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For rural-dwelling older people, becoming ill outside GP surgery hours is complex and the barriers faced are often insurmountable at times of greatest need. Worries about accessibility and lack of information give rise to a hesitancy to use GPOOH services in a population that is already known to be reluctant to ask for help, even when such help is justified. In turn, the lack of familiarity with what is a fundamental community health service further impacts the willingness of older adults to call on GPOOH services for help when needed. Addressing the impact of rurality on access and use of out-of-hours medical services is essential to enable more older adults to live longer in their rural homes and communities, supported by services that are responsive to their needs regardless of where they live. Given GPOOH is the only current alternative out-of-hours medical service to accident and emergency departments, more research is urgently needed on both accessibility of GPOOH services by older adults and the impact of inaccessibility on use of emergency services by older people in rural areas.

'Just lie there and die': barriers to access and use of general practitioner out-of-hours services for older people in rural Ireland