2013 GSA Symposium: Optimal Aging and Evidence-based Research in Indigenous Populations

1. 2013 GSA SYMPOSIUM: Optimal Aging and Evidence-based Research in Indigenous Populations Wednesday, 11/20 to Sunday, 11/24 Sheraton New Orleans New Orleans Marriott New Orleans, Louisiana

2. Overview Inoi (prayer) Waiata tapu (sacred song) Context for LiLACS NZ Waiora Port PhD Paea Smith Leiana Reipae Reynolds Betty McPherson Hone and Florence Kameta Inoi (prayer to close) Waiata tapu (sacred song)

3. He inoi (a prayer) offered by Hone Kameta E te tua kaha rawa, Our heavenly Father, we pray to you Whakatuwheretia mai na kuaha o te tika o te ora to open the doors of righteousness and glory. Mtou koe whakamoemiti e whaka kororia irunga i to ingoa tapu; We offer this pray in your blessed name Ake tonu atu. mine Forever. Amen

4. He waiata tapu-Whakaaria mai Whakaaria mai Tu rpeka ki au Tiaho mai R roto i te p Hei kona au Titiro atu ai. Ora, mate, Hei au koe noho ai

5. Te kaumtuatanga: indigenous ageing in Aotearoa, New Zealand INTRODUCING Te RpKaitiaki o ng tikanga Mori/Protectors of principles of conduct in Mori research, LiLACS NZ: Dr Mere Kpa, Betty McPherson, Hone Kameta, Florence Kameta, Paea Smith, Leiana Reynolds, & Dr Waiora Port Corinthia Kpa, Carer to Te RpKaitiaki Dept of General Practice and Primary Health Care, School of Population Health, Faculty of Medicine and Health Sciences.

6. In Aotearoa, New Zealand: context The population of Mori men and women aged 65 years and over is increasing faster than non-Mori people. The number of Mori aged 80 + years old will triple by 2026. Statistics New Zealand reported that in 2012 approximately 5,000 Mori were aged 80 years and over; a 50% increase in number from 2002 The advanced aged cohort will increase from 1% to 8% of NZs population by 2050.

7. Te puwaitanga o ng tapuwae kia ora tonu Life and living in advanced age: a cohort study in New Zealand, LiLACS NZ The only longitudinal study of Mori aged 80 plus years old

8. No routinely collected data on Mori LiLACS NZ is the worlds first longitudinal study of an indigenous population aged 80 plus years old During any one year of LiLACS NZ, one in ten of the cohort will die and one in five will be hospitalised for cardiovascular disease. Indigenous Mori ageing in Aotearoa

9. A narrow age band, 80 to 90yrs for M ori To make recruitment easier 85yrs for non-M ori. Designed to study environmental, social, cultural, health, family and whnau. Designed to study issues associated with ageing, wellbeing, and quality of life. LiLACS NZ commenced in 2010 preceded by the feasibility study, Reaching Advanced Age

10. Where and how? Bay of Plenty region, North Island, NZ Equal explanatory power Mori and non-Mori Visit the participants every year until all of them have died

11. Significant observations Greater language and cultural engagement is associated with higher QOL for Mori Unmet social needs and discrimination are associated with lower QOL

12. Using scientific inquiry & kaupapa Mori Engagement & recruitment 421 out 766 Mori, 80 to 90 years old (56%) Non-Maori 516 out of 870 , 85 years old (59%) A total of 937 participants were recruited in 2010

13. Kaupapa Mori approach to research is a political method promoting and supporting research and education [health] for Mori by Mori, conducted in Mori ways including using te reo Mori me ng tikanga/Mori language and culture. Reference Ngha, A.B . (2011). Te Reo, a language for Mori alone? An investigation into the relationship between the Mori language and Mori identity. PhD Thesis. Mori Studies: University of Auckland ( my brackets)

14. Kaupapa Mori involves .. Te RpKaitiaki o Ng Tikanga Mori/Protectors of principles in the conduct of Mori research Dr Waiora Port, Te Rrawa and Te Aupouri. Paea Smith, Ngti Apa and Ngti Kahungunu; Leianna Reynolds, Ngti Rehia and Ngti Twharetoa; Betty McPherson, Te Rrawa; Hone Kameta, Whakathea, Ngi Thoe, and Te Arawa; and Florence Kameta, Ngi Tai and Ngti Prou. Role : Governors, advisors, designers, translators, authors, presenters, parents, tribal leaders, community leaders, grandparents, great grand parents, & parents

15. Dr Waiora Port: explaining the term Kaumtua Te Rwara & Te Aupouri tribes from the Far North Second language learner of te reo Mori Great grandmother Carer to her husband, Garth Teacher & PhD (the University of Auckland) Author

16. Dr Waiora Port: explaining the term Kaumtua The term kaumtua has connotations of rangatira/ noble birth as well as chieftainship, and the term has become a title which some Mori use to describe leaders outside their own areas. Kaumtua is an inclusive word describing both elderly male and female, in both the singular and plural. The term can be used as a title, such as, Elder. Kaumtua are the leaders of the whnau/extended family who made decisions concerning the working of family land, the control and use of family property, the rearing and education of children. The kaumtua was usually the recognised spokesman on behalf of the whnau in the forum of the marae/the ceremonial courtyard of the village.

17. Paea Smith: thinking about kaumtua and research Ngti Apa, West Coast, North Island; Ngti Kahungunu, East Coast, North Island, Aotearoa Widow Great Grandmother Former parliamentary secretary Mother of 3 PhDs: 1Distinguished Professor//CEO, 1 Independent Mori researcher businesswoman, 1 Kai whakairo (Master Carver) Researcher & author

18. Paea Smith: thinking about kaumtua and research What I love about the research Meeting with interesting kaumtua/people aged 65 plus years old around the world. Learning the statistics of the diseases that are prevalent among our people like diabetes, dementia, cancer, et cetera. Being part of any research that can help our people and future ones to come. Just being there to support the wonderful leaders of this project doing this work that is so valuable for generations to come. Being able to go between her and other organisations like the Mori Womens Welfare League, and the Rp Kaumtua Kaunihera. Just being a Kaumtua !

19. Leiana Reipae Reynolds: an honour, a privilege, and research Ngti Rehia from the Far North & Twharetoa from the Central North Island of Aotearoa Grandmother Florist, landscape gardener, musician, & lead singer of Te RpKaitiaki Researcher & author

20. Leiana Reipae Reynolds: an honour, a privilege, and research My grandparents time must have been difficult, for example, the drop- hole toilet, water pulled up from the Well; no power; walk or ride a horse to the far-distant school, hospital, and shops. Horses to plough the fields to grow their food and, seafood if they were close to the sea. My Papa and Nana died in their 60, many others a lot younger. My Mum and Dad had a better life with good jobs, a home with all the comforts including a flush toilet, transport, and their own car later in life. Dad died in his late 60s and Mum at 82 years of age. My husband, and I look back down memory lane and wish our loved ones were here to share our warmer, well-appointed homes. Barry is 69 and still happily working. I enjoy gardening. We are living longer, in better health, food is plentiful, transport is easy and we have the freedom of choice

21. Betty McPherson: kaumtua and LiLACS NZ Te Rrawa tribe from the Far North of Aotearoa, New Zealand Native speaker of te reo Mori me ng tikanga Widow Great grandmother Teacher Researcher & author

22. Betty McPherson: kaumtua and LiLACS NZ I am passionate about my work with LiLACS NZ. I love sharing my experiences with the elderly and as I am moving into that stage of my life it means so much to me. I am also one of the team of 4 people responsible for translating the English language questionnaires into the Maori language. I have been involved with this project since 2007. I was happily surprised to be interviewed for a feature article on ageing for, The New Zealand Herald and, to be asked for my opinion about studies associated with LiLACS NZ , for example, the nutritional studies. We participated in the feasibility programme and now we are completing Wave 4 and preparing for Wave 5.

23. Florence & Hone Kameta: Te Rautahi many into one Ngi Tai, Ngti Prou, East Coast, North Island Native speakers of te reo Mori Grandparents Husband, wife and, mates for years Kai rangahau (Master Weaver) and Kai Krero (orator) Masterate Candidate & Master of Researchers & authors

24. Hone Kameta Whakathea, East Coast, North Island; Te Arawa, Central North Island Native speaker of te reo Mori Grandfather Husband to Florence Rangatira/Chief Lumberman, hunter, fisher, environmentalist, politician Researcher & author

25. Florence & Hone Kameta: Te Rautahi marae For Mori, the institution at the heart of Te Ao Mori (Mori society) is the marae (sacred gathering place of kin relations). The marae is a necessity for without a marae much of Te reo Mori me ng tikanga (Mori language and culture) is missing. The marae is the place where the whnau, hap, and iwi gather to pray to god; h ost our manuhiri (visitors); mourn our dead; listen to our Kaumtua recite our whakapapa (shared ancestry) and narrate stories from our past; and d ebate about what is going on in Te Ao Pkeh (New Zealand European Pkeh society) and Te Ao Mori. On the marae, Mori people learn about our history and come to know about the richness of our life, and the proud heritage that is truly ours.

26. Message for indigenous researchers Indigenous peoples pasts are companions of ageing

27. A Prayer of Care & Service We offer you our hands to do your work. We offer you our feet to go your way. We offer you our eyes to see as you do. We offer you our tongues to speak your words. We offer you our minds that you may think. Above all, we offer you our souls that you may love, your spirits, ancestors, and all people. We offer you our care and service Kia ora.

28. He waiata tapu (sacred song) E hara i te mea No naianei te aroha No ng tpuna Tuku iho, i tuku iho (x2)

29. References Dyall, L., Kpa, M., Teh, Ruth., Mules, R., Moyes, S., Wham, C., Hayman, K., Connolly, M., Keeling, S., Loughlin, H. Jatrana, S., & Kerse, N. (in review). Cultural and social factors and Quality of life of Mori in advanced age: Te Puwaitanga o Ng Tapuwae Kia ora Tonu. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ) . New Zealand Medical Journal Kpa, M; Kpa, C.A; McPherson, B; Kameta, H; Kameta, F; Port,W; Loughlin, H; Smith, P; & Reynolds, L . (in review) E kore e ngro ng kkano i ruia mai i Rangitea: The language and culture from Rangitea will never be lost in health and ageing research . Journal of the Canadian Health Libraries Association Special Issue on Aboriginal Health Kpa, M., Kameta, F., McPherson, B., Smith, P., Reynolds, L., Dyall, L., Kerse, N., Hayman, K., & Moyes, S. (2013). Donating a sample of blood tissue to research: Where to from there? Pacific Edge Transforming Knowledge Into Innovative Practice. Research papers from the fourth Health Research Council of New Zealand Pacific Health Research Fono pp. 100-107. ISBN 978-1-877495-10-6

30. References Kpa, M., Kerse, N., Dyall, L. (2012). Te Puwaitanga o Ng Tapuwae Kia Ora Tonu: Cultures and ageing. International Indigenous Research Development Conference Proceedings 2012 , pp 158-166. Ng Pae o te Mramatanga. ISBN 978-0-9864622-4-5. http://www.indigenousdevelopment2012.ac.nz Kpa, M. Technical Report to Ng Pae o te Mramatanga. Kaumtua: Taonga Aroha Project. The University of Auckland. http://www.ageconcern.org.nz/files/TechnicalReporttoNgaPaeoteMaramatangaJuly2011.pdf July 2011 Ngha, A.B . (2011). Te Reo, a language for Mori alone? An investigation into the relationship between the Mori language and Mori identity. PhD Thesis. Mori Studies: University of Auckland ( my brackets) Smith, G. H. (1997). The Development of Kaupapa Mori Theory and Praxis . Unpublished Doctoral Thesis. University of Auckland Smith, L.T. (1999) Decolonizing Methodologies. Research and Indigenous Peoples. University of Otago Press, Dunedin

31. Whakawhetaitanga Acknowledgements Corinthia Kpa (Carer to Te RpKaitiaki), & Professor Ngaire , Kerse, Dr Lorna Dyall, Dr Ofa Dewes, & Dr Ruth Teh, Dept of General Practice and Primary Health Care, School of Population Health, Faculty of Medicine and Health Sciences Dr Sela V. Panapasa & Dr James W. McNally, University of Michigan University of Michigan Mervina K.M . Cash-Kaeo, ALU LIKE Inc., S. Haunani Apoliona, Office of Hawaiian Affairs R. Turner Goins , Oregon State University, Charles B. Chen, West Virginia University, S. Melinda Spencer, University of South Carolina

32. Kaiutu Funders Professor Ngaire , Dept of General Practice and Primary Health Care, School of Population Health, Faculty of Medicine and Health Sciences, the University of Auckland Ng Pae o te Mramatanga , New Zealands Indigenous Centre of Research hosted by the University of Auckland Te Whare Kura Indigenous Knowledges, Peoples and Identities, Thematic Research Initiatives , the University of Auckland Mori Health Research Grant , Health Research Council of New Zealand Sir John Logan Campbell Medical Trust, Auckland