IntroductionChronic disease studies have omitted analyses of the American Indian/Alaska Native (AI/AN) population, relied on small samples of AI/ANs, or focused on a single disease among AI/ANs. We measured the influence of income, employment status, and education level on the prevalence of chronic disease among 14,632 AI/AN elders from 2011 through 2014.MethodsWe conducted a national survey of AI/AN elders (≥55 y) to identify health and social needs. Using these data, we computed cross-tabulations for each independent variable (annual personal income, employment status, education level), 2 covariates (age, sex), and presence of any chronic disease. We also compared differences in values and used a binary logistic regression model to control for age and sex.ResultsMost AI/AN elders (89.7%) had been diagnosed with at least one chronic disease. AI/AN elders were also more than twice as likely to have diabetes and more likely to have arthritis. AI/AN elders with middle-to-low income levels and who were unemployed were more likely to have a chronic disease than were high-income and employed AI/AN elders.ConclusionAddressing disparities in chronic disease prevalence requires focus on more than access to and cost of health care. Economic development and job creation for all age cohorts in tribal communities may decrease the prevalence of long-term chronic diseases and may improve the financial status of the tribe. An opportunity exists to address health disparities through social and economic equity among tribal populations.

Current definitions of elder abuse and neglect include physical, sexual, financial, emotional, and psychological dimensions. Such definitions overlook the spiritual lives of elders. Acknowledging and understanding spiritual abuse may be incredibly important for Native American Elder communities. Abuse of Native American elders can be detrimental on individual, communal, and cultural levels given that elders possess important cultural knowledge and are considered highly respected within indigenous communities. This article outlines the historical context of spiritual abuse within Native American communities and reviews the spiritual abuse literature in order to develop a culturally appropriate definition of spiritual abuse. Components of spiritual abuse include abuse from a trusted spiritual leader or mentor, limitations of access to sacred objects of ceremonial practice, and contamination of sacred objects or practice. Examples of spiritual abuse components are provided within both Native American spirituality as well as other modes of spiritual practice. Components of this definition can be utilized by health professionals, researchers, and tribal governments intending to develop culturally appropriate responses to elder abuse.