NRCNAA survey suggests urban Native Elder health needs not being met

Native Elders living in urban locations have needs that are not being met. This finding is significant because over 70% of Elders live in urban areas, not on reservations.

This conclusion is a result of the first ever Native Urban Elder Needs Assessment Survey (NUENAS 1.0), which was administered nationally through the National Resource Center on Native American Aging (NRCNAA) housed at the Center for Rural Health (CRH) within the University of North Dakota School of Medicine & Health Sciences.

Today, the results of the survey have been released in a report and data booklet format.

In total, 1,023 urban Elders from 41 states, ages 55 and older, were surveyed from March 2021 through November 2022.

The NRCNAA and partners met with AARP in the summer of 2018 to propose the idea of conducting a national survey, specifically looking at the health and social needs of the urban Native Elder population. After realizing the project’s importance, AARP was on board. As a result, the Coalition on Urban Indian Aging (CoUIA) was formed in 2019 to ensure that the project was focused on promoting urban Native Elder health. This unique partnership brought together six organizations with one goal in mind: improving health equity for urban Native Elders.

The results show needs greater than initially thought:

• Only 56.7% of Elders had visited a dentist or dental hygienist in the past year.
• 39.8% of respondents reported being diagnosed with a disability. Of those with a disability, 37.9% said the condition was due to chronic disease; 35.5% due to accident/injury; 31.5% ‘other,’ 5.9% military service, and 5.6% congenital (Elders could select more than one option).
• Most respondents (50.2%) relied on Medicare for healthcare coverage.
• 30.2% of respondents cut the size of meals or skipped meals because there wasn’t enough money for food; 30.6% ate less than they felt they should due to lack of financial resources.
• Most urban Native Elders socialized 1-2 times per week (26.3%) or 3-4 times per week (23.4%), although 25.9% reported never socializing.

“This project is very important,” said Dr. Collette Adamsen, the director of the NRCNAA and associate director of CRH, “because we don’t know of any other project that has taken on research of this magnitude that focuses on identifying the needs of our urban Native Elders across the nation. We knew the data collection had to be done the right way, be culturally appropriate, and respectful of our urban Native Elders and the urban organizations that serve them. These Elders are living in urban areas and many times do not have the supports and services needed. This project gives the opportunity to gather evidence of these needs and use this data to fill those gaps in services and resources. This effort is about improving the quality of life for our urban Native Elders and allowing them to access the services and resources that will improve their health and well-being: to let them know that they are not forgotten.”

The data in the report and data booklet are aggregate data. Each urban organization participating in the survey received their own data, which remains confidential.

The survey contained 132 questions and covered topics such as physical, social, emotional, and mental health service quality; overall quality of life; and unidentified needs, among other topics. All questions were asked to provide data to support improvement of health equity, quality of life, and overall cultural responsiveness. The survey was designed to be taken in-person at their urban organizations through a scantron hard copy survey or online using computers, tablets, and smart phones. Assistance was available from urban center staff to help Elders fill out the surveys. After analyzing the results, each urban center that participated was able to acquire specific data for the urban Native Elders they served, allowing them to identify and work to address their Elders’ needs.

The project faced some challenges initially due to the COVID-19 pandemic. The first planned administration of the survey was slated for April 2020. However, with older adults being the most susceptible to infection, a new plan was developed that included pausing the project until the COVID-19 situation improved. When it was determined safe for Elders and urban centers to open back up, the NRCNAA partnered with its first pilot site to administer the survey in March 2021.

After the pilot site completed its surveys, NRCNAA officially rolled out the survey to all urban organizations and urban Native Elders in May 2021. The original project was projected to last 25 months. Due to the pandemic, it took five years.

Survey results indicate that food insecurity is prevalent among the Elder population, and that many of the Elders who have health conditions are caregivers to grandchildren:

• Among the 15.6% of Elders who said they didn’t have enough money to buy the food they needed, 16.5% had an annual income of less than $5,000; 89.4% were at a high nutrition risk (none had a good nutrition status); and 34.6% reported taking care of grandchildren.
• Among the 35.5% of urban Native Elders who took care of grandchildren, the average number of chronic illnesses was 3.15; 11.8% made less than $5,000 annually; 58.2% said their health was excellent, very good, or good.
• Among the 15.8% of urban Native Elders who reported not feeling very safe or not feeling safe at all, 47.5% were disabled; 20.3% had a memory issue; and 38.5% took care of grandchildren.

“Our Native urban population is underrepresented in national data sets, which is key to identifying and addressing the needs of this population,” continued Adamsen. “If there are no data to justify the needs, then Native urban Elders are left out of the conversation, especially when it comes time for the allocation of resources and funding.”

Planning is underway to bring the data on a roadshow to share what has been learned and encourage discussions on how these needs can be met. CoUIA is hopeful that a second phase of NUENAS will begin in 2024, and that its work will help inform policy decisions.

“I am so grateful for all of the partners who played a role in the success of the needs assessment survey,” Adamsen said. “The data collection is the first step in truly beginning to understand what our urban Native Elders need and will help us plan for how to meet those needs.”