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Vulnerable Population: Native Hawaiian Elderly

Aubry Hire
Ferris State University

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Vulnerable Population: Native Hawaiian Elderly
The Native Hawaiian elderly are a vulnerable population. They are at risk because of
several different factors. These factors can be divided into two main groups: general risk factors
associated with aging and culturally specific risk factors (Browne et al., 2014). General factors
associated with aging include cost associated with care, access to health care, and transportation
associated challenges.
Culturally specific risk factors include historical trauma, beliefs about sickness and
health, discrimination, and loss of traditional healthy lifestyles (Braun et al., 2014). Historical
trauma stems from the overthrow of the monarchy in 1893 (Browne et al, 2014). This trauma
impacts the first generation; every generation after that feels the impact as well, according to the
Historical Trauma Conceptual Model. Many Hawaiians relate sickness as an inability to balance
responsibilities to the group, land, and spiritual world (Braun et al., 2014) and may not see an
illness as just that, an illness. Discrimination is prevalent for all minorities, and the Native
Hawaiians are no different. The loss of traditional lifestyles can be traced back to the monarchy
being overthrown, and the Native Hawaiians having land, food, and their lifestyle taken away
from them.
Personal Awareness of the Population
I believe that I do not have any biases toward the Native Hawaiian elderly population. I
think that some general stereotypes that people may have of Native Hawaiians is that they are all
hula dancers or surfer dudes. Another stereotype may be that all Native Hawaiians wear leis and
are always friendly, living the aloha lifestyle. If I were to meet a Native Hawaiian elder, I am
sure that I would treat them with respect and courtesy, just like I would treat any other elder of
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any race. I would treat them as an individual and value them as such. I personally have never
been to Hawaii and I do not know anyone from Hawaii, so I believe that this opportunity to study
this population will help me to formulate an attitude of care towards this population.
Demographics
In Michigan there are 2,604 Native Hawaiian Pacific Islanders; the median age is 32
years old (Current Native Hawaiian, 2014). This signifies that as nurses, we may come across
Native Hawaiians in our practice. According to Kaopua et al. (2011) Native Hawaiians make
up 24.3% of the Hawaiian population, but Native Hawaiian older adults make up only 12.6% of
the states over 65 population. The population drops by nearly half when the population ages.
The average life expectancy in 2000 was 74 years of age (Ka'opua et al., 2011) for Native
Hawaiians, while the average life expectancy of everyone in Hawaii was 81.3 years of age
(Lewis & Burd-Sharps, 2013). Native Hawaiians make up 0.1% of the total US population, with
60% living in Hawaii (Browne, Mokuau, & Braun, 2009). 15% of Native Hawaiians hold a
bachelors degree and 5% hold a graduate or professional degree (White House initiative, n.d.).
This indicates that very few have received advanced education. Hawaiians are more likely than
non-Hawaiians to get diabetes, and they have the third highest death rates from cancer in the
United States (White House Initiative, n.d.). Native Hawaiian elders live within or below 100
199% of the poverty level (Ka'opua et al., 2011). This statistic is significant because it is clear
why many do not seek out health care; they simply cannot afford the cost of modern health care.
Effect of Research on Personal Attitudes
My attitude towards the Native Hawaiian elderly has not changed due to my research on
the population, partially because I had no opinion of them beforehand. I think that my research
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has given me more of an understanding on where the population comes from and challenges that
they face. I would like to think that my research has given me a base on which to stand, when I
do meet someone from this population.
Self-Reflection
The perceptions that I had before doing research and the perceptions that I have now are
very similar. Before my research I had never really thought about the Native Hawaiian elderly,
therefore I did not have any opinion of them. I had no knowledge on any of the challenges that
many of them face. My perceptions after doing this research have changed slightly, because I
now have some information on which I can begin to form an opinion. I now know why there is
such a disparity in the numbers of Native Hawaiian elders. Much of this population is poor; this
prevents them from receiving adequate health care and thus will have an impact on their lifespan.
I hope that this research will not sway how I treat any Native Hawaiians that I may come across,
and that I will treat each patient that I come across as an individual and not a statistic.
Impact on Health Care
Knowledge of the Native Hawaiian elderly will have an impact on health care. This
knowledge can be either positive or negative. A nurse could believe that because most of the
Native Hawaiians are poor and have a shorter life expectancy than others, they do not deserve
the best treatment and the best care that we can provide. On the other hand, a nurse could
understand that because the majority of the population is poor, it is a big step for them just to
come into a hospital and ask for help. The nurse could educate them on programs that could help
them to pay for medical care. Knowledge of the culture will also help the nurse to provide
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culturally competent care. It is important to remember that each person is an individual, and that
as nurses, all patients should be treated equally.





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References
Braun, K. L., Kim, B., Ka'opua, L. S., Mokuau, N., & Browne, C. V. (2014, August 18). Native
Hawaiian and Pacific Islander elders: What gerontologists should know. The
Gerontologist, 00(00), 1-8. doi:10.1093/geront/gnu072
Browne, C. V., Mokuau, N., & Braun, K. L. (July, 2009)Adversity and resiliency in the lives of
Native Hawaiian elders. Social Work,54(3), 253-261. Retrieved from
http://jsw.sagepub.com/
Browne, C. V., Mokuau, N., Ka'opua, L. S., Kim, B., Higuchi, P., & Braun, K. L. (2014, March
23). Hawaiian elders and 'ohana caregivers: Discussions on aging, health, and care
preferences. Journal of Cross-Cultural Gerontology, 29(2), 131-151.
doi:10.1007/s10823-014-9227-8
Current Native Hawaiian Pacific Islander population in Michigan 2013, 2014 by gender and age
(2014). In Suburban Stats. Retrieved from http://suburbanstats.org/race/michigan/how-
many-native-hawaiian-pacific-islander-people-live-in-michigan
Ka'opua, L. S., Braun, K. L., Browne, C. V., Mokuau, N., & Park, C. (2011). Why are Native
Hawaiians underrepresented in Hawai's's older adult population? Exploring social and
behavioral factors of longevity. Journal of Aging Research, 2011, 1-8.
doi:10.4061/2011/701232
Lewis, K., & Burd-Sharps, S. (2013). The measure of America 2013-2014 (American Human
Development Report). Retrieved from Measure of America website:
http://www.measureofamerica.org/measure_of_america2013-2014/
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White House Initiative on Asian Americans and Pacific Islanders. (n.d.). Fact sheet: What you
should know about Native Hawaiians and Pacific Islanders (NHPI's). In White House
Initiative on Asian Americans and Pacific Islanders. Retrieved 2014, from
https://www2.ed.gov/about/inits/list/asian-americans-initiative/what-you-should-know.pdf