How to manage spiritual distress in the elderly?

From the Guidelines

Managing spiritual distress in the elderly requires a compassionate, multifaceted approach that addresses their unique needs, as highlighted in the 2020 European Association for Palliative Care task force expert position statement 1.

Key Considerations

To effectively manage spiritual distress, consider the following:

• Create opportunities for open conversations about spiritual concerns, allowing seniors to express their feelings about meaning, purpose, and transcendence without judgment.
• Encourage connection with faith communities by arranging transportation to religious services or inviting spiritual leaders for visits.
• Incorporate meaningful rituals into daily routines, whether through prayer, meditation, reading sacred texts, or other practices that align with their beliefs.
• Support life review processes by listening to their stories and helping them find meaning in their experiences.
• Engage family members in understanding the elder's spiritual needs and preferences.
• For those in healthcare settings, request chaplain services when appropriate, as suggested by the 2017 American Society of Clinical Oncology consensus guideline 1.
• Respect cultural and religious diversity by learning about specific practices important to the individual.
• Address existential questions about mortality with patience and presence, acknowledging that some questions may not have definitive answers.
• Consider complementary approaches like music therapy, nature connection, or art that may provide spiritual comfort, as noted in the 2019 evolution of spiritual care in the NCCN distress management guidelines 1.

Holistic Approach

This holistic approach recognizes that spiritual wellbeing is deeply personal and integral to overall health, particularly as individuals face the challenges of aging and mortality. By prioritizing spiritual care and incorporating these strategies, healthcare providers can better support the unique needs of elderly individuals experiencing spiritual distress, ultimately improving their quality of life and overall wellbeing.

From the Research

Managing Spiritual Distress in the Elderly

To manage spiritual distress in the elderly, it is essential to understand the spiritual needs of this population and provide appropriate care.

• Spiritual care aims to counter negative outcomes from spiritual distress and is beneficial to persons living with dementia 2.
• Healthcare providers are well situated to observe the nature of spiritual needs across and within medical conditions, and their roles in addressing them are crucial 2.

Assessing Spiritual Needs

Assessing the spiritual needs of patients is fundamental to providing effective spiritual care.

• Several formal spiritual assessment tools are available to assist nurses to identify patients' spiritual needs and to determine whether they are experiencing spiritual distress 3.
• Eleven domains in spirituality that might be assessed in older adults have been identified, including an explanation and a brief discussion of the rationale for including each domain in the classification 4.
• Informal assessment of patients' spirituality can be done by asking open questions about their spiritual beliefs and needs 3.

Providing Spiritual Care

Providing spiritual care to the elderly requires a holistic approach that takes into account their physical, emotional, and social needs.

• Nurses who provide spiritual care operate from an integrated holistic worldview, which develops from personal spirituality, life experience, and professional practice of working with the dying 5.
• Quality spiritual caregiving requires time for nurses to develop the personal, spiritual, and professional skills that enable spiritual needs to be identified and redressed 5.
• Supportive work environments underpin such care, and nurses should be aware of the limits of their competence in undertaking spiritual assessment and providing spiritual care, and refer patients to the healthcare chaplain or other spiritual support personnel where necessary 3.

Spiritual Care in Geriatric Palliative Care

Spirituality is an essential domain of geriatrics palliative care, and guidelines for clinicians to diagnose spiritual distress and to integrate spirituality into their clinical practice are available 6.

• Spiritual care provision to end-of-life patients is crucial, and nurses are responsible for assessing these needs and providing holistic care 5.