The Existential Dilemma of Older Adults With Severe Mental Disorders in Rural Areas: A Scoping Review

This review aims to systematically examine the survival dilemmas faced by older adults with severe mental illness (SMI) in rural areas and to provide a theoretical foundation and practical guidance for improving their health and well-being. Adopting the scoping review framework proposed by Arksey and O'Malley, the study systematically searched CINAHL, Embase, PubMed, Web of Science and Cochrane databases and screened literature according to predefined inclusion criteria. Key information-including research questions, study design, sample characteristics and main findings-was extracted and synthesised through thematic analysis. A total of 30 eligible studies were included. The results revealed that older adults with SMI in rural areas experience multiple, interrelated challenges, including a marked decline in quality of life, limited access to healthcare services, significant economic burden, insufficient social support, increased caregiving pressure on families and cultural as well as cognitive barriers related to mental illness. These multidimensional dilemmas are mutually reinforcing and collectively pose a substantial threat to older adults' survival and overall well-being. Addressing these issues requires the establishment of a multi-level, systematic intervention framework, including strengthened policy support, optimised healthcare delivery models, improved accessibility and appropriateness of services, targeted health education, enhanced community support networks and the promotion of interdisciplinary collaboration. Future research should focus on the specific needs of this population and conduct high-quality empirical studies to provide robust, evidence-based recommendations for improving their quality of life and promoting social inclusion.