Clinical Assesment: Health History

Many Alaska Native older adults grew up in a period when social and cultural bonds were severely damaged.  They believe the soul and psyche of generations of Alaska Natives inherited the pain, loss, and frustration of their ancestors. A mental health assessment must be a component of the health history with an emphasis on the psychological and emotional strengths of the Alaska Native older adult, such as resiliency, patience, praying for guidance, and other cultural values of the different Alaska Native cultural groups. Allow for telling stories to collect the needed clinical data and give ample time.

Clinicians need to assess for behavioral and emotional symptoms that may be associated with untreated or ongoing post traumatic stress disorder (PTSD) among veterans, specifically those of WWII, the Korean conflict, and Vietnam War. In rural Alaska, there are aging Vietnam veterans and their family members who are living with PTSD who are now in their late 50s and well into their 60s.  Suicides in these communities have been reported. Some American Indian groups in the Continental U.S. have formed Warrior Societies to honor their Vets and help those with PTSD (Kanaqlak-Charles, 2007). It is recommended that providers recognize and screen for these continuing illnesses and support Alaska Native Vet groups who make referrals.

Possible issues around older adult abuse may emerge during the assessment, especially when performing a physical exam (Section 2.b.), evaluating cognitive and affective status (Section 2.c.), evaluating functional status (Section 2.d.), and performing a family assessment (Section 2.e.). Elder abuse must be differentiated from historical trauma, although the later may be a risk factor for older adult abuse. Physical signs (bruises, burns, etc.) and/or behavioral symptoms (e.g. depression) would merit further investigation (Tatara, 1999).