New Zealand’s population is ageing. Currently, Māori make up 6% of those aged 65-plus. By 2038, this number is expected to more than double from 48,500 to 126,000 people, with Māori making up approximately 10% of people in this age group.1 That the numbers of older Māori are greatly increasing within a short period, Māori are growing as a proportion of those aged 65-plus, and Māori have higher rates of disability and dependency relative to the general population aged 65-plus warrants particular consideration. In April 2018 the New Zealand Government announced the development of a new Positive Ageing Strategy (PAS) to help manage future demographic shifts. The previous PAS was released in 2001 and described the need to affirm the values and strengthen the capabilites of older Māori and their whānau. It largely reflected a “Western” view of the world, however, by not capturing a Māori perspective on ageing.2 The 2017 Health Ageing Strategy also referred to a number of aspects of ageing well, including achieving equity for Māori.3 Again however, there was limited consideration of what healthy ageing looks like from a Māori viewpoint.

What are the key aspects of Māori positive ageing and how can we best support good long-term outcomes?

A lifelong process

Māori positive ageing is a lifelong process that begins at the earliest moments of life, well before Māori reach older age. Studies of lifecourse epidemiology suggest that the future burden of disease for Māori will be substantial, but that early and ongoing interventions that prevent disabilities and lengthen life could circumvent this burden.4 The cumulative effects of lifelong disadvantage result in Māori experiencing disability, ill health and death at an earlier age than non-Māori. Ageing for Māori in today’s society has been influenced by the historical impacts of colonisation resulting in land loss, dislocation and trauma.5 Many of today’s older Māori have experienced swift and dramatic changes over their lifecourse (eg, rapid urbanisation in the 1950s and 1960s, cultural erosion and revitalisation).2 The combination of these factors likely results in very different health, socioeconomic and other outcomes in later life for Māori relative to those of non-Māori.2

Determinants of positive and compromised ageing

On average, Māori have not only fewer years of good health, but shorter lives than do non-Māori. Life expectancy at birth for Māori males and females is estimated to be 73.0 and 77.1 years, respectively, compared to 80.3 and 83.9 for non-Māori males and females.6 Health disparities result from differentials in access and exposure to determinants of health, both positive (eg, good education, employment opportunities, affordable and quality housing, good income) and negative (eg, racism, exposure to the criminal justice system).5 Negative differentials increase health risk behaviours (eg, poor nutrition, tobacco use).5 For these reasons, it is critical to address the structural drivers of compromised Māori ageing. Interventions that focus solely on individuals changing their health behaviours will, therefore, be of limited value.

Positive ageing as Māori

Ageing for Māori should also be considered within the context of community, including hapū (subtribe) and iwi (tribe). Being Māori and engaging with te ao Māori (the Māori world) are elements of positive ageing that are culturally based and distinctive for Māori. Having a secure Māori cultural identity, including a sense of connection to one’s marae, hapū and iwi have been described as features of Māori positive ageing.2 Further, whānau wellbeing and ageing well for Māori are inextricably linked; whānau cohesion, based on quality relationships, intergenerational relations and regular positive interactions are important for ageing well.7 Conversely, isolation from positive whānau interactions and whānau burden (eg, whānau who are over-reliant on their older members) can impact negatively on older Māori. Early onset of disability and resulting dependency can also create a burden on whānau, particularly whānau who may already be struggling to meet their own day-to-day needs. Note also that maintaining independence and autonomy within the context of whānau is, therefore, likely to be an important foundation for Māori positive ageing.2,8

Positive interactions within wider Māori contexts and Māori community organisations can support positive ageing. Older Māori are critical and valued for upholding Māori culture and the intergenerational transfer of knowledge and legacy.7 Māori in advanced age, however, can experience a high degree of expectation and demands placed upon them to fulfil leadership roles within te ao Māori.2,7,8 The roles and responsibilities of older Māori often increase if they are speakers of te reo Māori (Māori language), are holders of mātauranga Māori (Māori knowledge), and have a wealth of lived experience.8

Māori positive ageing is reinforced when the needs and desires for social connectedness are met, which includes the capacity to serve others, being valued and included, having purpose and making a contribution.2,9 The wellbeing of older Māori has been conceptualised as balancing active participation and achievement in te ao Māori (including whānau) and te ao whānui (the wider world).9

Older Māori have diverse realities—some are culturally connected and equipped to take on cultural roles and others are less connected, may face greater isolation and have fewer resources to ease their way into old age.9 Understanding how these diverse realities impact differently on positive ageing is important when considering ways to support Māori positive ageing.

Culturally responsive services

Culturally appropriate services and respectful relationships between service providers/professionals and older Māori and their whānau are crucial.2,9,10 Providing culturally responsive activities and services can help to enhance wellbeing, connectedness and quality of life. Health professionals have an important role to play in how they communicate health information and build skills and knowledge to promote health literacy. Health literacy is about the appropriateness of the health information and services provided for Māori, and the organisational systems and processes that help health professionals to build health literacy among older Māori. Reducing barriers to health and social service utilisation; equitible access to services, including gaining entry into and through services; timeliness and quality in terms of processes and outcomes; and access to user-friendly information are all important for Māori positive ageing.9,11 This includes end-of-life care that maintains and enhances the mana of the person and supports whānau carers.12

Conclusion and implications

Māori positive ageing is important for Māori futures and New Zealand as a whole. Māori perspectives on ageing take a lifecourse approach, are strengths-based, and inherent is the high value placed on older Māori for the critical roles they fulfil within Māori society. Māori conceptualisations of positive ageing can provide a framework to inform prevention, health promotion and primary healthcare to reduce the impact of ill health and disability for older Māori. Reducing inequalities in the determinants of compromised ageing can enable increased participation of older Māori in te ao Māori and te ao whānui. Strengthening relationships between older Māori and their whānau, as well as service providers, is also key. Importantly, all health professionals have a role in supporting Māori positive ageing; influencing the health and wellbeing trajectories of Māori—young and old—can contribute to better outcomes in old age. This is particularly the case where interventions focus on strengthening whānau and Māori communities.

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