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Hendrix, MSN, RN, GNP, Ph D Affiliated Core Faculty, Stanford Geriatric Education Center. World view, life experiences, and the cultural context in which today’s American Indian elderly live is described as it relates to health care.Assistant Clinical Professor, Department of Physiological Nursing, University of California, San Francisco Learning Objectives Content I. Patterns of Health Risk Culturally Appropriate Geriatric Care III. The 2000 Census indicates that there are 4.1 million people who identify themselves as AI/AN (either alone or in combination with other races) in the United States (U. Census Bureau, Census 2000.) This is more than twice the count in the 1990 census of 1.9 Million.

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(It should be noted, however, that in 1990 individuals were asked to list only one racial identification.) Researchers believe that self-identification of race by American Indian (AI) respondents in Census counts since 1960 have dramatically increased, but that the 1990 Census contained a severe undercount of American Indians estimated to be 4.6%, and 12.2% in tribal areas (Harris, 1994; Passel, 1996).

About half of the Indian population 60 years and older lived in five states in 1990: Oklahoma (18%), California (13%), Arizona (9%), New Mexico (9%), and North Carolina (5%) (John, 1999).

The other states with a large number of American Indian elderly are Alaska, New York, Texas, Washington, and Michigan (John, 1999; US Dept. Preliminary data from Census 2000 including multiple racial identification indicate that California now has the greatest number of Indian elderly population, followed by Oklahoma, Arizona, Texas and New Mexico (M. (See Figures 3, 4, 5, and 6.) 1990 census identified 27% of AI/AN women, and 18% of AI/AN men, age 60 and over, living alone.

There are now more people who identify themselves as Indian in urban areas (62%) than on reservations and other rural areas, according to the 1990 Census.

In this urban Indian subculture many of today's elders have been part of the development of Pan- Indianism, where individuals from many different tribal backgrounds band together to preserve their cultural heritage and develop culturally relevant services, programs and activities (Straus & Valentino, 2000).

The number of older AIs increased 69% between 19 and is projected to show an even more dramatic jump in the 2000 census.

There are at least 558 different federally recognized tribes/nations and 126 tribes/nations applying for recognition.

At the time of first contact with Europeans, the continental United States was fully occupied by Indian Nations, and some 300 Indian languages existed, approximately 106 of which are still spoken.

(See Figures 1 and 2.) The diversity and heterogeneity of the American Indian community cannot be overstated.

(See discussion of Pan-Indianism in Appendix A: Chronology of Selected Historical Events.) These urban elders are more likely to live alone than their reservation counterparts but less likely to live in poverty.

Many are not served by the Indian Health Service (IHS).

Figure 3 Where American Indians and Alaska Natives Live: 1990 Source U. Department of Commerce, Economics and Statistics Administration, Bureau of the Census, 2000 Figure 4 Figure 5 Ten Most Populous American Indian Tribes, 1990 Source: U.

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