The Invisible Urban American Indian and Alaskan Native Older Adults
 

By Kendra Kuehn, MSW, APS TARC Subject Matter Expert

March 2025

As the older adult population continues to grow nationally, the number of American Indian and Alaskan Native (AI/AN) older adults is also growing, and they are living longer. Between 2019 and 2060 the population of AI/AN individuals over the age of 65 is expected to more than double to 648,555, and AI/AN lifespans are increasing through efforts to address health disparities. But with over 574 federally recognized tribes and many state tribes, AI/AN older adults and people with disabilities are not homogeneous. Education and training are an important part of an adult protective service (APS) approach to understanding these differences. 

Location of residence can also factor into the availability of services for AI/AN clients. Services for individuals and partnerships within a tribe look very different on a reservation or tribal land, while AI/AN older adults living off tribal lands have their own challenges and disparities. These “urban elders” are often an invisible population that needs greater attention by APS and service providers.
 

Who Are Invisible Urban Elders?

Over 70% of the AI/AN population lives off tribal lands. They may live near the reservation and routinely go back and forth for work or other needs, or they may live much further away. Within urban areas, AI/AN residents tend to be dispersed and not to have developed a neighborhood focus. Though dispersed, they may gather through AI/AN community groups and have a more “pan-native” approach. 

In speaking with such elders, the National Resource Center on Native American Aging found a variety of reasons for older adults to move off the reservation, including being born or growing up in an urban area or looking for additional opportunities and resources. Other relocation factors involve historical federal policy, such as being taken to a government boarding school or pushes for families to move off reservation under the Indian Relocation Act of 1956. Understanding the policy periods a client lived through and their impact can be important. Many older adults today are likely to have lived through the “termination and relocation period” in the 1950s and 1960s. This effort focused on encouraging or forcing tribes to move from their reservations to urban areas for assimilation, forced attendance at boarding schools, sterilization, and institutionalization. These policies may contribute to distrust of the government, including APS programs.
 

Recognizing and Reporting Maltreatment of Urban AI/AN 

There is limited research in general on maltreatment of AI/AN elders and people with disabilities, and there is much less on urban populations. Crowder et al. found a maltreatment rate of 33% among AI/AN elders in the National Elder Mistreatment Study (NEMS). Thirty percent of those surveyed also noted maltreatment at earlier points in their life. Specifically looking at physical abuse of urban AI/AN older adults as part of a chart review of primary care patients, Buchwald et al. found at least 10% of the AI/AN elders had suffered definite or probable physical abuse, with only 31% of the cases identified reported. Both studies note that AI/AN cultural norms, such as honor and respect for elders, are often assumed to be a protective factor preventing maltreatment of elders. They also saw an assumption that moving off tribal lands would cause assimilation and loss of the protective culture. However, the authors found cultural norms are not necessarily a protective factor and AI/AN elders do not necessarily face a higher risk of maltreatment by moving off tribal land. Shame from disrespect, historical trauma, distrust, and lack of cultural sensitivity all contribute to reluctance to report.

The Native American Elder Justice Resource Center (NAEJI) notes that alternative phrases may be more helpful when speaking with AI/AN elders. The center notes that using terms such as “being disrespected” or “being bothered” can begin a more productive conversation than using “abuse” at the outset of the interaction. Spiritual abuse is also noted as significant and may be demonstrated through theft of ceremonial objects or isolation from important ceremonies. Urban AI/AN clients may be particularly dependent on others for transportation to ceremonies further away, which creates a potential for isolation. Crowder et al. highlighted that almost one-quarter of AI/AN elders, nearly double that of white respondents, reported emotional abuse in the NEMS study, including spiritual abuse.
 

Supporting Urban AI/AN Elders and People with Disabilities

Federally funded support services for clients vary depending on the state and proximity to tribal land. The U.S. Indian Health Service (IHS) is responsible for provision of health services to members of federally recognized tribes. IHS health facilities are the predominant service provider for those living on the reservation. But even if an urban AI/AN client is eligible for services, the travel cost and time to receive services on the reservation is often a challenge. IHS also contracts with private AI/AN-controlled nonprofits to run urban Indian health organizations (UIHOs). These organizations can provide a range of services including primary care, traditional healing and medicine, behavioral health, and social and community services. Not all UIHOs provide all services and, unfortunately, they represent only 1% of IHS' budget, limiting their reach. As of 2022 there were 41 UIHOs with over 80 sites. Find a UIHO here and consider initiating cross-training with the UIHO to fill the knowledge gaps highlighted by researchers.
 

As NAEJI notes, awareness of unique situations and backgrounds is key. With 574 federally recognized tribes and many more state-recognized tribes, APS programs and caseworkers must recognize that AI/AN elders’ and AI/AN people with disabilities’ needs may vary by setting. General resources such as the U.S. Substance Abuse and Mental Health Services Administration’s American Indian and Alaska Native Culture Card can provide an overview of key terms and historical background. Building relationships with local AI/AN organizations and leaders is key to building cultural awareness and relationships. Reaching out to a UIHO or inviting a community leader to do training, co-sponsor an event, or share resources can assist APS in understanding the unique considerations of AI/AN older adults and people with disabilities. 
 

The APS Blog is updated regularly with posts from contributing authors and new publications from the APS TARC.

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