Religion and Spirituality in Older Adults

Religion may provide the following psychologic benefits:

Many older people report that religion is the most important factor enabling them to cope with physical health problems and life stresses (eg, declining financial resources, loss of a spouse or partner). In one study, > 90% of older patients relied on religion, at least to a moderate degree, when coping with health problems and difficult social circumstances. For example, having a hopeful, positive attitude about the future helps people with physical problems remain motivated to recover.

People who use religious coping mechanisms are less likely to develop depression and anxiety than those who do not; this inverse association is strongest among people with greater physical disability. Even the perception of disability appears to be altered by the degree of religiousness. Of older women with hip fractures, the most religious had the lowest rates of depression and were able to walk significantly further when discharged from the hospital than those who were less religious. Religious people also tend to recover from depression more quickly.

In older adults, active involvement in a religious community correlates with better maintained physical functioning and health. Some religious groups (eg, Mormons, Seventh-Day Adventists) advocate behaviors that enhance health, such as avoidance of tobacco and heavy alcohol use. Members of these groups are less likely to develop substance-related disorders, and they live longer than the general population.

Religious beliefs and practices often foster the development of community and broad social support networks. Increased social contact for older adults increases the likelihood that disease will be detected early and that older people will comply with treatment regimens because members of their community interact with them and ask them questions about their health and medical care. Older people who have such community networks are less likely to neglect themselves.

Religious faith also benefits caregivers. In a study of caregivers of patients with Alzheimer disease or terminal cancer, caregivers with a strong personal religious faith and many social contacts were better able to cope with the stresses of caregiving during a 2-year period.

Taking a spiritual history shows older patients that the health care practitioner is willing to discuss spiritual topics. Practitioners may ask patients whether their spiritual beliefs are an important part of their life, how these beliefs influence the way they take care of themselves, whether they are a part of a religious or spiritual community, and how they would like the health care practitioner to handle their spiritual needs.

Alternatively, a practitioner may ask patients to describe their most important coping mechanism. If the response is not a religious one, patients may be asked whether religious or spiritual resources are of any help. If the response is no, patients may be sensitively asked about barriers to those activities (eg, transportation problems, hearing difficulties, lack of financial resources, depression, lack of motivation, unresolved conflicts) to determine whether the reason is circumstances or their choice. However, practitioners should not force religious beliefs or opinions on patients or intrude if patients do not want help.

Many clergy members provide counseling services to older adults at home and in the hospital, often free of charge. Many older patients prefer such counseling to that from a mental health care practitioner because they are more satisfied with the results and because they believe such counseling does not have the stigma that mental health care does. However, many clergy members in the community do not have extensive training in mental health counseling and may not recognize when older patients need professional mental health care. In contrast, many hospital clergy have extensive training in the mental, social, and spiritual needs of older people. Thus, including hospital clergy as part of the health care team can be helpful. They can often bridge the gap between hospital care and care in the community by communicating with clergy in the community. For example, when a patient is discharged from the hospital, the hospital clergy may call the patient’s clergy so that support teams in the patient’s religious community can be mobilized to help during the patient’s convalescence (eg, by providing housekeeping services, meals, or transportation, by visiting the patient or caregiver).

Patients seek medical care for health-related reasons, not religious ones. However, health care practitioners should not discourage a patient’s religious involvement as long as it does not interfere with necessary medical care, because such involvement may contribute to good health. People who are actively involved in religious groups, particularly those in major religious traditions, tend to be healthier.

If patients are not already involved in religious activities, suggesting such activities requires sensitivity. However, health care practitioners may suggest that patients consider religious activities if patients seem receptive and may benefit from such activities, which can provide social contact, reduce alienation and isolation, and increase a sense of belonging, of meaning, and of life purpose. These activities may also help older people focus on positive activities rather than on their own problems. However, some activities are appropriate only for more religious patients.