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Respecting Diversity: Religious and Spiritual Beliefs of the Older Person Vicki Murdock, MSW, PhD University of Wyoming


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Title: Respecting Diversity: Religious and Spiritual Beliefs of the Older Person Vicki Murdock, MSW, PhD University of Wyoming

Respecting Diversity Religious and Spiritual
Beliefs of the Older Person Vicki Murdock, MSW,
PhD University of Wyoming

  • This module was developed for and peer reviewed
    by the South Carolina Geriatric Education Center.

Module Learning Objectives
  1. Define religion and spirituality from a diversity
  2. Identify theory, research, and policy that
    supports addressing client/patient spirituality.
  3. Recognize particular spiritual issues of late
  4. Recognize the importance of worker self-awareness
    and the challenges of addressing client/patient
  5. Describe various methods that can help address
    the older client/patients spirituality.

The great error of our day is that physicians
separate the soul and body, when they treat the
body. Plato (427-347 BCE)
  • Spirituality relates to the persons search for
    meaning and morally fulfilling relationships
    between oneself, other people, the encompassing
    universe, and the ground of existence, whether a
    person understands this in terms that are
    theistic, atheistic, non-theistic, or any
    combination of these1

  • Religion involves the patterning of spiritual
    beliefs and practices into social institutions,
    with community support and traditions maintained
    over time1

One Model of the Whole Person, Suggesting the
Importance of Body, Mind, and Soul
Outside Environment
Inner Person
Theories of Aging that Include Spirituality3
  • Continuity theory
  • Social constructionism and phenomenology
  • Symbolic interactionism

Theories of Aging that Include Spirituality3
  • Eriksons generativity stage
  • Crisis/grief/loss theories
  • Social exchange theory

Theories of Moral and Faith Development that
Include Aging3
  • Eriksons stage/developmental theory
  • Fowlers stages of faith
  • Kohlbergs moral development theory
  • Maslows hierarchy

Theories of Moral and Faith Development that
Include Aging3
  • Krill, Jung, and Assagiolis work
  • Wilbers transpersonal theory
  • Gilligans womens moral development
  • Tornstams gerotranscendence4

Spirituality/Religiosity and Physical and Mental
  • Over 750 empirical studies validate the benefits
    of spirituality/religion on health and mental
    health outcomes.5

Spirituality/Religiosity and Physical and Mental
  • Client spirituality correlates with
  • Reductions in mortality, anxiety, depression,
    suicidal ideation, substance abuse, hypertension
  • Increases in life satisfaction, well-being,
    immune function

Cultural Competence Continuum Applied to
  • 6. Spiritual proficiency builds community
    diversity awareness
  • 5. Spiritual competence acceptance and respect
    for spiritual diversity
  • 4. Spiritual pre-competence aware of problem
  • 3. Spiritual blindness all people are the same
  • 2. Spiritual incapacity unintentional sense of
    superiority of dominant group
  • 1. Spiritual destructiveness intentional

Professional Organizations that Mandate Respect
for Religious Diversity
  • American Medical Association
  • American Psychiatric Association
  • American Psychological Association
  • American Nursing Association
  • National Association of Social Workers
  • American Counseling Association
  • American Association of Pastoral Counselors
  • American Association of Professional Chaplains

All Major Healthcare/Helping Professions in the
  • Mandate Respect for the Religious/Spiritual
    Diversity of our Patients/Clients.

Respectful Practice Behaviors
  • To ask about client/patient spiritual beliefs and
  • To make a referral to their religious group of
  • To listen to their beliefs in order to provide
    best care to the client/patient
  • To honor your own beliefs, but without any need
    to share/convert/convince others
  • For staff to receive training on this topic in
    order to be respectful toward clients/patients

Behaviors that are Not Respectful
  • To ignore, neglect, or fail to ask about the
    religious or spiritual beliefs of your
  • To fail to connect them to the social support of
    their religious/spiritual group and leaders
  • For written or unwritten agency policy to prevent
    trained staff from addressing client/patient
  • To share your beliefs with clients/patients from
    any conversion motives

Research Findings on Addressing Spirituality with
  • Clients want professionals to ask them about
    their beliefs.7
  • Clients/patients respond best to inquiries by
    the healthcare professional.8
  • 83 of 921 patients in outpatient settings
    reported that they wanted their healthcare
    professional to ask them about their spiritual
  • 91 of these 921 patients reported that they had
    never been asked by their healthcare professional
    about their spiritual beliefs.9

Research Findings on Spirituality and Older
  • 76 of persons 65 regard religion as highly
    important in their lives.10
  • Of 4,000 older persons, the religiously active
    were half as likely to be depressed, regardless
    of age, gender, race, social support or
  • Coping through faith predicted positive outcomes
    in a study of 586 persons.12

Some Aging Demographics We are growing from 35
million Americans 65 in 2005 to a projected
70-75 million by 2030, or from 12 of the
population to 22!13
American Generational Differences
  • We can expect some cross-generational issues in
    our work
  • Current old cohort grew up in the early 20th
  • Baby boomers grew up in the 1945-1965 era
  • Gen X and Y grew up in 1970-1990
  • What different worlds these generations
  • have experienced!

Spirituality and the Lifespan
  • Some studies find religiosity a constant across
    the individual lifespan.14
  • Some studies indicate people may become more
    religious with age.14,15
  • As outward signs of religiosity decline,
    non-organizational religious activities may
    increase (private prayer, meditation).16

The Uniqueness of Being Old
  • Ability to look back across a life span and
    integrate parts into a whole
  • Ability to engage in inner or integrative
    activity that crosses the life span, despite
  • Ability learned over a lifetime to face loss and

Imminent Psycho-Spiritual Needs of Older Persons
  • Need for a sense of the wholeness of life
  • Need for a sense of purpose in being,
    especially when doing is more difficult
  • Need to acknowledge positive and negative life
    and spiritual events
  • Need to confront, accept, and plan

Why Discuss Spiritual Beliefs with an Older
  • Explores a persons journey, similar to a life
  • Explores often neglected spiritual aspects of
  • Explores late life and end-of-life issues

Why discuss?
  • Ensures a more thorough, holistic assessment
  • Responds to emerging professional mandates on
  • Clients/patients want professionals to ask them
    about their beliefs7,9

more reasons to discuss
  • Affirms the persons past, present, and future
  • Identifies persons beliefs and values
  • May open a dialogue on topics never addressed
  • Creates a spiritual baseline for interventions

And more reasons
  • Gives context to losses
  • Emphasizes an aspect of life over which personal
    control is possible
  • May point to individual, group, and community
    programming of private and shared faith activity

  • Two major areas that hold us back from
    spiritually competent care are
  • Worker Competence
  • and
  • Societal Taboos about Spirituality

Worker Competence Issues in Addressing
Patient/Client Spirituality
  • Self awareness
  • Cultural/spiritual competence
  • Professional and personal boundaries
  • Little training in school or post-graduate

Worker Self Awareness
  • Three activities to help you think about aging
    and spirituality in your own life
  • Worker Self Awareness -Longevity Quiz
  • Loss Awareness
  • Spiritual Groups Awareness

Cultural/Spiritual Competence
  • Willingness to learn about other beliefs
  • Willingness to promote organizational and
    community respect for diverse beliefs
  • Willingness to learn from our clients, rather
    than think of ourselves as the expert
  • Willingness to suspend our own personal beliefs
    in order to hear the client's story
  • Willingness to recognize diversity and not ignore

Professional and Personal Boundaries
  • Professionally
  • We are mandated to be respectful of religious or
    spiritual diversity.
  • We follow an ethical code or professional mission
    that respects human rights.
  • Personally
  • We may believe that we follow the one true way.
  • We may hold biases against people who represent,
    or behave in ways that we believe are evil.

Educational Preparation on Spiritual Issues
  • Many disciplines have surveyed their workers to
    find that little or no time during their
    schooling was spent on issues that involved
    religion or spirituality.8,17,18
  • Workers in many healthcare disciplines report
    continuing uncertainty about whether they should
    discuss spiritual issues with their clients.8,17,

Societal Taboos about Addressing Patient/Client
  • Antithetical to science
  • Too personal
  • Measurability concerns
  • Misunderstood legal concept of separation of
    church and state

Antithetical to Science
  • Spirituality is designed to be imprecise.19
  • Spirituality addresses the mysterious or holy
    science studies objects, behaviors, measurements.
  • Religion and science have been placed on opposing
    sides in debates across the centuries (e.g.,
    placement of the earth, evolution).
  • Science depends on objective observation
    spirituality is a subjective experience of the
    human mind/body/soul.

Too Personal to Discuss
  • Like sex and politics, American society has
    proclaimed that we do not discuss religion.
  • Spirituality and religion can only be measured by
    self-report and observable behaviors.
  • Many people, including professionals, are
    uncomfortable with ideas that are unfamiliar, or
    that challenge what they believe.

Measurability Concerns
  • Outward behaviors that can be counted may not
    provide an accurate measure of beliefs.
  • Self-report may be limited by subjectivity or
    bias because of a desire to please the
  • Language used to describe spiritual beliefs may
    be misunderstood, even with definitions, due to
    abstractness of concepts.
  • Results are seldom generalizable due to the
    diversity of spiritual beliefs.
  • Researcher bias, scale bias, methodological bias
    distort the results.20

Clarifying the Commonly Used Phrase Separation
of Church and State
  • The 1st Amendment states, in its entirety
    Congress shall make no law respecting an
    establishment of religion or prohibiting the free
    exercise thereof.21
  • Which means only that
  • There will be no official religion of the U.S.
  • Each individual is free to worship as they choose.

Church and State
  • Constitutional scholars continue to debate the
    intent of the First Amendment.
  • Respectful treatment of a client/patients
    spirituality is not hindered by the First
    Amendment. 21
  • Simply, respectfully, ask the client/patient to
    tell us their story.

Challenges in Addressing Spirituality in Late Life
  • Increasing cultural diversity, including
    religious and spiritual diversity in the
    United States13
  • Helping professions offer little preparation in
    spiritual care8,17,18
  • Ethical issues of autonomy, rights, and privacy

More challenges
  • Being able to hear client/patient stories of
    negative experiences with religion or
  • Agencies serving the aging population acknowledge
    offering little spiritual intervention to
  • Continuing societal fears about mortality,
    beliefs about after-life, the dying process,
    facing painful past memories

Methods for Exploring Spirituality with Older
  • Begin with questions about their childhood,
    rather than current beliefs (less personal and
    abstract practices in childhood were not a
  • Consider the cognitive functioning level of the
    adult(s) when planning an activity.
  • Think big big paper, big diagrams, big markers
  • Use sensory-based spiritual activity to reach
    people with cognitive impairments.

Tools for Exploring Spirituality with an Older
  • Develop diagrams with a group or individual, such
  • timelines
  • ecomaps
  • genograms
  • symbolic shapes that have meaning for the person

More Tools
  • Use an interview format with an individual or
    with a group
  • Suggest oral or written responses
  • Ask semi-structured or open-ended questions
  • Ask a group just one question for that session,
    or move through many questions

More Tools
  • Use prepared scales/tools with an individual or a
  • Written instruments
  • closed- or open-ended questions
  • Questions that call for scaled response (e.g.,
  • Autobiographical narrative written on
    their own or with guidance

Another Tool Ethical Wills22
  • Ethical wills are a written account of a
  • Values
  • Beliefs
  • Life lessons
  • Hopes for the future
  • Understanding of Love
  • Understanding of Forgiveness

Sensory-based Spiritual Interventions for Persons
with Dementia
  • Recognize that sensory interventions may or may
    not be welcomed by the patient.
  • Use audio and video recordings of songs and
    services that are part of the client/patients
    spiritual tradition.
  • Invite the appropriate spiritual leader to offer
    prayers, burn incense, wear traditional robes,
    sing traditional songs, offer symbolic foods.

Sensory-based Spiritual Interventions for Persons
with Dementia
  • Encourage family or friends to bring traditional
    foods tied to spiritual traditions.
  • In a group environment, explain activity to other
    patients so they may choose to stay or leave the

Timeline of a Spiritual Journey 23
End of Life
Significant Life or Spiritual Events
After Life
Spiritual Ecomap24
God or Transcendence
Faith Community
Supernatural Beings
Spiritual Leader
Fathers Spiritual Tradition
Individual or Family
Mothers Spiritual Tradition
The Cherry Tree A Personal Model of Spiritual
Visible responses to the spiritual life
Adjectives describing the spiritual life
Things that anchor you in your beliefs
A Unifying Community Model of Meaning-Making26
Diverse Spiritual Behaviors- both positive and
Religions, individual beliefs, philosophies,
cultures, myths, evolving groups
Universal search for meaning of life
Hidden biases
  • Healthcare professionals are now mandated to
    address the patients spiritual beliefs,
    regardless of the workers personal views or
    fears. Our patients want us to ask them about
    this dimension of their life. Failing to ask
    about this dimension is not respectful care.
  • It is incumbent upon each of us to work toward
    cultural proficiency by encouraging our workplace
    and our community to embrace the growing
    pluralism of the United States, and to work for
    dialogue about spiritual diversity.

  1. Canda E.R. (1997) Spirituality. In Encyclopedia
    of social work (19th ed.), 1997 supplement.
    Washington, D.C. NASW Press.
  2. Hutchison E.D. (1999). Dimensions of human
    behavior Person and environment. Thousand Oaks,
    CA Pine Forge Press.
  3. Robbins, S. P., Chatterjee, P., Canda, E. R.
    (1998). Contemporary human behavior theory A
    critical perspective for social work. Boston
    Allyn Bacon.
  4. Tornstam, L. (1999). Gerotranscendence and the
    functions of reminiscence. Journal of Aging and
    Identity, 4(3), 155-166.
  5. King, D.E. (2000). Faith, spirituality, and
    medicine Toward the making of the healing
    practitioner. New York Haworth Press, Inc.
  6. Cross, T. L., Bazron, B. J., Dennis, K. W.,
    Isaacs, M. R. (1989). Toward a culturally
    competent system of care. Washington, D.C.
    Georgetown University Child Development Center.
  7. Oyama, O., Koenig, H.G. (1998). Religious
    beliefs and practices in family medicine.
    Archives of Family Medicine, 7, 431-435.
  8. Maugans, T. A. Wadland, W. C. (1991). Religion
    and family medicine A survey of physicians and
    patients. The Journal of Family Practice, 32(2),

References (Continued)
  • 9. McCord, G., Gilchrist, V.J., Grossman, S.D.,
    King, B.D., McCormick, K.F., Oprandi, A.M.,
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    spirituality with patients A rational and
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  • 10. Princeton Religious Research Center. (1994).
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    your health? The effects of religion on physical
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    as predictors of the outcomes of significant
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  • United States Bureau of the Census (2004).
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    religiosity in later life What can gerontology
    learn from the psychology and sociology of
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    study of religion, health, and aging. Washington,
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    Public Health Service, National Institutes of
    Health, National Institute on Aging

References (Continued)
  • 15. Schultz-Hipp, P.L. (2001). Do spirituality
    and religiosity increase with age? In D.O.
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References (Continued)
  • 21. (2005). The First Amendment.
    Retrieved August 6, 2005 from http//
  • 22. Baines, B. K. (2002). Ethical wills Putting
    your values down on paper. Cambridge, MA
    Perseus Publishing.
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  • Vicki Murdock is an Assistant Professor of Social
    Work at the University of Wyoming. Vickis
    research interests include gerontology,
    spirituality, and social work field education.
    Currently, research involves the aging of
    Boomers, loss issues for adult siblings whose
    family lost an infant at birth, and
    educational/curricular progress on aging.