Spirituality and Aging

Helen Lavretsky


Aging Health. 2010;6(6):749-769. 

In This Article

Measuring Spirituality in Clinical Practice & Research

Measuring spirituality in clinical practice and research has been a challenge because of the complexity of contributing elements and definitions. There is no widely accepted measure of spirituality.[143] Components such as spiritual wellness and spiritual maturity received more attention, because scientific research depends upon measurement, while human services require assessments.[144] Hill and Hood reviewed 125 measures of religion and spirituality from 17 categories (e.g., beliefs, attitudes, religious orientation, faith development, fundamentalism, attitudes toward death, congregational involvement and satisfaction).[145] Others have identified similar dimensions of religion and spirituality.[146] Measurements of religion and spirituality rely almost exclusively on paper-and-pencil self-report measures, with the limitations of subjective reporting. Accurate assessments can extend knowledge about spiritual wellness, help to diagnose spiritual ailments and indicate the spiritual care needed to restore spiritual health. Instruments used to measure spirituality tend to emphasize questions assessing positive character traits or mental health (e.g., optimism, forgiveness, gratitude, meaning and purpose in life, peacefulness, harmony and general wellbeing).[147]

Table 1 describes more popular instruments and other less-well-known instruments proposed for future research. These instruments were selected to demonstrate the breadth of the various aspects of spirituality that can contribute to the health outcomes in the elderly. The Spiritual Wellbeing is a popular and excellent way to assess spiritual and religious commitment in a person's life.[148] The Spiritual Perspective Scale similarly assesses the importance of spirituality in a person's life, but does not subdivide the religious and spiritual domains as the former scale does.[149,150] The Spiritual Perspective Scale was used in a terminal population. In order to use the Spiritual Wellbeing, it would need to be tested in this same population. The Multidimensional Measurement of Religiousness/Spirituality – 59 items has been used in religion/spirituality research, and demonstrated good reliability and validity in assessing three primary factors (meaning, spirituality and religious practices), and two secondary factors (guilt vs God's grace and loving/forgiving God). Stewart and Koeske and Underwood and Teresi reported on the reliability and validity of the Daily Spiritual Experience Scale, with internal consistency greater than 0.9.[151,152]

The following three scales are of interest for future research because of the importance of the domains they address for the aging population coping with death and dying. The Death Attitude Profile analyzes the fear of death.[153] The Death Transcendence Scale looks at how people transcend death and can be used by the healthcare professional in guiding patients through their last days.[154,155] The Herth Hope Index is an excellent scale used to assess the patient's hopefulness.[155] Knowing that a person is hopeful guides the provider in determining ways to sustain that hope. If a person lacks hope, the providers would need to determine what aspects of their life could be drawn upon in order to ignite hope within the dying patient. Given the correlation of low scores on the Herth Hope Index with depression and low self-esteem, the clinician should assess the patient for depression and self-esteem. In addition, we would recommend adding specific questions regarding how well the patient's spiritual needs are being met.

For future research, new instruments will be needed to assess the spiritual needs in the dying population, which incorporates the concepts of death transcendence, spiritual and religious wellbeing, and hopefulness, as well as to assess how well those needs are being met. We need to use these instruments to test whether specific interventions can improve their spiritual wellbeing, increase their hopefulness and enhance their meaning in life (Table 1).


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