R. Turner Goins

Influence of caregiving on health-related quality of life among American Indians.

Caregiving can have a profound effect on the health of the caregiver, yet research on caregiving among American Indians is limited. The purpose of this study was to examine the influence of caregiving on the health‐related quality of life (HRQoL) of American Indians enrolled in the Education And Research Towards Health (EARTH) study. Participants in the EARTH study represented three different tribes in the Northern Plains and Southwestern regions of the United States who completed self‐administered, computer‐assisted questionnaires between 2003 and 2006. Participants were classified as caregivers if at least one adult relied on them for personal care or as non‐caregivers (n = 3,736). Caregivers were further classified according to type; those caring for an adult with unspecified needs (CAU, n = 482) and those caring for an adult with mental or physical difficulties (CAD, n = 295). HRQoL was measured using the mental and physical health component scores of the Medical Outcomes Study 12‐item Short‐Form Health Survey. Regional differences emerged with regard to caregiver type. Across both regions, non‐caregivers reported significantly better mental and physical health than CAD, and the health of participants classified as CAU did not differ from that of non‐caregivers. The health of American Indian caregivers depends on the kind of care provided, but detailed measures of caregiving are necessary to understand how caregiving influences health. This has implications for the design of effective interventions in tribal communities.

Community as a source of health in three racial/ethnic communities in Oregon: a qualitative study

BackgroundA 2011 report by the Oregon Health Authority and the Department of Human Services documented disparities in its Latino and American Indian populations on multiple individual-level health indicators. However, research is lacking on the social contexts in which Latinos and American Indians in Oregon live and how these environments influence the health of communities as a whole. To help fill this gap, this study sought to contextualize the social environments that influence the health of Latinos and American Indian residents in three Oregon communities.MethodsGuided by an ecological framework, we conducted one-time semi-structured qualitative interviews with 26 study participants to identify the prominent health-related issues in the communities and to examine the factors that study participants perceived as enabling or inhibiting healthy lifestyles of community residents. We used a grounded theory approach to perform content and thematic analyses of the data.ResultsStudy participants identified preventable chronic conditions, such as diabetes, obesity, and hypertension, as the most pressing health concerns in their communities. Results showed that traditional and cultural activities and strong family and community cohesion were viewed as facilitators of good community health. Poverty, safety concerns, insufficient community resources, and discrimination were perceived as barriers to community health. Three themes emerged from the thematic analyses: social connectedness is integral to health; trauma has an ongoing negative impact on health; and invisibility of residents in the community underlies poor health.ConclusionsThis study’s findings provide insight to the social contexts which operate in the lives of some Latinos and American Indians in Oregon. While participants identified community-level factors as important to health, they focused more on the social connections of individuals to each other and the relationships that residents have with their communities at-large. Our findings may also help to explain how the intra- and inter-personal levels, the community/institutional level, and the macro level/public policy contexts can serve to influence health in these communities. For example, trauma and invisibility are not routinely examined in community health assessment and improvement planning activities; nonetheless, these factors appear to be at play affecting the health of residents.

Correlates of social support in older American Indians: the Native Elder Care Study

Objectives: This study examined social support and identified demographic and health correlates among American Indians aged 55 years and older. Methods: Data were derived from the Native Elder Care Study, a cross-sectional study of 505 community-dwelling American Indians aged ≥55 years. Social support was assessed using the Medical Outcomes Study Social Support Survey measure (MOS-SSS) of which psychometric properties were examined through factor analyses. Logistic regression analyses were used to identify associations between age, sex, educational attainment, marital status, depressive symptomatology, lower body physical functioning, and chronic pain and social support. Results: Study participants reported higher levels of affectionate and positive interaction social support (88.2% and 81.8%, respectively) than overall (75.9%) and emotional (69.0%) domains. Increased age, being married/partnered, and female sex were associated with high social support in the final model. Decreased depressive symptomatology was associated with high overall, affectionate, and positive interaction support, and decreased chronic pain with affectionate support. The count of chronic conditions and functional disability were not associated with social support. Conclusions: Overall, we found high levels of social support for both men and women in this population, with the oldest adults in our study exhibiting the highest levels of social support. Strong cultural values of caring for older adults and a historical tradition of community cooperation may explain this finding. Future public health efforts may be able to leverage social support to reduce health disparities and improve mental and physical functioning.

Developing a Framework and Priorities to Promote Mobility Among Older Adults

Mobility, broadly defined as movement in all of its forms from ambulation to transportation, is critical to supporting optimal aging. This article describes two projects to develop a framework and a set of priority actions designed to promote mobility among community-dwelling older adults. Project 1 involved a concept-mapping process to solicit and organize action items into domains from a broad group of stakeholders to create the framework. Concept mapping uses qualitative group processes with multivariate statistical analysis to represent the ideas visually through maps. A snowball technique was used to identify stakeholders (n = 211). A 12-member steering committee developed a focus prompt, “One specific action that can lead to positive change in mobility for older adults in the United States is . . .” Project 2 included a Delphi technique (n = 43) with three iterations to prioritize four to six items using results from the concept mapping rating process. Project 1 resulted in 102 items across nine domains (Research to Practice, Independence and Engagement, Built Environment and Safety, Transportation, Policy, Housing and Accessibility, Community Supports, Training, and Coordinated Action). The number of items ranged from 6 to 18 per domain. Project 2 resulted in agreement on four items that reflect the importance of promoting environmental strategies through collaborative initiatives aimed at planning and best practices focusing on environmental enhancements or transit, training of professionals, and integration of mobility into state and local public health plans. These findings can be applied to support coordinated, multidisciplinary research and practice to promote mobility among older adults.

An Examination of the Disablement Process Among Older American Indians: The Native Elder Care Study

PURPOSE OF THE STUDY Older American Indians disproportionately suffer from poorer physical and mental health and have greater disability compared to their racial and ethnic counterparts. The purpose of this study was to examine the disablement process among older American Indians. DESIGN AND METHODS Data analyzed were from the Native Elder Care Study, which included in-person interviews with 505 community-dwelling American Indians aged ≥55 years. We used structural equation modeling to examine the contributive direct and indirect effects of health, demographic, and psychosocial risk factors on disability. RESULTS Pathology had direct and indirect effects through social support and depressive symptoms on chronic pain intensity. Pathology also had direct and indirect effects on disability. Chronic pain intensity was a significant mediator between pathology and functional limitations. With contributive effects of older age and female sex, greater functional limitations were associated with increased disability. IMPLICATIONS Our results support the theorized main pathway of the Disablement Process Model with our sample of older American Indians. Our findings support the importance of taking into account intra and extraindividual factors in assessing the prevalence and incidence of disability for older American Indians.

Association of Depressive Symptomatology with Receipt of Informal Caregiving Among Older American Indians: The Native Elder Care Study

OBJECTIVE Our study objectives were to identify the primary sources of informal caregiving and to examine the association of depressive symptomatology with receipt of informal caregiving among a sample of community-dwelling older American Indians. DESIGN We conducted a cross-sectional study of older American Indians. PARTICIPANTS Community-dwelling adults aged 55 years and older who are members of a federally recognized American Indian tribe in the Southeast United States. MEASUREMENTS We collected information on the participants primary caregiver, number of informal care hours received in the past week, depressive symptomatology, demographic characteristics, physical health status, and assistance need. RESULTS Daughters, spouses, and sons were the most common informal primary caregivers with distinct differences by sex of those receiving care. Compared with participants with lower levels, those with a high level of depressive symptomatology received substantially greater hours of informal care (33.4 versus 11.5 hours per week). CONCLUSION Older American Indians with higher levels of depressive symptomatology received more informal caregiving than those with lower depressive symptomatology. The burden of caregiving of older adults is primarily shouldered by spouses and children with those who care for older adults with depressive symptomatology likely experiencing an even greater burden of care.

Older American Indians’ Perspectives on Health, Arthritis, and Physical Activity: Implications for Adapting Evidence-Based Interventions, Oregon, 2013

Introduction Despite the high prevalence of arthritis and physical disability among older American Indians, few evidence-based interventions that improve arthritis self-management via physical activity have been adapted for use in this population. The purpose of this study was to identify beliefs about health, arthritis, and physical activity among older American Indians living in a rural area in Oregon to help select and adapt an arthritis self-management program. Methods In partnership with a tribal health program, we conducted surveys, a focus group, and individual interviews with older American Indians with arthritis. Our sample comprised 6 focus group participants and 18 interviewees. The 24 participants were aged 48 to 82 years, of whom 67% were women. Forms B and C of the Multidimensional Health Locus of Control (MHLC) instrument, modified for arthritis, measured MHLC. Results The concepts of health, arthritis, and physical activity overlapped in that health was a holistic concept informed by cultural teachings that included living a healthy lifestyle, socializing, and being functionally independent. Arthritis inhibited health and healthy behaviors. Participants identified barriers such as unreliable transportation and recruiting challenges that would make existing interventions challenging to implement in this setting. The Doctor subscale had the highest MHLC (mean = 4.4 [standard deviation (SD), 1.0]), followed by the Internal subscale (3.9 [SD, 1.4]) and the Other People subscale (2.8 [SD, 1.1]). Conclusions Existing evidence-based programs for arthritis should be adapted to address implementation factors, such as access to transportation, and incorporate cultural values that emphasize holistic wellness and social interconnectedness. Culturally sensitive programs that build on indigenous values and practices to promote active coping strategies for older American Indians with arthritis are needed.

Association Between Self‐Reported Type 2 Diabetes Mellitus and Physical Function in Older American Indians

To the Editor: Type 2 diabetes mellitus (T2DM) is a common and serious chronic disorder associated with significant economic burden and profound negative effects on health, well-being, and quality of life. Although vascular complications and related medical comorbidities have long been thought to explain the adverse health effects of T2DM, recent studies suggest that impaired function and mobility may also contribute. A growing number of studies indicate that T2DM is strongly associated with impairment in physical function, in turn a strong predictor of dependency, morbidity, and mortality in older adults. Older American Indians (also called Native American) have a disproportionately high prevalence of T2DM and physical disability and experience significantly higher T2DM-related mortality, but research regarding the association between T2DM and physical function in American Indians is lacking, and few studies in any population have assessed this relationship using performance-based physical functioning measures. The current study was designed to assess the relationship between self-reported T2DM and physical functioning in a population of older American Indians. METHODS

Type 2 diabetes management among older American Indians: beliefs, attitudes, and practices

ABSTRACT Objective: The purpose of this study was to examine beliefs, attitudes, and practices of older American Indians regarding their type 2 diabetes mellitus (T2DM) management. T2DM is one of the leading causes of morbidity and mortality among American Indians. American Indians are more than twice as likely to have T2DM and have over three times a T2DM mortality rate as Whites. Design: Study participants were older members of a federally recognized tribe who had T2DM. A low-inference qualitative descriptive design was used. Data were collected through semi-structured in-depth qualitative interviews with a mixed inductive, deductive, and reflexive analytic team process. Results: Our study sample included 28 participants with a mean age of 73.0 ± 6.4 years of whom 16 (57%) were women. Participants’ mean self-confidence score of successful T2DM management was 8.0 ± 1.7 on a scale from 1 to 10 with 10 representing the greatest amount of confidence. Participants’ mean HbA1c was 7.3% ± 1.5%. Overall, participants discussed T2DM management within five themes: 1) sociocultural factors, 2) causes and consequences, 3) cognitive and affective assessment, 4) diet and exercise, and 5) medical management. Conclusions: It is important to be aware of the beliefs and attitudes of patients. Lay understandings can help identify factors underlying health and illness behaviors including motivations to maintain healthy behaviors or to change unhealthy behaviors. Such information can be helpful for health educators and health promotion program staff to ensure their efforts are effective and in alignment with patients’ realities.

Traumatic Stress, Social Support, and Health Among Older American Indians: The Native Elder Care Study

OBJECTIVES To estimate the prevalence of lifetime traumatic experiences, describe related symptoms of traumatic stress, and examine their association with perceived social support and physical and mental health among older American Indians. METHOD Analyses of existing interview data from the Native Elder Care Study, a random age-stratified sample of 505 tribal members ≥55 years of age conducted in partnership with a large Southeastern tribe. Interviews assessed trauma exposure, traumatic stress, measures of social support, and physical and mental health status. RESULTS Overall, 31% of participants had experienced a traumatic event; of these, 43% reported traumatic stress at the time of the interview. Higher perceived social support was associated with a reduced prevalence of traumatic stress. Compared to their counterparts without traumatic stress, women participants reporting traumatic stress reported more symptoms of depression, and both symptomatic men and women had a higher prevalence of cardiovascular disease and chronic pain. DISCUSSION Traumatic stress was associated with less perceived social support and poorer health. Social support was not found to moderate the relationship between traumatic stress and physical and mental health.