By Austine Duru and Marilyn Williams
In the United States and most industrialized nations the population is aging significantly. In the U.S., the aging baby boomer population is putting significant pressures on the health delivery systems. Evidence from research literature suggests that spirituality and religion are important components of meaning-making for many elderly patients. We have assembled some substantive, peer-reviewed research on the topic of aging and pastoral/spiritual care that will interest chaplains, chaplain educators and those who serve elderly patients in any capacity.
A study published in the April issue of Nursing Ethics explores the influence of ethnicity, religiosity and health literacy on end-of-life decision-making and advance care plans. This article concludes that policy makers, educators, and other health professionals continue to overlook engagement with religious communities in favor of educational programs regarding a medical model of advance care planning. An earlier article in the Journal of Palliative Medicine also investigates the experiences of older people regarding advance care planning from a meta-synthesis of 50 articles. This study explores how their views of life and death influences their willingness to discuss their future. The authors conclude that cultural differences are significant, and health professionals need to develop strategies for different cultural groups based on differing cultural beliefs regarding life and death.
Chaplains working in residential settings for older adults will find an April 2019 article in the Journal of Religion and Health by David Drummond and Lindsay B. Carey very interesting. The authors review the literature regarding spiritual screening, history-taking, and assessment and advocate for the development of a brief instrument for assessing spiritual well-being for those living in residential centers. They conclude that existing instruments are too unwieldy and focused on religion. Likewise, they contended they were too aimed at identifying crisis or distress rather than on wellness or well-being.
In a 2016 article published in the Journal of Religion, Spirituality & Aging, Jackson, D., Doyle, C., Capon, H., and Pringle, E. explore three key questions: How are spirituality, spiritual need, and spiritual care in aged care defined? What constitutes spiritual care for older people in aged care? What are the organizational barriers and enablers to providing spiritual care? The findings suggest that there are multiple ways to meaningfully speak about spirituality. Also, caregivers for the elderly are effective at identifying and addressing their patients’ spiritual needs. And finally, organizations that serve the elderly and vulnerable populations should focus systematically on addressing their spiritual or pastoral needs. The authors present guidelines for spiritual care of the elderly, which were published in the International Journal for Quality in Healthcare in October 2016.
Snodgrass, J. (2009) explores care for the elderly from the behavioral health point of view. In “Towards holistic care: Integrating spirituality and cognitive behavioral therapy for older adults,” published in the Journal of Religion, Spirituality & Aging, the author shows that integrating spirituality and cognitive behavioral therapy as a tool for counseling older adults has some remarkable benefits. The article invokes previous work that supports reimbursement of spiritual care services as one way to encourage adaptation of the integrative model. It recognizes the importance of holistic care for elderly patients. The author concludes by making a case for personalized therapy for elderly patients through incorporating spirituality and meaning-making in cognitive behavioral therapy.
Chaplains caring for baby boomers will find this next article quite informative. MacKinlay, E., & Burns, R. (2017) explore the importance of spiritual dimensions for baby boomers as they enter older adulthood. This mixed-method study is among few studies that explore the significance of spirituality for baby boomers. The authors study the dimensions of aging and the correlation of physical and mental health and aging anxiety with spirituality. They also explore how spirituality in later life aids in meaning-making and minimizing adverse experiences. The conclusions have interesting implications for chaplains and those who care for baby boomers. This is not available for free or on the open source platforms, but may be accessed through institutional subscription services or by paying a small access fee.
In a recent article published in the Journal of Palliative Medicine, Maiko, M., Ivy, S., Watson, B.N., Montz, K., & Torke, A.M. explore religious and spiritual coping for individuals who make medical decisions for hospitalized older adult patients. The authors recognize that making medical decisions for someone else comes at a cost, and they seek to understand the role of spirituality and religion (S/R) as a coping resource in the context of surrogate medical decision-making. This study suggests that the majority (67%) of individuals studied identify some S/R resources as key to coping. This relates to chaplains who care for critically ill elderly patients. The findings suggest that attending to the S/R needs of surrogates before, during, and after medical decision-making might be beneficial. Chaplains and caregivers can draw on the findings of this study to plan and provide appropriate chaplaincy care services to this specialized population of medical decision makers.
Palliative care chaplains and those on an interdisciplinary palliative care team will be interested in this study published in the Archives of Palliative Care and Medicine in January 2018. The study identifies relevant palliative care assessment tools for elderly patients that might be available in medical literature to determine their scope, utilization and content. The authors describe nine different palliative care assessment tools for older adults and conclude that there is no single dominant tool for early detection of palliative care needs in this population. However, they recommend the Palliative Care Outcome Scale and the Resident Assessment Instrument for Palliative Care tools above the others.
Austine Duru, BCC, is regional director of mission integration at SSM Health WI in Madison, WI.
Marilyn Williams, BCC, is bereavement and spiritual care coordinator at AseraCare Hospice in Decatur, AL.
