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Invoking the Spirit: A Model of incorporating the spiritual dimension into Gerontological Health Care practice
-P. Udhayakumar and P. Ilango Abstract This paper presents a perspective on the development of knowledge in the spiritual dimension of aging. This article provides the important understanding of incorporating spirituality in to elders health care. Spirituality is considered to be as a core component which widely influences the health status of the elders. Moreover, old age is said to be as a period of decline and the major concern during this age is physical and mental illness. Further, spirituality as a low cost therapeutic intervention gives the real meaning of life and this in turn helps the individual to understand his inner strength to cope effective with illness. The salutary effects of spirituality on gerontological wellbeing is also been widely discussed. Keywords: Spirituality, Health and Elderly P.Udhayakumar, Ph.D Research Scholar, Department of Social work, Bharathidasan University, Tirchirappalli. Dr.P. Ilango, Professor & Head, Department of Social work, Bharathidasan University, Tirchirappalli. Introduction: Spirituality (literally the breath of life) is conceptualized as a complex, intrapsychic dimension of human development, in which the individual moves toward "higher" states of connectiveness, well-being, consciousness, and/or meaning a desire to realize one's "true self or "inner potential" (Derezotes, 1995). Spiritual well-being is considered the epitome of health and is described as 'an overall sense of personal fulfilment and satisfaction with life, a sense of peace with oneself and the world a sense of unity with the cosmos of a personal closeness to God, or with nature.' (Bloomfield, 1980). According to Salder and Biggs (2006) spiritual concerns of older people are important to consider because they may act as potential resources for well-being in later life, helping to shape a meaningful and fulfilling existence. Spiritual resources may also assist an older person to successfully adjust to some of the changes associated with growing older (Baltes & Smith, 2003; Coleman & O’Hanlon, 2004). Spirituality appears to be preventative of mental disorders (Cohen & Koeing, 2004). Many studies show that spirituality has a positive correlate with life satisfaction, happiness and higher morale. At present more emphasize is given to spirituality by the health care professionals in dealing with older persons with chronic illness and while defining health, world health organisation has also added another dimension called spirituality stating that health is a complete state of physical, mental, social and spiritual wellbeing . Proponents of holistic health believe
that the time has come to give serious consideration to the spiritual dimension. Spiritual health in this context refers to that part of the individual which reaches out and strives for meaning and purpose in life. (Park, 1970). This article first introduces the health issues of older adults. Second, briefly discusses about spirituality and healthy aging. Third, it sets the wider context of spirituality in later life. Forth, spirituality and its effect on health of the older adults. Finally, discussion about utilizing spiritual practices as a low cost intervention Health issues of older adults Population aging is a global trend. In 1950, only 8% of the world population was aged 60 years or older; however, by 2005, that proportion had risen to 10%. It is expected to more than double over the next 45 years, reaching 22% in 2050. That is, the number of older persons (aged 60 years or older) will nearly triple in size, increasing from 673 million in 2005 to almost 2 billion by 2050 (United Nations, 2005). Elderly people are regarded as one of the vulnerable populations in the field of nursing. Vulnerable populations are defined as being at risk of poor physical, psychological, and/or social health (Aday, 2000) and thereby require special care and attention. Along with aging, older people experience declining functional status and are likely to have multiple chronic illnesses. It is indicated that 88% of individuals 65 or older have at least one chronic condition and that 69% of the elders with chronic illness have more than one condition to manage (Hoffman, Rice, & Sung, 1996). India, a sub-continent that carries 15 per cent of the world’s population, is gradually undergoing a demographic change as a result of many factors including specific development programs. The leading cause of death in old age in India is cardiovascular disease (CVD). Earlier in life, infections are still the leading causes of death but among older people most deaths are due to non communicable diseases (Guha Roy, 1994). Spirituality and Healthy Aging Spirituality has a significant implication on elders health and successfully aging. Various research studies form the western perspective has documented the role of spirituality and its impact on older person’s health. Udermann (2000) concluded that there is strong scientific evidence that individuals who a) regularly participate in spiritual worship services or related activities and / or b) feel strongly that the presence of a higher being or power is a source of strength and comfort to them are healthier and possess greater healing capabilities than people who do not attend worship services and / or have a strong relationship with a higher being or power. Koenig et.al (2001) completed a substantial review of the religion and health literature and concluded that religion and spirituality may be a positive influence on the individual. Specifically, religion and spirituality have a positive effect on health, and decrease depression and mortality among a medically ill population. Lee and Oh (2003) examined the correlations between spiritual well-being, physical function and health promoting behaviors and explored the effects of spiritual well-being and physical function on the health promoting behavior among 102 elders in Korea. The results showed that spiritual well-being and physical function had a significant effect on health promoting behavior.
Spiritual Need in Later Life Although every person is different, most people face a great deal of change during their later years. According to Moberg (2001) material, physical, social, and psychological needs are troublesome for many elders. Their health and strength are declining, relative income is diminishing under inflating prices of goods and services, friends are departing though death or moving to different communities, children and other family members are scattering, self-concepts may be changing, sometimes shattered though loss of roles by retirement from work or other meaningful position, and they may feel the need to move to a safe, usually smaller home. Frankl (1984) offers us a vision of humanity that moves away from reductionism and biological drives, and gives us the opportunity to see human beings as essentially spiritual. He suggests that human beings are spiritual beings with an irreducible core. This is expressed in a spiritual unconscious. The spiritual unconscious allows the mind to relate to what is not yet understandable or known, whereas the conscious mind can only relate to what is or what has been. The essence of the spiritual being is self transcendence. Shelly and Fish (1988) suggest that all spiritual needs fit under three main categories: meaning and purpose, love and relatedness, and forgiveness. Connected with them, however, are other practical, social and psychological issues and people cope with the transitions, losses, anxieties, fears of dying and death, and blows to self-conceptions encountered in varying degrees by every aging person, all of which contribute to spiritual problems. Lee’s (2003) study, the relationship among spiritual well-being and loneliness and life satisfaction was examined in 143 elders over 65 years who participated in local churches in Busan, Korea. He found that spiritual well-being was positively related with life satisfaction, but negatively correlated with loneliness. Spirituality and its Salutary Effect on Health of the Older Persons An overview of spirituality and aging by Blazer (1991) stated that for older adults, both spirituality and religion are described as one of the most frequently used coping and support mechanisms. For example, following family and federal governmental support, religious groups are an important source of instrumental support (Blazer, 1991). Use of spirituality as a coping mechanism may be even more prevalent in racial ethnic minority elderly than in white elderly, although research in this area tends to be mixed (Musick, 1996). Specifically for older adults, spirituality and religion are associated with a myriad of mental health and physical benefits. For example, spirituality has been described as a buffer against depression, a way to maintain meaning at the end of life, and a mechanism for preparation for death and dying (Blazer, 1991; Holt and Jenkins, 1992). Also, increased happiness and life satisfaction have been linked empirically with spirituality for older adults (Kelly, 1995; Reed, 1991). Finally, spirituality and religion have been related to higher levels of adjustment for older adults (McFadden, 1996). Spiritually oriented psychodynamic psychotherapy pays particular attention to the roles that religious and spiritual beliefs, practices, and experiences play in the psychological life of the client. Contemporary psychoanalytic theorists offer multiple approaches to understand the functions of religious experience. Spirituality provides a means to address existential issues and provide a context to form personal meaning. God images or other symbolic representations of the transcendent have the power to
evoke emotions, which in turn, influence motivation and behavior (Shafranske, 2009). Utilizing Spiritual Practices as a Low Cost Intervention Spirituality plays a significant role in influencing the health status of elders. Research finding depicts that Spirituality has a positive correlation with wellbeing and negative correlation with stress, anxiety and depression of an individual. At present spirituality is used as therapeutic intervention in dealing with the patients with chronic illness. Moreover, inclusion of spirituality into modern health care is well documented in western nursing literature and spirituality is used as a therapeutic approach in the western countries in medical practice. Besides, with respect to Indian perspective there is no such kind spiritual intervention used by the heath care professionals to understand the spiritual needs of the patients. Conceptual Model
Elders with Illness
Regular Spirituality Practice
The conceptual model clearly depicts that spirituality is considered to be as a core component which influences the health status of the older persons. Research in the field of medical sciences have found that elders with physical and psychological discomfort have shown positive results like decrease in level anxiety, depression, stress and improvement in physical and psychological wellbeing after practicing spirituality. The major concern during the old age period is that, most of the elders consider themself that they have lost their meaning in life and their existence in this earth is no more going to be useful to the society and family as well. Hence, the above fact leads to physical and psychological discomfort during the old age period. Besides, regular spiritual practice or being highly spiritual gives the real sense and meaning of one’s life and in turn spirituality helps an individual to identify his inner potential or inner strength. Henceforth, spirituality is considered to be as a low cast intervention in promoting the wellbeing of the elders. Conclusion This paper seeks to convey the message that spirituality has a positive effect on physical and mental well-being of older persons. Since spirituality is defined as higher state of inner consciousness, it has the potential to improve the quality of life of an individual. Further, the model used by the author clearly indicates that, spirituality is a core component which influences the health status of the elders. Besides, daily spirituality practice has a significant implication in elders wellbeing. At present, spirituality is widely used as a therapeutic intervention in dealing with the patients with chronic illness in order to understand the spiritual needs of the client and for better therapeutic relationship. Since spirituality as a therapeutic intervention is widely used in western countries, this concept is entirely new with
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