The geriatric healthcare team for the Alaska Native older adult should include all health care providers valued and used by the patient and family, including a tribal doctor and other healers from non-biomedical traditions. Recognize, discuss, accept, and respect the differences in goals among the biomedical providers, traditional health care providers, and the older adult and family’s goals.
Medication Issues
Access to prescribed medications may depend on the Alaska Native older adult’s finances and the availability of the medication in the region, particularly in remote areas. Seeking treatment from a tribal doctor may be the first option for relief of symptoms, and possibly use of over-the-counter (OTC) drugs. A clinician may periodically assess the older adult’s medications and herbal plant use to prevent interactive adverse effects. Patients can be taught about medications (e.g., dose, frequency, and side effects) in either English or the older adult’s indigenous language. Explore the older adult’s plan for keeping track of her/his medications, and identify meaningful daily activities that can be used as a reminder for taking medications appropriately.
Surgical Interventions/Hospital Admission
The Alaska Native older adult may need to be transported out of the village to an urban area for more complex medical care. The situation creates a severe disruption to the older adult’s cultural and social support system. In some situations a family member may not be able to accompany the older adult, usually due to economic or family responsibilities. Clinicians need to identify a local Alaska Native network that can help keep the older adult culturally connected. Family members may contact a respected Alaska Native leader in the area to assist the older adult during the treatment period.
To comply with HIPAA regulations, the clinician needs to legitimize the Alaska Native leader’s role. This would pave the way for better communication between the healthcare team, the patient and family, and the Alaska Native community. Families who can be with the older adult must arrange their own air transportation, ground transportation, and lodging. Airline schedules are infrequent and expensive. Providers need to verbally acknowledge and appreciate the economic burden on the family when these efforts are made. When possible, refer the family for short-term support to help with these expenses.
