Journal of Gerontological Social Work

ISSN: 0163-4372 (Print) 1540-4048 (Online) Journal homepage: http://www.tandfonline.com/loi/wger20

Inuit Elderly: A Systematic Review of Peer Reviewed Journal Articles Balvinder K. Somogyi, Melanie Barker, Calvin MacLean & Pamela Grischkan To cite this article: Balvinder K. Somogyi, Melanie Barker, Calvin MacLean & Pamela Grischkan (2015) Inuit Elderly: A Systematic Review of Peer Reviewed Journal Articles, Journal of Gerontological Social Work, 58:5, 484-502, DOI: 10.1080/01634372.2015.1032469 To link to this article: http://dx.doi.org/10.1080/01634372.2015.1032469

Accepted author version posted online: 31 Mar 2015. Published online: 31 Mar 2015. Submit your article to this journal

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Date: 06 November 2015, At: 02:00

Journal of Gerontological Social Work, 58:484–502, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 0163-4372 print/1540-4048 online DOI: 10.1080/01634372.2015.1032469

Inuit Elderly: A Systematic Review of Peer Reviewed Journal Articles BALVINDER K. SOMOGYI, MELANIE BARKER, CALVIN MACLEAN, and PAMELA GRISCHKAN Downloaded by [University of Lethbridge] at 02:00 06 November 2015

Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada

Over the last century, Inuit have experienced rapid social changes that have greatly impacted their way of life, health, and intergenerational traditions. Although there is a growing body of research concerning Inuit youth, relatively little is known about elderly Inuit. In an effort to bridge this knowledge gap, a systematic review of peer-reviewed journal articles was conducted. This review identified a dearth of research on older Inuit, and highlighted limitations in service provision to this primarily rural and isolated population. Implications for policy and practice and recommendations for future research are also discussed. KEYWORDS caregiving, chronic illness, poverty, social work practice, substance abuse and addiction

INTRODUCTION Inuit1 are an indigenous population that is native to the circumpolar Arctic, which spans four nations, including Canada, USA, Greenland, and Russia (Ellsworth & O’Keeffe, 2013; Kanatami, 2009; Simon, 2011). Inuit have lived in this region for over 6000 years (Galan, Odlum, Grymonpre, & Brecx, 1993) and there are an estimated 160,000 Inuit currently residing in this area (Ellsworth & O’Keeffe, 2013). Inuit comprise 87% of the population of Greenland and make up most of Canada’s arctic population (Bjerregaard, Young, Dewailly & Ebbesson, 2004; Ellesworth & O’Keefe, 2013). 1 Typically, when referring to this indigenous population, articles written in the Canadian context used the term Inuit; and articles from the United States more commonly used Alaska Native. In sections that refer to both nations, we use the broader term Inuit. Received 4 May 2014; revised 7 March 2015; accepted 18 March 2015. Address correspondence to Balvinder K. Somogyi. E-mail: [email protected]

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There are many terms used to identify Inuit people, which vary based on geographical location (Bjerregaard et al., 2004). Kalaallit is frequently used in Greenland; Yupik is used in both Alaska and Russia; Inuit and Inuvialuit are used in Canada; and Alaska Native is a term broadly used to capture several Indigenous groups, including Inuit residing in Alaska (Bjerregaard et al., 2004). Inuit of the circumpolar Arctic have certain features in common: all have traditionally been fishing and hunting societies and share a variety of cultural practices (Ellesworth & O’Keefe, 2013; Simon, 2011). Inuit are not, however, a homogeneous group, with notable differences in areas such as regional dialects and access to healthcare (Ellesworth & O’Keefe, 2013). There have been surprisingly few studies on older Inuit in recent peer-reviewed journal articles. Presently, Inuit are experiencing challenges to many facets of their health and well-being (Ellsworth & O’Keeffe, 2013). These include cultural preservation, food insecurity and nutrition, mental health, and addictions. Inuit also experience greater levels of chronic illness, (e.g., heart disease, diabetes, chronic obstructive pulmonary disease, lung cancer), infectious diseases, (e.g., tuberculosis), and a much lower life expectancy than non-Inuit populations (Kanatami, 2009; Ellsworth & O’Keeffe, 2013). Much of the research conducted on Inuit has focused on youth and younger adults. There is little current research devoted exclusively to the concerns of elderly Inuit. Due to the fact that we could only review English-language literature, the focus of this article is primarily on Inuit in the United States and Canada. The purpose of this systematic review of the peer-reviewed literature is to gain a greater understanding of the issues facing elderly Inuit, including the impact of social and technological change, poverty, mental health issues and addiction. Literature on successful aging, nutrition and food security, chronic diseases, and formal/informal care services among Inuit elderly is also discussed.

METHODS An electronic search of the peer-reviewed literature pertaining to older Inuit was conducted in February 2014. A total of 12 databases were searched. The six medical data bases were: Ovid Medline R, Ovid Medline R (In Process and Other), Psych Info, Embase & Embase Classic, EBSCO, CINHAL. The six social science databases included Social Work Abstracts, Health and Psychosocial Dissertations, Sociological Abstracts, Social Service Abstracts, Ageline, and the Bibliography of Native North Americans. Under the guidance of a medical research librarian and a social science librarian, the following key words were used:

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(Inuit∗ OR Eskimo∗ OR aleut∗ OR inupiat∗ OR kalaallit∗ OR Alaskan Natives OR Alaskan Native OR Alaska Native OR Alaska Natives) AND (elder∗ OR senior∗ OR older adult OR older adults OR older person OR older persons)

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Inclusion and Exclusion Criteria Peer-reviewed studies were deemed eligible for review if their primary focus was on Inuit older adults or if significant sections of the data sources were devoted to aging in the Inuit population. Data sources were excluded if they (a) were reported in a language other than English, (b) had little or no content regarding aging Inuit, (c) focused on age groups other than the elderly within Inuit populations and/or did not specifically analyze Inuit elderly, or (d) were published before the year 1995.

Data Extraction As indicated in Figure 1, the initial search of databases yielded a total of 512 distinct titles with abstracts. Two authors independently reviewed each of the abstracts. In cases where there was a disagreement during the vetting process, agreement was reached through a process of discussion, which led to 398 abstracts being rejected. Fully, 114 abstracts were selected for further review. After carefully reading the full text of these articles, 96 were excluded and 18 were selected according to the inclusion criteria.

512 titles and abstracts in total included in search

114 Full-text articles were searched

398 articles were excluded

96 articles excluded after review of full text

18 articles met inclusion

FIGURE 1 Identification of the titles/abstracts, inclusion and exclusion review.

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RESULTS

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A total of 18 articles from peer-reviewed journals were selected for inclusion in this systematic review. From these sources, eight major themes were identified: 1. 2. 3. 4. 5. 6.

Methodological barriers; Acculturation and cultural adaptation; Poverty; Addiction; Mental health issues and suicide; Trends in physical health including chronic disease prevalence, nutrition and food security; 7. Evidence of successful aging in spite of these issues; and 8. Challenges of providing formal and informal care services to rural elderly.

Methodological Barriers The studies selected for review revealed a number of methodological barriers inhibiting the study of Inuit communities, including the remoteness and isolation of these populations, most of which are accessible only by air or water (DeCourtney, Branch & Morgan, 2010; Saudny, Cao, & Egeland, 2012). Furthermore, in Alaska, there are six separate native populations: Tlingit/Haida, Yup’ik Eskimo, Inupiaq, Athabascan, Aleut, and the Alutiiq/Sugpiaq (DeCourtney et al., 2010; Saudny et al., 2012). To ensure reliability when studying these populations, methods of data collection and appraisal had to be tailored to each culture (DeCourtney et al., 2010; Saudny et al., 2012). The need to build connections with the community residents to be accepted and allowed to complete their research was mentioned, and often required staying in the communities for extended periods of time (DeCourtney et al., 2010). Other barriers included the need to find interpreters who speak the local language (DeCourtney et al., 2010; Saudny et al., 2012). Although not explicitly addressed in the literature, we assume that these barriers help account for the paucity of research focusing on elderly Inuit, who may be more isolated, physically and culturally, than their younger counterparts.

Acculturation and Cultural Adaptation Throughout the literature reviewed, we noted the recurring theme of acculturation at the heart of many of the issues challenging Inuit people today. Nine of the 20 articles reviewed cited acculturation and colonization as significant issues that have had an impact on Inuit populations across generations (Collings, 2001; DeCourtney et al., 2010; Dillard & Manson, 2000;

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Eggerston, 2013; Garrett, Baldridge, & Williams, 2012; Graves, 2004; Hagen, 2008; Kral, 2012; Seale, Shellenberger, & Spence, 2006). Dillard and Manson (2000) noted that the history of Inuit people is marred by the trauma of colonization whereby Inuit people in Alaska and Canada have endured suppression and loss of their language and culture, as well as their traditional ways of obtaining food, practicing religion, and self-governance (Dillard & Manson, 2000; Graves, 2004; Kral, 2012; Smith, Easton, & Saylor, 2009; Smith, Saylor, Easton, & Wiedman, 2009). Although contact with Quallunaat, an Inuit term for non-Inuit people, occurred as early as 1008 with Scandinavian Vikings, and later with British and European fishing ships, Inuit preserved their traditional ways of life for many generations after contact (Kral, 2011). In the 1950s, however, the Canadian government relocated Inuit from camps of extended family members living on the land to settlements, which “changed northern life enormously” (Kral, 2011, p. 427). This significant cultural shift is the lived experience of today’s elderly Inuit. The resulting disconnect from traditional ways of life has been especially hard on Inuit men, as described by Inuit elder Meeka Arnakaq: If the sled is toppled over, it cannot go. The man is underneath. This is how Inuit men are today. They are stuck. Their responsibilities have been taken away. Who is going to stand them up? We’ve found different ways of healing women, but now the men. The qamutik (sled) has to stand up. The dogs have to start running. (Wadden, 2008, p. 143)

Although the negative aspects of acculturation were highlighted in the studies selected, we note that the theorists, such as Collings (2014), argued that Inuit are not passive recipients in this process. Rather, Inuit have been active participants in a process of adaptation, mindfully changing those things deemed beneficial for their society and steadfastly preserving valued cultural traditions and norms. Collings (2014) stated that many Inuit voluntarily relocated to the settlements over time, seeking wage-labor opportunities to finance the high cost of trapping and hunting equipment. Inuit have also benefited from other modern conveniences that the Qallunaat brought with them. Historically, Inuit have faced high infant mortality rates, periods of famine, and damp housing. These issues have since been mitigated by the introduction of healthcare, increased food options, and better housing (Billson & Mancini, 2007). These improvements likely have had a large, positive effect on the health and longevity of elderly Inuit in particular, although research is needed to support this speculation. Although acculturation has influenced the traditional lifestyle of Inuit, it is important to recognize that Inuit have not assimilated to all modern influences and have displayed, at times, considerable resistance to them. Kral stated that “concerns among Inuit related to land claims and self-government

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emerged in the early 1970s and resistance to government control began. Inuit negotiated with the federal government about increasing their autonomy for a few decades” (Kral, 2011, p. 428). The settlement of Indigenous land claims, including the establishment of Nunavut, has created a platform for increased autonomy among Inuit (Stern & Stevenson, 2006), who have actively asserted themselves and participated in their evolving culture. Moreover, the three other Inuit regions in the Canadian Arctic are initiating land claims and working toward selfgovernance (Kral, 2011). Furthermore, some Inuit communities have become proactive in developing their local economies to include resource extraction. The Inuvialuit Development Corporation is involved in the northern hydrocarbon industry building gas pipelines (Stern & Stevenson, 2006), seeing this as a way to bring benefits to their people. An interesting topic for future research would be to investigate how older Inuit perceive these changes.

Poverty The introduction of Western religious practices, military culture, criminal justice systems, Anglicized educational institutions, economic changes, and capitalism, have resulted in dramatic changes in social arrangements for Inuit (Graves, 2004; Seale et al., 2006). In the early 1980s, the fur trade industry collapsed, causing devastation to many Inuit communities (Kral, 2011). Subsequently, poverty has become a significant problem for the Inuit in Canada—(Eggertson, 2013; Kral, 2012) and in the United States, where Alaska Natives are twice as likely to live in poverty as the general population (Castor et al., 2006). In our review of the literature, lack of education (Graves, 2004; Hagen, 2008; Seale et al., 2006), and widespread unemployment emerged as subthemes to the issue of poverty (Graves, 2004; Kral, 2011, 2012; Seale et al., 2006). Furthermore, although women have been gaining access to employment, men are being displaced as the primary providers, which have created new problems, including family conflict and/or role confusion (Graves, 2004; Seale et al., 2006). In one study from the review, respondents to qualitative interviews with Inuit community members in Nunavut indicated that the wage economy has made it difficult to share limited resources with extended family members, as was historically traditional (Kral, 2011). An Inuit elder stated that “we are concentrating so much on the value of a dollar that we are not as neighborly as we used to be” (Kral, 2011, p. 433). There is also a substantial housing crisis in Nunavut, with 39% of the community living in crowded homes and high unemployment rates, ranging from 15% to 72%, across the region (Kral, 2011). Not surprisingly, we found that most research on poverty, education, and unemployment among Inuit focuses on younger adults and families with children. There is a great need, therefore, for research in this area that focuses on Inuit elderly specifically.

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Addiction Alcohol abuse and drug use are a widespread problem within Inuit communities (Billson & Mancini, 2007; Collings, 2014; Dillard & Manson, 2000; Graves, 2004; Kral, 2011, 2012; Seale et al., 2006). Alcohol abuse has been deemed an epidemic, and identified as the number one health problem in Alaska Native communities (Seale et al., 2006). Alaskan Natives are considerably more likely than the general population of the United States to die from cirrhosis of the liver, and alcohol related deaths are almost nine times the national average in Alaska Native communities (Seale et al., 2006). Problems with addiction are also closely tied with suicide (Billson & Mancini, 2007; Collings, 2014; Kral, 2011, 2012; Pauktuuit Inuit Women of Canada, 2006). These issues undoubtedly affect elderly Inuit, however no studies under review addressed this population. It is worth noting that, in response to the growing problem of abuse, Inuit in Canada have established The National Advisory Committee on Abuse Prevention, and created The National Strategy to Prevent Abuse in Inuit Communities, which promotes best practices, supports collaboration and community mobilization, and incorporates Inuit principles of healing and working together (Pauktuuit Inuit Women of Canada, 2006). Community members are at the core of this initiative, including male and female youth, adults, and elders. Inuit have created this strategy to address abuse in their communities. This is an example of their power and resilience.

Mental Health and Suicide Much of the literature suggests that colonization and family breakdown has contributed to an array of mental health issues; including depression, anxiety, posttraumatic stress disorder, and addiction (Billson & Mancini, 2007; Dillard & Manson, 2000; Graves, 2004; Kral, 2011, 2012; Seale et al., 2006). Kral (2011) studied Inuit meanings of well-being, health, unhappiness, and social change in Nunavut, where there is one of the highest rates of suicide worldwide. Kral (2011) found that the most significant theme across all interview questions was kinship and family. Inuit well-being and happiness was closely related to family, talking with family members, being on the land with family and taking part in activities such as camping, sharing food with family, and visiting. Unhappiness was related to feeling disconnected from family, not visiting with family, and with anger, drugs, alcohol, sexual abuse, and family violence (Kral, 2011). Talking and communication was identified as the most important part of suicide prevention, intervention, and emotional healing (Kral, 2011). Kral (2011) concluded that “kinship is the central structure of Indigenous societies, and its changes related to colonialism have been identified as a

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key factor in social problems being experienced by these peoples” (p. 427). Colonialism has had a significant effect on traditional parenting styles and intergenerational relationships (Kral, 2011, 2012). Older Inuit in particular lament the changing social structure, and their concerns regarding this significant shift in social relationships has been well documented (Kral, 2011, 2012). Our review also revealed that Inuit identify intergenerational segregation as a problem, indicating that parents and grandparents had previously been mentors for youth (Billson & Mancini, 2007; Kral, 2012, 2011). However, rapid change is moving Inuit away from their traditional lifestyle, resulting in isolation and less interaction between youth and older adults (Billson & Mancini, 2007; Kral, 2011, 2012). In Kral’s (2011) study, respondents indicated that regular socializing and visits with family were less frequent due to increased personal responsibilities, the introduction of technology, increased travel distance, divergent interests between younger and older Inuit, and a large cohort of youth who identify more with the Western style of relating with their peers rather than with older generations. The high suicide rate is an important issue studied extensively in the wider literature on Inuit life. Suicide rates are reported to be up to ten times higher among Inuit than the general population in Canada (Kral, 2012). Kral (2012) suggested that colonialism, which has impacted family experiences and relationships, is at the root of many social problems, including suicide. In contrast, Waldram (2004) argued that aboriginal cultures have historically, and continue to, produce their own stresses and tensions that contribute to mental health concerns. Although the literature highlights suicide as a growing problem for Inuit youth (Dillard & Manson, 2000; Eggertson, 2013; Graves, 2004; Kral, 2011. 2012; Seale et al., 2006; Stevenson, 2012), none of the articles under review discussed suicide as it relates to older Inuit. One study mentioned a historical tradition of altruistic suicide, by which older or sick adults would end their lives in times of famine or poor hunting conditions (Kral, 2012); however, it did not explore this issue in depth. Similarly, the literature presents mental health issues as affecting youth and young adults disproportionately (Dillard & Manson, 2000; Graves, 2004; Kral, 2012; Seale et al., 2006), with little consideration of how this affects Inuit across generations or the elderly (Kral, 2012; Seale et al., 2006).

Chronic Disease Prevalence Little information about the prevalence of chronic diseases in the elderly Inuit population is available in peer reviewed journal articles. Using participatory research to record dietary patterns and exercise, Erber, Beck, De Roose, and Sharma (2010) collected self-reported data from participants regarding their

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history of chronic conditions including heart disease, hypertension, diabetes, and cancer. The study revealed that over 20% of the 228 participants aged 19–84 had a chronic disease (Erber et al., 2010). Interestingly, elderly Inuit were found to rate their health status as poor at twice the rate of younger Inuit populations (Saudny et al., 2012). Although a higher prevalence of poor health is expected due to aging, future research should investigate whether the extent of the disparity between young and old is larger than in other non-Inuit populations. Richmond (2009) found that Inuit communities in the Canadian arctic that had strong support networks enjoyed greater health than those who had not. When compared to younger cohorts, Inuit between the ages of 45 and 54 had access to the strongest social supports, whereas elderly Inuit were the least likely to have strong supports (Richmond, 2009). Interestingly, Inuit were identified as less likely to have strong social supports than First Nations people or the Metis. Low social support among Inuit was associated with decreased physical mobility. Developing friendships, being intimate with others, and having supportive social networks were all factors leading to improved physical and mental health (Richmond, 2009). Ways to increase social support among Inuit elderly would be an interesting area of future research. Ebbesson and colleagues (2005) examined the heart and vascular disease rates in Alaska Natives and risk factors for cardio vascular disease (CVD). Participatory research conducted with 1,214 participants from nine villages, discovered that the mortality rate due to stroke in Alaska Natives is one and a half times higher than the rate for Caucasians in the United States (Ebbesson et al., 2005). Historically, diabetes and CVD have been thought to be rare among Alaska Natives. However, incidences of diabetes and high cholesterol have increased in the past 30 years, leading to an elevated risk of CVD (Ebbesson et al., 2005). Our review indicates that some media-based programs geared toward educating community members about diet and exercise exist, but they are slow in their development (Ebbesson et al., 2005). Moreover, mediabased programs are unlikely to be effective for older Inuit.

Nutrition and Food Security Inuit diet consists of both traditional country food, acquired though customary hunting and harvesting practices, and imported market foods (Duhaime & Bernard, 2008; Harder & Wenzel, 2012). The traditional sharing of country food, often along kinship lines, is an integral part of Inuit cultural identity (Duhaime & Bernard, 2008l Harder & Wenzel, 2012). Market food consumption varies across communities and is influenced by factors including regional and seasonal availability and the age of the consumer (Duhaime et al., 2008). Younger Inuit tend to consume more market foods; older Inuit have the

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highest rate of country food intake compared to other age groups across the arctic (Myers, Powell, & Duhaime, 2004). Our review revealed research indicating that the traditional Inuit diet may offer protective mechanisms against health problems affecting the elderly, including cardiovascular disease and diabetes (Duhaime et al., 2008). Although younger Inuit tend to consume higher levels of market foods, a study conducted in three Nunavut communities found that as they grew older, Inuit youth increased their intake of traditional foods (Myers, Powell, & Duhaime, 2008). This is an interesting finding, and an area worthy of further exploration of how dietary changes over the life course impact the health of future cohorts of older Inuit. Food security involves having access to, and the means to acquire, food that is safe, nutritious, and preferred, and that allows one to meet the dietary requirements necessary to live a healthy life (Huet, Rosol, & Egeland, 2012). The literature reviewed indicates that Inuit experience high rates of food insecurity (Smith, Easton et al., 2009). Food insecurity is linked to low socioeconomic status, and is most prevalent in isolated communities that are forced to be self-reliant due to limited social services (Duhaime et al., 2008). A study conducted by Smith, Saylor et al. (2009) identified the lack of nutritional support programs located in rural communities that are geared specifically toward older adults. Inuit have experienced concerns with food storage for generations, leaving them at risk for food borne illness (Fagan et al., 2011). A study conducted by Fagan et al., (2011) regarding the incidence of botulism among Alaska Natives noted that older adults and women experienced higher rates of botulism than other groups. Although food insecurity is a serious concern among Inuit people, there is some debate over whether the elderly are truly food insecure. The manner in which food security is measured does not factor in the cultural context of food sharing among Inuit (Harder & Wenzel, 2012). The amount of food provided for older adults by family and the community through traditional sharing practices tends to increase with age, making elderly Inuit more food secure than their younger counterparts (Smith, Easton et al., 2009). A study of three communities in Nunavut found that in the week prior, 78% of the elderly participants had received country food from family and/or community members implying that at least some of the food needs of older adults are being met informally through traditional food sharing practices (Myers et al., 2008).

Successful Aging Of the literature reviewed, three articles specifically discussed the concept of successful aging. As defined by Rowe and Kahn (1997) successful aging is understood to encompass three key elements; “(1) low probability of

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disease and disease-related disability, (2) high cognitive and physical functional capacity, and (3) active engagement with life” (p. 433). Lewis (2011) noted that an issue with this mainstream definition of successful aging is that it does not incorporate cultural perspectives. Collings (2001) explained that Inuit believe that declining health is a reality that everyone must face and, therefore, good health in the latter years does not exist. In contrast to the commonly held view that successful aging means one must be free from disease and disability, an overarching theme to emerge from the literature is that Inuit place much greater emphasis on holistic approaches to aging, encompassing individual, family, and community health (Collings, 2001; Lewis, 2011). Our review also reveals that successful aging can be viewed differently from culture to culture across Inuit communities. Lewis (2011), who studied Alaska Native cultures in Bristol Bay, Alaska identified four indicators of aging successfully including (a) emotional well-being; (b) community engagement; (c) spirituality; and (d) physical health (Lewis, 2011). Alternatively, Collings (2001), who studied Inuit in Holman, a community located in Northern Canada, categorized successful aging in four areas: (a) natural, (b) domestic, (c) economic, and (d) attitudinal. Two overlapping themes can be identified from this. First, successful aging in Inuit culture constitutes having a good attitude or emotional and spiritual well-being that is best demonstrated through persevering in spite of physical decline. Second, it embodies Ihuma, meaning “the development of wisdom and knowledge” (Collings, 2014, p. 371), and sharing this accumulated knowledge with younger generations through active engagement with the community (Collings, 2014; Lewis, 2011). Aging successfully, thus, is exemplified by possessing a collection of positive attributes that is often associated with the Elder status, which is being widely respected within the community (Lewis, 2011). Importantly, the position of Elder is not necessarily determined by chronological age, but rather by the attainment of a certain level of awareness and wisdom that is being shared with other members of the community (Collings, 2001; Graves, Shavings & Rose, 2009). Interaction with youth and maintaining community connections are also key elements of aging successfully (Collings, 2001; Graves et al., 2009; Lewis, 2011). Remaining actively involved in the community allows older individuals to assume a respected role and maintain good quality of life, while also engaging in the traditional intergenerational transfer of knowledge (Lewis, 2011). The willingness for an elder to pass on their knowledge to younger generations is integral to how they were viewed by others and a good indication that they were aging successfully (Collings, 2001). Our review also reveals that Inuit perceptions of successful aging are largely influenced by one’s construction of the life course, which is predominantly shaped by gender differences (Collings, 2014). Guemple (1995), for

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example, noted that the distinct gender roles of Inuit men and women that are shaped in childhood and continue throughout the life course. For example, traditionally, Inuit men participate in activities conducted outside of the home (e.g., traditional hunting and gathering practices), and women provide childcare duties and household management (Guemple, 1995). Collings (2001) concluded that men are more likely than women to associate poor health with unsuccessful aging, but women tend to emphasize other factors equally, such as negative attitudes and domestic themes. Lewis (2011) argued that in spite of physical decline, elders are still likely to feel that they are, indeed, aging successfully because of their spiritual beliefs and good emotional health, which has kept them from viewing their situation in negative terms. However, good physical health is not discounted as an indication of aging successfully, because it demonstrates the value of taking care of oneself and also allows for active participation in society (Collings, 2001).

Formal and Informal Care Services Alaskan Natives comprise up to 95% of rural elderly population in Alaska (Rosich & Thompson, 1997). Problems associated with providing services to the many remote Alaskan Native communities featured heavily in the literature (DeCourtney et al., 2010; Garrett et al., 2012; Hagen, 2008; Rosich & Thompson, 1997). Themes related to rural service provision included a general lack of services within these communities (Garrett et al., 2012; Hagen, 2008; Rosich & Thompson, 1997). Until recently, Alaska was a relatively young state, populated disproportionately by young migrants from the lower 48 states and, thus, only minimal elderly services are available (Rosich & Thompson, 1997). When services are available, our review identifies a number of service gaps including a lack of tribal long-term care homes close to the rural communities (Garrett et al., 2012; Hagen, 2008; Rosich & Thompson, 1997) and a deficiency of assisted living services for Alaskan Native seniors in rural communities (Rosich & Thompson, 1997). Other themes related to the delivery of services in rural communities include the following: few trained and certified doctors and other health care staff (Garrett et al., 2012; Rosich & Thompson, 1997), limited opportunities for health care providers in these remote areas (DeCourtney et al., 2010; Rosich & Thompson, 1997), a lack of hospital beds, and a shortage of health care supplies in rural clinics (Garrett et al., 2012; Rosich & Thompson, 1997). Our review suggests that compounding the dearth of services available is a lack of family caregivers, due to younger generations moving to larger urban centers in search of education and employment (DeCourtney et al., 2010; Garrett et al., 2012). As a result, many rural Alaskan Native elderly have to travel to larger urban centers to seek out care (Garrett et al., 2012;

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DeCourtney et al., 2010; Rosich & Thompson, 1997). Such a move causes many Alaskan Native elders to become socially isolated from families who are far away (Garrett et al., 2012). Our review suggests that incorporating culturally appropriate Alaskan Native health care into nontribal services is a pressing issue (DeCourtney et al., 2010; Garrett et al., 2012; Rosich & Thompson, 1997) This includes providing foods from the elderly person’s culture (Garrett et al., 2012), blending both traditional native and Christian rituals (DeCourtney et al., 2010; Garrett et al., 2012), and overcoming cultural barriers regarding talking and preparing an elderly person for death. Providing palliative care services in a culturally appropriate manner discussed at length by DeCourtney et al. Another focused on incorporating traditional Alaskan native knowledge into emergency preparedness plans to better serve such populations (Hagen, 2008). The author argued that this could be done by acknowledging the richness of information passed down through generations with regard to the natural disasters that affect the state, such as earthquakes, volcanoes, tsunamis and floods.

Implications for Research and Practice Although there appears to be a growing body of research pertaining to Inuit youth, particularly on the subjects of mental health, addiction, and suicide, there is a scarcity of research devoted to Inuit elderly. The studies reviewed here examined several Inuit communities both within the United States and Canada; however, none provide a comprehensive picture of the concerns experienced by older Inuit. Implications for future study include finding effective ways to engage Inuit communities, particularly their elderly residents in research. Three studies emphasized the importance of culturally appropriate methods of data collection, such as the use of participatory action research, through which Inuit have ownership and control, (Kral, 2011, 2012) focus groups, and interviews as they correspond with the Inuit tradition of storytelling (Dillard & Manson, 2000). Additionally, future Inuit studies should not be combined with other First Nations research, as these communities are very distinct from one another. Clustering aboriginal populations’ together creates challenges for identifying and addressing the unique concerns experienced by Inuit communities, particularly among their elderly populace. Inuit are widespread across several countries and the issues they face will vary due to regional differences including government policies and economic opportunities. Implications for practice include the need for the development of mental health services that incorporate Inuit values and traditional knowledge, and include the role of elder and indigenous best practice strategies (Kral, 2012). Three studies emphasized the importance of culturally appropriate methods of intervention, including strengths-based counseling, which highlights

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resilience (Korhonen, 2003); cognitive behavioral techniques, with “expression of feeling” cited as being particularly important to elders (Korhonen, 2003); and integrating traditional cultural concepts into mental health and addiction programs (Dillard & Manson, 2000; Kral, 2012). Waldram (2004) cautioned that certain programs claim to emphasize the significance of “natural healing,” stories, and oral traditions, however they can end up becoming highly structured, incorporating Western concepts such as rigid schedules and text-based activities. Moreover, Western epistemology can sometimes influence interpretations of research with Aboriginals (Waldram, 2004). Waldram noted that “reactions to potentially traumatizing events are shaped by culture, yet cultural analyses of the phenomenon are sorely lacking” (Waldram, 2004, p. 221). Problems can occur when outsiders are conceptualizing programs for Inuit, which reinforces Kral’s (2012) point that the most effective programs will be developed by community members for the specific communities where they reside.

CONCLUSION A total of 18 articles were reviewed from academic literature databases. From these sources, eight major themes were identified including: (a) methodological barriers; (b) acculturation and cultural adaptation; (c) poverty; (d) addiction; (e) mental health issues and suicide; (f) trends in physical health including chronic disease prevalence, nutrition and food security; (g) evidence of successful aging in spite of these issues; and (h) challenges of providing formal and informal care services to rural elderly. There is scant information on elderly Inuit, revealing the need for future research in the following areas: strategies for poverty alleviation; ways to increase social supports; studies on health disparities between young and old Inuit as compared to non-Inuit populations; and researching ways to provide culturally appropriate programs and services to remote northern Inuit communities. Knowledge-building in this regard is important, as it will lead to improved service provision and appropriate interventions, creating better prospects of meeting the needs of elderly Inuit populations.

ACKNOWLEDGMENTS We thank Esme Fuller-Thomson, PhD, for her exceptional guidance and support on this project, as well as the University of Toronto librarians Jenaya Webb, MA, MLS and Carla Hagstrom, MA, MLS for their invaluable assistance with the search process. We also thank Jessica Pegis for her expert advice and Sarah Brennenstuhl for her assistance with manuscript preparation. We also sincerely thank the two anonymous reviewers for their critical insight and detailed commentary.

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REFERENCES Billson, J. M., & Mancini, K. (2007). Inuit women: Their powerful spirit in a century of change. Lanham, MD: Rowman & Littlefield. Bjerregaard, P., Young, T. K., Dewailly, E., & Ebbesson, S. O. (2004). Review article: Indigenous health in the Arctic: an overview of the circumpolar Inuit population. Scandinavian Journal of Public Health, 32(5), 390–395. Castor, M. L., Smyser, M. S., Taualii, M. M., Park, A. N., Lawson, S. A., & Forquera, R. A. (2006). A nationwide population-based study identifying health disparities between American Indians/Alaska Natives and the general populations living in select urban counties. American Journal of Public Health, 96, 1478–1484. Collings, P. (2001). “If you got everything, it’s good enough”: Perspectives on successful aging in a Canadian Inuit community. Journal of Cross-Cultural Gerontology, 16(2), 127–155. Collings, P. (2014). Becoming Inummarik: Men’s lives in an Inuit community. Montreal, Canada: McGill-Queen’s University Press. DeCourtney, C. A., Branch, P. K., & Morgan, K. M. (2010). Gathering information to develop palliative care programs for Alaska’s Aboriginal peoples. Journal of Palliative Care, 26(1), 22–31. Dillard, D. A., & Manson, S. M. (2000). Assessing and treating American Indians and Alaska Natives. In I. Cuellar & F. A. Paniagua (Eds.), Handbook of multicultural mental health: Assessment and treatment of diverse populations (pp. 225–248). San Diego, CA: Academic Press. Duhaime, G., & Bernard, N. (Eds.). (2008). Arctic food security (No. 58). Edmonton, Canada: Canadian Circumpolar Institute Press. Duhaime, G., Dwailly, E., Halley, P., Furgal, C., Bernard, N., Godmaire, A., . . . Grondin, J. (2008). Sustainable food security in the Canadian Arctic. An integrated synthesis and action plan. In G. Duhaime & N. Bernard (Eds.), Arctic food security (No. 58, pp. 73–103). Edmonton, Canada: Canadian Circumpolar Institute Press. Ebbesson, S. O. E., Laston, S., Wenger, C. R., Dyke, B., Romenesko, T., Swenson, M., . . . Howard, B. V. (2005). Recruitment and community interactions in the Gocadan study. International Journal of Circumpolar Health, 65(1), 55–64. Eggertson, L. (2013). Inuit leaders announce national Inuit suicide-prevention strategy. CMAJ: Canadian Medical Association Journal, 185(15), E703–E704. Ellsworth, L., & O’Keeffe, A. (2013). Circumpolar Inuit health systems. Circumpolar Health Supplements, 72, 937–945. Erber, E., Beck, L., De Roose, E., &Sharma, S. (2010). Prevalence and risk factors for self-reported chronic disease amongst Inuvialuit populations. Journal of Human Nutrition and Diet, 23(1), 43–50. Fagan, R. P., McLaughlin, J. B., Castrodale, L. J., Gessner, B. D., Jenkerson, S. A., Funk, E. A., & Butler, J. C. (2011). Endemic foodborne botulism among Alaska Native persons—Alaska, 1947–2007. Clinical Infectious Diseases, 52(5), 585–592. Galan, D., Odlum, O., Grymonpre, R., & Brecx, M. (1993). Medical and dental status of a culture in transition, the case of the Inuit elderly of Canada. Gerontology, 10(1), 44–50.

Downloaded by [University of Lethbridge] at 02:00 06 November 2015

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499

Garrett, M. D., Baldridge, D., & Williams, E. (2012). American Indians and Alaska Natives in nursing homes: Initial results from the 2008 minimum data set. Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health, 10(1), 109–123. Graves, K. (2004). Resilience and adaptation among Alaska Native men. International Journal of Circumpolar Health, 63(1), 93–94. Graves, K., Shavings, L., & Rose, E. (2009). Alaska Native Elders’ view of abuse: The tradition of harmony, respect, and listening. Alaska Journal of Anthropology, 7(1), 71–88. Guemple, L. (1995). Gender in Inuit society. In L. F. Klein & L. A. Ackerman (Eds.), Women and power in native North America (pp. 17–27). Norman: University of Oklahoma Press. Hagen, J.C., (2008). Emergency management structure for the use in the Alaskan Native elderly population. International Journal of Emergency Management, 5(3/4), 275–283. Harder, M. T., & Wenzel, G. W. (2012). Inuit subsistence, social economy and food security in Clyde River, Nunavut. Arctic, 305–318. Huet, C., Rosol, R., & Egeland, G. M. (2012). The prevalence of food insecurity is high and the diet quality poor in Inuit communities. Journal of Nutrition, 142(3), 541–547. Kanatami, I. T. (2009). Inuit & cancer: Fact sheets. Retrieved from https://www.itk. ca/publication/inuit-and-cancer-fact-sheets Korhonen, M. (2003). Helping Inuit clients: Cultural relevance and effective counselling. Journal of Circumpolar Health. 63(2), 135–138. Kral, M. J. (2011). Unikkaartuit: Meanings of well-being, unhappiness, health, and community change among Inuit in Nunavut, Canada. American Journal of Community Psychology, (48) 426–438. Kral, M. J. (2012). Postcolonial suicide among Inuit in Arctic Canada. Culture, Medicine, and Psychiatry, 36(2), 306–325. Lewis, J. P. (2011). Successful aging through the eyes of Alaska Native elders. What it means to be an elder in Bristol Bay, AK. Gerontologist, 51(4), 540–549. Myers, H., Powell, S., & Duhaime, G. (2004). Setting the table for food security: policy impacts in Nunavut. Canadian Journal of Native Studies, 24(2), 425–445. Myers, H., Powell, S., & Duhaime, G. (2008). Food production and sharing in Nunavut; Not only discourse, but reality. In G. Duhaime & N. Bernard (Eds.), Arctic food security (No. 58, pp. 121–137). Edmonton, Canada: Canadian Circumpolar Institute Press. Pauktuuit Inuit Women of Canada. (2006). The national strategy to prevent abuse in Inuit communities and sharing knowledge, sharing wisdom: A guide to the national strategy. Retrieved from http://pauktuutit.ca/wp-content/blogs.dir/1/ assets/InuitStrategy_e.pdf Richmond, C. A. M. (2009). The social determinants of Inuit health: A focus on social support in the Canadian arctic. International Journal of Circumpolar Health, 68(5), 471–487. Rosich, R. M., & Thompson, S. R. (1997). Gerontological knowledge and elderly health care services in Alaska: Aging in the last frontier. Educational Gerontology, 23, 443–452.

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B. K. Somogyi et al.

Rowe, J. W., & Kahn, R. L. (1997). Successful aging. Gerontologist. 37(4), 433–440. Saudny, H., Cao, Z., & Egeland, G. M. (2012). Poor self-reported health and its association with biomarkers among Canadian Inuit. International Journal of Circumpolar Health, 71, 1–7. Seale, J. P., Shellenberger, S., & Spence, J. (2006). Alcohol problem in the Alaska Natives: Lessons from the Inuit. American Indian and Alaska Native Mental Health Resource. 13(1), 1–31. Simon, M. (2011) Canadian Inuit. International Journal, 66(4), 879–891. Smith, J., Easton, S. P., & Saylor, B. L. (2009). Inupiaq elders study: Aspects of aging among male and female Elders. International Journal of Circumpolar Health, 68(2), 182–196. Smith, J., Saylor, B., Easton, P., & Wiedman, D. (2009). Measurable benefits of traditional food customs in the lives of rural and urban Alaska Inupiaq elders. Alaska Journal of Anthropology, 7(1), 89–99. Stern, P. R., & Stevenson, L. (Eds.). (2006). Critical Inuit studies: An anthology of contemporary Arctic ethnography. Lincoln: University of Nebraska Press. Stevenson, L. (2012). The psychic life of biopolitics: Survival, cooperation, and Inuit community. American Ethnologist, 39(3), 592–613. Wadden, M. (2008). Where the pavement ends. Vancouver, Canada: Douglas & McIntyre. Waldram, J. B. (2004). Revenge of the Windigo: The construction of the mind and mental health of North American Aboriginal peoples. Toronto, Canada: University of Toronto Press.

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Lewis (2011) Richmond (2009) Rosich and Thompson (1997)

Kral (2012)

Korhonen, (2003)

Hagen (2008)

Garrett et al. (2012) Graves et al. (2009)

Collings (2001) DeCourtney et al. (2010) Dillard and Manson (2000) Ebbesson et al. (2005) Erber, Beck, De Roose, and Sharma (2010) Fagan et al. (2011)

Author

Qualitative interviews using grounded theory Participatory action A1, A2, A4 research using qualitative interviews Qualitative interview Exploratory analysis A3 Discussion B1,B3

B3

C3

C1, C2, C3, C4

C3

B2, B3

A3

D1

D1

E1, E2, E3, E4 E4

E4

E1, E2, E3, E4

Qualitative study using grounded theory discussion

E4

F1

F2 B1, B3

D1

Secondary analysis of health data discussion A3

Physical Health

F2

E1, E2, E3, E4 E4

Successful Aging

B2

D1, D2, D3

Addiction

Quantitative research

C1, C2, C3, C4

Mental Health

F2

B3

Poverty

B1, B2, B3

A1, A4 A3

Acculturation and Cultural Adaptation

Book chapter, A1, A2, A4 discussion Participatory research

Qualitative interview Discussion

Research Methodology

TABLE A1 Data From Articles on Inuit Elderly Included in the Systematic Review (N = 18)

APPENDIX

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G1, G2, G5, G6, G7

G1, G2, G3, G5, G6, G7

G1, G2, G3, G4, G5, G6, G7

G1, G2, G5, G7

Formal/Informal Care Service

(Continued)

H2

H1, H2, H3, H4

Methodological Barriers

502

A1, A4 A1, A4

Face-to-face survey

A1, A2, A4

Acculturation and Cultural Adaptation

Cross Sectional Survey Focus groups and qualitative interviews Face-to-face survey

Research Methodology

B1, B2, B3

Poverty

C1, C2, C4

Mental Health

D1, D2, D3

Addiction

E1

Successful Aging

F2

F1, F2

F1

Physical Health

Formal/Informal Care Service

H1, H2, H3, H4

Methodological Barriers

Note. A1 = History of colonization. A2 = Gender role shifts. A3 = Shift from rural to urban lifestyle. A4 = Loss of culture/traditions. B1 = Unemployment. B2 = Lack of education. B3 = Socioeconomic status. C1 = Historical trauma. C2 = Psychological disorders. C3 = Culturally grounded interventions and counselling. C4 = Suicide. D1 = Alcohol and drug use. D2 = Health problems stemming from alcohol and/or drug addiction. D3 = Premature death/dying at a young age. E1 = Positive attitude. E2 = Emotional and spiritual well-being. E3 = Physical health. E4 = Family and community engagement. F1 = Chronic disease prevalence. F2 = Nutrition and food security. G1 = Rural service provision. G2 = Culturally appropriate services in urban long-term care facilities. G3 = Long-term care and social isolation. G4 = Early admittance to long-term care due to lack of community caregivers. G5 = Aging in place. H1 = Many distinct cultures. H2 = Need to tailor methods of date collection. H3 = Isolated communities. H4 = Find researchers that speak language.

Saudny, Cao, and Egeland (2012) Seale, Shellenberg, and Spence (2006) Smith, Easton, and Saylor (2009) Smith, Saylor, Easton, and Wiedman (2009)

Author

TABLE A1 (Continued)

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Inuit Elderly: A Systematic Review of Peer Reviewed Journal Articles.

Over the last century, Inuit have experienced rapid social changes that have greatly impacted their way of life, health, and intergenerational traditi...
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