Cultural Anthropologist, Robert Orsi explains that human beings are perpetually caught up in the daily pursuit of cultural creation which periodically gets disrupted by certain occurrences known as cultural "hot spots"-events that do not fit neatly into daily life such as death, pain, sickness and transition. These incidences produce feelings of vulnerability in people, which activate religious beliefs that manifest in religious practices to express what matters most in their world. (Orsi 1993:3) This notion of cultural "hot spots" such as sickness, pain, transition and death are most acute in the elderly. It is the purpose of this literature review paper to explore the question, What effects does religion or spirituality have on the cognitive health of elderly patients and the hospital volunteers and care-givers who work with them.
In the Journal of Religion and Health, Vol. 41, No. 3, (2002), "Spirituality and Health Outcomes in the Elderly", it was found that there was a protective factor of religion to health and that religious belief played a role in averting physical and mental health problems. Furthermore, religious commitment helped facilitate coping strategies with illness and recovery. Moreover, religion, in multiple populations, has a positive relationship to psychological well-being and a preventative effect against morbidity (Meisenhelder & Chandler 2002:243). Various studies have also shown a relationship between religiosity and higher self-esteem, lower levels of depression, greater social support, better physical well-being and lower alcohol and drug consumption. Their approach examined the relationship of behavioral measures, such as the frequency of prayer; and attitudinal measures such as, importance of faith and the use of religion in coping with physical functioning, role functioning-physical, bodily pain, general health, vitality, social functioning, role functioning-emotional, and mental health (Meisenhelder & Chandler 2002:244). Their results found a significant and positive relationship between mental health and the Importance of Faith. Furthermore, a positive relationship was found between mental health and religious behaviours, such as prayer and church attendance. However, these indices could be explained by a more significant factor-Importance of Faith. Overall, their study showed attitudinal measures as the more accurate indices of the association of religiosity and mental health in the elderly (Meisenhelder & Chandler 2002:250).
In a 1982 New Haven, Connecticut study of non-institutionalized elderly residents, Ellen Idler examines patterns of religious involvement, health status, functional disability and depression. Idler draws on classical sociological theories of religion, including Durkheim and Weber. "If the religious institution is considered in the broadest sense as an element of culture, religious involvement becomes an indication of access to a system of symbols which offers patterns for the conduct of personal and social life" (Idler 1987:228). Four hypotheses of religious involvement are explored as possibly having effects on individual health status. The "Health Behaviour Hypothesis" suggests that religious individuals behave differently than nonreligious people when dealing with health risk factors, such as smoking, drinking, eating meat, sexual activities, and regular periods of rest and relaxation. The "Social Cohesiveness Hypothesis" posits that involvement in a religious group provides psychological access to emotional, cognitive, and material support that can nurture an individual's perception of being loved and cared about. The "Coherence Hypothesis" implies that there is a positive relationship between religion and cognitive health. From a Weberian perspective, religious involvement gives access to a unique system of symbols, cultural knowledge and meanings that help individuals understand and cope with their experiences, thus reducing uncertainty. Religious involvement provides two cognitive outcomes on the effects of health: 1) reducing helplessness in the face of an unpredictable situation; and 2) nurturing an attitude of hopefulness that everything will turn out positive. The fourth theory: the "Theodicy Hypothesis" suggests that in marginal situations of human life such as aging and the decline of physical and functional ability, religious involvement acts to modify an individual's distress associated with suffering. For example, the Judeo-Christian traditions offer many interpretive strategies for situations of human suffering. The study concluded that "religiousness is associated with lower levels of both functional disability and depressive symptomatology". However, among the four hypotheses, health behaviour, social cohesiveness, and the coherence, all failed to account for any relationship between better health and religious involvement. Only the theodicy hypothesis had some support (Idler 1987:236). The study showed that access to a religious symbol system seemingly modifies the strong link between disability and depression in the elderly (Idler 1987:237).
The Journal of Religion and Health, Vol 42, No. 4 (2003), "Religion, Spirituality, and Health Service Use by Older Hospitalized Patients", studied how religiosity or spirituality affected a patient's need and use of health care services during acute hospitalization. With rising health care costs, even a small measurable difference on the use of acute hospitalization services could mean substantial savings on expenditures. Studies have shown that chaplain interventions were effective in reducing hospital stays, use of medication and nursing time. Male veterans, undergoing coronary artery bypass grafting, were reported to have shorter hospital stays where religious beliefs were indicated. (Koenig, Titus & Meador 2003:302) Another study showed indices, such as religious attendance, self-rated religiousness and religion as a source of comfort had been correlated with longer walking periods for patients discharged with hip surgery. However, other studies have shown no association between religiousness and the length of hospital stay. Perhaps there is a difference between religiousness and spirituality and its affect on health services. Religion defined as a system of beliefs, practices, and symbols designed to facilitate a relationship with a higher power and an understanding of one's relationship and responsibility to a community. Spirituality is defined as a search for answers to the ultimate meaning and purpose of life. It has been hypothesized that spirituality is more individually focused with less involvement in a supportive community thus having a lesser effect on health services, whereas, religiousity has a stronger relationship between social support and health service (Koenig, Titus & Meador 2003:303). Overall, the Koenig, Titus and Meador study findings on the relationship between religiosity and length of hospitals stay and use of hospital services were weak. The relationship between daily spiritual experiences and length of hospital stay has clinical implications. Research does show that patients who believe or feel they are being punished, abandoned or are unloved by God or their faith community have negative health outcomes, such as increased mortality after hospital discharge. Their study suggests that health professionals and chaplains might be helpful by promoting positive spiritual experiences that would affect a patients attitude toward their illness and motivate them toward recovery, thus resulting in earlier discharge and reduced need for health services (Koenig, Titus & Meador 2003:303).
Gary Lea's paper on "Religion, Mental Health, and Clinical Issues" concluded that there are "methodological problems relating to defining religion and mental health" (Lea 1982:347). Furthermore, correlation studies have dominated the research in this area and requires caution in interpreting research data and stresses the need for more experimental methodology because "empirical studies of the psychology of religion is rare" (Lea 1982:347). Furthermore, social scientists have biases towards conservative religion as abnormal and detrimental to psychological functioning, while religionists assume there is a positive association between religion and psychological functioning. However, Lea did make a general statement about the religion and mental health, saying, "religiosity appears positively related to adjustment in the adult population, especially the elderly" (Lea 1982:347).
In a study, "Religion, Social Support, and Health among the Japanese Elderly, researchers noted that world religions exalt the virtues of helping others, but little is known as to the actual benefits of practicing this tenet. Past studies have focused on three issues: 1) support received from coreligious members; 2) support received from strangers; 3) social support and religion with primarily Christian respondents living in Western nations. This particular study focused on those who practiced a mixture of Shinto and Buddhism. Furthermore, the data collected provided a nationally representative sample of elderly Japanese. Also of note, in Japan religious involvement becomes increasingly important with age. Japanese religion encourages older men to provide assistance to their social network. The study showed that those elderly Japanese men who helped significant others tended to rate their own health more positively than those who practiced less with members of their social network.
In another study, " Religion, Disability, Depression, and the Timing of Death" it was found that public religious involvement, defined as "frequent attendance at religious services and active participation in the social life of the congregation", had a strong relationship to improved functional ability, including the ability to perform basic self-care and more strenuous physical performance activities. Furthermore, Idler discovered that the effects of public religious involvement observed after one year had a lasting effect of a least three years. The significance of these findings, from an epidemiology of aging perspective, affect three issues. First, functional disability is an important benchmark of health status in the elderly, and is especially associated with mortality and depression. Moreover, functional disability is an important indicator for projecting active life expectancy or years remaining for independent living. Furthermore, it was found that public religious involvement, not private, show the greatest cognitive effects. The ritual element of religion and their respective religious symbols, as Durkheim would argue, hold their special power through a concentration of meaning in these public religious rites. Weekly and yearly ceremonies intensify the member's sense of identity within the group. Anticipation and participation in these repeated public rituals, not only "serve to remake individuals and groups morally, they stimulate social and cognitive functioning, connecting the inward-looking act of remembering with the outward physical performance that build a sense of continuity. (Idler, Stanislav 1992:1076). Overall, the study indicated a powerful phenomenon at work. Public religious involvement of the elderly was linked to preservation of life and health, ability to perform basic daily activities, prevent feelings of emotional distress and even control one's timing of death (Idler, Stanislav 1992:1078).
A German study focused on differentiating between "religious" and "spiritual" attitudes of patients with cancer multiple sclerosis, and other diseases and how it impacted their health and how they cope with illness. In contrast to non-religious patients, those with a high religiosity or spirituality reported religious/spiritual views played a major role in their lives and were convinced that it helped them better to cope with their life and their illness. Furthermore, patients said their religious/spiritual attitudes helped to restore their spiritual and physical health and facilitated a deeper connection to the world around them. Moreover, practicing religiousness/spirituality heightened their sense of contentment, inner peace and strength and had lower rates of anxiety, depression, and suicide (Bussing, Osteman, Matthiessen 2005:337).
In the paper, "A Critical Review of the Forms and Value of Religious Coping Among Informal Caregivers", Michelle J. Pearce found that caregivers who turn towards high religious involvement reported improved mood, caregiving experience, spiritual well-being, as well as less burden and distress (Pearce 2005:82). Furthermore, 96% of Alzheimer patient caregivers, who considered themselves religious or spiritual, stated high levels of religious coping. Another study reported that cancer patient caregivers, used religious faith as the second most common means to frame their acceptance of dying. Prayer was cited as the most common form of religious coping (Pearce 2005:101). Moreover, those caregivers who stated religious involvement was important, were healthier than those caregivers who thought religion was less important (Pearce 2005:104). Overall, religious beliefs and involvement and religious coping were related to more caregiving satisfaction. With the trend towards informal outpatient care, longer survival times and reduced health care resources, identifying adaptive coping resources that give caregivers an effective means for handling stressful situations associated with caregiving is important. This apparent helpfulness of religious coping strategies among caregivers and religion's affect on their health and well-being seems particularly relevant and suggests that religion is an important adaptive coping resource for caregivers.
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2005. Büssing, Arndt, Ostermann, Thomas, Matthiessen, Peter F. The Role of Religion and Spirituality in Medical Patients in Germany. Journal of Religion and Health, Vol. 44, No. 3, pp. 321-340
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2003. Koenig, Harold G., George, Linda K., Titus, Patricia, Meador, Keith G. Religion, Spirituality, and Health Service Use by Older Hospitalized Patients. Journal of Religion and Health, Vol. 42, No. 4., pp. 301-314
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2005. Pearce, Michelle J. A Critical Review of the Forms and Value of Religious Coping among Informal Caregivers. Journal of Religion and Health, Vol. 44, No. 1, pp. 81-118