The International Association for Indigenous Aging (IA2) applauds the release of the Institute of Medicine’s (IOM) most recent report: Cognitive Aging: Progress in Understanding and Opportunities in Action. The IOM identified a number of issues relative to the prevention, assessment and treatment of cognitive disorders (including Alzheimer’s disease) specific to minority populations.
- People from racial or ethnic minority backgrounds might not do as well on certain tests as the rest of the population, even though their cognitive ability being tested may be perfectly intact.
- Nationally representative surveys and studies often have too few people with similar characteristics to assess regional or local variations with the precision needed to inform public health decisions or explore less common minority, nationality, or language groups.
- Nationally representative surveys and studies often have an insufficient sample size to explore less common minority, nationality, or language groups with the precision needed to affect public health decisions; understanding these groups in any detail usually requires separately targeted surveys or expanded samples or subsamples.
The report also raises the question of how to ensure an adequate representation of racial, ethnic, national, and non- English-speaking minority individuals in future work.
Earlier this year, IA2 published an article in the Gerontologist’s special White House Conference on Aging edition about the impact of the crises of dementia and depression on American Indians and Alaska Natives (AIAN). Using dementia and depression as examples of how Native Americans continue to be perceived and treated as an invisible minority–particularly the nation’s Native elders.
The population of AIAN seniors is projected to quadruple in the coming decades, a pace of growth faster than white or other minority populations. Yet, health care policies and systems needed to provide adequate support and care generally fail to receive adequate funding or attention.
The United States has a well-established Federal Trust Responsibility to provide for the care of AIAN people, and it routinely falls short of fulfilling its responsibility, as AIANs continue to experiencing chronic, devastating disparities in care. The IA2 article cited a number of recommendations, several of which align with the IOM report recommendations:
- The federal government should conduct or sponsor studies of the prevalence and incidence rate of depression and dementia among the AIAN population, including those who reside within tribal lands and those who do not (the preponderance of AIANs). Ideally, support would come from the National Institutes of Health in collaboration with the Indian Health Service (IHS).
- The federal government should support or otherwise undertake a comprehensive review of the state of elder health specifically including mental among the nation’s AIAN population.
- IHS should eliminate Years of Productive Life Lost (YPLL) as a metric or create metrics to measure progress in health outcomes among the nation’s elderly AIAN population.
- The IHS, the Administration for Community Living/Administration on Aging, and other agencies dedicated to serving the older AIAN populations must ensure an adequate commitment to the health needs—including those related to depression, dementia, and other forms of mental health – of AIAN elders.
- Policymakers should amend Title VI of the Older Americans Act (OAA) to ensure Title VI providers have capacity to provide accurate and relevant education to elders about depression, dementia, and other mental health needs and that they are knowledgeable about tribal and nontribal resources available to respond to such needs including diagnosing and providing appropriate treatment or care for such conditions.
- Policymakers should amend the AIAN part of the OAA’s National Family Caregiver Support Program to ensure that AIAN caregivers have training, educational, and other forms of support for dealing more effectively with depression, dementia, and other mental health needs of family members and others for whom they provide caregiving services.
- Federal policy should catch up with the extraordinary demographic shift of AIANs from reservations and tribal lands to urban areas. Federal agencies not dedicated to serving tribal communities must recognize that their constituents include growing numbers of urban-dwelling AIANs, many of whom are severely disadvantaged or otherwise invisible to the health and service systems in U.S. cities. Agencies such as the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (HRSA), and the Administration for Community Living must ensure their programs respond to the mental health needs of nonreservation-dwelling AIANs.
- The existing Indian health care delivery system (I/T/U), should develop and improve the capacity of clinical and social service staff to recognize, identify, and treat depression, dementia, and other mental health issues among elderly AIANs.
- Providers working outside the I/T/U system should develop and improve the capacity of clinical and social services staff who serve AIAN elders to recognize, identify, and treat depression, dementia, and other mental health issues.
- Policymakers should develop a national research agenda that is focused on identifying and evaluating effective culturally appropriate interventions that can be employed by clinicians and community social services for diagnosing and managing dementia, depression, and other mental health disorders in the AIAN population.
We encourage policymakers, legislators and advocates to heed the recommendations cited in both the IOM report and the IA2 article and begin the process of working together to make real progress in addressing these issues.
Contact: Dave Baldridge, dave@iasquared.org
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