Physiological and Psychosocial Factors in Spiritual Need Attainment for Community-Dwelling Elders
Jennifer Palmer, MS, PhD, Post-Doctoral Research Fellow, Institute for Aging Research, Hebrew SeniorLife (Affiliate of Harvard Medical School)
Margaret Bryan, Hebrew SeniorLife
Elizabeth Howard, Hebrew SeniorLife
Susan Mitchell, Hebrew SeniorLife
John Morris, Hebrew SeniorLife
Despite findings that older persons with positive spiritual well-being enjoy better physical and psychological health, surprisingly little work has been done to identify factors that may advance spiritual need attainment in this population. To address this research gap, this work sought: 1) to describe the proportion of community-dwelling older persons who report that their spiritual needs are met, and 2) to identify physical, functional, psychosocial, and health service use factors associated with whether or not these individuals’ spiritual needs were met. Subjects included elderly individuals residing in 65 U.S. facilities (i.e., continuing care retirement communities or independent senior housing) belonging to the COLLAGE consortium. Individuals had to have no more than moderate cognitive impairment, according to the well-established Cognitive Performance Score, to be included in the sample. We conduced secondary analysis of cross-sectional data obtained from these subjects or their proxies during administration of a paired set of structured assessment instruments from the interRAI organization (i.e., the Community Health Assessment and the Wellness Survey) upon COLLAGE facility admission. Subjects (N=4077; mean age 81.6 ± 7.5; female, 71.2%; and White race, 70.7%) reported excellent or good health status (77.2%) and independent function (Activities of Daily Living (ADLs), 94.6%; Instrumental ADLs, 64.9%). 93.4% of the sample affirmed spiritual need attainment. Potentially modifiable factors associated with spiritual need attainment in adjusted regression analyses were: enough sleep (adjusted odds ratio (AOR) 1.59, 95% CI 1.15, 2.19) and no pain (AOR 1.35, 95% CI 1.01, 1.82). In addition, compared to subjects who had someone to talk to about death and dying and end-of-life issues, subjects who reported not having someone to talk to were significantly less likely to have their spiritual needs met (interested in such discussion: AOR 0.39, 95% CI 0.23, 0.39; not interested in such discussion: AOR 0.17, 95% CI 0.10, 0.28). In sum, this work suggests that targeting a constellation of modifiable factors (i.e., lack of sleep, pain, and death and dying and end-of-life discussion) may help promote spiritual needs in community-dwelling elders. Wellness coaches (such as in the COLLAGE initiative), outpatient medical providers, and chaplains should consider addressing these factors in spiritual needs assessment of and spiritual care interventions with older persons which may, in turn, optimize these elders’ quality of life and general health status.
Margaret Bryan, Hebrew SeniorLife
Elizabeth Howard, Hebrew SeniorLife
Susan Mitchell, Hebrew SeniorLife
John Morris, Hebrew SeniorLife
Despite findings that older persons with positive spiritual well-being enjoy better physical and psychological health, surprisingly little work has been done to identify factors that may advance spiritual need attainment in this population. To address this research gap, this work sought: 1) to describe the proportion of community-dwelling older persons who report that their spiritual needs are met, and 2) to identify physical, functional, psychosocial, and health service use factors associated with whether or not these individuals’ spiritual needs were met. Subjects included elderly individuals residing in 65 U.S. facilities (i.e., continuing care retirement communities or independent senior housing) belonging to the COLLAGE consortium. Individuals had to have no more than moderate cognitive impairment, according to the well-established Cognitive Performance Score, to be included in the sample. We conduced secondary analysis of cross-sectional data obtained from these subjects or their proxies during administration of a paired set of structured assessment instruments from the interRAI organization (i.e., the Community Health Assessment and the Wellness Survey) upon COLLAGE facility admission. Subjects (N=4077; mean age 81.6 ± 7.5; female, 71.2%; and White race, 70.7%) reported excellent or good health status (77.2%) and independent function (Activities of Daily Living (ADLs), 94.6%; Instrumental ADLs, 64.9%). 93.4% of the sample affirmed spiritual need attainment. Potentially modifiable factors associated with spiritual need attainment in adjusted regression analyses were: enough sleep (adjusted odds ratio (AOR) 1.59, 95% CI 1.15, 2.19) and no pain (AOR 1.35, 95% CI 1.01, 1.82). In addition, compared to subjects who had someone to talk to about death and dying and end-of-life issues, subjects who reported not having someone to talk to were significantly less likely to have their spiritual needs met (interested in such discussion: AOR 0.39, 95% CI 0.23, 0.39; not interested in such discussion: AOR 0.17, 95% CI 0.10, 0.28). In sum, this work suggests that targeting a constellation of modifiable factors (i.e., lack of sleep, pain, and death and dying and end-of-life discussion) may help promote spiritual needs in community-dwelling elders. Wellness coaches (such as in the COLLAGE initiative), outpatient medical providers, and chaplains should consider addressing these factors in spiritual needs assessment of and spiritual care interventions with older persons which may, in turn, optimize these elders’ quality of life and general health status.