American Indians appear to have a lower frequency of dementia than other populations and are less likely to be institutionalized than older Whites or Blacks despite higher rates of chronic illness (Chapleski, et al, 1997). Orientation to the present time, taking life as it comes, and a general acceptance of physical and cognitive decline as a part of aging are believed to be contributing factors in caring for a cognitively impaired elder in the community (Ogrocki, et al, 1997). It has been suggested that American Indian caregivers differ from White caregivers in the use of “passive forbearance” as a coping strategy, which was not found with White caregivers. Also, American Indian caregivers did not expect to control or to be able to gain control of the situation of caregiving for a cognitively impaired elder, whereas the White caregiver did expect control, leading to anger and frustration (Strong, 1984).
It is unlikely that “memory loss” would be the presenting complaint of a cognitively impaired American Indian elder. The most common problems in one study were understanding instructions and recognizing people they know. Approximately 1/3 exhibited restless and agitated behavior all the time, and the two least common demented behaviors were wandering/getting lost or exhibiting dangerous behaviors to self or others (John, Henessey, Roy, & Salvini, 1996).
Concept of Caregiver Burden
The concept of caregiver burden is unacceptable in many American Indian cultures, and behavior by a person with dementia that may be considered inappropriate in Euro-American culture is accepted in the American Indian elder’s community without social stigma (Henessey & John, 1996). American Indian caregivers from the southwestern Pueblos reported that they “often felt inadequate dealing with behavioral difficulties” such as stubbornness, resistance to caregiving regimens and repetitive requests. However, cultural respect for elders with or without dementia does not allow for the direct expression of anger toward the elder or for infantilization witnessed in Anglo settings (John, et al., 1996).
The cultural incongruence of caring for an elder with cognitive impairment and the cultural values of non-interference, individual freedom, non-directive communication and respect for elders may increase stress felt by the caregiver significantly. Culturally appropriate support systems would be important resources for providers to offer as resources to American Indian caregivers.