1The Appalachian mountainous region of the eastern United States is defined by cultural and political boundaries that shape the experience of ageing for people who live among the hills and hollows. The hollows—the close spaces between these ancient hills—are often a repository for local cultures. However, there is a dearth of literature that ties ageing research to interdisciplinary work on Appalachia, although both areas of study seek to act as a corrective to popular culture’s “deficit perspectives” on the region and on the ageing person.
2In this paper, I discuss the ways in which Appalachia has been problematized historically; provide a history of salient life course events of contemporary older Appalachians, demonstrating how social changes have impacted the everyday lives of people in the region; and conclude with examples of ways to reimagine late life as a time of cultural renaissance and intergenerational resilience in the Appalachian Mountains.
3Before delving into the history of the cultures of the region, it is important to note my own position in this contested space. I am not only a highly educated writer and researcher currently residing in a small, prosperous university town in the mountains; but I have deep personal, intergenerational history in the heart of central Appalachia, which is known for struggles with industrial exploitation and intergenerational poverty. I grew up working class with no plans or means to attend college. Most of my ancestors were original European colonizers who helped “settle” the region beginning in the 17th century. We have been farmers, miners, healers, and teachers, as well as involved in feuds that fed stereotypes of the region throughout the 20th century. Thus, I embody the contradictions of the region—the stereotypes and the counter-narratives. As I enter the second half of my life, I reflect in this paper on the history of the region and what it means to be an “elder” in the multifaceted cultures of Appalachia, basing my analysis on literature from the humanities and social sciences.
4The Appalachian Mountain chain encompasses a large geographic area (Map 1), running beyond the state of Maine in the uppermost northeastern United States to deeply southern states such as Alabama and Georgia. It is important to delineate what I mean by the term “Appalachia” as, in the U.S., cultural connotations of Appalachia differ from the geographic reality. It is typically the central and southern mountains which have historically been characterized as Appalachia (Williams, 2002), and it is in the region delimited by this definition where I focus my discussion.
Figure 1: Appalachian Map
5Political and economic centers in urban, and, historically, more modernized areas outside the mountains, have greatly impacted the everyday lives of Appalachian populations, including older people. Beginning with colonization, for hundreds of years the people of the central and southern mountains have been governed by interests located outside the region (Ludke & Obermiller, 2012). These external actors have extracted the natural resources of the Appalachia—from botanical medicines to timber to fossil fuels—with little regard for the long-term well-being of inhabitants (Manget, 2022; Williams 2002). Nevertheless, because of the region’s relative geographic isolation and the intermingling of Indigenous, European, and African traditional knowledges and technologies, Appalachia has a unique cultural heritage that survived longer than other places in the U.S.
6However, in public discourse, industrial leaders, missionaries, journalists, and politicians have used a deficit perspective to frame the central and southern region’s strong traditional culture as impoverished (e.g., subsistence farming, indigenous health practices) and in need of help from outsiders (Billings, 1974). Terms such as “contemporary ancestors” (e.g., Frost, 1899) and “yesterday’s people” (e.g., Weller, 1965) highlight the tendency to problematize the people of southern Appalachia and the Appalachian coalfields.
7Even in the 21st century, much has been written about the U.S. Vice President JD Vance’s memoir, Hillbilly Elegy (2016), which problematized Appalachian culture. Notably Vance only visited his mountain relatives while growing up and was a child of out-migration from the region. While his book was initially popular in the broader U.S., Appalachian scholars, activists, and artists (e.g., Catte, 2018) noted that his work rehashed centuries-old tropes, including unflattering descriptions of his grandmother, rather than focusing on the devastating effects of industrialization and environmental degradation—from logging the mountains’ ancient forests to, more recently, decapitating the hills to feed the global demand for gas and coal (see Zanini and colleagues in this issue). But politicians, for better or worse, have long used the region’s challenges to further their own political agendas.
8For example, in the late 20th century—(see links to Engle’s timeline in the bibliography) beginning with Presidential Candidate John F. Kennedy’s visit to the region in 1960—the U.S. government formed what would become the Appalachian Regional Commission (ARC) to address long-standing economic issues (similar political movements appeared in France in the same period of time, see Morin in this issue). The ARC is focused on understanding reasons for persistent poverty, health disparities, and low life expectancy in Appalachia, and distributes financial resources to development projects within the region. The ARC not only defines which counties are “Appalachian,” but gives each county an economic designation: distressed, at-risk, transitional, competitive, or attainment (see Map 2; ARC, 2024). As of 2024, 225 counties were designated as “transitional”, 101 “at-risk”, and 82 “distressed”; only 4 were defined as “reached attainment” and 11 “competitive”.
Figure 2: County Economic Status in Appalachia, Fiscal Year 2025
Appalachian Research Center, June 2024
9As mentioned, thirteen states in the U.S. have at least some counties that are designated as Appalachian, from northern Georgia to southern New York, with West Virginia being the only state entirely within ARC borders. Central Appalachian counties, located on the Appalachian Plateau, typically fare worse on economic and well-being measures for several reasons: first, coal mining is the dominant economy in central Appalachia and has been characterized by boom-and-bust periods since its inception (Williams, 2002); second, geographic distance from major urban centers has affected access to hospitals and mainstream healthcare; third, in recent years, the opioid crisis (discussed below) has disproportionately affected central Appalachia. Generally, other rural Appalachian counties, particularly those in the Mississippi Delta region of the deep south (a region that is historically inhabited by African Americans), share characteristics of central Appalachia and experience similar problems. Counties that include growing urban centers, or are vacation destinations, have more resources but different problems such as glaring wealth disparities within communities (Coggeshall, 2022; Edin, Shafer & Nelson, 2023).
10While there is diversity within the region, particularly in counties with metropolitan areas or where there are major universities, central Appalachia is less racially diverse than the U.S. in general, with about 80% of the population identifying as White and many counties having less than 10% minority populations. African Americans typically make up around 5% of the population of central Appalachian counties while people of Hispanic origin are the fastest-growing minority group. Of the older adults in central Appalachia, approximately 47% are disabled compared to 33% in the U.S. overall. Central Appalachia, in general, has high disability rates across all adult age groups (Pollard & Jacobsen, 2022).
11Finally, a greater percentage of people in central Appalachia, like the region in general, are older than other places in the U.S., with nearly 20% of the population being 65 years old or older. Possibly related, compared to the U.S. overall, home ownership is high in Appalachia, including the central region, where older people tend to age in place on family land (Coggeshall, 2022). Despite high rates of home ownership, people living in counties in central Appalachia are more likely to have lower education and lower income levels than others in the nation (Pollard & Jacobsen, 2022). This creates a situation of being “land-rich but cash-poor,” typically meaning that the older person’s greatest financial asset is their land and home.
12Given this historical and demographic background, using the propositions from life course perspective (Dannefer, 2003), I next discuss how the unique cultural context of the region intersects with ageing in rural Appalachia. We know from studies using life course theory that cumulative dis/advantage over the lifespan create divergent experiences of old age (Ferraro & Shippee, 2009). I argue that deep inequities over the life course, particularly for those who are born and have intergenerational ties in central Appalachia, create unique challenges and opportunities for ageing in Appalachia in the 21st century.
13From its inception, theorizing Appalachia has been a political act (Lewis & Billings, 1997). Social theories of Appalachia have been dominated by a culture of poverty analysis (i.e., typically in justifications for removing populations beginning with indigenous peoples in the colonial era, and later, settlers whose homes stood in the way of park formation, dam building, etc.) or a romanticized past (i.e., “our contemporary ancestors” and white-washing diversity within the region) usually by scholars, industry leaders, and politicians with little personal history in the region (Manget, 2022; Smith, 2004; Synder, 1982; Williams, 2002).
14However, in the latter half of the 20th century, followed by folk revivals, labor activism, and civil rights movements in the U.S., regional scholars, artists, and activists challenged the prevailing “culture of poverty” narratives about southern Appalachia and pushed back against romanticized hillbilly stereotypes (Lewis & Billings, 1997). The Appalachian Studies Association was formed in 1977 and, with an annual conference and a journal, has served as a central hub for Appalachian-focused work. This work, while important for amplifying untold stories of people of the region, is based in historical and humanities scholarship, and rarely focuses on issues regarding ageing in the mountains. Rather, much of the work is centered on challenging stereotypes and feature youth and labor movements.
15For example, emerging from these early movements within Appalachian scholarship is a model of central and southern Appalachia as an internal colony (Lewis, Johnson & Askins, 1978). In this reading of the region’s history, scholars have convincingly argued that outside extractive industries—from timber, to railroads, to coal—have functioned to keep power and resources from Appalachian people and mired the region in chronic poverty by exploiting the region’s rich natural resources including the people’s labor. The focus here is on labor histories. In this model, however, scholars theorize that social institutions such as intergenerational kin networks and church congregations provide communal resistance to corporate exploitation, implicitly invoking older Appalachians.
- 1 I acknowledge my Appalachian colleague and indigenous scholar Victoria Ferguson who encouraged me t (...)
16The internal colony model, while powerful, is losing explanatory power due to changes within the region in the last several decades. In the late 20th century, another theory of Appalachia emerged influenced by leftist new populism, which focuses on grassroots labor struggles. Fisher’s (1993) edited volume, Fighting Back in Appalachia, details the traditions of resistance to exploitative industrial forces and dissent from alienating aspects of modernity that undermine the transmission of traditional cultures and technologies1 of Appalachian peoples from one generation to the next. Similar to the internal colony model, ageing issues are implicit, at best, in this new populist model.
17Many changes within the region directly reflect another theory of Appalachia, one focused on enhancing economic development (e.g., Wood, 2005). These changes have greatly impacted the experience of ageing within the Appalachian Mountains due to developing more infrastructure such as roads and access to healthcare services. In 1965, U.S. President Lyndon B. Johnson signed the Appalachian Regional Development Act with the purpose of “strengthening Appalachia’s economy and helping the Region’s 13 states achieve economic parity with the rest of the Nation.”
18Beginning with an influx of federal money for road building to connect the rural communities to larger urban centers, in later years the Appalachian Regional Commission has spent resources on the development of healthcare services, educational institutions, and other public programs and projects (ARC, 2015). The assumption behind this regional development model is that if Appalachia has a diverse economy and access to urban amenities, such as healthcare options, economically distressed and at-risk counties will reach “attainment.” Conversely no consideration is given to how road building, migration, or economic development impacts ageing Appalachians and intergenerational community capacity.
19One of the common aspects of these broad theories of Appalachia is that they problematize the region in some way, typically focusing on persistent poverty as measured against mainstream, suburban American norms that focus on employment and income. I propose to use life course theory (Dannefer, 2003; Elder & Giele, 2009), a theory rooted in the social sciences rather than economics, literary studies, or history which guides most Appalachian scholarship.
20Life course theory is appropriate for understanding not only the challenges people in the region live with, but also the strengths that come along with ageing in Appalachia. Two important propositions from this theory explain how Appalachian people experience ageing (Bengston & Allen, 1993). The first proposition is that there are multiple ways of experiencing time: I focus on generational time (cohort of people who experience cultural shifts, e.g., baby boomers) and individual time (literal age). The second proposition is to consider “linked lives” (Bengston & Allen, 1993); these include those “close others,” such as family members, whose destinies determine our own. Operationalizing linked lives helps to focus on people as members of complex communities. Thus, rather than conceptualizing “place” as a static variable with hard boundaries, life course theory invites us to consider Appalachia as a place of confluence of ever-changing factors. Below I focus on childhood influences, demographic changes in the last several decades, and family diversity within the region.
21U.S. baby boomers, people born in the first two decades after World War II, and Appalachian boomers in particular (Wood, 2005), have lived through enormous social and cultural changes throughout the 20th and 21st centuries. First, in the United States of America, many baby boomers experienced childhood during a time of unprecedented post-war economic prosperity and suburban growth; however, people in rural Appalachia experienced the 1950s as a time of widespread economic struggles (ARC, 2015). In central Appalachia the increasing mechanization of the coal mines and environmental disasters, such as devastating floods due to poor mining practices, meant that some people either left the region to find work or returned to family farms to live a traditional rural life. Many workers, and then families, traveled to and from northern cities via the Interstate Highway 75, dubbed “hillbilly highway” as migrant workers. Appalachian educational systems maintained small, one- or two-room community schools, and did not keep pace with changes in American schools more broadly. Thus, migrant Appalachian children of the 1950s and 1960s were often at least a grade level or two behind their urban corollaries. They were also subject to discrimination from urban school personnel who saw their educational differences as evidence of cultural or genetic inferiority (Ludke & Obermiller, 2012), rather than seeing the differences as markers of a rural childhood where children learned practical technologies such as hunting, gardening, carpentry, quilting, and so forth in addition to their formal community education.
22Families who made do with employment choices available in the mountains typically relied on intermittent jobs as well as traditional ways of life such as foraging, farming, and food preservation. In my research (McCann, 2010), I found that it was common for Appalachian baby boomers to describe their childhood with the following sentiment: We were poor, but we didn’t know we were poor because everyone around us lived in similar circumstances. Although their parents may have felt economic pressures due to their circumstances, contemporary older adults frequently feel nostalgic for their idyllic rural childhood with dirt roads, large extended families, and an agrarian lifestyle focused on the changing of the seasons (McCann & Allen, 2018). Many current Appalachian baby boomers remember having no indoor plumbing, and technologies such as telephones and TVs, common in suburban America, were few and far between. Although regional hospitals and doctors’ offices became more common by the mid-twentieth century, especially in coal towns where companies originally set up these medical facilities to serve workers, baby boomers recall that it was their Appalachian elders of the 1950s and 1960s who were the local healers in rural areas: they knew which plants to use to help heal a broken bone, act as a disinfectant, prepare for childbirth, and more (McCann, 2025).
23In terms of “racial” demographics, much of the Appalachian region is predominantly of Northern European origin (i.e., White). The absence of large-scale plantations due to the mountainous geography meant that smaller-scale farmers enslaved fewer people of African origin; but there have always been people of color in the region (Inscoe, 2001; Schwartzman, 2022). Some of those formerly enslaved found freedom in the more isolated areas, some stayed in the region following the Civil War and others moved up from farther south to work in the coal mines, creating rich communities despite the times of formal segregation (Harrison, 2024). Additionally, some indigenous people stayed in the region, despite the forced western migration of many American indigenous nations, with Cherokee, North Carolina in the Smoky Mountains [a distinct ecoregion of the larger Appalachian mountain chain] being the home of the Eastern Band of Cherokee Indians. Other indigenous Appalachians live outside Native Nation lands and account for about 2% of the population in West Virginia, for example (Brown et al., 2022).
24In the 19th and 20th centuries, industries such as coal mining recruited southern Black workers and workers from eastern and southern Europe, particularly Italy, to Appalachia as a source of labor in segregated mining towns. Living in a company town was problematic beyond the way that the places were segregated by “race,” ethnicity, and class: the companies in these coal towns owned everything, including housing and the currency, called “scrip,” which was good only at the company-owned store. However former residents enjoyed access to goods and services such as modern housing, fashionable store-bought clothes, and healthcare so long as they worked at the mines (Duff, 2005). This felt like a step-up from tenant farming in terms of access to goods and services, but the problem remained that poor people—Indigenous, Black, White, and immigrant alike—were unable to build generational wealth so important to class movement in the United States (Schwartzman, 2022).
25With the mechanization of the mines, as in the agricultural deep south, many African Americans left the coal fields for better opportunities in cities such as Chicago and Detroit. Those who stayed in historically Black communities in the Appalachian region were often caught in the double-bind of being poor like their White neighbors, but also being subject to racial discrimination and violence. Black feminist author bell hooks wrote about this in her book, Where We Stand: Class Matters (2000) in which she details the intersections of gender, “race,” and class. First, growing up in the foothills of rural Kentucky where she experienced discrimination that was particularly harsh from among poor White folks, and then after moving out of the region for college, experiencing classism for her rural upbringing, in addition to gender discrimination at home and in public.
26In terms of gender norms, Appalachia is widely perceived to be deeply patriarchal. On the one hand, research bears this out. In my own research on romantic relationships in later life, the older central Appalachian women I interviewed in 2009 espoused very traditional beliefs about gender (McCann & Allen, 2018). The single, heterosexual baby boomer women often felt frustrated by what they perceived as inequities in the gender bargain: namely, they were willing to be submissive, traditional wives for a man who would be a Godly (framed in Christian terms) head of the home and family. As they entered later life, however, most of the women did not trust the men in their communities to follow the gendered script of being hard-working, moral leaders.
27Despite their endorsement of traditional gender roles, older Appalachian women have been powerful political activists in the region (Duff, 2005). They have fought for the unionization and rights of coal miners alongside their husbands, sons, and fathers (Smith & Dotter, 2020); collaborated in community building as urban migrants (Torres, 2005); and in their younger working years rallied for equity in male-dominated employment sectors (Engelhardt, 2005).
Figure 3: Struggle Coon Branch: Still from The Struggle of Coon Branch Mountain, directed and edited by Mimi Pickering
This film documents their fight for a better road and decent schools by following the parents through community meetings, a march on the governor's office, and on to a partial victory and determination to continue the struggle.
© Appalshop
28Finally, the economy of Appalachia has rapidly changed with the growth of service economies and the healthcare sector. Although many people who are now older adults left southern and central Appalachia for work in Midwestern industrial cities, often these migrant workers returned “home” to Appalachia after retirement or migrated to and from the region during a downturn in the economy (Harrison; 2024; Lozier & Althouse, 1974). Others who worked in jobs related to coal mining or textiles, or in other declining industries, may have had to find careers in other industries such as retail or healthcare.
- 2 Note that different states have different titles and requirements.
29Arguably as an extension of the rich granny-midwife folk tradition (Scott, 2008), the contemporary healthcare industry has offered a variety of careers for people, depending on how much time and money they are willing and able to invest in training. Although people in central Appalachian counties are an officially recognized group underrepresented in research and in medical professions by the National Institutes of Health (NIH, 2019), there are avenues to healthcare careers widely available in the region’s community college systems. The licensing requirements to be a nurse’s aide2 takes about six weeks to complete and offers pay typically slightly above the minimum wage; a variety of two-year programs are offered through community and technical colleges (such as a medical lab technician) and offer higher wages; and registered nurses (RNs) require a four-year degree and give people access to careers with salaries above the median U.S. income. Not only are healthcare settings places where generations meet, but healthcare work can be a viable career for midlife and older women returning to the workforce after motherhood or to supplement retirement incomes. Early marriage and parenthood were common in southern and central Appalachia, so that entering college in midlife when children were older and women had more time to pursue higher education (Genco, 2007) gave some women a new trajectory in their life course.
30Generally, marriage and partnership patterns follow those in the greater U.S., which means that there is an increasing diversity in this domain. Cohabitation is a common alternative to marriage, and “interracial” marriage and childbearing is on the rise (Qian et al., 2018; Sassler & Lichter, 2020). In Appalachia, however, childbearing has historically happened at younger ages (Hale et al., 2022), and, although not condoned for the young and unmarried, having children outside the context of marriage is accepted. Thus, Appalachian people may enter grandparenthood in midlife (in their 40s) and may experience becoming great-grandparents and/or step-grandparents.
31The growth in small-to-medium-sized urban areas within the region, often due to investments by the ARC, have contributed to greater diversity in those areas. One study of “LGBT” older adults interviewed by researchers in a bustling Appalachian university town, none of whom were lifelong residents (Dakin, Williams & MacNamara, 2020), found that the full-time residents in the study (as opposed to retirees for whom Appalachia was their second home) tended to have supportive social networks both with close others as well as with neighbors. Work environments were more nuanced with some participants feeling the need to be discreet or hiding their sexual or gender orientation to minimize discrimination towards themselves or their partners/spouses. To that, a limitation of the study, as the authors discuss, was that their sample was recruited largely from organizations that were explicitly affirming (e.g., welcoming faith communities, list serves for “LGBT” residents). The perspective of lifelong Appalachian LGBTQ people who have remained in the region over time is missing from research; although accounts from arts communities (e.g., memoir writing) suggests that older LGBTQ Appalachian people typically left their rural homeplaces to find community in the region’s larger towns and cities.
32A positive aspect of modernization has been greater access to resources for people experiencing intimate partner violence. In my own work (e.g., McCann & Allen, 2018; Roberto & McCann, 2021) older Appalachian women have reported being able to exit violent marriages and partnerships because of the availability of women’s shelters in the region that provide temporary housing and act as an entryway for other services and information needed when starting over. Thus, a challenge for the contemporary elders is to retain positive aspects of our traditional culture while embracing changes that enhance egalitarian ideals.
33In life course theory, “linked lives” happen in the context of life course transitions (e.g., retirement, grandparenthood) and turning points (e.g., divorce, inheritance, addiction) which are often shared with close others (Gilligan, Karraker & Jasper, 2018). The salience of linked lives is especially true in Appalachia, where dense kin networks are characteristic of rural Appalachian families. Multiple members of an extended family often live in close proximity to one another on land that has been in the family for generations where they are able to share family and cultural knowledge.
34Despite rural Appalachia being known as a destination site for outdoor activity, and at least some stereotypes being associated with the ruggedness of the people, like other communities in the U.S. that struggle with poverty, central Appalachian towns often top the list for communities with poor health outcomes, particularly in regards to so-called “diseases of despair” (i.e., addiction/substance misuse, suicide, and alcoholic liver disease; Heffernan, Papanikolaou & Meit, 2023). In recent decades especially, older people in central and southern counties in Appalachia have been challenged by interlocking transitions including the opioid epidemic and high rates of disability. As I will discuss below, both the opioid crisis and health disparities highlight the importance of linked lives.
35Living full-time or part-time with a grandparent is not an uncommon experience in Appalachia, particularly if a child’s parents are unable or unavailable to provide care due to work obligations or a substance use disorder (Phillips & Alexander-Eitzman, 2016). In the region, colloquially, it is known as being “granny raised,” indicating that a grandparent, typically a grandmother, is the primary caregiver for a child. Beginning in the 1990s more and more grandparents found themselves raising grandchildren due to the opioid epidemic.
36The opioid crisis began with drug manufacturers marketing powerful, opioid-based pain killers to people in the Appalachian mountains where disability rates are high and chronic pain common (McGranahan & Parker, 2021). Despite the length of the crisis, recovery efforts have been fraught due to access to appropriate services, including lack of appropriate mental healthcare professionals and a lack of education and employment opportunities (Moody, Satterwhite & Bickel, 2017). This crisis-turned-epidemic has produced a generation of mountain families deeply affected by opioid misuse in tight-knit communities. From a societal and family perspective, in most cases, grandparents are an ideal choice when biological parents are unable to care for their children: first, these “grandfamilies” bring strengths to a challenging situation, such as a prior loving relationship with their grandchildren, stability in housing, and positive parenting techniques (Keller, Bi & Schoenberg, 2018); secondly, they keep children out of the overburdened and fraught foster care system in Appalachian counties (Welch, 2018). Given the importance of extended families in the Appalachian mountains, and lack of public options, grandparents became crucial sources of intergenerational care in the ongoing opioid pandemic.
37Due to a widespread lack of support for grandparents suddenly responsible for their grandchildren, after years of activism in the Appalachian region, the U.S. Congress passed two related acts to finally give grandparents, in particular, the legal and societal support they needed: the Supporting Grandparents Raising Grandchildren Act (2017) and the Recognize, Assist, Include, Support & Engage (RAISE) Family Caregivers Act (2018). These acts make explicit that grandparents and other family members are in the best position to care for minor children in their families and provide funding for programs and services for these mountain families that were especially hard hit by the opioid epidemic as a result of decades of economic and political exploitation resulting in high rates of disability and chronic pain (Pittman & Young, 2023). It is unknown how deep cuts in federal funding during the current Donald Trump’s presidential administration will affect this support to grandfamilies.
38Not only are older adults affected by the opioid epidemic by taking on parental roles later in life, but the opioid epidemic has left some frail older adults susceptible to elder abuse in the form of financial exploitation and neglect (Roberto et al., 2021). These relationships can be complex in that oftentimes family loyalties and interdependencies play a role in how opioid-related elder abuse cases play out (Roberto et al., 2022). Sometimes older parents have been providing help and support to adult children who struggle with illegal substance use for years. Then, over time, the situation reverses so that the older adult is gradually more dependent on their adult children who are unable to provide appropriate care to a vulnerable parent. Social workers and other family members who want to protect vulnerable older adults in mountain communities must carefully navigate these complex family relationships.
39Older people who are in a caregiving role in the Appalachian mountains put their own health at risk (Smith et al., 2022). In regard to frail older adults, those with lifelong ties to rural areas may embody competing discourses of not wanting to be a burden, yet refusing paid help (Skinner & Winterton, 2018). Family carers—who, often, are themselves older relatives such as spouses and siblings—may be caught in a double-bind of deferring to their relative’s wishes of not having outside help from home and community-based services and taking on increasing amount of care work to maintain their relative’s well-being and ability to age in place (Roberto et al., 2022). These issues around care for frail and vulnerable elders in Appalachia are similar to challenge mountain communities face around the world where fewer adults in a family are available to provide care work (e.g., Russel, 2024; Walsh et al., 2020).
40Additionally, services are often difficult to obtain in more isolated rural areas (Nah, Savla & Roberto, 2024), and are likely to become more difficult to access with recent cuts in federal funding. Researchers in Ohio compared perceptions of healthcare access and satisfaction of participants who lived in Appalachian counties versus non-Appalachian Ohio (Morrone et al., 2021). They found Appalachian people (average age of respondent was 69 years old) perceived there to be fewer health services available to their locale; also, Appalachian people felt less satisfied with health services. The researchers noted that in comments in the open-ended section of the survey, Appalachian people were more likely to cite discrimination from health professionals as a cause for their dissatisfaction compared to those not living in Appalachian counties.
41Regarding health promotion, Appalachian people tend to self-report better health than what objective measures of health risks show (such as being sedentary and having hypertension) (Griffith et al., 2011). Although self-reported measures are helpful for understanding people’s everyday feelings of well-being, they do not necessarily reflect the presence of disease (Geng & Calasanti, 2023). When focusing on age, one study found that in rural Appalachian Kentucky people over 60 were more likely to eat fruits and vegetables but get less physical activity as compared to adults under 60; however regardless of age, both groups fell well-below national averages for both fruit and vegetable consumption as well as for physical activity (Hoogland et al., 2019). The authors pointed out that changes in the regional economic structures, particularly from subsistence farming to an industrial and service economy, make healthy living difficult, such as having to commute long distances to work and having little time or opportunity to prepare home-cooked meals and exercise regularly. Other regional barriers include a dearth of parks, gyms, grocery stores, sidewalks, public transportation, and other infrastructure in small towns and rural areas in the mountains.
42Despite challenges, older adults have long been positioned as icons and culture bearers within Appalachia. As the second half of 20th century brought modernization to the region, ethnographers began to interview older people as they were seen as a way of preserving and recording cultural folkways that were in threat of being lost (e.g., Wigginton, 1972). For example, the popular Foxfire series began as a project in a classroom in the 1960s when students interviewed older relatives about regional technologies such as making cane-backed chairs, planting by the signs (i.e., gardening by the moon phases), and basic carpentry (Wigginton, 1972). The interviews were collected and published first as a journal then a book series. Today, the Foxfire books and magazines are the anchor of a regional folkways organization and cultural center. Also emerging from the folk revival of the 1960s and 1970s is Appalshop, which began as a local film production company. Their rich archive of film, photography, and other media feature the traditions and culture of central and southern Appalachia and often feature older adults. Although their building was devastated by flooding in eastern Kentucky in 2022, Appalshop has been adding digitized videos to YouTube for public viewing, in addition to their many other community-focused arts initiatives. These types of cultural productions seek to preserve and amplify older voices in the mountains.
Figure 4: Advertising poster for Appalshop's Annual Seedtime on the Cumberland Folk Festival
© Appalshop
43In response to challenges in 21st century Appalachia, several other programs and cultural movements have popped up over the last few years such as Appalachian Sustainable Development (focused on foodways); the Central Appalachian Living Traditions Program; published research, imprints, and series focused specifically on marginalized voices in the region; and a demonstrated interest in land stewardship using traditional and indigenous methods. People are once again looking to regional older adults as another folk culture revival is emerging in the mountains.
- 3 Note that hours vary by State and region.
44Many older Appalachians grew up learning to “plant by the signs,” which is an ancient system of using moon phases and astrological signs to guide the timing of starting seed, planting, weeding, harvesting, preserving and other activities related to both gardening and animal husbandry (Hall, 2023). More conventionally, Master Gardener programs operate out of county extension offices and provide local opportunities for older adults (and others) to build community through sharing their skills with others and learning new techniques. For certification, Master Gardeners must take upwards of 60 hours of courses and provide 50 hours of volunteer hours3, most of which must public-facing community education. Gardening and preserving food are important activities for many older adults in the Appalachian region that draw on generational skills and muscle memory. In the Hoogland and colleagues’ study discussed above (2019), over 40% of older adults were eating the recommended daily amount of fruits and vegetables. As the authors note, these older adults were likely to have grown up gardening and eating home-cooked meals. Food production and preservation continue to be a way that older adults contribute to Appalachian cultural heritage. This old knowledge intersects with the commonly held animistic beliefs among back-to-landers who have moved into the region to start farms and reconnect with nature. The resonance in worldview between older “inhabitants” and newer “residents” (Coggeshall, 2022) provides a potential point of contact between various groups of people living in 21st century Appalachia. As more and more older people in contemporary times seek out mountain areas for the retirement decades, more programs focused on common interests such as sustainable food productions and traditions could unite local and newcomers.
45Likewise, campaigns focused on folk culture in Appalachia—for example, “Folk is future,” a social media slogan from the radio show/podcast Inside Appalachia—is a promising example of how highlighting positive aspects of Appalachia can strengthen intergenerational ties. In addition to the possible benefits for economic developments focused on tourism and cultural enrichment, these kinds of initiatives play an important role in community development and heritage preservation and acknowledge the valuable contributions of older adults in the region. Mountainous regions, because of their historic relative geographic isolation, can be repositories of important cultural knowledge such as sustainable food production, practical arts and crafts such as textile work, and deep knowledge of local ecologies.
46In this paper, I have shown how unique life course events, such as the opioid epidemic, and changes in regional infrastructure, like the building of major highways, have radically changed the everyday lives of older Appalachians. At the same time, older people in this mountainous region also grapple with problems that are common among other older adult populations in the United States of America –– and elsewhere –– such as dementia caregiving and living with chronic health conditions, but more so (Marshall & Alcalde, 2023). Despite these cultural challenges, older adults are positioned to act as culture bearers for the mountain region; this role can provide a sense of purpose and contribute to the positive continuity of self and mountain culture, particularly in the face of health vulnerabilities and environmental concerns.
Figure 5: Snapshot of flooding in Kentucky 2022
© Appalshop
47A limitation of this paper is the absence of a discussion on the experience of recent migrants and refugees in the region, as well as mountain retirement communities, particularly those in and around larger urban areas such as Asheville, North Carolina, which was recently devastated by flooding. Given climate change, and the likely increase in natural disasters affecting the mountains, these communities warrant scientific investigation. It is important to understand the strengths and challenges of such communities, so that in the event of other disasters, grass-roots organizations and governmental agencies can be in the best possible position to help those affected. The scientific research regarding these communities is sparse, and not particular to ageing (e.g., Hilliard, 2022) but as I suggested above, renewed interest in folk traditions is an important way that various stakeholders can come together to build community as is evidenced by recovery efforts after Hurricane Helene (2024). Despite relatively poor infrastructure in the region, at the time of this writing, coalitions in the form of mutual aid groups (such as BeLoved Asheville, Mountain Mule Packers, Blue Jay Rising, and Holler2Holler), church congregations throughout the region, herbalist collectives, and many others have worked across cultural and political divides to bring resources to the city and surrounding devastated towns and vulnerable communities and individuals. Often these intergenerational groups are connected through informal networks focused on folk practices such as gardening, music, and other practical arts and technologies. This mutual aid work is more important than ever as the region loses federal funding under the current political administration.
48In sum, the Appalachian mountain region is a large and complex place. Ageing people in Appalachia would benefit from more resources as older adults provide key help in multiple domains in their communities, particularly in terms of providing care and support to vulnerable members in kin networks. Service providers such as social workers and mental health professionals should be aware that Appalachian older adults, in particular those in the more distressed counties, may be coping with multiple competing social demands in addition to their own physical and mental health challenges (Elliott & Ripley, 2021; Potter, Allen & Roberto, 2019). Building community capacity to help older adults, particularly in terms of opportunities for respite, can help older Appalachians see to their own physical, emotional, and spiritual well-being.