Spiritual Need Five: Providing Quality Pastoral Care as a Congregation

SUMMARY

Critical to the needs of older adults is the care and nurturing of the feelings and emotions that often offer context for the human spirit. Grounded in the history of pastoral care, this chapter explores an approach to pastoral care that is reflective of the author's study and experience in the parish.     

Spiritual Care: Recognizing Spiritual Needs of Older Adults

SUMMARY

This paper explores aspects of spiritual needs and assessment, while emphasizing the importance of aged care providers being spiritually self-aware. The context of this exploration is meaning in life, spirituality and quality of life as experienced by older adults. Depression and dementia are frequently seen among older adults in residential aged care with resultant lowered quality of life. Pastoral and spiritual care may be used effectively to help alleviate depression and support older people who have dementia. However, to be able to provide appropriate spiritual care, spiritual needs should be assessed. Ways of assessing spiritual needs are suggested.     

Actions,Feelings, and Values: Foundations of Meaning and Personhood in Dementia

SUMMARY

Viktor Frankl's writings on the sources of meaning in human life are compared to emergent views on personhood in older individuals with dementing illnesses. An ethnomethodological study of a CBRF (community based residential facility) with two sections, each housing about 10 persons, revealed meaning in residents' actions, feelings, and expressions of values. These individuals showed it is possible to retain what Frankl called “tragic optimism” despite cognitive deterioration. Through active engagement with their environments and with one another, a wide range of expressed emotions including happiness and humor, and caring sensitivity toward others, these elders showed that given a supportive environment, dementia does not destroy meaning. These observations form the basis of suggestions for pastoral care and ministry with people with dementia.     

‘Just Because I Can't Remember …’ Religiousness in Older People with Dementia

SUMMARY

This paper reports part of a pilot study that used spiritual reminiscence techniques to explore issues of religiosity, church attendance and meaning in life of a group of older people with dementia. The study used small groups, individual interviews and participant observation to examine the experience of dementia and the search for meaning used by people with dementia. There were 22 participants from three aged care facilities involved in the project. The majority of participants had been long-term church attendees and could describe how their religion and relationship with God had impacted on their lives. They had few fears for the future and derived considerable meaning in life from their relationships with family. Participants were able to describe early memories and also remember things happening recently in their aged care facility. This would seem to be the opposite of community expectations (and sometimes staff expectations) of older people with dementia.     

Spirituality promotes better health outcomes and lowers anxiety about aging: The importance of spiritual dimensions for baby boomers as they enter older adulthood

Baby boomers present unique challenges to aged care service provision. Like previous generations, baby boomers will face challenges of ageing. Spirituality in later life, understood largely as meaning in life, is crucial to well-being. Little has been studied about this dimension of ageing for baby boomers. This mixed methods study used survey and focus groups methods to investigate spirituality in a sample of baby boomers (N = 143). Participants comprised staff, children of adults in care, and Uniting Church congregational members. We examined associations between physical and mental health, and ageing anxiety with spirituality and whether baby boomer spirituality buffered the impact of negative life events. Focus groups revealed fears of future frailty, loss, and fears of dementia. Religious affiliation in study was lower, yet spirituality was important, even with those without religious affiliation. Closeness of association of staff with older people in their care seemed to account for lower levels of fear of older people amongst staff, but higher fears of future loss compared with the other groups. Higher levels of spirituality were related to better mental and physical health and lower anxiety about and fear of ageing, and buffered the impact of negative life events where they occurred.     

Pastoral Counseling of Older Adults: Toward a Short-term Integrative Approach

A rapidly aging population with its mental health care needs presents an enormous challenge in the current mental health field. In light of this, pastoral counselors will have an increasingly important role to play in the care of older adults because of their strategic position in the community and their competence in dealing with religious/spiritual issues particularly salient in old age. This article proposes a short-term integrative approach to enable pastoral counselors to effectively and efficiently meet the mental health care needs of the elderly.

Pastoral Support for Late-Life Sexuality

SUMMARY

As more persons live longer and enjoy relatively good physical health, new ethical questions arise. One set of questions regards the continuation of sexual life among older persons, especially among older unmarried persons. Women live many years longer than their spouses and often were of a younger age than the spouses. The Judeo-Christian tradition affirms the vitality of sex as a basic part of God's gift of physical creation. A large majority of older people view sexual expression as important and many see it as crucial to a good relationship with a partner. These issues are raised for the awareness of pastoral counselors to understand and be responsive to the varied sexual alternatives m the later years m order to offer practical help to older persons.     

Spiritual advisors and old age psychiatry in the United Kingdom

This survey investigates the role and views of NHS spiritual advisors across the United Kingdom on the provision of pastoral care for elderly people with mental health needs. The College of Health Care Chaplains provided a database, and questionnaires were sent to 405 registered NHS chaplains/spiritual advisors. The response rate was 59%. Quantitative and qualitative analyses were carried out. Spiritual advisors describe their working patterns and understanding of their roles within the modern NHS, and their observations of the level of NHS staff awareness of the importance of spiritual issues in the mental health care of older adults. They provide insights into possible negative and positive perceptions of their roles at a service level, and contribute suggestions of topics relevant to shared education between pastoral care and clinical services. This survey further highlights ethical and operational dimensions at the point of integration of the work of spiritual advisors and multidisciplinary teams.     

Listening to People with Dementia: A Pastoral Care Perspective

SUMMARY

Pastoral and Spiritual Care approaches to the reduction of depression in residential aged care facilities are considered. They are examined through specific one-to-one pastoral care, through a pastoral care person in the team approach to care and through a one-to-many relationship for group spiritual and religious activities. The suggestions in this article are offered as extensions to a manual, Challenge Depression, on managing depression in residential aged care as a way of including pastoral and spiritual care as part of an integrated approach and as part of a stand alone approach of pastoral care.     

Mental health and quality of life in non-binary transgender adults: a case control study

Abstract

Background: The social challenges that non-binary people experience, due in part to social intolerance and the lack of validation of non-binary gender identities, may affect the mental health and quality of life of this population. However, studies that have distinguished between non-binary and binary transgender identities are lacking.

Aim: To compare the mental health and quality of life of a community sample of non-binary transgender adults with controls (binary transgender people and cisgender people) matched on sex assigned at birth.

Method: A total of 526 participants were included. Ninety-seven were classified as non-binary and were compared with two control groups: 91 people classified as binary and 338 cisgender people. Only transgender people not on gender affirming hormone treatment or who had not undergone gender affirming surgery were included. Participants were invited to complete an online survey that included mental health and quality of life measures.

Results: Non-binary people reported significantly better mental health than binary transgender people, but worse than cisgender people. Overall, there were no significant differences in quality of life between non-binary and binary transgender participants assigned male at birth and transgender females, but non-binary assigned males at birth had better scores on the psychological and social domains of quality of life than transgender males. Quality of life was better across all domains in cisgender people than transgender groups.

Conclusion: There is an inequality with regard to mental health and quality of life between non-binary (and binary) transgender people and the cisgender population that needs to be addressed. The better mental health scores in non-binary people may reflect lower levels of body dissatisfaction among the non-binary population. Mental health problems and poor quality of life are likely to have social causes and hence legislative measures and broader government-led inclusive directives should be put in place to recognize and to validate non-binary identifying people.     

Feeling states of people experiencing depression,anxiety, or comorbid depression and anxiety symptoms during a multi-day charity cycling ride: An ecological momentary assessment study

ObjectiveRegular exercise has substantial benefits for mental health. The way people feel during exercise impacts motivation. This study investigated whether experiencing depression, anxiety or comorbid depression and anxiety symptoms impacted feeling state responses throughout a charity cycling ride.DesignTo achieve this aim, we conducted an ecological momentary assessment study of feeling states (via Pleasant and Negative Affect Schedule items) across a multi-day cause-based cycling event.MethodMultivariate and univariate generalized linear mixed models was applied to test how affective and self-conscious emotional experiences changed across time and whether feeling state change differed between people experiencing depression, anxiety, or comorbid depression and anxiety symptoms.ResultsFor people experiencing depression symptoms, positive feelings decreased and negative feelings increased throughout the event. People experiencing anxiety symptoms had initially elevated negative feeling states that decreased across the event. For people experiencing comorbid depression and anxiety symptoms, changes in pride mirrored that of people experiencing only depression symptoms (decrease from initially high levels); whereas changes in guilt mirrored that of people experiencing only anxiety symptoms (initially high levels that decreased throughout event).ConclusionsThese findings demonstrate that depression and anxiety symptoms put people at risk for having negative affective and emotional experiences during exercise events and that these effects are further complicated when depression and anxiety symptoms co-occur. Exercise events and interventions must consider how to mitigate the potentially demotivating impacts that negative affective judgments can have on motivation for future exercise participation of people experiencing depression and/or anxiety symptoms.     

What happened in kindergarten? Mother-child conversations about life story chapters

ABSTRACT

Research indicates that adults form life story chapters, representations of extended time periods that include people, places and activities. Life chapter memories are distinct from episodic memories and have implications for behaviour, self and mental health, yet little is known about their development during childhood. Two exploratory studies examined parent–child conversations about life chapters. In Study 1, mothers recorded naturalistic conversations with their 5–6 year old children about two chapters in the child’s life. In Study 2, mothers recorded conversations with their 6–7 year old children about a particular life chapter—the child’s kindergarten year—and also about a specific episode of their choice. The results indicated that young children are able to recall and discuss information about life chapters and that parents actively scaffold children’s discussion of general information in chapters as well as specific events. Mothers’ conversational style when discussing chapters (e.g., elaborativeness) predicted children’s memory contributions, and was also positively correlated with their style when discussing specific events. The results suggest new avenues for research on the ontogeny of life chapters, the factors that shape them, and their role in development.     

Mental Health,Culture and Spirituality: Implications for the Effective Psychotherapeutic Care of Australia's Ageing Migrant Populations

SUMMARY

In this essay, attention is given to discussing the notions of and influences of culture, mental health and spirituality. Research shows that people who came to Australia either as immigrants or refugees are at risk of suffering a disproportionate incidence of mental problems relative to the rest of the Australian population. Older male immigrants are particularly at risk. A key variable influencing the mental health of immigrants/refugees in Australia is the social conditions in which they live. Another largely unrecognised variable influencing mental health is spirituality. The extent to which the expression of spirituality promotes mental health and healing, however, will depend on cross-cultural perceptions of what spirituality is, and how it influences mental health, illness and recovery. Whatever the perceptions of spirituality, it is important to understand that its roots are cultural, and its influence is on meaning construction. Meaning construction, in turn, is itself culturally mediated and framed. Given this, it is crucial that culture-what it is and how it influences human experience-is understood by health professionals if they are to be able to provide meaningful and therapeutically effective care to culturally diverse people and their mental health problems. A central aim of this essay is to facilitate this understanding.     

A continuing sense of self in the lived experience of dementia

ABSTRACT

Diagnosis with dementia often leads to an overwhelming fear of loss of self, which is assumed in the social discourse about the condition. After my own diagnosis with dementia in 1995, I reflected on this fear from a Christian theological perspective and was nonetheless able to discover a sense of hope. Highlighting what remains in dementia, as seen through the lens of the lived experience, provides a counter-story to the views of outside observers, which have dominated the literature to date. Although people with dementia experience a change in their cognitive sense of self, there are still important aspects of self that remain, which are: a sense of being an embodied self, in relationships with others and with God, and being able to find meaning in the present moment. By demonstrating that people living with dementia have a continuing sense of self, the aim is to prompt improved pastoral care and ministry.     

Counseling Older Adults with Dementia: A Survey of Therapists in Massachusetts

Although much has been written about therapeutic interventions with caregivers, little is known about the counseling services that are available for victims of dementia. The present study was designed to explore community mental health center (CMHC) services and therapists' experiences in providing psychotherapy to this population in Massachusetts. Only 27 of the 36 CMHCs in the state reported providing mental health services to older adults with a dementing illness. A survey of therapists who specialized in working with older adults found that the percentage of older adult clients estimated to have dementia averaged about half of their caseload. Older persons in the early phase of a dementing illness were most frequently referred for depression and anxiety, whereas those with moderate decline were most frequently referred for management of disruptive behavior. The most common services provided to clients with dementia consisted of assessment and individual counseling. The latter finding indicates a discrepancy between what is practiced and the professional literature. Most of the psychotherapy described in the literature concerns group interventions, which were rarely provided by the mental health centers in Massachusetts. The centers tended to offer individual counseling; however, little information on how to provide this form of treatment can be found.     

Suffering–At the Bedside of the Dying

SUMMARY

Care of people at the end of life is a challenge for the person with a life-limiting illness, their family and friends, and their professional carers. Clinicians, including pastoral care workers, nurses, doctors, and allied health professionals, find themselves at the bedside of the dying. At times, the professional's sense of self is challenged both by the suffering that they witness (physical, emotional, existential, social, sexual, or financial) and a sense of helplessness to relieve not only the patient's suffering but also that of the people to whom the dying person is close. What framework can help us to deal with the suffering that we cannot help but encounter? Ultimately people connecting in a real and meaningful way with other people is probably the only way that each of us can confront suffering and not have it destroy us. Creating an environment where people can begin to, or continue to connect with others at a level that is meaningful for all concerned is a pivotal starting point in dealing with suffering in any encounter with people at the bedside.     

Non-Speech Based Pastoral Care: A Pastoral Care Program for Aged Care Residents with Little or No Ability to Speak

SUMMARY

Pastoral care depends on the ability to communicate, most commonly through the medium of speech. The aged person who has suffered illness or accident that has adversely affected their speech, is in great need of pastoral care. Yet chaplains and pastoral carers can feel helpless in the face of such a significant deficit and may not know what to do. At Tregenza Avenue Aged Care Service, the Chaplaincy service has developed helpful individual programs for non-speech based pastoral care. Using visual and tactile symbols, pictures, touch, and music, we have been able to minister to people with a variety of speech problems, with promising results.     

Prospective associations between changes in mental health symptoms and health-related quality of life in veterans seeking posttraumatic stress disorder residential treatment

Background and Objectives: This study examined prospective associations between changes in mental health symptoms (posttraumatic stress disorder [PTSD], depression) and health-related quality of life (physical health, psychological well-being) for veterans with PTSD. Design: This study focused on 139 patients who completed a residential treatment program for PTSD in the Veterans Health Administration. Methods: Patients completed the veteran-specific, 12-item Medical Outcomes Study Short Form, PTSD Checklist – Military version, and Beck Depression Inventory at pre-treatment, discharge, and a four-month follow-up. When accounting for demographic factors, combat exposure, and baseline scores on the respective outcome variables (e.g. mental health, physical health, PTSD, and depressive symptoms), a series of multivariate analyses were conducted for treatment-related changes in mental and physical health on the outcome measures. Results: Reductions in PTSD symptomatology during the treatment period were prospectively linked with better health-related outcomes at the four-month follow-up. In addition, improved physical health and psychological well-being during treatment were each similarly associated with better PTSD and depression outcomes in the months following treatment. Conclusions: Addressing concerns in mental and physical health might have synergistic effects across both domains, supporting the need for holistic models and integrated health care strategies for treating veterans with PTSD.     

The Impact of Community Mental Health Programs for Australian Youth: A Systematic Review

Australia has undergone significant youth mental health reform over the past 10 years, leading to numerous studies examining the effects of community-based mental health care programs for Australian youth. However, no synthesis of this literature currently exists. Therefore, this systematic review aimed to: (1) describe the types of community-based mental health programs that have been delivered to Australian youth in the past 10 years; and (2) examine their impact in improving young people’s mental health symptomology and psychosocial functioning. A systematic search of the peer-reviewed literature was conducted. Studies were included if they evaluated the extent to which such programs improved mental health symptomology (e.g., depression, anxiety, substance use) and/or psychosocial outcomes (e.g., social functioning, school engagement, employment) for Australian youth aged 10–25 years. Thirty-seven studies were included. Four types of community-based youth mental health care programs were identified: therapy (n?=?16), case management (n?=?9), integrated ‘one-stop-shop’ (n?=?6) and lifestyle (n?=?6) programs. The majority of therapeutic programs were effective in reducing mental health symptomology. Case management and integrated approaches consistently yielded significant improvements in both symptomology and psychosocial outcomes. Lifestyle programs were effective in alleviating depressive symptoms, but inconclusive for other outcomes. This review provides support for youth-friendly, systemic, multidisciplinary and integrated assertive outreach models of community mental health care to improve outcomes for young Australians experiencing mental health concerns. Several recommendations for future research are provided to strengthen the local evidence-base supporting community mental health programs to ultimately enhance young people’s life trajectory.

     

To Flourish or Languish,that is the question: Exploring the mental health profiles of Danish elite athletes

ObjectivesThe purpose of this study was (a) to investigate mental well-being and the prevalence of anxiety and depressive symptoms in Danish male and female elite athletes, (b) to identify latent profiles in athletes based on their mental health and ill health, and (c) to examine whether the different profiles vary in selected protective and risk factors concerning mental health.MethodsA total of 612 Danish athletes (M = 18.99, SD = 4.29) from 18 different sports completed an online version of the Holistic Athlete Mental Health Survey that assessed well-being, depression, and anxiety together with potential risk and protective factors (e.g., injuries, stress, sleep, social support, sport environment).ResultsOverall, 13.9% of athletes reported moderate or severe anxiety symptoms while 21.1% reported moderate or severe depressive symptoms. Female athletes had a significantly higher prevalence of anxiety and depressive symptoms and lower mental well-being scores than male athletes. Through a latent profile analysis, three distinctive mental health profiles (flourishing, moderate mental health, languishing) were discovered. MANOVA following Kruskal-Wallis tests revealed substantial differences between these profiles regarding their perception of social support, sport environment, and stressors from different life domains.Conclusions: Danish elite athletes display similar levels of anxiety and depressive symptoms as the Danish general population. Flourishing athletes report lower stress levels, receive higher support from the private and sport domain, and perceive their sport environment as more supportive than athletes who are languishing. A tailored approach is proposed to support athletes' mental health.