Elders are deeply honored in many indigenous cultures. In the U.S., they also often face unique stresses, some passed down through generations. Many Native American older adults witnessed grief and intense racism as well as the loss of their ancestral lands and cultural practices. This can weigh on them throughout their lives and especially as they age.

Still, the ties that bind an indigenous community can do a lot to support them through the aging process, says Blythe Winchester, MD, director of geriatric services for Cherokee Indian Hospital in Cherokee, NC, and a member of the Eastern Band of the Cherokee Indians.

Winchester grew up on the Qualla Boundary Cherokee Indian Reservation in western North Carolina and lived there until leaving for Davidson College, followed by medical school at the University of North Carolina. After doing her geriatrics fellowship in Asheville, NC, in 2013, Winchester became the head of the skilled nursing facility at Cherokee Indian Hospital.

From a very young age, Winchester has been drawn to taking care of her elders. She’s revered them, learned from them, and she combines her formal medical education with that of her heritage to care for them. They’re the beating heart of her community, she says.

Winchester describes the challenges they face – and what she thinks would help.

What can be done to help Native Americans avoid isolation as they age?

Winchester: “It’s important to have employment and volunteer opportunities for the elderly throughout the reservation to keep them involved in their community.”

“For example, even those who have significant health problems and issues with mobility can work at our cultural center. Despite whatever medical condition elders might have, it’s important to spend productive time doing something with a purpose.”

What community services can help combat some of the issues associated with aging?

Winchester: “A close-knit indigenous community can make a big difference when it comes to taking care of the aging. The Qualla Boundary in particular helps elders with tasks like mowing their grass, paying heating bills, and getting necessary supplements. They can even help provide Christmas gifts for those who can’t afford them as well as other senior services that might not be available in other communities.”

Who are the most at risk?

Winchester: “Elders who are living in urban areas who have been removed from their homelands for one reason or another are particularly vulnerable. The connection and cultural understanding that can get lost when they leave where they’re from can put them at risk, especially if they lack many of the services mentioned above.”

“Some of the elders are in their 90s or older and have witnessed extremely traumatic events. For example, some remember being forcibly placed in boarding schools far away from their families. Memories of these events can cause undue stress to our elders.”

What are some of the health challenges facing Native Americans?

Winchester: “Indigenous people are already up against issues that might not face other communities. They face many of the same types of chronic conditions as other aging populations, including heart failure, coronary artery disease, and diabetes. But they also face conditions that occur more commonly in Native American communities for reasons we don’t understand, like autoimmune diseases as well as higher rates of neurocognitive disorders like dementia.”

What’s an example of how built-in stress impacts the overall health of elder populations?

Winchester: “Everything is connected to stress. Diabetes, for example, is a vascular disease that’s caused by inflammation in the body. And inflammation can be caused by stress. That’s one of the reasons we use behavioral health consultants for patients who are doing what they can to control their blood sugar through diet, exercise, and medication but still aren’t seeing results. If you don’t ask about what’s going on in their life, you might be missing a huge piece of what’s causing the condition. And diabetes is just one example.”

What can be done to improve health outcomes among this population?

Winchester: “The more we can educate around and revive our cultural practices, the better. It’s that connection to what we used to have that’s so important. We had an intricate and sophisticated method of taking care of our elders before that was taken from us, and the more we can connect back to that heritage, the more the aging community will benefit.”

“Our health care used to be empowered, driven by the individual person trying to bring their bodies back into balance. Now it’s about a doctor having complete power, and for many indigenous people, there’s still a lack of trust in this method. When you feel like you have a say, you’re much more likely to participate in your own wellness.”