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Unique circumstances that affect aging for older Alaskan Native Adults

This presentation explores the unique circumstances that affect the aging process for older Alaskan Native adults, including historical trauma, disabilities, and cultural integration in care. Recommendations will be discussed for supporting this population. Questions and answers will be included.

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Unique circumstances that affect aging for older Alaskan Native Adults

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  1. Unique circumstances that affect aging for older Alaskan Native Adults 5th Annual Disability & Aging Summit September 26, 2019 Jordan P Lewis, Ph.D., MSW, CPG Professor UAA School of Social Work Director, National Resource Center for Alaska Native Elders

  2. Presentation Overview • About me • Population statistics • Adults with disabilities • Working with Elders and people with disabilities • Integrating culture in care • Recommendations • Questions and answers

  3. About me • Unangax/Aleut • Commercial fishing background • Raised among Elders in my family and community: • Great grandparents, late Paul & Anna Chukan • Grandparents, late Gordon & Anisha McCormick; Alden & Muriel Lewis • Elders in village of Naknek

  4. Projected growth rate of Alaska Native Elders • Alaska Native population is projected to grow steadily through 2045, from 143,868 in 2015 to 184,561 in 2045. •  The proportion of the Native population aged 65+ is projected to increase greatly between 2015 and 2045, rising from 7% to 12%. Alaska Department of Labor & Workforce Development, 2016

  5. Alaska Natives are living longer • Elders are living longer and healthier lives AND tend to have more chronic illnesses • Require extensive health care services and supports • Elders live in extended family environments • Elders are held in high regard by family and community • Elders are honored and cared for by family and community

  6. Elder’s history • Orphanages • Boarding School • Kill the Indian, save the white man • Forbidden to speak Native language, • Cut hair, disconnect from culture, family, community • Raised by extended family or foster parents • Family illnesses, death, relocation • TB Sanitarium

  7. Collective trauma across generations • Communally-based incidents that cause high levels of community distress within Native communities • Flu epidemic • Boarding schools Historical Trauma & Events Brave Heart (1995); Yellow Horse Brave Heart (2000)

  8. Common consequences include loss of: • Spiritual beliefs, culture, language, history • Family, community, unity • Connection to others and the world • Commonly associated diagnoses: • Anxiety • Depression • Substance abuse • Isolation, withdrawal • Psychological ramifications: • Unresolved grief and mourning • Suicide Impact of Historical Trauma

  9. Disability types comparing U.S. with Alaska  Data Source: 2017 Behavioral Risk Factor Surveillance System (BRFSS).

  10. Disability n Native Communities • At least 550,000 AIAN live with disabilities • 22% of AIANs has one or more disability; the highest rate in the U.S. population • Rate of disability for AIAN is 23% as compared to 18% for national average.

  11. Most common disabilities • Spinal cord injury • Diabetes • Blindness • Mobility disability • Traumatic brain injury • Deafness/hardness of hearing • Orthopedic conditions • Arthralgia

  12. Experience poorest health • Projected growth of minority elders is a public health issue: • Longer life spans= increasing costs for living and health care expenses. • According to the American Community Survey, 29% of AIAN live in poverty (nearly double the national rate, which is 15.9%)

  13. Challenges in Native communities • Attitude – we see disability and not the person • Lack of awareness, education • Rural transportation – lack of transportation in rural and remote locations • Rural infrastructure – unable to support access and accommodations for persons with disabilities • Public access – buildings not always accessible • Housing – not always able to meet needs • Advocacy – no centrally located services • Personal Care Attendance – lack of services

  14. Working with Alaska Native older adults and persons with disabilities

  15. Communication strategies Make eye contact Handshakes Information by word of mouth Pay attention to nonverbal/indirect communication Listen for indirect requests Withdrawal – sign of disapproval Humor

  16. Cultural Humility – Strategies • Acknowledge biases • Educating non-Natives on tribal differences, similarities, strengths, history • Person-Centered Care/Elder-centered care • Traditions, customs, beliefs • Communication (verbal, non-verbal)

  17. Integrating culture into care

  18. Communication strategies • Introduce yourself • Indirect requests • Non-verbal communication • Pace of communication • Comfortable with silences

  19. Engage family, community • Ask about family history • Ask about community history • Family is not always relatives • Seek permission to include family when appropriate

  20. Religious and Spiritual Preferences • At intake, ask about religious preferences • Engage family and others in discussions • Be comfortable with different forms of religious and spiritual practices • Dementia may impact religious beliefs and practices

  21. Subsistence Foods • Ask about favorite foods, recipes • Learn about food preparation, regional subsistence foods • Engage them in preparing subsistence foods • Food is an important part of family and community identity

  22. Community Engagement • Encourage older adult to stay connected to community, family • Attend local cultural events • Bring cultural activities and groups to their home • Read local Native news, watch videos • Connect with others from their community, region, family

  23. Recommendations • Offer culture-specific activities to engage residents and encourage interactions • Prepare and share traditional AI/AN foods • Incorporate the use of elders’ favorite recipes • Incorporate traditional dance and music • Provide opportunities for arts and crafts

  24. Recommendations • Encourage Native activities to be held in your facility so Elders feel included in community events • In-service training to educate health care workers in cultural diversity & humility • Engage Elders in activities, traditional foods preparation, and determining future programming • Encourage the involvement of family (of all ages) in Elders’ life and facility activities, as much as the Elder feels comfortable

  25. Conclusion: The Path to Healing • Create awareness • Acknowledge our fear • Educate others • Accept and understand differences • Compassion for others • Forgive and teach others • We need to build upon the strengths and resources in tribal communities. • We all possess unique strengths and talents to support elders and persons with disabilities.

  26. Thank you! Jordan P Lewis, CPG, MSW, PhD (Aleut) jplewis@alaska.edu (907) 786-6902

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