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Interview: How Spirituality Benefits Older Adults


Studies have shown that spirituality plays an important and adaptive role in aging. Some people find their spirituality in a holy book and the sound of a favourite hymn. Others find their spirits lifted in meditation or in communion with the natural world.

Dr. Helen Lavretsky summarizes the latest research in her book, Resilience and Aging. Dr. Lavretsky is a professor of psychiatry at the University of California, Los Angeles and director of the Late-life Depression, Stress, and Wellness Program at the Semel Institute for Neuroscience and Human Behavior.

AHB reached her in Los Angeles.

Ruth Dempsey: In Resilience and Aging, you devote an entire chapter to spirituality. Why is spirituality important?

Helen Lavretsky: Spirituality is an integral part of our lives. It defines how we live, how we make choices and, especially, how we meet challenges of the end of life.

Spirituality is a source of coping in the face of severe stress, such as chronic illness or trauma. Clinicians who deal with older adults or dying patients of any age should be familiar with their patients' spiritual beliefs and preferences.

RD: In your book, you refer to the concept of gerotranscendence. Can you explain?

HL: The Swedish gerontologist Lars Tornstam developed the theory of gerotranscendence. "Gero" means "old age" in Greek. And in Latin, the word "transcendence" means "to climb over."

According toTornstam, gerotranscendence is a developmental stage that occurs when individuals enter the final chapter of life and they shift their perspective from a materialistic and rational view of the world to a more cosmic and transcendent one. The shift is normally accompanied by an increase in satisfaction.

Research shows that gerotranscendent elders are less self-occupied and more altruistic. As they age, they often become more selective in their choice of activities, avoiding social interactions they judge unnecessary, for example.

They are less interested in material things, viewing too many possessions as burdensome. Many express a need for "alone time" for thought and meditation. This is referred to as positive solitude.

Gerotranscendent elders let go of their "masks" because they no longer feel the need to play their old roles. These individuals find themselves simply accepting the mysteries of life, acknowledging that they can't understand everything.

An elder may talk about experiencing feelings of being a child, a young person, an adult and an older person all in one moment. This view of time allows individuals to re-evaluate past events, gain new perspectives, and it provides opportunities to right old wrongs.

Finally, gerotranscendent individuals view death as a natural part of the life process. They appear to fear death less than those who are younger.

RD: What are the physical benefits of spiritual and religious practices?

HL: Most studies suggest that spirituality and religious engagement (e.g. church attendance), offer a buffer against physical and mental disease.

Sometimes it is attributed to protective beliefs in a "higher power" taking care of an individual, an after life or even increased social support from a religious community and increased social engagement. All of these factors may play a positive role in helping patients cope with stress and the aging process.

RD: What about the impact of spirituality on mental health?

HL: Religious affiliation and practices are associated with lower rates of suicidal behaviour in depressed individuals. And some studies have found that religious attendance buffers the effects of stress on mental health.

RD: Is spirituality covered in medical school?

HL: Systematic attention is rarely given in medical school to examining patients' spiritual beliefs and using them to enhance healing. But today, cultural competence and sensitivity is a required part of medical training. Physicians should receive training in assessing spiritual beliefs in medicine and end-of-life care.

RD: As a physician, what has been your own experience? Have you found that a spiritual orientation plays a role in patient's lives. Can you give me an example?

HL: I routinely assess a patient's spiritual beliefs and preferences at the beginning of the therapeutic relationship, so that I can understand how best to approach care. I invite patient's participation in decisions about their care. This allows me to establish a close collaboration with my patients and their families

For example, I ask about their family roots and upbringing. I ask what spiritual beliefs and practices they finding soothing and helpful in coping with stress. If they are open to yoga, meditation or mindfulness training? Perhaps being in nature brings them peace? Sometimes expressive arts like painting, music or dance allows them full expression of their soul's desires and that becomes an important aspect of healing.

Very frequently, I find it is my patients' relationship with their pets that keep them alive and provide solace in chronic pain.

Social support and relationships are important, so are lifestyle choices. These are heavily influenced by a person's spiritual beliefs. You see it all comes down to what we believe. Changing our beliefs or pursuing joy of life, under all circumstances, shapes the way we live and die.

RD: So, will spirituality become a more common component of resilience-building in the future?

HL: In our diverse society, it is increasingly important to develop a respectful understanding of individuals' beliefs and wishes.

Human beings wish to have safe, fulfilling and happy lives. All mothers and fathers want their children to have a safe and healthy future, regardless of their spirituality. Building communities that welcome diversity will lead to greater individual and community resilience.

Historically, elders have passed on society's stories, sacred knowledge and rituals. They established an awareness of the culture's roots, encouraged the young and fostered a sense of community.

Interest in spirituality and aging has been on the increase since at least the 1990s. Overcoming barriers to proper assessment and understanding, as well as respecting an individual's spirituality, can help shape personalized medical care for older adults and improve health outcomes.

Mind-body approaches to stress-reduction – such as meditation, yoga, mindfulness and tai chi – show great promise for improving overall functioning and well-being in older people.