Aging in America. Spirituality

I had moderate difficulty picking a topic that would expand both of the aspects of aging that our two classes have been studying over the course of this summer. After much debate with myself, and the wise council of my elders, I have decided to take a moderate dip into the connections between ‘spirituality’ and ‘successful aging’ and make a tie in with how policy is affecting what dictates ‘successful aging’ and ‘spirituality’ itself. Then I will provide an example of a current program/facility that is providing exactly what the researchers I reference are calling for.
Aging, Spirituality, and Policy
Defining the terms
According to Atchley, et al. (as referenced in Sadler & Biggs, 2006), “a person’s spirituality may be broadly defined as the personal quest for meaning the purpose in life that goes beyond the material and temporal dimensions of human existence, and can include both beliefs and practice.” Many state that spirituality and religion are one in the same, however Sadler & Biggs (2006) state that there are definite differences in how our culture recognizes the two. Spirituality can be a rather vague term. If you are religious, ask yourself are you spiritual? You more than likely will answer yes. However, if you are spiritual and were asked if you were religious – one could say “no.” Being religious usually connotates some sort of organization of beliefs, or codes and practices based on tradition (Sadler & Biggs, 2006). Spirituality definitely can become pretty ambiguous when it hits the public level of how one interacts with their environment (i.e. a person could never proclaim there is a god, yet claim to be spiritual, or a person could state they are religious yet never consciously refer to their inner spirituality on moral decisions). For my own purposes, when I refer to spirituality and/or religion, I am referring to the “innate human search for meaning and purpose in life” (Sadler & Biggs, 2006; Boswell, Kahana, & Dillworth-Anderson, 2006).
As has been referenced previously in our class, the definition of aging and aging successfully quite possibility is even more ambiguous than that of spirituality/ religiosity. If you were asked how you would define successful aging, how would you? Could you? This is a difficult question for me. Sadler & Biggs (2006) shed some light on why this may be difficult for us: “measurement of successful aging has predominately relied on information available in survey data…little research has asked older people themselves for their definitions”. What really struck me was when Sadler & Biggs mentioned that most researchers exclude older adults living in institutionalized settings from their data gathering. Granted, a majority of older adults do not live in such a setting; however I believe it would be an interesting subset to research and explore. Is the stigma that surrounds those facilities really true? What researchers currently are going off of for their research, and what we have as reading material on this subject, is largely being sourced by static questions. With static questions like “On a scale from one to ten, how healthy are you?” it is not difficult to understand how there is a great amount of emotional, sociological, and psychological (and spiritual) aspects of each answer that are missing. In the time that Sadler and Biggs were writing their article, the way researchers were doing their research on successful aging was wrong in the sense that they weren’t getting the whole story. The only way you could get the whole story, the whole truth, would be to do a case study of a few individuals over the course of several years of aging. One could include components of health, social status, physical activity as self-report and open-ended questions would, but one would also document surrounding observations of each activity or change in health. The tiniest change in lifestyle can leave a ripple effect across the remainder of an older adult’s life. I believe that successful aging should be defined as “a process of adaptation to increasing biological and environmental demands associated with growing older” (Sadler & Biggs, 2006). In my own words, how well are you living in the life you were given?

How do spirituality and aging connect?
As has been previously researched (Baltes & Smith, 2003; Coleman & O’Hanlon, 2004 as referenced in Sadler & Biggs, 2006) spirituality provides resources for the older adult to cope and adjust to some of the changes associated with growing older. This becomes especially true when friends, close family and other relatives either die or move away. Spirituality can provide the comfort in a time of finality. There appears to be a small movement in research and a call to include spirituality as an official component to defining successfully aging. However, there is hesitation since one could then argue that if one is not, in at least some way, spiritual then they are lacking a component of successful aging. Whichever direction that a researcher takes, there is likely to be some sort of criticism from one side or the other.
I believe the largest proponent for the inclusion of spirituality in ones’ life and research is the results of life reviews. Life reviews, in their most basic aspect, are examination(s) of one’s life and what accomplishments and failures exist. In Erik Erikson’s eight-stage life model, he describes old age as a time marked by the need of the individual to psychologically resolve tension between “ego-integrity” and “despair” in order to reach a balance (what he described as a spiritual reconciliation) towards the end of life. In order for one to have integrity, one must be able to reflect back on both the good and the bad and face inevitable death without fear. As a student and as a Christian, I seem to have this discussion often with my peers and elders. Am I scared of death? And if not, why? I think my spirituality (and ultimately religiosity) helps calm my fears of my certain death, but I cannot help but wonder if my fear would be greater if I were older. Currently, since I am so young, it is hard to imagine I will die soon. There is a lot of stress at the end of life, and added on, one worries about the very thing that will no longer allow them to worry. I believe there is some comfort in believing in Heaven (it’s better there). Perhaps spirituality is the ability to place fear behind ones’ self via faith and trust and focusing on what the present has for us.
Aging successfully through spirituality and policy implications It is very difficult to discuss aging successfully, let alone aging in general without the conversation touching on at least one thing about policy (or in the most general sense, the factors that would affect how you are aging). Since there is growing evidence that spirituality should be taken into account when considering how people respond to adult aging (Sadler & Biggs, 2006), it is only logical then to ask, “What implications do new policies regarding funding of institutions, general healthcare (including counseling, hospitals, and even hospice), and at-home care have on successfully aging including spirituality?” To clarify this question: My father is currently attending the VA and has regular sessions with a government-paid therapist (counselor). Currently, there are restrictions, according to my fathers’ counselor, on what probe questions and topics that can be used. The counselor cannot make any reference to spirituality, or religion without getting “fed” the information by the patient first (i.e. if my father stated that going to church was helping him cope with an issue, the counselor could use that to probe further into the issue). If spirituality becomes a definitive part of successfully aging, will the government allow counselors to use that as a suggestion or at least a topic starter? There must be a separation of church and state – however, what is the church? Remember, spirituality is not the same as religion.
Sadler and Biggs (2006) state that there must be five changes in the way policy is currently written. First, there needs to be an adequate assessment of “spiritual and existential needs” that an older person might have as a part of complete care strategy. Secondly, there needs to be a change of political agenda that drives aging debates so that they broaden their views to include spirituality and perhaps even the thought of spiritual support and guidance. Sadler and Biggs give the example of the World Health Organization in 2002 adapting the contribution of the spiritual dimension in their definition of quality of life. Thirdly, the authors point out that it is important to “consider the diverse ways in which an older person may express their spirituality.” Even though religion is largely the practice that spirituality materializes into, there are many other ways to be spiritual. Those need to be appropriately acknowledged. Fourth, counseling services for older adults should be extended to include the consideration of spiritual and existential issues. Finally, there needs to be a greater awareness by carers of older adults for the potential for both intergenerational differences and similarities between them and their older clients. In other words, there needs to be an understanding that even though you may be caring for an older adult that is also Lutheran – your version/understanding of what it is to be Lutheran may be completely different. (I believe that is an issue currently in the LC-MS, or at least practice wise anyway.)
In conclusion, aging successfully should be multi-facetted in its definition, yet not overly complicated to understand on the basic level. To gracefully adapt to what life has provided would be a good place to start in a definition. Even though both aging successfully and spirituality are ambiguous terms on the surface of both society and government, there needs to be some formality to it all in order to create a better system to support the idea that spirituality can be incorporated into a healthy, successful end of life. Finally, government and private facilities need to start recognizing there is an effect by spirituality in some individuals’ lives, and adding it to programming may be for the better. The facility
My mother pointed me towards an advertisement that was recently run in the Lutheran Witness (a monthly magazine that is “the premier magazine for Lutherans who want to be informed and stay informed”). There is an older adult facility called The Arlington in Naples, Florida. It is a Lutheran Life Community (part of a series of facilities located across the U.S.). From their website:
“The Arlington of Naples is a Lutheran Life Community. Lutheran Life Communities is one of the fastest growing, most nationally recognized and respected providers of senior living in the United States. Located in Arlington Heights, Illinois and with five other communities in the Midwest, Lutheran Life Communities has been setting new standards for quality and innovation in residential lifestyles and compassionate response to healthcare needs for senior adults since 1892.
A rich heritage of Christian service and a dedication to mission-driven values will bring time-tested experience and expertise to Lutheran Life Communities ' mission for faithful service and growth at The Arlington. The community is open to those of all faiths, beliefs and traditions.”
Behind the scenes, this facility offers counseling that leaves room for spiritual reasoning behind an individual concluding that they are aging successfully, when traditional research would declare them failures (i.e. bad health, below average social awareness, and poor reasoning skills). Before even becoming a resident, an older adult sits down one-on-one with an experienced social worker that will go beyond the common static questions. Over the course of the first several months, the workers develop a profile similar to a case study to better understand an individual. They offer hospice programs tailored to the individual (religion or lack thereof can change the way one is “treated” in hospice). The staff in general is highly aware of, and respectful of any and all facets of aging. They take pride in their services and making sure that there are no negative experiences that can be prevented. Even their fitness program has the option to include a spiritual or biblical outlook (walking ‘x’ amount of miles is equal to or symbolizes travel that the disciples or Jesus did).
There are several private and somewhat exclusive (the costs are pretty high no matter where you are in the U.S. for these facilities because of the amenities they offer) currently in existence that allow for the connection of successful aging and spirituality to take place and grow. However, I believe our goal should be to advocate a more public, non-exclusive, not expensive service to those who need it. This challenge is not to be taken lightly, and it will require more research, experiments (case studies and needs assessments), and most importantly, time for both our government and our society to embrace what seems logical – holistic, practical, and humane care.

Questions
1. What does ‘aging successfully’ mean to you?
2. What does being spiritual mean to you?
3. What implications do you foresee in policy creation to include spirituality in the definition of successfully aging?
4. Optional: How well are you living the life you were given?
5. Do you know of any programs or facilities like the one mentioned in this report that tailor towards the growing need for a more “wholesome” care for late life?

References
Author unknown (2010). The Arlington. Retrieved from http://www.arlingtonnaples.org/residences.html
Boswell, G., Kahana, E., & Dilworth-Anderson, P. (2006). Spirituality and healthy lifestyle behaviors: Stress counter-balancing effects on the well-being of older adults. Journal of Religion & Health, 45(4), 587-602. Retrieved from Academic Search Premier database.
Sadler, E., & Biggs, S. (2006). Exploring the links between spirituality and ‘successful ageing. Journal of Social Work Practice, 20(3), 267-280. Retrieved from Academic Search Premier database.

References: Author unknown (2010). The Arlington. Retrieved from http://www.arlingtonnaples.org/residences.html Boswell, G., Kahana, E., & Dilworth-Anderson, P. (2006). Spirituality and healthy lifestyle behaviors: Stress counter-balancing effects on the well-being of older adults. Journal of Religion & Health, 45(4), 587-602. Retrieved from Academic Search Premier database. Sadler, E., & Biggs, S. (2006). Exploring the links between spirituality and ‘successful ageing. Journal of Social Work Practice, 20(3), 267-280. Retrieved from Academic Search Premier database.