The graying of America is inescapable. The U.S. Census Bureau projects people over 65 will outnumber those under 18 for the first time in history – 77 million vs. 76.5 million – and comprise 21% of the population. We’re aging as a nation, but lifespan differs depending on a someone’s racial/ethnic background, socio-economic status, lifetime access to health care and other factors.
American Indians and Alaska Natives (AI/ANs) are two groups whose longevity and health span are especially affected by these influences. While the AI/AN older population will more than double by 2060 to 648,000, AI/ANs have a lower life expectancy, lower quality of life, and are disproportionately affected by many chronic conditions when compared with other racial/ethnic groups, according to the CDC.
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AI/ANs born today have a life expectancy that is 5.5 years less than the average U.S. population (73.0 years to 78.5 years, respectively, according to the Indian Health Service.
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AI/ANs also have higher death rates for most of the top leading causes of death and in most age groups compared with whites, Blacks and Hispanics.
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Factors affecting AI/AN lifespan:
– Multiple comorbidities, e.g., cardiovascular disease and diabetes
– Obesity
– Poverty
– Food deserts/Food insecurity
– Housing
– Crime
– Education level
– Physical activity level
– Tobacco and alcohol use
– Illegal drug use
However, genetics only plays a small role — less than 7% of variation in how long people live is because of genes, according to recent studies.
Chronic conditions among AI/AN populations
The top five leading causes of death for AI/AN men age 65 and older in 2018 were:
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Heart disease
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Cancer
- Chronic lower respiratory diseases
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Diabetes
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Stroke
For AI/AN women, heart disease, cancer, and chronic lower respiratory diseases were also the leading causes. Women suffered from more strokes than men and had fewer diabetes-related deaths, according to the Administration for Community Living.
Heart disease among the AI/AN population is very high compared to their white counterparts due to risk factors such as obesity, hypertension and smoking.
- Obesity. Over one in three AI/AN adults 50 and older are obese. Two of every three AI/AN older adults do not engage in monthly physical activity.
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High blood pressure. AI/ANs are 30% more likely to have high blood pressure.
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Smoking. AI/ANs are 20% more likely than other groups to smoke (They have the highest prevalence of all racial/ethnic groups in the United States.)
One in three AI/ANs in their 50s and one in four in their 60s still smoke cigarettes; the percent usually declines with age in other groups.
Contrary to some stereotypes, AI/AN populations do not consume alcohol more than other groups. Their consumption levels were comparable or lower when compared with whites.
Access to quality care, including preventive care, looms large across their lifespan. This population reports a lower prevalence of having a personal doctor or health care provider (63.1%) than did whites (72.8%) Older AI/AN adults (65 and older) are more likely to have difficulty accessing health care than their peers of the same age in the non-AI/AN U.S. population.
Reasons why health care access can be challenging
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A lack of trust in government health systems.
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Difficulty accessing transportation or long distances to health care facilities.
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The Cost of health care and prescriptions.
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Being underinsured: a large majority of AI/ANs 65 and older have Medicare, yet many may qualify for but not be enrolled in programs such as Medicaid or Medicare Savings Programs.
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Discrimination/lack of culturally appropriate care: Available health care providers may not speak native languages, be aware of traditions or address older adults respectfully and in a culturally-sensitive way.
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A lack of accurate health information, especially on Alzheimer’s and neurological diseases
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A lack of proximity to family and caregiving services, especially for those living on tribal lands or on rural reservations.
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More than half (56%) of AI/ANs aged 50 and older do not live on tribal land. That may increase difficulty accessing culturally-relevant services and supports.
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Younger AI/ANs are more likely to reside in urban vs. rural areas.
Issues that affect other aging populations that also affect AI/AN elders
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Lack of care workers – both family caregivers and direct care workers (equity issues)
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Lack of housing options – nursing homes, assisted living and senior communities are costly or unavailable
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Unsafe housing/home environments – disrepair, stairs, clutter
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Waiting lists for home and community services
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Transportation issues
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Food nutrition
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Abuse/neglect
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Elder fraud
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Loneliness/social isolation
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Widow/widowerhood – loss of income, standard of living, friends,
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Lack of affordable, easily accessible age-friendly programs and services
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Ageism in society (old is bad/young is good mindset)
Some aging challenges disproportionately affect AI/AN elders
One in every four elders of all backgrounds age 65 and older, falls. Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death, according to the CDC.
AI/AN elders report the greatest percentage of falls (34.2%) of all races/ethnicities. A 2012-2016 survey by the New Mexico Behavioral Risk Factor Surveillance System found that one in three American Indian elders age 45 and over in New Mexico fell at least one time in the past year and 45% of those who fell were injured.
Why so many falls?
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Diabetes and other chronic illnesses are key culprits. For example, diabetic neuropathy leads to loss of feeling in the lower extremities.
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Diabetes also increases odds of osteoporosis, meaning a higher risk of injuries and fractures from a fall.
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AI/ANs also have higher rates of other chronic illnesses, which increases the risk of dying from a fall.
Heart disease
In 2018, AI/ANs were:
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50% more likely to be diagnosed with coronary heart disease than their white counterparts.
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50% more likely to be cigarette smokers as compared to non-Hispanic whites.
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10% more likely to have high blood pressure compared to non-Hispanic whites.
Cancer
A/IAN populations in the United States have unique cancer patterns because of their history and culture, where they live, how they get health care and institutionalized racism. For example, rates of getting lung, colorectal, liver, stomach, kidney, and other cancers are much higher compared with non-Hispanic white people in the United States.
While the CDC routinely links cancer registry data and death certificate data with Indian Health Service registration data to identify Native people correctly, they are often misreported as members of other racial groups.
AI/AN-specific programs to familiarize yourself with
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Native American Family Caregiver Support Program -This program is for caregivers of older people, those with Alzheimer’s disease and related neurological disorders or grandparents raising grandchildren. This program provides education, assistance, case management, emotional support and resources, training, respite care and some supplemental services like assistive technology.
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WELL-Balanced (Wise Elders Living Longer) – WELL-Balanced is a group program designed specifically for Native American elders. The program uses exercise, information, and social interaction to help elders remain active and independent in their own homes as long as possible and covers fall prevention, chronic disease management, socialization and strategies for independent living.
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The Healthy Brain Initiative (HBI) Road Map for Indian Country – a guide for AI/AN leaders to learn about dementia and start discussions throughout their communities. The guide offers an introduction to Alzheimer’s disease and other dementias and highlights data from Indian Country that help define the challenge of dementia across these communities. The Road Map for Indian Country suggests eight strategies that embrace
Federal agencies and programs
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CDC American Indian Adults and Caregiving (2017 data)
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Centers for Medicare & Medicaid Services American Indian/Alaska Native Center
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Indian Health Service Elder Care Initiative, 413-584-0790
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National Indian Council on Aging, 505-292-2001
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Native Elder Service Locator *(interactive map)
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Profile of American Indians and Alaska Natives Age 65 and over (Administration for Community Living – 2017 data)
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The Native Wellness Diabetes Program of CDC’s Division of Diabetes Translation
Organizations and research centers
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The Healthy Brain Initiative (HBI) Road Map for Indian Country (Alzheimer’s Association)
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Center for Rural Health, Univ. of North Dakota School of Medicine & Health Sciences
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National Resource Center on Native American Aging (NRCNAA), University of North Dakota
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Colorado RCMAR specializes in Native American issues
Story ideas
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Why is there a need for culturally appropriate care that honors and respects traditions?
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What are the federal government, states and tribal nations doing to address disparities in longevity, such as the high incidence of chronic diseases/multi-morbidities and lack of quality preventive care?
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How are home and community based services/programs affected, particularly in states that have not expanded Medicaid?
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What is being done to address the family caregiver shortage on tribal lands?
Experts
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Larry Curley is executive director of the National Indian Council on Aging.
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Fawn Sharp is president of the National Congress of American Indians (contact press office: NCAIpress@ncai.org)
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Collette Adamsen, Ph.D., is director of the National Resource Center on Native American Aging.
