Abstract
Many Alaska Native Elders attended government-run boarding schools as children, were forbidden to speak their native language, and were forced to abandon their traditional subsistence lifestyle, yet they maintained an optimistic outlook on life and continued to age well. The Explanatory Model Interview Protocol was adapted to interview a purposive sample of Alaska Native Elders (n = 26) and grounded theory was used to develop a model of successful aging for Alaska Native Elders in Bristol Bay, Alaska. The theme of optimism was significant in the findings and was also found in each of the elements of successful aging, which were spirituality, emotional well-being, community engagement, and physical health. These four elements served as the foundation of the Model of Successful Aging. The Elders believed they were able to age successfully because they continued to be optimistic despite the challenges they faced (and are currently facing) in their communities.
Keywords
In 2009 the State of Alaska celebrated its 50th anniversary; this is a fairly young history in comparison to the rest of the United States. Alaska underwent numerous positive developments early in its statehood (oil development, management and contracting of health care services, and so forth) and there were countless success stories, but several of these developments came at a price (Brown, 2012). In comparison to other elderly cohorts in the United States, Alaska Native Elders have been exposed to numerous disproportionate changes in one lifetime, which has put tremendous strain and stress on their health and well-being.
The history of Alaska is full of painful events focused on forcefully and coercively assimilating Alaska Natives to make them productive citizens of the United States. These efforts included forbidding them to speak their native language, converting to Western religion through missionaries (Langdon, 1987), and the introduction of foreign diseases and illnesses that killed thousands and decimated entire communities (Fortuine, 1992). In addition to missionaries and educators, there was a clash of worldviews, with the Native peoples being told their lifestyle was inferior and that they had to assimilate (Kawagley, 2006). Many Alaska Natives perished from diseases such as diphtheria, influenza, cholera, smallpox, measles, mumps, chickenpox, and tuberculosis (Fortuine), which has been described by Napoleon (1991) as the “great death” (p. ix). These illnesses and outside influences drastically changed the lives and experiences of older adults across Alaska.
This article is based on a qualitative research study that established a culturally grounded understanding of what successful aging meant for Alaska Native Elders in Bristol Bay, Alaska (Lewis, 2010). Indigenous communities in Alaska respect their Elders, and this is a cultural convention that distinguishes those Elders who live traditionally, continue to serve as an integral part of their community, and are role models for their family and community. The term elder is capitalized in this article to differentiate between the indigenous Elders of Alaska and those who are simply considered aged people who are indigenous but without a particular position within the community. In this article, I focus specifically on those Elders recognized by their community as role models (Lewis, 2011). In this article I discuss the importance of optimism among Alaska Natives and its role in their ability to age successfully in Bristol Bay, Alaska. As an Aleut (Alaska Native), I bring an understanding of Alaska Native cultures and sensitivity to the unique characteristics of rural communities. Being from Bristol Bay, I am familiar with the culture of the region where this research took place, and being a native of the region helped me gain access to, and win the trust of, community members.
Literature
Martin Seligman, a pioneer in the field of positive psychology who has studied the connection between optimism and health, argued that one of the main reasons optimists have better health is their social support (Seligman, 2006). He stated that having friendships and love seemed to directly affect an optimistic person’s health and health behaviors. According to studies on optimism (Achat, Kawachi, Spiro, DeMolles, & Sparrow, 2000; Angner, Ray, Saag, & Allison, 2009; Ingledew & Brunning, 1999; Scheier & Carver, 1992; Seligman; Snyder & Lopez, 2005), optimistic individuals experience less distress when dealing with difficulties in their lives and recover in a shorter period of time.
Peterson and Bossio (2001) explained that optimism encourages individuals to believe their behaviors will affect outcomes. Scheier, Carver, and Bridges (2001) also stated that optimism was directly related to self-efficacy and psychological adjustment. These two groups of researchers explored the connection between optimism and positive health outcomes, enabling older adults to recover or overcome physical ailments at a faster rate than pessimists. Peterson and Bossio argued that optimism is directly related to the idea that good health can be controlled, maintained, and promoted. They explained that optimistic people have larger social networks and are not as isolated, whereas pessimists tend to be isolated, which results in poorer health. Optimism, in these two studies, was synonymous with living well, which was also referred to as wellness. They defined wellness as a “zest for ongoing life, fulfilling career, and satisfactory relationships with family members and friends” (p. 139).
Ranzijn (2002) discussed the interconnectedness of social networks in communities and elders’ connections in their community. He stated that the quality of life of the elders declined if they worried about the well-being of their children and grandchildren. It was this passion to care for and teach the youth, serve as role models, and live their lives to the fullest that has enabled these elders to become Elders in their community. Ranzijn conducted a study on older adults’ ability to improve the community’s quality of life and highlighted the importance of optimism. He discussed the need to change our view of older adults from a burden to a resource, and that this idea of proactive aging can also enhance an elder’s quality of life. Tapping into the unique talents and wisdom of the Elders in each respective community contributed to the community’s well-being, as well as strengthened their individual sense of well-being.
Methods
To determine what successful aging meant in Bristol Bay, a purposive sample of Alaska Native Elders were interviewed over a period of 3 months. The Explanatory Model Interview Protocol (Kleinman, 1980) was previously used to study models of pathology and disease cross-culturally, but was adapted to discover a cultural model of successful aging among Alaska Natives in this region of Alaska. Rather than being driven by Western theory, which dominates the gerontology literature, I used a grounded theory (Glaser & Strauss, 2006) approach. Grounded theory is a “research methodology for developing theory by letting the theory emerge from the data or be ‘grounded’ in the data” (Monette, Sullivan, & DeJong, 2002, p. 226). With the use of this methodology, there was a continual interplay between data collection, data analysis, and theory development. Theory development occurred in the midst of data collection, rather than taking place after it. Those who use grounded theory often conduct qualitative research by making direct observations or conducting interviews in field settings. One-on-one interviews were conducted with the Elders in their own home or wherever they felt most comfortable. The interviews ranged from 30 to 90 minutes in duration, with the average interview lasting 60 minutes.
Gaining the perspectives of Elders and working collaboratively with each participating community represented a tribal participatory research (TPR) framework (Fisher & Ball, 2003; see also Lewis & Boyd, 2012). Using TPR, consensus was reached with the tribal communities on a shared research interview protocol, gaining permissions, and creating culturally compatible data collection methods. This research process also involved entering the setting and gaining the trust of the community and Elders, engaging the community throughout the entire research process, sharing early results to solicit input, and disseminating data to tribes and the regional tribal health corporation for review and approval.
Interviews were scheduled and conducted at the discretion of the individual tribal councils and the availability of the Elders. The communities and Elders served as coresearchers and were involved in the research process as much as they felt was necessary to be adequately represented in the research process, data analysis, findings, and dissemination. This study adhered to the ethical standards of the University of Alaska Fairbanks Institutional Review Board and the Alaska Area Institutional Review Board, and was approved by the regional tribal health corporation and each participating tribal council.
Sample
Participants consisted of a purposive sample (n = 26) of Alaska Native Elders in six southwest villages recruited through the traditional village councils. The regional tribal health corporation determined the study selection criteria and they wanted to include the region’s Alaska Native tribal groups (Aleut, Athabascan, and Yup’ik Eskimo). The villages were selected by the regional health corporation because they represented the diversity of each of the cultural groups within the Bristol Bay region, and they agreed to participate when I approached them about the study. The participant criteria were (a) to self-identify as Alaska Native and (b) to be considered an Elder by their respective communities. A nominating process was used whereby each participating tribal council selected individuals considered an Elder by their respective community who were willing to participate, rather than using a chronological age-based definition. It was my goal to interview 10 Elders during each visit to the community, but not every community had enough Elders who were interested or available, so rather than reaching a total of 60 interviews, I interviewed 26 Elders across all six communities. Data saturation was evident after completing the ninth interview, but I continued to interview Elders in the participating communities because they agreed to participate and expected me to visit.
Study Demographics
Six Aleut Elders, 19 Yup’ik Eskimo Elders, and 1 Athabascan Elder were interviewed over the course of 3 months. Participants ranged in age from 61 to 93 years and were from one of the six villages that participated in the study. More than half of the Elders lived with their spouse or partner, and a majority of the widowed women lived with their extended family. Five listed English as their first language and had learned their native language (Aleut and Yup’ik Eskimo) after they were grown. Of the participants, 12 Elders were widowed (10 women, 2 men), and more men were married than women (8 men vs. 5 women). In regard to education, 17 participants had less than a high school education and one Elder had finished high school. Four Elders received their GED (General Educational Development certificate) later on in life, and 2 had taken some college courses but had not completed a college degree. Two Elders did not respond to this question. The Elders’ household sizes ranged from living alone to 10 people living in their home, the average household size being four. Twenty Elders owned their own home and 6 lived in the home of their extended family. One Elder lived by himself in senior apartments located in the regional hub community.
Findings
During the analysis of the interview data, four major themes or elements of successful aging emerged, each of which highlighted important aspects of successful aging. (For more detailed information on the data analysis process, see Lewis, 2011). These four elements defined eldership in Bristol Bay: (a) emotional well-being, (b) community engagement, (c) spirituality, and (d) physical health (see Figure 1). These emerged during data analysis and served as the foundation of the Alaska Native Model of Successful Aging that developed as a result of this research.
Alaska Native Model of Successful Aging.
Much of the literature on successful aging is theory driven from a Western perspective (Rowe & Kahn, 1997; Strawbridge, Wallhagen, & Cohen, 2002), which does not include indigenous Elders’ perspectives. The present findings differ from the Western, or medical model of aging because they emphasize community, relationships, and an ecological systems approach to health and well-being. The most widely accepted definition of successful aging developed by Rowe and Kahn (1987) is based on the biomedical model of aging and focused on three components: low probability of disease and disease-related disability, high cognitive and physical functional capacity, and an active engagement with life. This definition has been criticized as being less focused on the entire person and the person’s physical and social environments (Strawbridge et al.), which differed from Alaska Native Elders’ holistic definition of successful aging.
The term successful aging served as the foundation of this study in that I wished to establish an Alaska Native understanding of successful aging to learn what this meant to Elders in Bristol Bay. Rather than defining successful aging, the participants described characteristics of Elders in their communities whom they felt demonstrated what they believed to be successful aging. These characteristics served as the foundation for the model of successful aging developed as a result of this research. Having a positive outlook on life was found in each of the four elements of successful aging listed above. The Elders in this study believed they had been able to age successfully and remain active in their community because they had not given up on all aspects of living and continued to be optimistic despite the numerous challenges they faced throughout their lives. The Model of Successful Aging illustrates what Alaska Native Elders in Bristol Bay considered as important to aging successfully in their respective communities, and optimism was a recurring theme.
Maintaining a positive outlook on life was mentioned throughout the interviews. An Elder stated, “I am going to have to be happy with exactly what I have done in my life and I am happy now.” Another Elder stated the importance of remaining positive about life and not letting others determine how one is going to live:
I think we all can, how do you say, we could still learn. They always say you can’t teach an old dog, but I don’t believe in that. I think old dogs can learn just as well as young dogs.
This theme of optimism was central to the four elements that supported the Model of Successful Aging and is discussed along with its relevance to each element of successful aging, including spirituality, emotional well-being, community engagement, and physical health.
Spirituality
Religion, or spirituality, served as one of the guiding principles of successful aging and leading a healthy and optimistic life. It is important to note that religion did not ensure successful aging, but rather enabled Elders to maintain a positive and healthy mental well-being. The use of prayer and attending church enabled Elders to place their worries out of their mind each morning or evening and focus on what was important. One Elder mentioned the role of religion in her outlook on life: “Maybe because I pray to myself all the time and hoping and praying for everybody, that they have good health. I am not afraid of aging. In fact, I don’t feel my age, I feel young.”
One Elder shared, “I give my worries to God. When I think positive, I do well.” One of the main reasons Elders attended church and prayed was because their belief in a higher power enabled them to overcome difficult times and reach a healthy older age: “It is important for me now, especially since what I’ve been going through with alcohol and uh, getting into wellness through the understanding of God.” One Elder discussed the importance of church and spirituality to the Elders in the community. One stated, “You know that the old people who are religious keep going to church until they can’t make it anymore. The ones I’ve seen were into their nineties, who were still going to church.”
Emotional Well-Being
In addition to maintaining a positive outlook, it was also important to have emotional balance and control and not act irrationally. Keeping a clear head and thinking through a situation before reacting was important to them. Elders explained the importance of forgiving others and not letting mistakes and damaged relationships stay bottled up inside, but expressing their feelings and moving forward. One Elder described this as “[f]orgiving people and talking about my worries.” Another Elder emphasized the importance of thinking through her feelings and not acting impulsively:
By not doing what first comes to mind. Even though I may be angry I try not to do what I really want to do. And holding back what I want to say to others if it will hurt them. This is how I become an Elder.
Another Elder stated, “Well, a person who does whatever comes to mind sometimes brings them to something not so good. But trying to live a good life is much better.” In addition to being optimistic and maintaining an emotional balance, it was important to avoid negativity. An Elder stated, “It’s good for the elders not to follow the negative thoughts. Avoid the negative and bad.” Another said, “Ones that don’t worry too much stay young. Ones that worry too much age faster.”
Community Engagement
Many of the Elders valued their relationships with their family and community members, and they discussed the importance of maintaining harmony and improving those relationships. Maintaining healthy relationships with others enabled them to maintain a positive outlook on life and feel invested and supported by their community. This idea of maintaining harmony in the community directly related to the health of the community. An Elder summed this up by stating, “As long as a person doesn’t make enemies around them and live right, they seem to live longer.” One Elder talked about the importance of family in her ability to remain optimistic and age well in her home:
But when they keep seeing their relatives, when I see my relatives regularly I am grateful. Some people give me strength when they come and talk to me, and they bring happiness. I would become happy again after not being so happy.
Another Elder talked about the importance of maintaining positive and healthy relationships with others and how this contributed to successful aging: “The attitude toward people is another thing. When you have a better attitude toward the people, you have an easier life.” The Elders maintained a positive attitude, demonstrated the ability to accept life as it happened, made the most of every situation, and served as a role model to others.
Physical Health
This theme was central to the health and well-being of Alaska Native Elders in that they focused on remaining optimistic in times of change or personal challenges, such as limited mobility or a chronic illness. One Elder stated, “People that are friendly and have a cheerful outlook seem to age better, view aging as another phase and are not bothered. It is just something that happens.” A majority of the Elders accepted the fact that they were aging and that biological changes were a part of this life process, yet they were not afraid of growing older. One Elder stated, “I am okay with aging. It doesn’t bother me. I just take things as they come.”
The Elders made a conscious decision to maintain a positive attitude and not give up on themselves regardless of health circumstances, which were key to successful aging and important to the Elders. One Elder stated, “They don’t. They don’t give up. Because they grew up with that, from their elders and their grandfathers. We keep those in mind, to focus every day.” They emphasized the importance of having a positive attitude toward life: “Positive mind. Positively, every morning when I become aware.” One Elder summarized the attitude of the Alaska Native Elders across the region: “I think our elders always will be optimistic.” A second Elder stated, “They are happy, otherwise they wouldn’t be here.”
Discussion
The words and experiences of the Alaska Native Elders on how to age successfully differed from those of participants in studies conducted in Western, or non-Native communities. Western definitions of successful aging are based on the biomedical model (Bowling & Dieppe, 2005; Rowe & Kahn, 1987; Strawbridge et al., 2002), whereas the Alaska Native Elders approached successful aging from a holistic perspective. Rather than approaching health from a biomedical, or disease, model, holistic health encompassed all aspects of their lives, from relationships and spirituality to their natural environment. A majority of the Elders in this study learned the importance of an optimistic outlook from watching and listening to the Elders in their own lives, which enabled them to age successfully. One Elder stated, “That is a good way, from the Elders that you know and how they lived, and look at how they are getting along. You try to do likewise.” An Elder summarized learning from his Elders: “Well, I would compare what I was doing with people who were making an effort to live a better life, and so, my understanding became in that area a little more effective.”
There have been numerous studies on the connection between optimism and well-being (Achat et al., 2000; Ingledew & Brunning, 1999; Peterson & Bossio, 2001; Scheier & Carver, 1992; Scheier et al., 2001), which are directly related in how people make lifestyle choices and their expectations about the consequences of those actions. Even though many Elders discussed the challenges and changes caused by Western influence, such as the Internet and video games, they remained optimistic about the preservation and transmission of their traditional, subsistence culture. According to Carver and Scheier (2005), optimistic people expect to have positive outcomes even during difficult or challenging times in their lives. Carver and Scheier believed that optimists experienced less distress than pessimists when dealing with difficulties in their lives, such as alcohol and drug abuse in the family or community, or the loss of loved ones. They stated that optimists reported greater satisfaction in their relationships and their jobs, and their quality of life was rated higher than others. Optimists were more likely to be engaged in active coping and learn from mistakes and challenges—characteristics the Elders in this study possessed and passed down to the younger generations.
The findings from this study provide a way to better understand the experiences of Alaska Native Elders and the importance of optimism to their health and well-being. The Elders discussed their challenges and successes in maintaining an optimistic attitude on life and how they successfully reached an old age. They shared stories of learning how to live off the land, using the wisdom and knowledge passed down to them; they also spoke of the importance of their culture, subsistence, and community for their health and well-being. It is also important to note that the four elements of Eldership all included optimism, or having a positive outlook on life. This characteristic was repeatedly discussed in the interviews and Elders attributed their health and well-being to it, along with spirituality and community engagement.
Conclusions
As Alaska’s older adult population continues to rise, it will be important to understand the challenges and benefits of growing older and maintaining a positive outlook on life regardless of health and well-being. The Elders in this study believed they were able to age successfully and remain active in their community because they continued to be optimistic. Their quality of life was also directly related to the quality of their social network. The community’s interaction with the Elders and providing outlets for them to share their knowledge were important to the Elders’ definition of successful aging and remaining optimistic. They emphasized that this must be a reciprocal relationship; they demonstrated a desire to be involved and the community provided activities and opportunities to engage thems. The communities in this study respected their Elders and understood the value of their wisdom and experience, and provided opportunities for them to participate and educate those who were interested and to teach the younger generations.
Each of the four elements was supported by an optimistic approach to life and the belief that health and well-being were directly related to one’s outlook on life and taking control of one’s behaviors. Every Alaska Native Elder in this study discussed the importance of maintaining a positive outlook, which directly impacted their view on life, overcoming diversity and hardships, continuing their engagement with the community, and maintaining a spiritual foundation. Each of the four elements was interrelated, yet the presence of all four did not automatically ensure a successful older age.
The presence of Alaska Native Elders in the community, as role models, contributed to the community’s health and sustainability. Active involvement in their culture was one of the foundations of their well-being and identity. As our Elders continue to engage with their community, teach the youth, and serve as role models, it will be important to ensure that these four elements of Eldership are supported and the Elders have an outlet to pass on their knowledge.
Dissemination
On completion of the individual interviews and data analysis, focus groups were conducted in four of the six Aleut, Athabascan, and Yup’ik Eskimo communities to discuss the results of the interviews and summarize the responses and experiences of the Elders. These four communities were selected because they represented each of the three cultural groups in the Bristol Bay region and had community leaders and members available to host and participate in the focus group presentations. The focus groups allowed participants to share their experiences and feelings, offer comments and suggestions on the Alaska Native Model of Successful Aging, and share anything else they felt was pertinent to the discussion and study. No focus group participants disagreed with the findings or the Model, but rather discussed their enjoyment of observing in a visual format what they all had been taught by their Elders.
Footnotes
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: A Dissertation Improvement Award from the National Science Foundation funded this research (No. 0823120).