CARE OF OLDER ADULT

Spirituality among Older Adults, Ethical Dilemma

⚫A spiritual connection can boost seniors’ wellness,
especially when their senior living community
supports faith practices.

⚫Spirituality is a significant part of many people’s lives,

and It become even more important as we grow older.

⚫Best practice increasingly identifies spiritual care as a

component of care in general
Spirituality
⚫Root words (Hebrew, Latin and Greek): wind, breath
or air which gives life.

⚫Allows a person to experience transcendent meaning

in life..whatever beliefs and values give a person a
sense of meaning and purpose
RELIGION
⚫Root word: Latin, to tie/secure/bind/fasten
together to create a system of attitudes and beliefs

⚫Participation in an “organized” religion may

involve:
⚫Practices
⚫Adherence
⚫Participation in a religious community
Spirituality, Religion and Culture

CULTURE

SPIRITUALITY
Culture frames both spirituality
and religion. Spirituality frames
culture and religion.
Religion frames culture and
RELIGION
spirituality
gerotranscendence
⚫Considered the 9th stage of lifecycle development
(Erik Erikson developed 8 stages of lifecycle)
⚫Asserts that spiritual development gradually
and steadily increases from middle age onward.

⚫3 dimensions
⚫Cosmic (life, death)
⚫Self-transcendent personal self no longer center of
attention)
⚫Social selectivity (focus on close friends and
family)elements
Spirituality and Suffering
⚫Suffering: the state of severe distress associated with
events that threatened the intactness of person

⚫We need to learn to stay with suffering without trying

to change it or fix it

⚫Only when we are able to be present for our own

suffering and can result in spiritual distress.
Prayer
⚫It has positive impact on patient outcomes, such
as fewer complications, less medication needed
and quicker return to health (prayed for by
religious group or receiving special bedside
spiritual therapies or both interventions)
Spirituality, Depression and Acute
Heart Failure
⚫In an exploratory study of older persons
hospitalized with acute heart failure, where
depressive symptoms are often exhibited, there
was a significant negative correlation between
spiritual well-being and depression; those who had
more depressive symptoms had a lower level of
spiritual well-being
Dementia and Spirituality
⚫In a study on cognitive Decline in Alzheimer’s Disease:
Impact of Spirituality, Religiosity and Quality of Life
⚫70 patients with AD were given the MMS to monitor rate of
cognitive decline.
⚫Religiosity and spirituality were measured
⚫A slower rate of cognitive decline was associated with
higher levels of spirituality and private religious practices
⚫The study concluded that higher levels of spiritually and
private religious practices, but not quality of life are
associated with slower progression of Alzheimer’s Disease
End of Life
⚫This study examined resilliency factors and processes
of older adults who experienced positive dying.
⚫Based on interviews with hospice patients and their
caregivers, core resilliency factors identified:
⚫Empowering relationships with others
⚫Spiritual beliefs and practices
⚫Ability to skillfully confront mortality
⚫Stable caregiving environment
⚫Personal growth
⚫Spiritual well-being were interrelated in the dying older
adults’ experience of life fulfillment
Improving Care for the End of
Life
⚫Patient and Family Needs
⚫Being held and comforted by loved ones
⚫Being listened to: sharing hopes, dreams, fears
and anxiety
⚫Having the opportunity to pray, meditate,
participate in sacred rituals, listen to music
⚫Receiving blessings from family, friends and
loved ones
⚫Being at peace with themselves and others
 Taking Spiritual History and Assessment

⚫The model guide the nurse in domains of questions

that need to be addressed:
⚫Available tools:
⚫FICA
⚫F – Faith: Do you have spiritual belief that helps you
cope with stress? With illness?

⚫I – importance: What importance does your faith or

belief have in your life? Does it influence how you think
about your health and illness and health care decisions?
⚫C – Community: Do you belong to a spiritual
community? Do you need to search for another
community, would it help you if you found one?

⚫A – ADDRESS IN CARE: How do your religious and

spiritual beliefs apply to your health? How might
we address your spiritual needs in your
healthcare?
2. Hope Model Developed by
Anadarajah & Hight
⚫H – Sources of hope, meaning, comfort, strength,
peace

⚫O – organized religion

⚫P – personal spirituality

⚫E – effects on medical care and end-of life issues

Three Questions Model
Developed by C. Kinney, Ph.D, RN
⚫1.What help you get through the tough
times?

⚫2. Who do you turn to when you need

support?

⚫3. What meaning does this experience have

for you?
⚫Settings of Care: Spiritual Advisors
⚫Know who is available for spiritual support in
all care settings – from the home to the nursing
home
⚫Chaplains, clergy, pastoral care, or other
spiritual leaders

⚫Healthcare Chaplains
⚫Chaplains: generic term refers to any clergy or
qualified layperson who assists patients, families
and staff in addressing spiritual/ religious needs
When to refer to Chaplains?
⮚ Grief
⮚ Major change
⮚ Desire to comfort
⮚ Decision making
⮚ Stress & distress
⮚ Isolation
⮚ Difficult ethical issues
⮚ Desire for rituals
⮚ Desire for sacred
Community Clergy/ Community
Support
⚫Can be vital resource for home settings
⚫Often have the big picture of the older adult and
their practical situation
⚫Support groups may offer support (eg. Breast
cancer grief, alcoholics anonymous)
⚫May not have a degree
⚫May have congregational health ministry, faith,
community nurse and parish nurse activties
Interventions of Spiritual Care: Overlap
with Cultural/ Psychosocial CAre
⚫A. Creative/ Expressive Arts
⚫Mastery and control and social engagement through engaging
arts programs yield better health outcome
⚫The new research on creativity and aging demonstrates. “The
very act of engaging one’s mind in creative ways affects
health directly via the many mind/body connections” – Dr.
Gene Cohen
⚫“Art is like chocolate to the brain” – Dr. Gene Cohen
⚫Art forms:
⚫Dance/movement
⚫Music
⚫Visual arts
⚫Theatre
⚫Poetry Writing
⚫Visual Art is viewed as an integral component of spiritual care.
⚫Art heals dis-ease through expression, integration, imagery,
symbols and imagination
⚫B. Music
⮚ Studies have shown that a person’s favorite music can be
powerful distraction from pain
⮚ Music can be a bridge to connecting and to
companioning
⮚ Assess for older adults musical preferences, mood,
identification of music that produces happiness, sadness,
relaxation and the importance of music in their life.

⚫C. Story
⮚ The stories people tell have a way of taking care of them.
If stories come to you, care for them, and learn to give
them away when they are needed. Sometimes a person
needs a story more than food to stay alive
⚫D. Spiritual Reminiscence
⮚ Focuses on gathering meaning through life story which
becomes more significant with frailty, dementia and
disability

⮚ Considers past experience and stories about:

connectedness, faith context, joy, sadness

⮚ Reframes present events though reminiscence, allowing

possibility for transcendence and finding hope amidst
vulnerability
⚫E. Compassionate presence
⮚ Deep and attentive listening connects you to the person
you are caring for.

⮚ Bearing witness to whatever arises

⮚ Being there..being fully present in the moment and

acknowledging deep belief systems and life world of self
and other

⮚ The word compassion means “to suffer with”

⚫F. Humor
⮚ Can be a source of spiritual uplifting and a coping
mechanism during difficult times

⮚ Is viewed as transcendent

⮚ Connects and bonds people together-connectedness is a

component of spiritual well-being

⮚ Releases endorphins and increases body’s ability to hal

and to tolerate pain

⮚ Can reveal the truth about ourselves, melt barriers and

release stress

⮚ Cultural sensitivity is an important consideration

⚫Self-care as Spiritual Practices: The ANA Code of
Ethics requires self care
⮚ Know what renews and restores your spirit

⮚ Care for your body, mind and spirit

⮚ Create your home as a place to restore you

⮚ Create an “inner home” that you can go

throughout the day

⮚ Practice resilience throughout the day

⚫Integrating Self Care into Your Day

⮚How do you enter the room of your

patient? Can you take a moment for
yourself beforehand?

⮚How/where do you eat your lunch?

⮚How do you leave the room of your patient?