Abstract: This paper describes the results from a needs assessment of American Indian elders residing on the Standing Rock Reservation in the Dakotas. Interviews were conducted by indigenous interviewers with 187 elders aged 49 to 90. Three scales were included: the Iowa Self-Assessment Inventory, the Family APGAR, and the General Self-Efficacy Scale. Findings revealed a high degree of economic stress, high levels of chronic illness and physical disability, and problems in accessing medical care and medicine. The importance of the role of the extended family in coping with problems needs to be considered in the development of health-related programs.
Key Words: Needs Assessment, Native Americans
A warrior I have been, a hard time I have now" (Sitting Bull as quoted in Rousseau, 1995). This statement clearly conveys the feelings of many older American Indians. Once active, healthy individuals contributing to society, they are now aging, with the inherent problems that result from aging. This paper reports the quantitative, descriptive results from the first needs assessment conducted with American Indian elders living on the Standing Rock Reservation in the Dakotas.
REVIEW OF THE LITERATURE
The over two million American Indians /Native Americans living in the United States are a heterogeneous group with over 500 identified tribes and bands. American Indian elders are the fastest growing ethnic subpopulation, and they comprise about 6% of the total American Indian population (Rousseau, 1995). The overall life expectancy for American Indians is 6 years less than that for white Americans. In the Dakotas, the difference is even greater, with a life expectancy of 11 years less for American Indians than for white Americans (Smith, 2001).
Older American rural populations suffer more chronic illness and disabilities than those who reside in urban areas (Shirey 2003). Other issues that plague rural elders are problems with transportation as well as lower incomes, lower educational levels, and poorer housing conditions than individuals living in urban areas. Trends are similar in the rural communities where most American Indian elders live (Indian Health Service [IHS], 2000). Empirical evidence about the health status of American Indian elders is largely limited to the statistics found in official IHS publications. However, these sources ignore large segments of the population, covering only 60% of all Indians residing in the United States (IHS, 2000).
The leading causes of hospitalization for American Indians over the age of 65 have been identified as circulatory and respiratory system disorders. Circulatory system and endocrine /metabolic diseases were noted to be the leading causes of ambulatory medical visits. Community Health Representatives (CHRs) on reservations deliver personal and healthrelated services to elders in their homes. The two leading health-related reasons for CHR contacts in 1998 were health promotion /disease prevention and diabetes. Among individuals ages 65-74, 26.9% of American Indians compared with 8.4% of whites fell below the poverty level; the respective percentages for the 75 and older groups were 33.3% versus 14.6% (IHS, 2000).
The director of the Standing Rock Reservation CHR Program requested a needs assessment in order to obtain data to assist the tribe in applying for grant monies to help the elders who reside in the community. A descriptive study was conducted with American Indian elders (note: the tribal designation for elder is 50 years and over) on that reservation, a vast area of 1500 square miles covering parts of North and South Dakota. The estimated population of elders is about 400. Using a survey random sample calculator from Creative Research Systems (2003), a 5% desired error level, and a 95% confidence level, power analysis showed that we needed 196 respondents. The tribal elders were identified through the Tribal Health Program, the Tribal Nutrition Program, the Elderly Protection Program, and the CHRs who served the elders. …