The Importance Of Reducing The Emissions That Are Emitted...

Altomonte- The article stats off with talking about the importance of reducing the emissions that are emitted by, and go into building buildings. The article explains the history of global warming, and the science behind the basics of climate change and warming. It stateZs how â€Å"humans have changed the chemistry of the atmosphere through the combustion of fossil fuels and living matter, bringing about the prospect of global alterations and shifts in the whole terrestrial climate system(Altomonte,2008,pg.97).† It is this reason that the world is experiencing climate change, and though the climate may have been naturally warming since the beginning of time, it was at a pace that was slow enough to species to migrate when they need to, and†¦show more content†¦Climate change is expected to negatively affect the future of most developing countries, increasing the pressure on available resources that are associated with urbanisation and industrialisation(102). With these affects in mind, Altomonte explains the mitigation and adaptations strategies to mitigate the possible consequences of climate change. He highlights the issue of buildings, and how they highly contribute to the issue of direct fossil fuel emissions, and therefore it is necessary that buildings reduce their dependency on fossil fuels, curb their energy demands, exploit clean power sources and minimise their wastes(103). Suitable technologies must therefore be integrated into the design of current buildings to guarantee social, economic and environmental growth. Using new design strategies is necessary to create buildings that ensure comfort and health of the staff, as well as do not negatively impact the environment. To create such a building all fields of study must be included, inclduing physchology, climatology and engineering so that there is whole understanding of the necessary features for the building to reduce emissions and include necessary social, econmic and cultural values (106). Altomonte states how these conditions of a new climate, now seem unavoidable(99), but there is solutions to be made to

Comparing Hercules by Walt Disney and Creating the Myth...

One of the greatest Greek mythological stories portrayed in a movie would be Hercules. Hercules is a well-known hero; he displays a supernatural individual who has to overcome the villain and his bad monsters. In â€Å"Creating the Myth† by Linda Seger, she argues that the hero myth as many obstacles (the death experience, the road back, the reborn) that he or she need to overcome to be transformed into a hero. However, these obstacles play a very important role in the hero’s stage of initiation. The movie â€Å"Hercules† by Walt Disney and the creator Alan Menken, we encounter the characters of the movie which are Hercules of course, Philoctetes the trainer, Pegasus the horse, loyal companion, Megera the love of Hercules and Hades the†¦show more content†¦Later in the movie we are introduced with Philoctetetes (a goat) the trainer who trains Hercules in gaining valuable exercises and activities that he may later has to challenge. Hercules then encounte r with 12 tasks and he overcome them all with his bare hands Phil Comes to realize that Meg Hercules love is betraying him, Hercules ignores him treating him unfair and leaves him. Unfortunately, Hercules found out that it was true ad felt awful forgave Phil he needed him at the end Hercules being a kind individual listened to all the good advice that Philoctetes had to offer. Secondly, without his courageous personality Hercules could not have overcome many obstacles. Hercules gained experienced of a quality hero and achieved appreciation â€Å"the hero is now ready to move into the special world where he will change from the ordinary into the extraordinary† (Seger 3) because he transformed into a new individual. Seger states that â€Å"this happens at the first turning point of the story† which is called the initiation (road of trials) therefore the hero is ready to begin with his task. For example, in the movie, Hercules encounters with many challenging task which were a battle of series monsters that were sent by Hades. His most important challenge was to rescue the tough-talking beautiful girl Megara who is secretly involved with hades to posses Hercules in falling in love with her and take over his power. But they both fall in love and it becomes

Brothers Collapse In Financial Time Series -Myassignmenthelp.Com

Question: Discuss About The Brothers Collapse In Financial Time Series? Answer: Introduction Audit is an independent process of investigation of books of accounts by an individual who has required qualifications in order to determine whether the books of accounts are showing true and fair view or not. The person who conducts an audit is called an auditor. The main responsibility of an auditor is to ensure whether the financial statements are showing true and fair view or not (Griffiths, 2012). Many Companies have wrong conception that the main responsibility of an auditor is to detect fraud, but this is not the case. An auditor always has to prepare a plan which will guide him how to conduct the process of audit step by step. The three fundamental principles which any auditor must follow are integrity, objectivity and independence (Wright Capps, 2012). The principle of integrity states that the process of audit should be conducted in a way which displays the level of skills and competence on the part of the auditor. The principle of objectivity states that the audit process should be conducted in a professional manner while collecting material audit evidences on the basis of which an auditor forms a judgement. The principle of independence states that the auditor should not be related to the clients for which the audit is being conducted. Independence of an Auditor The independence of an auditor is a crucial factor which affects the overall audit process. In any audit, the auditor are specifically disqualified from conducting audit for any related person to the auditor. The independence of an auditor is important as the opinion of the audit needs to unbiased and uninfluenced (Tepalagul Lin, 2015). The auditors opinion on a financial report of a company is the basis on which investors decide whether or not to invest in the company. The auditor is responsible to the investors and it is their responsibility to report to the general public whether the financial statements are showing true and fair view or not. In other words, the role of an auditor is essential in establishing credibility of the financial report (Vona, 2012). While the process of audit has wide range of variables which affect the opinion on financial reports which is used by stakeholders, investors, government on the basis of which decisions about capital allocations are taken. Th e importance of an auditors independence is significantly depicted by the corporate failures which have taken place in recent times. As per the various standards which have been introduced in most of the countries on the independence of the auditor states that the auditor should be independent both in facts and in appearance. As per the provisions of section 290 of APES 110, an auditor must be independent from the client. Independence as per section 290 can be classified in two kind independence of mind and independence in appearance (Cpaaustralia.com.au., 2018). The concept of independence is crucial to the principles of integrity and objectivity for quality of the audit. As per section 120.1 of APES 110, the principle of objective states that an auditor should not compromise their judgement or become bias under undue influences of others. Another main principle of audit is that an auditor must be independent in making judgement on the financial statements of the client. The major threats to independence which arises out of which some instances are mentioned below: When an auditor holds an important position in the company where the auditor is conducting audit such as a post of director or holds certain self interest in the company. In such cases the auditors independence gets affected. When the auditor is closely related with the client whose audit is being performed. Another situation is that when the auditor advices the company on how to improve the accounting process of the company during the course of audit is considered to be unethical and a threat to the principle of independence. Therefore from the above instances it is clear that the auditors independence is threaten by factors such as self interest, familiarity and intimidation on the part of the management. In some cases the management also puts restriction on the independence of the auditor. For example when a management does not provides access to the auditor to a particular set of records during the course of audit than such shall be regarded as restriction on the audit by management. However such threats to independence can be overcome by implementing suitable safeguards to mitigate the threats to independence. The rotation of the audit team in case of an audit firm can to a wide extent overcome the threats to independence. Risks in Audit Risk based auditing is an independent and objective process of collecting audit evidences for the purpose of framing an opinion on the financial statements. It is primarily related to the inherent risks that an auditor faces while conducting an audit. It is a dynamic process which is continuously evolving and which is very effective (Hull, 2012). In any audit process there is major amount of risks involved whether these are inherent risks, business risks or compliance risk. Moreover risk based audit is more effective than the traditional approach as it continuously surveys those areas where there is a chance of risk or fraud or those areas where effective control has not been exercised. This helps in resolving the issues before any major damage is committed. It also ensures that internal control is always at its best at detecting errors and whether necessary measures are also taken or not. Business Risks can be defined as the risks that a business faces which can result in lower earnings than what was expected or a situation where there is no profit that is a loss. It is influenced by many factors such as change in technologies, change in taste and preference patterns, rise in input prices, governmental regulations (Alexy Reitzig, 2012). In other words business risk means that there might be uncertainty in profits or a situation may arise where there is a risk of loss. Business risks which arises due to some future events which may or may not happen, might affect the going concern of a business. These risks can arise due to both external factors as well as internal factors. Internal risks are risks which occur within the organisation and which can be controlled by the organisation (Knechel Salterio, 2016). For example errors committed by employees, fraudulent activities of employees, technological upgrade, better access to credit facilities. External risks are those risks which arise from outside the organisation and which cannot be controlled. Business risk can be classified into five main types Strategic risks: These are risks which are associated with the business environments of the industry concerned. Financial risks: These are associated with the financial requirements of an industry (Christoffersen, 2012). Operational risk: These are associated with the operational activities of industry. Compliance risks: These refers to the legal risks that an industry faces , for example rules and regulation of the land. Other risks: These contains miscellaneous risks like natural disasters which are depended on natural forces. Risk of Material Misstatements are associated with financial accounts in which one or more data is misstated to a level of material significance. This is to be determined by the auditor whether a misstatement exists and whether it is material enough for him to consider it as a material misstatement. This aspect consists of risks of detection, inherent risks and risk related to internal controls. Detection risks are risks which can be reduced by the auditor. Inherent risks occur when there is an omission or error which has nothing to do with the companys internal control. Inherent risks take place when the transactions are of complex nature or a situation where better judgement is required on the part of the auditor. Control risks are those risks which are not detected by the companys internal control. When the material misstatement risk are high then it will also affect the overall audit process Literature Review The concept of audit independence states that the auditor should not be related in any way to the organization on which the audit is being conducted. The term of independence is very crucial to the whole auditing process as if an auditor is independent than the reliability of the audited financial statements increases (Wright Capps, 2012). An article shows that an auditors independence and the overall quality of audit is closely related. The article recognizes four major threats which can affect the independence of the auditor are client importance, non-audit services, auditor tenure and client affiliation with the firm. As per this article these affect the overall independence of the auditor is major determinant of the quality of the audit. Recent studies show that the auditor is able to perform much better in case he is independent. Besides this, Independence of an auditor is one of the fundamental principles of auditing (Tepalagul Lin, 2015). Auditing is also closely related wit h corporate governance. A recent study of china show that the government is trying to improve the corporate governance of the county and also the quality of external audit. Though the main responsibility of an audit is not to detect frauds and errors, but effective audit process helps management identify the weakness which are present in the organization whether such weaknesses exists in internal control or some process of the company (Gao Kling, 2012). The auditors responsibility is not to detect frauds, however if during the course of audit the auditor finds occurrence of fraud then he must inform the management of such and also suggest necessary steps which can be taken. Therefore it is clear that auditing process provides assistances to the overall corporate governance policy of the company. If proper audit is conducted then such reduces the chances of scams and the company can thus supervise its governance effectively. In this modern times, risk management has taken up lot of attentions of the people as the society have seen a lot of scandals which could have been managed or detected earlier. Similar is the case of Enron, which was a natural gas pipeline company. The company changed from gas supplying company to an energy trading company and later on was engaged in building powerplants and utilities from abroad. Theses were based on financial contracts based on prices of gas which the company used to reduce risks with such future gas prices. Now in behind doors the company hid losses which the company suffered and debts as well which were concealed through complex process. The company was also involved in electricity in California, where soon crisis started out which involved frequent blackouts and overpriced electricity. When the financial records of the company was audited the scandal was revealed and the company immediately went in bankruptcy (Ailon, 2012). Similar case study shows the scandal of Worldcom which is regarded as the biggest in the history. Worldcom was a US based company which provided telecommunication services in the country. While conducting an internal audit of the company, the financial records revealed that the company had improperly accounted for $3.8 billion in operating expenses over a period of five quarter. This was major blunder which attracted criminal proceedings against the CEO and CFO of the company and the company was filed for bankruptcy. The CEO was sentenced to imprisonment for 25 years as the economy has suffered a huge loss, stock market was deeply affected and more than 17000 employees of the company were now unemployed. The company also had a huge amount of personal loans in the name of the directors of the company (Cronje, 2014).The auditing of the Worldcom was done by Aurther Anderson an auditing firm which also audited Enron corps which was also closed due to mismanagement. Hence it is clear the role that audit plays in the efficient investigation of the financial statements with a view to form an opinion but also detect scandals which can affect the economy as a whole. The case study of Lehman Brothers show how risks and miscalculated moves can bring about a downfall in the company. The company had invested in the subprime mortgage market and acquired five mortgages. As the crisis started in 2007 the stock prices of Lehman fell sharply and the company had to cancel 2500 mortgages and shut down one of its units. The company the for some quarters earned losses and the prices of the stocks continued to fall along with the pressure of high leverage of the firm (Quax, Kandhai Sloot, 2013). This shows how too much risk and ineffective risk management can affect a business drastically. Conclusion Thus from the above analysis of facts and cases it is clear that the independence of auditor is a crucial factor for a proper audited financial reports which can then be used by stakeholders to take investment decisions. Moreover effective risk management strategy is also essential for the business which can counter situations which arise in Lehman Brothers. The report concludes with the fact that how audit can be used for effective investigation of the books of accounts as well as detection of any frauds which may be happening in a business. Reference Ailon, G. (2012). The discursive management of financial risk scandals: The case of Wall Street Journal commentaries on LTCM and Enron.Qualitative Sociology,35(3), 251-270. Alexy, O., Reitzig, M. (2012). Managing the business risks of open innovation.McKinsey Quarterly,1(1), 17-21. Christoffersen, P. F. (2012).Elements of financial risk management. Academic Press. Cpaaustralia.com.au. (2018).APES 110. [online] Available at: https://www.cpaaustralia.com.au/professional-resources/accounting-professional-and-ethical-standards/apes-110-code-of-ethics-for-professional-accountants [Accessed 8 Jan. 2018]. Cronje, C. (2014). Corporate accounting scandals: reconnaissance.Word and Action= Woord en Daad,53(423), 15-17. Gao, L., Kling, G. (2012). The impact of corporate governance and external audit on compliance to mandatory disclosure requirements in China.Journal of International Accounting, Auditing and Taxation,21(1), 17-31. Griffiths, M. P. (2012).Risk-based auditing. Gower Publishing, Ltd.. Hull, J. (2012).Risk management and financial institutions,+ Web Site(Vol. 733). John Wiley Sons. Knechel, W. R., Salterio, S. E. (2016).Auditing: Assurance and risk. Taylor Francis. Quax, R., Kandhai, D., Sloot, P. M. (2013). Information dissipation as an early-warning signal for the Lehman Brothers collapse in financial time series.Scientific reports,3. Tepalagul, N., Lin, L. (2015). Auditor independence and audit quality: A literature review.Journal of Accounting, Auditing Finance,30(1), 101-121. Vona, L. W. (2012).Fraud risk assessment: building a fraud audit program. John Wiley Sons. Wright, M. K., Capps, C. J. (2012). Auditor independence and internal information systems audit quality.Business Studies Journal,4(2), 63-84.

Religion Healthy Aging Essay Example

Religion Healthy Aging Essay A STUDY OF THE IMPACT OF SPIRITUALITY, RELIGION AND FUNCTIONAL HEALTH OF THE ELDERLY A Dissertation Presented to the Faculty of the School of Health Administration Kennedy-Western University In Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Health Administration by Kendall Brune St. Louis, Missouri Table of Contents Chapter 1 – Introduction†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 1 Introduction†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 1 Statement of the Problem†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 2 Purpose of the Study†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 3 Importance of the Study†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦4 Scope of the Study†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 Rationale of the Study†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦9 Overview of the Study†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 1 Definition of Terms†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 141 Chapter 2 – Review of Related Literature†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 13 History of Religious Studies-Health Care†¦15 Demographic Trends in Health Care†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦16 Science Religion†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 23 Review-Religion in Medical School †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 26 The Relaxation Response: Harvard. †¦Ã¢â‚¬ ¦26 Aging as a Spiritual Journey: Loyola†¦Ã¢â‚¬ ¦27 Faith- life-promoting: Emory†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 30 Physician Religion: St. Louis†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦31 International Center for the Integration of Health and Spirituality†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦. 34 Centers for Disease Control†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦35 Joint Commission on Accreditation of Healthcare Or ganizations (JCAHO) †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 37 A Review of: Patient Satisfaction†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 41 Spiritual Directives†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 42 ii Health Outcomes†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 38 Spiritual Emotional Needs†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦.. 40 Clinical Cohorts from Benjamins†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦44 Clinical Cohorts from Daaleman†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 45 Patients Desire for Religion†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 47 Clergy Issues in Healthcare†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦53 Ethical Issues in Healthcare †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦. 56 Summaries Conclusions. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 57 Chapter 3 – Methodology†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 59 Approach of the Benjamins’ Study†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 61 Benjamins’ Conceptual Framework†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦61 Benjamins’ Study Mechanisms†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦61 Benjamins’ Control Mechanisms†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 62 Benjamins’ Social Resources †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 3 The Database of the Study†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 66 Variables in the Benjamins Study†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 71 The Approach of the Daaleman Study†¦.. 75 Daaleman’s Conceptual Framework†¦Ã¢â‚¬ ¦.. 76 Daaleman’s Study Variables†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦77 Daaleman’s Well Being Questionnaire†¦.. 79 Summary†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 86 Chapter 4†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 87 Demographics and Statistics†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 89 The Data Analysis for Daaleman†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 92 The Data Analysis for Daalema n†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 94 Data Charts†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 96 Chapter 5†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦108 Theory on Aging†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 109 iii Recommendations/Action Items†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 112 Spiritual Care Assessment†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 121 Role of the Physician†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 21 Conclusion: National Impact of Studies†¦132 Final Comment†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 136 Bibliography†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. I Tables and Charts†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. XVIII Chart 1: Faith Support Flowchart†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦XVIII Table 1: Relative Risk of Dying, Strawbridge†¦XXI Table 2: Life Expectancy Religious Activity†¦XXI Table 3: JCAHO RI. 1. 13 Care @ End of Life†¦. XX Table 4: JCAHO Reading Referrals to Patients. XXII Table 5: Benjamins Statistical Results†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. XXIII Table 6: Daaleman – Demographics†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦XXV Table 7: Spirituality Index of Well Being†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. XXVII Appendices†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. XXVIII A: Joint Commission Regulations†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦XXVII We will write a custom essay sample on Religion Healthy Aging specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Religion Healthy Aging specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Religion Healthy Aging specifically for you FOR ONLY $16.38 $13.9/page Hire Writer B: SF – 12v1 Survey Description†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. LIII C: SES Descriptive Charts †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. LXIII D: Health Retirement and Survey Data†¦. LXVI E: JCAHO Spiritual Assessment Tool†¦Ã¢â‚¬ ¦CXXII F: Geriatric Depression Scale†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. CXXVI G: Spirituality Survey – 12-item Scale†¦Ã¢â‚¬ ¦CXXII iv Abstract of Dissertation A STUDY OF THE IMPACT OF SPIRITUALITY, RELIGION AND FUNCTIONAL HEALTH OF THE ELDERLY By KENDALL BRUNE Kennedy-Western University THE PROBLEM Religion is a source of comfort to some and a conflict to others. A study done by Gallop at Princeton claimed a vast majority of Americans (94%) claim to believe in God. Koenig’s study found among older Americans, 98% believe in God, and pray. Maungans, et al. found physicians tend to ignore religious issues in the care of their patients (Maugans, 1991. pp. 210-13). However, this trend is changing. As reported by Koenig (1999, p. 25) Hundreds of major scientific studies by other researchers have found statistical benefits to the consistant exposure to religion. The risk of dying from all causes is up to 35 percent lower for people who attend religious services once or more a week than for those who attend less frequently. This statistical significance has rompted two thirds of the medical schools to offer required or elective courses on religion, spirituality, and medicine. In the published medical literature, there is a conflict regarding the effects of religion on the functional health of older Americans. Sloan et al. reviewed the literature and found inconsistent and weak links between religion and health. In v contrast, the reviews by Levi n and Schiller and by Larson et al. found positive effects of religion on physical and mental health. Koenig and Benjamins found in their clinical research that religion has a direct relationship with functional health. Given this conflict, this study is a critical review of the medical literature and how two particular studies focus on whether the attendance at religious services has an inverse association with functional health among the elderly. The Daaleman study is a regional review of geriatric patients participating in a program at the University of Kansas Medical Center. Daaleman performed a cross-sectional analysis of 277 geriatric outpatients participating in a cohort study in the Comparatively, Maureen Benjamins from Kansas City area. the University of Texas at Austin developed a less involved tudy that is a longitudinal and cross sectional analysis of national data sets. Benjamins states it is critical to examine the possible differing effects of religion and functional health with the elderly population, because this age is rapidly expanding. More information on religion and functional health is also needed because the information is not conclusive, but rather conflictive. METHOD The go al of this study is to assess the impact (positive or negative) of religion on functional health outcomes. The Daaleman Study was a secondary analysis of cross-sectional data from a larger cohort study. The parent study was designed to determine the feasibility of performance measures in predicting future health service utilization, health status, and functional status in older, community-dwelling primary care patients (Studenski, 2003). Patients underwent a home assessment of multiple health status, performance, and functional indicators by trained research assistants. A previously validated five-item measure of religiosity was utilized from the National Opinion Research Center in Chicago, and a twelve-item spirituality instrument developed in an earlier vi Daaleman Study (2002) were embedded during the final data ollection. The current study represents data collected 36 months after enrollment. Participants were older adults who were screened and recruited for the parent study between April and November of 1996 from primary care sites within a Veteran’s Affairs (VA) network (n = 142) and a Medicare health management organization (HMO) (n = 350) serving the Kansas City metro politan area. The Benjamins Study used the Assets and Health Dynamics Among the Oldest Old Survey, a nationally representative, longitudinal data set, to estimate the effects of religious attendance and salience on functional health in the elderly. The primary study hypothesis proposes that religious attendance and salience will be associated with a decrease in functional limitations for older respondents. FINDINGS In conclusion, the researcher presents the results of this study as a contribution to the growing body of knowledge regarding the issue of religion services and its positive impact on functional health of the elderly. The results of the current studies in review were consistent with the previous studies by Idler and Kast (1997), which also found that â€Å"more frequent church attendance is associated with lower levels of disability. Despite the limitations of the various studies, the preponderance of evidence supports the beneficial effects of religion on health outcomes. The need for ongoing research in this area is evident. Considering the elderly think religion is important, religion likely benefits health outcomes, and religion is without financial cost, health care providers should include religion in the care of their elderly patients. vii Chapter 1: Introduction Spirituality and Faith Communities Throughout history, humans have suffered ills and sought healing. In response, the two healing traditions— religion and medicine—historically have joined hands in aring for the sick. The same person often conducted these efforts; the spiritual leader was also the healer. Hospitals, which were first established in monasteries then spread by missionaries, often carry the names of saints or faith communities. As medical science matured, healing and religion diverged. Rather than simply asking God to spare their children from smallpox, people began vaccinating them. Rather than seeking a spiritual healer when burning with bacterial fever, they turned to antibiotics. It was a very logical progression, but has lacked the human compassion experience. However, the separation between religion and medicine is now shrinking. Spirituality has made a comeback (Koenig, 2001, p. 25): †¢ †¢ †¢ Since 1995, Harvard Medical School has annually attracted 1000 to 2000 health professionals to its Spirituality and Healing in Medicine conferences. Duke University, a leading Research Medical Institution in the United States, has established a Center for the Study of Religion/Spirituality and Health. 86 of Americas 126 medical schools offered spirituality and health courses in 2002, up from 5 in 1992 (Koenig, 2001). 1 †¢ †¢ 94 percent of HMO professionals and 99 percent of amily physicians agreeing that personal prayer, meditation, or other spiritual and religious practices can enhance medical treatment. (Yankelovich,1997) This renewed convergence of religion and medicine appears in such books as The Faith Factor (Viking, 1998), The Healing Power of Faith (Simon Schuster, 1999), Religion and Health (Oxford University Press , 2000), and Faith and Health (Guilford, 2001). Is there fire underneath all this smoke? Do religion and spirituality actually relate to health, as polls show four out of five Americans have believed (Matthews, 1997)? Statement of Problem: Does Faith Impact Health Healing? More than a thousand studies have sought to correlate the faith factor with health and healing. Does religion significantly influence the health outcomes of the elderly? Very few studies have followed cohorts long enough to examine a cause and effect relationship. It is possible the increasing levels of religious participation may strengthen the functional health of the elderly (Benjamins, 2004, pp. 355-74). Kark and his colleagues in 1996 compared the death rates for 3900 Israelis either in 1 of 11 religiously orthodox or in 1 of 11 matched nonreligious collective communities (Kark, 1996, pp. 341-46). The researchers reported that over a 16-year period, belonging to a religious collective was associated with a strong protective effect not 2 explained by age or economic differences (Kark, 1996, p. 345). Koenig and Larson have found religion has a salutary or protective effect on a variety of health outcomes. Despite numerous studies that indicate positive benefits from religious involvement, Sloan states the evidence is not empirical. It is the â€Å"Sharp Shooters Accuracy† model of study. If you take a sharp shooter out and have him fire six rounds into a concrete wall and then draw a target, the accuracy will be incredible. Sloan believes it is hard to control for all the variables involved in religious beliefs. Purpose of the study The purpose of this study is to review two significant different cohort groups that were focused on the impact of religion on the health outcomes of elderly individuals. The first study was a large national longitudinal study completed by Benjamins at the University of Texas at Austin. One of the concluding remarks was that smaller, regional studies should be completed to accommodate for denominational influences over lifestyle and environmental variations. The second study in comparison is a small regional nalysis completed in a large midwestern metropolitan area. Daaleman and colleagues from the University of Kansas Medical Center completed a smaller regional study focused on elderly clients served through its outpatient clinics. In every age group, those belonging to the religious communities were about half as likely as their nonreligious counterparts to have died. To fu rther understand the 3 relationship among religion, spirituality, and self-reported health status, Daaleman performed a secondary analysis of the parent studies cross-sectional data. Daaleman utilized a health status model developed by Johnson and Wolinsky s the research model to examine the relationship between self-reported health status and religiosity (Johnson, 1994). A similar large cohort study of 91,909 persons in one Maryland county found those who attended religious services weekly were less likely to die during the study period than those who did not—53 percent less from coronary disease, 53 percent less due to suicide, and 74 percent less from psoriasis of the liver (Comstock Partridge, 1972). In response to such findings, Sloan and his skeptical colleagues remind us that mere correlations can leave many factors uncontrolled (Sloan, 1999). Consider one bvious possibility: Women are more religiously active than men, and women outlive men. So perhaps this might sugg est religious involvement is merely an expression of the gender effect on longevity. Importance of the Study Epidemiologist Strawbridge and his co-workers followed 5286 Alameda, California, adults over 28 years. After adjusting for age and education, the researchers found that not smoking, regular exercise, and religious attendance all predicted a lowered risk of death in any given year. Women attending weekly religious services, for example, were only 4 54 percent as likely to die in a typical study-year, as were non-attendees. With the focus of health maintenance organizations centered on prevention and profit, religious activity might soon become a question for new insured’s (Strawbridge et al. , 1997, 1999; Oman et al. , 2002). A National Health Interview Survey (Hummer et al. , 1999) followed 21,204 people over 8 years. After controlling for age, sex, race, and religion, researchers found nonattendees were 1. 87 times more likely (See Table 1) to have died than were those attending more than weekly. This translated into a life expectancy at age 20 of 83 years for frequent attendees and 75 years for infrequent attendees. Hummer showed regular attendance at religious services is associated with an additional eight years of life expectancy when compared to never attending. These effects of religious attendance were consistent across all age, gender, and race/ethnicity groups and for all major causes of death (Hummer et al. , 1999, pp. 273-85). Dychtwald, psychologist, gerontologist and entrepreneur, suggests the educated senior consumer desires to take charge of the quality of life by participating in his/her mental and physical well-being. If there is an increased awareness of positive mental and physical health enefits for seniors, marketing dollars will be redirected toward spiritual health in this growing demographic (Dychtwald, 2005). The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has acknowledged that patients’ â€Å"psychosocial, spiritual, and cultural values affect 5 how they respond to their care† (Joint Commission Resources: 2003 Comprehensive Accredi tation Manual for Hospitals: The Official Handbook. 2003, p. RI-8) and has addressed spirituality and emotional well-being as aspects of patient care. Researchers’ interest in the connections between mind and body (Damasio, 1999; Penrose, 1999) oincides with increasing interest in the holistic view of health care, in which emotional and spiritual needs are considered inextricable from physical and psychological needs (Sherbourne et al. , 1999, pp. 357-63). For example, Standard RI. 1. 3. 5 refers to â€Å"pastoral care and other spiritual services† (p. RI-15). The intent for Standard RI. 1. 2. 8, â€Å"The hospital addresses care at the end of life† (p. RI-13), refers to â€Å"responding to the psychological, social, emotional, spiritual, and cultural concerns of the patient and family† (p. RI-13). Scope of the Study The purpose of the Benjamins Study is to examine the nteraction of religion and spirituality with self-reported health status in a community -dwelling geriatric population. The two main studies in review differ in scope and breadth of patients sampled. The Benjamins Study utilizes the national data base AHEAD, developed by the University of Michigan. The Benjamins Study review found over 1200 comprehensive reviews (Koenig, 2001 Larson, 1998) have focused on the association between religion and physical and mental health (Chatter, 2000, pp. 355-67; Ellison Levin, 1998, pp. 700-20; Jarvis Northcott, 1987, pp. 813-24). The Daaleman Study is a regional review of geriatric patients participating in a program at the University of Kansas Medical Center. Daaleman performed a crosssectional analysis of 277 geriatric outpatients participating in a cohort study in the Kansas City area. This study tested the hypothesis from a large continental longitudinal study design to a focused univariate and multivariate logistical regression analysis study design from a specific region of the United States. In a national health survey financ ed by the U. S. Centers for Disease Control and Prevention, religiously active people had longer life expectancies (Hummer, et al. 1999). These co-relational findings do not indicate non-attendees who start attending services and change nothing else will live eight years longer (See Table 2), but they do indicate as a predictor of health and longevity, religious involvement rivals nonsmoking and exercise effects. Such findings demand explanation. First, religiously active people tend to have healthier life-styles; for example, they smoke and drink less (Koenig, 1999, p. 24; Strawbridge et al. , 2001, pp. 957-61). Religiously orthodox Israelis eat less fat than do their nonreligious compatriots. But such differences are not reat enough to explain the dramatically reduced mortality in the religious kibbutzim, argued the Israeli researchers. In the recent American studies, too, about 75 percent of the longevity difference remains after controlling for unhealthy behaviors such as inacti vity and smoking (Musick et al. , 1999, pp. 73-86). Social support is another variable that helps explain the faith factor (George et al. , 2002, p. 115). For Judaism, Christianity, and Islam, faith is not solo spirituality but a 7 communal experience that helps satisfy the need to belong. The more than 350,000 faith communities in North America nd the millions more elsewhere provide support networks for their active participants—people who are there for one another when misfortune strikes. Moreover, religion encourages another predictor of health and longevity— marriage. In the religious kibbutzim, for example, divorce is almost nonexistent. But even after controlling for gender, unhealthy behaviors, social ties, and preexisting health problems, the mortality studies find much of the mortality reduction remaining (George et al. , 2000, pp. 102-116). Healthy Behaviors Religious Involvement Social Support (Faith Groups) Health (Absence of Illness) Positive Emotions Hope /optimism (Adapted from: Koenig Larson, 1998) Researchers therefore speculate a third set of intervening variables is the stress protection and enhanced well-being associated with a coherent worldview, a sense of hope for the long-term future, feelings of ultimate 8 acceptance, and the relaxed meditation of prayer or Sabbath observance. These variables might also help to explain other recent findings, such as healthier immune functioning and fewer hospital admissions among religiously active people (Koenig, 1999, p. 25; Koenig et al. , 1995, pp. 365-75). Rationale of the study Hospitals have often assigned the responsibility of ddressing emotional and spiritual issues to chaplains or to pastoral teams. Yet others—nurses, physicians, clinicians, and other caregivers—play equally important roles. The hospital staff’s ability to address patients’ emotional and spiritual needs factors into patients’ perceptions of the overall experience of care, the p rovider, and the organization. Patients have a desire to feel their circumstances and feelings are appreciated and understood by the health care team professionals. Shojania states it as follows, â€Å"If patients feel that the attention they receive is genuinely caring and tailored to eet their needs, it is far more likely that they will develop trust and confidence in the organization† (Shojania Bero, 2001, p. 160). A comprehensive literature review was completed by JCAHO staff to guide hospital administrators’ management of patients’ emotional and spiritual needs. This review provided the national literature benchmark for hospitalized patients’ emotional and spiritual needs and presents JCAHO’s survey findings on the importance of these needs in patients’ perceptions of care. Three questions are 9 addressed: (Values and Beliefs Respected; RI. 2. 10. May, 2005. Appendices A) 1. Are patients’ emotional and spiritual needs important? 2. Are hospitals effective in addressing these needs? 3. What strategies should guide improvement in the near future and long-term? The religion factor is multidimensional and therefore, very hard to measure. Although the religion-health correlation is yet to be fully explained Pincus, deputy medical director of the American Psychiatric Association, believes these findings have made clear that anyone involved in providing health care services . . . cannot ignore . . . the important connections between spirituality, religion, and health (Pincus, 1995). Consider the fact that older Americans will more than double in number from 35 million today to 70 million by year 2030. Already, some 6,000 Americans turn age 65 every day in our country. In just 10 years, the number reaching that personal milestone will rise to about 10,000 Americans each day. As hard as it may be for some to admit, the very icons of American youth and the Baby Boom generation will soon become part of the largest Medicare generation in history (Alliance for Aging Research. â€Å"Social Security Widow(er) Insurance Benefits† Web site report, 2005). 10 Overview of the study Religion and spirituality have entered the agenda of research on psychosocial factors in health. Benjamins found over 1200 comprehensive reviews have focused on the association between religion and physical and mental health (Chatters, 2000, pp. 335-67; Ellison Levin, 1998, pp. 700-20; Jarvis Northcott, 1987, pp. 813-24). These studies have separately reported both long-term and shortterm beneficial effects of individual religiousness on physical health status. The goal of this study is to assess the impact (positive or negative) of religion on functional health outcomes. The Daaleman Study performed a crosssectional analysis of 277 geriatric outpatients participating in a cohort study in the Kansas City area. Patients underwent a home assessment of multiple health status and functional indicators by trained research assistants. A previously validated 5-item measure of religiosity and 12item spirituality instrument were embedded during the final data collection. Univariate and multivariate analyses were performed to determine the relationship between each factor and self-reported health status. The Benjamins Study used the Assets and Health Dynamics Among the Oldest Old Survey, a nationally epresentative, longitudinal data set, to estimate the effects of religious attendance and salience on functional health in the elderly. The primary study hypothesis proposes that religious attendance and salience will be associated with a decrease in functional limitations for older respondents. This review of literature is a small snapshot of findings that represe nts a variety of national population groups, 11 validated outcome measures, different study designs, various analytical techniques, multiple follow-up periods, and focused geographic regions. 12 Chapter 2: Review of Related Literature A History of Religious Studies in Health Care Most of the time, a doctors advice for successful aging would offer the familiar mantras of good health: quit smoking, exercise regularly, and eat five to seven helpings of fruits and vegetables a day. Yet perhaps the day could be coming when your family physician might prescribe some unusual advice: go to your house of worship, meditate, and pray. In the United States, the traditional boundaries between church and state are blurring with President George W. Bushs recent initiative to allow faithbased charities to compete for government funding. Family medical providers emphasize medical care for the whole erson, which includes the complete understanding of a patient’s family and living environment. Daaleman completed a survey in 1998 that showed 72% of the physicians interviewed were interested in training in prayer, but only 33% believed in prayer as a legitimate medical practice. King’s research within healthcare settings found that â€Å"religious and spiritual bel iefs wield substantial influence on patient health benefits, and some may directly affect clinical outcomes† (King, 1994, p. 351). Might the boundaries between medicine and religion be blurring as well? Does the Baby Boomer generation eally want to know this information? According to Keyes (2002) the Baby Boomer generations are better economic consumers and civic citizens, investing in methods and products that improve health outcomes (Keyes, 2002, p. 55) January 1, 2011, is more than just a 65th birthday for the first of the 76 million Baby Boomers in the United 13 States. On this date, Baby Boomers will begin to enter the rolls of many federal programs. This will undoubtedly place a substantial economic burden onto both the government and taxpayers alike. However, it is important to strengthen our research on medicine and religion now in order to repare the nation for the influx of older Americans, as they help to preserve the independence and quality of life of our nationâ €™s seniors (Alliance for Aging: Medicare Report, 2005). Demographics Economic Impact So many creative and innovative programs are being implemented by faith communities throughout the nation that we can begin to think in terms of a faith and health movement in America. The objective of the Interfaith Health Program is to nurture this movement, because health is central to the mission of every faith tradition (Gunderson, 2002). The contributions of faith communities to health and ealing have been relatively insignificant in this century. This was due largely to the scientific breakthroughs that gave modern medicine enormous prestige and power. However, concern for healing was never lost in faith communities. This concern was evident in prayers for the sick, the establishment of Jewish and Christian hospitals, medical missions, and the practice of faith healing. Until recently, however, both medical and faith groups have focused almost exclusively on the treatment of disease. Th e emphasis in the last two decades has shifted from healing to health, from a narrow focus on physical ailments, 14 o the health of the whole person. This shift of emphasis, as welcome as it is, still reflects a narrow individualism within our culture. The leading edge of the faith and health movement is focusing attention on the health of communities. A bipartisan effort in congress was pushed by the United Jewish Federation in partnership with other faith groups to pass a critical piece of legislation call â€Å"The Return to Home† bill. Under the â€Å"Return to Home† legislation, most hospitalized elderly patients of all faith groups living in senior facilities and who are temporarily hospitalized will not be prohibited by their HMO s from eturning to their local communities for post-hospitalization recovery and rehabilitation (Koenig, 2004, p. 43). Promoting health is the challenge both religious and health leaders face as America ages into the next century. No Am ericans want to be without modern medical advances, but health is more than the absence of disease. It involves mental and spiritual well-being as well as physical health. It involves the health of communities as well as the health of individuals. Physicians should be aware of the role religion plays in how patients cope with illness. Scientists are only now beginning to discover the owerful effects the mind and social relationships can have on health outcomes. By reclaiming health as part of their mission, faith groups once again are partners with other community agencies in improving health (Koenig, 1999, pp. 42-43). Where do the healthcare policy makers need to focus their efforts? First, more than half of the leading causes of death in this country are preventable. Deaths 15 due to alcohol, tobacco, and inactivity would decrease significantly if lifestyles were modified. The 10 Leading Medical Causes of Death Deaths Lifestyle Factors Deaths Leading to Half of Them Heart Disease 20,000 Tobacco Cancer 505,000 Diet, Sedentary 300,000 Lifestyle Cerebrovascular Disease 144,000 Alcohol 100,000 Accidents 92,000 Infections 90,000 Chronic Pulmonary Disease 87,000 Toxic Agents 60,000 Pneumonia and Influenza 80,000 Firearms 35,000 Diabetes 48,000 Sexual Behavior 30,000 Suicide 31,000 Motor Vehicles 25,000 Liver Disease, Cirrhosis 26,000 Illicit Drug Use 20,000 AIDS 25,000 400,000 16 Total 2,148,000 Total 1,060,000 (McGinnis Foege, 1993). In addition to promoting lifestyle changes, faith groups share with public health agencies a commitment to social justice as this relates to health. There is a clear connection between socioeconomic status (SES) and health. No matter how SES is measured, persons who are impoverished, homeless, or vulnerable are likely to have negative health patterns. Health is a goal for everybody, but socioeconomic status factors undermine it in spite of personal efforts. Because health is a goal for all, community members have a moral imperative to address socioeconomic status (McGinnis, 1993, pp. 2207-2211). Public health agencies and faith communities share social justice as a fundamental core value. This provides a basis for collaboration. Community-level systemic change n addressing problems like substance abuse and violence can best be achieved through partnership. Aging Stats: †¢ In 10 years, 10,000 Americans will turn 65 each day. †¢ By 2030, the older population of the United States will have doubled to more than 70 million people. †¢ By 2050, the â€Å"oldest old† (over age 85) will increase almost fourfold, from 4 million today, to nearly 19 million by 2050. 17 Boomer Health Care Needs: †¢ †¢ †¢ †¢ †¢ †¢ In 2011, hospital spending is expected to reach $885. 2 billion (CMS, National Health Expenditures, 2002). Prescription drug expenditures for 2011 are expected to reach $435. 2 billion (CMS, National Health Expenditures, 2002). Nursing home expenditures will reach an expected $164. 4 billion in 2011 (CMS, National Health Expenditures, 2002). It is estimated that by 2010, 2. 6 million Americans will be moved to a nursing home (Data from Bureau of US Census, 2005). By 2010, expenses related to Alzheimer’s disease are expected to increase by 54. 5% to $49. 3 billion (Medicare and Medicaid Costs for People with Alzheimer’s disease. Washington, D. C. : April 2001: The Lewin Group). By 2050, the need for direct care/long-term care workers will grow from 4. 2 million workers to 8. 6 million, though this workforce is expected to increase nly slightly (HH