‘To be fully integrated people each one of us needs to be spiritually at peace’
In the western world people are living longer but increasingly, with changes in household compositions, the frail elderly are being cared for by professional caregivers. Often these are younger people whose understanding and experience of any God is very different from their own. Life is in front of these carers, their focus is on planning a future and many find speaking about death difficult. It is important that an older person wishing to explore issues around end of life, or even share difficult questions, is offered honest and sympathetic discussion. There is overwhelming evidence, both anecdotal and researched, that high levels of spirituality are correlated positively with life satisfaction, health, healing, and well-being.
Those in the fourth quarter of their lives will have sustained many losses: loved ones, friends, career, sense of worth and image, life’s acquisitions and freedoms, some degree of competence. And they face the final loss – of self. How these losses are dealt with is important to their well-being. Care is a core value giving meaning to life, a value enabling individuals to find a place of belonging in the world. Mayeroff writes, ‘Caring, helping another grow . . . is a process, a way of relating to someone that involves development’ Malcolm Johnson sees spiritual care as creating a facility for ‘putting right’, a task of helping to mend broken spirits, through love and service and, for the believer, through prayer.
Society often fails to see the older adult as having potential for development and growth. John Wattis and Stephen Curren (2000) admit that old age is seen as a handicap, even amongst trained psychiatric staff. Both see a developmental approach as useful in understanding an individual’s ageing. This approach divides life into stages, each having its aspirations and challenges, with tensions between an individual’s process of maturing and external conditions. Many psychiatrists and psychologists see that the degree of satisfaction a person has in the way they dealt with these aspirations and conflicts integrates into their sense of personal satisfaction of life, or sense of fear of the future. It thus has an important impact on them today in the meaning of their lives.
Older people so often look back over their lives, seeming to enjoy remembering both happy and sad memories. Greater self-esteem can be developed by recovering and integrating memories and emotions from their past with their present, using them to develop increased self-awareness, as well as transmit family history. Reaching out and taking responsibility to search for meaning in their lives is seen by Frankle (1992) as transcendence and regarded as a developmental task of ageing. It supports and reaffirms a sense of self, allowing the integration of now and then which Moody (1995) sees as ‘bringing to wholeness’. For Erikson (1986) this is the eighth and final stage of psychological and social development, building on a person’s previous meaning of life with opportunities to reassess and ‘reframe’ the past, accept what cannot be changed and move forward. ‘Failure to do so may result in a sense of despair for the individual’ (Mackinlay. 2001).
There are numerous definitions of human spirituality. Whatever specific words are used, most authorities seem to understand spirituality as an inner resource that animates, drives, and motivates the person. A dimension, bringing together the person’s sense of meaning and relationship worked out with others and, if the person has a faith, with God. Moltmann (1992) has ‘Spirit of Life’ enlivening body and soul, bringing wholeness.
Revd. Albert Jewel argues that to ignore the spiritual is to ignore an important part of what it means to be a human being. Stating, ‘we each have an inner being that needs nurturing’. He focuses spiritual needs in six ways:
Isolation - Humans are social beings and need companionship and friendship
Affirmation - We all need to feel that we are of value and use in life, that we are wanted, loved and needed
Celebration - This is a natural instinct. Without room for celebration life becomes a burden
Confirmation - Older people need someone who will simply listen and allow them to share their deepest feelings
Reconciliation - Older people often say they 'want to die at peace': with others, with their own heart and (if they are believers) with God
Integration - Feeling that you have pulled the whole mixed bag of life together and made sense of it.
My own research in 2002/3 found very similar results. Of the seventeen individuals I spoke with, aged between 79 and 102, living in ‘residential settings’ and requiring considerable help with their day to day activities, only one gentleman was unsure about a spiritual dimension. He saw his future only through his children and grandchildren. Most spoke of searching for a meaning in their lives and often felt ‘protected’ from news. Many spoke of feeling lonely whilst being surrounded by noise. Several of the cohort felt a lack of meaningful and intimate relationships where they could be totally honest. Although most felt grateful for their care all wished for people to have time ‘just to talk’. They did not, though, wish to be a ‘bother’ or a financial ‘burden’. Self-esteem seemed to be diminishing and even those who had led very full, ‘useful’ lives were suggesting that their only concern now was for the ‘youngsters’. Several seemed to be asking if the world was a better place for their having being there. They wished to maintain personal dignity and self-esteem. Spiritual needs are closely related to this desire.
Amongst their needs was the desire:
· to have choices
· for purpose and meaning in their life
· for love and satisfying relationships
· to give and receive forgiveness
· to feel part of the world
· to cope with their losses
· to ask or just share difficult questions
· to be flexible, accept & prepare for change
· to prepare for dying and death - physically, materialistically and spiritually
· for honest sympathetic discussion
· to be useful
· to be thankful, find a balanced perspective. Count their blessings
· to have their value accepted
The challenged then, for the professional caregiver, is to ensure each older person in their care is given the opportunity to reassess and take stock of their lives. To refocus where necessary and reintegrate any unresolved conflicts or fears, as well as offer an opportunity to reconcile previously broken relationships. The person needs to feel, and be, valued in the here and now. The caregiver (and society as a whole) ought to recognise that people in the third and fourth quarter of their lives have potential for development and growth leading to worth and integrity being enhanced.
Supplying a safe environment, that does not seek to impose either differing belief systems or values but helps and supports an individual explore their spiritual needs, enables a person to move to the next stage, which includes death, as fully integrated people, spiritually at peace.
Janet Parker, Spiritual Care for Older People (SCOP) project, Diocese of Oxford.
References
Mayeroff, M. (1971), On Caring. New York: Perennial Library: Harper Collins
Wattis, J.P. & Curren, S. (2001), Practical Psychiatry of Old Age. Abingdon: Radcliffe Medical Press Ltd.
Moltmann, J. (1992), The Spirit of Life. Minneappolis. Fortress Press
Frankl, V.R. (1992), Man’s Search for Meaning: Boston: Beacon Press
Erickson, E.H., Erickson, J.M., & Kivnivk, H.Q. (1986), Vital Involvement in Old Age: New York: WW Norton & Co.
MacKinlay, E. (2001), The Spiritual Dimension of Ageing. London: Jessica Kingsley Publishers Ltd.
