Crouch MC, Cheromiah Salazar MBR, Harris SJ, Rosich RM. Dementia, Substance Misuse, and Social Determinants of Health: American Indian and Alaska Native Peoples’ Prevention, Service, and Care. Chronic Stress (Thousand Oaks). 2023 Jan 18;7:24705470221149479. doi: 10.1177/24705470221149479. PMID: 36699807; PMCID: PMC9869198.
A qualitative study was conducted to understand the cultural practices and beliefs among American Indian and Alaskan Native (AI/AN) Elders about Alzheimer’s disease and related dementia (ADRD). Interviews investigated the etiology, course, treatment, and cultural meanings of ADRD as well as the social determinants of health related to ADRD and role of substance use disorder. AI/AN tribal Elders are identified as individuals who are designated culture bearers, wisdom holders, and role models in their respective communities. Twelve AI/AN Elders (mean age=73) who speak English participated in semi-structured interviews. The sample was predominantly female (66.7%), Athabascan Tribal heritage (58.3%) and retired (66.7%). All participants had a family member with ADRD but did not themselves have an ADRD diagnosis. Qualitative analyses identified 6 themes of etiology, barriers to treatment, and social determinants: (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. Findings highlight potential causal factors in disease development and manifestation as viewed by AI/AN Elders. This study exemplified historical and ongoing discrimination and stress in Western medicine and the importance of adopting a holistic view to address cultural health disparities.