Can attention to spiritual needs help self-neglecting elders?

When considering the lives of older people holistically, threats to personal freedoms often compound other existing issues of ageing, such as increased frailty, disability, and threats to identity and autonomy.

In some cases, increased dependency brings a level of helplessness and shame that may lead to self-neglecting behaviours, such as poor nutrition, hygiene and social isolation.

Consequently, many workers in aged care feel overwhelmed and ill-equipped to appropriately tackle the problem of self-neglect and the ethical issues arising from it. It follows that there is a pressing need to appropriately support older adults who put themselves at risk through self-neglect, while at the same time upholding their identity and the dignity of risk-taking in other ways. This difficult area lies at the intersections of personal autonomy, the right to self-determination and the responsibilities of health and social services professionals to respond quickly and appropriately.

More and more frequently, spirituality is being recognised for its significant role in promoting health and wellbeing. Its role is due in part to what is often described as the profound human desire to “construct a sacred reality” that may be expressed through a personal relationship with God, or more secularly by way of a deep connection to nature, art or other activity that nurtures a transcendent sense of meaning and purpose.

When considering the effects of self-neglecting behaviours, current research on spirituality and ageing supports the important role that spirituality plays in mediating illness, decline and relationship conflict. For example, age-related physical decline and future vulnerability is linked to increased fear and anxiety in older persons. Conversely, forgiveness and reconciliation with others has been known to increase overall life satisfaction and to improve health.

Elizabeth MacKinlay, author of The Spiritual Dimensions of Ageing, considers listening to be “a vital starting place” when working with older persons, particularly in regards to identity, finding meaning and purpose in life, and for the resolution of past trauma or conflict.  MacKinlay explains the importance of retelling life stories as a “vehicle for carrying meaning” that may assist an individual to reflect and view past events with renewed clarity, leading to the possibility of a re-evaluation of the past that may encourage a change in perception and attitude towards themselves and others.

She considers the need to find meaning as an essential task in the ageing process, as ultimate meaning in life brings hope, intimacy and the ability to transcend the negative effects of ageing. Importantly, attention to language of the sacred offers the opportunity for a spiritual assessment that may assist an individual to identify their own personal centres of meaning which may be drawn upon to assist in managing life’s challenges, especially the challenges of ageing.

It may be, then, that appropriate later-life access to discovering or rediscovering spirituality will assist against self-neglect, whilst also respecting the essentials of autonomy, dignity and timely response. Such access may also lighten the load of harried professionals unsure of how to respond.  In this way, access to spiritual care can support the sum total of care.

About the author

Christina Micallef holds a Bachelor of Behavioural Studies and is completing a Master of Ageing and Pastoral Studies at Charles Sturt University. She has worked in aged care and community services for 25 years, currently supporting Commonwealth Home Support Program service providers through the national aged care reforms in Victoria.