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Improving Long-term Care for American Indians in Region VIII

Using Health Promotion & Disease Prevention


Alan Allery, M.H.A., M.Ed., Director, National Resource Center on Native American Aging, Center for Rural Health, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND.

Patricia Els, Chair, Wisdom Steps Board of Directors, Duluth, MN.

Mary Snobl, M.S., R.N., Indian Elder Desk, Minnesota Board on Aging, St. Paul, MN.

An individual's long-term care needs often result from a chronic disease. Drs. McDonald's and Ludtke's work indicates that health promotion and disease prevention could be very effective at reducing American Indian long-term care needs because of the higher incidence among this population of such chronic conditions as arthritis, congestive heart failure, asthma, prostrate cancer, high blood pressure, and diabetes.

Maximizing the effect of health promotion and prevention in American Indian communities, according to Alan Allery, Director of the University of North Dakota's National Resource Center on Native American Aging, will require, "a commitment to providing information in a way that American Indian people can understand and act upon in order to improve their health." Mr. Allery emphasized that doing so will require societal and system change.

How can American Indian communities improve elders health through disease prevention and health promotion?

Wisdom Steps, a partnership between American Indian communities and the Minnesota Board on Aging, is an example of a health promotion and prevention program specifically designed to help American Indian elders (

Patricia Els, Chair of the Wisdom Steps Board of Directors, and Mary Snobl of the Minnesota Board on Aging informed meeting participants that Wisdom Steps promotes community partnerships, motivates American Indian elders to take steps to improve their health, and encourages the coordination of resources. It does this through developing innovative model projects that address risk factors for heart disease, cancer, diabetes, and stroke (the leading causes of death for Tribal elders):

  • A model health screening project, "Medicine Talk," seeks to improve communication between elders, health specialists, and pharmacists. Pharmacists review with the elder all the traditional, prescription, and over the counter medicines an elder is taking. They discuss possible food/drug interactions and any concerns the elder may have. They also follow up with elders who need assistance with medicine management.

  • A model health education project, "Medicare in American Indian Communities," seeks to encourage eligible elders to enroll in Medicare and other related programs, such as the Medicaid program that pays Medicare cost sharing for low-income elders. As part of this effort, elders and their health professionals designed culturally appropriate educational materials for elder consumers, tribal, and health staff training.

  • A model healthy living activity project, "We Walk Many Together," encourages elders to get involved in regular walking or routine exercise programs.

Wisdom Steps also offers an incentive plan to encourage elders to participate in its activities. Elders who complete two of three health promotion activities within a year (complete five health screenings, attend a health fair, or participate in either an organized walk or another form of routine exercise) receive an incentive at an annual conference held by the Wisdom Steps program. The incentives include a certificate and a pin and eagle charm in the first year of participation. Two other charms (a wolf and a bear) are added in succeeding years.

Each participating Tribal government appoints a representative who is responsible for communicating with each community about Wisdom Steps, and each participating community decides which programs they will adopt. The goal of the first three years of program operation has been to create awareness among elders of what they can do to maintain their health and among the communities of how they can support the elders. In the next three years, the Wisdom Steps program plans to focus more on health interventions.

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