Respecting Diversity:
Religious and Spiritual
Beliefs
of the Older Person
Vicki Murdock, MSW, PhD
University of Wyoming
This module was developed for and peer reviewed by the South
Carolina Geriatric Education Center.
Module Learning Objectives
1. Define religion and spirituality from a diversity
perspective.
2. Identify theory, research, and policy that supports
addressing client/patient spirituality.
3. Recognize particular spiritual issues of late life.
4. Recognize the importance of worker selfawareness and the challenges of addressing
client/patient spirituality.
5. Describe various methods that can help address
the older client/patient’s spirituality.
“The great error of our day is
that physicians separate the
soul and body, when they
treat the body.”
Plato (427-347 BCE)
Spirituality
Spirituality “relates to the person’s search
for meaning and morally fulfilling
relationships between oneself, other
people, the encompassing universe, and
the ground of existence, whether a
person understands this in terms that are
theistic, atheistic, non-theistic, or any
1
combination of these”
Religion
Religion “involves the patterning of
spiritual beliefs and practices into
social institutions, with community
support and traditions maintained
1
over time”
One Model of the Whole Person,
Suggesting the Importance of
2
Body, Mind, and Soul
Outside Environment
Biological
Psychological
Inner Person
Spiritual
Theories of Aging that Include
3
Spirituality
• Continuity theory
• Social constructionism and
phenomenology
• Symbolic interactionism
Theories of Aging that Include
3
Spirituality
• Erikson’s generativity stage
• Crisis/grief/loss theories
• Social exchange theory
Theories of Moral and Faith
Development that Include Aging3
•
•
•
•
Erikson’s stage/developmental theory
Fowler’s stages of faith
Kohlberg’s moral development theory
Maslow’s hierarchy
Theories of Moral and Faith
Development that Include Aging3
•
•
•
•
Krill, Jung, and Assagioli’s work
Wilber’s transpersonal theory
Gilligan’s women’s moral development
Tornstam’s gerotranscendence4
Spirituality/Religiosity and
Physical and Mental Health
Over 750 empirical studies validate the
benefits of spirituality/religion on health and
mental health outcomes.5
Spirituality/Religiosity and
Physical and Mental Health
Client spirituality correlates with:
• Reductions in mortality, anxiety,
depression, suicidal ideation, substance
abuse, hypertension
• Increases in life satisfaction, well-being,
immune function
Cultural Competence Continuum
6
Applied to Spirituality
6. Spiritual proficiency: builds community
diversity awareness
5. Spiritual competence: acceptance and respect
for spiritual diversity
4. Spiritual pre-competence: aware of problem
3. Spiritual blindness: all people are the same
2. Spiritual incapacity: unintentional sense of
superiority of dominant group
1. Spiritual destructiveness: intentional destruction
Professional Organizations that Mandate
Respect for Religious Diversity
• American Medical
Association
• American Psychiatric
Association
• American
Psychological
Association
• American Nursing
Association
• JCAHO
• National Association of
Social Workers
• American Counseling
Association
• American Association of
Pastoral Counselors
• American Association of
Professional Chaplains
• COA, NAADAC
All Major Healthcare/Helping
Professions in the U.S.
Mandate Respect for the
Religious/Spiritual Diversity of
our Patients/Clients.
Respectful Practice
Behaviors
• To ask about client/patient spiritual beliefs and
practices
• To make a referral to their religious group of choice
• To listen to their beliefs in order to provide “best care”
to the client/patient
• To honor your own beliefs, but without any need to
share/convert/convince others
• For staff to receive training on this topic in order to be
respectful toward clients/patients
Behaviors that are Not
Respectful
• To ignore, neglect, or fail to ask about the
religious or spiritual beliefs of your
patients/clients
• To fail to connect them to the social support of
their religious/spiritual group and leaders
• For written or unwritten agency policy to prevent
trained staff from addressing client/patient
spirituality
• To share your beliefs with clients/patients from
any conversion motives
Research Findings on Addressing
Spirituality with Clients/Patients
• Clients want professionals to ask them about their
beliefs.7
• Clients/patients “respond best” to inquiries by the
healthcare professional.8
• 83% of 921 patients in outpatient settings reported
that they wanted their healthcare professional to ask
them about their spiritual beliefs.9
• 91% of these 921 patients reported that they had
never been asked by their healthcare professional
about their spiritual beliefs.9
Research Findings on
Spirituality and Older Adults
• 76% of persons 65+ regard religion as highly
important in their lives.10
• Of 4,000 older persons, the “religiously active”
were half as likely to be depressed, regardless
of age, gender, race, social support or
disability.11
• Coping through faith predicted positive
outcomes in a study of 586 persons.12
Some Aging Demographics:
We are growing from 35 million Americans 65+ in 2005 to
a projected 70-75 million by 2030,
or from 12% of the population to 22%!13
Increasing Senior Population
350,000,000
300,000,000
250,000,000
Population of
U.S.
200,000,000
Seniors
150,000,000
Younger
100,000,000
50,000,000
0
2005
2030
Year
American Generational Differences
We can expect some cross-generational issues in
our work…
Current old cohort grew up in the early 20th
century
Baby boomers grew up in the 1945-1965 era
Gen X and Y grew up in 1970-1990
What different worlds these generations
have experienced!
Spirituality and the Lifespan
• Some studies find religiosity a constant
across the individual lifespan.14
• Some studies indicate people may
become more religious with age.14,15
• As outward signs of religiosity decline,
non-organizational religious activities may
increase (private prayer, meditation).16
The Uniqueness of Being Old
• Ability to look back across a life span
and integrate parts into a whole
• Ability to engage in inner or
integrative activity that crosses the life
span, despite limitations
• Ability learned over a lifetime to face
loss and change
Imminent Psycho-Spiritual Needs
of Older Persons
• Need for a sense of the wholeness of
life (integration)
• Need for a sense of purpose in
“being,” especially when “doing” is
more difficult
• Need to acknowledge positive and
negative life and spiritual events
• Need to confront, accept, and plan
Why Discuss Spiritual Beliefs
with an Older Person?
• Explores a person’s journey, similar to
a life review
• Explores often neglected spiritual
aspects of life
• Explores late life and end-of-life
issues
Why discuss…?
• Ensures a more thorough, holistic
assessment
• Responds to emerging
professional mandates on
spirituality
• Clients/patients want professionals
7,9
to ask them about their beliefs
…more reasons to discuss
• Affirms the person’s past, present, and
future
• Identifies person’s beliefs and values
• May open a dialogue on topics never
addressed before
• Creates a “spiritual baseline” for
interventions
And more reasons…
• Gives context to losses
• Emphasizes an aspect of life over
which personal control is possible
• May point to individual, group, and
community programming of private
and shared faith activity
Barriers
Two major areas that hold us back
from spiritually competent care are:
Worker Competence
and
Societal Taboos about Spirituality
Worker Competence Issues in
Addressing Patient/Client Spirituality
• Self awareness
• Cultural/spiritual competence
• Professional and personal
boundaries
• Little training in school or postgraduate
Worker Self Awareness
Three activities to help you think about aging and
spirituality in your own life:
•Worker Self Awareness -Longevity Quiz
•Loss Awareness
•Spiritual Groups Awareness
Cultural/Spiritual Competence
• Willingness to learn about other beliefs
• Willingness to promote organizational and
community respect for diverse beliefs
• Willingness to learn from our clients, rather than
think of ourselves as the “expert”
• Willingness to suspend our own personal
beliefs in order to hear the client's story
• Willingness to recognize diversity and not
ignore it
Professional and Personal
Boundaries
Professionally:
We are mandated to be respectful of religious or
spiritual diversity.
We follow an ethical code or professional mission that
respects human rights.
Personally:
We may believe that we follow the “one true way.”
We may hold biases against people who represent, or
behave in ways that we believe are “evil.”
Educational Preparation on
Spiritual Issues
• Many disciplines have surveyed their
workers to find that little or no time during
their schooling was spent on issues that
8,17,18
involved religion or spirituality.
• Workers in many healthcare disciplines
report continuing uncertainty about whether
they should discuss spiritual issues with their
clients.8,17, 18
Societal Taboos about
Addressing Patient/Client
Spirituality
•
•
•
•
Antithetical to “science”
Too personal
Measurability concerns
Misunderstood legal concept of
“separation of church and state”
Antithetical to Science
• Spirituality is “designed to be imprecise.”
• Spirituality addresses the mysterious or “holy;”
science studies objects, behaviors,
measurements.
• Religion and science have been placed on
opposing sides in debates across the centuries
(e.g., placement of the earth, evolution).
• Science depends on objective observation;
spirituality is a subjective experience of the
human mind/body/soul.
19
Too Personal to Discuss
• Like sex and politics, American society has
proclaimed that we do not discuss religion.
• Spirituality and religion can only be measured
by self-report and observable behaviors.
• Many people, including professionals, are
uncomfortable with ideas that are unfamiliar, or
that challenge what they believe.
Measurability Concerns
• Outward behaviors that can be counted may not
provide an accurate measure of beliefs.
• Self-report may be limited by subjectivity or bias
because of a desire to please the researcher.
• Language used to describe spiritual beliefs may be
misunderstood, even with definitions, due to
abstractness of concepts.
• Results are seldom generalizable due to the diversity
of spiritual beliefs.
• Researcher bias, scale bias, methodological bias
distort the results.20
Clarifying the Commonly Used
Phrase “Separation of Church and
State”
The 1st Amendment states, in its entirety:
“Congress shall make no law respecting an
establishment of religion or prohibiting the free
exercise thereof.”21
Which means only that:
•There will be no “official” religion of the U.S.
•Each individual is free to worship as they
choose.
Church and State…
•Constitutional scholars continue to
debate the intent of the First
Amendment.
•Respectful treatment of a
client/patient’s spirituality is not
21
hindered by the First Amendment.
•Simply, respectfully, ask the
client/patient to tell us their story.
Challenges in Addressing
Spirituality in Late Life
• Increasing cultural diversity, including
religious and spiritual diversity in the
United States13
• Helping professions offer little preparation
in spiritual care8,17,18
• Ethical issues of autonomy, rights, and
privacy
More challenges…
• Being able to hear client/patient stories of
negative experiences with religion or
spirituality
• Agencies serving the aging population
acknowledge offering little spiritual
intervention to patients
• Continuing societal fears about mortality,
beliefs about after-life, the dying process,
facing painful past memories
Methods for Exploring Spirituality
with Older Adults
Begin with questions about their childhood,
rather than current beliefs (less personal and
abstract; practices in childhood were not a
choice).
Consider the cognitive functioning level of the
adult(s) when planning an activity.
Think big: big paper, big diagrams, big markers
Use sensory-based spiritual activity to reach
people with cognitive impairments.
Tools for Exploring Spirituality
with an Older Adult
Develop diagrams with a group or
individual, such as:
•
•
•
•
timelines
ecomaps
genograms
symbolic shapes that have meaning for
the person
More Tools…
Use an interview format with an
individual or with a group:
• Suggest oral or written responses
• Ask semi-structured or open-ended
questions
• Ask a group just one question for that
session, or move through many
questions
More Tools…
Use prepared scales/tools with an
individual or a group:
•Written instruments
•closed- or open-ended questions;
•Questions that call for scaled response
(e.g., agree/disagree);
•Autobiographical narrative written
on their own or with guidance
Another Tool: Ethical Wills
22
• Ethical wills are a written account of a
person’s:
– Values
– Beliefs
– Life lessons
– Hopes for the future
– Understanding of Love
– Understanding of Forgiveness
Sensory-based Spiritual Interventions
for Persons with Dementia
• Recognize that sensory interventions may or
may not be welcomed by the patient.
• Use audio and video recordings of songs and
services that are part of the client/patient’s
spiritual tradition.
• Invite the appropriate spiritual leader to offer
prayers, burn incense, wear traditional robes,
sing traditional songs, offer symbolic foods.
Sensory-based Spiritual Interventions
for Persons with Dementia
• Encourage family or friends to bring traditional
foods tied to spiritual traditions.
• In a group environment, explain activity to other
patients so they may choose to stay or leave
the area.
Timeline of a Spiritual Journey
Birth
Significant Life or
Spiritual Events
23
End of After
Life
Life
Spiritual Ecomap
Faith Community
God or
Transcendence
Supernatural
Beings
Spiritual
Leader
Father’s
Spiritual Tradition
Mother’s
Spiritual Tradition
24
Individual or Family
Rituals
The Cherry Tree: A Personal Model of Spiritual Growth25
-Barriers
+Goals
Visible responses
to the spiritual life
Adjectives describing the spiritual life
Things that anchor you in your beliefs
A Unifying Community Model of Meaning-Making26
Diverse Spiritual Behaviorsboth positive and negative
Religions, individual beliefs, philosophies,
cultures, myths, evolving groups
Universal search for meaning of life
Hidden biases
Conclusion
Healthcare professionals are now mandated to
address the patient’s spiritual beliefs,
regardless of the worker’s personal views or
fears. Our patients want us to ask them about
this dimension of their life. Failing to ask about
this dimension is not respectful care.
It is incumbent upon each of us to work toward
cultural proficiency by encouraging our
workplace and our community to embrace the
growing pluralism of the United States, and to
work for dialogue about spiritual diversity.
References
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supplement. Washington, D.C.: NASW Press.
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of Aging and Identity, 4(3), 155-166.
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References (Continued)
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Warren, R. (1990). God help me: Religious coping efforts as predictors of the
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13. United States Bureau of the Census (2004). Retrieved from www.agingstats.gov
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References (Continued)
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References (Continued)
21. Findlaw.com (2005). The First Amendment. Retrieved August 6, 2005 from
http://caselaw.lp.findlaw.com/data/constitution/amendment01/
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BIOGRAPHY
Vicki Murdock is an Assistant Professor of
Social Work at the University of Wyoming.
Vicki’s research interests include
gerontology, spirituality, and social work field
education. Currently, research involves the
aging of “Boomers,” loss issues for adult
siblings whose family lost an infant at birth,
and educational/curricular progress on
aging.