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Research · for Indigenous Elders' & Indigenous health organisations

Indigenous Older People: Shorter Lives, Earlier Dementia and Gaps in Care

Published 2026-10-16

In each of the countries with good data, Indigenous peoples live shorter lives on average than the non-Indigenous population, and fewer reach old age. Those who do often live with dementia, chronic illness and low incomes earlier than other older people, and meet care systems that were not designed with them. The evidence places these gaps in history and in services, not in Indigenous people themselves.

There are an estimated 476.6 million Indigenous Peoples worldwide, 6.2% of the global population, and they account for 18.2% of people living in extreme poverty; the World Bank notes that some countries show a life expectancy gap of "as much as" 20 years[1]. Yet most of the detailed evidence on Indigenous older people comes from four countries: Australia, New Zealand, Canada and the United States. This study draws on their official statistics and on peer-reviewed research, keeps each figure tied to its country and year, and says where the data run out. Elsewhere in the world, much of the evidence on Indigenous Elders simply has not been collected.

8.8 yearsshorter life expectancy at birth for Aboriginal and Torres Strait Islander males than for non-Indigenous males in Australia, 2020-2022 (8.1 years for females)[2]
21.0%age-standardised dementia prevalence among urban and regional Aboriginal people aged 60 and over in a New South Wales community study[3]
17.4%of American Indian and Alaska Native adults aged 65 and over in the United States had incomes below the official poverty line in 2020-2022, against 7.7% of White older adults[4]

Fewer Indigenous people reach later life, though the gap narrows for those who do

The life expectancy gap is the starting point for everything else in this study, because it decides who gets to grow old. In Australia, life expectancy at birth in 2020-2022 was 71.9 years for Aboriginal and Torres Strait Islander males and 75.6 years for females, against 80.6 and 83.8 years for non-Indigenous Australians[2]. The gap is widest away from the cities: 12.4 years for both sexes in remote and very remote areas, against 8.5 years for males and 7.5 years for females in major cities[2].

New Zealand shows the same shape. In 2022-2024, life expectancy at birth was 75.8 years for people who identify as Māori, against 81.8 years for the population as a whole; Māori gained 3.1 years since 2005-2007, more than any other broad ethnic group, but Stats NZ notes that their life expectancy "remains lower than that of other ethnic populations"[5]. In the United States, provisional estimates put life expectancy for American Indian and Alaska Native people at 67.9 years in 2022, up from 65.6 in 2021, against 77.5 years for White non-Hispanic Americans[6].

Canada's most detailed estimates are older. Using census-linked data for people in private households in 2011, Statistics Canada found life expectancy at age 1 of 72.5 years for First Nations males and 77.7 for females, 76.9 and 82.3 for Métis, and 70.0 and 76.1 for Inuit. Life expectancy at birth "could not be reliably estimated"[7].

Life expectancy at birth, Indigenous and comparison populations, Australia, New Zealand and the United StatesLife expectancy at birth in years. Australia 2020-2022: Aboriginal and Torres Strait Islander males 71.9, non-Indigenous males 80.6; Aboriginal and Torres Strait Islander females 75.6, non-Indigenous females 83.8. New Zealand 2022-2024: Māori males 73.7, European or Other males 81.3; Māori females 78.0, European or Other females 84.4. United States 2022 (provisional, both sexes): American Indian and Alaska Native non-Hispanic 67.9, White non-Hispanic 77.5.IndigenousComparison population022.54567.590Australia, males (2020-22)71.980.6Australia, females(2020-22)75.683.8New Zealand, males(2022-24)73.781.3New Zealand, females(2022-24)78.084.4United States, all (2022)67.977.5
Comparison populations differ: non-Indigenous Australians; New Zealanders of European or Other ethnicity; White non-Hispanic Americans. US figures are provisional and for both sexes. Methods differ, so compare gaps within a country rather than across countries. Sources: Australian Bureau of Statistics; Stats NZ; NCHS, provisional 2022 estimates.

For people who do reach later life, the picture changes. In Australia, an Aboriginal or Torres Strait Islander man aged 65 could expect 15.5 more years of life in 2020-2022, against 19.3 for a non-Indigenous man, a gap of 3.9 years; for women the figures were 16.7 and 21.1 years[2]. By 85, the remaining years were close: 4.4 against 4.7 for men, and 4.5 against 4.8 for women. In Canada in 2011, the gap at 65 was 4.6 years for First Nations men and 6.2 years for women, 2.7 and 3.8 years for Métis, and 4.9 and 5.9 years for Inuit[7].

Remaining life expectancy at ages 65 and 85, Aboriginal and Torres Strait Islander and non-Indigenous Australians, 2020-2022Years of life remaining. At 65: Aboriginal and Torres Strait Islander males 15.5, non-Indigenous males 19.3; females 16.7 and 21.1. At 85: males 4.4 and 4.7; females 4.5 and 4.8.Aboriginal and Torres Strait IslanderNon-Indigenous06.2512.518.7525Males at 6515.519.3Females at 6516.721.1Males at 854.44.7Females at 854.54.8
Period life expectancy: the average further years a person would live at current death rates. Source: Australian Bureau of Statistics, Aboriginal and Torres Strait Islander life expectancy, 2020-2022.

Much of the gap, in other words, comes from deaths before old age, and it shapes the size of the older population. In Canada's 2021 Census, the share of Indigenous people aged 65 and over rose from 7.3% to 9.5% in five years, but the average Indigenous person was 33.6 years old, against 41.8 for non-Indigenous people[8]. Indigenous older people are a growing group, and a smaller share of their communities than older people are elsewhere. The ABS cautions that its 2020-2022 estimates should not be compared with earlier ones because of changes in counting and identification[2], so trends need care.

Gap in life expectancy at age 65 compared with non-Indigenous people, Canada, 2011Years by which life expectancy at age 65 was shorter than for the non-Indigenous household population, 2011: First Nations men 4.6, women 6.2; Métis men 2.7, women 3.8; Inuit men 4.9, women 5.9.MenWomen02468First Nations4.6 yrs6.2 yrsMétis2.7 yrs3.8 yrsInuit4.9 yrs5.9 yrs
Household population only (people living in private dwellings), from census-linked mortality data; figures are now more than a decade old. Source: Statistics Canada, Health Reports, 2019.

Dementia is several times more common, and arrives younger

Dementia is one of the clearest examples of later-life illness arriving early. In a study run with urban and regional Aboriginal communities in New South Wales, 336 of the 546 people aged 60 and over identified in a community census took part. The crude prevalence of dementia was 13.4%, and the age-standardised prevalence was 21.0%; a further 17.7% had mild cognitive impairment. Alzheimer's disease and mixed dementia were the most common types, and the authors found high rates at younger ages, in line with earlier findings in a remote population[3].

The protocol for a 2024 study that is bringing together three of Australia's landmark cohort studies in this area summarises the evidence in its background: rates of dementia for Aboriginal and Torres Strait Islander peoples "are three to five times greater", "with earlier age of onset", "compared to non-Indigenous Australians"[9]. The same study set out to examine protective factors as well as risks, a reminder that the research is not only about deficit. For dementia across all older people, see our study of dementia risk factors.

These figures come from community studies in particular places, not from national registers, so they show how high rates can be rather than a single national figure. Comparable dementia estimates for Māori, First Nations, Métis, Inuit and American Indian and Alaska Native older people were not available at source for this study.

Chronic illness tells a similar story, though the national data are rarely broken down by older age. Australia's 2022-23 National Aboriginal and Torres Strait Islander Health Survey found that 49% of Aboriginal and Torres Strait Islander people had one or more selected chronic conditions, up from 46% in 2018-19, and 37% reported disability[10]. Diabetes was about twice as common in remote areas (13.6%) as in non-remote areas (6.4%)[10]. These figures cover people of all ages in a young population, and the published summary does not break them down for older people. A review of co-design in health with First Nations Australians traces these gaps to "the continuing impact of colonisation", which "perpetuates health care and outcome disparities"[11].

In the US, poverty in later life is more than twice as common as among White older adults

Income in old age reflects a lifetime of work, pay and opportunity, and for many Indigenous people those were shaped by dispossession and exclusion. The clearest older-age figure comes from the United States. Three-year averages of Current Population Survey data for 2020 to 2022 show that 17.4% of American Indian and Alaska Native adults aged 65 and over had incomes below the official poverty line, against 7.7% of White older adults, a share "more than double"[4].

Globally, the World Bank estimates that Indigenous Peoples are 6.2% of the world's population but 18.2% of those in extreme poverty[1]. That figure covers all ages. Comparable official figures on income in later life for Indigenous older people in Australia, New Zealand and Canada were not found at source for this study, and we found none for Indigenous older people outside these four countries. That is itself a finding: without age-specific income data, it is hard to see whether income support in old age reaches Indigenous older people on equal terms.

Aged care starts younger, and is used differently

Australia builds the life expectancy gap into its aged care rules. Aged care services are available to eligible First Nations people from age 50, against 65 for non-Indigenous Australians[12]. In 2023-24, First Nations people accounted for 1.8% of all admissions to aged care services, and their admissions "more commonly occurred at younger ages than non-Indigenous Australians – 12% of admissions to permanent residential care were for First Nations people aged under 65, compared with 0.2% for non-Indigenous Australians"[13]. The official data portal also warns that "it can be difficult to obtain exact numbers of First Nations people needing or using aged care"[12].

Using care less is not the same as needing it less. In New Zealand's LiLACS NZ cohort of people in advanced age, 860 people living outside long-term care were followed for an average of 4.9 years: 41% of non-Māori entered long-term residential care, against 22% of Māori[14]. The Māori participants were aged 80 to 90 and the non-Māori participants 85 at the start, so the groups are not exactly matched, and the authors found that the factors predicting entry differed by ethnicity, which they link to possibly different needs and preferences[14]. Lower use of residential care may reflect whānau (family) care, a preference to stay in community, or services that do not feel safe or welcoming; the data alone cannot say which. For the wider picture, see our study of older people from minority ethnic groups.

The best research is shaped by Elders, and points to care close to family and culture

Indigenous older people are not only people who receive care, and the better research treats them as partners. New Zealand's LiLACS NZ study enrolled Māori aged 80 to 90 alongside non-Māori aged 85, recorded tribal affiliation and participation in cultural practices, and translated its questions into te reo Māori; its researchers wrote that "the involvement of the kaumātua/older Māori people has been fundamental in laying the foundation" of the study[15]. The Australian dementia study above was likewise carried out with Aboriginal communities[3].

At the end of life, the evidence points in one direction across four countries. A review of palliative care for Indigenous peoples in Australia, New Zealand, Canada and the United States screened 522 articles and included 39. It found preferences "to die close to or at home; involvement of family; and the integration of cultural practices"[16]. These are reasonable things to ask of any service, and they depend on care being available near home and on staff who understand culture and family roles.

Even so, the knowledge base is thin. Researchers starting a New Zealand study of living and dying in advanced age wrote that "very little is known about the specific circumstances, cultural needs and care preferences of indigenous older people"[17]. The gap in evidence mirrors the gap in services: what has not been asked has not been built. Older Indigenous people who also live alone or care for others face further pressures; see older people living alone.

What the evidence asks of us

The figures point to a small number of clear tasks for governments, health and care services, funders and researchers.

  • Close the gap before old age, and plan for it in old age. Life expectancy gaps at birth of 8.8 years for Australian males[2] and 9.6 years in the United States[6] are not closed by care in later life, and in Australia much of the gap opens before 65[2]. Until they close, care systems need age rules that reflect them; Australia's eligibility from age 50 for First Nations people is one model[12].
  • Treat early dementia as a service priority. Rates reported as three to five times higher, with earlier onset[9], mean memory services, diagnosis and support built with communities, and available to people in their fifties and sixties as well as older.
  • Fund care close to home and culture. The preferences to stay near home and family and to include cultural practice[16], and the lower use of residential care by Māori in advanced age[14], argue for community-based and Indigenous-led services rather than residential care alone, and for the gap between remote and city life expectancy[2] to be met with services where people live.
  • Count Indigenous older people properly. Australia's own aged care data portal says exact numbers are hard to obtain[12]; the Canadian life expectancy figures used here date from 2011[7]; and outside four countries there is little older-age evidence at all. Statistics agencies and researchers should report Indigenous status by older age band, with Indigenous communities shaping what is collected, as LiLACS NZ did with kaumātua[15].

Language: this piece says "older people" rather than "the elderly", and uses "Indigenous older people" and "Elders" for the group as a whole. Where a figure covers one people or country, it uses the names used by those peoples and by the statistics agency that published it: Aboriginal and Torres Strait Islander people (or First Nations people) in Australia, Māori and kaumātua in New Zealand, First Nations, Métis and Inuit in Canada, and American Indian and Alaska Native people in the United States. Indigenous peoples are many distinct peoples, and no single term fits all of them.

Why we're publishing this

Indigenous Elders and the organisations that work with them already know much of what is here. Our aim is to put the figures in one place, with their sources, so that they are easy to cite when arguing for services, funding and better data. The case these numbers make is theirs: that shorter lives and earlier illness are the result of history and of gaps in services, and that care designed with Indigenous communities, close to home and culture, is what the evidence supports.

How to read this data

Life expectancy figures here are period estimates from official statistics agencies: the average years a person would live if current death rates held. They depend on how Indigenous identity is recorded at census and at death, which differs between countries and over time; the ABS warns that its 2020-2022 estimates are not comparable with earlier ones[2], and Stats NZ counts people in every ethnic group they identify with[5]. The comparison groups also differ (non-Indigenous Australians; New Zealanders of European or Other ethnicity, or the whole population; White non-Hispanic Americans), so gaps should be compared within a country, not across countries. US figures for 2022 are provisional[6]. Canadian figures are for 2011 and for people in private households only[7].

The dementia figures come from community studies, not national registers, and the New Zealand care figures from one cohort of people in advanced age with slightly different age bands for Māori and non-Māori. Australia's national health survey figures cover all ages. The US poverty figure is from survey data. Several sources were drawn from abstracts only. The evidence for this intersection is strongest in four countries, and thin or absent elsewhere; it should not be read as describing Indigenous older people worldwide.

Use this data

Free to cite with attribution to Understanding Aging. Charities, carers' groups, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Suggested citation: Understanding Aging (2026). Indigenous Older People: Shorter Lives, Earlier Dementia and Gaps in Care. https://understandingaging.org/research/indigenous-older-people

Important: This article summarises published research and statistics for general information. It is not medical, care or financial advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's health, please speak to a doctor, an Aboriginal or Indigenous health service, or another qualified health professional.

Sources

  1. World Bank. Indigenous Peoples (topic overview). World Bank, accessed 2026. worldbank.org/en/topic/indigenouspeoples
  2. Australian Bureau of Statistics. Aboriginal and Torres Strait Islander life expectancy, 2020-2022. ABS, latest release. abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/aboriginal-and-torres-strait-islander-life-expectancy/latest-release
  3. Radford K, Mack HA, Draper B, Chalkley S, Daylight G, Cumming R, Bennett H, Delbaere K, Broe GA. Prevalence of dementia in urban and regional Aboriginal Australians. Alzheimer's & Dementia, 2015;11(3):271-279. europepmc.org/article/MED/24985534
  4. KFF. How Many Older Adults Live in Poverty? (analysis of the Current Population Survey, 2021-2023 ASEC). KFF, 2024. kff.org/medicare/how-many-older-adults-live-in-poverty
  5. Stats NZ. Māori have highest increases in life expectancy (National and subnational period life tables: 2022-2024). Stats NZ. stats.govt.nz/news/maori-have-highest-increases-in-life-expectancy
  6. National Center for Health Statistics. Provisional Life Expectancy Estimates for 2022 (release). CDC/NCHS, 2023. cdc.gov/nchs/pressroom/releases/20231129.html
  7. Statistics Canada. Life expectancy of First Nations, Métis and Inuit household populations in Canada. Health Reports, 2019. www150.statcan.gc.ca/n1/pub/82-003-x/2019012/article/00001-eng.htm
  8. Statistics Canada. 2021 Census of Population: Indigenous peoples release. The Daily, 21 September 2022. www150.statcan.gc.ca/n1/daily-quotidien/220921/dq220921a-eng.htm
  9. Nguyen HXT, Hyde Z, McNamara BJ, Hughson JA, Radford K, Russell S, Flicker L, Quigley R, Malay R, et al. Strength together: examining risk and protective factors associated with dementia and cognitive impairment in Aboriginal and Torres Strait Islander peoples through harmonisation of landmark studies. BMC Neurology, 2024. europepmc.org/article/MED/38824519
  10. Australian Bureau of Statistics. National Aboriginal and Torres Strait Islander Health Survey, 2022-23. ABS, latest release. abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/national-aboriginal-and-torres-strait-islander-health-survey/latest-release
  11. A Comprehensive Review of Optimal Approaches to Co-Design in Health with First Nations Australians. International Journal of Environmental Research and Public Health, 2022. europepmc.org/article/MED/36498237
  12. Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander people using aged care (dashboard). GEN Aged Care Data. gen-agedcaredata.gov.au/resources/dashboards/aboriginal-and-torres-strait-islander-people-using-aged-care
  13. Australian Institute of Health and Welfare. Admissions into aged care fact sheet, 2023-24. GEN Aged Care Data. gen-agedcaredata.gov.au/…/Admissions-into-aged-care-fact-sheet_2023-24.pdf
  14. Holdaway M, Wiles J, Kerse N, Wu Z, Moyes S, Connolly MJ, Menzies O, Teh R, Muru-Lanning M, Gott M, Broad JB. Predictive factors for entry to long-term residential care in octogenarian Māori and non-Māori in New Zealand, LiLACS NZ cohort. BMC Public Health, 2021. europepmc.org/article/MED/33407278
  15. Dyall L, Skipper TK, Kēpa M, Hayman K, Kerse N. Navigation: process of building relationships with kaumātua (Māori leaders). New Zealand Medical Journal, 2013. europepmc.org/article/MED/23385836
  16. Shahid S, Taylor EV, Cheetham S, Woods JA, Aoun SM, Thompson SC. Key features of palliative care service delivery to Indigenous peoples in Australia, New Zealand, Canada and the United States: a comprehensive review. BMC Palliative Care, 2018. europepmc.org/article/MED/29739457
  17. Gott M, Moeke-Maxwell T, Williams L, Black S, Trussardi G, Wiles J, Mules R, Rolleston A, Kerse N. Te Pākeketanga: living and dying in advanced age - a study protocol. BMC Palliative Care, 2015. europepmc.org/article/MED/26691519