Health and Functioning of Community-Dwelling Older Adults in Urban and Rural Areas of Portugal—What Are the Implications for Physiotherapy Care?

Ageing leads to physical, cognitive, and social changes that affect functionality and social participation. Health literacy, sociodemographic, and environmental factors influence health outcomes and access to care. This study aimed to characterize the health and functioning of Portuguese adults aged 65 and over, focusing on sociodemographic factors, health status, lifestyle, fall risk, functional capacity, and social participation, comparing rural and urban populations. An exploratory, cross-sectional study was conducted using data from older adults who completed the FallSensing screening protocol. Participants were classified by residence type (rural vs. urban), and group comparisons were made. The sample (n=474) was predominantly female (66.5%) with a mean age of 74.62 (±6.49) years. Rural participants were older, had higher body mass index (BMI), lower education, and more hypertension, while urban participants showed higher rates of osteoporosis, hearing loss, and alcohol use. Rural residents scored worse on grip strength, gait speed, timed up and go test (TUG), and exercise self-efficacy, with greater use of assistive devices and more severe social participation limitations. Although falls were more reported in urban areas, rural residents experienced them more frequently. These findings suggest that rural living is associated with lower functional capacity and poorer health, underscoring the need for targeted physiotherapy and primary care strategies in rural settings.