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Background: Older Indigenous adults encounter multiple challenges as their age intersects with health inequities. Research suggests that a majority of older Indigenous adults prefer to age in place, and they will need culturally safe assistive technologies to do so.

Objective: The aim of this critical review was to examine literature concerning use, adaptation, and development of assistive technologies for health purposes by Indigenous peoples.

Methods: Working within Indigenous research methodologies and from a decolonizing approach, searches of peer-reviewed academic and gray literature dated to February 2016 were conducted using keywords related to assistive technology and Indigenous peoples. Sources were reviewed and coded thematically.

Results: Of the 34 sources captured, only 2 concerned technology specifically for older Indigenous adults. Studies detailing technology with Indigenous populations of all ages originated primarily from Canada (n=12), Australia (n=10), and the United States (n=9) and were coded to four themes: meaningful user involvement and community-based processes in development, the digital divide, Indigenous innovation in technology, and health technology needs as holistic and interdependent.

Conclusions: A key finding is the necessity of meaningful user involvement in technology development, especially in communities struggling with the digital divide. In spite of, or perhaps because of this divide, Indigenous communities are enthusiastically adapting mobile technologies to suit their needs in creative, culturally specific ways. This enthusiasm and creativity, coupled with the extensive experience many Indigenous communities have with telehealth technologies, presents opportunity for meaningful, culturally safe development processes.

doi:10.2196/jmir.7520 KEYWORDS

The Canadian population is aging rapidly. In July 2015, Statistics Canada reported that people aged above 65 years outnumbered children below the age of 14 years. The trend of an aging Canada is projected to continue: by the year 2024, over 20% of the total population will be over the age of 65 years [ 1 ]. National bodies such as the Canadian Medical Association have expressed concern about increasing demands on Canadian health care systems due to the aging of the population, which will result in an increase in age-related disorders such as dementia [ 2 ]. Within the Canadian population, Indigenous populations now exceed one million and are growing at a rate 6 times greater than that of the population as a whole [ 3 ]. The number of Indigenous adults aged 60 years and above is projected to increase 3.4 times from 2006 to 2031, resulting in over 184,000 older Indigenous adults [ 4 ]. Aging within Indigenous communities interacts with social inequities; consequently, older Indigenous adults may be more likely to require regular and specialized health care. For example, First Nations communities in Canada have higher rates of chronic conditions such as diabetes and heart disease [ 5 ], impacting quality of life and need for health services. These same communities often have insufficient financial resources to address growing health concerns and may be geographically disadvantaged in terms of access to facilities and providers [ 6 ]. This geographic concern is compounded by findings that the majority of older Indigenous adults prefer to grow older in their own homes, known as “aging in place” [ 7 ]. Aging in place is also more cost effective than long term care for both families and governments [ 8 ] and aligns with recent findings suggesting that family caregiving models in Indigenous communities are preferred. Indigenous caregiving models are not only more robust than those of the general population but are culturally grounded and present unique health and social service needs [ 9 ].

Literature concerning technological innovations for aging in place has developed significantly over the past several years, and meaningful user involvement has been identified as critical to adoption [ 10 […]

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