Spirituality and Aging

^†Religious wellbeing scales.
^‡Existential wellbeing scales.
DAP: Death Attitude Profile; DSES: Daily Spiritual Experience Scale; EWB: Existential wellbeing (sub) scale; HHI: Herth Hope Index; MMRS: Multidimensional Measurement of Religiousness/Spirituality Instrument; RWB: Religious wellbeing (sub) scale; SD: Spiritual decline; SG: Spiritual growth; SPS: Spiritual Perspective Scale; SWB: Spiritual Wellbeing Scale.

Authors and Disclosures

Helen Lavretsky<sup>†

†</sup>Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Tel.: +1 310 794 4619 Fax: +1 310 206 4399 hlavrets@ucla.edu

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Executive Summary

• Interest in spirituality and aging has increased recently, owing to overwhelming evidence of positive health outcomes linked to spirituality and religious participation.

• Psychological and gerontological theories from a broad range of perspectives provide the idea that there is an increased spirituality in late life. Increasing longevity in the modern society puts the spiritual needs of older adults at the forefront of immediate societal needs. Given the issues of loss, physical illness and mortality confronted in old age, understanding an individual's spiritual perspective becomes increasingly important.

• There are multiple barriers to the proper assessment of spirituality (e.g., the lack of professional training for healthcare professionals, shortage of time, and discomfort in healthcare providers in discussing spiritual issues and needs) in clinical practice and research.

• Improved understanding and respect for an individual's spiritual practice can help shape personalized medical care for older adults, and improve health outcomes.

• The definitions of spirituality have been changing over time and are increasingly considered a construct related to mental and physical health. The National Interfaith Coalition on Aging was organized in 1971, and defined spiritual wellbeing as the affirmation of life in a relationship with God, the self, the community and the environment that nurtures and celebrates wholeness.

• Various systematic reviews and meta-analyses have demonstrated that religious involvement correlates with decreased morbidity and mortality, and increased survival in a variety of medical illnesses.

• The impact of religion and spirituality on mental health has been studied more extensively than the impact on physical health. Much of the research in spirituality and aging has studied at the relationship between spiritual or religious coping and health. There is abundant evidence that spirituality and religious participation are associated with positive mental health outcomes.

• A few systematic studies have shown that religious involvement and spirituality are associated with negative physical and mental health outcomes. Religious beliefs can affect a person's health by encouraging avoidance or discontinuation of traditional treatments, or leading to a delay or failure to seek timely medical care, leading to higher mortality. In addition, religions can stigmatize those with certain diseases and prevent those from seeking proper medical care.

• Spiritual practices can change one's attitude toward death and dying. Developing interventions will raise awareness of the dying process and, ultimately, result in a more peaceful experience. These interventions will likely improve the experience of death and dying for the patient and their families in various medical settings, such as palliative care, hospice, long-term care and in primary care settings.

• The guidelines of the Joint Commission on Accreditation of Healthcare Organizations require hospitals to meet the spiritual needs of patients. An effort should be made to train healthcare providers in appropriate assessment and integration of patient's spiritual beliefs in healthcare decisions.

• The challenges with spirituality and religion research include logistical and funding limitations, but also the ambiguity of defining and measuring the concept of spirituality and religiosity.

• There are very few well-designed large-scale studies.

• Religious or spiritual activities can be practiced to help treat or prevent illnesses. These may include prayer, meditation, bibliotherapy, meditation, yoga and many others. Mind–body interventions can help enhance mental and physical wellbeing, and improve outcomes of psychiatric and physical illnesses.

• Despite modest progress to date, the evidence point to the intricate neurobiological mechanisms underlying meditative practices that have revealed a significant increase in α and τ activity during meditation, and low frequency activation of τ and α bands that have been suggested to reflect enhanced and sustained attention to internal events.

• Although most modern functional imaging studies have typically been conducted in very small subject numbers and without the use of control conditions, the findings support the evidence that meditation leads to increased activation in frontal and subcortical brain regions, which are important for sustained attention and emotion regulation. Fronto–parietal and fronto–limbic brain networks seem to be activated in the attention practices that lead to meditation, reflecting processes of internalized and sustained attention and emotion regulation. The findings of dopamine release in limbic brain regions are comparable with previously reported activation findings in left-frontal and limbic areas during the abstract sense of joy using the same meditation technique. All of the findings point to the potential benefit to offset deleterious effects of aging on the brain and body.

• Future studies of the neurobiology of spiritual interventions and individualized spiritual treatment should include neuroimaging, an assessment of individual genetic, psychosocial and biological vulnerability factors, which can lead to the development of more effective preventive interventions for depression and anxiety, and stress-reduction in older adults.

• Integrated use of spiritual interventions enhancing individual resilience to stress, and the mind–body approaches to stress reduction (e.g., meditation, yoga, mindfulness and Tai Chi) are likely to improve the overall functioning and wellbeing in older adults.