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BACKGROUND American Indians have excess risk of depression, which can contribute to cerebrovascular and cognitive disability, with effects on memory, processing speed, executive function, and visuospatial ability. However, studies examining depression and cognition in American Indians are limited; this study aims to report associations of depression with general cognition, verbal fluency and memory, and processing speed. DESIGN Cohort study. SETTING The Cerebrovascular Disease and its Consequences in American Indians study was an ancillary examination of Strong Heart Study participants from 3 U.S. regions. PARTICIPANTS All eligible were included in this analysis (N=818). MEASUREMENTS Participants completed evaluations for depressive symptomology, cognition, and physical function—including Center for Epidemiologic Studies Depression (CESD), Modified Mini‐Mental State Examination (3MSE), Wechsler Adult Intelligence Scale‐Fourth Edition coding (WAIS), Controlled Oral Word Association (COWA), California Verbal and Learning Test, Halstead finger tapping, grip strength, and Short Physical Performance Battery (SPPB) tests. Linear mixed models were adjusted for site, age, sex, education, income, marital status, alcohol, smoking, diabetes, hypertension, obesity, cholesterol, stroke, infarct, and hemorrhage. RESULTS: Symptoms of depression were common, with 20% (N=138) endorsing CES‐D scores of 16+. More depressive symptoms were associated with older age, female sex, lower education, lower income, non‐married status, not using alcohol, not smoking, hypertension, diabetes, and stroke. In adjusted analyses, processing speed (WAIS: β −0.13, 95%CI −0.25, −0.03), general cognition (3MSE: β −0.10, 95%CI −0.17, −0.03), verbal fluency (COWA: β −0.10, 95%CI −0.19, −0.01), and motor function (SPPB: β −0.05, 95%CI −0.07, −0.03) were significantly associated with more symptoms of depression. CONCLUSION: These findings maybe informative for health disparities populations, especially those with depressive risk. Clinicians may require particular training in cultural humility. Future studies should validate use of the CES‐D scale in this population; longitudinal studies may focus on causal mechanisms and potential secondary prevention, such as social support. J Am Geriatr Soc 68:1739‐1747, 2020. [ABSTRACT FROM AUTHOR]

OBJECTIVES: American Indians experience disproportionately high rates of poor mental health and type 2 diabetes mellitus (T2DM). We examined the association between depressive symptoms and all‐cause mortality in older American Indians with T2DM. DESIGN: We used the Native Elder Care Study survey data from community‐dwelling American Indians aged 55 years or older, linked to data extracted from participants' electronic health records. We focused on those who had an International Classification of Diseases‐Ninth Revision diagnosis of T2DM in their electronic health records. SETTING: The study was conducted with a federally‐recognized tribe with approximately 16,000 enrolled members, most of whom reside on or near tribally‐owned lands that span several rural counties. PARTICIPANTS: Participants were among the Native Elder Care Study participants with a final analytic sample of 222. MEASUREMENTS: We measured depressive symptoms with the Centers for Epidemiologic Studies‐Depression (CES‐D) scale. We used Cox proportional hazard models to examine the association between depressive symptoms and all‐cause mortality in the final analytic sample of 222 subjects. RESULTS: Survival curves revealed that individuals in the third and fourth CES‐D scale categories had higher mortality than those in the first and second categories. Mortality risk was significantly higher for participants with CES‐D scale scores in the third highest compared with the lowest category (hazard ratio = 2.07; 95% confidence interval = 1.07‐4.04), after adjustment for demographic characteristics, health behaviors, obesity, and prevalent T2DM complications. Analyses with the CES‐D scale as a continuous variable also showed a positive association with mortality. CONCLUSION: The impact of mental health on older American Indians with T2DM is often overlooked, yet it is vital to clinical and public health practice. Our findings underscore the importance of addressing the mental health needs of this population, particularly because depression in older patients is often undetected or inadequately treated. J Am Geriatr Soc 67:1940–1945, 2019 [ABSTRACT FROM AUTHOR]

Background/Objectives: Home‐based primary care (HBPC) is a comprehensive, interdisciplinary program to meet the medical needs of community‐dwelling populations needing long‐term care (LTC). The U.S. Department of Veterans Affairs (VA) expanded its HBPC program to underserved rural communities, including American Indian reservations, providing a “natural laboratory” to study change in access to VA LTC benefits and utilization outcomes for rural populations that typically face challenges in accessing LTC medical support. Design: Pretest‐Posttest quasi‐experimental approach with interrupted time‐series design using linked VA, Medicare, and Indian Health Service (IHS) records. Setting: American Indian reservations and non‐Indian communities in rural HBPC catchment areas. Participants: 376 veterans (88 IHS beneficiaries, 288 non‐IHS beneficiaries) with a HBPC length of stay of 12 months or longer. Measurements: Baseline demographic and health characteristics, activities of daily living (ADL), previous VA enrollment, and hospital admissions and emergency department (ED) visits as a function of time, accounting for IHS beneficiary and functional statuses. Results: For HBPC users, VA enrollment increased by 22%. At baseline, 30% of IHS and non‐IHS beneficiaries had 2 or more ADLs impairments; IHS populations were younger (P < .001) and had more diagnosed chronic diseases (P = .007). Overall, hospital admissions decreased by 0.10 (95% confidence interval (CI) = −0.14 to −0.05) and ED visits decreased by 0.13 (95% CI = −0.19 to −0.07) in the 90 days after HBPC admission (Ps < .001) and these decreases were maintained over 1 year follow‐up. Before HBPC, probability of hospital admission was 12% lower for IHS than non‐IHS beneficiaries (P = .02). Conclusion: Introducing HBPC to rural areas increased access to LTC and enrollment for healthcare benefits, with equitable outcomes in IHS and non‐IHS populations. [ABSTRACT FROM AUTHOR]

Background: More than six million American Indians live in the United States, and an estimated 1.6 million will be aged ≥65 years old by 2050 tripling in numbers since 2012. Physical functioning and related factors in this population are poorly understood. Our study aimed to assess lower body functioning and identify the prevalence and correlates of "good" functioning in a multi-tribe, community-based sample of older American Indians.Methods: Assessments used the Short Physical Performance Battery (SPPB). "Good" lower body functioning was defined as a total SPPB score of ≥10. Potential correlates included demographic characteristics, study site, anthropometrics, cognitive functioning, depressive symptomatology, grip strength, hypertension, diabetes mellitus, heart disease, prior stroke, smoking, alcohol use, and over-the-counter medication use for arthritis or pain. Data were collected between 2010 and 2013 by the Cerebrovascular Disease and Its Consequences in American Indians Study from community-dwelling adults aged ≥60 years (n = 818).Results: The sample's mean age was 73 ± 5.9 years. After adjustment for age and study site, average SPPB scores were 7.0 (95% CI, 6.8, 7.3) in women and 7.8 (95% CI, 7.5, 8.2) in men. Only 25% of the sample were classified with "good" lower body functioning. When treating lower body functioning as a continuous measure and adjusting for age, gender, and study site, the correlates of better functioning that we identified were younger age, male gender, married status, higher levels of education, higher annual household income, Southern Plains study site, lower waist-hip ratio, better cognitive functioning, stronger grip strength, lower levels of depressive symptomatology, alcohol consumption, and the absence of hypertension, diabetes mellitus, and heart disease. In our fully adjusted models, correlates of "good" lower body functioning were younger age, higher annual household income, better cognitive functioning, stronger grip, and the absence of diabetes mellitus and heart disease.Conclusions: These results suggest that "good" lower body functioning is uncommon in this population, whereas its correlates are similar to those found in studies of other older adult populations. Future efforts should include the development or cultural tailoring of interventions to improve lower body functioning in older American Indians. [ABSTRACT FROM AUTHOR]

This article outlines a framework the authors have used to infuse sustainability study into humanities teaching at the middle school level. Native American tribal elders can act as co-teachers in such classrooms, and the place-based stories that shaped their views of the environment can serve as important classroom texts to investigate sustainable philosophies. Middle school students can learn to read with a sustainable lens and learn to use the narrative wisdom of tribal elders to read across texts for sustainability themes and messages. Respect for Native American culture flourishes in such an environment. Examples of Native American storied resources for sustainability are offered in this article. [ABSTRACT FROM AUTHOR]

In this phenomenological study 11 Native American elders addressed three research questions: (a) the effect of historical trauma on self, family, and community; (h) how historical trauma currently affects Native people and their communities; and (c) what they would recommend that counselors and therapists do in addressing issues of historical trauma for Native and tribal people. All participants spoke of historical trauma in terms of loss of tribal language and culture. They seemed to speak directly to Native people themselves as having the answers to healing and wellness for their own people; however, recommendations for nontribal people who work with Native people and communities were discussed. [ABSTRACT FROM AUTHOR]

Effective foodways transmission is critical to maintain the food sovereignty of indigenous peoples. In order to determine their own foodways, indigenous communities have developed diverse systems to convey knowledge related to the procurement, preparation, distribution, and consumption of food. In recent years, community organizations are taking a more active role in facilitating foodways transmission. In the Standing Rock Nation of the northern Great Plains, several community organizations, including tribal government agencies, are creating opportunities for elders to share their knowledge about traditional foods. The impetus for these activities comes from elders themselves, who attribute high rates of diet-related diseases to a loss of knowledge about traditional foods. We conducted eighteen semi-structured interviews with elders and organizers in the midst of these activities to reflect on processes of foodways transmission, including the implications of facilitation by community organizations. Interviews were focused on four human ecological concepts: perception and diversity; human ecological relations; context; and practical wisdom. Insights generated through our discussions were immediately applicable to the ongoing activities in Standing Rock and can inform elders and community organizations leading similar efforts in other communities. [ABSTRACT FROM PUBLISHER]

We examined the association of resilience with measures of mental and physical health in a sample of older American Indians (AIs). A validated scale measuring resilience was administered to 185 noninstitutionalized AIs aged = 55 years. Unadjusted analyses revealed that higher levels of resilience were associated with lower levels of depressive symptomatology and chronic pain, and with higher levels of mental and physical health. Resilience remained significantly associated with depressive symptomatology after controlling for demographic and other health measures. Our findings suggest that resilience among older AIs has important implications for some aspects of mental and physical health. [ABSTRACT FROM AUTHOR]

The article discusses the issue of elder abuse in the Native American communities of the U.S and the laws related to its prevention. It provides information on various forms of elder abuse, its causes and reporting and also informs about the Old American Act of 1965 and Public Law 280. It suggests that federal government should encourage the tribes and aid them so that the implementation of traditional methods of dispute resolution can be acted upon and proper tackling of its causes can be met.

The article highlights the importance of tackling the growing menace of exploitation of the elderly, which was called for by the International Network for Prevention of Elder Abuse. Various factors showing the extend of discrimination and neglect of the elderly include health, personality, and availability of resources. It should be noted that national programmes should work towards empowering older people to achieve health, food, and financial security.

The article reviews some of the available literature focused on elder abuse in the Indian context and offer preliminary results from a household survey on elder abuse and neglect from Kerala State, India. Results indicate that neglect and verbal abuse were the most common form of abuse followed by physical abuse and material exploitation. Widowed females experienced more mistreatment compared to their counterparts.

Background. Cardiovascular disease (CVD) is the leading cause of death among American Indians. It is not known if symptoms of insomnia are associated with CVD in this population. Methods. We examined 449 American Indians aged ≥55 years from the Native Elder Care Study. The main outcome-of-interest was self-reported CVD. Results. Short sleep duration, daytime sleepiness, and difficulty falling asleep were positively associated with CVD after adjusting for demographic, lifestyle, and clinical risk factors. Compared with a sleep duration of 7 h, the multivariable odds ratio (OR) (95% confidence interval [CI]) of CVD among those with sleep duration ≤5 h was 2.89 (1.17-7.16). Similarly, the multivariable OR (95% CI) of CVD was 4.45 (1.85-10.72) and 2.60 (1.25-5.42) for daytime sleepiness >2h and difficulty falling asleep often/always. Conclusion. Symptoms of insomnia including short sleep duration, daytime sleepiness, and difficulty falling asleep are independently associated with CVD in American Indians aged ≥55 years. [ABSTRACT FROM AUTHOR]

Little is known about Indigenous communities and dementia and Elders have not been involved as advisors or participants in most research to date. This exploratory research sought to address this gap through a constructivist grounded theory project on the views of First Nation Elders on memory loss and memory care in later life, conducted in collaboration with decision-makers from the local Health Authority and Elders from three First Nation communities in British Columbia, Canada. Elders served as advisors to this research and research agreements were negotiated and signed with each community. Data collection occurred through a series of sharing circles and interviews with a total of 21 Elders, four of whom were experiencing memory loss, and two community members. Four themes arose through the constant comparative data analysis process: Being Secwepemc, growing older, losing memory, and supporting one another. These themes indicate that memory loss and memory care in First Nation communities has changed over the past century, including the causes attributed to memory loss in later life and community responses to those affected. Elders hold differing views about memory loss, including the traditional-'going through the full circle' [of life]-and the shémá [white] way-' your dementia', with the latter being much more common. This research indicates the importance of protecting and reviving traditional knowledge and ways of life in order to prevent ' your dementia' and avoid the adoption of health care practices that may be culturally unsafe for First Nation Elders. [ABSTRACT FROM AUTHOR]

Comorbidity is a growing challenge and the older adult population is most at risk of developing comorbid conditions. Comorbidity is associated with increased risk of mortality, increased hospitalizations, increased doctor visits, increased prescription medications, nursing home placement, poorer mental health, and physical disability. American Indians experience some of the highest rates of chronic conditions, but to date there have been only two published studies on the subject of comorbidity in this population. With a community-based sample of 505 American Indians aged 55 years or older, this study identified the most prevalent chronic conditions, described comorbidity, and identified socio-demographic, functional limitations, and psychosocial correlates of comorbidity. Results indicated that older American Indians experience higher rates of hypertension, diabetes, back pain, and vision loss compared to national statistics of older adults. Two-thirds of the sample experienced some degree of comorbidity according to the scale used. Older age, poorer physical functioning, more depressive symptomatology, and lower personal mastery were all correlates of higher comorbidity scores. Despite medical advances increasing life expectancy, morbidity and mortality statistics suggest that the health of older American Indians lags behind the majority population. These findings highlight the importance of supporting chronic care and management services for the older American Indian population. [ABSTRACT FROM AUTHOR]

There is very little research on Alaska Native (AN) elders and how they subjectively define a successful older age. The lack of a culturally-specific definition often results in the use of a generic definition that portrays Alaska Native elders as aging less successfully than their White counterparts. However, there is a very limited understanding of a diverse array of successful aging experiences across generations. This research explores the concept of successful aging from an Alaska Native perspective, or what it means to age well in Alaska Native communities. An adapted Explanatory Model (EM) approach was used to gain a sense of the beliefs about aging from Alaska Natives. Research findings indicate that aging successfully is based on local understandings about personal responsibility and making the conscious decision to live a clean and healthy life, abstaining from drugs and alcohol. The findings also indicate that poor aging is often characterized by a lack of personal responsibility, or not being active, not being able to handle alcohol, and giving up on oneself. Most participants stated that elder status is not determined by reaching a certain age (e.g., 65), but instead is designated when an individual has demonstrated wisdom because of the experiences he or she has gained throughout life. This research seeks to inform future studies on rural aging that prioritizes the perspectives of elders to impact positively on the delivery of health care services and programs in rural Alaska. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine belief systems about diabetes in American Indian elders, and the effects of culture on care-seeking, adherence, and diabetes self-care. Health belief theory predicts that care-seeking and medical adherence are a function of culturally mediated beliefs that result in behaviors that effect health status. In order to elicit cultural meanings of diabetes, in-depth interviews were conducted with an intensity sample of 30 American Indian diabetic elders (55+). Two models of diabetes were identified, divergent in terms of 1) health behaviors, and 2) cultural identification. One model was characterized by delayed care-seeking, and a non-valuing of adherence to diabetes self-care. Non-adherence to medical recommendations was perceived as being socially desirable, because adherence placed the elder outside their peer group. The second model was characterized by early care-seeking and improved adherence to diabetes self-care. These divergent models of diabetes, in which care-seeking, diabetes self-care, and adherence vary as a function of cultural immersion, has implications for health education and disease management and may contribute substantially to health disparities. [ABSTRACT FROM AUTHOR]

The objectives of this study were to examine the prevalence of assistive technology (AT) use, type of assistance used for each activity of daily living (ADL) limitation, and correlates of AT use among Native Indian aged 55 and older. Data were collected as part of a cross-sectional study of disability with 505 members of a federally recognized tribe using in-person interviewer administered surveys. Participants who reported difficulty with ADLs, including bathing, dressing, eating, transferring, walking, toileting, grooming, and getting outside, were asked about AT use. Other measures were demographics, living arrangements, receipt of personal care, Medicare and Medicaid beneficiary status, number of chronic conditions, lower body function, and personal mastery. Results indicated that 22.3% of participants aged 55 and older and 26.0% aged 65 and older reported AT use. Toileting had the largest percentage of participants who relied on AT only and getting outside had the largest percentage of participants relying on a combination of AT and personal care. Multiple variable logistic regression analysis identified receipt of personal care, having more chronic conditions, and poorer lower body function as significantly associated with higher odds of AT use. The results suggest that there is greater AT use in this sample than in same-aged adults in national samples. This greater use may be reflective of a combination of higher disability rates, cultural factors, and greater access to AT. Clinicians can use this information to identify the activities with which their patients are experiencing the most difficulty and which ones can be addressed with AT versus personal care. [ABSTRACT FROM AUTHOR]

Many elderly people of Aboriginal origin find themselves displaced as they move from rural reserves into urban settings. The majority relocate to cities for medical purposes and fall between the cracks of an already fragile support system. Responsibility for their needs, particularly in relation to housing, is not clearly assigned to band organizations or governments within the current neoliberal policy climate. Some move in with family members or friends. Others have secured units in non-profits, while several reside in single room occupancy hotels or rooming houses. Preliminary research indicates many are living in unhealthy and unsafe environments. This study begins to document situations and conditions in which elderly people of Aboriginal origin are currently living in Winnipeg and across Canada. It also aims to assist the Aboriginal Senior Resource Centre (ASRC) in supporting elderly Aboriginals in Winnipeg and suggests broader long-term considerations on how to address the needs of these individuals. [ABSTRACT FROM AUTHOR]

The article presents a study seeking to identify the different types of abuse experienced by American Indian elders living on or off Indian reservations. Particular attention is paid to how these abuses may contribute to health disparities among older American Indians. The study's definition of elder abuse incorporates all intentional or unintentional physically, psychologically, sexually, or financially abusive acts. The consequences of elder mistreatment are associated with shorter life expectancy, interpersonal stress, depression, suicide, and increased overall health risks. The root causes of American Indian elder abuse are discussed.

The article presents a study examining the major illnesses among elderly American Indians living on or close to a reservation in order to reduce existing health disparities and increase the quality of life and life expectancy among older American Indian populations. Information gathered from Google Scholar, Medline, CINAHL, and PsycInfo is reviewed to develop recommendations for health intervention programs in areas of disease that were the leading cause of death among the American Indian elderly. A detailed assessment of health problems related to cardiovascular disease, cancer, and diabetes is provided.

The article discusses the importance of elderly American Indians to the lives of American Indian families and communities. A review of ethnographic studies of American Indian elders is used to describe the vital role elders played in the evolution of the human brain, social behavior, and culture. Particular attention is paid to exploring issues related to hierarchy formation, the influence of elders on social learning, and the persistence of traditional cultural knowledge. The loss of traditional knowledge transmission is associated with a breakdown in close kinship ties, reduced cooperation, and the disappearance of tribal identification.

The article focuses on the increasing population of elderly people in India, which is projected to rise to 177 million by 2025 from the 77 million in 2001. Older people in urban India experience weak community support and 88.36% of older people are living with their sons based on a 1982 survey. Mentioned is retirement as the crucial phase among the elderly in India as well as the plight of widows. Also noted are the best practices in India including the Labour Fund, the Free Food Grain, the Livelihood Support and the Mobile Healthcare.

The article features the policies and programmes on ageing in India. Constitutional provisions on the legal protection of elderly persons in India include the Code of Criminal Procedure, 1973, the Hindu Adoption and Maintenance Act, 1956 and the Legislation in Himachal Pradesh Maintenance of Parents and Dependents Act, 2001. Also discussed is the National Policy on Older Persons, the Annapurna Scheme, Old Age Pension, Day Care Centers, Old Age Homes, Integrated Programme for Older Persons and Assistance for Constructing Old Age Homes/Centres.

Objectives: American Indians/Alaska Natives are underrepresented in clinical trials. There- fore, they must participate in large-scale cancer clinical trials to ensure the generalizability of trial results and improve their access to high-quality treatment. Our goal was to identify factors that influenced participation in cancer clinical trials among American Indians! Alaska Natives. Methods: An anonymous survey that assessed willingness to participate in a hypothetical cancer clinical trial and how 37 factors influenced their willingness to participate was administered to 112 older American Indian! Alaska Native adults at an annual social event honoring elders. Responses ranged from one (definitely would not participate) to five (definitely would participate). Data were analyzed with ordinal logistic regression. Results: Factors that most strongly increased willingness to participate were having a lead researcher of Native descent, having a study physician with experience treating American Indians/Alaska Natives, personal experience with the cancer being studied, family support for participation, and belief/hope that the study would result in new treatments. Factors that decreased willingness to participate most strongly were living far from the study site and a high risk that confidentiality could be breached. Conclusions: Our results identify conventional and culturally unique barriers to research participation among older American Indians! Alaska Natives. These data emphasize the need to establish partnerships with Native communities and include American Indian! Alaska Native and culturally competent professionals in research efforts. Of equal importance are disseminating information about clinical trials and recognizing the role of family in decisionmaking in this group. [ABSTRACT FROM AUTHOR]

Although educational attainment and physical activity levels tend to be positively associated in majority populations, this relationship has not been investigated in American Indian and Alaska Native (AI/AN) elders. This study examined the association between education and physical activity among AI/AN elders (N = 107) using self-report and behavioral outcomes. Regression models showed that higher education was significantly associated with total caloric expenditure for moderate-intensity physical activities and distance traveled during a 6-minute walk test of fitness. Additional research is needed to understand modifiable personal, social, and environmental physical activity barriers in these populations. [ABSTRACT FROM AUTHOR]

The article offers information on the situation of the older people in India. It states that the elderly comprises eight percent of the country's total population and is expected to grow by 21 percent in 2050. It states that issues related to the aged are not given so much consideration because the government is more occupied with various problems in society such as family centric complacence. It cites the move to adopt a minimalist attitude towards the challenges of the older people.

The article presents a study on the demographic aspects of the aging population of India and the challenges that they will face related to globalization. It reveals that the state and civil society should be aware of the rights and needs of the older people and formulate policies, legislations, and effective implementation of health schemes that is already existing. It notes that the ageing population is vulnerable and their health, independence, and protection should be the main focus.

The article discusses health care and human service needs of the older Native American Indian with disabilities. According to the 1990 Census, there were approximately 1.96 million Native American Indians in the United States. There are no exact figures as to how many elderly Native American Indians live on or near reservations versus urban areas. The quality of life is also of concern. Too often, an Indian elder leads a life that is characterized by poverty, deprivation, poor health, poor housing, and greatly limited social opportunities. Elderly Indian people form the most undeserved group of individuals in the United States. The effect of poor living conditions on Native American Indians is evidenced through major health indices. These characteristics place Native American Indian people in general, and the elderly Indians in particular, at greater than average risk for exposure to multiple diseases and disabling conditions. Many elderly Indians, in particular, do not receive services and benefits to which they are entitled. In this study, 51 percent of the 100 Native American Indians interviewed were ages 45 to 69 years. On an average, those interviewed reported three disabling conditions each.

Evaluates the results of a training project designed to enhance home-care worker programs for American Indian elderly in the United States. Dissemination of American Indian aging information to individuals and organizations; Feasibility of implementing a home-care program at colleges; Availability and quality community-based in-home care for frail elders.

Describes a program that was developed to train indigenous personnel in skills needed to help American Indian elders who have visual impairments. Work of Lonetree (1990) which identified the resource needs associated with delivering services within American Indian Vocational Rehabilitation Projects; Training program for reservation-based community representatives; More.

Describes a training project that sought to .Shance services to American Indian elders by training individuals as home-care workers. Fund from the US Administration on Aging; Replication of the project developed by American Indian paraprofessional home-care worker curriculum at Fond du Lac Tribal and Community College in Cloquet, Minnesota.

Examines service usage among a sample of urban, rural, and reservation-based eastern Great Lakes American Indian elders in the United States. Service need of American Indian elders; Prerequisite for any services utilization; Factors which had an impact on the use of services by older American Indians.

Presents a study of American Indian family caregivers' views of their situation and needed support services. Cultural mandate to provide care for elder American Indians; Access to essential long-term care services; Anxiety about managing in-home medical care; Psychosocial aspects of care; Strains on family relations; Personal health and well-being.

The article discusses several manuscripts on Native North American elders that were published within the issue including the elders' views on diabetes, the memory loss issue in the three First Nations communities and the prevalence of chronic diseases among the American Indians in the southern region of the U.S.

The author discusses the importance of American Indian elders in the Indian community and the need to ensure their well-being. Forecasts predicting rapid growth in the number of elderly among American Indian populations in the U.S. are discussed. The use of pluralistic healing methods that combine traditional knowledge with modern medicine is mentioned. The various reasons elder care is becoming a priority for the Indian community is discussed.

The author comments on the increased suffering experienced by American Indians who are living longer with higher rates of diabetes, heart disease, kidney disease, and blindness than the general population. Particular attention is paid to the problems associated with increased life expectancy in the midst of increased substance abuse and obesity. The author stresses that the way American Indian communities care for their elderly is a reflection of who American Indians are as a people.

The author introduces a special edition of the journal titled Traditions, Health Care, and Lifestyles Impacting American Indian Elders. A description of articles featured in this edition is presented including "How Elders Guided the Evolution of the Modern Human Brain, Social Behavior, and Culture," by Kathryn Coe and Craig T. Palmer, "Elder Abuse in American Indian Communities," by Briana Anisko and "Starting Stories Among Older Northern Plains American Indian Smokers," by Christopher E. Hodge.

To ascertain the extent of, and risk factors for, physical abuse among older urban American Indian/Alaska Natives (AI/ANs), we conducted a chart review of 550 urban AI/AN primary care patients >/=50 years old seen during 1 year. Mistreatment was documented in 10%. A logistic regression found younger age (P <.001), female gender (P <.001), current depression (P <.001), and dependence on others for food (P <.05) to be significant correlates of physical abuse. In only 31% of instances of definite abuse were the authorities notified. We conclude that providers should be alert to the possibility of physical mistreatment among older urban AI/ANs. Improvements in detection and management are sorely needed. [ABSTRACT FROM AUTHOR]

The author comments on the medical care options for the poor and elderly in American Indian communities. It is argued the budgetary restraints and financial cuts within the Indian Health System have severely limited health services for American Indians. The dependence of medical care eligibility based on tribal status, place of residence on or near a reservation, and issues related to medical provider acceptance is discussed.