Spirituality across the lifespan.

What do physicians need to know to help their patients deal with the impact that spirituality can have on their health and medical outcomes? The following special section in the SMJ addresses a variety of topics covering spirituality over the lifespan. Spiritual needs that are relevant to the patient's health and medical care differ at every life stage and depend on the psychosocial tasks of that stage. (1) This is because religious involvement is widespread in the United States. Belief in God ranges from 85% in teens aged 13 to 17 to 95% of adults over age 75; weekly religious attendance is reported by 41% of teens to 60% of those over age 75; and religion/faith is pretty or very important in 51% of teens to 75% of older adults (see Fig. 1). (2-3)

We begin this section with a discussion of the spiritual history, which is the first step in beginning a dialogue with patients about these issues. Understanding the importance of the spiritual history, when it should be taken, what kind of information should be sought, how to gather it, and what to do with this information will help clinicians feel more comfortable in broaching this subject with patients.

Spiritual factors play a major role at all ages in dealing with life change and helping persons to cope with pain, anxiety, and disability of medical illness. Cultural factors influence how spirituality is used to cope with illness, and clinicians need to know how persons from different ethnic and religious backgrounds express their spirituality in relationship to health problems. Spirituality will also differ in its expression depending on the age of the individual, so that the spiritual needs of children may be different from those of young, middle-aged or older adults. It is crucial to realize how individual and unique these spiritual needs are for every person, and how this variability increases with age, life experience, and health condition.

Spirituality and religion also impact health behaviors and lifestyle. What are these effects, and how can physicians utilize them to help patients live healthier, happier and longer lives? Regardless of lifestyle, however, if people live long enough most will experience chronic illnesses that cause disability, loss of independence, and unpleasant physical symptoms. Perhaps nowhere else is the challenge of aging more evident than for patients suffering from chronic pain due to arthritis, chronic injuries, or medical conditions such as cancer or heart disease. Chronic pain disrupts almost every area of life, and is frequently associated with depression, irritability and hopelessness. Here we address how people may use their spirituality to help maintain independence in the face of chronic disease, cope better with pain, and accept increasing dependence when medical interventions have reached their limits.

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Emotional disorders are also common among older adults with chronic illness. Epidemiologic studies find that nearly 50% of acutely hospitalized older adults and many in nursing homes experience a depressive disorder that destroys well-being and quality of life. Many have given up hope that they will ever again have fulfilling and meaningful lives. Some may feel so trapped that they would rather end their lives in suicide than continue on in what seems like an unending state of agony and despair. Do spiritual resources help to prevent or speed the resolution of depression in such circumstances?

Besides grappling with increasing disability, chronic pain, and struggles with depression and loss of purpose, many older adults experience a decline in cognitive functioning that represents either age-related memory impairment or more sinister conditions such as dementia. Does religious or spiritual involvement help to slow down the progression of cognitive impairment? Does it help patients, caregivers and family members cope better with changes in independence and lifestyle that cognitive decline brings with it?

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We also deal here with end-of-life challenges that arise in the nursing home and during the dying process. How can spiritual resources be made available to persons in nursing homes and chronic care facilities where patients are separated from their faith communities and seldom have access to clergy, pastoral counselors or chaplains? What are their spiritual needs and who is there to meet them? What do physicians need to know about how to address and meet the needs of dying patients, and what resources are available to them in terms of referral?

Finally, we are fortunate to have Rabbi Steve Sager round out this section by providing insights about what physicians need to know about aspects of Judaism that might impact care for Jewish patients.

There are many questions regarding spirituality across the lifespan that the authors of the articles in this section will attempt to address. Although there may not be definitive answers to many of these questions, we hope that the discussions that follow will help clinicians become more aware of and sensitive to these issues.

References

1. Erikson EH. The Life Cycle Completed. New York, WW Norton, 1982.

2. National Study of Youth and Religion, 2002-2003. University of North Carolina at Chapel Hill Available at: http://www.youthandreligion.org/publications/docs/PortraitsProtTeens.pdf. Accessed July 2, 2006.

3. Gallup GH Jr. The Religiosity Cycle. June 4, 2002. Gallup Brain: The Gallup Organization. Available at: http://brain.gallup.com/content/default.aspx?ci=6124. Accessed July 2. 2006.

If you can't change your fate, change your attitude.
--Amy Tan

Harold G. Koenig, MD and Harvey Jay Cohen, MD

From the Departments of Psychiatry & Behavioral Sciences and Medicine, and the Center for Aging, Duke University Medical Center, GRECC VA Medical Center, Durham. NC.

Reprint requests to Dr. Harold G. Koenig. Box 3400, Duke University Medical Center, Durham, NC 27710. Email: [e-mail]