Is there a process of spiritual change or development associated with ageing? A critical review of research

How to Promote Gerotranscendence in Older Adults? A Scoping Review of Interventions

Gerotranscendence is a psychosocial theory that proposes older adults experience a mindset shift in multiple dimensions (cosmic, coherence, solitude), associated with different constructs, such as life satisfaction and well-being. Increasing studies are employing gerotranscendence, but the practical aspects of how gerotranscendence can be developed are still underexplored. This review involved an assessment of the size and scope of the existing literature on interventions related to gerotranscendence and their effect on participants' well-being. Six databases were searched, and eight studies were selected: five were observational, while three were randomized control trials. Findings showed that gerotranscendence can be developed through weekly thematic encounters. Moreover, the interventions examined in the selected studies were described as having positively impacted participants' mental health and life satisfaction. Future studies should explore gerotranscendence interventions using a rigorous methodology and long-term follow-up data to add consistency to these findings.

Spirituality During the COVID-19 Pandemic: An Online Creative Arts Intervention With Photocollages for Older Adults in Italy and Israel

The present study aimed to examine how expressions of spirituality were stimulated and reflected in an online creative arts intervention for older adults during COVID-19 lockdowns. The online process focused on the creation of digital photocollages together with narrative elements of dignity therapy. Twenty-four Israeli and Italian community-dwelling older adults aged 78–92 participated in a three-session online intervention involving the production of three photocollages. The visual and verbal data (participants’ chosen photos and photocollages, and transcripts of the sessions) were qualitatively analyzed within an abductive framework. Four themes were generated, representing the four domains of spirituality that were stimulated by and expressed in the process: (1) Connectedness with the self, (2) connectedness with others, (3) connectedness with the environment, and (4) connectedness with the transcendent. The findings show how photographs can serve as projective visual stimuli which elicit personal content through spontaneous thinking, and they reveal the multifaceted nature of spirituality, wherein each domain nourishes the others. Overall, the findings illustrate how creative arts intervention guided by the tenets of dignity therapy can contribute to the spiritual care of older adults during periods of social isolation, or to the spiritual support provided in palliative care.

'Living in a shrinking world'-The experience of loneliness among community-dwelling older people with reduced mobility: a qualitative grounded theory approach

BACKGROUND

Loneliness is associated with severe consequences for both the physical and mental health of older people. Research has shown that mobility limitations are an important risk factor for the emergence and maintenance of feelings of loneliness. The aim of this study was to explore the experiences of loneliness among community-dwelling older people with reduced mobility and its underlying dynamics.

METHODS

This study employed a qualitative, descriptive design, inspired by a grounded theory approach. Participants were purposively recruited in collaboration with home health care providers. The main inclusion criteria were as follows: aged 75 years or older, being mobile impaired, experiencing feelings of loneliness, and living at home and being cognitively able to be interviewed. Data analysis of 15 semi-structured, in-depth interviews was conducted based on the Qualitative Analysis Guide of Leuven (QUAGOL).

RESULTS

Loneliness was expressed through all the stories, but it appeared as an elusive, intangible phenomenon. Both indicating the presence of loneliness and describing what this phenomenon means were difficult to express for most participants. Loneliness was experienced as an inherent part of the ageing process characterised by losses, limitations and meaninglessness. Participants described how they have experienced losing grip on the world in which they live and feel isolated in a literally and figuratively shrinking world. Loneliness is described as the feeling that one is unable to address the situation that results in deep sadness and the feeling of no longer being of value to their environment.

CONCLUSIONS

This study shows that loneliness among community-dwelling older persons with reduced mobility is embedded in experiences of loss related to ageing, among which reduced mobility plays a significant role. The results suggest the existence of a more profound experience of loneliness than might appear at first glance. How to recognise experiences of loneliness and how to support a meaningful existence for community-dwelling older persons should be given priority in health care. The findings of this study can increase professional caregivers' sensitivity to implicit signals of loneliness. Further research is necessary to refine the outcomes and to further explore the role of reduced mobility in the experience of loneliness.

The effect of mortality salience on status consumption among elderly individuals: the moderating role of chronological age and subjective age

Purpose

Over the past two decades, a large body of research has examined the effect of the awareness of the inevitability of death on consumption behaviours. However, the literature has shed little light on the effect of mortality salience (MS) on elderly individuals. The present research specifically aims to challenge the effect of MS on status consumption among elderly individuals.

Design/methodology/approach

Two experiments were conducted among individuals over 50. The experiments manipulated MS to test its effect on status consumption.

Findings

The results demonstrate that MS positively influences the preference for status products among elderly individuals (experiment 1) and that this effect is less pronounced as elderly individuals age (experiment 2). Subjective age bias, defined as the potential gap between chronological age and subjective age, negatively moderates this effect (experiment 2).

Practical implications

Luxury marketers need to pay attention to generational cohorts rather than other demographic variables in the segmentation of their market. Moreover, subjective age may be a better segmentation variable for marketers than objective variables such as chronological age.

Originality/value

This research provides insights that support a better understanding of status consumption among elderly individuals and the role of subjective ageing in this process.

The effects of confronting one's own end of life on older individuals and those with a life-threatening disease: A systematic literature review

BACKGROUND

Awareness of the impending end of one's life can pose profound existential challenges, thereby impairing well-being. Confronting one's own end of life may be an approach to meet the psychological needs and consequently enhance overall well-being. Different approaches of confrontation have been evaluated positively using measures of psychosocial comfort. To date, there exists no systematic overview on the different ways of confrontation (e.g. psychosocial or individual coping approaches).

AIM

To synthesize the existing knowledge on the effects of different approaches of confronting one's own end of life on older individuals and those with a life-threatening disease.

DESIGN

A systematic review of quantitative, qualitative, and mixed-methods full research reports was conducted. The retrieved studies were screened and appraised for methodological quality by two independent reviewers based on MMAT and CASP. The findings were synthesized narratively using the meta-summary technique by Sandelowski and Barroso.

DATA SOURCES

Medline, PsycINFO, and Web of Science were searched from inception to 12/2020.

RESULTS

N = 49 studies reported on different approaches of confronting one's own end of life, including psychosocial interventions, meaning-enhancing approaches, educational programs, and learning from lived experiences. The results suggest a clear trend toward beneficial effects on psychosocial comfort (e.g. anxiety, sense of meaning, well-being).

CONCLUSION

Low-threshold opportunities of confrontation have the potential to improve well-being and should be emphasized in practical implementation. The results can serve as a comprehensive basis for future research aiming to investigate the determinants of psychosocial comfort for people nearing the end of life.

Seeking and maintaining connections: A grounded theory study of maintaining spirituality in residential aged care facilities

BACKGROUND

Moving to a residential aged care facility involves living far from family and a familiar environment, and leaving behind the social support system of relatives, friends, and society. The pressure to find and develop new and meaningful connections in a residential aged care facility can be significant for older adults.

OBJECTIVE

To provide a theoretical explanation of how older adults seek and maintain connections in a residential aged care facility.

METHODS

A grounded theory study was conducted. A total of 17 residents were recruited from two Nepalese residential aged care facilities using theoretical sampling. Face to face in-depth, semi-structured interviews and observation within interviews were conducted. Data analysis included the process of open, axial, selective coding, and constant comparative analysis as per Corbin and Strauss' variant of grounded theory.

RESULTS

This study identified that the process of seeking connections in a residential aged care facility was forward-moving, and involved "identifying sources," "developing connections," and "appraising responses." By seeking connections, residents built new connections. Similarly, the study found that maintaining connections was a continuous process of "sustaining connections with co-residents," "preserving connections with nurses/caregivers," and "continuing connections with inner-self and higher being/s." Maintaining connections led residents to balance shifting connections. Furthermore, it was found that the process of seeking and maintaining connections was conditional on facility arrangement i.e. the way residents were placed, rules, regulations, co-residents' language, gender, religious affiliation, attitudes, the attitudes and practices of nurses/caregivers, decreasing physical abilities of residents, increasing illness of residents, illness or death of co-residents, and retirement or resignation of nurses/caregivers.

CONCLUSION

The current study provides unique insights into the process of seeking and maintaining connections in a residential aged care facility. Facility arrangement, rules, regulations, and caregiving practices should resonate with residents' socio-cultural expectations and spiritual belief system to support their process of seeking and maintaining connections.

IMPLICATIONS FOR PRACTICE

The findings can be beneficial for managers, nurses, caregivers, and spiritual advisors in developing interventions that promote the development of meaningful connections in a residential aged care facility.

Gerotranscendence and Alaska Native Successful Aging in the Aleutian Pribilof Islands, Alaska

The population of the United States is aging and by 2045 it is projected that approximately 1 in every 6 Alaskans will be 65+. Delivering healthcare and meeting the needs of older Alaskans in their community is critical to supporting healthy aging and community sustainability. Alaska Native (AN) Elders are underserved with very few studies providing an emic perspective on their experience aging. This research opens the door and allows us a glimpse of the AN Elder experience of aging: the values, beliefs, and behaviors that allow them to age well. This study highlights the characteristics and activities of AN Elders in the Aleutian and Pribilof Islands to further develop the model of AN successful aging. There are many theories of aging and this study explores a cross-cultural understanding of gerotranscendence - the personal and interpersonal changes that result from successful aging or achieving Eldership. This study interviewed Elders in two communities of the Aleutian and Pribilof Islands region. Using 22 standardized questions based on the explanatory model, researchers facilitated discussion of what it means to be an Elder and age successfully. Employing thematic analysis, interview transcripts were analyzed for themes to organize the data. Themes were organized into 5 core elements of successful aging with specific emphasis on values, beliefs, and behaviors that were protective and helped them adapt to aging-related changes. Interview content, meaning, and themes support the four elements of the AN model of successful aging developed by Lewis (The Gerontologist, 51(4), 540-549, 2011): Mental and Emotional Wellbeing, Spirituality, Purposefulness and Engagement, and Physical Health. Elders' stories highlight the importance of reflection, personal growth, and psychosocial development. Elders who more strongly identified with their role in the community described how their perspective had changed and they shared stories that emphasized culture, connection to the land, and enjoyment of daily activities that resulted in increased life satisfaction. Elders provided clear evidence that they experienced aspects of gerotranscendence, which Tornstam (Journal of Aging Studies, 11(2), 143-154, 1997) categorized as the cosmic dimension, the self, and social and personal relationships. Elders adapting to aging-related changes and embracing their role as an Elder provided the greatest evidence of gerotranscendence - they developed new perspectives on life, took on new roles within the community, and experienced a shift in mindset that reinforced the importance of culture, tradition, and the Native Way of Life. This research allowed AN Elders to share their experiences, define successful aging, and expand the concept of Eldership to include changes in mindset, values, and relationships with themselves and others. The study is a framework to help us better understand the experiences of AN Elders aging successfully and the wisdom they wish to impart to others to help them learn to live healthy and meaningful lives.

An integrative counselling program to promote active ageing for older people in Thai nursing homes: an intervention mixed methods design

BACKGROUND

Active ageing has been a rapidly developing field of study in light of the growing population of older people. Acknowledgement of the lack of a counselling program to promote active ageing for the older people in nursing homes led to the development of this study which aims to investigate active ageing of the Thai elderly in a nursing home in addition to promoting active ageing for them through integrative counselling.

METHODS

The study was conducted in a nursing home in Samut Prakan province, Thailand. The integrative counselling program referred to appropriate literature along with implementation of the Satir Model and Motivational Interviewing techniques. An intervention mixed methods design was applied in the study, which consisted of two phases. Phase 1 involved an investigation of the concept of active ageing, based on the context of older people in nursing homes by way of in-depth interviews, involving 5 participants. Phase 2 comprised of an investigation of the effects of an integrative counselling program to promote active ageing for older people in the same nursing home. There was a total of 16 participants in phase 2 which were divided equally into experimental and control groups respectively.

RESULTS

Phase 1 of the study showcased qualitative results of the progress of active ageing development in older people that resulted in 4 sub-themes (Health development, spiritual development, active engagement and psychosocial support). Two parameters were used to analyze the results in phase 2. The quantitative results showed that the active ageing score of participants in the experimental arm increased significantly after enrollment (p < 0.05). Furthermore, the experimental group had a higher overall active ageing score in comparison to the control group. Qualitative results of phase 2 elicited factors promoting active ageing in the elderly which included activities, group facilitator and group atmosphere. Both quantitative and qualitative results of phase 2 proved to be significant, showing that the program managed to develop active ageing in participants.

CONCLUSION

Psychologists and multidisciplinary teams looking after older people in nursing homes are able to use this integrative counselling program for development of active ageing in the elderly population.

Religiosity and health among Chinese older adults: a meta-analytic review

The ageing population has been rapidly growing over recent years. Theoretically, religion seemingly plays an important role in improving older people's health. This study examines whether believing in religion is related to better health conditions among Chinese older adults through a meta-analysis. Two researchers independently extracted the studies from a comprehensive database and grey literature search and evaluated their scientific quality. From the 3,777 potentially eligible papers, just 76 were selected. The pooled effect size detected no significant difference between Chinese religious and non-religious older adults’ overall health and wellbeing. Dividing the outcomes into different categories, religious older adults reported both a higher level of anxiety (Hedge's g = −0.392, 95% confidence interval (CI) = −0.494, −0.290; p = 0.004) and yet a higher level of happiness (Hedge's g = 0.342, 95% CI = 0.074, 0.610; p = 0.018). Having a higher proportion of females in the sample is related to a smaller effect size in overall health outcomes (β = −2.205, 95% CI = −3.800, −0.613; p = 0.007) and social support specifically (β = −4.660, 95% CI = −6.261, −3.058; p < 0.0001). This study is among the first to synthesise the quantitative evidence regarding health differences between older religion believers and non-believers in China. It calls for future studies investigating the pathways underlying the religion–health relationship.

Spirituality, satisfaction with life and health-related behavior of older residents of long-term care institutions-a pilot study

Spirituality and satisfaction with life are psychological factors related to health behavior. The aim of the study was to determine whether satisfaction with life acts as a mediator in the relationship between the spirituality of residents of long-term care institutions and their health-related behavior. A total of 102 people aged 60-99 were examined. It was found that satisfaction with life played a mediating role in the relationship between spirituality and health behavior. The study addresses the gap in knowledge regarding institutionalized older adults, exploring the role of spirituality and satisfaction with life on lifestyle in nursing home settings.

Spirituality and Well-Being in Old Age: Exploring the Dimensions of Spirituality in Relation to Late-Life Functioning

A growing body of research connects spirituality with positive late-life functioning. In this research, spirituality is often approached as a single measure in relation to well-being, neglecting its complex nature. Therefore, this study explores whether different dimensions of spirituality contribute uniquely to psychological well-being in advanced age. Results indicated that well-being was positively predicted by spirituality experienced through connectedness with the transcendent and through connectedness with others. Spirituality experienced through connectedness with nature did not predict well-being. These findings highlight the unique influence of each spirituality dimension on well-being as well as the need for a multidimensional approach.

Spirituality, social support, and flexibility among older adults: a five-year longitudinal study

ABSTRACTObjectives:The objectives of the study were to examine the trajectory of spirituality among older adults, to investigate the roles of gender and religion on the developmental trajectory of spirituality, and to explore whether the linear growth of spirituality accelerated or decelerated at time points at which the participants reported high scores of social support and flexibility.

DESIGN

A five-year longitudinal study.

SETTING

The research used data from a longitudinal study, which follows a non-institutionalized older adults cohort of residents from France. The data used in this paper were collected at three time points (T1: 2007; T2: 2009; T3: 2012).

PARTICIPANTS

A total of 567 participants were included in the analysis (59.44% female; Mage = 75.90, SD = 5.12).

MEASUREMENTS

Multilevel growth curve analysis was used measuring spirituality, satisfaction with social support, and flexibility.

RESULTS

The results indicated the following: (1) stability of spirituality over time, (2) older women reported higher levels of spirituality than older men, and those who had a religion reported higher scores of spirituality than their counterparts who had no religion (these effects were strong and clinically meaningful), (3) older adults who reported higher levels of social support and flexibility also reported higher levels of spirituality, and (4) the slope of spirituality seemed to accelerate at time points at which participants also had higher levels of social support and flexibility (these effects were rather small but of theoretical interest).

CONCLUSION

The results of the present study help to improve the understanding of the potential benefit of encouraging the spiritual aspects of life.

The Role of Existential Beliefs Within the Relation of Centenarians' Health and Well-Being

The purpose of this study was to explore the role of existential beliefs in mediating the influence of health on centenarians' well-being. A total of 80 centenarians (mean age 101.1; SD = 1.3; 81.3 % women) with no/minor cognitive impairment were included. The OARS questionnaire for diseases and functional capacity (ADL, IADL), the Satisfaction with Life Scale, and the existential beliefs subscale were used for data collection. The findings suggest that existential resources are a crucial element for mitigating the impact of health constraints in subjective well-being in this population. Appropriate models of intervention for very old age that recognize the importance of religion, spirituality, and meaning of life are to be considered.

Ten-Year Course of Cosmic Transcendence in Older Adults in the Netherlands

Objectives Gerotranscendence is defined as a transition from a materialistic and rationalistic perspective to a more cosmic and transcendent view of life accompanying the aging process. Would gerotranscendence levels still increase in later life? The current prospective study investigates 10-year trajectories of cosmic transcendence (a core dimension of gerotranscendence). Methods Four interview cycles of the Longitudinal Aging Study Amsterdam with 3-year intervals from 1995 to 2006 provide data on cosmic transcendence, demographics (ages 57-85), religiousness, health, sense of mastery, and humor coping. Data are available for 2,257 respondents and 1,533 respondents in multivariate models. Results Latent Class Growth Analysis shows three course trajectories of cosmic transcendence: stable high, intermediate with a decrease, and stable low. Higher levels are predicted by age, importance of prayer, Roman Catholic affiliation, a low sense of mastery, higher cognitive ability, and humor coping. Similar results were obtained for the respondents who died during the study ( N = 378). Discussion Although levels of cosmic transcendence do not show much change during 10 years of follow-up, the oldest respondents nonetheless attain the highest cosmic transcendence levels. An inclination toward relativism and contemplation may facilitate cosmic transcendence. However, lower cognitive ability probably impairs the development toward cosmic transcendence.

In Search of Rationality in Human Longevity and Immortality

The human body is machine-like, but self-moving, self-regulating, and self-adjusting, governed by willpower and intelligence. Aging of the body is basically a maintenance problem and so it could perhaps be postponed by thorough and frequent maintenance. Aging brings on a cascade of ills and health problems leading to deterioration of physical, mental, emotional, and social dimensions of life. This paper deals with solution of the problem philosophically in the light of Indian scriptures without entering into traditional bioethical issues. With a meaningful reason for existence, life can be extended. Examining the scientific perspectives on aging, some common manipulations for its extension are discussed. These are calorie restriction, vitamin and antioxidant treatment, exercise and hormonal interventions, etc. Finally, the question of longevity is explored through pursuance of eternal value-based activity and spirituality in the tradition of Indian heritage.

Characterizing Change in Religious and Spiritual Identity among a National Sample of African American Adults

We explore changes in self-reported religious/spiritual identity in 313 African American adults over an average period of 2.5 years. Changes in religious and spiritual identity were reported by half of the participants and were associated with age, education, and income. The least stability was observed among respondents identifying as religious/not spiritual at baseline but shifting to religious and spiritual at follow-up. This trend was significant for respondents age 55 and over. Faith-based interventions for African Americans should consider viewing religious and spiritual identity as a fluid rather than fixed characteristic assessing changes in spiritual and religious attributes over time.

Differences in perception of gerotranscendence behaviors between college students and community-dwelling older adults

Within the field of gerontology, several different theories have attempted to explain common psychological and social changes associated with the aging process. The Theory of Gerotranscendence is one such theory which purports that a shift in meta-perspective from a more materialistic and pragmatic view of the world to a more cosmic and transcendent one occurs as we age. Corresponding with this shift in meta-perspective, the individual exhibits certain behaviors that could be mistaken as signs of psychopathology if viewed based on the assumptions of more culturally-assimilated theories of aging. The purpose of this study was to examine the difference in perception of gerotranscendence behaviors between college students and older adults. Perceptions were quantified using an instrument that described many behaviors indicative of gerotranscendence within the context of a written narrative depicting an older adult living in an assisted living facility. Respondents were then asked to rate these behaviors in terms of how unusual they were and how concerning they were. As hypothesized, results indicated that several behaviors indicative of gerotranscendence were rated as more concerning and unusual by college students compared to older adults. Implications of these findings in terms of interactions between younger and older individuals occurring in the community and within healthcare settings are discussed.

Psychometric properties of the Swedish version of the Self-Transcendence Scale among very old people

BACKGROUND AND PURPOSE

This study tested the psychometric properties of a Swedish version of the Self-Transcendence Scale (STS).

METHODS

Cohen's weighted kappa, agreement, absolute reliability, relative reliability, and internal consistency were calculated, and the underlying structure of the STS was established by exploratory factor analysis. There were 2 samples available: 1 including 194 people aged 85-103 years and a convenience sample of 60 people aged 21-69 years.

RESULTS

Weighted kappa values ranged from .40 to .89. The intraclass correlation coefficient for the original STS was .763, and the least significant change between repeated tests was 6.25 points.

CONCLUSION

The revised STS was found to have satisfactory psychometric properties, and 2 of the 4 underlying dimensions in Reed's self-transcendence theory were supported.

Spirituality and religion in older adults with dementia: a systematic review

BACKGROUND

Religious and spiritual issues are clearly important to the older adult population and may play a positive role in maintaining health and recovering from illness. This study systematically reviewed the literature examining the effects of religion and spirituality on health outcomes such as cognitive functioning, coping strategies, and quality of life in people with dementia.

METHODS

First, 51 articles with defined keywords were collected from online databases. Then, using inclusion and exclusion criteria, 11 articles were selected. These were classified according to methodological quality before being analyzed one by one.

RESULTS

The findings highlight the benefits of spirituality and religion on health outcomes. Three articles showed that in participants who used their spirituality or religion more, through their faith, their practices and in maintaining social interactions, their cognitive disorders tended to reduce or stabilize. In the other eight articles, use of spirituality or faith in daily life enabled people to develop coping strategies to help accept their disease, maintain their relationships, maintain hope, and find meaning in their lives, thereby improving their quality of life.

CONCLUSIONS

Spirituality and religion appear to slow cognitive decline, and help people use coping strategies to deal their disease and have a better quality of life. This literature review allows us to take stock of research over the last decade on spirituality/religion and health outcomes. The benefits observed should be considered with caution and included in rigorous experimental research in the future.

Experiences of spirituality and spiritual values in the context of nursing - an integrative review

Spirituality is often mistakenly equated with religion but is in fact a far broader concept. The aim of this integrative review was to describe experiences of the positive impact of spirituality and spiritual values in the context of nursing. The analysis was guided by Whittemore and Knafl's integrative review method. The findings revealed seven themes: 'Being part of a greater wholeness', 'Togetherness - value based relationships', 'Developing inner strength', 'Ministering to patients', 'Maintaining one's sense of humanity', 'Viewing life as a gift evokes a desire to 'give back'' and 'Achieving closure - life goes on'. It is difficult to draw definite conclusions, as spirituality involves many perspectives on various levels of awareness. However, spirituality was considered more inclusive, fluid and personal. Furthermore, it emerged that spirituality and spiritual values in the context of nursing are closely intertwined with the concept of caring.

Development and psychometric testing of the active aging scale for Thai adults

Background

Active aging is central to enhancing the quality of life for older adults, but its conceptualization is not often made explicit for Asian elderly people. Little is known about active aging in older Thai adults, and there has been no development of scales to measure the expression of active aging attributes.

Purpose

The aim of this study was to develop a culturally relevant composite scale of active aging for Thai adults (AAS-Thai) and to evaluate its reliability and validity.

Methods

Eight steps of scale development were followed: 1) using focus groups and in-depth interviews, 2) gathering input from existing studies, 3) developing preliminary quantitative measures, 4) reviewing for content validity by an expert panel, 5) conducting cognitive interviews, 6) pilot testing, 7) performing a nationwide survey, and 8) testing psychometric properties. In a nationwide survey, 500 subjects were randomly recruited using a stratified sampling technique. Statistical analyses included exploratory factor analysis, item analysis, and measures of internal consistency, concurrent validity, and test–retest reliability.

Results

Principal component factor analysis with varimax rotation resulted in a final 36-item scale consisting of seven factors of active aging: 1) being self-reliant, 2) being actively engaged with society, 3) developing spiritual wisdom, 4) building up financial security, 5) maintaining a healthy lifestyle, 6) engaging in active learning, and 7) strengthening family ties to ensure care in later life. These factors explained 69% of the total variance. Cronbach’s alpha coefficient for the overall AAS-Thai was 0.95 and varied between 0.81 and 0.91 for the seven subscales. Concurrent validity and test–retest reliability were confirmed.

Conclusion

The AAS-Thai demonstrated acceptable overall validity and reliability for measuring the multidimensional attributes of active aging in a Thai context. This newly developed instrument is ready for use as a screening tool to assess active aging levels among older Thai adults in both community and clinical practice settings.

Productive engagement in older adults: a concept analysis

This study aimed to clarify the concept of productive engagement as it applies to older adults. The concept analysis was based on Walker and Avant's eight-step method. A literature review of articles published in English between 1990 and 2011 (n = 37) was conducted, using an electronic search of multiple sources. Results revealed that four defining attributes for productive engagement include continuing to work either paid or unpaid, caring for others, engaging in social activities, and growing spirituality. The antecedents of productive engagement are sociocultural factors as well as individual and institutional capacities. Meanwhile, the consequences are increased feelings of usefulness, improved health and well-being, aged successfully, and enhanced quality of life. Model, borderline, and contrary cases are presented to illustrate the concept's defining attributes. Defining the concept of productive engagement provides a basis for nurses and other health professionals to better understand productive engagement in older adults, thus effective strategic plans or programs for promoting productive roles among older adults can be further developed.

A espiritualidade nas pessoas idosas: influência da hospitalização

A espiritualidade é a busca pessoal do significado e propósito da vida, e assume relevância na velhice. A hospitalização na velhice é vivida com muita ansiedade, tendo a espiritualidade demonstrado ser uma boa estratégia de coping. Este estudo procura analisar a influência de variáveis sociodemográficas, patologia e tempo de internamento. A amostra é constituída por 250 participantes (≥ 65 anos), sendo 50,4% do sexo feminino. A Escala de Espiritualidade, composta por cinco itens organizados em escala de Likert de cinco pontos, foi administrada por entrevista. Os principais resultados mostram que: a) 57% dos participantes mantêm a média de espiritualidade na admissão e alta (57%), sendo que 22,5% mantêm espiritualidade baixa e 22,5% mantêm espiritualidade elevada; b) 43% dos participantes revelam alterações na espiritualidade, 21,9% apresentam diminuição entre admissão e alta e 20,8% demonstram aumento. Os dados indicam que os idosos que vivem em casal são os que tendem a aumentar a espiritualidade durante a internação. A hospitalização pode ter impactos diferentes na espiritualidade das pessoas idosas, por isso deve ser valorizada pelos profissionais de saúde.

Power resources of older people in Iran

BACKGROUND

Maximising the client's power resources facilitates their ability to cope with chronic illness. Nurses must be well informed about power resources and feelings of empowerment among older people.

AIM

This article reports on a study exploring power resources in daily life from the perspective of older people in Iran.

DESIGN

A qualitative content analysis study was conducted. The participants were selected from older community dwellers in Iran using in-depth, semi-structured interviews to understand their experiences with power resources.

RESULTS

Power in older people in Iran is represented by four dimensions: spiritual, intellectual, social and physical. Each power dimension can be divided into intrinsic and extrinsic modes.

CONCLUSION

By maximising older people's power in intellectual, social and especially in spiritual resources, the effect of the loss of physical power, with its deteriorative or depressogenic effect on older people's sense of power and well-being can be compensated for. It is recommended that nurses should plan their interventions to enhance older people's power, especially their spiritual power.

IMPLICATIONS FOR PRACTICE

Different models of empowering older people should be explored in Iranian nursing care delivery.

Spiritual perspectives of Black Caribbean and White British older adults: development of a spiritual typology in later life

Spirituality is positively linked to health and well-being in later life, particularly among older adults of black ethnic groups. However, definitions of spirituality in the literature have largely been theoretically informed, rather than based on the views of older people themselves. We examined the spiritual perspectives of Black Caribbean and White British older adults based on in-depth interviews with 34 individuals aged between 60 and 95 years. Our aim was to develop a spiritual typology to add to an understanding of the process of spirituality in later life. Findings showed that Black Caribbean older individuals mostly defined spirituality in relation to their belief in a transcendent God, whereas White British older individuals tended to draw upon a wider range of spiritual, religious or secular notions. A spirituality typology in later life captured four categories of relationship, between ‘God to self’, ‘self to God’, ‘self to universe’ and ‘self to life’. The typology highlights the central role of ethnicity in shaping spiritual perspectives in later life, and identifies the multidimensional nature of spirituality among older adults, reflecting in part a developmental process, although a process which is socially and culturally constructed.

Holocaust survivors: three waves of resilience research

Three waves of resilience research have resulted in resilience-enhancing educational and therapeutic interventions. In the first wave of inquiry, researchers explored the traits and environmental characteristics that enabled people to overcome adversity. In the second wave, researchers investigated the processes related to stress and coping. In the third wave, studies examined how people grow and are transformed following adverse events, often leading to self-actualize, client creativity and spirituality. In this article the authors examined data from a study, "Forgiveness, Resiliency, and Survivorship among Holocaust Survivors" funded by the John Templeton Foundation ( Greene, Armour, Hantman, Graham, & Sharabi, 2010 ). About 65% of the survivors scored on the high side for resilience traits. Of the survivors, 78% engaged in processes considered resilient and felt they were transcendent or had engaged in behaviors that help them grow and change over the years since the Holocaust, including leaving a legacy and contributing to the community.

Does Psychological Contract Breach Decrease Proactive Behaviors? The Moderating Effect of Emotion Regulation

In a set of two studies, based on employees from two countries, we examined how emotion regulation moderates the relationship between psychological contract breach and (a) feelings of violation and (b) proactive behaviors (knowledge sharing and taking charge). We found that cognitive change buffers the negative effect of breach on feelings of violation and knowledge sharing (Study 1, United States). We replicate this result using taking charge as an outcome. In addition, we demonstrate that using high levels of attentional deployment as an emotion regulation strategy accentuates the negative effect of both social and generative breach on employees’ taking charge (Study 2, the Netherlands). Based on our results, we call for additional research on how emotion regulation modifies the relationship between psychological contract breach and work outcomes.

‘We want a peaceful life here and hereafter’: healthy ageing perspectives of older Malays in Malaysia

Healthy ageing concepts have been extensively studied in Western societies but few studies have explored the perceptions of older people from other cultural backgrounds. The aim of the study was to explore the conceptualisations of healthy ageing and perceived influences on ageing well amongst relatively healthy older Malays, a major ethnic group in Malaysia. Eight focus groups were conducted, with 38 participants recruited via community groups and leaders. Six themes were identified: spirituality, physical health and function, peace of mind, financial independence, family, and living environment. In this paper, we focus on the role of spirituality in healthy ageing which was a core resource in participants' lives. Participants reported that good physical health was an important resource that facilitated commitment to their spiritual activities. Furthermore, deteriorating functional ability appeared to provide an opportunity to optimise their spirituality, rather than hinder it. Participants wished for a ‘peaceful life’ and experienced this by enhancing their spirituality. Other ingredients for a peaceful life were financial independence, living in a place they love and having family members who live in harmony. In this community where religious affiliation is a tradition, spirituality can be fundamental for healthy ageing and its inclusion in aged care policy is imperative. However, further exploration on the diversity of individual expression of spirituality is important.

Coping with the caregiving role: differences between primary and secondary caregivers of dependent elderly people

OBJECTIVES

The topic of how primary informal caregivers cope with their caregiving demands has generated significant research. However, little is known about secondary informal caregivers, who often share caregiving responsibilities. This cross-sectional study aims to analyse and compare the use and effectiveness of coping strategies of primary and secondary informal caregivers of dependent elderly people, living at home.

METHOD

A sample of 180 informal caregivers of dependent elderly people - 90 primary and 90 secondary caregivers - was obtained. The study was conducted in the district of Aveiro (Portugal). The Portuguese version of Caregivers' Assessment Management Index - CAMI (Nolan, Keady, & Grant, 1995) was administrated to both sub-samples.

RESULTS

Findings suggest that emotion-cognitive strategies are less efficient for secondary caregivers (e.g. drawing on personal or religious beliefs). Common problem-solving strategies adopted by both types of caregivers involve relying on own their experience and expertise and addressing and finding a solution to the problem. Neither group were highly efficient at managing care-related stress, but both identified benefits from taking time off or maintaining interests outside of caregiving.

CONCLUSION

These findings can guide professionals in targeting and monitoring interventions aiming to develop caregivers' effective coping strategies. Besides, engaging secondary caregivers in current available interventions and services, usually targeted to the primary caregiver, is of paramount need, as they can reduce the burden of primary caregivers and delay institutionalisation.

The role of religion in shaping sexual frequency and satisfaction: evidence from married and unmarried older adults

This study assesses the role of religion in influencing sexual frequency and satisfaction among older married adults and sexual activity among older unmarried adults. The study proposes and tests several hypotheses about the relationship between religion and sex among these two groups of older Americans, using nationally representative data from the National Social Life, Health, and Aging Project. Results suggest that among married older adults, religion is largely unrelated with sexual frequency and satisfaction, although religious integration in daily life shares a weak, but positive, association with pleasure from sex. For unmarried adults, such religious integration exhibits a negative association with having had sex in the last year among women, but not among men.