Wellness Check: Spirituality

Understanding purpose in life in older adults may require a multifaceted approach

1. In this systematic review, purpose in life was conceptualized as: health and well-being, meaningful goals and purpose, inner strength, social relationships, mattering to others, spirituality and religiousness.

2. Purpose in life was associated with female gender, higher education and income, being married, ethnicity, health and well-being, inner strength, social integration and spirituality.

Evidence Rating Level: 2 (Good)

In the literature, purpose and meaning in life have often been used interchangeably. However, many argue that purpose in life (PIL) has a more specific role than the broader definition of meaning in life (MIL) and may promote health outcomes. Given the growth of this field and the need for a distinction between MIL and PIL, the objective of the present systematic review was to assess how PIL is conceptualized, measured, and what factors are associated with PIL.

Of 1173 identified records, 44 were included in the study from 1995 to November 2021. Studies were included if they investigated PIL in community-dwelling older adults (≥65 years old). Patients in nursing homes and clinical cohorts (e.g. terminally ill) were excluded. Bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist as well as the Mixed Methods Appraisal Tool (MMAT).

Results demonstrated that PIL was conceptualized as: health and well-being, meaningful goals and purpose, inner strength, social relationships, mattering to others, spirituality, and religiousness. Furthermore, PIL was associated with female gender, higher education and income, being married, ethnicity, health and well-being, inner strength, social integration and spirituality. However, the present study was limited by the inclusion of multiple articles from the same authors from the same country, thereby limiting how PIL may be assessed internationally. Nonetheless, this is the first review that has aided in conceptualizing, measuring and elucidating the determinants of PIL in the elderly.

Alcohol recovery narratives are dynamic and may be composed of multiple dimensions

1. In this study, the eight principle narrative dimensions related to alcohol recovery identified were: genre, identity, recovery setting, drinking trajectory, drinking behaviors, stages, spirituality and religion, and recovery experience.

2. In female narrators, shame was a prominent theme; a lack of sense of belonging and spirituality were prominent for LGBTQ+ narrators; whereas alienation and inequality were prominent in indigenous narrators.

Evidence Rating Level: 2 (Good)

Alcohol misuse presents a major health concern due to its prevalence and associated complications. Although many engage in alcohol recovery, little is known at the individual level regarding recovery characteristics such as age, gender, and ethnicity. As a result, the objective of the present systematic review and narrative synthesis was to develop a framework describing the characteristics of alcohol recovery narratives in order to inform future research, policy and practice in various settings.

Of 11 332 identified records, 32 (n=1055, 52.6% male) were included in the final analysis from inception to March 2021. Studies were eligible if they presented an original framework of typologies and/or themes of alcohol misuse recovery narratives through an analysis of empirical data. Studies were excluded if the narrator did not have a personal experience of alcohol misuse. Risk of bias was assessed using the Critical Appraisals Skills Programme (CASP tool for qualitative research). Data was synthesized using a three-stage narrative synthesis approach.

Results demonstrated that there were eight principle narrative dimensions identified: genre, identity, recovery setting, drinking trajectory, drinking behaviors, stages, spirituality and religion, and recovery experience. With respect to specific populations: 1) shame was a prominent theme amongst female narrators; 2) a lack of sense of belonging and spirituality were prominent for LGBTQ+ narrators; 3) alienation as well as inequality were prominent amongst indigenous narrators. However, this systematic review and narrative synthesis was limited by the absence of studies from low income countries and non-Caucasian populations. Nonetheless, the present study contributes to a greater understanding of recovery narratives which will be helpful to influence future research and healthcare practice.

Wishes and needs of nursing home residents are heterogeneous and comprise various themes

1. Wishes and needs of nursing home residents were assigned to 12 different themes, the most frequently mentioned being: autonomy, independence, choice, control, death, dying, end of life, medication, treatment, hygiene.

2. Wishes and needs were found to vary significantly between individual residents and were not generalizable.

Evidence Rating Level: 2 (Good)

Research has shown that when nursing home (NH) residents are cared for using a person-centered approach, they experience greater satisfaction of care. This approach relies on the understanding of NH residents wishes and needs which have no yet been studied. As a result, the purpose of the present scoping review was to provide an empirical overview of the range of wishes and needs of NH residents.

Of 1356 screened articles from 12 databases, 51 (n=28 quantitative studies) were included in the analysis from 1990 to 2020. Studies that included constructs of “wishes” and/or “needs” in NH residents were included. Studies that included people not living in a NH or who were on average <60 years old were excluded. Data analysis was done using thematic analysis.

Results demonstrated that wishes and needs were assigned to 12 different themes; the most frequently mentioned being: autonomy, independence, choice, control, death, dying, end of life, medication, treatment, hygiene. Furthermore, wishes and needs were found to vary significantly between individual residents and were not generalizable – for instance some residents wanted to receive life-sustaining measures while others rejected them. However, this study was limited by the potential overweighing of the qualitatively surveyed wishes and needs due to the absence of reporting on frequencies. Nonetheless, the present study highlighted the diversity and complexity of NH resident wishes which underscores the importance of expertise in providing individualized care for this population.

Religious and spiritual practices may improve mental health in older adults

1. In the present systematic review and meta-analysis, high religious and spiritual (RS) practices were negatively associated with the prevalence of symptoms of anxiety and depression.

2. Furthermore, there was a positive association between RS practices and life satisfaction, meaning in life, social relations, and psychological well-being.

Evidence Rating Level: 1 (Excellent)

It is expected that one in five seniors will experience some form of mental illness (e.g. depression, anxiety) late in life. An increasing number of studies support the finding that involvement in RS activities enhance mental health status; however, a specific pooled analysis of reviews on the older population is still needed. As a result, the objective of the present systematic review and meta-analysis of observational studies was to investigate the association between RS and the prevalence, severity, and incidence of mental health conditions in older adults.

Of 44 180 identified studies, 62 were included in the final meta-analysis from inception to July 2021. Studies that evaluated the association between RS and mental health in people aged >60 years old were included. Studies were excluded if they compared the prevalence of mental health parameters among different religious affiliations without a comparison to no religious identification or atheism. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). A random effects model and sensitivity analysis was performed.

Results demonstrated that high religious and spiritual (RS) practices were negatively associated with the prevalence of symptoms of anxiety and depression. Furthermore, there was a positive association between RS practices and life satisfaction, meaning in life, social relations, and psychological well-being. However, the present study was limited by the inclusion of mostly cross-sectional studies, thereby limiting inferences of causality. Nonetheles, the study’s results provide further support for the utility of RS in enhancing the mental health of older adults.

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