2013 GSA SYMPOSIUM: Optimal Aging and Evidence-based Research in Indigenous Populations

1. 2013 GSA SYMPOSIUM: Optimal Aging and Evidence-based Research in Indigenous Populations Wednesday, 11/20 to Sunday, 11/24Sheraton New Orleans • New Orleans MarriottNew Orleans, Louisiana

2. Overview • Inoi (prayer) • Waiata tapu (sacred song) • Context for LiLACS NZ • Waiora Port PhD • Paea Smith • Leiana Reipae Reynolds • Betty McPherson • Hone and Florence Kameta • Inoi (prayer to close) • Waiata tapu (sacred song)

3. He inoi (a prayer) offered by Hone Kameta E te Ātua kaha rawa, Our heavenly Father, we pray to you Whakatuwheretia mai na kuaha o te tika o te ora to open the doors of righteousness and glory. Mātou koe whakamoemiti e whaka kororia irunga i to ingoa tapu; We offer this pray in your blessed name Ake tonu atu. Āmine Forever. Amen

4. He waiata tapu-Whakaaria mai Whakaaria mai Tōu rīpeka ki au Tiaho mai Rā roto i te pō Hei kona au Titiro atu ai. Ora, mate, Hei au koe noho ai     

5. Te kaumātuatanga: indigenous ageing in Aotearoa, New Zealand INTRODUCING … Te RōpūKaitiaki o ngā tikanga Māori/Protectors of principles of conduct in Māori research, LiLACS NZ: Dr Mere Kēpa, Betty McPherson, Hone Kameta, Florence Kameta, Paea Smith, Leiana Reynolds, & Dr Waiora Port Corinthia Kēpa, Carer to Te RōpūKaitiaki Dept of General Practice and Primary Health Care, School of Population Health, Faculty of Medicine and Health Sciences.

6. In Aotearoa, New Zealand: context • The population of Māori men and women aged 65 years and over is increasing faster than non-Māori people. • The number of Māori aged 80 + years old will triple by 2026. • Statistics New Zealand reported that in 2012 approximately 5,000 Māori were aged 80 years and over; a 50% increase in number from 2002 • The advanced aged cohort will increase from 1% to 8% of NZ’s population by 2050.

7. Te puāwaitanga o ngā tapuwae kia ora tonuLife and living in advanced age: a cohort study in New Zealand, LiLACS NZ The only longitudinal study of Māori aged 80 plus years old

8. No routinely collected data on Māori LiLACS NZ is the world’s first longitudinal study of an indigenous population aged 80 plus years old During any one year of LiLACS NZ, one in ten of the cohort will die and one in five will be hospitalised for cardiovascular disease. Indigenous Māori ageing in Aotearoa

9. A narrow age band, 80 to 90yrs for Māori To make recruitment easier 85yrs for non-Māori. Designed to study environmental, social, cultural, health, family and whānau. Designed to study issues associated with ageing, wellbeing, and quality of life. LiLACS NZ commenced in 2010 preceded by the feasibility study, Reaching Advanced Age

10. Bay of Plenty region, North Island, NZ Equal explanatory power Māori and non-Māori Visit the participants every year until all of them have died Where and how?

11. Greater language and cultural engagement is associated with higher QOL for Māori Unmet social needs and discrimination are associated with lower QOL Significant observations …

12. 421 out 766 Māori, 80 to 90 years old (56%) Non-Maori 516 out of 870, 85 years old(59%) A total of 937 participants were recruited in 2010 Using scientific inquiry & kaupapa MāoriEngagement & recruitment

13. Kaupapa Māori approach to research is … a political method promoting and supporting research and education [health] for Māori by Māori, conducted in Māori ways including using te reo Māori me ngā tikanga/Māori language and culture. Reference Ngāha, A.B. (2011). Te Reo, a language for Māori alone? An investigation into the relationship between the Māori language and Māori identity. PhD Thesis. Māori Studies: University of Auckland (my brackets)

14. Kaupapa Māori involves .. Te RōpūKaitiaki o Ngā Tikanga Māori/Protectors of principles in the conduct of Māori research • Dr Waiora Port, Te Rārawa and Te Aupouri. • Paea Smith, Ngāti Apa and Ngāti Kahungunu; • Leianna Reynolds, Ngāti Rehia and Ngāti Tūwharetoa; • Betty McPherson, Te Rārawa; • Hone Kameta, Whakatōhea, Ngāi Tūhoe, and Te Arawa; and • Florence Kameta, Ngāi Tai and Ngāti Pōrou. Role: Governors, advisors, designers, translators, authors, presenters, parents, tribal leaders, community leaders, grandparents, great grand parents, & parents

15. Dr Waiora Port: explaining the term Kaumātua • Te Rāwara & Te Aupouri tribes from the Far North • Second language learner of te reo Māori • Great grandmother • Carer to her husband, Garth • Teacher & PhD (the University of Auckland) • Author

16. Dr Waiora Port: explaining the term Kaumātua • The term kaumātua has connotations of rangatira/ noble birth as well as chieftainship, and the term has become a title which some Māori use to describe leaders outside their own areas. • Kaumātua is an inclusive word describing both elderly male and female, in both the singular and plural. • The term can be used as a title, such as, Elder. • Kaumātua are the leaders of the whānau/extended family who made decisions concerning the working of family land, the control and use of family property, the rearing and education of children. The kaumātua was usually the recognised spokesman on behalf of the whānau in the forum of the marae/the ceremonial courtyard of the village.

17. Paea Smith: thinking about kaumātua and research • Ngāti Apa, West Coast, North Island; Ngāti Kahungunu, East Coast, North Island, Aotearoa • Widow • Great Grandmother • Former parliamentary secretary • Mother of 3 PhDs: 1Distinguished Professor//CEO, 1 Independent Māori researcher businesswoman, 1 Kai whakairo (Master Carver) • Researcher & author

18. Paea Smith: thinking about kaumātua and research What I love about the research … • Meeting with interesting kaumātua/people aged 65 plus years old around the world. •  Learning the statistics of the diseases that are prevalent among our people like diabetes, dementia, cancer, et cetera. •  Being part of any research that can help our people and future ones to come. •  Just being there to support the wonderful leaders of this project doing this work that is so valuable for generations to come. •  Being able to go between her and other organisations like the Māori Women’s Welfare League, and the Rōpū Kaumātua Kaunihera. •  Just being a Kaumātua!

19. Leiana Reipae Reynolds: an honour, a privilege, and research • Ngāti Rehia from the Far North & Tūwharetoa from the Central North Island of Aotearoa • Grandmother • Florist, landscape gardener, musician, & lead singer of Te RōpūKaitiaki • Researcher & author

20. Leiana Reipae Reynolds: an honour, a privilege, and research My grandparents’ time must have been difficult, for example, the drop-hole toilet, water pulled up from the Well; no power; walk or ride a horse to the far-distant school, hospital, and shops. Horses to plough the fields to grow their food and, seafood if they were close to the sea. My Papa and Nana died in their 60, many others a lot younger. My Mum and Dad had a better life with good jobs, a home with all the comforts including a flush toilet, transport, and their own car later in life. Dad died in his late 60s and Mum at 82 years of age. My husband, and I look back down memory lane and wish our loved ones were here to share our warmer, well-appointed homes. Barry is 69 and still happily working. I enjoy gardening. We are living longer, in better health, food is plentiful, transport is easy and we have the freedom of choice

21. Betty McPherson: kaumātua and LiLACS NZ • Te Rārawa tribe from the Far North of Aotearoa, New Zealand • Native speaker of te reo Māori me ngā tikanga • Widow • Great grandmother • Teacher • Researcher & author

22. Betty McPherson: kaumātua and LiLACS NZ • I am passionate about my work with LiLACS NZ. I love sharing my experiences with the elderly and as I am moving into that stage of my life it means so much to me. • I am also one of the team of 4 people responsible for translating the English language questionnaires into the Maori language. I have been involved with this project since 2007. • I was happily surprised to be interviewed for a feature article on ageing for, The New Zealand Herald and, to be asked for my opinion about studies associated with LiLACS NZ, for example, the nutritional studies. •  We participated in the feasibility programme and now we are completing Wave 4 and preparing for Wave 5.

23. Florence & Hone Kameta: Te Rautahi “many into one” • Ngāi Tai, Ngāti Pōrou, East Coast, North Island • Native speakers of te reo Māori • Grandparents • Husband, wife and, mates for years • Kai rangahau (Master Weaver) and Kai Kōrero (orator) • Masterate Candidate & Master of • Researchers & authors

24. Hone Kameta • Whakatōhea, East Coast, North Island; Te Arawa, Central North Island • Native speaker of te reo Māori • Grandfather • Husband to Florence • Rangatira/Chief • Lumberman, hunter, fisher, environmentalist, politician • Researcher & author

25. Florence & Hone Kameta: Te Rautahi marae • For Māori, the institution at the heart of Te Ao Māori (Māori society) is the marae (sacred gathering place of kin relations). The marae is a necessity for without a marae much of Te reo Māori me ngā tikanga (Māori language and culture) is missing. The marae is the place where the whānau, hapū, and iwi gather to pray to god; host our manuhiri (visitors); mourn our dead; listen to our Kaumātua recite our whakapapa (shared ancestry) and narrate stories from our past; and debate about what is going on in Te Ao Pākehā (New Zealand European Pākehā society) and Te Ao Māori. • On the marae, Māori people learn about our history and come to know about the richness of our life, and the proud heritage that is truly ours.

26. Message for indigenous researchers… Indigenous peoples’ pasts are companions of ageing …

27. A Prayer of Care & Service We offer you our handsto do your work.We offer you our feetto go your way.We offer you our eyesto see as you do.We offer you our tonguesto speak your words. We offer you our mindsthat you may think.Above all, we offer you our soulsthat you may love,your spirits, ancestors, and all people.We offer you our care and service… Kia ora.

28. He waiata tapu (sacred song) E hara i te mea No naianei te aroha No ngā tūpuna Tuku iho, i tuku iho (x2)

29. References Dyall, L., Kēpa, M., Teh, Ruth., Mules, R., Moyes, S., Wham, C., Hayman, K., Connolly, M., Keeling, S., Loughlin, H. Jatrana, S., & Kerse, N. (in review). Cultural and social factors and Quality of life of Māori in advanced age: Te Puāwaitanga o Ngā Tapuwae Kia ora Tonu. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ). New Zealand Medical Journal Kēpa, M; Kēpa, C.A; McPherson, B; Kameta, H; Kameta, F; Port,W; Loughlin, H; Smith, P; & Reynolds, L. (in review) E kore e ngāro ngā kākano i ruia mai i Rangiātea: The language and culture from Rangiātea will never be lost in health and ageing research. Journal of the Canadian Health Libraries AssociationSpecial Issue on Aboriginal Health Kēpa, M., Kameta, F., McPherson, B., Smith, P., Reynolds, L., Dyall, L., Kerse, N., Hayman, K., & Moyes, S. (2013). Donating a sample of blood tissue to research: Where to from there? Pacific Edge Transforming Knowledge Into Innovative Practice.  Research papers from the fourth Health Research Council of New Zealand Pacific Health Research Fono pp. 100-107. ISBN 978-1-877495-10-6

30. References Kēpa, M., Kerse, N., Dyall, L. (2012). Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu: Cultures and ageing. International Indigenous Research Development Conference Proceedings 2012, pp 158-166. Ngā Pae o te Māramatanga. ISBN 978-0-9864622-4-5. http://www.indigenousdevelopment2012.ac.nz Kēpa, M. Technical Report to Ngā Pae o te Māramatanga. Kaumātua: Taonga Aroha Project. The University of Auckland. http://www.ageconcern.org.nz/files/TechnicalReporttoNgaPaeoteMaramatangaJuly2011.pdf July 2011 Ngāha, A.B. (2011). Te Reo, a language for Māori alone? An investigation into the relationship between the Māori language and Māori identity. PhD Thesis. Māori Studies: University of Auckland (my brackets) Smith, G. H. (1997). The Development of Kaupapa Māori Theory and Praxis. Unpublished Doctoral Thesis. University of Auckland Smith, L.T. (1999) Decolonizing Methodologies. Research and Indigenous Peoples. University of Otago Press, Dunedin

31. Whakawhetaitanga Acknowledgements Corinthia Kēpa (Carer to Te RōpūKaitiaki), & Professor Ngaire, Kerse, Dr Lorna Dyall, Dr ‘Ofa Dewes, & Dr Ruth Teh,Dept of General Practice and Primary Health Care, School of Population Health, Faculty of Medicine and Health Sciences Dr Sela V. Panapasa & Dr James W. McNally, University of Michigan University of Michigan Mervina K.M. Cash-Kaeo, ALU LIKE Inc., S. Haunani Apoliona, Office of Hawaiian Affairs R. Turner Goins, Oregon State University, Charles B. Chen, West Virginia University, S. Melinda Spencer, University of South Carolina

32. Kaiutu Funders Professor Ngaire, Dept of General Practice and Primary Health Care, School of Population Health, Faculty of Medicine and Health Sciences, the University of Auckland Ngā Pae o te Māramatanga, New Zealand’s Indigenous Centre of Research hosted by the University of Auckland Te Whare Kura Indigenous Knowledges, Peoples and Identities, Thematic Research Initiatives, the University of Auckland Māori Health Research Grant, Health Research Council of New Zealand Sir John Logan Campbell Medical Trust, Auckland