Elderly patients living in rural areas often cancel their medical appointments - or simply don't show up - because they don't have reliable transportation. On Friday, members of a diverse eastern Maine collaboration met to review a recent study that indicates the extent of the problem and makes general recommendations for resolving it. 

The yearlong study presented by Lenard Kaye, director of the Maine Center on Aging at the University of Maine, is focused on the transportation needs of elderly Mainers with chronic illnesses who live in Hancock, Penobscot and Washington counties. 

Within this tri-county region, 16 percent of the population is 65 or older, compared to 12 percent nationally. Many have been diagnosed with three or more chronic conditions - such as diabetes, heart disease, lung disease and certain kinds of cancer - which require frequent medical care to treat and control. As economic conditions cause more young Mainers to leave rural communities, the percentage of ailing elderly is increasing. 

Speaking to about a dozen members of the Eastern Maine Transportation Collaborative, Kaye said the majority of older patients, family members, volunteer drivers, medical office schedulers and social workers interviewed for the study identified lack of transportation as a significant obstacle to maintaining or improving rural elders' health status. 

The burden falls most heavily on the many rural seniors who do not qualify for free or low-cost services through Medicaid but still cannot afford to pay taxi fare for a monthly routine physical, much less for weekly or daily appointments for cardiac rehabilitation, dialysis, radiation, chemotherapy or other treatments. 

"They depend on family, friends and neighbors, who will always be a crucial part of the transportation network," Kaye said. "But our survey found that these escorts range in age from 20 to 87 years, with an average age of 57 years. They're beginning to be vulnerable to the complications of aging themselves. 

Many are working and have other responsibilities."

In addition, the increasing price of gasoline is affecting volunteers' willingness and ability to provide transportation. Those who give rides to low-income patients may be reimbursed by the state, but in most cases it's not enough to offset gas costs and wear and tear on their vehicles. 

Kaye emphasized that for the growing number of seniors who don't have family or friends who can help, it's essential to make the best use of existing services available through government programs and private nonprofits, churches, businesses and other organizations, he said. Many seniors are unaware of the services available to them or may hesitate to take advantage of them. 

Public bus services such as Bangor's BAT should consider placing "senior escorts" on daytime buses to assist elderly riders, Kaye said. Media outlets and other corporations should be encouraged to pay for public service announcements and advertising that alert elders and their family members to the availability of transportation assistance. Doctor's offices, municipal offices, grocery stores and other sites should make transportation information easily available. 

Perhaps most importantly, Kaye said, seniors should be encouraged to take part in mental and physical fitness programs and periodic driving courses to keep them independent and on the road themselves for as long as possible. 

The Eastern Maine Transportation Collaborative was established about a year ago to improve communication among transportation providers, health care groups, government agencies, municipal officials, social service groups and others concerned with the welfare of Maine seniors. The group is coordinated by the United Way of Eastern Maine, which recently restructured its guidelines to require nonprofit agencies to work together in such fashion in order to receive funding. 

United Way director Eric Buch said Friday that the change was needed to make the most of his agency's resources. 

"We can't spread ourselves a mile wide and an inch deep and still make meaningful change," he said. 

Funding for the transportation study was provided by a grant from the Maine Health Access Foundation.