Spirituality, disability and chronic illness.

Religious coping is the most widely used spiritual resource that older people utilize to deal with illness and stressful life events. Religious coping behaviors include two major dimensions, organizational and intrinsic. (1,2) Organizational religiousness includes church attendance and religious group participation. Intrinsic religiousness includes faith in God, prayer, reading of scriptures, and religious attitudes. Both religious dimensions, by providing spiritual identity, social support, life meaning, life satisfaction, and a sense of hope, buffer stress and enhance coping.

A great number of older adults report that they cope with health problems, disability and related stressors--even hospital stressors-primarily through religious beliefs and behaviors. In a study of older hospitalized (geriatric unit) or institutionalized (nursing home) patients, Ayele and colleagues reported that 86% of patients used religion as a coping resource for medical illness and disability. (1) Among those patients who use religious activities, 98% prayed, 94% put their faith in God, 75% read the Bible, 38% were active with church friends, and 19% attended church activities. In another study including disabled or medically ill older patients admitted to the general medicine, cardiology or neurology services, Koenig reported that 53.4% of patients attended religious services at least once a week, and 58.7% prayed or were involved in Bible study at least daily. (2) In these patients, intrinsic religious attitudes were highly prevalent; the two most commonly endorsed statements were "In my life, I experience the presence of the Divine, ie, God" (91.2%), and "One should seek God's guidance when making every important decision" (89.6%). In addition, when assessing what enabled them to cope with illness, 42.3% responded spontaneously that they use religion to cope ("my religious faith," "God," "the Lord," "prayer"). When patients where asked to what extent they used religion for coping purpose, two-thirds (67.4%) circled 7.5 or higher ("large extent," on a visual analogue scale of 0-10).

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Other studies have reported associations between religious activities and positive health outcomes or coping among older patients in the community and in outpatient clinics. Using data from the New Haven Established Populations for the Epidemiologic Studies of the Elderly (EPESE), Idler and Kasl found that attendance at religious services was a strong predictor of better physical functioning between 6 and 12 years later, after controlling for baseline functioning. (3) This association between attendance and better functioning remained after adjusting for sociodemographics, cognitive function, and medical conditions such as stroke, angina, diabetes, fractures, congestive heart failure, and amputations. Also, they found that disability had minimal effects on subsequent attendance. (3)

In another study using data from the Hispanic EPESE, Reyes-Ortiz and colleagues showed that frequent church attendance (at least once or twice a month) was an independent predictor of lower fear of falling; its effect remained after adjusting for sociodemographics, objective lower body performance, history of falls, cognitive status, functional status, depressive symptoms, and chronic conditions. (4)

Finally, in a German study using outpatient clinics' data for older patients with Parkinson's disease (PD) and stroke, Herrmann and colleagues showed that both PD and stroke patients relied on religious beliefs to cope with their diseases, but that PD patients relied on religion to a greater extent than did stroke patients. (5)

In conclusion, spiritual and religious activities are frequently used by older patients in many settings such as the hospital, nursing homes, outpatient clinics and the community. Physicians should be aware that religious coping may help older patients to face chronic illness and disability. Religious activities are also related to social, psychological and physical outcomes in older patients.

Acknowledgment

Supported in part by the University of Texas Medical Branch, Center on Population Health Disparities grant NIH P50CA105631.

References

1. Ayele H, Mulligan T, Gheorghiu S, et al. Religious activity improves life satisfaction for some physicians and older patients. J Am Geriatr Soc 1999;47:453-455.

2. Koenig HG. Religious attitudes and practices of hospitalized medically ill older adults. Int J Geriat Psychiatry 1998;13:213-224.

3. Idler EL, Kasl SV. Religion among disabled and nondisabled persons II: attendance at religious services as a predictor of the course of disability. J Gerontol B Psychol Sci Soc Sci 1997;52B:S306-S316.

4. Reyes-Ortiz CA, Ayele H, Mulligan T, et al. Higher church attendance predicts lower fear of falling in older Mexican-Americans. Aging Ment Health 2006;10:13-18.

5. Herrmann M, Freyholdt U, Fuchs G, et al. Coping with chronic neurological impairment: a contrastive analysis of Parkinson's disease and stroke. Disabil Rehabil 1997;19:6-12.

It's about taking a leap of faith,... and hoping it turns out all right.
--Vincent D'Onofrio

Carlos A. Reyes-Ortiz, MD, PhD

From the Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX.

Reprint requests to Carlos A. Reyes-Ortiz, MD, PhD, 301 University Boulevard, Galveston, TX 77555. Email: [e-mail]