The influence of cognitive decline on rural identity: perspectives of older women.

PURPOSE: The purpose of this study was to examine the perspectives of community-dwelling rural, older women concerning the meaning of cognitive decline and to ascertain how cognitive decline affects their lives and the lives of those around them. DESIGN: An ethnographic design guided 1 year of cultural immersion in a rural, farming county in Nebraska. METHOD: Four life history interviews, participant observations, field notes, and cultural artifacts were collected for case-focused analysis. FINDINGS: Cognitive decline was believed to threaten one's social identity as a "good woman" because of three strongly held beliefs that (1) the rural lifestyle protected health, (2) demands of the farm were more important than personal health needs, and (3) mainstream health care services were unnatural and insensitive, and therefore best avoided. Using mainstream health care also resulted in the loss of informal social support, which existed as a protective social silence and helped sustain older women's rural identity. The older women feared developing cognitive decline and believed the loss of one's life purpose would be the outcome of the condition. CONCLUSIONS: Holistic nursing actions that preserve older women's rural identity and social support may increase the likelihood that women accept rural health care aimed at treating cognitive decline.