Health Promotion Strategies
Should be based on areas of increased risk for American Indian, as well as risk for all elders.
American Indian elderly are at increased risk for: heart disease,
- vision problems due to retinopathy
- functional decline due to arthritis
- diabetic peripheral neuropathy
Most frequent causes of death for American Indian elders are at least partially preventable and could be addressed by development of culturally congruent education programs. Recent educational projects in Indian Country have indicated that it is necessary to use an intercultural collaboration model in both planning and implementation of patient education with the specific American Indian community to be served. In addition, elders have asked for one-on-one education with a trained provider, rather than written printed materials or educational lectures. Pictures, videos, and demonstrations rather than explanations have also been requested. “Doing” rather than “talking” has been a traditional way of teaching for many American Indians (Indian Health Service Research Conference, 2001).
Many older American Indian participate in Title VI food programs under the Older Americans Act. For many, it is the only meal they may have in a day. Commodities programs have provided such foods as cheese, peanut butter, lard, sugar, condensed milk, and white flour to contribute to an unbalanced diet. Many Indian communities are looking to re-create the more healthy diet of their ancestors, with squashes, melons, corn, beans, fruits, other vegetables, and some meat. Lamb, venison, and buffalo are used when available. Soups and stews are traditional dishes that may be nutritious and culturally appropriate.
Nutrition guidance is helpful for special diets, especially for diabetes and gallbladder disease, but care must be taken to use culturally acceptable foods, portions, and timing of meals, as well as food preferences and foods used in ritual and ceremony. Also, oral health and dentition is a major factor in nutrition and general health of the older American Indian.
In hospital settings the American Indian may wish to share hospital food with family and friends, and to eat food brought in by visitors. One recommendation is to accommodate these wishes whenever possible, as hospitality and generous sharing is a deeply held tradition. There is a saying in Indian Country that “you can’t refuse” food offered, and that “food is always offered” as an expression of “taking care of our people”.
Several programs have been implemented in Indian Country and in urban centers with varying results. Although exercise has always been a part of Indian life, in terms of daily activities and walking, exercise levels in today’s more sedentary lifestyle seems to be dependent on individual motivation. However, in most cases, a relatively high level of activity is maintained despite poor health or functional impairment.
The people of Zuni pueblo in New Mexico have developed an innovative approach to alcohol and substance abuse treatment in combining tribally ordered driver’s license suspension, counseling, community service, and a 30-, 60-, or 90- day mandatory physical work-out at the Zuni Wellness Program’s gym for driving while intoxicated arrest. Zuni also has extensive physical fitness programming for older American Indians.