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