Spirituality, Religion, and Aging

Illuminations for Therapeutic Practice

Holly B. Nelson-Becker

• Publisher: SAGE Publications, Inc
• Year: 2017
• ISBN:
  9781483315249
• Edition: 1
• Topic: Scienze sociali
• Subtopic: Lavoro in ambito sociale

This highly integrative book was written for students, professionalsin aging, religious leaders, and older adults themselves.Readers will gain the knowledge and skills they need to assess, engage, and address the spiritual and religious needs of older persons. Taking a fresh approach that breaks new ground in the field, the author discusses eight major world religions and covers values and ethics, theories, interventions, health and caregiving, depression and anxiety, dementia, and the end of life. Meditations and exercises throughout the book allow readers to expand and explore their personal understanding of spirituality. Referencing the latest research, the book includes assessments and skill-based tools designed to help practitioners enhance the mental health of older people.

Part one Principles of Spirituality and Religion for Gerontological Practice

Chapter One The Importance of Spirituality and Religion for Gerontology

There was something formless and perfect before the universe was born.

It is serene. Empty. Solitary. Unchanging. Infinite. Eternally present. It is the mother of the universe. . . .

It flows through all things, inside and outside, and returns to the origin of all things.

—Tao Te Ching, trans. Mitchell, p. 25

We collect data, things, people, ideas, “profound experiences,” never penetrating any of them . . . But there are other times. There are times when we stop. We sit still. We lose ourselves in a pile of leaves or its memory. We listen and breezes from a whole other world begin to whisper.

—James Carroll

No wise person ever wanted to be younger.

—Jonathan Swift

This chapter will introduce the reader to religion and spirituality in mental health practice with older adults. It will provide statistical evidence for the value of spirituality and religion to older adults within the wider demographic portrait of aging. It discusses the history of mental health disciplines in relation to religion and religious values, and it identifies a few of the assumptions that make working with religious and spiritual beliefs difficult for practitioners. Key figures and ideas about aging consciously will be presented. The chapter will close with some clinical notes for the aging journey in life’s second half.

The quote above from the Tao Te Ching suggests that the universe is purposeful and, although unknowable, has a dynamic quality of unity within it that mirrors the birth-to-death cycle of life. The second quote ponders the pace of life in postmodernity, which is so quick and full it fails to include the moments of profound experience when we begin to know ourselves and, hence, connect more deeply to the entire outside world. This is one of the benefits of aging suggested in the third quote by Swift. Although explanations for the selected quotes will not always be provided, in order to permit the reader to identify his or her own applications and meanings, examples of potential meanings are given here. Generally, you, the reader, will carry your own abundant ideas for what these quotes evoke in you.

Aging in a Postmodern Time

The founder of American philosophy and psychology, William James (1902/1961), associated old age with heightened religious involvement due to assumptive concerns about impending mortality (McFadden, 2005, 2015). It is important to recognize that old age then, when the average lifespan was about 50 years for those born in 1900, had a different meaning than old age today, when many people remain active into their 70s, 80s, and even 90s. In the early 20th century, people lived with acute illnesses that might lead to quicker deaths. Moreover, in the early part of the 19th century, the U.S. culture was permeated by a largely Protestant, Catholic, and Jewish sensibility that was well-integrated with daily life. That is beginning to change, but older adults remain the age group most connected to religious faith. The role of religion and spirituality has become increasingly recognized for older people in managing expected changes to physical health; related or unrelated challenges to mental health; social support network changes with deaths of peers, siblings, and spouses/partners; increasing awareness of mortality; questions about life meaning; and coping with other end-of-life and existential concerns (Ai, Ardelt, & Wink, 2010; Nelson-Becker, 2006; Puchalski et al., 2009).

Although aging today contains within it greater numbers of opportunities and potentials than in past decades, there are also new kinds of vulnerabilities and risks for diminishment, morbidity, and ambiguous dying. The path of chronic illness leading to death is no longer a quick pathway as in sudden death, or a downward slope as in some terminal illnesses, but by contrast is often slower and more confusing, with many small ascents and descents within a gradual downward trajectory. However, it is important not to understand the second half of life as solely a gradual downward slide into death. In fact, that slope begins at birth. Instead, the goals of the second half of life suggest a much richer differentiation in terms of finding meaning and purpose and achieving growth. The potentials for positive aging are numerous and expansive. Investigation into positive aging is a newer focus of research. Increased vibrancy, wisdom, and legacy may be outcomes of increased years. Describing this richness and diversity of pathways enhanced by spirituality and religion as perceived by individuals is the aim of this book.

There are a number of prevalent myths about the aging experience that tend to assail a holistic and realistic viewpoint. Further, myths can be one of the most insidious forms of bias, as these represent prejudice against the success of living to an older age and constitute an impression of one’s future self. The following are common understandings or myths:

1. Creativity diminishes with age.
2. People become more religious as they age.
3. Depression is more widespread in older people than younger ones.
4. Cognitive decline is concomitant with advanced age.
5. Older workers are less productive and thus less valuable employees.
6. Loneliness is more likely.
7. More exercise is always better. (Breytspraak & Badura, 2015)

1. Creativity. In terms of creativity, experimental innovators require decades to achieve their peak potential through a process of searching (Galenson, 2010). Their work builds gradually and incrementally. As an example, the highest prices commanded in the works of Cezanne were for pieces he executed in the last year of his life. This contrasts with a second creative type, conceptual innovators, who tend to plan their work using ideas and emotions and may make important contributions early in their careers.

2. Religion. Older adults represent the most religious demographic group, so it may be supposed that people become more religious as they age. However, the Religious Landscape survey (Pew Forum on Religion & Public Life, 2007) demonstrated that people move in and out of religious affiliation in very fluid ways. Nearly 28% of adults leave the religion in which they were raised to join another or remain religiously unaffiliated. If switching among different Protestant denominations (joining or leaving) are included, that percentage rises to 44 (Pew Forum on Religion & Public Life, 2007).

3. Depression. Prevalence of depression in the community is highest among those from ages 18 to 25 (8.9%) and lowest among those over age 55 (5.5 %) according to the National Institute of Mental Health (NIMH, 2012). Those figures do not include institutionalized older adults for whom depression rates are generally higher.

4. Cognitive decline. Neurologically there are changes in the aging of the brain, but cognitive decline is not inevitable. Baltes (1993) suggested that there are many forms of knowledge-building, memory retrieval, and wisdom development and much variation across individuals. My father, David N. Nelson, is an example of a 96-year-old who continues to live independently and retains excellent cognitive ability and memory recall.

5. Older workers. Older adults in the workforce tend to remain highly productive according to labor market research by Burtless (2013). This is partly because people with higher educational levels tend to stay longer in the workforce. Those who have more fragile health and less education are less likely to continue employment.

6. Loneliness. A longitudinal study of U. S. older adults followed between 2002 and 2008 who were questioned about loneliness (and thus focused on it), suggested that 13% were often lonely and 30% were sometimes so (Perissinotto, Stijacic, & Covinsky, 2012). However, other research by Carstensen’s group indicates that at older ages people cull their social networks to maximize emotionally satisfying relationships (Carstensen & Mikels, 2005). Thus, while loneliness is a concern, the portrait of loneliness looks different at older ages.

7. Exercise. There is no question that the single most important key to ongoing health is movement. In older adults, encouraging exercise appropriate to ability is important. However, recent research suggests there may be an upper limit to the amount of exercise that returns a positive benefit. The fastest running paces or walking rates indicated a higher mortality rate for heart attack survivors (Williams & Thompson, 2014).

So, although myths about the aging experience abound, let us not carry them with us into the pages of this book. Instead, we can peek at the promise and possibility in possessing the gift of long life, one that is balanced by consideration of a spiritual perspective. In fact, viewpoints about age and aging, such as reaching for the wisdom and spiritual power of our ancestors, those known and unknown, and living in a way that respects the earth and generations to come, are also prominent narratives. Age does require physical and psychological adjustment to observable change, but it also signals a much less visible and grander opportunity for expansion and deepening through following a spiritual path.

Practical and Orienting Definitions

Brief definitions will be provided here, with more expansive definitions in Chapter 2. Religion is defined as formal engagement in religious activity, for example, involvement in religious ritual or other forms of religious participation (Dowling, 2007). In the social sciences, religion is often viewed as a subset of spirituality (Canda & Furman, 2010), but in the theological and religious disciplines, spirituality may be seen as a subset of religion. Religion is often distinguished from spirituality by its focus on behavioral manifestations of religious belief or values and social relationships among those who hold a common faith. It is particularly salient for those in the United States who are more likely to engage in religious activity compared with others in the Western world (Coleman, 2011; Coleman, Ivani-Chalian, & Robinson, 2004).

As used in many gerontological and geriatric studies, the concept of religion is more organizationally oriented, namely an organized system of beliefs, practices, rituals, and symbols designed (a) to facilitate closeness to the sacred or transcendent God, higher power, or ultimate truth/reality and (b) to foster an understanding of one’s relationship and responsibility to others living together in a community (Koenig, McCullough, & Larson, 2001, p. 18). This refers to the beliefs, experiences, rituals, and ethical code shared by a community and transmitted over time (Canda & Furman, 2010; Nelson-Becker, 2003, 2005). Physical limitations imposed by poor health may lead to the declines seen in attendance at religious services among the oldest old. A further issue that may affect religious attendance of older people in adverse ways concerns the social-psychological context. Issues of guilt and challenges to a former identity, if an older person’s circumstances and identity shift, can lead to fears about lack of acceptance. Familial constraints involving multifaith families may also serve as a limiting factor. Or, sometimes older people may simply feel they have outgrown faith community. On the other hand, pursuit of faith-based sources, such as prayer, scriptural text reading, and electronic religious media such as TV and radio may satisfy spiritual needs at home. Assisted living and nursing care facilities may provide onsite services or transportation to religious services, which also mitigates the decline in actual religious participation, even if formal attendance falters.

Spirituality in helping professions has a broader orientation and includes relationships with entities that are considered sacred, such as God/Universe/Higher Power, nature, or ourselves. People are viewed as relational beings with an underlying spirituality, though this is not acknowledged by everyone. Spirituality may include whatever is important in an individual’s worldview, so it can expand to include deceased relatives, angels, guides, and other energies and forces determined by cultural background and personal belief (Nelson-Becker & Canda, 2008). The quest for meaning and purpose and to determine and achieve right action form two important aspects of spiritual development. Spirituality is not limited to alignment with theistic belief; it also may be subsumed in atheistic, nontheistic, panentheistic, polytheistic, animistic, mystical, and other conceptual and heart-centered structures.

Portrait of Religion and Aging in the United States

Roughly 84% of older adults from ages 60 to 69 who reside in the United States have reported maintaining membership in Christian religions, with an additional 5% reporting membership in other world religions such as Islam, Hinduism, and Buddhism (Pew Forum on Religion & Public Life, 2007). These percentages increase slightly for adults aged 70 and older. Of Americans who are 65 and older, slightly more than half (53%) attend church weekly. Table 1.1 shows religious attendance by age from the Religion in Public Life Survey (Pew Forum on Religion & Public Life, 2007).

Table 1.1

Moreover, 90% of Americans report believing in God, while 80% report a belief in the afterlife (Pew Research Center, 2009). Table 1.2 provides data from the Religion in Public Life Survey (Pew Forum on Religion & Public Life, 2007) on belief in God or a Universal Spirit. As can be noted, this does not vary widely across age cohorts, with 92.6% of those 18 to 24 in agreement, compared to 94.5% of those 65 and over. Fifty-nine percent of Americans express belief in God with no doubts. Atheism is still very rare in the United States, at about 3% of Americans in 2012 (NORC at the University of Chicago, 2013). A third important variable is importance of religion. Accord...