Journal of Gerontological Nursing


Mary Byrne, MSN, RN


For some of your clients, spiritual support is their greatest need.


For some of your clients, spiritual support is their greatest need.

Life satisfaction is considered to be an important factor in successful aging.

The study and measurement of life satisfaction is as old as the field of gerontology itself. As early as 1933, Conkey became interested in measuring variables which affected the life satisfaction of older persons.1 Since that time, gerontologists have spent considerable time and effort attempting to define this concept and identify correlates of it. Their goal was to obtain knowledge of the human life cycle and to use this knowledge to enhance the life satisfaction of the older person.2 One variable found to correlate with life satisfaction was religiosity.*

In an effort to determine the implications for health care workers that concepts of religiosity and life satisfaction in the aged have, the authors present the information contained herein.

Holistic care connotes the care of the whole person. This includes the spiritual or religious dimensions of a person, as well as the physical, emotional, and social aspects. The spiritual part is not a separate entity of a person's life but an integrating force within it.4 Maslow subscribes to this holistic concept of the human person.5

The White House Conference (1981) defined spiritual well-being as the affirmation of life in a relationship with God, self, community and environment which nurtures and celebrates wholeness.6 Wholeness is emphasized in contrast to fragmentation and isolation.

In this paper the following definitions are used:

Religiosity - Religiosity pertains to the knowledge, beliefs, feelings and practices of persons as measured by the ideological, intellectual, ritualistic, experiential and consequential scales from the Religiosity Five-Dimensional Tool by Faulkner and DeJong. Some similar valid and reliable measurements may also be used.

Life Satisfaction - Life satisfaction is the attainment of social and psychological well-being which includes a zest for life, versus apathy; resolution and fortitude as opposed to resignation; congruence between desired and achieved goals; high physical, psychological, and social self-concept, and a happy optimistic mood tone as measured by Life Satisfaction Index-? or by some similar measurement.8

The investigators who studied life satisfaction ratings concluded that an individual- possesses psychological well-being if he:

1 . Enjoys the activities that constitute his everyday life;

2. Sees his life as meaningful and accepts his past;

3. Feels a sense of accomplishment in the achievement of his major goals;

4. Holds a positive self-image, and

5. Maintains happy and optimistic attitudes and mood.9

The intrinsic importance of religion in the life of a person is sufficient to justify the study of individual religiosity. If we examined the religions of the world, it is evident that the details of religious expression are varied; different religions expect different behaviors of their adherents.

In the midst of great variations in religious beliefs, there exists a consensus as to the general areas in which religiosity should be manifested. These areas may be thought of as the core dimensions of religiosity. Within these areas, five dimensions can be identified. These are: the experiential, ritualistic, ideological, intellectual, and consequential dimensions.

The experiential dimension recognizes that all religions have certain expectations that the religious person will, at one time or another, achieve direct knowledge of ultimate reality or will experience religious emotion.

Every religion places some value on subjective religious experience as a sign of religiosity.

The ideological dimension holds that every religion sets forth its own set of beliefs to which its followers must adhere.

The ritualistic dimension encompasses religious practices expected of its adherents. These practices include worship, prayer, participation in the sacraments, and fasting.

The intellectual dimension is concerned with the expectation that the person will be informed about the basic tenets of his or her faith and the sacred scriptures. The intellectual and the ideological dimensions are closely related since acceptance of a dimension presupposes knowledge of it.

The consequential dimension includes all the religious prescriptions that specify what people ought to do and attitudes they ought to have as a consequence of their religion. The consequential deals with man's relation to man. Glock indicates that we are far from an adequate understanding of the individual and his or her religion; that we cannot assume that religiosity expressed in one dimension assures its being manifested in other dimensions as well.10

These five dimensions provide a framework for studying religion and assessing religiosity.

According to Maslow, the religious impulse resides within each person and in its highest fulfillment integrates the life experience rather than dividing it into the sacred and the profane.11 He believes that the organizational and ritual aspects of religion can be expressions of meaning for the person. The pyramid construct showing the fundamental importance of certain basic needs may be viewed significantly from the holistic viewpoint.

In its application to the aged, Maslow's theory purports that more energy is released as one goes up the ladder. The self-actualization at the peak of the pyramid suggests new relationships to self and the universe and the acceptance of the unknown. Maslow defines the five basic needs, each of which must be met successfully before advancing to the next.12 At the base of the pyramid, Maslow has placed the biological or physiological needs of food and water, which are common to all the animal kingdom. Next, he has placed safety and security needs, generally satisfied in our society. Belonging and love needs emerge after safety and security needs are met. Further up the steps in the pyramid, he has placed self-esteem, which is the need to think well of one's self and to be well thought of by others. Finally, at the top of the pyramid, he has placed the need for self-actualization, which he considers as the highest need . Maslow believed that maturity and self-knowledge reached through living a number of life experiences, with its valleys and peaks, prepares one for selfactualization. This is why his framework is applicable to the older person who has lived a number of years. These five needs set goals for the person, give direction to behavior and sensitize the person to the aspects of the environment that will lead to satisfaction.

Implications for Religious Leaders

Religion is thought to become increasingly important as one grows older. Mathiasen has stated that religion i& the key to life satisfaction in old age; that a sense of the encompassing love of God is the basic emotional security and a firm spiritual foundation for the elderly at the end of life. I3 A consideration of religious needs in this developmental stage of the life cycle of the aging person could help to create a more meaningful existence.

The most crucial religious requirements of the aging person are the need for affirmation in facing death and the coming to grips with life as a totality. These needs originate in the inner subjective life of the person and, if met successfully, will provide meaning and satisfaction as the aging person prepares for death. It has been contended that religion is an important factor in the life of the aging person and that it is to the church he turns for support. I4

Kalish contends that the elderly receive adequate support services through their churches, clergy and their religious faith. I5 Therefore, professionals should recognize and assist these existing supports. Some of the advantages of obtaining services through a church affiliation include the following:

1. It is familiar;

2. It does not cost money;

3. There are no waiting lists;

4. There are no records kept;

5. There is no stigma attached;

6. In later years many concerns pertain to life and death.

Kalish indicates that the clergy are responsible for about half the hours the elderly spend in being counseled. Churches are an underdeveloped resource which can help the aged. Churches should give special attention to elderly members to compensate for generally declining religious activities and to maximize the benefits of their religious experience.16 Fahey in his article, "The Church and the Third Age" presents the striking rise in the age structure of society which poses new problems and presents new possibilities for the church.'7 For the church today to serve older persons well, and in turn to utilize the capabilities of older persons, it is important to analyze this new human experience and explore its possibilities. Pope John Paul II endorses this concept in his message to the World Assembly meeting held in Vienna from July to August, 1982. 18

Implications for Caretakers

Efforts should be made to keep elderly members at home in family settings and in a familiar environment, if at all possible. Assistance should be given to them to meet their needs according to Maslow 's hierarchy of needs. Help should be available to meet their religious needs. Should other living arrangements become necessary, then the family and society have an obligation to provide suitable facilities in keeping with the dignity of the older person.

Implications for Health Care Workers

Nursing and health literature are replete with discussion on recognizing a person's emotional needs and attempting to meet them. There is much less emphasis on the spiritual needs of the person or client. Yet for some, the spiritual is their greatest need. The nurse is often the one who can help the patient regardless of the nurse's personal religious affiliation. Emotional support alone will not suffice if the person's problem is spiritual in nature.19

The nurse can assess the individual's perception of how personal spiritual beliefs influence the ways in which the patient attempts to meet basic needs. To assess this area, some guidelines are necessary:

1 . The assessment should be included in the history and information methods;

2. The approach should be based on respect for the person and his/her religious belief;

3. There should be respect for silence or objection when assessing this need;

4. Questions should be organized in an appropriate format.

The assessment interview can obtain information about the person's religious beliefs and how these affect his needs for achievement and purpose in life, for love and a sense of belonging and dependence, and for feelings of self- worth. These are factors that increase or decrease feelings of selfesteem or the esteem of others. It can help to understand the effect on feelings of security, safety, integrity or wholeness. It aids satisfaction pertaining to sensory stimulation, which pertains to enjoyment of religious practices, such as sacred music, ceremonies, prayers, and readings.4

Information can also be gathered about spiritual needs from cues the person might give, such as the person's mentioning the subject casually; facial expressions indicating fear, doubt, depression or despair; crises situations; or statements pertaining to death or dying.19·4

If the general goal of nursing is holistic care, then the clinical specialist and other health care workers must recognize the potential healing force of all aspects of a person's life, including the spiritual dimension.4 Moberg believes that nurses and family practitioners should be aware of the importance of the spiritual well-being of the elderly.20 It is evident that the religious aspect of a person's life contributes to life satisfaction.


  • 1 . Conkey F: Adaptions of fifty men and women to old age. In Toseland R, Rasch J (eds): Correlates of Life Satisfaction: An Aid Analysis, int J Aging Hum Dev 1979-1980; 10:203.
  • 2. Toseland R, Rasch J: Correlates of life satisfaction: an aid analysis, lnt J Aging Hum Dev 1979-1980; 10:203-211.
  • 3. Hadaway CK: Life satisfaction and religion: a reanalysis. Social Forces 1978; 57:636-643.
  • 4. Ellis D: Whatever happened to the spiritual dimension. The Canadian Nurse 1980; 9:42-43.
  • 5. Maslow AH: Toward a psychology of being. In Ebersole P, Hess P (eds): Toward Healthy Aging St. Louis, CV Mosby Company, 1981.
  • 6. White House Conference on Aging: Report of Technical Committee on Creating an Age Integrated Society: Implications for Spiritual Well-Being, 1981.
  • 7. Faulkner JE, DeJong CF: Religiosity in 5-D: an empirical analysis. Social Forces 1966; 45:246-254.
  • 8 . Adams D: Analysis of life satisfaction index. J Gerontol 1969; 24:470-474.
  • 9. Neugarten BL, Havighurst RJ, Tobin SS: The Measurement of Life Satisfaction. J Gerontol 1961; 16:134-143.
  • 10 . Glock CY : On the study of religious committment. Religious Education Research Supplement 1962; 42:98-110.
  • 1 1 . Maslow A: Religious values and peak experiences. In Ebersole P, Hess P (eds): Toward Healthy Aging St. Louis, CV Mosby Company, 1981.
  • 12. Maslow A: Motivation and personality. In Ebersole P, Hess P (eds): Toward Healthy Aging St. Louis, CV Mosby Company, 1981.
  • 1 3. Mathiasen G: The role of religion in the lives of older people. In Blazer D, Palmore E: Religion and aging in a longitudinal panel. Gerontologist 1976; 16(6):82-85
  • 14. Green E. Simmons H: Toward an understanding of religious needs in aging persons. The Journal of Pastoral Care 1977; 31:273-278.
  • 15. Kalish R: The religious triad: church, clergy and faith in the resources network. In Ebersole P, Hess P (eds): Toward Healthy Aging St Louis, CV Mosby Company, 1981.
  • 16. Blazer D, Palmore E: Religion and aging in a longitudinal panel. The Gerontologist 1976; 16:82-85.
  • 17. Fancy CJ: The church and the third age. America July, 1982; 31:46-49.
  • 18. Pope John Paul II: "Message from Pope John Paul II to the World Assembly on Aging;" Vienna, Austria, July 26 - August 6, 1-5, 1982.
  • 19. Piepgras R: The other dimension: spiritual help. Am J Nurs 1968; 68:2610-2613.
  • 20. Moberg DO: Religion and the aging family. In Ebersole P, Hess P (eds): Toward Healthy Aging St Louis, CV Mosby, 1981.
  • Bibliography
  • Atchley RC: The Social Forces in Later Life.
  • Belmont, California: Wadsworth Publishing Company, 1980.
  • Bumside IM: Nursing and the Aged.' New York. McGraw-Hill Book Company. 1981.
  • Butler RN, Lewis MI: Aging and Mental Health. St Louis, CV Mosby Company, 1982.
  • Cutler SJ: Membership in different types of voluntary associations and psychological well-being, Gerontologist 1976; 16. 335-339.
  • Devine BA: Attitudes of the elderly toward religion. J Gerontol Nurs 1980; 6( 1 1 ): 679-687.
  • Edwards JN, Klemmack DL: "Correlates of Life Satisfactions: A re-Examination," J Gerontol, 1973; 28:497-502.
  • Heisel MA, Faulkner AO: Religiosity in an older black population. Gerontologist 1982; 22(4):354-358.
  • Himmelfarb HS: Measuring religious involvement. Social Forces June, 1975; (53):606-6l8.
  • Kilduff T: Aging, Spiritual Life 1980; (26):3-20.


Sign up to receive

Journal E-contents