Native Americans are a very heterogeneous group, made up of approximately 530 different tribes. Of these, 280 reside on reservations, which accounts for approximately 50% of Native Americans in the United States (Wise & Miller, 1983). Reservation tribes differ between themselves, in customs, language, and family structure. In addition, Native Americans, in general, differ greatly in their degree of acculturation (adoption of mainstream society's values and ways of life), having to do with whether or not they live on reservations (Sue & Sue, 1990). This cultural variance, in turn, includes values and tribal identities that are different from those of most other Americans, who often do not understand many of the rituals, beliefs, and kinship differences (Axelson, 1985). Traditional Native American values can come into conflict with those of the mainstream, particularly when efforts are not made toward exploring and understanding these differences within their cultural context. As a result, inaccurate and/or overgeneralized stereotypes may be perpetuated, further complicating attempts to care for and provide services to Native American elderly.

VALUES AND CHARACTERISTICS: Given the identified differences both within and between Native American people, there remain a few generally agreed upon values and characteristics applicable to the traditional Native American experience as a whole (Axelson, 1985). Understanding these values can greatly facilitate interactions and service provision regarding Native American elderly. According to Bryde (1971), the majority of Native American values and actions relate to four universal objects that have been important in the culture for thousands of years. These include God, as the great power above everything, including one's destiny. The spiritual God of the native Americans is positive, benevolent, and part of daily living (Axelson, 1985). God is part of everything; thus all of nature's objects are to be respected as both spiritual and physical entities.

For Native Americans, the self is seen as an integral part of the universe and total workings of the world. Valued attributes of self include bravery, endurance of pain and suffering with patience and silence, controlled emotions, honesty and strength, self-respect and self-worth, respect for others, and individual freedom -- meaning to do what one wants as long as it is in harmony with nature (Deloria, 1973).

Relationships are also a key part of Native American life, particularly regarding the family. Group sharing of knowledge and responsibilities is integral to the Native American lifestyle. Generosity is valued, especially in helping others who are less fortunate. According to Native American tradition, equality of position, title, or material possessions (Axelson, 1985). Native Americans are also taught not to interfere with others; direct eye contact, particularly with an elder, is traditionally considered a sign of disrespect.

Concerning the aging process, elders are respected for their knowledge and experience. In fact, in traditional families, it becomes their responsibility to pass down their wisdom and learning to the young. All members of a tribe care for the elderly. Death is an accepted fact of natural life, not to be approached with fear. The soul is believed to be immortal, in the sense of experiencing a "changing of worlds" (Deloria, 1973, p. 184.)

The world in Native American culture is interconnected -- everything, including human beings, is believed to live according to the same process. Each being has its own unique function and place in the universe, and every part of nature contains a spirit. While mainstream society has attempted to overcome/overpower nature, and tends to make material comfort an end goal in itself, Native American culture seeks a balance with nature wherein both can benefit from and support one another.

Also important to recognize is that time takes on new meaning in Native American culture. They do not traditionally "go by the clock." Rather, time is measured according to natural phenomena such as the changing of day to night and seasonal change. The "right time" is, in general terms, viewed as when one is ready (Axelson, 1985), and living in the present takes precedence over planning for the future (Sue & Sue, 1990).

Within the context of the four universal objects, discussed above, the role of family emerges as an important factor in Native American culture and, thus, in developing relationships with their elders. As noted, family structure may vary from tribe to tribe. However, generally speaking, Native American families are characterized by a strong role for women and dependence on extended family support (often through second cousins) versus mainstream society's reliance primarily on the nuclear family for help.

RISK FACTORS: Several concerns complicate the picture of Native American caregiving and service provision. For instance, the overall life expectancy of the Native American is shorter than that of all other U.S. races: 65 years for Native Americans; 73.3 for non-native Americans (National Indian Council on Aging, 1981). This means that the average Native American barely lives long enough to reach the age of eligibility for most age-related programs (Bane, 1992). Of further concern is evidence indicating that Native Americans experience the same limitations in their daily living at age 45 as do non-Native American people at age 65.

One condition many Native Americans struggle with, often from early adolescence, is that of substance abuse. Statistics, in fact, reveal death from alcoholism to be 6 ½ times greater for Native Americans than in the general population (Westermeyer, 1972).

Suicide rates for Native Americans are also twice that of the national average, the greatest risk period being between adolescence and adulthood (Shore, 1988). In addition to economic strife and discrimination, such lifestyle evidence would suggest that a great many adults entering their later years are survivors of significant stressors, often throughout life, great enough to take a toll on their physical and mental health. This situation is often compounded by adherence to a set of cultural beliefs, values, and practices which can make outside intervention difficult at best.

REACHING NATIVE AMERICAN ELDERLY: Studies have indicated that reaching and assisting Native American elderly may be difficult for an number of reasons, in addition to those highlighted above. For instance, over 80% of Native American elderly do not have telephones, and the majority do not receive newspapers or have television sets (Bane, 1992). Additionally, as tradition dictates, knowledge and assistance is passed from elders to the young, primarily through the family. Thus, even information and help reaching the Native American elder may not be as openly received from an outsider, especially if they are much younger.

Several guidelines have been proposed in attempting to meet the challenges of the Native American experience, applicable to elderly care provision as well. First, and foremost, approach the elder with an attitude of acceptance and unconditional positive regard for their cultural heritage and experience. Attempt to understand problems and concerns from the individual's perspective, allowing the Native American elder to explore his or her own values (rather than imposing one's own) in arriving at solutions (Sue & Sue, 1990). These qualities, of course, apply to all elders, but may be especially critical for establishing a relationship with Native American elders who have been living on reservations their entire lives, and thus have been isolated from mainstream society.

Because self-disclosure about personal concerns to someone outside of the family is not traditionally done, it may be helpful to initially approach the Native American elder about other topics prior to delving into personal matters, in order to develop a sense of trust. Bryde (1971) indicates that American Indians tend to expect people such as counselors (viewed as "experts") to offer alternatives and solutions, once problems have been identified and discussed. Therefore, combining a person-centered approach (to establish rapport) with more direct behavioral suggestions may be more effective. Because of the importance of extended family, caregiving interventions may also be more successful in the elder's home, and perhaps even with other family members present (Sue & Sue, 1990). Further suggestions include:


     Axelson, J.A. (1985). Counseling and Development in a Multicultural Society. Monterey, CA: Brooks/Cole Publishing.

     Bane, S.D. (1992). Rural minority populations.  In Stanford, E.P., & Torres-Gil, F.M. (Eds.), Diversity: New Approaches to Ethnic Minority Aging (pp 123-128). Amityville, NY: Baywood.

     Bryde, J.F. (1971). Indian Students and Guidance. Boston, MA: Houghton Mifflin.

     Deloria, Y., Jr. (1973). God is Real. New York: Grosset & Dunlop.

     National Indian Council on Aging. (1981). American Indian elderly: A national profile by the National Indian Council on Aging. Albuquerque, NM: Author.

     Shore, J.H. (1988). Introduction. American Indian and Alaska Native Mental Health Research, 1, 3-4.

     Sue, D.W., & Sue, D. (1990). Counseling the culturally different: Theory and practice (2nd ed.). New York: John Wiley & Sons.

     Westermeyer, J.J. (1972). Options regarding alcohol use among the Chippewa.  American Journal of Orthopsychiatry, 42, 398-403.

Wise, F., & Miller, H.B. (1983). The mental health of American Indian children. In G.J. Powell, J. Yamamato, A. Romeo, & A. Morales (Eds.), The Psychosocial Development of Minority Group Children (pp 344-361). New York: Brunner/Mazel.


     American Association of Retired Persons (1987). A Portrait of Older Minorities. Washington, DC: Author.

     American Indian Elders: A Demographic Profile (1990). San Diego, CA: San Diego State University.

     Narduzzi, J.L. (1994). "Mental health among elderly Native Americans." Garland Studies on the Elderly in America. New York: Garland.

     Stanford, E.P., & Torres-Gil, F.M. (Eds.). 1992. Diversity: New Approaches to Ethnic Minority Aging. Amityville, NY: Baywood.


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