Abstract

Spirituality is a multidimensional concept with various facets which primarily include a greater understanding of self in the context of being a part of the whole. Although usually studied or considered along with religion or faith, spirituality is distinct from religiousness. It is relevant in mental health and positive ageing for various reasons. Spirituality brings meaning and understanding to many inherent parts of the ageing process. It can help cope with negative life experiences, deal with challenges, and support a sense of belonging, self-contentment, and understanding the meaning of life. It has been blended into various psychotherapeutic interventions, with positive outcomes. Spirituality also improves the quality of life of older adults. Caregivers need to be aware of the spiritual needs of older adults and support them in achieving those during everyday interactions. Integration of spirituality into old age care is essential.

Keywords

Ageing, Mental health, Psychotherapy, Quality of Life, Spirituality

Introduction

Spirituality is a broad concept; however, it has many core universal essences. It is an understanding of the self being a part of the whole, a search for meaning and purpose in life. Spirituality is entwined with religion or faith;¹ and often they are studied together, although they are different as people can be spiritual without being religious. It is a complex, multidimensional construct involving various facets. It has a varied meaning for different people. Spirituality is often linked to qualities such as love, compassion, wisdom, patience, tolerance, a sense of detachment, and hope. It is evident from the qualities of spirituality that it is so connected to mental health. At the same time in various ways, it is also relevant for physical health, chronic illnesses, suffering, and end-of-life issues. In frail older adults, spirituality is a known contributor to psychological well-being.² Interestingly a connection between spirituality and longevity has been suggested.

Spirituality has several roles in the everyday lives of older adults. It hones the capacity to bear the limitations, difficulties, and losses inherent to the ageing, and facilitates acceptance. It is reported to be a source of strength, comfort, and hope, and brings about a sense of

community and belonging;³ self-contentment, and clarifies the meaning of life.^4,5 It also contributes to positive late-life functioning and promotes healthy ageing.

Mental health

There are observations that spirituality has a positive impact on the mental health of older people.⁶ People feel a higher sense of purpose, peace, hope, and meaning; they may experience better confidence, self-esteem, and self-control. It may help to make sense of the experiences in life. When unwell, spirituality may help individuals to resort to their inner strength and recover faster. At the least, spirituality may help to have better relationships with others.

In the process of understanding the influence of spirituality on mental health, it is often needed to unravel the religious beliefs and experiences of the individual. It has been observed that older adults who have high religious and spiritual levels have greater life satisfaction and psychological well-being, better social relations, and more definite meaning in life along with lower levels of anxiety and depression.⁷ Spirituality evaluations can be a routine part of the assessment of older adults in various adverse situations and clinical examination, which can provide a better and complete understanding of their life and wellbeing. This can help caregivers to provide higher standards of holistic person-centered care.

Spiritual health

Individuals can improve their spiritual health by various means, e.g. understanding what makes one peaceful, loved, and connected; sharing time for community services, helping others, being generous, meditating, and practicing yoga are helpful. Similarly, mindfulness, having time for one’s own self, being and living in the present rather than dwelling in the past or worrying about the future, supports individuals achieving their spiritual self. As spirituality is being understood through its various facets, it is important for people to learn and explore, sometimes independently, to find reliable sources and information. More importantly, it is better to realise what it means for one’s own self, and how one can practice and lead a life of spirituality.

Spirituality as a therapeutic intervention

Spirituality has been used in therapeutic interventions for mental illnesses. Supporting older adults spiritually helps them to have positive emotions and to cope with stress.⁴ It is observed that older adults prefer the inclusion of religious/ spirituality in their therapies for anxiety and depression.⁸ Integrating spirituality into usual caregiving may improve the caregiver and older adult relationships. Spiritual care can be facilitated by supporting patients to connect, complete unfinished business, respecting and providing them with privacy and personal time, comforting and reassuring, supporting them to conduct their religious practices (prayers), etc.

Spirituality has been blended into existing psychotherapies. For example, a psychotherapeutic method has been developed which is Spiritually Augmented Cognitive Behaviour Therapy, providing whole-person care and achieving better global outcomes.⁹ This technique incorporates spiritual values into cognitive behaviour therapy and emphasizes acceptance, hope, achieving meaning and purpose, and forgiveness. The spiritual concepts have also been incorporated into the treatment programmes of substance use disorders.

In essence, the spiritual qualities may help individuals to cope better,⁴ have more resilience, and contribute productively to their society, which is suggestive of a better mental state. This might also suggest a better prognosis while recovering from mental illnesses. Thus, it is essential to assess and give importance to the spiritual values of the individual patients.

Quality of life

While the effects of age and chronic diseases are non-modifiable variables for the quality of life of older adults, spirituality has been observed as a modifiable variable.¹⁰ This can be supported for a positive outcome of various mental and physical illnesses, and as a consequence, these can improve quality of life. Older adults living in miserable conditions, in insufficiently supportive environments, with loneliness, frailty, and helplessness, require support to improve their spiritual health.

Conclusion

Spirituality has a positive value for older adults, supporting them in various ways for a healthy ageing and maintaining resilience in the context of age-related consequences of life. Individual approaches towards spirituality should be explored and supported. Family members, caregivers, and clinicians should remain aware of this and may get trained, to increase their skills in applying or blending this approach in the day-to-day care of older adults. Further research is needed to understand the effect of spirituality in psycho-sociocultural aspects of ageing and clinical outcomes in old age-related illnesses.

Acknowledgement

We thank The Institute of Insight, United Kingdom and Quality of Life Research and Development Foundation (QoLReF), India; Geriatric Care and Research Organisation (GeriCaRe) for administrative and technical support.

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