Understanding spirituality and religiosity among very old people : measurements and experiences

Abstract: Background: Spirituality is a multifaceted concept. In this thesis, spirituality is understood as an overarching term and a core of a person´s being. Religiosity is seen as one of many expressions of spirituality. Very old people are a vulnerable population, with an increased risk to be exposed to negative life events. Spirituality is suggested to have an impact on the possibility to adapt to life circumstances and manage age-related challenges.Aim: The overall aim of this thesis was to assess psychometric properties of instruments and to gain understanding about associations and experiences in relation to spirituality and religiosity among very old people.Method: The thesis has been conducted in the population based Umeå 85+/GERDA study. Half of those aged 85, all 90 year old, and all aged 95 and older in Umeå, Västerbotten, northern Sweden and in Ostrobothnia in Western Finland were invited to participate (cf. Näsman et al, 2017). Questionnaires used to measure religiosity versus spirituality were the Religious Orientations Scale (SROS) and the Self-Transcendence Scale (STS). None of these has previously been validated among very old people in a Swedish context. Factors associated and correlating with STS score are presented. How very old people express and perceive spirituality is also studied. Result: The participants in study I scored high on both subscales, indicating that they were religious in both an intrinsic and extrinsic manner. The SROS ability to distinguish between intrinsic and extrinsic items was tested. The cluster analysis revealed three clusters interpreted as intrinsic, extrinsic-personal, and extrinsic-social religious orientation, with no cross-loadings. The revised version of STS, (study II) with 10 items, had satisfactory psycho­metric properties (α .83). A factor analysis resulted in a two-factor solution (α .78 & .73). Test-retest reliability and concurrent criterion validity were supported. In study III STS showed a positive association with psychological well-being, self-rated health, having someone to talk with, and being able to go outdoors indepen­dently. A negative association was found between STS and diagnosis of depression, dementia disease, osteoporosis, living in a geriatric care institution, and feeling lonely. An accumulation of negative life events was associated with a larger decline of STS score over five years. Findings in study IV showed that spirituality was perceived as a connectedness to God, and other people. Telling about spiritual experiences was described as un­common in conversation due to the private nature of the subject area and because of a fear of being considered as dubious. The findings also showed that experiences of spirituality were connected to a view of life where participants were transcending life’s circumstances, and experiencing mysteries. Conclusion: The results propose that the Swedish version of SROS and STS, aimed to measure religious orientation versus self-transcendence have satisfactory psychometric properties and are feasible to use among very old people. Furthermore, self-transcendence was positively and significantly, associated and correlated, to a number of factors known to enhance well-being. Spirituality was understood as including religiosity, a belief in God, connectedness to other people and conviction about a spiritual reality. The very old expressed a desire to share personal beliefs and experiences of spirituality, but they found it difficult due to a fear of not being taken serious. Hence spiritual needs can be unnoticed within the health care context, health care professionals need knowledge in order to recognize expressions of spirituality, and skills to support patients in a need of spiritual care.