Supporting Spirituality in Seniors

By Dorrie Rosenblatt

Years ago, when I was working as a geriatrician, I had a patient named Maria. She was an 82-year-old Italian woman who had been raised in a convent in Italy. She had crippling arthritis that gave her terrible back and knee pain, and was only minimally relieved by all the many medical interventions we tried. She spent most of her day on a narrow bed in her bedroom where she had a life-size statue of Saint Therese of Lisieux. She managed to drag herself to church every day where she insisted on painfully kneeling during Mass despite my attempts to convince her that God would hear her prayers just as well if she sat in the pew. Although I considered myself to be a spiritual person, I still found it hard to understand how her faith could sustain and allow her to keep going in a situation that most people would have found intolerable.

In the last few decades, spirituality has become a hot topic. Searching on Amazon for books on spirituality pulls up over 70,000 titles. Although spirituality in general has been a focus of interest, spirituality in the elderly has really only received academic attention in the last twenty years. Robert Atchley’s seminal book, Spirituality and Aging, was written in 2009. One problem with research on the topic has been the lack of clarity on differentiating between religiosity and spirituality. There is now something of a consensus that spirituality is the personal search for deeper connection with the Divine, as the person understands it, as opposed to religiosity, which is associated with a specific religion with fixed theology, dogma, and rituals. 

A spiritual journey may take place in the setting of specific religious observance, but often it takes the form of a search outside the boundaries of formal religious observance. A spiritual journey usually involves aspects of committed spiritual practice, self-discipline, and integrating insights gained into daily life. The spiritual practices can take the form of prayer, meditation, chanting, mindful movement such as Tai Chi or Yoga, or time spent in Nature as a few examples. In a recent survey, a quarter of people defined themselves as spiritual but not religious. This percentage is predicted to grow as the Baby Boomers, a generation of eclectic seekers, ages.

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Traditionally, elders had the role of transmitting sacred knowledge and rituals. In many cultures people were expected to spend their later years focusing on spirituality. A prime example of this is the fourth, or Sannyasa (renunciate), stage of life in the Hindu tradition. In this stage of life, elders were expected to leave the family and worldly concerns, and retire to the forest to seek God and enlightenment. Even without withdrawal from society, spirituality continues to be an area in which people can experience continued growth and development in their later years. 

Studies have also shown that seniors who report deep religious or spiritual connection have a better quality of life and better health outcomes. Even those seniors who actively seek to age “successfully” experience many kinds of losses in later life which can include decreases in vision and hearing, decreased mental acuity, loss of robust health with simultaneous development of acute and chronic illness, loss of mobility, loss of independence, loss of home when care needs mandate a move to a facility, loss of family and friends, and finally facing loss of life as death approaches.

Facing death can be a particularly scary experience without the support of a spiritual connection. I know from my own experience. When I was told at age thirty-six, after a cardiac catheterization that was supposed to prove the chest pain I had been having for almost two years was “psychosomatic,” that I needed emergency bypass surgery, I was terrified. That was in 1984. It has been an interesting experience to see how, over the years of a more committed spiritual practice and deepening connection with the Divine, my feelings have changed from fear to deep gratitude for every day and a complete lack of fear of death. This experience has convinced me of the importance of a sense of spiritual connection, especially in later life when people face multiple losses and death.

In the past, most spiritual counseling has taken the form of pastoral counseling based in a particular religious tradition. As the number of “spiritual but not religious” people increases, there will be an increased need for people trained in spiritual counseling who are not clergy associated with a specific religious tradition.

My own background is that of a geriatric physician, an Interfaith minister trained in Interspiritual counseling, and a long-term spiritual seeker. Interspiritual counseling draws on the Perennial Wisdom that is common to all the major religious traditions.  As the German theologian and mystic Meister Eckhart (c.1260 – c. 1328) said, “Theologians may quarrel, but the mystics of the world speak the same language.” The four major tenets of Perennial Wisdom as outlined by Rabbi Rami Shapiro are:

The phenomenal world of matter and individual consciousness is a manifestation of a Divine Ground in which all have their beginning and without which they would not exist; 

The Divine Ground can be known not only from inference but also, and more importantly, through direct intuition which unites the knower with that which is known;

Man possesses a phenomenal ego (small self) and an Inner Self (a spark of the Divine) with which he can choose to identify: 

The purpose of Mankind’s life on earth is to identify himself/herself with the inner Divine Self and to come to unitive knowledge of the Divine Ground.

Visit Ann Arbor Center for Mindfulness online for more information.

Interspiritual counselors use teachings and practices drawn from all the major religious traditions to assist their counselees in deepening their connection with the Divine and in integrating their insights and wisdom into their daily life. One of the main challenges in Interspiritual counseling is to create an individualized spiritual practice consistent with the counselee’s beliefs and interests. I think the most challenging person I have worked with was a middle-aged professional woman with a very high anxiety level and an inability to relax and just be. She had signed up for the pro bono counseling program at the seminary that was staffed by trainees. When we first connected, I began, as usual, by asking her about her spiritual beliefs, and she stated that she did not believe in any sort of higher power. My first reaction was one of not understanding why, in that case, she had signed up for spiritual counseling, but I came to realize that she felt a need for connection with something. She liked being in nature and she liked practicing yoga. After contemplation and connection with my own source of inner wisdom, I was moved to offer her a breathing meditation. I suggested that she sit and ground herself. Then I asked that on the in breath she say internally “may I receive what I need to receive” and on the out breath say “may I release what needs to be released.” I asked her to try it for a minimum of five minutes a day until we met again. At our next session, she reported that the practice had really resonated for her and that she felt more relaxed and connected with something outside of herself. She had even taught the practice to members of her yoga group. She had taken a first, tiny step on a spiritual journey, and I was happy that I had been able to create a practice that worked for her.

There is also a role for Interspiritual and traditional clergy in educating those caring for the elderly, particularly those in the Health Care Professions, about the importance of asking about older patients’ spiritual beliefs and integrating spiritual care into their over-all Plan of Care. As noted above, seniors with a deep religious or spiritual connection have better outcomes in terms of health and quality of life. So, it is vitally important that all those caring for the elderly, from caregivers, to medical personnel, to those providing psychosocial support, be trained in addressing the spiritual needs of seniors and how to provide the spiritual support that can make such a difference in the quality of patients’ lives and also in how they and their families experience death.

Starting in 2030, when all “boomers” will be older than 65, older Americans will make up 21 percent of the population (compared to 15 percent today). By 2060, nearly one in four Americans will be 65 years and older, the number of 85-plus will triple, and the country will add a half million centenarians. This makes it imperative that there be more research into spirituality in the older population, more education on how to assess and support the spiritual needs of older people, and more people prepared to undertake the requisite training and to provide the needed support for all of those seniors for whom spiritual life is so important.

Rev. Dorrie Rosenblatt, M.D., Ph.D. practiced as a physician board certified in Internal Medicine and Geriatrics, first at Harvard and then at the University of Michigan. When she had to take early retirement from medicine due to illness, she started a second career as an Interfaith Minister and was ordained in 2014 after a two year training in Interspiritual Counseling. She offers both individual and group counseling, and as part of her own spiritual practice, she offers these services to seniors for whatever fee fits their budget. She can be reached at drosenbl@umich.edu or (734) 665-4186.

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