Aging Well for Indigenous Peoples: A Scoping Review

Memory self-efficacy and working memory

Dementia affects multiple aspects of cognitive functioning, including working memory and executive functioning. Memory self-efficacy (MSE) has previously been related to episodic memory performance and to executive functioning, but little research has examined the relations between MSE and working memory. United States older adults (N  = 197) were recruited via MTurk to complete an MSE questionnaire before completing a digit span working memory task. Hierarchical regression results revealed that the model accounted for a significant amount of variance in working memory performance after statistically controlling for several covariates, F(11, 179) = 4.94, p < .001, adjusted R2 = .19. MSE explained a large and unique portion of variance (B = 1.02, SE = 0.17, p < .001). Based on our findings, one's beliefs about their memory are positively associated with their working memory performance. These novel findings provide support for neuropsychologists to consider using MSE measures and utilizing MSE interventions.

Aging in Indigenous Communities: Perspective from Two Ancestral Communities in the Colombian Andean-Amazon Region

The phenomenon of world aging is not foreign to indigenous communities. In the last few years, research about these communities around the world has increased, but aging in indigenous towns still has not been studied widely. The purpose of this research is to interpret the meaning of old age in two indigenous communities from the Colombian Andean-Amazon region (the Inga and Kamëntsa) to reinforce the relevance of the local sociocultural context within the configuration of the meaning of old age and to emphasize the importance of considering particular regional characteristics for the design of policies and interventions aiming to recognize and integrate indigenous populations. This is a qualitative study with an interactionism-symbolism approach. In total, six indigenous people older than 60 years from two ancestral communities from the Colombian Andean-Amazon region participated in the in-depth interviews. Data analysis was carried out in three moments: discovery, coding, and relativization of the information. The results show that old age means wisdom, "I am wise," which is supported in the cosmology and the trajectory of life, reinforces the identity and autonomy, and allows them to be agents in the dynamics of their communities from the "I do," in other words, their roles as builders of the family-society and as guards of ancestral knowledge. The loss of this knowledge and the elements that it is composed of uproot them and put them at risk of disappearing as individuals and as a collective. In conclusion, the meaning of old age in these communities is not centered on a determinate age; you are not old, you are wise, and as such, they play a central role in their communities. Moreover, wisdom is built in parallel with their cosmology and assigns them the task of safekeeping ancestral knowledge. In order to do this, they use oral tradition as a tool, words that are born in their territories, travel in a nonlinear timeline, and get strengthened by the community while also protecting it and building it. Knowing what aging means for Indigenous communities can facilitate to the development of policies and initiatives and to provide culturally appropriate and effective programs.

Harnessing Resilience in the Healthy Ageing Discourse: Insights from Attappadi Indigenous Older Adults, Kerala, India

In this "Decade of Healthy Ageing," the integration of resilience into the healthy aging discourse becomes paramount, particularly in the context of indigenous communities grappling with the enduring effects of historical oppression, persistent poverty, and health disparities in their aging journey. Employing a phenomenological lens, this study seeks to derive the resilient characteristics exhibited by the Attappadi indigenous older adults of Kerala, aiming to explore the role of resilience in their pursuit of healthy aging. In-depth phenomenological interviews (n = 34), observation, and document analysis have revealed four key themes: A life course marked by adversities, Embracing the unyielding strength within, Personal resilience catalysts, and Extrinsic resilience catalysts. The participants exhibited a reasonably well-functioning collective, given their persistent adversities in their life course. Narratives illuminated a notable connection between the presence of resilience characteristics and the overall functioning of older adults. From a social work standpoint on resilience, this article underscores the vital interplay between individual agency and environmental factors in addressing adversity. The article advocates culturally sensitive, asset-based strategies to strengthen indigenous older adults' intrinsic and extrinsic resilience to ensure that they are not left behind in the global pursuit of healthy aging.

Protective Factors in the Context of Successful Aging in Urban-Dwelling Alaska Native Elders

Successful aging in rural Alaska communities has been established as a characteristic best described by reaching "Eldership," conveying reverence and respect from the community and implying leadership responsibilities. Most Alaska Native (AN) Elders believe that aging successfully or aging well happens within their home communities. However, limited rural resources lead Elders to relocate to urban settings. While protective factors supporting aging well in rural communities have been established, little is known about which factors support aging well after relocation to an urban setting. This exploratory, qualitative, community-based participatory research study explored AN Elder's (ages 48-84) experiences comparing successful aging within four rural Alaska communities and of Elders who relocated from a rural to an urban community. Thirteen rural-based Elders and 12 urban-based Elders semi-structured interviews were compared to explore how successful aging was experienced similarly and differently in rural and urban settings. To age well in urban Alaska, access to health care services, family, and community engagement were essential. The main challenges for urban Elders involved establishing a sense of community, intergenerational involvement, and the ability to continue traditional ways of living. This research identified challenges, similarities, and differences in aging well in an urban community. The findings of this study inform practices, services, and policies to improve existing urban services and initiate needed urban services to foster successful aging after relocation from remote rural areas into urban communities in Alaska.

Cyclical Migration in Alaska Native Elders and Its Impact on Elders' Identity and Later Life Well-Being

OBJECTIVES

This paper outlines the unique culturally driven cyclical migration of Alaska Native (AN) Elders, distinct from previously described migration patterns in that Elders spend extended time in more than one community. We describe this Indigenous cyclical migration of AN Elders and its influence on their identity and later life health and well-being.

METHODS

Interviews with 124 AN Elders were conducted across 5 regions of Alaska: Bristol Bay, Interior, Norton Sound, Aleutian Pribilof Islands, and Southcentral. Within this sample, 87 participants engaged in cyclical migration. Thematic analysis was employed to identify themes related to Elders' cyclical migration between rural and urban communities and the impact on their identity and later life health and well-being.

RESULTS

We identified 2 distinct patterns of Indigenous cyclical migration-Elders living primarily in rural communities migrating to urban communities and Elders living primarily in urban communities migrating to rural communities. Elders engaged in these 2 patterns of cyclical migration to maintain cultural practices, access social, and health care services to maintain their physical health and well-being, and continue their community roles contributing to their AN Elder identity.

DISCUSSION

This study builds upon existing migration theories by introducing a cyclical pattern uniquely driven by AN identity, culture, and traditional practices. Findings illustrate how AN communities can support Elders who experience cyclical migration patterns to ensure they age successfully in both locations. Future research should explore cyclical migration patterns among other Indigenous populations with migration histories.

Best practice models of aged-care implemented for First Nations people: a systematic review aligned with the Good Spirit Good Life quality of life principles

BACKGROUND

Aged-care programs that are based in First Nations worldviews are believed to translate to improved quality of life for First Nations Elders. First Nations perspectives of health and well-being incorporates social and cultural determinants in addition to traditional Western biomedical approaches. This is exemplified by the Good Spirit Good Life (GSGL) framework, which comprises 12 strength-based factors determined by First Nations Elders as constituting culturally appropriate ageing. Our objective was to conduct a systematic review of existing aged care models of practice to determine the degree of alignment with the GSGL framework. Recommendations of the national Australian Royal Commission into Aged Care Quality and Safety informed this work.

METHODS

We conducted a systematic search of academic and grey literature in the PubMed, Scopus, Ovid Embase, and Informit online databases. Inclusion criteria comprised English language, original research describing the implementation of First Nations culturally appropriate aged care models, published before August 2022. Research that was not focused on First Nations Elders' perspectives or quality of life was excluded. We subsequently identified, systematically assessed, and thematically analyzed 16 articles. We assessed the quality of included articles using the Aboriginal and Torres Strait Islander Quality Assessment Tool (ATSIQAT), and the Joanna Briggs Institute (JBI) critical appraisal tool for qualitative research.

RESULTS

Most studies were of medium to high quality, while demonstrating strong alignment with the 12 GSGL factors. Nine of the included studies detailed whole service Models of care while 7 studies described a single program or service element. Thematic analysis of included studies yielded 9 enablers and barriers to implementing models of care.

CONCLUSIONS

Best-practice First Nations aged care requires a decolonizing approach. Programs with strong adherence to the 12 GSGL factors are likely to improve Elders' quality of life.

Strategies that support cultural safety for First Nations people in aged care in Australia: An integrative literature review

OBJECTIVE

The 2019 Royal Commission into Aged Care Quality and Safety highlighted the need for First Nations peoples to have improved, culturally safe care. This paper is a call to action for First Nations peoples to be involved in developing culturally safe care and services to be embedded within Australian aged care services.

METHODS

The first screening examined the Australian literature (peer-reviewed articles published since 2010 in English) detailing key aspects relevant to Cultural Safety for First Nations peoples supported by aged care services in Australia. The second screening assessed whether the findings of these studies aligned with the key aspects of Cultural Safety of First Nations peoples in aged care.

RESULTS

The initial literature search yielded 198 papers, of which 13 met the inclusion criteria for the final review. Topics that required further interrogation included barriers to communication, racism and discrimination, impacts on health outcomes, health-care workforce education needs and the importance of cultural connections to Country and kin. These topics influenced the perception of First Nations peoples feeling culturally safe when supported by aged care services.

CONCLUSIONS

The literature identified a need to recruit more First Nations peoples into the aged care workforce, involve more First Nations family and community members in aged care and retain a consistent workforce overall. Together these strategies were seen to address the barriers that continue to affect aged care provision for First Nations peoples.

Loneliness among Chilean indigenous women: Family, community, and socio-cultural integration as protective factors

This study examined the incidence of loneliness among Chilean indigenous older adult women (106 Aymara and 180 Mapuche) and how family, community and socio-cultural integration are associated with lower levels of loneliness. A cross-sectional study involving 800 older adults living in a rural context in Chile, of whom 35.8% were indigenous women. The De Jong Gierveld Loneliness Scale (DJGLS-6) were used to assess loneliness and a questionnaire about the maintenance of certain indigenous cultural practices was created. The descriptive findings indicate more loneliness among Mapuche women. Moreover, hierarchical regression models confirmed that women who did not live alone, who participated in social groups and who maintained cultural practices reported lower levels of loneliness, with notable transmission of indigenous knowledge to their children. While, taking part in the indigenous New Year, leading or organizing a ceremony and receiving attention with a health cultural agent were associated with more loneliness. These seemingly contradictory findings are discussed and may be explained by religious changes in indigenous communities; however, this study would confirm that social integration in different dimensions is a protective factor against loneliness.

Valuing indigenous quality of life: A review of preference-based quality of life instruments and elicitation techniques with global older indigenous populations

Indigenous perspectives of quality of life (QoL) are different to that of non-Indigenous populations. Determining how to identify and value what is important to QoL for people from diverse cultural backgrounds is crucial for assessing effective outcomes for quality assessment and health economic evaluation to guide evidence-based decision making. This is particularly important for older Indigenous people who have complex care and support needs within health and aged-care systems. This scoping review aims to assess the existing literature in this field by firstly identifying preference based instruments that have been applied with older Indigenous peoples and secondly, exploring the extent to which existing preference based instruments applied with older Indigenous peoples encompass older Indigenous peoples QoL perspectives in their design and application. The inclusion criteria for the review were studies using preference based QoL instruments with an Indigenous population where the cohort was aged 50 years or over. This resulted in the critical analysis of 12 studies. The review identified that preference based QoL instruments have rarely been applied to date with older Indigenous populations with most instruments found to be designed for non-Indigenous adults. Typically, instruments have not incorporated Indigenous worldviews of QoL into either the content of the descriptive system or the elicitation techniques and corresponding value sets generated. To encapsulate Indigenous cultural perspectives accurately in economic evaluation, further research is required as to how QoL domains in preference based instruments for Indigenous peoples can be reflective of Indigenous perspectives. It is imperative that the QoL preferences of older Indigenous peoples are adequately captured within preference based QoL instruments applied with this population.

A systematic review of ageing in place among Indigenous People in Canada, USA, México, Chile and New Zealand

The ageing in place (AIP) model enjoys widespread recognition in gerontology and has been strongly encouraged through social policy. However, progress remains to be made in terms of analysing AIP for minority groups and groups with diverse life pathways in old age. This systematic review aims to identify studies that address the AIP model in indigenous communities, answering the following questions: In which geographical contexts and for which Indigenous Peoples have AIP been researched? Which physical dimensions are considered in the assessment of AIP? Which social dimensions are considered in the assessment of AIP? This systematic review applied the SALSA (Search, Appraisal, Synthesis and Analysis) method to AIP among Indigenous older adults on the Web of Science, PsycINFO, MEDLINE and Scopus digital platforms for publications from 2011 to 2021. We identified 12 studies conducted in five countries in North and South America and Oceania. The results show that the following elements of the physical environment are assessed: household, neighbourhood, local surroundings or reserve and native territories. Meanwhile, assessed elements of the social environment are as follows: personal characteristics, attachment to place, social networks, social participation and social policies. There is discussion of the need to develop AIP in order to promote successful ageing among Indigenous older adults.

Validation of the Good Spirit, Good Life quality-of-life tool for older Aboriginal Australians

OBJECTIVE

Improving the quality of life (QoL) of older people is a key priority for governments, clinicians, researchers and service providers worldwide. However, the lack of culturally appropriate QoL tools for First Nations people is a major barrier to such efforts. The purpose of this study was to evaluate the psychometric properties of the Good Spirit, Good Life (GSGL) QoL tool for older Aboriginal Australians.

METHODS

One hundred and twenty older Aboriginal people living in Perth and Melbourne, Australia, were administered the GSGL tool, along with several other instruments assessing cognition (KICA-Cog), depression (KICA-Dep), anxiety (GAI-SF), health and well-being (EQ-5D-5L and ICECAP-O) and resilience (ARRQ-25). Associations between these instruments and the GSGL tool were explored to determine concurrent and known-groups validity. Internal consistency was assessed with split-half reliability and Cronbach's alpha. Exploratory factor analysis was performed to investigate construct validity.

RESULTS

GSGL scores were positively correlated with ICECAP-O and ARRQ-25 scores, and negatively correlated with EQ-5D-5L score. GSGL scores differed significantly between participants with a probable anxiety disorder or depression, but not those with cognitive impairment. The Spearman-Brown prophecy estimate was 0.83 and Cronbach's alpha was 0.75. Principal component analysis identified two factors, which were labelled foundation and external.

CONCLUSIONS

The GSGL tool is a valid tool to assess quality of life in older Aboriginal Australians. The tool demonstrates acceptable convergent, concurrent and known-groups validity. It was co-designed at all stages with older Aboriginal people contributing to its strong face and content validity.

From Deficit to Strength-Based Aboriginal Health Research-Moving toward Flourishing

Aboriginal Australians have a fundamental human right to opportunities that lead to healthy and flourishing lives. While the impact of trauma on Aboriginal Australians is well-documented, a pervasive deficit narrative that focuses on problems and pathology persists in research and policy discourse. This narrative risks further exacerbating Aboriginal disadvantage through a focus on 'fixing what is wrong' with Aboriginal Australians and the internalising of these narratives by Aboriginal Australians. While a growing body of research adopts strength-based models, limited research has sought to explore Aboriginal flourishing. This conceptual paper seeks to contribute to a burgeoning paradigm shift in Aboriginal research, seeking to understand what can be learned from Aboriginal people who flourish, how we best determine this, and in what contexts this can be impactful. Within, we argue the case for a new approach to exploring Aboriginal wellbeing that integrates salutogenic, positive psychology concepts with complex systems theory to understand and promote Aboriginal wellbeing and flourishing. While deeper work may be required to establish the parameters of a strength-based, culturally aligned Aboriginal conceptualisation of positive psychology, we suggest the integration of Aboriginal and Western methodologies offers a unique and potent means of shifting the dial on seemingly intractable problems.

Race, class, caste, disability, sterilisation and hysterectomy

This interdisciplinary historical paper focuses on the past and current state of diverse forms of surgical hysterectomy as a global phenomenon relating to population control and sterilisation. It is a paper grounded in historical inquiry but is unconventional relative to the norms of historical scholarship both in its wide geographical scope informed by the methodologies of global and intercultural history, in its critique of current clinical practices informed by recent feminist, race, biopolitical and disability studies, and by its engagement with scholarship in health sociology and medical anthropology which has focused on questions of gender and healthcare inequalities. The first part of the paper surveys existing medical, social-scientific and humanistic research on the racial, class, disability and caste inequalities which have emerged in the recent global proliferation of hysterectomy; the second part of the paper is about the diverse global rationales underlying radical gynaecological surgeries as a form of sterilisation throughout the long twentieth century. Radical gynaecological surgeries have been promoted for several different purposes throughout their history and, of course, are sometimes therapeutically necessary. However, they have often disproportionately impacted the most disadvantaged groups in several different global societies and have frequently been concentrated in populations that are already maligned on the basis of race, ethnicity, age, criminality, disability, gender deviation, lower class, caste or poverty. This heritage continues to inform current practices and contributes to ongoing global inequalities of healthcare.

Loneliness and Psychosocial Resources among Indigenous and Afro-Descendant Older People in Rural Areas of Chile

(1) Background: loneliness is a problem that becomes increasingly acute in old age, with greater repercussions among socially disadvantaged groups such as indigenous and Afro-descendant older adults. The aim of this research is to analyze the psychosocial variables related to loneliness in old age. (2) Methods: a multi-ethnic sample was involved, with the participation of eight indigenous peoples and Afro-descendant tribal people (n = 1.348). Various gerontological scales previously validated among the Chilean population (De Jong Gierveld Loneliness Scale, Brief Resilient Coping Scale, Health Problems Questionnaire, and Family APGAR questionnaire) and a model are contrasted, establishing the relationship between psychosocial variables and loneliness. (3) Results: Structural equation modeling (SEM) showed the existence of indirect relationships between health problems, via family functioning and resilience, and loneliness. Resilience and family functioning were directly related to loneliness (WLSMV-χ² (df = 345) = 875.106, p < 0.001; CFI = 0.992; TLI = 0.991; RMSEA = 0.034 [C.I. 90% = 0.031-0.037]). (4) Conclusions: loneliness has cross-culturally affected older Chilean people living in rural areas and it appears that the COVID-19 pandemic has had a negative effect on well-being. This study proves that loneliness is related to several psychosocial variables that can be intervened.

Alaska native successful ageing in Northwest Alaska: how family impacts how one ages in a good way

aged well, yet today they experience high rates of illness and lower access to care because of colonisation. Aand this research explores successful ageing from an AN perspective or what it means to achieve "Eldership" in the rural Northwest Alaska. A community-based participatory research approach was used to engage participants at every stage of the research process. Semi-structured interviews were conducted with 16 AN men and 25 women and the interviews were professionally transcribed. Kleinman's explanatory model served as the foundation of the questionnaire to gain a sense of the beliefs about ageing and guide the thematic analysis to establish an AN understanding of successful ageing. The foundation of the Norton Sound southern sub-region Model of Successful Ageing is the reciprocal relationship between Elders and family which enables Elders to access meaningful activities, including Native ways of life, physical health, spirituality, and emotional well-being. Community-based interventions should foster opportunities for Elders to share their Native way of life alongside family and community members, which will enable them to remain physically active, maintain healthy emotional well-being, continue engaging in spiritual practices, and contribute to the health and well-being of families.