Elderly, Religiosity, and Meaning of Life: A Critical Review

Chamilul Hikam Al Karim

and Ika Febrian Kristiana

Postgraduate Program, Faculty of Psychology, Diponegoro University, Jl. Prof Sudharto, SH, Indonesia

Faculty of Psychology, Diponegoro University, Jl. Prof Sudharto, SH, Indonesia

Keywords: Religious Intervention, Meaning of Life, Nursing Home.

Abstract: The increasing elderly population raises the empowerment need of becoming healthy and productive. Many

religious-based interventions have been carried out for the elderly to achieve the meaning of their lives. It is

essential to understand whether religious-based interventions are related to increasing the meaning of life for

the elderly, especially those living in nursing homes, how and why this can happen. The critical review was

the right approach to highlight this. Article searches were conducted through e-databases: ScienceDirect,

Springer, ProQuest, and ERIC. Two articles were obtained by applying the article search strategy, inclusion-

exclusion criteria in screening, and critical appraisal criteria (n=2). The results of the review showed that

religiosity/spirituality benefitted the elderly. Spirituality/religiosity gave meaning to the elderly’s existence

and helped them adapt to changes caused by aging itself. The number of female subjects became one of the

limitations in the first article. In the second article, spirituality/religiosity was more attached to the Christian

religious context. There is a need for further research related to spirituality/religiosity in the context of other

religions. Intervention based on religiosity/spirituality is one of the programs that can be designed to improve

the condition of the elderly.

1 INTRODUCTION

One success indicator of development in a country is

the increase in life expectancy. Life expectancy

estimates the average length of life of the population,

assuming no change in mortality patterns according

to age (Central Bureau of Statistics, 2020). The global

life expectancy in 2019 was 73.4 years (WHO, n.d.).

While in Indonesia, it increased over the years.

Central Bureau of Statistics Republic of Indonesia

(2020) reported that the life expectancy from 2018 to

2020 has increased from 69.30 years to 69.59 years

for men and 73.19 years to 73.46 years for women.

The consequence of increasing life expectancy is the

rise in the elderly population. Data from the United

Nations Department of Economic and Social Affairs

Population Division (2020) suggested that the elderly

population in 2019 reached 709 million and is

estimated to double by 2050. The elderly population

of Indonesia makes up 10.57% of all. By 2045 it is

predicted to reach 19.9% of the population.

In 2017, the Ministry of Health of the Republic of

Indonesia stated that the elderly population reached

7% of the population, which they called the global era

of the aging population. This era applies to all

countries, especially the developing countries,

including Indonesia (Central Bureau of Statistics,

2020). The rise of the elderly population can have

both positive and negative impacts. It has a positive

impact if the elderly are healthy, active, and

productive. On the other hand, it will be a negative

impact if the elderly become a burden. It is related to

declining health which increases health services cost,

decreasing income, increasing disability, the absence

of social support, and an unfriendly environment for

the elderly population (Indonesian Ministry of

Health, 2017).

One of the crucial affairs is also the place for the

elderly to reside (Indriana, 2012). The nursing home

is one of the places where the elderly live. Based on

Article 7 of the Regulation of the Minister of Social

Affairs of the Republic of Indonesia Number 19 of

2012, the first objective of a (nursing) house is to

improve the elderly’s life quality and welfare.

Secondly, to fulfill the basic needs of the elderly; and

thirdly, to increase the participation of the community

and the local government in implementing and

providing social services for the elderly. Nursing

homes types of services referring to Article 9 are 1)

adequate housing, 2) life insurance in food, clothing,

Al Karim, C. and Kristiana, I.

Elderly, Religiosity, and Meaning of Life: A Critical Review.

DOI: 10.5220/0010809300003347

In Proceedings of the 2nd International Conference on Psychological Studies (ICPsyche 2021), pages 103-110

ISBN: 978-989-758-580-7

103

health care, 3) free time including recreation, 4)

mental, social, skill, and religious guidance, and 5)

funeral arrangements. Afriansyah and Santoso (2019)

suggested that nursing homes have the first function

of accommodating the elderly by providing activity

facilities that nurses and social workers perform. As

well as meeting the basic needs of the elderly and

provides a residential complex that can facilitate their

activities and social recreation, along with age

healthily and independently.

A place to live is one of the significant things in

determining the condition of the elderly themselves.

Geriatric depression is common in nursing homes

(Patra et al., 2017). The depression is caused by the

loss of freedom and inability to continue life as

before, feelings of isolation and loneliness, lack of

privacy and discomfort due to having roommates and

sharing bathrooms, and loss of autonomy due to

policies in nursing homes (Choi, Ransom, & Wyllie,

2008). The elderly living in the community have more

independence in daily activity than those who live in

nursing homes. It significantly affects the quality of

life (Nugraha & Aprillia, 2020). The poor elderly life

quality can also be caused by several things such as

inadequate care, living in a nursing home due to

compulsion, having a chronic disease, and lack of

social support (Pramesona & Taneepanichskul,

2018b). The loneliness felt by the elderly can worsen

their welfare (Astutik et al., 2019). Quality of life is

the most influential variable on life satisfaction

(Şahin et al., 2019).

Indriana, Sawitri, Karim, and Hanifah (2021)

found that the resilience of the elderly differed when

viewed from the residency. The resiliency of the

elderly living in nursing homes was the lowest

compared to living at home and in Islamic (nursing)

houses. According to Pramesona and

Taneepanichskul (2018a), the depression prevalence

in the elderly in nursing homes reached 42.5%.

Research on the working elderly reported that social

functioning and income were considerably correlated

with life quality (Hanklang, Ratanasiripong,

Naksranoi, Sathira-Anan & Patanasri 2018). Coping

strategies with a religious approach are one of the

many used by the elderly living in nursing homes

(Choi et al., 2008).

Religious/spirituality-based intervention

programs have a significant positive effect on

increasing life satisfaction and lowering depression in

the elderly with a heart failure history (Abdi et al.,

2019). Religion strongly influences a person's

psychological functioning, one of which is

psychological comfort (Przepiorka & Sobol-

Kwapinska, 2018). The elderly who perceive religion

as necessary and do not use negative coping strategies

tend to have better psychological well-being than

those who see it as less important (Scandrett &

Mitchell, 2009). According to Salman and Lee

(2019), older people who experience depression tend

to have a bad perception of health. Spiritual well-

being is one of the suitable coping mechanisms in

dealing with stressful and painful events. It is proven

that spiritual well-being is a mediator between

depression and perceptions of health in the elderly

(Salman & Lee, 2019). Religious practice has been

shown to positively affect one's mental health (You,

Yoo & Koh, 2019).

There has been a minimal review of research

related to religious-based interventions on well-being

in the elderly. The purpose of this critical review was

to understand how religious-based interventions

impacted the elderly’s well-being. Thus, this

religious-based intervention could be an option for

empowering the elderly.

2 METHODS

2.1 Data Search and Database Strategy

The approach used in this research was critical

review. The article search method was based on

Preferred Reporting Items for Systematic Reviews

and Meta-Analyses (PRISMA). The literature used

was related to religious-based and spirituality-based

interventions on the meaning of life in the elderly in

nursing homes. Articles selected were of the last five

years (2016-2021) and were peer-reviewed articles in

English and could be downloaded in full text.

The literature database used in this study were

ScienceDirect, Springerlink, ProQuest, and ERIC,

using the keywords "(Religious Intervention) AND

(Elderly) AND (Nursing Home) AND (Meaning of

life)".

2.2 Screening Process

The screening process was done by setting exclusive

and inclusive criteria, namely:

1. The empirical studies about the influence of

religion on the condition of the elderly who

lived in home care or nursing home.

2. Peer-reviewed articles, empirical research

(qualitative and quantitative approaches).

3. The articles were written in English and can be

downloaded in full text.

ICPsyche 2021 - International Conference on Psychological Studies

104

Initial searches with the keywords mentioned

above yielded at least 978 articles. After screening,

the initial papers were reduced to 804 because 174

articles were not researched. Among 804 articles, six

were not presented in English, 13 did not discuss the

elderly, 81 were review articles, and 702 were

irrelevant. The remaining 2 articles were used to

review.

3 RESULT

3.1 Article Searching and Screening

Process

Figure 1 shows that based on article searches in four

databases, 978 journal articles were found. After the

front-page screening, it was found that 174 were not

journal articles, leaving 804 articles. Screening based

on abstracts discovered six articles were not in

English, 13 did not discuss the elderly, 81 were

review articles, and 702 did not match the theme. The

authors were left with two articles.

3.2 Article Quality Evaluation &

Review

The two final articles were then assessed for their

quality. Quantitative research used CASP Critical

Skills Appraisal Program guide (CASP

CHECKLISTS, n.d.). The process of evaluating

articles included an evaluation of the introduction,

methods, analysis, results, and discussion (Jack et al.,

2010). Based on the assessment results, four articles

were experimental studies with good-excellent

quality. Six were cross-sectional/correlational

quantitative studies with excellent quality, and four

qualitative articles were of excellent quality.

Figure 1: Article selection flow chart.

Front-page screening

Not in journal

(n=174)

The results of screening

the front-page

n=804 articles

Screening the abstract

Non-English articles (n=6)

Did not discuss the elderly (n=13)

Review article (n=81)

Irrelevant to the theme (n=702)

2 final

articles

Selection of qualified articles (applying

protocol from CASP):

2 qualitative articles categorized as

excellent quality

978 articles

found

Elderly, Religiosity, and Meaning of Life: A Critical Review

105

Table 1: Summary of Articles.

Title, Author, and

Year

Research

Place

Research

Design

Number of

Participants

Research

Instrument

Main Finding Developed Criticism

“Spirituality and

Religiosity for the

Transcendence of the

Elderly Being”

Raul Fernando

Guerrero-Castaneda,

Tania Maria de Oliva

Menezes, Marta

Lenise do Prado, and

Jonathan Alejandro

Galindo-Soto (2019)

Brazil Qualitative

phenomenological

hermeneutic study

11 elderly who

were divided into

two groups living

together

(coexistence). The

first group was

retirees who

periodically met to

do joint activities.

The second group

was several people

in the gerontology

center.

The

phenomenological

interview allowed

to penetrate the

subjectivity of

being and allowed

one to reveal

oneself through

their historicity.

Religiosity and

spirituality became

the source of

strength and

protection to

overcome all

difficulties and

achieve fulfilment.

It gave meaning to

the existence of the

elderly.

This research was conducted in

a city consisting of several

groups of elderly. However, the

authors only limited the elderly

to specific groups.

The authors only outlined the

questions asked to the

participants.

This study only involved

Catholic participants whose

majority were women. The

female participants were nine

people, and the male

participants were two.

“The Meaning of

Religion/Religiosity

for the Elderly”

Ana Luiza Barreto de

Oliveira and Tania

Maria de Oliva

Menezes (2018)

Urban

Social

Center in

Salvador,

Brazil

Qualitative

phenomenological

study

13 elderly in Centro

Social Urbano or

Urban Social

Centre

Phenomenological

questions with

core questions:

How is religion/

religiosity in your

daily life?

Religion/religiosity

offered comfort and

well-being to the

elderly, helping

them cope with

changes that arose

from aging.

The participants were limited to

one community. The author did

not explain the interview guide

in detail, only the function of the

phenomenological approach

initiated by Martin Heidegger.

The elderly had high autonomy

and independence in daily

activities, so that it contributed

to well-being.

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4 DISCUSSION

According to the two final articles,

spirituality/religiosity positively affected the meaning

of life in the elderly. Guerrero-Castañeda et al. (2019)

showed that the elderly had acknowledged the

existence of a great, high, metaphysical power called

God, who had been providing support,

encouragement, and strength. Religiosity and

spirituality had a role to be a source of strength, a

source of protection, a source of strength to overcome

various difficulties that exist and help achieve

fulfillment or unity. Transcendence from being

elderly became more meaningful with the presence of

spirituality. The elderly’s daily experience was

imbued with spiritual relationships and religiosity

that gave meaning to the existence of the elderly

themselves.

A study by Guerrero-Castañeda et al. (2019) used

more female subjects (n=9) than male subjects (n=2)

and was only conducted in one city. The study results

by Guerrero-Castañeda et al. (2019) were more

suitable to be understood in a Catholic religious

setting considering that the participants were only

Catholic. The authors only mentioned the trigger

questions regarding the research instrument without

mentioning the interview guide in detail. The authors

did not mention the details of the research location.

However, they only mentioned that the study was

conducted on two groups of elderly cohabitation in

the community. One was a group of retirees and the

other was elderly in the gerontological center.

According to Guerrero-Castañeda et al. (2019), it

was possible to develop a spirituality/religiosity-

based intervention. After all, the study results

reported that spirituality/religiosity made the elderly

understand their existence better and enabled them to

overcome various problems because they knew God

would always help. Spirituality/religiosity was a

source that healed various daily problems. Spirituality

had religiosity connectivity, religiosity could help

guide carrying out various rituals and with rituals, it

would help the elderly found the meaning of their

existence.

Oliveira and Menezes (2018) stated that

spirituality/religiosity raised concern for others. The

elderly became more concerned with others through

expressing feelings and helping others with religious

orientation and religiosity. The elderly felt united

with others which then created comfort and a feeling

of well-being. The behavioral change also emerged.

Religious dogma guided them, brought comfort and

well-being, felt religiosity's role in daily life, and

engaged in religiosity related to achieving and

maintaining good health conditions. Therefore,

religiosity was vital for the existence of the elderly

because it could provide comfort and a feeling of

well-being. The limitation in their research was that

participants were only involved in one particular

group. It could not be understood in the context of the

elderly in general. The participants in the study were

13 people. All of them were women, with the majority

being Christian (Catholic and Protestant), so future

research should consider the sex and religious

aspects.

The author explained the function of

phenomenology initiated by Martin Heidegger but

did not explain in-depth related to the research

instrument. Participants involved in the study by

Oliveira and Menezes (2018) were elderly people

who have high autonomy and independence related to

their daily activities, which might be a variable that

contributes to well-being in addition to religion.

Religiosity-based interventions could be

developed based on Oliveira and Menezes (2018)

because they could provide meaning, comfort, and

support to face the end of life. Research on culture

can also be considered because the authors mentioned

the relationship between culture and

religion/religiosity.

Interventions based on spirituality/religiosity had

a positive impact on well-being and quality of life.

Singh et al. (2020) suggested that

spirituality/religiosity-based interventions could

significantly improve physical health, body

balancing, and self-care. There was also a significant

difference in the group that used to practice

religiosity/spirituality activities compared to the non-

practitioner group regarding health, quality of life,

and well-being. Further, the difference between

practitioners and non-practitioners was in

participants' perceptions of leading the best possible

life, general health, general social activities, and life

quality.

Sharif et al. (2021) found a positive relationship

between close attachment and religiosity, along with

a negative relationship between anxiety attachment

and religiosity. Religiosity had a positive relationship

with hope, and hope was positively associated with

life satisfaction. Spirituality/religiosity-based

interventions could increase subjective vitality and

scale down loneliness (Borji & Tarjoman, 2020). The

involvement of the elderly in worship was also

beneficial because the more active the elderly

worship, the more self-caring for the elderly with

heart failure (Kazeminezhad et al., 2020). In the

Christians elderly, church attendance resonated with

depressive symptoms. Spiritual connectedness

Elderly, Religiosity, and Meaning of Life: A Critical Review

107

buffered depressive symptoms against functional

limitations (Lee & Zhang, 2018).

Abdi et al. (2019) explained that religious

interventions could increase life satisfaction and

reduce depression in the elderly who suffer from heart

failure. The author also reported no difference in the

average score on life satisfaction in both the control

and experimental groups. However, after the

intervention, there was a significant difference in

which the experimental group was higher than the

average score of the control group. Likewise, with the

average depression score, there was no difference in

either the experimental or the control group before the

intervention. There was also a significant difference

in which the experimental group had a lower score

than the control group. Forms of religious

intervention that can be done are: 1) Reciting the

Koran, 2) Reading prayers and discussing the

psychological effects of prayer, 3) Telling stories

about role models in religion, 4) Participating in

religious programs, 5) Repenting and asking

forgiveness, and 6) Practicing moral analysis of value

moral (Abdi et al., 2019).

Interventions based on spirituality/religiosity

affected the elderly’s cognitive state (Aloustani et al.,

2019). Before the intervention, the average score in

the two groups did not show a significant difference.

Meanwhile, after the intervention, there was a

significant difference between the experimental and

the control group. It can be concluded that this

spiritual group therapy could be an inexpensive and

effective method to improve the elderly’s cognitive

state. Perceived stress in the elderly living in nursing

homes could be reduced by spiritual-based

interventions (Heidari et al., 2019).

The elderly defined spirituality as a connection

with God/beliefs/communities in the church, music,

family, friends, nature, and people living in the

nursing home (Harrington et al., 2019). Although not

all elderly people experienced spirituality with God,

all participants defined spirituality as a connection.

Three other themes that emerged were “lost”,

“adaptation”, and “they are busy”. The “lost” was

related to the aging process and loss of relationships

with friends. “Adaptation” was related to

compensation for the loss that they experienced.

When the elderly found ways to perform spiritual

expression, they would be successful in adapting.

“They are busy” was related to the loneliness older

people felt. The word busy was used by the elderly

because their family members were unable to visit

because they were busy, making the elderly felt

neglected. Providing spiritual care for the elderly was

important because it emphasized the value and

dignity of humans (Rykkje, 2018). Love is a crucial

element in dignity, spirituality, and spiritual care for

the elderly because love in caring for others, oneself,

nature, and God are essential in life (Rykkje, 2018).

Rykkje (2018) explained the value of humanity or

dignity as a human being which was understood when

a human being could give loving attention to others.

Furthermore, that other people reciprocated the

affection that had been given. Unfortunately, the

study classified as having good quality based on the

evaluation of international appraisal criteria was only

qualitative research, whereas to see the effect, an

experimental or longitudinal study is needed.

5 CONCLUSION

Religiosity/spirituality interventions had a beneficial

impact on the elderly. It included reducing depression

levels, reducing perceptions of stress, alongside

improving mental health and well-being. In order to

empower the elderly to stay healthy and productive,

religiosity/spirituality intervention could be an

alternative. Research related to spirituality/religiosity

needs to consider where the research is conducted

because the cultural aspect is related to the

understanding and understanding of

spirituality/religiosity. Spirituality/religiosity also

needs to be understood based on the religious context

adopted because the religious background can be

related to understanding spirituality/religiosity itself.

Experimental or longitudinal research is needed with

rigorous designs and procedures to determine the

effectiveness of spirituality/religiosity-based

interventions on the meaning of life for the elderly.

Experimental and longitudinal studies with rigor

designs and procedures need to be carried out to see

the effectiveness of this religiosity intervention in

helping the elderly find a positive meaning in life.

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