The Traditional Roles of Caring for Elders: Views from First Nations Elders Regarding Health, Violence, and Elder Abuse

This study sought to respectfully understand Northern British Columbia First Nations Elders' views regarding health of communities, intergenerational relationships, Elder roles, and violence towards Elders.Injuries, both intentional and unintentional, are a leading cause of death for First Nations Peoples.Information regarding Elder abuse in First Nations communities is lacking, though family violence has been identified as a problem within First Nations communities.The goal of this research was to understand the point of view and Elders' reality through the creation of a dialogue with Elders, and to discern the interface between Traditional First Nations' belief systems, healing methods, and current legal and health care systems within Canada.This study used a community-based participatory research design to explore social and cultural context through the views of Carrier Sekani Elders in the Ts'il Kaz Koh community.The design acted to support the aims of the study which were: To explore how First Nations Elders understand violence in their communities, to explore what First Nations Elders believe gives rise to violence in First Nations communities; to illuminate the factors that First Nations Elder view as affecting the safety and well-being of Elders living in First Nations communities; to explore First Nations Elders' narration of intergenerational relationships before and after contact; and to make clear factors which First Nations Elders view as required for Elders to remain safe and stay within their respective communities.The study followed the CIHR Guidelines for Research with Aboriginal Peoples.Approval was obtained from Carrier Sekani Family Services' Research Review Committee, from the Ts'il Kaz Koh Chief and Council and Ts'il Kaz Koh Community, the Ethics Review Board of the University of Northern British Columbia, and the Institutional Review Board of the University of Tennessee.Informed consent was obtained both from the Ts'il Kaz Koh community and from participating Elders, utilizing Ts'il Kaz Koh cultural protocol.Six Ts'il Kaz Koh Elders residing in Northern British Columbia participated in interviews utilizing an interview guide.Interviews were then read, categorized, and coded according to identified concepts, allowing for retrieval of themes.Codes were submitted to two committee members for review and consensus regarding the categories of each code for reliability.Both a domain analysis and a taxonomic analysis were performed on the data.A convergent analysis of themes was performed to assure internal and external validity.The findings were presented to the Elders at each step of the analysis to ensure validity and reliability.The final document was presented to the community to ensure that all information was accurate and acceptable to the community.Limitations of the study include the limited sample of Elders solely from the Ts'il Kaz Koh (Burns Lake) community.This limitation is also viewed as an opportunity for the Ts'il Kaz Koh to request program development funding as a pilot initiative.This sample limited to one First Nations community prohibits the generalization of findings to other communities until further research occurs with other communities.Themes related to the problems of violence were multiple, including changes from Traditional way of living to contemporary way of life, changes from the Residential School experience, loss of Traditional roles, and change in community from communal structure to that of nuclear family units, and the influence of alcohol and drugs on individuals and families.Sub-themes related to violence included the loss of intergenerational relationships, changes in Elder roles from the past, and the change in roles and behavior from the past across all ages.Also identified as sub-themes were the influences of change from that of communal caring, to individuals watching out for their own welfare, and the change from hard work being valued within Traditional roles to lack of value for hard work in contemporary society.Disruption of intergeneration roles within the community was also identified as a theme related to violence.Recommendations from this study include the need to further research the views of Elders surrounding violence and Elder abuse in other First Nations communities, with translation to clinical practice and the development of a culturally appropriate screening tool for First Nations Elder safety and abuse.Further research with other First Nations communities will allow generalization of results to be utilized in program development and evaluation.This study supports the utilization of the health determinants model in program planning and the developing of capacity for First Nations to control their health care services.The findings of this study also support the need for funding of Youth-Elder initiatives which foster the reestablishment of intergenerational relationships and the concurrent translation of Elders' Traditional knowledge.Utilizing Elders as leaders and a source of Traditional health knowledge is part of a viable model of combining contemporary and Traditional health care practices.The Elders' views supported the importance of a strength-based approach to healing with the prior work of McCormick who found that effective healing for First Nations people must have a focus on "interconnectedness" rather than personal autonomy in order for communities to heal.This study would like to acknowledge the strength of these Elders and the Ts'il Kaz Koh community to deal with the historical trauma of Residential Schools and the effects on individual, family and community health.

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