Chickahominy Tribal Elders Help Shape Brain Health Conversations

Chickahominy elders recently gathered to answer a simple but meaningful question, “What matters most to you?” They placed their words on an image of a bald cypress tree. Bald cypress trees line the banks of the Chickahominy River, where the Chickahominy Indian Tribe is located. The activity kicked off a new effort by the Tribe to promote healthy aging using the 4Ms of Age-Friendly Care.

As an Indian Health Service Alzheimer’s Program grantee, the Tribe is expanding dementia awareness, early recognition, and caregiver support. The 4Ms framework was designed to help health care organizations improve how care for older adults is delivered. The Tribe is adapting the framework to guide conversations with elders about their health and priorities in a clear, easy-to-understand way.

Stormie Miles, LPN, serves as the Tribe’s Brain Health Navigator. She leads outreach, education, and conversations that help elders focus on the four areas, or “4Ms,” that shape daily well-being:

• What Matters: What you value most in your life and health
• Medication: What you take and how it affects you
• Mind: Your mood, memory, and mental well-being
• Mobility: How you move, stay active, and get around safely

The Virginia Geriatric Education Center at the Virginia Center on Aging delivered a three-part series on the 4Ms and invited elders to participate. The activity was eye-opening.

“After being approached about the series, elders expressed interest in learning more,” Miles shared. “They helped to shape the sessions and showed how the 4Ms can align with local priorities and cultural values.” 

The messages on the cypress tree remind the Tribe where the work begins—with elders stating, in their own words, what matters most. Miles said the tree will have a permanent home at the Tribe’s office.

Pictured: Elders placed their messages on a bald cypress tree, an important symbol along the Chickahominy River.

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From Fellowship Project to Publication: Journey Mapping Dementia Care

Former IHS Geriatric Nurse Fellow Jinelle Goodwin recently co-authored an article in EXPLORE on caregiver journey mapping. Journey mapping is a tool that helps health care teams understand how patients and families experience care, including where barriers occur and where services can be improved. 

Goodwin and co-author Dr. Mary Koithan describe how the process can be especially relevant in rural and tribal communities, where caregiving is deeply connected to family, culture, language, trust, and community relationships.

Their article describes how journey mapping can help care teams identify where caregivers may need education, where referrals break down, and where home- or community-based services could better support families. 

Read the article to learn more about how journey mapping can help improve systems of care and better respond to the experiences of patients and caregivers.