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September 2007
Spirituality and Aging: Looking at the Big Picture

As clients grow older, they often become more spiritual in their thinking, even if it’s not a deliberate choice. But it’s not as simple as you may have thought.

By Arn Bernstein

If you’ve worked with older adults in nearly any capacity, you’ve likely already encountered it. As people realize they’re approaching the end of their life, they naturally begin thinking about it more often, and, as a result, turn more toward religion. It’s something that takes place on a daily basis.

But what you may not be aware of is that, often, this decision on the client’s or patient’s part may not always be completely conscious. Additionally, sometimes their thoughts may not involve religion per se, but more accurately, spirituality. And while they’re often tied together, there remains a definite difference between the two.

“Religion is, in simplest terms, an overt systematized method of connecting with something beyond oneself and/or making sense of one’s world,” says Rev. Donald Koepke, director of the Center for Spirituality and Aging in Anaheim, CA. “The majority of people in the world belong to a traditional religion. Spirituality is much larger. As people age, confronting their mortality is part of it, but as things change, they begin to recognize who they are and who they aren’t, the strengths they have and haven’t. They begin to think about the value and meaning of life. Tending to look more interior than exterior often happens when we’re 45 to 50, but there’s a screaming need for it when we reach 85 or 90.”

Accepting Dependency
The reason for this, Koepke explains, is because in many societies, aging represents a loss of independence and power. As we age, we often become more vulnerable and dependent on others and don’t like the idea. But what we need to understand is that this is nothing new. “We delude ourselves into thinking we’re independent, when in fact, we’re constantly dependent on others, from birth,” he says. “Our parents, employers for our paychecks, customers to buy our goods or services, the people who deliver gas to the station. The only thing that doesn’t change is what’s inside us.”

He gives an example of individuals whose ability is diminished because of a stroke and stop attending church because they’re angry at God, when in reality, they simply cannot admit to themselves that they’re now vulnerable and in need of assistance. “Many choose to draw away from religion and begin to reject God,” he says. “They say He’s not their friend, He doesn’t like them, He doesn’t care. If they don’t find a new perspective, they remain angry for the rest of their lives. That’s where spirituality comes in, because it doesn’t have to be religiously oriented. You can be an atheist but still be spiritual, because you still see an order to things, a recognition of connection of all people to each other.”

Knowing Spirituality
The exact words differ, but for most, spirituality is described as an inner state of tranquility, a connection to whatever power one perceives gives order to life.

“Before institutional religion ever existed, humans began to ask spiritual questions – where do we come from, what happens when we die, and so on,” says Eugene Bianchi, PhD, professor emeritus of religion at Emory University. “More traditional religion is often a base that leads to spirituality and is usually our first introduction to it.” Some remain with religion, he says, while others move on to more secular processes such as meditation, and still others use religious elements (meditating on the cross, for instance) to reach a more secular point.

Koepke believes that, for this reason, caregivers should never assume a person is theistic, but first ask questions such as, “How do you feel about what’s happened to you?”, “How do you cope with it?”, and “What has real meaning in your life?” If, he notes, the person responds in terms of religion, the caregiver now has a point of reference as to how to proceed (i.e., whether or not to add a spiritual aspect to future discussions).

Attitude Is Key
Realistically, most older adults need some guidance toward spirituality that a caregiver can provide. For Bianchi, a patient’s mental state is critical: “In elderhood, you have to stress having a positive mental attitude. That might sound pollyannaish, but it’s more connected to simply keeping oneself mentally alive.”

This can be accomplished in a number of ways, he notes. One is simply encouraging clients via discussion of current events and fads such as the day’s newspaper, hot sporting events, celebrity scandals, new films and books, etc.

A second approach is to encourage more interaction with others, specifically peers. This accomplishes not only a social network of sorts, but again, keeps the mind and social skills more active. It can be a book group, a discussion about the news, watching a movie and then talking about it, or other interpersonal activities.

A third method is to encourage people to share their memories and tell stories about their lives, ideally to others. They can be happy or sad, humorous or serious, relating accomplishment or failure. What matters is that they are remembering, sharing, and celebrating their past.

All of these activities, Bianchi allows, enable a person to see the bigger picture overall because they have a sense of being current and are focused on subjects other than themselves.

A Step Up
Along the same lines, when feasible, it’s valuable to have clients tap into and utilize their inner creativity. This can range from writing poetry to painting landscapes to reading aloud to cooking killer linguini with white clam sauce to acting in a show to sewing a skirt to planting green beans. The possibilities are vast. The main point to remember is to suggest activities that are appropriate for any physical limitations.

Another activity to be encouraged, Bianchi says, is learning. Again, depending on restrictions and resources, this can include several endeavors– taking a course (actually attending onsite, online, or having the instructor come to the facility), traveling, watching shows about traveling, or reading and discussing various books.

Together, these factors give older people a sense of accomplishment, empowerment, and contribution, which diminishes feelings of worthlessness.

Gratitude
Once a degree of self-worth is established, Bianchi says, a caregiver can move on to more direct spiritual matters. One of these is to encourage gratitude both in themselves and to others. The first is to explain that while there might be limitations or downsides, there are also elements of life in all sizes worth appreciating -- a flower, a nice day, a beautiful painting, the fact that they can still accomplish certain tasks. “It sounds simplistic,” Bianchi says, “but it’s a step toward acceptance of a spiritual state of mind.”

He adds that helping others, or simply helping them feel better by laughing or listening to them, is also rewarding. “It’s the idea that even though you may be living with diminishments, you’re able to do something that can help make someone’s day brighter.”

Acceptance
Perhaps one of the more challenging aspects of a spiritual outlook, but also one of the most necessary, is the concept of a person accepting the fact that death is indeed closer and that, no matter what happens to them emotionally and/or physically, they can still have a positive outcome. Bianchi calls these occurrences “small deaths” – the death of a spouse, a stroke, a diagnosis of cancer, etc., and believes that by facing them and accepting them, with counseling when necessary, a person gains inner strength and, in a sense, a “rehearsal” for eventually having to confront death.

“The final aspect is letting go gracefully,” he says. “A big part of that is no longer being such a separate ego and being a greater part of the whole of life and what’s beyond.”

Listen For It
Helping someone become spiritual may sound a little intimidating for a caregiver, but keep in mind that what’s offered is guidance, not leadership. “It’s a matter of caregivers needing to be a little more attuned or at least aware of the searching older people may be doing for spirituality,” Koepke says. “Those who work in long-term care are more attuned, particularly those in hospice. But physicians constantly bump up against it. In many ways, doctors are still scientists because they keep the body running, but that doesn’t define the whole reality. After all, many first got into gerontology because they realized that these bodies operated just a little differently. The same goes for their emotions.”

Arn Bernstein is a Philadelphia-based writer and editor.