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Religion and Spirituality in Older People

by Daniel B. Kaplan, PhD, MSW, Barbara J. Berkman, DSW, PhD

Religion and spirituality are similar but not identical concepts. Religion is often viewed as more institutionally based, more structured, and more traditional and may be associated with organized, well-established beliefs. Spirituality refers to the intangible and immaterial and thus may be considered a more general term, not associated with a particular group or organization. It can refer to feelings, thoughts, experiences, and behaviors related to the soul or to a search for the sacred (for example, a Divine Being, Ultimate Reality, or Ultimate Truth).

Traditional religion involves accountability and responsibility. Spirituality has fewer requirements. People may reject traditional religion but consider themselves spiritual. In the United States, more than 90% of older people consider themselves religious and spiritual. About 5% consider themselves spiritual but not religious. Others consider themselves neither religious nor spiritual and do not depend on religious or spiritual practices or traditions to provide meaning.

For most older people in the United States, religion has a major role in their life:

  • 96% believe in God or a universal spirit

  • More than 90% pray

  • More than 50% attend religious services weekly or more often

The level of religious participation is greater among older people than among any other age group. For older people, the religious community is the largest source of social support outside of the family, and involvement in religious organizations is the most common type of voluntary social activity—more common than all other forms of voluntary social activity combined.

Benefits

People who are religious tend to have better physical and mental health than nonreligious people. However, experts cannot determine whether religion contributes to health or whether psychologically or physically healthier people are attracted to religious groups. If religion is helpful, the reason—whether it is the religious beliefs themselves or other factors—is not clear. Many such factors (for example, mental health benefits, encouragement of healthful practices, and social support) have been proposed.

Mental health benefits

Religion may provide the following mental health benefits:

  • A positive and hopeful attitude about life and illness, which tends to lead to better health outcomes

  • A sense of meaning and purpose in life, which affects health behaviors and social and family relationships

  • A greater ability to cope with illness and disability

Many older people report that religion is the most important factor enabling them to cope with physical health problems and life stresses (such as declining financial resources or loss of a spouse or partner). For example, having a hopeful, positive attitude about the future helps people with physical problems remain motivated to recover.

Some studies have found that older people who use religious coping mechanisms are less likely to develop depression and anxiety than those who do not. Even the perception of disability appears to be altered by the degree of religiousness. One study of older women with hip fractures found 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.


Health-promoting practices

Active involvement in a religious community is associated with better maintained physical functioning and health. Some religious groups (such as Mormons and 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.


Social benefits

Religious beliefs and practices often foster the development of community and broad social support networks. Increased social contact for older people 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.


Caregivers

Religious faith also benefits caregivers. One study of caregivers of people with Alzheimer disease or terminal cancer found that caregivers with a strong religious faith and many social contacts were better able to cope with the stresses of caregiving.


Harmful Effects

Religion is not always beneficial to the older people. Religious devotion may promote excessive guilt, narrow-mindedness, inflexibility, and anxiety. Religious preoccupations and delusions may develop in people with obsessive-compulsive disorder, bipolar disorder, schizophrenia, or psychoses.

Certain religious groups discourage necessary mental and physical health care, including lifesaving therapies (for example, blood transfusions, treatment of life-threatening infections, and insulin therapy), and may substitute religious rituals (such as praying, chanting, or lighting candles). Religious cults may isolate and alienate older people from family members and the broader social community. Some cults sometimes encourage self-destruction.

Role of Health Care Practitioners

Health care practitioners may talk to older people about their religious beliefs because these beliefs can affect the person's mental and physical health. Knowing about a person's religious beliefs can help a doctor provide better care under some circumstances:

  • When people are severely ill, under substantial stress, or near death and ask or suggest that a practitioner talk about religious issues

  • When people tell a practitioner that they are religious and that religion helps them cope with illness

  • When religious needs are evident and may be affecting person's health or health behaviors

When doctors or other health care practitioners understand a person's spiritual needs, they can help the person obtain the necessary help (for example, spiritual counseling, contact with support groups, participation in religious activities, or social contacts from members of a religious community). Doctors may ask whether spiritual beliefs are an important part of the person's life and how these beliefs influence the way they take care of themselves. Or doctors may ask people to describe their most important coping mechanisms. If the person expresses an interest in religious or spiritual resources, doctors may ask if there are any barriers to accessing such resources and may be able to recommend alternatives. For example, doctors may be able to suggest transportation services for older people who are not able to attend religious services.

Sometimes older people are more comfortable accepting counseling from a member of the clergy rather than from a mental health practitioner. When clergy members are trained in counseling and in recognizing when people need professional mental health care, such religious counselors can be very helpful. Clergy members can also help the person obtain needed community supports—for example, by visiting after a person has been discharged from the hospital or providing meals or transportation.