November has been a busy month for the IA² Brain Health team. This month our team has had the opportunity to share with others about the different types of caregiving as well as about our new information products. 

   --- IA²'s Dave Baldridge was able to share his personal experiences on the BOLD Public Health Center of Excellence on Dementia Caregiving webinar: Experiences of Diverse Older Adults Living with Dementia.
   --- IA²'s Mary Ann O'Meara had the opportunity to share about the organization and the many new resources available at the Addressing Alzheimer's in Indian Country Webinar.

Be sure to check out our ever-evolving Brain Health Resource Library for American Indian and Alaska Native communities, available on our website.

            -- By IA² - Healthy Food, Healthy Brain Rack Card (1st in a 6-card series) for American Indian in Alaska Native communities
            -- By IA² - 10 Warning Signs Flyer for American Indian in Alaska Native communities (6 designs to choose from)
             -- By IA² - Tribal Law and Policy for Dementia and Alzheimer's 
             -- Ideas for Tribal Public Health Approaches to Dementia - a menu of activities for health & public health
             -- Banner Alzheimer's Institute releases "Walk with Me" CD with Native music for people living with dementia
             -- Research - Spirituality as a Coping Mechanism for Dementia Caregivers
            -- Resources – Administration for Community Living’s Brain Health Resources

In other IA² news:

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The International Association for Indigenous Aging (IA²) celebrates Native American Heritage Month this November. National Native American Heritage Month empowers American Indians and Alaska Native people from all around the country to honor traditions, culture, history, and livelihood on ancestral lands. This is an opportunity for Native representation to raise visibility within our Nation and others can join in through awareness, education, and celebration of Native people.

For many, Native American Heritage Month is only recognized once a year in November, but heritage is something to celebrate every day. Native American Heritage Month also provides a special opportunity to honor the role Native elders play in their communities. Elders are keepers of sacred tribal knowledge and keep culture and traditions alive. We continuously look forward to meaningful and measurable improvements in the lives of our elders.

Written by NICOA

Beverly F. Owens was the oldest of four children born in Anchorage, Alaska to Karen Rae Hopkins. For over 20 years, she has worked for the Nisqually Indian Tribe as the executive secretary of the Public Works Department.

She graduated from West High School in 1984 and business school in 1987. She has continued her education, not only to improve upon her skills, but to role model the importance of learning to her three sons. She enjoys learning new things and teaching people and children the skills she knows.

She moved to Washington 28 years ago and now lives in Onalaska with her husband and youngest son. She also has a beautiful 1-year-old grandson, who is her pride and joy. Watching her three boys grow into honorable men has been her greatest source of satisfaction.

She has taught her children the very same tribal traditions that she learned from her grandmother. Read about Beverly’s journey, the skills and wisdom her grandmother imparted, and the importance of standing up for your rights as Native people:

“Every day is a new day and we as a united gathering need to move forward to improve opportunities for Native peoples. We need to push for better schooling, housing, and medical care, as well as any other issues that may arise.

We must strive to stay informed about Native issues happening throughout the country because they affect us all. What happens in Indian Country has an impact on all Native communities. We will only have a promising tomorrow for our Tribal people if we work together as a whole. Without our unity, strength and wisdom, there will be no tomorrow for us as a people.

We need to look back at our ancestors and thank them for their hard fight. Because of them, we exist as a people today! I never forget to tell my sons where they come from, what they are, and how proud we are of their heritage.

Our families are warriors and survivors. We are an honorable people. As the saying goes, ‘We are the First People of the land. We as a people have to set an example not only for our children, grandchildren, and future generations to come, but we need to show all people that we are warriors and survivors for today and tomorrow.’

I am proud to be an honorable, strong, traditional Native woman succeeding in a modern world. I have instilled that pride in each of my sons, and we are now imparting that pride and tradition to my firstborn grandchild. My sons and I participate in Native song and dance every summer during Tribal Journeys here in Washington State.

I have taught them how to hunt, gather, grow, prepare and store foods. I have taught them how to tan hides, sew, and weave. These skills were passed on to me by my ancestors and I am passing them on to my children, grandchildren, and members of the Native community.

I hope to show others that our traditional teachings and skills are not lost. I hope to inspire others to learn and continue sharing the survival skills and strength we have inherited. Because of the skills learned from our ancestors, we stand tall as warriors, survivors, and teachers with honor, pride, and integrity.

My Grandmother

My grandmother was my greatest inspiration. She was a very strong Native elder. She stood up to everyone and everything and she always told me ‘Nobody owes you anything in life but yourself! You have to work for what you get in life! So, work hard and be proud of what you do in your life, because only you know your true struggles and life challenges that got you to where you are today!’ I have always lived by those words to this day because of her.

She is the one who taught me how to work hard every summer once school was out. I would go and stay with her for the whole summer. I miss those times so much! She taught me how to cook, gather wild herbs and vegetables, sew and make traditional regalia.

When it was gathering season, she would wake me up in the early morning and we would gather roots, plants and berries and she would tell me traditional stories as well as stories about her life. The time I spent with her was magical. I learned so much from her and will always cherish those memories. She told me culture is taught from the heart and from family, and to always learn as much as you can.

She was also a strong believer in Native rights. The neighborhood that she lived in it was low-income housing, but it was home and I always felt safe. Once, when I was 12 years old, while my grandmother was out on her doorstep fixing a bird cage with a hammer, police officers showed up and started asking questions. At first she complied but when the officer wanted to go into her home and look around, she told them they had to first get a warrant to enter her home.

I think the officer thought she just an old Native woman who didn’t understand her rights. As an officer tried to enter my grandmother’s home anyway, she again stated that he needed a warrant. When he proceeded anyway, my grandmother hit his foot with the hammer!

She stood up and said, ‘get a warrant and then you are more than welcome in my home’ and slammed the door on him. I never saw anything like that! I was scared they were going to arrest my grandmother, but she told me that he had violated her rights by entering her home without a warrant. She even got his badge number.

Thankfully, he never came back. She told me to always stand up for my rights. Even though the police are the law it still does not make them right. I have never forgotten that.

This is an original story from NICOA. 

This project was an awarded grant for the Department of Justice. The purpose of this project is to prevent wandering among tribal elders living with Alzheimer’s disease and related forms of dementia (ADRD), develop a robust wandering search and rescue support strategy in the Pyramid Lake Paiute Tribe (PLPT) reservation, and create a replication guide to benefit tribes nationwide. The International Association for Indigenous Aging (IA²) and Pyramid Lake Numaga Senior Center, led by Carla Eben, will work in partnership to develop person-centered and culturally appropriate wandering prevention activities and search and rescue support strategies. The project will serve tribal elders, especially those living with ADRD, their family caregivers, tribal police and first responders, and members of the PLPT.

IA² was invited to the International Association of Chiefs of Police Conference (IACP) last month in Dallas, Texas. IA² sent our Tribal Public Health and Aging Associate, Breana Dorame, to represent the project team and meet the other grantees. There was great discussion in a roundtable setting where the grantees were able to share their projects and also learn from each other. IA²’s project with the Pyramid Lake Paiute Tribe is unique and seems to be the only grantees exclusively working with tribal elders on a reservation. 

“I am very excited that we are paving the way for this type of ADRD wandering work in Indian Country. We are looking forward to having this project to be replicated in other tribal communities,” says Breana. Dave Baldridge, Executive Director of IA² says, “We’ll see more senior citizen wanderers in cities, parks, suburbs, and wilderness. Search and rescue teams do their best to mitigate the often-devastating effects of wandering, but they can’t prevent the incidents. Therefore, outreach and education about dementia wandering in elders is important for all communities.”

By: Mary Ann OMeara, MPH, Breana Dorame, International Association for Indigenous Aging; Mike Splaine, Splaine Consulting 

Alzheimer's disease and related dementias affect American Indian and Alaskan Native people at a high rate. According to the Healthy Brain Initiative's Roadmap for Indian Country, 1 in 9 people over 65 in America experience Alzheimer's or related dementia. This percentage increases for American Indians over 65 to 1 in 3 elders. Communities are beginning to recognize that elders with Alzheimer's or dementia may need support beyond that of the family. For many Native families, it is commonplace for their elders to remain in the home and for immediate family to care for their loved ones. For many, caregiving comes with many stressors. As a result, tribal authorities are analyzing their capabilities to provide culturally competent Alzheimer’s or related dementia care in their communities or residential settings. American Indian and Alaska Native communities need long-term services and support, and steps can be taken to continue to protect elders and caregivers.  

 

Warning Signs of Alzheimer's and Dementia 

Identifying warning signs early in elders and loved ones is crucial to finding the best care possible while preserving their long-term health. In an informative interview with A.L.Z. Magazine, Violet Blake discovered the challenges facing Alzheimer's firsthand when her mother became ill. Violet and her family moved to the Oneida reservation to care for her mother, Shirley. She explained that some tribes don't have a word for dementia and had never heard of the disease when she became her mother's caregiver. This, among others, is a situation that is seen time and time again. For caregivers like Lorraine Wildcat, caring for her mother with Alzheimer’s is hard. After her mother’s diagnosis a few years ago, and with her father’s health failing, Lorraine quit her job and she and her husband moved in with her parents in their rural tribal community to provide care. By then, her mother’s memory issues were so advanced that she couldn’t remember how to use a phone. For many it is critical to identify early signs of memory changes that could be Alzheimer’s or dementia.  

 

Some prominent warning signs are:  

• Memory loss that disrupts daily life.  

• Challenges making plans or solving problems.  

• Difficulty completing familiar tasks. 

• Confusion with times and places.  

• Decreased or poor judgments. 

• Misplacing things or not remembering where things are. 

 

For a more comprehensive list, be sure to check out the 10 Warning Signs of Alzheimer's. , as well as IA2’s 10 Signs of Thinking or Memory Changes that Might Be Dementia, specifically for American Indian and Alaska Native Communities. Should someone be displaying signs of dementia, reach out to a medical care provider as soon as possible. An early diagnosis can make all the difference. 

 

More Resources are Needed in Tribal Communities 

American Indian and Alaska Native (AI/AN) people ages 65 and older are more predisposed to dementia, including Alzheimer’s, than other racial and ethnic groups. This increases the likelihood of family members becoming caregivers in tribal communities. It is not surprising then that one in three AI/AN adults is a caregiver, more than other racial and ethnic groups. Therefore, it is more important than ever to establish long-term services and care to help elders experiencing Alzheimer's and dementia and provide support for their caregivers. 

 

"After funding, workforce issues are the common bottom line problem faced when tribes and tribal organizations are planning for long-term services," says Elaina Seep, C.E.O. and Project Lead at Aniwahya Consulting Services. "Everywhere, especially after COVID, we see issues of enough workers, trained workers, and retaining workers to do this vital work."  

 

The life expectancy for members of AI/AN communities has increased rapidly over the decades, increasing the number of elders in the community. It is a blessing to have a more significant amount of tribal elders, but the resources to provide for them must also grow.  

 

Today, of the 574 Federally Recognized tribes, 35 tribes are estimated to be operating nursing homes, and as many as another 50 have assisted living communities. In addition, Title VI programs deliver support, and some tribes participate in state Medicaid waiver programs that support persons with disabilities in the community.  

 

Solutions for AI/AN Communities 

The surest ways to help reduce the risk of Alzheimer's and other dementias are maintaining a good diet, regular physical activity, lifelong stress management, spiritual wellness, among other things. However, even if all preventative measures are taken, there is still a risk. Although dementia-related conditionss are increasing in American Indian and Alaska Native communities, resources to help are rising to match the demand.  

 

Recognizing workforce as core issue, the Administration for Community Living has awarded a five-year, $6 million grant to establish a center called The National Direct Care Workforce Capacity Building Center. This center will strengthen and expand the direct care workforce across the country. 

 

This center will serve as a hub that provides resources, training, and tools to assist state systems and service providers. It will also support developing and coordinating policies and programs that contribute to a stable direct-care workforce. 

 

In addition, the center will facilitate shared peer-to-peer advice and support collaboration between state systems, including Medicaid, and other aging, disability, and workforce agencies. Finally, it will open communications between aging and disability service providers and stakeholders, which creates an opportunity for tribes to engage them directly. 

 

Long-Term Services and Support Resources 

There are many resources to help elders who experience Alzheimer's and dementia-related illnesses. In addition, resources to provide culturally appropriate care and assistance to community elders are available. Early identification and prevention are the first steps to helping those you love. 

 

• The Healthy Brain Initiative's Road Map for Indian Country is a public health guide focusing on dementia and brain health for American Indians and Alaskan Native communities.  

• The Alzheimers Association has a program enabling you to enter your zip code and connect you with local programs to help.  

• The National Indian Council on Aging (NICOA) empowers American Indian and Alaskan Native elders and provides free resources to help native communities in need. Be sure to check out the National Indian Council on Aging (NICOA) LTSS Compass to find tribal resources and more.  

• The United Nursing Homes of Tribal Excellence, U.N.I.T.E., provides resources to increase the quality of life for AI/AN elders and provides culturally relevant education for caregivers.  

• The Center for Medicaid and Medicare Services released an informational bulletin that helps the AI/AN community sign up for Medicare and receive disability benefits.  

• The International Association for Indigenous Aging continues to provide a suite of American Indian and Alaska Native brain health resources as well as opportunities to participate to become a Dementia Friend or Dementia Friends Champion for American Indian & Alaska Native Communities.  

The International Association for Indigenous Aging (IA²) is looking to hear your feedback about resources that we could host, create or share with tribal communities. Please reach out to us with any suggestions.

Our Advisory Group member Josea Kramer, Ph.D., from the Veterans Health Administration and as the founder of the Geriatrics Scholars, will be hosting two-in person workshops for primary care IHS and Tribal Clinics on:

1. Team-Based Care for Elders (Rural Interprofessional Team Training in Care of ELDERS or RITT). RITT, the interdisciplinary training approach empowers all members of the team– clinicians, clerks, and others who interact with elders — to recognize and address nine health or safety concerns that should be discussed during a primary care visit. The course also covers geriatric syndromes and how to assess problems, such as falls and changes in thinking, activities, and function. RITT also includes training on screening for cognitive impairment. The program was created first for rural VA clinics, which like IHS clinics, may have few local specialty healthcare resources. 

2. Dementia Caregiving (Addressing Behavioral Challenges in Dementia (ABCD)). The ABCD program builds on public health nursing skills in primary prevention. These nurses already engage the community to manage diabetes and high blood pressure and promote brain health. Recognizing that they also are or will be working with community members who experience memory disorders, ABCD aims to enhance secondary prevention, including how to recognize signs and symptoms of dementia in someone who has not yet been diagnosed, and tertiary prevention, including home safety and support for caregivers in managing challenging behaviors and their own self-care. 

For more information, reach out to GRECC Associate Director for Education/ Evaluation Director, VA Geriatric Scholars Program: Josea Kramer or Betty Jo.

National Indigenous Elder Justice Initiative (NIEJI), has released a new product, the My Advance Care Plan & Guide for Native Americans. The guide is to assist Indigenous Elders in planning for health issues and end of life decisions and being able to share with loved ones their wishes.

Sections of the guide include:

• What is important to you now

• How you like to make decisions

• What care and treatment you would like in the future

• What is important to you after your death

IA² is providing consulting services as a third-party evaluator to grantees of the Alzheimer’s Disease Program Initiative (ADPI). In this role, IA² serves as a member of the grantees’ grants service team and contributes to the pre-and post-award evaluation process.

IA² works with grantees in the pre-award phase to identify the funding announcement’s evaluation requirements and helps conceptualize how to evaluate the program’s goals and objectives. Program evaluation activities play an essential role in documenting the progress of implementation and sustaining a comprehensive, dementia-capable system.

A resource that can be used to select ideal measurable outcomes is ACL’s National Alzheimer’s and Dementia Resource Center’s (NADRC) compendium, Evaluating Dementia Services and Supports: Instrument Resource List - well-researched Alzheimer’s disease and related dementias (AD/ADRD) evaluation measures.

Below are select instruments from published work that reference their use to evaluate dementia services and supports in Native populations.

• Alzheimer’s Disease Knowledge Scale (ADKS) – This self-rated 30-question instrument assesses what people know about Alzheimer’s disease in different key domains.

 

• Zarit Burden Interview - Originally a 28-question instrument, this caregiver self-report measure addresses caregiving burden.

For more information about Developing an Evaluation Plan, check out The University of Kansas’ Community Tool Box.

If you would like help telling your story, improving your programs, demonstrating program effectiveness to sustain funding, or need an evaluator as part of your grants services team, please contact admin@iasquared.org.

 
 
About ADPI Alzheimer’s Disease Program Initiative (ADPI)
Through the federal Administration for Community Living’s ADPI grantees’ programs will bring dementia-capable services and supports to the communities they serve, expanding existing home and community-based service systems for persons with Alzheimer's disease and related dementias (ADRD), their families, and their caregivers. The initiative supports the provision of direct services, evidenced-based interventions, and dementia-specific training for formal and informal caregivers.

As part of this cooperative agreement, the Administration for Community Living (ACL) requires that programs include an outcome-based evaluation design that will demonstrate program impact and contribute to the guidance of future programmatic components.
 

When Mary Angie started to forget more often, Yvette and her family had to make difficult decisions to best support her. Now she lives in assisted living and gets help with all her care. Tune in to hear their story of dementia and staying healthy.
 

IA²  hosted a Dementia Friends Information Session for American Indian and Alaska Native communities on November 29^th, and we had 44 participants!  We look forward to our next Information Sessions and Champion’s Trainings to be held early next year. IA²  has been working with Tribal Talking Circles to create an updated version of the Information Session Workbook and working closely with the University of Nevada, Reno’s DEER Program to update the Champion’s Guide to match the updated workbook. The changes to the content improve readability and health literacy. We strive to create culturally relevant content by embracing American Indian and Alaska Native community values.

About Dementia Friends
Dementia Friends is a global movement that aims to change the way people view dementia. By educating communities about what dementia is and how it affects people, we can all make a difference for people affected by dementia. This program has been adapted specifically for American Indian and Alaska Native individuals and communities. Dementia Friends will aid in spreading awareness, reducing stigma, and reducing risk in tribes, urban-Indian communities, and Alaska Native communities.

To learn more about the Dementia Friends Initiative, participate in a review of the materials, pilot the training content, or attend an upcoming session, please visit our Dementia Friends page by clicking here.

Download the first in a planned 6-series ready-for-use rack card for American Indian and Alaska Native nations and tribal serving organizations.

This healthy eating-focused message series includes practical advice and culturally relevant recipes.

Rack cards can be distributed through senior centers, inter-tribal organizations, healthcare facilities, administrative offices, tribal newspapers/radio stations, and as mailers to tribal members. Tribal meal delivery programs can incorporate weekly distribution for in-person and home-delivered meals. High-resolution files are available for download.

Rack cards are 3.67″ x 8.5″ and can be laid out to print 4 to a standard size page. 

As sovereign nations, tribes are uniquely situated to use law as a public health tool to promote the health and well-being of their communities. Additionally, federal law creates a framework that governs the relationships among tribes, states, and the federal government that can affect tribal public health. (U.S. Centers for Disease Control and Prevention, 2017) 

Check out this new policy report for American Indian and Alaska Native (AI/AN) communities. This report explores existing tribal laws and policies related to Alzheimer's Disease and Related Dementia for Native communities.

Law, regulation, and policy are all  essential public health services as tools to promote equity and improve public health.

From the International Association for Indigenous Aging by Splaine Consulting.

 

 

Designed by and for American Indian and Alaska Native Communities!

Access high resolution 1) Adobe pdf, 2) .jpg, 3) .png and 4) original design files for use in your community.

Looking for a different customized picture for your community? For a limited time contact us to request an image swap.
We have $250 printing stipends for tribes and urban Indian organizations and can ship flyers directly to your community.
Contact us for design help or info on printing stipends at admin@iasquared.org.
 

Agency Name: Centers for Disease Control - NCCDPHP

Description: This NOFO carries out actions from the Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act PL115-406. This NOFO will  fund public health departments to increase their capacity to contribute to the field of Alzheimer’s Disease and Related Dementias (ADRD) to expand and improve the response to ADRD in their jurisdictions and develop a connected approach to build the dementia infrastructure, including addressing social determinants of health to facilitate health equity, to improve the public health approach to Alzheimer’s disease and related dementias (ADRD) using the CDC Healthy Brain Initiative State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map (for state/local applicants) as well as the Road Map for Indian Country (for tribal applicants) as a framework. This 5-year NOFO will fund awardees in two different components, both with an emphasis on ADRD risk reduction, early diagnosis of ADRD, prevention and management of comorbidities leading to preventable hospitalizations, coordination of community services, caregiving for persons with ADRD, health equity, SDOH and community-clinical linkages: Component 1: “Capacity Building and Implementation” For jurisdictions without previous full spectrum ADRD-related goal setting, improve the infrastructure for dementia, create or expand a coalition, develop a single jurisdiction-wide ADRD strategic plan, and implement strategies and activities described below. Component 1 will be funded for 2 planning years and 3 implementation years.  Component 2: “Implementation” is for jurisdictions with infrastructure in place to implement jurisdiction-wide ADRD strategies and activities.  Component 2 will be funded for 5 full implementation years. Recipients will apply for either Component 1 or Component 2.  In addition to strategies and activities listed in the NOFO, recipients are expected to increase awareness and understanding among the general public (including populations of high burden), providers, and other professionals, of ADRD topics including risk reduction, early diagnosis of ADRD, prevention and management of comorbidities leading to preventable hospitalizations, and caregiving for persons with dementia.  Recipients are also expected to increase coordination of statewide efforts including improvement of community-clinical linkages between clinical, services, supports and community resources.

• Forecasted Date: Jul 26, 2022
• Estimated Post Date: Dec 14, 2022
• Estimated Application Due Date: Feb 15, 2023  
• Estimated Award Date: Jul 29, 2023
• Estimated Project Start Date: Sep 30, 2023
• Fiscal Year: 2023

Eligible Applicants:

1. County governments

2. City or township governments

3. Special district governments

4. Native American tribal governments (Federally recognized)

5. Native American tribal organizations (other than Federally recognized tribal governments)

6. State governments

Everyone needs social connections to survive and thrive. As people age, they often find themselves spending more time alone. Loneliness and social isolation have been associated with higher rates of depression, a weakened immune system, heart disease, and an increased risk of dementia. However, there are things older adults can do to stay connected. If you are looking for additional opportunities, consider joining a Dementia Caregiver Drop-In Support Group. Be sure to check out the IA² Calendar of Events by clicking the button below the NIH video about loneliness and social isolation and staying connected.