Keeping our Nlaka’pamux Elders at Home

The Nlaka’pamux Services Society (NSS) actively works with and on behalf of the Chiefs and Councils of its member communities to address social, educational and health issues and endeavors to recognize and meet the needs of the communities it serves and all Nlaka’pamux communities in a culturally unique and effective way. It is dedicated to implementing services and supports which are informed by membership and are implemented in a carefully considered and well-planned manner. Throughout its 24 years of service, the NSS has engaged with Seniors as advisors and has always actively involved Seniors in all aspects of programming. Partners on this project include: Nlaka’pamux Nation Tribal Council (NNTC) and Fraser Thompson Indian Services Society (FTISS).

Based on findings from a 2011 Symposium, the BC Injury and Research Prevention Unit identified elevated levels of falls and injury within First Nations populations and the need to collaboratively engage with communities to ascertain their needs and address the gap between Aboriginal and non-Aboriginal populations. From 2011 – 2015 a participatory research project was undertaken by the Fraser Health Authority and communities within the Nlaka’pamux Nation to develop relevant community-based falls and injury prevention programming for older Aboriginal adults.

Qualitative research was undertaken in April – May 2014 involving 31 Elders, family members, community leaders and health providers. The results reinforced the need to develop a culturally relevant and sustainable falls and injury prevention program to help keep elders in their communities. The following three top priorities were identified through the research: (1) Implementation of home safety improvements (2) Improved access to exercise programs for older adults and (3) Improving intergenerational understanding and prevention of falls.

In a follow up qualitative research study, undertaken in 2017/2018, Seniors identified access to appropriate exercise as a high priority for their sense of well-being and health. To that end, Nlaka’pamux communities accessed funding through the Community Action Initiative to implement pilot exercise programs in the Fraser Corridor extending from Spuzzum to Lytton. The project and study met with enormous success as participants improved on measures of strength, overall health and quality of life as part of the The Best at Home: Prevention Through Active Engagement study. Subsequent consultations with Seniors and Nlaka’pamux health providers reinforced the need for increased community capacity to provide sustained exercise and physical activity opportunities for Seniors, and to help facilitate access to those programs to surrounding communities.

Indigenous worldviews and traditional approaches to well-being support finding balance between physical, mental, emotional, and spiritual dimensions contributes significantly to health and wellness. Research and personal stories tell us that when physical issues arise other aspects of health suffer, hence, poor physical conditioning leads to difficulties in conducting daily living activities and contributes to falls with increasing injuries and eventually, the need for care. Seniors are often required to be taken out of their home and community to seek and receive medical attention.

Health providers and community leaders caution that when Seniors are forced to leave their families and the social supports which sustain them, they become despondent, and, as a result, experience loneliness and sadness. This leads to isolation, depression, poor healing and can result in frailty, loss of mobility and premature death. Our project is designed to help prevent this downward spiral of mental, spiritual, emotional and physical deterioration through offering a range of suitable social and exercise programs which address the abilities and health status of Seniors and which are delivered across communities in a variety of settings on a sustained basis.

nkshAytkn gatherings engage Elders by providing opportunities to gather and share their knowledge, skills and experience with one another, and collectively remember Nlaka’pamux traditional practices. Elders meet on a monthly basis in a range of settings to discuss and document ceremonies, tell stories, connect children and youth to their culture, teach drumming and singing, recount how things were traditionally done by Nlaka’pamux ancestors, teach respectful ways of doing things, and encourage all Nlaka’pamux people to learn the Nlaka’pamux language. By doing so, the benefits are manifold. nkshAytkn gatherings reduce the social isolation of Nlaka’pamux Elders, promote their active engagement in their communities, establish a record of Nlaka’pamux traditions, and reaffirm the Nlaka’pamux legacy which will inform younger generations. nkshAytkn gatherings are directed by Elders and provide opportunities for intra- and intergenerational sharing and learning. We would like to continue supporting this invaluable program and extending its reach to embrace a greater number of Elders.

Evaluation: We will measure social participation and inclusion by identifying where Elders are coming from and the frequency with which they are attending sessions. We will assess engagement by encouraging Elder feedback at the end of each session to ensure initiatives are ‘on track’. We will also follow up on the benefits of nkshAytkn to Elders by asking Elders and community members to identify the benefits of gatherings (we anticipate it may be different across age groups). We will also identify anticipated outcomes to inform subsequent gatherings.

ElderAction provides an opportunity for Seniors to gather, to socialize, to exercise, to contribute, and to engage in seasonal activities within the territory which they call “home”. It also provides Seniors with increased opportunity to spend time with family members and model the healthy behaviours they hope to instill in their children and grandchildren. ElderAction also provides the opportunity to network through social media, such as Facebook and our website (safeforelders.com). A pilot study was conducted with a convenience sample of 25 participants who consented to be part of a ‘before and after’ study. The results of the pilot suggest that the physical activity program had a positive impact on overall mobility, and of the 13 activities initially offered, the activities with the greatest level of uptake in the communities were: Walking Group (outdoor in Nature as weather permits, indoor as required), Drumming and Dancing, and Be Fit Be Strong which is a circuit style fitness program tailored to different fitness levels and capacities. We would like to continue supporting and growing those programs.

Evaluation: We track attendance, demographics, and participants Quality of Life using a validated quality of life tool, the EQ5D-L before and after participation in the programs. Additional evaluation tools include questionnaires to ascertain the progress of individuals in activities and their improved sense of well-being, and standardized tools to measure improvements over time in strength and mobility (4-Stage Balance Test, Timed Up and Go Test, and 30 Second Chair Stand).

We will partner with 5 member First Nation communities, the Nlaka’pamux Nation Tribal Council, and the Fraser Thompson Indian Services Society. We have worked closely with these communities over the last 5 years, all of whom are committed to moving forward. This part of the project will focus on a top priority identified in the recently completed qualitative study: the need for home safety improvements. The project will focus on the actions required to pursue home safety improvements for older adults in the 5 participating First Nation communities. These actions will include:

1. Assessment of home safety needs by occupational therapists in Elders homes
2. Implementation of home improvements to address safety needs
3. Evaluation of impact of home improvements on Elder’s lives with respect to activities of daily living, independence, fear of falling and quality of life
4. Evaluation of the impact of home improvements on falls and related injuries
5. Collaboration with provincial, Federal and First Nations organizations to improve access to home improvement grant funding