Advancing Spiritual Care Through Research

Advancing Spiritual Care with Older Adults

George Fitchett, DMin, PhD

My first job as a chaplain was at Oak Forest Hospital, the long-term care and geriatric facility for Cook County (Illinois). I joked with friends that when I started the job, I couldn’t spell gerontology. It was a reflection, in part, of the fact that care for older adults had never been mentioned in my theological or clinical education. My work at Oak Forest was the start of a long-standing interest in aging and spiritual care with older adults.

A few years later, as I began to focus on research about religion and health, my attention was drawn to studies about older adults. In the early 1980’s, the National Institute of Aging funded four longitudinal studies of older adults known as the Established Populations for Epidemiologic Studies of the Elderly (EPESE) studies. The studies all used a core set of measures that included a few items about religion. The studies produced many Important findings about religion and health by researchers such as Harold Koenig and Ellen Idler.

I became especially interested in Idler’s work in which she and her colleagues examined the relationship between religion and disability among the 2,800 older adults in the New Haven (CT) EPESE study (Idler and Kasl, 1997A and 1997B). They found that more frequent worship attendance predicted better functional status (less disability) over 6 years of follow-up for community-dwelling older adults. The effect appeared to be strongest for those with the highest levels of disability. The effect also appeared to be mediated by better health practices, social networks, and emotional well-being among the more frequent worship attenders. Later I had an opportunity to follow up on Idler’s work, examining the relationship between worship attendance and disability among 5,800 older white and Black participants in the Chicago Health and Aging Project. My colleagues and I found more frequent worship attendance was associated with lower levels of disability at baseline, but worship attendance provided no protection against increases in disability over time (Fitchett et al., 2013). We found no white-Black racial differences in these associations.

Work on this study led me to Elizabeth MacKinley’s (2001) research on the religious/spiritual (R/S) tasks associated with aging. Her model assumes there is a potential for spiritual growth across the life span with the goal of continued spiritual growth until death; that aging is a spiritual journey. The 6 spiritual tasks in her model are: 1) to identify with what brings ultimate meaning, 2) to find appropriate ways to respond, 3) to transcend disabilities, loss, 4) to search for final meanings, 5) to find intimacy with God and/or others, and 6) to find hope.

Whether we use MacKinley’s model or another one, thinking about aging as a spiritual journey brings into focus the question of where older adults get support for this journey. Of particular interest are the 2 million older adults who live in nursing homes or other residential care facilities. One study of 140 residents in one of 2 nursing homes in Boston, found that religion was very important for 54% of the residents and somewhat important for an additional 27% (Scandrett & Mitchell, 2009). In this sample,  the importance of religion was a statistically significant predictor of psychological wellbeing. The investigators also found that nearly half (47.9%) of the residents in their study reported some R/S struggle and that R/S struggle was significantly associated with poorer emotional wellbeing.

Who is addressing the R/S struggle of these and other residents in what our Aussie colleagues call aged care facilities? Some older adults continue contact with spiritual leaders from their congregations, but those connections often end. Some aged care facilities may provide spiritual care, but the proportion that do and the training of those spiritual care providers are unknown. Few theological schools include any education about spiritual care with older adults nor do our CPE programs; shocking omissions in light of the growing proportion of older adults in the U.S. population (estimated 71 million by 2030), not to mention in the pews. Further, currently 6.25 million Americans have Alzheimer’s disease; a number that is expected to more than double to 13.85 million by 2060. Research and education to strengthen spiritual care for older adults with dementia, and their loved ones, is urgently needed.

To help address these needs, Transforming Chaplaincy is pleased to announce the Elder Care Research Network. The Elder Care Research Network will bring together chaplain researchers and non-chaplain researchers, chaplains and clinicians interested in advancing knowledge about the functions and practices of chaplains that work with an aging (elder) population in a post-acute care setting. It is led by Kathryn Lyndes and Sarah McEvoy. More information about the Network is in this issue of our Newsletter and on our website. If you work in aged care, I hope you will join the Network. Together we can develop research and education that will support excellence in spiritual care for older adults and their loved ones.


Fitchett G, Benjamins MR, Skarupski KA, Mendes de Leon CF (2013). Worship attendance and the disability process in community-dwelling older adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 68(2):235-45.

Idler EL & Kasl SV (1997A). Religion among disabled and nondisabled persons. I: Cross-sectional patterns in health practices, social activities, and well-being. Journal of Gerontology: Social Sciences, 52B:S294-S305.

Idler EL. & Kasl SV (1997B). Religion among disabled and nondisabled persons. II: Attendance at religious services as a predictor of the course of disability. Journal of Gerontology: Social Sciences, 52B:S306-S316.

MacKinlay EB (2001). The spiritual dimension of caring: Applying a model for spiritual tasks of ageing. J Relig Gerontol 2001; 12: 151-166.

Scandrett KG & Mitchell SL. (2009). Religiousness, religious coping, and psychological well-being in nursing home residents. Journal of the American Medical Directors Association 10(8):581-86.

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