With the rapid aging of the U.S. population, American Indian and Alaska Native (AI/AN) communities face many of the same concerns as the rest of the nation, such as the diminishing size of families, which traditionally have provided informal assistance to older adults.
As of mid-2002, U.S. Census data show more than 4.3 million AI/AN people in the United States, comprising 1.5% of the total population. Overall, Al/ANs have higher rates of mortality and morbidity from heart disease, injuries, cancer and diabetes. Also, rates in AI/AN populations of these and other conditions, such as communicable diseases, infant mortality and kidney disease, exceed those of the general population.
In addition, AI/AN people have long maintained separate and distinct lands. Within these mostly small and independent geographic areas, the aging of populations can have devastating results. For example, our research shows that some AI/AN communities already have no potential caregivers available.
Older adults in AI/AN communities have always depended heavily on their families for care. This system seems to have functioned well in the past, contributing to the belief that AI/ANS are stoic figures who do not need assistance and can take care of their own elders. However, some researchers have concluded that the reason caregivers in these populations performed so well with fewer health problems was because AI/AN caregivers tended to be younger than those in the broader population. This advantage will be lost if there are fewer younger AI/ANS-and, therefore, fewer caregivers-available to look after an increasing number of chronically frail older adults in the local population.
Although families remain the primary providers of long-term care services to older adults for all races and ethnicities, AI/AN communities exhibit changing dynamics, which will further affect their families' capacity to provide care in the future. Identifying these dynamics is important because if caregivers-especially those in small communities-are less available, it behooves local planners to search for alternative ways to meet the needs of. their frail and disabled older adult constituents.
Unique aspects of caregiving in Indian Country go beyond the lack of caregivers. One Alaska Native provider commented, "Villages were struggling to survive and people moved to the big cities. We had mentors (grandparents) and now I don't see it that much. Some cultural activities are coming back, but high regard for elders is not as much as it used to be."
In order to identify communities experiencing diminished capacity to meet the caregiver needs of the older adult population, we recently conducted a study, using 2000 U.S. Census data, of potential caregiver availability among 345 native communities (including Hawaiian Home Lands). The research goal was to identify those distinct local areas that have more frail older adults than caregivers.
A valuable tool we used to examine caregiver availability is the Caregiver Ratio Index (CRI)-the number of potential caregivers divided by the number of potential frail older individuals. The higher the CRI, the greater the number of potential caregivers available for each trad elder. We determined the number of frail elders by comparing the portion of AI/AN elders who have …