Introduction

The issue of rural ageing and dementia care has largely been neglected in Ireland. As populations age, the need to provide services to an increasing number of older people with dementia living in rural areas will become more acute, even if the share of older people living in rural areas is likely to decline in Ireland in the future. Concern for older people with dementia who continue to live in rural areas is based on a number of potential disadvantages arising from economic, social, geographical, environmental and demographic sources. There is a tendency for cumulative cycles of decline to occur in rural areas; poor employment opportunities tend to lead to out-migration which in turn leads to population decline, unbalanced age structures and falling economic activity, which reinforces unemployment issues and further out-migration (Milbourne and Doheny, 2012; Hanlon et al, 2015). This is quickly followed by a reduction in health and social care provision putting even more responsibility for care on people themselves and their shrinking networks and more dispersed families (Dwyer and Hardill, 2011; Skinner and Joseph, 2011; Warburton et al, 2014).

It is now routinely accepted in policy deliberations that social services in rural areas cannot always be provided to the same level as in urban areas for reasons of economies of scale. That leads to service objectives in rural communities (and sometimes even quality-of-life goals) being expressed in efficiency terms only, without reference to the distributional consequences of different policies in relation to infrastructure, connectivity and fairness. This is particularly true for older people with dementia. The potential for older people to experience multilevel and multifaceted forms of social exclusion across infrastructural, social and economic spheres (McDonald and Heath, 2008; Forbes et al, 2011; Peel and Harding, 2014) is very real – even before considering the ramifications of dementia symptoms, diagnosis and pathology. There are reasons, linked to relational, cultural and historical embeddedness of individuals, why older people want to remain in their rural communities, whether they have dementia or not (Herron and Rosenberg, 2017). Such reasons challenge us to think about orthodox service provision for people with dementia living in rural settings, in the context of the fullness of people's everyday experiences.