and Procedures, page 6.

 ` k
l
-12-
Health Ailments
The first question concerning health ailments was, "Do you now ,
have any ailment or health condition that bothers you either all l
the time, or off and on?" If the respondent answered yes, he was
then asked to name the kinds of ailments which bothered him. 1
Slightly fewer than 7 out of 10 persons in the study (68 percent)
reported that they were bothered, either all the time or off and on,
with one or more health ailments. One out of 4 persons (26 percent) I
reported no ailments. Almost half of the total sample (45 percent)
reported one ailment, almost 1 out of 4 persons (23 percent) reported
two or more ailments, and the remaining 6 percent did not respond.
The 835 older persons who reported one or more ailments named an E
average of 1.4 per person (Table 2). i
The six health ailments of highest prevalence were (in descending p
order) arthritis and rheumatism, heart trouble, blood pressure, uro-
logical difficulties, problems of the digestive system, respiratory
ailments, and ailments associated in some way with the skeletal struc-
ture (Table 2). Almost 1 out of 4 persons in the total sample (24 A
percent) named health ailments associated with the heart, such as
heart trouble, blood pressure, hardening of the arteries, and poor
circulation. About l out of 6 older persons (16 percent) named arthri- J
tis or rheumatism as bothersome health ailments. Respiratory, urinary, V
and digestive ailments were each named by 6 percent of the total sample, I
and 5 percent reported broken bones or other skeletal problems. The
categories of the lowest incidence (1 percent each) were hearing

 -13»
Table 2. Reported Health Ailments of Persons Aged 60 and Older,
Casey County and Lexington, Kentucky, 1959,
by Sex and Residence
 
Ailment §g§ Residence Total
Male Female Rural Urban Sample
!.9.a!£.E;.*I~&£<£e* @1*.2;;*52.1%* @1*.9;*
Arthritis, rheumatism 65 12 128 18 109 17 84 14 193 16
Heart trouble 75 14 92 13 90 14 77 13 167 13
Blood pressure 45 9 88 13 82 13 51 8 133 11
Urological 34 6 45 6 51 8 28 5 79 6
V Digestive system 35 7 44 6 37 6 42 7 79 6
Respiratory 36 7 36 5 49 8 23 4 72 6
Skeletal structure 33 6 34 5 35 6 32 5 67 5
Eye trouble 24 5 29 4 25 4 28 5 53 4
Nervousness 16 3 35 5 31 5 20 3 51 4
Rupture, hernia 20 4 11 2 17 3 14 2 31 3
Diabetes 8 2 13 2 7 1 14 2 21 2
Hearing trouble 8 2 10 1 5 1 13 2 18 1 `
Foot trouble 7 1 10 1 6 1 11 2 17 1
Throat trouble 7 1 8 1 12 2 3 ** 15 1
Other ailments 68 12 86 12 69 11 85 14 154 12
None reported 138 26 187 27 116 19 209 34 325 26
` No response 43 8 33 5 50 8 26 4 76 6
Number of cases (532) (704) (627) (609) (1,236)
 
*Percentages exceed 100 because of multiple responses.
**Less than 0.5 percent.

 1/ s I “ . · Y i' 4
-14- ‘
difficulties, foot trouble, and health problems associated with the `
throat. Only one person said he had dental problems and this was
labelled "toothache." The absence of reported denture ailments
suggests that the older people surveyed did not include these under
the term "health ailments."
Twelve percent of the total sample reported a variety of health
conditions and ailments which could not be classified into any of the
14 categories in Table 2. These were placed in an "other" category,q l
which included such ailments as glandular disturbances, paralysis,
female disorders, cancer, gall stones, allergies, Parkinson's disease,
tumors, and headaches and other pains.
Rural-Urban Differences. The problem of the relative health status
of rural and urban persons has been a subject of study for many years.
Rural living, it is generally believed, provides a more favorable e
environment for maintaining physical health than does the city. The
rural person has the advantages of fresh air, sunshine, outside work,
and Qack of congestion. On the other hand, many rural persons don't
have the kinds of health facilities available to those living in urban
centers. Loomis and Beegle concluded a careful examination of rural
health data with the statement, "Despite the natural advantages of I
rural life, in many respects rural people in the United States are
less healthy than urban."3
The findings in this study support that conclusion with respect
to older persons. Those living in the rural area reported more I
3Charles P. Loomis and J. Allan Beegle, Rural Social Systems,
(New York: Prentice—Hall, 1951), p. 760.

 4 -15-
health ailments than did those in the urban areaa Seventy-three
percent of rural persons reported one or more ailments, compared
with 62 percent for urban residents° One out of 3 urban persons
(34 percent) did not report any ailments, but only l out of 5 rural
persons (19 percent) said they were not bothered with poor health
(Table 2)¤
Compared with urban residents, rural men and women reported
slightly more difficulties with blood pressure (13 to 8 percent), a
slightly higher prevalence of arthritis and rheumatism (17 to 14
percent), slightly more respiratory ailments (8 to 4 percent), and
slightly more urological problems (8 to 5 percent). Ailments in
the remaining illness categories were approximately equal for rural
and urban respondents (Table 2)¤
Not only did rural persons assess their physical health as poorer
1 than that of urban persons but, for rural man, ill health appeared to
occur at an earlier ageo For example, 71 percent of the rural men
aged 60 to 64 reported that they were bothered by one or more health
ailmentso In contrast, only 49 percent of the urban men in this age
category reported ailments; a difference of 22 percentage points,
which was substantially above the rural·urban differences in the age
category 65 and over.
The relatively high prevalence of ailments among rural men aged
60 to 64 is probably a reaction to greater demands of the rural en-
- ` ‘ Vif¤¤¤é¤€ QS ¢¤mp3¥éHTwi¢h*¥hé~Urb&n» *Agricultural work requires
considerable physical strength and agilityc Occupations in metro-
politan centers probably do not place such strong emphases upon

 -16- V
physical prowess. Peak performance is probably reached at an earlier
age in rural areas. With the normal decline in physical vigor and the
consequent inability to perform as well as in the past, the rural
male probably becomes aware of his physical incapacities at an earlier
age than does the man living in the city.
Many empirical studies in the United States attest that persons»A
at lower economic levels have considerably less access to means of
achieving many dominant American values, including that of health,
than do persons at higher economic levels.4 The persons in this
study are no exception to this generalization. Among both rural and
urban respondents, socio-economic status was related to the prevalence
of reported health ailments, and the differences by socio-economic
status were approximately equal in both rural and urban areas. In the
rural area, 76 percent •f the persons of low s•cio-economic status
reported one or more health ailments, but •nly 63 percent of high
soc1o·econom1c status persons made this raport._ In the urban area,
the proportions of low and high socio-econ•mL• status persons who
reported one or more ailments were 71 and 6D percent, respectively.
Age Differences. It is generally recognized that physical vigor
declines with advancing age. Io what extent does poor health increase
with age among noninstltutionalized older pers•n• llvlng in the
comm nity? · lj -l ` -· l j` ` —
4See Leo F. Schnore and james D. Cowhig, hScme Correlates of
Reported Health in M tropolitan Centers," Social Problems Vol. VII,
No. 3, Winter, 1959-60, pp. 218-225. I _ p ·

 -17-
In this research, the proportions reporting one or more health
ailments increased slightly with age. In the yonngest age category
(60 to 64), 65 percent reported that they were bothered with one or
more health ailments. This proportion increased to 70 percent in
the oldest age category (75 and over), a difference of only 5 pere
centage points. Apparently those persons who survived to advanced
age and continued to live in the co munity experienced little change
in their health condition beyond age 60. If this study had included
institutionalized older persons, probably a higher incidence of health
ailments in the oldest age category would have been reported.
Sex Differences. It is commonly alleged in the United States
that women are more inclined to reveal and report health ailments
than are men. It is asserted that men tend to ignore minor symptoms
and exhibit a greater reluctance to being called sick. This tendency
7 probably reflects the views men hold of the masculine role in American
society and the view women hold of the feminine role. Most young and
middle~aged males probably do not consider it "man1y" to complain of
minor aches and pains. A ong young and middle~aged women, on the
other hand, such confessions probably do not violate their conception
n of the feminine role.
Do older men and women maintain this difference in viewpoint?
The findings in this study suggest that they do not. Very slight
differences were found between men and women in reported health ail¤
ments. Sixty~six percent of the men and 69 percent of the women
reported one or more ailments, and almost equal proportions of men
and of women reported they had no bothersome ailments (26 and 27

 -Ig-
percent, respectively). In only two of 15 categories of ailments _
shown in Table 2 were there any appreciable difference between
men and women, and the difference was slight. A slightly greater ·
proportion of women than of men reported they suffered from arthritis
and rheumatism (18 and l2 percent) and from difficulties with blood
pressure (l3 and 9 percent).
Role Impairments —
It is generally recognized that human beings vary widely in their
reactions to health problems. Some persons "glve in" easily to physi-
cal complaints and withdraw from their normal role activities. Others
disregard minor symptoms, continue with their usual tasks and duties,
and curtail activities only when seriously afflicted. It is perti-
nent to examine the assessments older persons made of their role im-
palrments. To what extent have they cut down on their activities?
what reasons do they offer? Do their self-assessed role impariments
coincide with their self-assessed health status? To what extent do
residence and socio-environmental factors influence their role impair-
ments?
The persons interviewed responded to a number of questions concern-
ing three aspects of role impairments: (1) a general evaluation of s
their reduction in activities, (2) their reduction in work activity,
and (3) their ability to get around.
One question was, "Have you cut down on any of your activities I
because of your health?" Almost 3 out of 5 older persons (59 percent)
replied they had. The 724 older persons who said they had cut down

 -19-
on their activities were asked which ones they had reduced. They
named an average of 1.6 activities which fell into three major
categories. Almost 3 out of 4 persons said they had cut down on
their work. About 1 out of 3 said they had reduced such strenuous
activities as athletics, hunting, and gardening. About l out of
3 reported that they had reduced their visiting and social life.
” Reduction in work activities was determined by asking the men
1 and women, "what is your present major occupation?" In response to
this question, 47 percent of the men and 22 percent of the women
volunteered the information that they were fully retired. Those
who named a present major occupation were then asked, "Are you
partly retired?" To this question an additional 26 percent of the
men and 29 percent of the women replied yes. Thus 73 percent of the
men and 51 percent of the women considered themselves either fully
or partly retired. Since retirement for all but a few women was
from household duties, further discussion of impairments in work
roles is limited to the men.
Another index of role impairment was obtained by asking, "which
one of the following statements best describes your ability to get
around at the present time?" Five choices were offered, ranging
from "Able to go practically any place" to "Stay in bed all the time"
1 (Table 3). Three out of 4 older men and women (74 percent) said they
were able to go practically any place they wanted. One out of 6 (16
percent) said they could get around the house, but seldom went out.
One out of 20 (5 percent) said they could get around the house, but
with difficulty. Two percent of the older men and women were confined
to a chair most of the day, and one percent were confined to their
U bed. (Two percent did not respond to the question.)

 -20-
Table 3. Ability to Get Around of Persons Aged 60 and Older, `
Casey County and Lexington, Kentucky, 1959
 
Ability to Get Around Rural Urban Total
 
No. Pct. No, Pgg, Ng; 2;;;
Able to go practically any place 451 72 464 76 918 74
Get around house, but seldom go out 100 16 91 15 194 16
Get around house, but with difficulty 38 6 24 4 68 5
Confined to chair most of day 13 2 12 2 18 2
Stay in bed all the time 6 1 6 l 9 1
No response 19 3 12 2 29 2
Total 627 100 609 100 1,236 100
 

 .21-
Although substantial proportions of the respondents reported they
had reduced their activities because of their health and an even
greater proportion reported they had cut down on their work activity,
these role impairments apparently did not seriously interfere with
their ability to get around. Only l out of 4 evidenced any restric-
tion in their ability-to get around, and of these the greatest propor- f
tion reported that they seldom went out (Table 3).
Health Status as a Factor in Role Impairments. As might be ex-
pected, the health status of the older persons was an important
factor in their assessment of their role impairments. A markedly
greater proportion of men and women with one or more health ailments
than of those with no ailments reported role impairments. For example,
almost 3 out of 4 persons with health ailments (73 percent) reported
that they had reduced their activities because of their health. In
contrast, only l out of 4 persons with no ailments (26 percent) made
this statement. For these latter persons their health condition
probably was not poor enough to cause them to report ailments, or they
may not have been aware of any specific problems. However, their
. health may have deteriorated sufficiently to interfere with their
usual activities and cause them to reduce them. `
The impact of health condition upon work activity is more diffi-
cult to assess. Retired men may be in poorer health than those not
retired, but this does not necessarily imply that poor health brought
about their retirement. The health condition may have developed after
e retirement took place. The 387 men who were fully or partly retired
were asked, "why did you retire?" It is recognized that responses to

 -22- `
such a question may reflect faulty memories, since some of the men
had been retired for many years. The men gave a variety of reasons
for retiring, but the largest proportion (66 percent) said they had
retired because of their health or inability to work. A small pro-
lportion (16 percent) gave age, and very slight percentages gave
other reasons, such as "no work available," "retirement pension,"
"company policy," and "wanted to retire" (Table 5).
The health status of the respondents appeared to have a marked
impact upon their ability to get around. Almost all (92 percent)
of the 325 older men and women who reported no health ailments said
they were able to go practically any place. In contrast, only 66
percent of the 835 older persons who reported one or more health
ailments made this assertion. Twenty-one percent of the respondents 4
with ailments said they seldom went out, but only 5 percent of those
with no ailments made this statement. Eight percent of the persons
with ailments reported they could get around the house, but with
difficulty, but only 1 percent of the persons with no ailments re-
ported this impairment. The remaining percentages of those with
ailments were confined to A chair most of the day (2 percent) or
confined to a bed (l percent). Two percent of the men and women with `
and without ailments failed to respond to the question on their ability
to get around. _
Rural-Urban Diffgrences. Since it has been suggested that the '
more rigorous demands of the rural environment had an adverse effect
upon the physical health of the rural men and women, it might be
expected that the rural environment also would have an adverse effect

 -23-
Table 4. Retirement Status of Men Aged 60 and Older,
Casey County and Lexington, Kentucky, 1959
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
Retirement Status Rural Urban Total
 
No. Pct. gg; Pct. gg; Pct.
Partly retired 107 34 33 15 140 26
Fully retired 127 41 120 55 247 46
Total 234 75 153 70 387 72
Number of cases (312) (220) (532)
 

 -24- .
Table 5. Reasons for Retiring Given by Men Aged 60 and Older
Casey County and Lexington, Kentucky, 1959
 
Reasons for Retiring Rural Urban Total
 
No. Pct. No. Pct. No. Pct.
Health, not able to work 195 83 62 40 257 66
Age 14 6 46 30 60 16
No work available -- —- 16 11 16 4
wanted to retire —- -· 14 9 14 4 8
Retirement pension 6 3 7 5 13 3
Company policy 1 * 8 5 9 2
No response 18 8 -- -- 18 5
Total 234 100 153 100 387 100
 
*Less than 0.5 percent

 -25-
upon the roles performed by rural people. Thus, role impairments
probably would be greater among rural than among urban older persons,
and would probably occur at an earlier age for rural than for urban
men.
These expectations are supported by responses to several ques-
tions relative to role impairments. A substantially larger propor-
tion of rural than of urban men and women reported that they had
reduced their activities because of their health (72 and 45 percent,
respectively). A slightly greater proportion of rural men than of
urban men considered themselves partly or fully retired (75 and 70
percent, respectively, (Table 4). Differences between rural and
urban older persons in ability to get around were slight but in the
direction expected. Seventy-two percent of the rural men and women
said they could go practically any place they wanted, but 76 percent
of the urban persons made this statement.
Role impairments among rural men appeared to occur at an earlier
age than they did among urban men. In the 60 to 64 age group, 75
percent of the rural men said they had reduced their activities because
of their health. Only 27 percent of the urban men in the same age
group made this statement, a difference of 48 percentage points, which
was considerably larger than the difference between the rural and the
urban men aged 65 and over, 1.e., 32 percentage points. _
Among the men, partial retirement, but not full retirement, occurred
‘ at an earlier age for rural than for urban men. For example, 37 percent
of the rural men aged 60 to 69 reported themselves partly retired, but
only 9 percent of the urban men in this age category made this state