Meeting the Religious and Spiritual Needs of Elder Residents

The religious and spiritual needs of elders are sometimes overlooked after admission to a nursing home. Meeting these needs may become the responsibility of the social services or activity department, especially when the facility does not have a chaplain or rabbi on the staff. This month's Council Connections focuses on the importance of helping the residents pursue their religious beliefs and spirituality.

There is a fine line between spirituality and religion. According to Webster's, religion is "any organized system of beliefs, including authority figures, rituals and rules, and traditions both oral and written." Spirituality, on the other hand, is generally defined as "whatever provides meaning, structure, and healing in one's life. This may be expressed as a belief in God -- whether related or unrelated to a particular religious tradition. For others, spirituality can be the enjoyment of music, art, poetry, or watching the sun come up in the morning. Spirituality can also be anything that elicits a sense of a `higher power,' the sacred, or divine."

Nancy C. Kehoe, RSCJ, Ph.D, is a practicing psychologist and instructor at the Cambridge Health Alliance, an affiliated institution of Harvard Medical School. She has done extensive studies related to the religious and spiritual needs of elders both living in the community and long term care settings.

Fourteen Spiritual Needs of Elders

• A need for meaning, purpose, and hope
• A need to transcend circumstances
• A need for continuity
• A need for support in dealing with loss
• A need for validation and support of religious behaviors
• A need to engage in religious behaviors
• A need for personal dignity and sense of worthiness
• A need for unconditional love
• A need to express anger and doubt
• A need to feel that God in on their side
• A need to love and serve others
• A need to be thankful
• A need to forgive and be forgiven
• A need to prepare for death and dying

Source: Harold G. Koenig, Aging and God: Spiritual Pathways to Mental Health in Midlife and Later Years, New York: Haworth Pastoral Press, 1994

Ms. Kehoe found that elders living in nursing homes depend on their religious or spiritual beliefs to help them cope with the many losses taking place in their lives -- loss of independence, loss of loved ones, loss of health and/or cognition, loss of loved ones, loss of home and possessions, etc. For the residents, each day becomes a struggle to deal with these losses and to try to figure out what the loss means to them as well as how to incorporate it into their life.

Lay-staff may feel that it is intrusive to ask a resident about their prayer life, relationship to God, or beliefs about suffering and life after death. The staffs' feelings of discomfort with addressing these subjects can result in the residents not receiving the support they need in these areas.

To make it easier to assess the resident's religious and spiritual needs, Ms. Kehoe has developed sample questions to enable the staff to "connect" with the resident, establish trust, and permit a fuller understanding of the resident's core values and beliefs, as well as how their values and beliefs may be used to assist the resident with their physical and emotional healing. The staff may use as many of these questions as necessary to gain insight into the resident's religious and spiritual beliefs:

1) Were you raised in a religious (or spiritual) tradition?  If yes, continue with 2, 3, & 4.  If no, skip to 5.

2) How would you describe your family's religious (or spiritual) practice?

3) In a crisis, did your family rely on God, a Higher Power, or Supreme Being?  In what way?

4) Did your family have contact with religious professionals, i.e., priests, nuns, ministers, rabbis?

5) Did you grow up in a neighborhood where other people belonged to a religious tradition?  If so, what was that like for you?

6) As you age, are your own religious (or spiritual) beliefs a source of comfort to you?  A source of distress?  Irrelevant?

7) Have your religious (or spiritual) beliefs provided a sense of meaning for you as you reflect on your life?

8) If you do not have a religious tradition/ or spiritual practice, what has provided you with a sense of meaning?

"Any caregiver can ask these questions," said Ms. Kehoe. "No one person is better suited than another." The one qualifier is that the person asking the questions needs to feel at ease and must be comfortable within his/her own religious or spiritual traditions. This will not work if the person has a hidden fear that he/she will be perceived to be preaching.

"The residents will want to be assured that they are not being judged and that they are being listened to respectfully, not critically," continued Ms. Kehoe. The person asking the questions needs to communicate to the resident that he/she wants to know and understand them better in order to learn what might be getting in the way of their physical and emotional healing.

The answers to the sample questions can provide the lay-staff with a wealth of information about how the resident has made meaning out of his/her life; what his/her life has been about; what needs to be grieved; what the resident thinks he/she is going toward; and what religious messages are a source of strength or conflict. Healing is different from being cured. A resident's beliefs can help them to heal or they can interfere with the healing process. "But we won't know until we ask," explained Ms. Kehoe.

Religion and Psychology: What the Data Says:

How religious beliefs and spirituality impact the resident's attitude towards life

Source:

Koenig HG et al., "Religious Coping in the Nursing Home: A Biopsychosocial Model," International Journal of Psychiatry in Medicine 27 (number 4) (1997): 365-376.

Principal Finding:

In a sample of 155 chronic care nursing home residents (average age, 79 years) in Durham, NC, almost 60% reported that they used religion at least to a large extent when coping with their problems; 34% said it was the most important factor that enabled them to cope.

Issue:

How religious beliefs and spirituality impact the symptoms of depression

Source:

Koenig HG et al., "Religious Coping and Cognitive Symptoms of Depression in Elderly Medical Patients," Psychosomatics 36 (July-August 1995): 369-375.

Principal Finding:

In a sample of 832 consecutively admitted older medical patients, cognitive (but not somatic) symptoms of depression - i.e., boredom, loss of interest, social withdrawal, feeling downhearted and blue, restlessness, feeling like a failure, feeling hopeless, or feeling that other people were better off - were all significantly less common among those with strong religious beliefs than those without.

Issue:

How participation in religious activities and spirituality impacts longevity

Source:

Koenig HG et al., "Does Religious Attention Prolong Survival? A Six-Year Fellowship Study of 3,968 Older Adults," Journal of Gerontology 54 (July 1999): M370-M376.

Principal Finding:

3,968 community-dwelling adults (aged 64-101 years) in North Carolina were grouped according to patterns of attendance at religious services. The relative risk of dying for those who attended religious services once a week or more was 46% less than for those attending services less than once a week. After controlling for demographics, health conditions, social connections, and health practices, the longevity advantage of frequent attendees remained significant.