Title VI Director’s Manual - 2007. Chapter ? – Data Uses. ADMINISTRATION ON AGING KAUFFMAN AND ASSOCIATES, INC. NATIONAL RESOURCE CENTER ON NATIVE AMERICAN AGING. Course objectives. By completing this chapter, you will:.
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Title VI Director’s Manual - 2007
Chapter ? – Data Uses
ADMINISTRATION ON AGING
KAUFFMAN AND ASSOCIATES, INC.
NATIONAL RESOURCE CENTER ON NATIVE AMERICAN AGING
By completing this chapter, you will:
CHAPTER ?CONDUCTING NEEDS ASSESSMENTS
DEVELOPED BY THE NATIONAL RESOURCE CENTER ON NATIVE AMERICAN AGING – 2007 – GRANT NUMBER AoA 90-AM-2751-03
Using NRCNAA Needs Assessment Data
The NRCNAA template is designed to help people with using data from the National Resource Center on Native American Aging survey; however, the template can be used with other sources if a different survey was used.
You can follow the examples that follow to expand the number of tables or items you include in your presentation of the your needs assessment. Please look at the comparison sheets to see what else might be important for your community and add those to the report using the sameformat. The example is not intended to include everything, but it is meant as a starting point for using the data for grant and reporting purposes.
Find relevant data and use it!
According to the ___________enrollment office, there are presently 853 men and women over the age 55 enrolled and living on or around the ________ reservation. Of the 853, there are 492 over the age of 65. According to the National Resource Center on Native American Aging (NRCNAA), the national Native elder population ages 55 and over are expected to grow by 110% between 2000 and 2020. Clearly the impact of the large cohorts born during post World War II, now known as the Baby Boom generation, will become a major source of change for our tribe.
The top chronic diseases found among our elders were high blood pressure, arthritis, diabetes, depression and osteoporosis. Each of these lead to limitations on peoples’ ability to take care of themselves and each are diseases where treatments are available to manage the disease. Nutritional care is particularly important for high blood pressure, diabetes and osteoporosis.
Comparisons between our tribe and the nation provide documentation of disparities on specific diseases where American Indian people appeared to be at greater risk than others in the nation. This information assists in identifying diseases where health promotion efforts will assist in making significant improvements in health status for our elders. The table on the next slide presents these diseases.
Functional limitations serve as the basis for establishing informal or formal need for care. Functional limitations or Activities of Daily Living (ADLs) include bathing, dressing, getting in or out of bed, walking and using the toilet. One’s ability to manage each of these is essential for self care. The following table shows that our people, although reporting higher rates of chronic diseases, are significantly less likely to report such needs for assistance.
Instrumental Activities of Daily Living
Instrumental Activities of Daily Living (IADLs) serve as indicators for assistance for living safely in ones home. This includes meal preparation, shopping, money management, telephone use, heavy and light housework and getting outside of the home. With the exception of meal preparation, our tribe’s elders reported fewer IADL limitations than the nation. This may be due to the relatively young age of our elders compared to the nation.
The measure of need for long term care contains four levels of limitation; little or none, moderate, moderately severe and severe. Each of these reflected differing levels of need and eligibility for care. Although our elders are relatively independent, they are also relatively young. The table on the next slide contains the percentages for each level of need for both our tribe and the nation.
The NRCNAA survey asked a series of questions on whether services were available, whether people were using them now and whether they would use them. The following table shows the services now available and the additional services that would most likely be in future demand. The survey suggested that people would use a larger array of services if they were available. In some instances, the expression of interest is very high when the services are rarely available. For example, respite care is almost non-existent, but over 40% indicated they would use it when the time was appropriate. These results provide the basis for maintaining and prioritizing services, and for determining what services the elders need to continue living in their homes.
Weight and Nutrition
Specifically related to nutrition are the findings about weight, diet and exercise. Using the people’s weight and height, a Body Mass Index was calculated to determine how many people are overweight (BMI 25 to 29) or obese (BMI 30 and over). Weight issues have become a focus of concern due to the relationship between weight and chronic disease (diabetes, arthritis, hypertension, and cancer) and functional limitations (ability to get around). Our results for the Body Mass Index are found on the next slide.
Another method used to determine weight issues is waist circumference.
Dietary concerns are reflected in an item that asked about eating habits and conditions that are important to consider when designing nutrition programs for our elders. A large proportion of the elders reported too few fruits and vegetables in their diet and many have an insufficient number of meals per day to receive adequate nourishment.
Social and Housing Characteristics
One third of the elders in our community live alone. These results indicate that 1/3 of our elders are at risk for requiring help from outside the household – formal services or informal care from relatives who do not live with them. This proportion is large and suggests a strong need for building home and community based services that can support both the elder and his or her informal care provider. Additionally, our elders reported 56% had received care from family members. Again, this supports the need for family caregiver support services as well as formal services for the elders.
Almost a third (30.4%) of the elders reported providing care to grandchildren. This responsibility is high and must be considered when designing programs for the elders. They have responsibilities and tasks that in many other contexts would not be present. This responsibility for child care limits their options for using some services.
Page 6: Section B: Information and Assistance.
Use items from Question 46 to establish a baseline for the percentage that are now using or would use in the future if needed. Each of these baseline percentages can be compared with the next survey in 3 years to see if they changed. Each should improve and exhibit higher percentages after 3 or more years.
Section on Native American Caregiver Support Program – Will be completed by summer!
Wisdom Steps-Health Promotion
Wisdom Steps was organized as a partnership between Minnesota American Indian communities and the Minnesota Board on Aging. Wisdom Steps is governed by a Board of Directors that is made up of a representative from each of Minnesota’s eleven reservations and from the cities of Duluth, Minneapolis, and St. Paul. Wisdom Steps developed a logo to provide for recognition, consistency, and ownership. The
logo consists of a pair of worn, tipped, moccasins surrounded by symbols from the Dakota and Ojibwe tribes. The moccasins identify with the American Indian community and the worn and tipped represent the wisdom of the elderly.
One of the first things Wisdom Steps did was to conduct a needs assessment. Wisdom Steps formed a partnership with the National Resource Center on Native American Aging (NRCNAA) to find out what elders could tell us about their health. The survey, Identifying Our Needs: A Survey of Elders was conducted in each interested community and the results were used for planning Wisdom Steps activities.
These preventive health activities correspond to the little or none category of the functional limitations chart developed by NRCNAA. Based on the needs assessment results, the majority of Minnesota’s American Indian elderly fell into this category.
Additionally, a model project was developed for each of the preventive health activities. Health screenings contain “Medicine Talk” where communication is encouraged between elders and pharmacists.
For more information on the Wisdom Steps program, please contact:
Minnesota Board on Aging Indian Elder Desk
444 Lafayette Road
St. Paul, MN 55155-3843
Telephone: (651) 297-5458
Or visit their website at http://www.wisdomsteps.com
Eagle Shield Senior Citizens Center-Home and Community Based Services
The Eagle Shield Senior Citizens Center is a program developed by the Blackfeet Tribe to provide assistance to the elderly of the Blackfeet Reservation. The Blackfeet Reservation is located in the northwestern part of Montana and encompasses approximately 1.5 million acres. Over the years, the Eagle Shield Senior Citizens Center has developed from a bare bones operation to a program that offers a wide range of senior services, from nutrition education and meal delivery to home personal assistance and social activities.
For more information about Eagle Shield please contact
Connie Bremner, Director
at (406) 338-3483
or visit their Web site at http://www.blackfeetnation.com
The wide range of tribal participation in the Identifying Our Needs: A Survey of Elders throughout the United States has resulted in the largest Native elder database in the country. The project is crucial to documenting Native elder disparities at the regional and national level to bring awareness to the health and social disparities experienced by these populations.
The National Resource Center on Native American Aging (NRCNAA) has provided testimony and documentation to educate tribal, state and congressional representatives as to the high level of need experienced by Native elders. NRCNAA staff could not have done this without our tribal partners and the data they allow our office to use in these efforts.
The following examples highlight an array of analyses at the regional and national levels that show how assessment data may allow an examination of disease prevalence and health disparities. The material is valuable to establishing the extent of need and the extent of unmet need in Indian communities.
Prevalence of Chronic Disease Among American Indian and Alaska Native Elders, October, 2005. Patricia Moulton, Ph.D. Leander McDonald, Ph.D. Kyle Muus, Ph.D. Alana Knudson, Ph.D. Mary Wakefield, Ph.D., R.N. Richard Ludtke, Ph.D.
Regional aggregation of data is useful in examining both health and social conditions and services. In this type of use, the regional data may be used as evidence that is derived from a larger and more detailed examination of conditions. In some cases, one might prefer to use regional estimates of need when the tribe is very small and local data is limited by small population size.
American Indian Elders in the Aberdeen IHS Area: Prevalence of Chronic Disease and Functional Limitations, presented by Kyle Muus and Leander R. McDonald at the Dakota Conference on Rural and Public Health, held March 8-10, 2005 in Bismarck, ND.
Needs assessment data establish the direction for patterns of change in Indian country and serve as a basis for targeting health promotion and wellness. The following type of use represents another dimension for creative use of needs assessment data.
Reducing Long Term Care Needs Through Health Promotion and Disease Prevention, presented by Alan Allery, PhD to Wisdom Steps & WELCOA.
Our use of the data for locating policy recommendations could be replicated for regional, state and local efforts, all of which would lead to eventual improvements in care for elders.
Policy recommendations for Native Elders, paper prepared for the National Congress of American Indians 2005 Mid-Year Conference, June 14, 2005, Green Bay, WI.
Data documents community disparities.
Data provides extensive information for strategic planning.
Data identifies community issues.
Data offers specific information for policy development.
Data presents the essentials for advocacy efforts at the tribal, state, and national level.
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How to use your data.