NATIVE AMERICAN ELDERLY
 
  Native Americans are a very heterogeneous group, made up of approximately 530
different tribes. Of these, 280 reside on reservations, which accounts for
approximately 50% of Native Americans in the United States (Wise & Miller, 1983).
Reservation tribes differ between themselves, in customs, language, and family
structure. In addition, Native Americans, in general, differ greatly in their
degree of acculturation (adoption of mainstream society's values and ways of
life), having to do with whether or not they live on reservations (Sue & Sue,
1990). This cultural variance, in turn, includes values and tribal identities that
are different from those of most other Americans, who often do not understand
many of the rituals, beliefs, and kinship differences (Axelson, 1985).
Traditional Native American values can come into conflict with those of the mainstream,
particularly when efforts are not made toward exploring and understanding these
differences within their cultural
context. As a result, inaccurate and/or overgeneralized stereotypes may be
perpetuated, further complicating attempts to care for and provide services to
Native American elderly.
  Relationships are also a key part of Native American life, particularly
regarding the family. Group sharing of knowledge and responsibilities is integral to
the Native American lifestyle. Generosity is valued, especially in helping
others who are less fortunate. According to Native American tradition, equality of
position, title, or material possessions (Axelson, 1985). Native Americans are
also taught not to interfere with others; direct eye contact, particularly
with an elder, is traditionally considered a sign of disrespect.
  Concerning the aging process, elders are respected for their knowledge and
experience. In fact, in traditional families, it becomes their responsibility to
pass down their wisdom and learning to the young. All members of a tribe care
for the elderly. Death is an accepted fact of natural life, not to be approached
with fear. The soul is believed to be immortal, in the sense of experiencing a"changing of worlds"
  The world in Native American culture is interconnected -- everything,
including human beings, is believed to live according to the same process. Each being
has its own unique function and place in the universe, and every part of nature
contains a spirit. While mainstream society has attempted to
overcome/overpower nature, and tends to make material comfort an end goal in itself, Native
American culture seeks a balance with nature wherein both can benefit from and support one another.
  Also important to recognize is that time takes on new meaning in Native
American culture. They do not traditionally "go by the clock." Rather, time is
measured according to natural phenomena such as the changing of day to night and
seasonal change. The "right time" is, in general terms, viewed as when one is
ready (Axelson, 1985), and living in the present takes precedence over planning forthe future
  Within the context of the four universal objects, discussed above, the role
of family emerges as an important factor in Native American culture and, thus,
in developing relationships with their elders. As noted, family structure may
vary from tribe to tribe. However, generally speaking, Native American families
are characterized by a strong role for women and dependence on extended family
support (often through second cousins) versus mainstream society's reliance
primarily on the nuclear family for help.
  RISK FACTORS: Several concerns complicate the picture of Native American
caregiving and service provision. For instance, the overall life expectancy of the
Native American is shorter than that of all other U.S. races: 65 years for
Native Americans; 73.3 for non-native Americans (National Indian Council on Aging,
1981). This means that the average Native American barely lives long enough to
reach the age of eligibility for most age-related programs (Bane, 1992). Of
further concern is evidence indicating that Native Americans experience the same
limitations in their daily living at age 45 as do non-Native American people at age 65.
  One condition many Native Americans struggle with, often from early
adolescence, is that of substance abuse. Statistics, in fact, reveal death from
alcoholism to be 6 ½ times greater for Native Americans than in the general population
  Suicide rates for Native Americans are also twice that of the national
average, the greatest risk period being between adolescence and adulthood (Shore,
1988). In addition to economic strife and discrimination, such lifestyle evidence
would suggest that a great many adults entering their later years are survivors
of significant stressors, often throughout life, great enough to take a toll
on their physical and mental health. This situation is often compounded by
adherence to a set of cultural beliefs, values, and practices which can make outside
intervention difficult at best.
  REACHING NATIVE AMERICAN ELDERLY: Studies have indicated that reaching and
assisting Native American elderly may be difficult for an number of reasons, in
addition to those highlighted above. For instance, over 80% of Native American
elderly do not have telephones, and the majority do not receive newspapers or
have television sets (Bane, 1992). Additionally, as tradition dictates, knowledge
and assistance is passed from elders to the young, primarily through the
family. Thus, even information and help reaching the Native American elder may not
be as openly received from an outsider, especially if they are much younger.
  Several guidelines have been proposed in attempting to meet the challenges of
the Native American experience, applicable to elderly care provision as well.
First, and foremost, approach the elder with an attitude of acceptance and
unconditional positive regard for their cultural heritage and experience. Attempt
to understand problems and concerns from the individual's perspective, allowing
the Native American elder to explore his or her own values (rather than
imposing one's own) in arriving at solutions . These qualities, of
course, apply to all elders, but may be especially critical for establishing a
relationship with Native American elders who have been living on reservations
their entire lives, and thus have been isolated from mainstream society.
  Because self-disclosure about personal concerns to someone outside of the
family is not traditionally done
 Do not expect direct eye contact, or take the lack of such to mean the elder
is not paying attention. Do not expect the elder to disclose personal details
on command. Confrontation should be kept to a minimum. Whenever possible use a
family or group treatment method. Anticipate difficulty in compliance with time
commitments and/or compliance with treatment, especially for elders of more
traditional descent