Religion, Spirituality, and a Good Old Age

Susan H. McFadden

University of Wisconsin Oshkosh

Recent Gallup Polls conducted by the Princeton Religion Research Center (PRRC) indicate that the majority (76%) of older persons today regard religion as highly important in their lives (PRRC, 1994). Over one-half (52%) of all older persons attend religious services on a weekly basis. Numerous studies have shown that even when poor health prevents public religious participation many older persons compensate with high levels of non-organizational religious activities such as frequent prayer, meditation, and Bible reading. In addition, when asked to describe the ways they cope with stressful events, older people most often talk about their religious faith and their prayer life (Koenig, George, & Siegler, 1988; Manfredi & Pickett, 1987; McCrae & Costa, 1986).

This high level of religious activity among today's elders suggests that psychotherapists need to put aside the antipathy to religion that often characterizes their discipline and begin to understand the dynamics and dimensions of religiosity in later life. For example, what could possibly explain the behavior of a group of severely disabled women who managed to attend religious services at least once a week? These women needed assistance in walking, feeding themselves, and bathing, and yet they seldom missed public worship (Idler, 1987). Why did these women do this and what benefits did they receive?

Do they intuitively understand that religious participation is positively associated with both the quantity and the quality of social relationships (Ellison & George, 1994)? Perhaps they found that religious participation reduced their feelings of loneliness. Maybe religious activities gave them a greater sense of meaning in lives marked by suffering and thus a better overall sense of well-being. Most probably, they engaged in this behavior for a number of reasons, religious life often being multi-causal.

Increasingly, those who study religion emphasize the importance of acknowledging its multidimensionality and diversity. In addition to being knowledgeable about the many forms that a religious life can take, psychologists and others studying religion, spirituality, and aging also need learn why some individuals are apathetic or indifferent toward religion. With evidence accumulating that religious beliefs and practices contribute to well-being in later life (McFadden, In press), more gerontologists need to include religion in studies of aging.

Several excellent books summarize much of the current research on the relation between religiosity and physical and mental health in later life (Levin, 1994; Koenig, Smiley, and Gonzales, 1988; Koenig, 1994; Kimble, Ellor, McFadden and Seeber, 1995). Compared to non-religious elders, older persons who are religious have better functional health and higher levels of adjustment as indexed by levels of depression, suicide rates, anxiety, and alcohol abuse.

In an important study affirming the interrelationship of physical and mental health, Idler and Kasl (1992) examined the relation among disability, depression, and mortality. They found that for men, religion had a buffering effect, reducing the probability that they would become depressed following disability. Their sample of Catholic, Protestant, and Jewish elders also revealed a pattern in the timing of death with significantly fewer deaths occurring in the month preceding important religious holidays. Acknowledging that this effect could result from the social meanings and not the religious meanings attached to these holidays, Idler and Kasl nevertheless urged recognition of the importance of religious rituals of preparation for these significant holidays. The significance of anticipating the holidays--significance built up through years of experience--may have provided a horizon of meaning sufficient to promote the survival of elders who were very ill. In other words, holiday preparations may have given them a sense of spiritual connection that they were not quite ready to give up.

Studies like this one and many others now beginning to appear in the literature focus attention on the effects of religious faith and practice upon older adults's lives. In addition, some behavioral scientists are showing interest in exploring how a sense of spirituality contributes to an experience of late life well-being that is not tied to the typical objective indicators of health, financial security, and social support. Through their discovery and utilization of spiritual resources, older persons may experience their lives as meaningful even in the face of multiple, serious challenges to satisfaction with life (Wong, 1989). It is this aspect of well-being--meaning--that has largely been missing from the research on aging well.

Victor Frankl (1963) has written that the drive to locate meaning and purpose in life is the essence of spirituality. This fundamental human motivation to understand life as meaningful can be associated with a variety of experiences, some of which are specifically identified with religion and all of which are signalled by the positive emotions that result from a sense of integration or connection. Religion provides many individuals with beliefs, symbols, rituals, traditions and institutions that help to articulate how meaning is found in relation to God. For some, however, religion may discourage or even destroy a sense of connectedness or integration within the self and with other persons, the world, and even God.

Today, increasing attention is being paid to the ways people claim to be spiritual without a focus upon God and the beliefs and activities traditionally associated with religion. These individuals experience a sense of spiritual connectedness within themselves through memory and imagination; they also experience the integrative powers of spirituality in their relationships with others and with the world. They embrace what Moberg and Brusek (1978) once called the "horizontal dimension" of spirituality which extends through ordinary life experiences without the "vertical dimension" that reaches toward God.

Many older persons experience a strong connection between their religious faith and a sense of spirituality that includes both the horizontal and the vertical dimensions. On the other hand, some elders experience bitterness and despair about the religious life even when they value spirituality highly. Other older persons may engage in various religious activities but feel apathetic toward the spiritual domain of human experience.

An understanding of the dimensions of spirituality--both those that are associated with religion and those that are not--can lead to a more complete portrait of the dynamics of aging well. For example, based on interviews with over 100 creative elders, Bianchi (1994) concluded that they had experienced the inward turn of spirituality, a spirituality signalled by their feelings of ego integration. For some, this deepened sense of spirituality directed them away from earlier religious convictions; others connected their emergent spiritual awareness with religious traditions that had sustained them earlier in life. Another aspect of spirituality moves from the inward view outward toward meaningful relationships with other persons. Interviews with older women who appeared to be aging well led Rubinstein (1994) to postulate a spiritual component in their generative responses to others. These women expressed caring, empathic concern for the well-being of others. Preferring not to associate this love of the other with religion, Rubinstein called this generativity a form of "pragmatic spirituality" (p. 170). Although Rubinstein indicated no specific religious motivation operating in the activities of the women he studied, for many older persons, religious commitments activate meaningful relationships with others that are infused with helpfulness and compassion (Ellison, 1992). For example, Gubrium quotes a nursing home resident describing a new friendship with a fellow resident by saying, "I feel that God has put her in my path, you know, to kind of look after... I guess it's that I feel I'm so blessed that I want to do for others" (Gubrium, 1993, pp. 51-52).

Many older persons derive a sense of meaning in life through their sense of connectedness to their homes, their neighborhoods, and the natural environment. There is a spiritual quality in the interviews reported by Rubinstein (1990) in which he inquired about older persons' environmental attachments and their significance. For example, a 90 year old man stated, "I love natural beauty. I always have. I feel close to nature. I never tire of it" (p. 140).

Whether this man attributed any religious meanings to his experiences of nature was not revealed in the interview although conversation with him clearly showed how his love of nature contributed to his overall sense of well-being. Some persons may find spiritual meanings in the self-transcendence they feel through connection with nature, art, and music; others may interpret these experiences as indications of God's creative power both in nature and in the works of human beings.

Psychologists do not yet know whether there are differential outcomes in well-being for persons who demonstrate religious and non-religious spirituality. In addition, considerable work remains to be done to obtain an understanding of influences on the development of a spiritual sense of meaning and purpose in life. Conversely, what prevents older persons from experiencing a sense of meaningful connectedness within the self, with other persons, with their environments, and with God?

Practitioners understand the urgency about finding answers to these questions. They know, for example, that some elders feel spiritually deprived if they are unable to attend religious services while others feel a spiritual loss if prevented from being able to go outdoors. Those who design programs of all kinds for older persons are beginning to recognize the importance of paying attention to meeting spiritual needs as well as physical, psychological, and social needs. Practitioners need to work with researchers to find ways to assess spiritual needs and to evaluate whether programs are effective in meeting them.

There is much exciting work yet to be done by psycho-therapists who believe it is important to examine issues of religion and spirituality in order to understand the parameters of aging well. This effort cannot be done by psychologists alone, however. They need to coordinate their efforts with persons in sociology, medicine, the humanities, and theology. Because of its interdisciplinary focus and its inclusion of both academicians and practitioners, the Center on Aging, Religion, and Spirituality (CARS) promises to provide a fertile ground for the germination of important new ideas about the origins and outcomes and the meaning and purpose of a good old age.

References:

Bianchi, E. (1994). Elder wisdom: Crafting your own elderhood. New York: Crossroad.

Ellison, C. G. (1992). Are religious people nice people? Evidence from the national survey of black American. Social Forces, 71, 411-430.

Ellison, C. G., & George, L. K. (1994). Religious involvement, social ties and social support in a southeastern community. Journal for the Scientific Study of Religion, 33, 46-61.

Frankl, V. (1963). Man's search for meaning. New York: Simon & Schuster.

Gubrium, J. F. (1993). Speaking of life. New York: Aldine De Gruyter.

Idler, E. L. (1987). Religious involvement and the health of the elderly: Some hypotheses and an initial test. Social Forces, 66, 226-238.

Idler, E. L., & Kasl, S. V. (1992). Religion, disability, depression, and the timing of death. American Journal of Sociology, 97, 1052-1079.

Koenig, H. G. (1994). Aging and God: Spiritual pathways to mental health in midlife and later years. New York: Haworth Press.

Koenig, H. G., George, L. K., & Siegler, I. C. (1988). The use of religion and other emotion-regulating coping strategies among older adults. The Gerontologist, 28, 303-310.

Koenig, H. G., Smiley, M., & Gonzales, J. A. P. (1988). Religion, health, and aging. New York: Greenwood Press.

Levin, J. S. (Ed.) (1994). Religion in aging and health. Thousand Oaks, CA: Sage Publications..

Manfredi, C., & Pickett, M. (1987). Perceived stressful situations and coping strategies utilized by the elderly. Journal of Community Health Nursing, 4, 99-110.

McCrae, R. R., & Costa, P. T., Jr. (1986). Personality, coping, and coping effectiveness in an adult sample. Journal of Personality, 54, 385-405.

McFadden, S. H. (In press). Religion and spirituality. In J. E. Birren & K. W. Schaie (Eds.), Handbook of the psychology of aging (4th ed.). San Diego: Academic Press.

Moberg, D. O., & Brusek, P. M. (1978). Spiritual well-being: A neglected subject in quality of life research. Social Indicators Research, 5, 303-323.

Princeton Religion Research Center (1994). Importance of religion. PRRC Emerging Trends, 16, 4.

Rubinstein, R. L. (1990). Personal identity and environmental meaning in later life. Journal of Aging Studies, 4, 131-147.

Rubinstein, R. L. (1994). Generativity as pragmatic spirituality. In L. E. Thomas, & S. A. Eisenhandler (Eds.), Aging and the religious dimension (pp. 169-181). Westport, CT:Auburn House.

Wong, P. T. P. (1989). Personal meaning and successful aging. Canadian Psychology, 30, 516-525.

RESPONSE TO SUSAN MCFADDEN'S

ARTICLE ON RSA

AND A GOOD OLD AGE

"Religion, Spirituality and Aging and a Good Old Age" by Susan McFadden raises a number of fundamental issues for those who manage long-term care facilities or, indeed, who provide any support services to the aged. By posing the question of what it is to be truly human, organizations involved in care for the elderly are forced to acknowledge why they are involved in the first place. In other words, they are compelled to review honestly their mission statements.

Is the purpose of geriatric care institutions basically to show a profit? Is it to provide a range of services under government guidelines based on a humanistic model of care and life? OR should the reality be acknowledged that religion and spirituality are important qualities to the client group? Further, the research evidence strongly suggests that religion and spirituality positively impact on what all would regard as a "good old age".

This evidence which the author summarizes is impressive. However, what exactly does it mean for the aged care industry? In the first place, it would appear to validate those organizations who have attempted to provide a framework of care services that include as an integral component a strong spiritual dimension, e.g. place for worship, full or part-time trained chaplain/pastoral care worker, a climate of valuing the person regardless of capacity, staff trained in a wholistic manner, etc.

However, there is a real challenge in the findings. If religiosity has such a positive influence on the elderly, then any impediments to religion would be expected to have a negative influence. As administrators and decision makers, we must ensure that this doesn't occur. Of course, if such positive results do flow from spirituality, it needs to be known so that such environments can be more strongly fostered.

Such environments would allow older persons a sense of meaningful connectedness within oneself, with other persons, with their environments and with God. In this context, I understand environment to mean such things as buildings, wholistic service provision, quality training/education of those who offer care, a sense of mission based on commonly held values - in other words, a truly value-driven organization.

Further, it is obvious that the author is attempting to bring about attitudinal change in the psychotherapy field, a change that would recognize the impact of religosity in later life. However, one question is whether the influence of religiosity is a lifelong phenomena, or is it mainly a manifestation found in the later years? Does it change as people age? It would seem that in order to gain acceptance among psychotherapists, the evidence of life-as-a-whole should be presented with the natural progression toward old age. If evidence is to the contrary, the matter will have to be approached as an aging issue.

To gain widespread acceptance, several other questions need to be teased out. Is the spiritual factor the name for all belief systems with positive results in evidence? Did the Gallup Poll(or other surveys) highlight any differences in gender bias?

In conclusion, the article is timely and should be seen in the context of an ever-increasing interest in this area. Susan McFadden is author of a number of other thoughtful scientific writings and it is hoped these will continue to challenge and guide all persons in the geriatrics field.

(Kevin Rocks is CEO of Wesley Gardens, a large Continuing Care Retirement Community in Sydney, Australia and has an interest in the spiritual base of ministry amomg retired older adults. He attended the 1995 Geriatric Pastoral Care Institute sponsored by the Center for Aging, Spirituality and Religion in St. Paul, MN.)

Susan's Response to Critic

Kevin Rock's response to my article clearly indicates that people interested in religion, spirituality and aging are going to have a lot to talk about in the coming years! The key concerns raised in Rock's reply point to both theoretical and practical issues. First, we need a much better understanding of the mechanisms that shape religion's salutary effect upon late-life well-being. Undoubtedly, they represent a complex and dynamic interface between the individual and the environment and involve multiple aspects of religiosity. Both the private and the public aspects of religious life contain elements that affect older persons' ability to cope and to grow. When we introduce the more broadly defined components of spirituality, we observe just how complex these issues are. This is why we need to continue to have theory-guided research to investigate the effects of religion and the experience of spiritual connectedness on well-being.

We also have a great deal more to learn about outcomes for persons whose environments stifle religiosity and a sense of spirituality. This leads to the second theme of Rock's reply. He suggests that practitioners need to be aware of research findings to ensure that residents of geriatric care facilities are receiving the best possible care - care of the body, the mind, and the human spirit. By understanding the importance of religion to older persons and by utilizing a wholistic model of spirituality, practitioners can take important steps toward guaranteeing the best possible old age for their residents.