Perspectives of the Elderly on Spirituality – A Qualitative Survey on Admitted Elderly
By Ms. Tan Mei Hong, Staff Nurse, Alexandra Hospital, Singapore
Summary of talk by: Ng Shi Hui
In her presentation, Ms. Tan sought to communicate to her audience her findings regarding the perspectives that the elderly (aged 65 to 85) in Singapore have regarding spirituality. She decided to embark on this study for she realized from her personal experiences that attending to a patient’s spirituality remains neglected in practice. Furthermore, while studies have been conducted in other Western countries regarding the role of healthcare providers as spiritual care providers, this has remained a vastly untouched topic in the Singapore healthcare system. Seeking to address this literature gap in Asian societies, she hence decided to conduct this study.
She highlighted the significance of spirituality in older adults, as it serves as a coping mechanism in dealing with problems and has been proven to lead to positive physical and mental health outcomes, such as the reduced occurrences of depression and anxiety in these older patients. She conducted this study by interviewing patients who have been admitted into the hospital for at least 2 days, and who have been certified by their attending physicians as fit for these interviews. These interviews were audio recorded for accuracy.
These interviews revealed certain themes regarding the elderly’s perspectives on spirituality, one of which would be that many of the elderly see their spirituality as a divine moral compass. They believe that there is a higher power guiding their life decisions. Such guidance allows them to navigate the decisions they have to make in their lives in order to be what these higher powers perceive as a good person. These notions on spirituality have allowed these elderly to respect other people’s religion and accord to them a sense of purpose in their lives. Such also allows them to believe that they will therefore die a good death, which was evident when one participant said that ‘when I die I go to heaven’. Spirituality hence strengthens the elderly’s coping mechanisms with respect to making sense of their illness, and many have stated that they find peace and relief in praying or chanting. It serves as a buffering factor in allowing the elderly to accept their choices in life so that they start to accept the fact that their time is running short.
When asked about their expectations of healthcare professionals as spiritual care providers, however, many of the elderly were pessimistic. They feel that there will be a conflict between science and spirituality for they view hospitals as a place to become physically well through technology and proven knowledge. They feel that when receiving health treatments, the main concern should be resolving their medical issues and not addressing their spiritual needs. Some also voiced the possibility of the emergence of mistrust towards medical science when science and spirituality are mixed together, and it may even give the impression to patients that spirituality is more important than science when receiving healthcare. Spirituality is also a sensitive matter – many have differing beliefs and religious systems. Should their healthcare professionals’ beliefs run counter to that of the elderly patients’, they are afraid that they will become proselytized. It is interesting to note that even if the healthcare provider is of the same religion, many have expressed discomfort in receiving spiritual care from these healthcare providers.
From this study, it can be therefore seen that receptivity is crucial in the provision of spiritual care to patients effectively. Furthermore, Ms. Tan has highlighted that fact that patients understand spirituality differently and that it is a very abstract concept, so this can become a roadblock in attempting to address their spiritual needs. Spirituality also does not equate to religion, although many may feel that way, for Ms. Tan has gathered that spirituality is very much an innate concept in many patients and patients who do not have religions may still require spiritual help. This evidently shows the abstract nature of spirituality. Therefore, to address a patients’ spiritual needs, it has been suggested that healthcare professionals can act as a bridge between patients and resources, instead of providing the resources themselves.
Many limitations have also been highlighted when healthcare professionals provide spiritual care to elderly patients. For one, personal factors pertaining to the healthcare professionals may affect the effectiveness of spiritual care. If healthcare professionals themselves have spiritual problems and unresolved issues, they can scarcely help patients. Organizational factors, such as the workload and workscope of doctors present themselves as a limitation as well. Besides that, patients who are associated with a religion also lament the lack of privacy in wards, which makes it extremely unconducive for them to perform prayers or other religious practices.
Moving forward, Ms. Tan feels that the medical community can undertake spiritual assessments to better understand the unique spirituality perspectives and needs of patients. Healthcare professionals can be provided with more training on providing appropriate spiritual care. Hospitals can also do their part by providing more conducive places for prayers and by seeking to understand their needs (such as providing to them the Mecca direction). In terms of research, Ms. Tan has highlighted the need to recruit participants from multiple geographical locations and different healthcare settings in future studies for her study was limited to one hospital due to logistical constraints. There can also be the exploration of differences in spirituality perspectives between males and females, and also studies to ascertain differences among different ethnic and religious groups.
In conclusion, while much still needs to be done in ensuring adequate spiritual care of elderly patients, much about spirituality has not been properly studied and great care should be taken when providing spiritual services for it presents itself as an extremely sensitive topic to elderly patients, some of whom may be staunch in certain beliefs.