ABSTRACT:Evidence and experience have shown that the behavior of rural elderly reflects a cultural system different from that of urban elderly and that this system, which precludes the use of services, results in poorer health. This study describes the culture and health status of isolated elderly people in all census tracts of Highlands County, the county with the highest percentage of rural persons age 65 and older in the state of Florida.

Anthropological and nursing theory supports the understanding of rural elderly by describing the impact of the ecology on their adaptation and by eliciting the rural elderly's (emic) point of view. Network analysis identifies personal and community network systems which can be used to augment available institutional services.

Sixty-two informants were visited in their homes at three different times for an average of 10 hours of contact time. Qualitative field notes collected by this means were triangulated with quantitative surveys (demographic, medical, social data), objective and subjective measurements of health in order to strengthen the study's findings.

While communities vary with respect to support services available to elderly residents, certain patterns emerge from the data. Ninety percent of the informants live on fixed incomes and pay their bills first, then buy food, leaving the purchase of health care and medicines as a last priority. Seventy five percent of these rural elderly informants did not have family nearby to assist them. Since the informants live 20 miles from the nearest health care, stores, and other amenities, transportation is a major problem.

The composite rural elderly person is deficient in two instrumental activities of daily living and one activity of daily living, has an average of three chronic diseases that are not well controlled, and does not participate in preventive health measures. The rural elderly appear mistrustful of offered services and are wary toward health providers, a finding that appears to be linked to their cultural adaptation to the environment.