Agents of Change: Geriatrics Workforce Programs Addressing Systemic Racism and Health Equity.

Many factors affect how individuals and populations age, including race, ethnicity, and diversity, which can contribute to increased disease risk, less access to quality healthcare, and increased morbidity and mortality. Systemic racism-a set of institutional policies and practices within a society or organization that perpetuate racial inequalities and discrimination-contributes to health inequities of vulnerable populations, particularly older adults. The National Association for Geriatrics Education (NAGE) recognizes the need to address and eliminate racial disparities in healthcare access and outcomes for older adults who are marginalized due to the intersection of race and age. In this paper, we discuss an anti-racist framework that can be used to identify where an organization is on a continuum to becoming anti-racist and to address organizational change. Examples of NAGE member Geriatric Workforce Enhancement Programs (GWEPs) and Geriatrics Academic Career Awards (GACAs) activities to become anti-racist are provided to illustrate the framework and to guide other workforce development programs and healthcare institutions as they embark on the continuum to become anti-racist and improve the care and health of vulnerable older adults.

Indigenous Elder-centered methodology: research that decolonizes and indigenizes.

Indigenous research posits that practice-based evidence is fundamental to culturally grounded, multifaceted methods. The objective is to outline the key tenets and characteristics of Elder-centered research and relevant methodology using an interconnected progression of Alaska Native studies. Semi-structured interviews were conducted with 12 Alaska Native Elders, 21 Alaska Native caregivers, and 12 Alaska Native and non-Native caregivers in two studies exploring cultural understandings of memory and successful aging. The design and implementation of these studies employed Elders at every level, ensuring cultural relevance, outcomes, and dissemination. Results reflect the benefits of engaging Alaska Native Elders in research and reveal methods for best practices: (a) creating advisory councils, (b) identifying stakeholders, (c) weaving together Elder and western knowledge systems, and (d) the reciprocal nature of Elder engagement and well-being. This research centers Indigenous values and research for an Elder-centered methodology that encourages engagement of older adults in applicable, meaningful, restorative, and enculturated ways.

Dementia, Substance Misuse, and Social Determinants of Health: American Indian and Alaska Native Peoples' Prevention, Service, and Care.

Background: American Indian and Alaska Native (AI/AN) peoples are disproportionately impacted by substance use disorders (SUDs) and health consequences in contrast to all racial/ethnic groups in the United States. This is alarming that AI/AN peoples experience significant health disparities and disease burden that are exacerbated by settler-colonial traumas expressed through prejudice, stigma, discrimination, and systemic and structural inequities. One such compounding disease for AI/AN peoples that is expected to increase but little is known is Alzheimer's disease and related dementias (ADRD). AI/AN approaches for understanding and treating disease have long been rooted in culture, context, and worldview. Thus, culturally based prevention, service, and caregiving are critical to optimal outcomes, and investigating cultural beliefs regarding ADRD can provide insights into linkages of chronic stressors, disease, prevention and treatment, and the role of substance misuse. Method: To understand the cultural practices and values that compose AI/AN Elder beliefs and perceptions of ADRD, a grounded theory, qualitative study was conducted. Twelve semistructured interviews with AI/AN Elders (M age = 73; female = 8, male = 4) assessed the etiology, course, treatment, caregiving, and the culturally derived meanings of ADRD, which provides a frame of understanding social determinants of health (SDH; eg, healthcare equity, community context) and impacts (eg, historical trauma, substance misuse) across the lifespan. Results: Qualitative analyses specific to disease etiology, barriers to treatment, and SDH revealed 6 interrelated and nested subthemes elucidating both the resilience and the chronic stressors and barriers faced by AI/AN peoples that directly impact prevention, disease progression, and related services: (1) postcolonial distress; (2) substance misuse; (3) distrust of Western medicine; (4) structural inequities; (5) walking in two worlds; and (6) decolonizing and indigenizing medicine. Conclusion: Barriers to optimal wellbeing and SDH for AI/AN peoples are understood through SUDs, ADRD, and compounding symptoms upheld by colonial traumas and postcolonial distress. En masse historical and contemporary discrimination and stress, particularly within Western medicine, both contextualizes the present and points to the ways in which the strengths, wisdom, and balance inherent in AI/AN culture are imperative to the holistic health and healing of AI/AN peoples, families, and communities.

The human mosaic: cultural beliefs and health professions training.

Developing culturally competent healthcare service must incorporate the needs of ethnic elders as well as the types of services provided. The question arises as to how to define optimal ways of teaching cultural diversity to the future healthcare professionals who will be treating older adults of indigenous heritage. Basing its work on an ethnogeriatric approach developed by the Stanford Geriatric Education Center, the Alaska Geriatric Education Center adapted the tool and utilized it with indigenous populations within Alaska. The reformatted approach examined and charted historical events (by cohort analysis) that have influenced Alaska's Native Elder's healthcare belief system over generations. Historical profiles produced from this approach may be used in studying and treating seniors from diverse ethnic backgrounds and provide an educational tool in training gerontology or geriatric healthcare professionals. The approach may also be used for organizing individuals' perceptions of the historical events in their lives within clinical health and mental health settings.