Important Cultural Issues

Due to their history, many Alaska Native older adults have been subjected to multiple sets of grief and losses as children. Many older adults may have been in orphanages, TB sanitariums, missionary schools, or government boarding schools where they may have suffered traumatic events. Health care providers need to consider these possible experiences during the intake, assessment, and treatment process. When Alaska Native older adults are institutionalized, they need to be provided with an environment that includes Alaska Native staff and Native foods. The elders need to be given the opportunity to speak their Native languages freely and encouraged to practice their cultural beliefs, ceremonies, and traditions.

Living Longer, but not Healthier

Data have revealed that there are more Alaska Native older adults living longer but not necessarily experiencing healthier lives. As the numbers of Alaska Native older adults increase, due to the lack of local resources many rural Alaska Natives are relocated to regional cities for long-term care. Traditionally, kin provided long-term care for elders, but increasingly there is a trend away from family caregivers due to increasing life span, smaller families, and geographic dispersion. The facilities are often located far from the home communities, which makes it difficult for family and community members to have meaningful interactions with the older adults. They may face problems with cultural and language barriers when removed from their community of origin.

Lack of Health Care Options

The lack of health care options for many rural Alaska Native older adults forces them to relocate and become disengaged from their role and function in their communities. This can negatively impact the individuals, their community, and their families. The “disengagement theory,” states it is normal and inevitable for the older adults to decrease their activity and seek more passive roles as they age. There is a “mutual withdrawal” between the older adults and society, and vice versa, which will insure the optimal functioning of both. Many have sharply criticized the theory of disengagement, and some argue that disengagement is not inevitable with old age (Hillier & Barrow, 1999).

Forced Disengagement

For Alaska Native older adults, removal from their communities and families appears to be a ‘forced disengagement’ of sorts. Alaska Native older adults do not reach a stage in their life whereby they are no longer making a contribution to their family, community, and tribe. They do not “retire” or disengage from society in the same manner as the older adult from the western society. Native Elders have an important role as a member of a collective society to act as the transmitters of cultural knowledge to the youth of their tribe, community, and family. When they are removed and they can no longer fulfill their obligation, there is a high probability that the survival and health of Native people will be negatively impacted.

Institutional Life

Native older adults who live in institutions are at risk when their traditional roles and activities are limited, yet when these activities are replaced with activities that build community and connect them with the local community, they will experience increased levels of mental, physical, and social wellness. This perspective states that activity is the essence of life, and that positive personal adjustment is connected to increased levels of activity (Hillier, S., Barrow, 1999). When they have opportunities to make contributions in this manner, the older adults and communities can benefit. Activities that build community and increase socialization can be utilized as well as traditional cultural activities such as berry picking, fishing, nature walks, gathering edible and medicinal plants, steam baths, and arts and crafts to enhance the spiritual, mental, and physical wellbeing of the older adults (Mills, 2002).

Long-Term Care

When planning long-term care for Alaska Native older adults, in-home services should be the least restrictive and in the most advantageous setting. Manson (1989) recommends that the most desirable setting for the care of older Indians is in their own or their families’ homes because a wide array of services have been developed that can facilitate independent living. Personal care services, homemaker services, and meals-on-wheels can be delivered in the home. These services reduce social isolation.


Alaska Native older adults belong to a collective culture which needs to be considered when designing programs. The members of collective cultures are interconnected and interdependent. Alaska Native elders come from a society that promotes reliance upon a close bond with family members and the community. The individual is not the focus; the group is the focus.