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Health Providers Have Desire & Opportunity to Intervene in Cases of Elder Abuse Among American Indian and Alaska Native Patients, But Lack Knowledge and Training: Findings From A New Report


By Jolie Crowder, PhD, MSN, RN, CCM, International Association for Indigenous Aging, and Dave Baldridge, International Association for Indigenous Aging

November marks the observance of Native American Heritage month–an opportunity to recognize the storied history, diversity, and contributions of American Indians and Alaska Natives (AIANs) in the United States.

The month also provides the opportunity to recognize the significant challenges Native people, especially elders, have faced. Elders are considered by many tribes as the keepers of tribal knowledge. Conventional wisdom, both within and outside of Indian country, is that they are revered for the role the play in their communities.

Yet, recent evidence indicates that the values of respect and reverence ascribed to tribal cultures seems to provide little protection for their elders from abuse. An analysis of the National Elder Mistreatment Study (NEMS), the largest population-based study of elder abuse prevalence in the U.S., found that AIAN elder respondents reported a cumulative abuse prevalence of 33% — almost double that of overall original study findings for white respondents (Crowder, Burnett, Byon, et al., 2019). This included emotional, physical, and sexual mistreatment in the past year, neglect, and financial abuse by a family.

Seeking  solutions to these disparities, our organization, The International Association for Indigenous Aging (IA2), conducted what we believe is the first comprehensive national needs assessment to date. Our goal was to identify facilitators and barriers for screening and management of elder abuse by tribal health care providers.

Overall, we found that participating outpatient health care providers are willing and ready to embrace screening for abuse among their older patients.

89 percent of tribal provider respondents think primary care providers should be screening for elder abuse, yet more than half don’t have a protocol or process for doing so.

These same providers are already required to intervene in clinical settings that more often than not lack protocols for managing cases of elder abuse, offer little training, and either lack information about—or lack the actual-community services and supports. Doctors, nurses, advanced practice nurses, and physician’s assistants shared moving stories about older patients who have been subjected to a range of abuse and exploitation, and their struggles as providers to help.

Assessment findings indicate that screening tools, protocols, and training are the most pressing priorities for tribal health care providers, and resulted in a number of key policy and practice recommendations.

Interviews and surveys identified valuable themes and insights surrounding the experience of managing elder abuse. These  included priorities for service and funding deficits and the need to understand connections between culture and abuse. Several promising programs and practices to address abuse of Native elders were also identified by participants.

You can learn more about key findings from this project as well as hear results from recent research on prevalence and predictors of abuse among AIAN elders in our upcoming webinar.

In recognition of Native American Heritage month, the National Center for Elder Abuse (NCEA)  will feature several blogs to discuss key findings from our assessment. We’ve asked a panel of respondents to talk to you each week for the next two weeks about the finding or recommendation that resonated most strongly for them. We welcome the opportunity to bring the issue of elder abuse in tribal communities to the forefront of the national discussion on abuse of older people.

You are invited to read summary findings of our project, which we believe are a stepping stone for future conversations on addressing the epidemic of elder abuse facing tribal communities.

This project was funded by a generous grant from The National Resource Center for Reaching Victims of Crime via the United States (U.S.) Department of Justice Office of Victims of Crime.

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Special Thanks to Judith D. Tamkin

We are sincerely appreciative to Judith D. Tamkin for her gift to help establish the USC Center on Elder Mistreatment’s website. Her deep and personal commitment to eradicating elder abuse is helping to reshape our understanding of elder abuse and ultimately save innumerable older adults from abuse and neglect.