How Can We Support Religious and Spiritual Practices of Older Adults with Mild Cognitive Impairment and Dementia?

Older adults, those facing advanced illness, and historically underrepresented communities find salience in religion and spirituality for coping in stress and illness (Chatters et al., 2013; Balboni et al., 2022). Religious and spiritual beliefs and practices serve as meaningful sources of social engagement and for some, a vital component of successful aging. But what do we know about the religious and spiritual practices of older adults with cognitive impairment and dementia? Well, we know it is important but there is limited research in this space. More work is needed to support the established religious and spiritual practices of older adults facing a progressive and terminal illness of dementia.

As adults age, their risk of developing cognitive impairment and dementia rises (Alzheimer’s Association, 2021). There are over 6 million Americans living with Alzheimer’s disease related dementia (ADRD) and these numbers are expected to rise as the population ages (Alzheimer’s Association, 2021). It is well-known that persons living with dementia rely on others to support their well-being. Currently in the U.S., there are 11 million caregivers (i.e., family members and friends) providing unpaid care for persons living with dementia Alzheimer’s Association, 2021). With this growing burden of dementia, we need to identify protective factors and nonpharmacological interventions that promote health, quality of life, and well-being for older adults at risk of and with dementia. If older adults and socially marginalized populations at greater risk of dementia find R/S important, why don’t we start there.

What are religion and spirituality exactly? Often times religion and spirituality are interchanged in research studies. While these terms do overlap, the concept of spirituality is more abstract and generally refers to forms of connectedness. For example, religion refers to a system of beliefs and practices related to one’s faith tradition while spirituality refers to individual expressions of meaning, purpose, and connectedness to self, nature, others, and the sacred and through transcendence to find peace (Koenig, 2012; Puchalski 2009). This conceptualization of spirituality has been put forth by a consensus conference of spiritual experts and leaders to arrive at one consolidated definition of spirituality. According to these spiritual experts and leaders, one consolidated definition of spirituality was necessary to best capture the essence of this concept and advance the science on spirituality and health.

How do we measure religion/spirituality (R/S) in research? Existing measures include frequency of religious service attendance, frequency of private prayer, religiosity (i.e., how religious a person is), daily spiritual experiences (i.e., one’s sense of connection to God, inspiration and awe, etc.), spiritual well-being, religious coping (negative and positive coping), religious beliefs, practices, and support, meaning, faith, peace, and life purpose (Britt et al., 2022a, Koenig, 2012). Findings from these measures suggest that R/S is used for coping in stress and illness and is associated with better mental and physical health (Balboni et al., 2022; Koenig, 2012). For physical health, this includes lower risk of all-cause mortality, cancer, stroke, hypertension and less substance use and smoking. R/S is also associated with better immune function and endocrine response. In mental health, R/S is associated with fewer depressive symptoms and lower anxiety and increased life satisfaction and psychological well-being (Coelho-Junio et al., 2022; Koenig et al., 2012; Williams & Sternthal, 2007; VanderWeele, 2017; Balboni et al., 2022).

Increasingly, studies are being conducted to look at mediators and moderators of the relationship between R/S and health outcomes in older adults including those with chronic conditions. Currently, it appears R/S promotes positive psychological emotions and virtues (i.e., hope, optimism, forgiveness, gratefulness) which may mediate the relationship (Luchetti et al., 2021). Other factors may also influence the association including healthy lifestyle adherence (i.e., decreased smoking, alcohol consumption). R/S communities provide social engagement opportunities with teachings that may stimulate cognitive thought. Preliminary studies have also found that R/S practices may reduce stress and anxiety and possibly inflammatory markers (Anyfantakis et al., 2013; Chen et al., 2020; King et al., 2001; Koenig et al., 2012; Williams & Sternthal, 2007).

Now, what do we know about R/S in dementia? Studies on R/S and dementia report similar associations as reported above. Higher religious/spiritual practices are associated with slower cognitive and behavioral decline and better functioning in older adults living with dementia (Britt et al., 2022a). One spiritual intervention using reminiscence found improved cognitive function among their sample with dementia (Wu & Koo, 2016). In a study conducted during the pandemic among dementia caregivers, 64% reported their loved one with dementia and 100% of caregivers identified as religious or spiritual (Britt et al., 2022b). Only one of the older adults with dementia received religious and spiritual support during social distancing of the pandemic from a religious or spiritual leader (Britt et al., 2022b). Religious and spiritual activities for older adults with dementia include watching or listening to religious services, listening to religious music, prayer rituals, and holding and using religious and spiritual objects (i.e., crucifix, prayer book, rosary beads, Bible). Due to limiting physical disabilities and technologic illiteracy, older adults with dementia were not able to continue their established R/S practices during the pandemic and relied heavily on caregivers to support their spiritual needs. Loss of established R/S practices may prompt decline in previous skills and function for older adults who do not have R/S support for their coping practices. The pandemic revealed the deeper need for meaning and connectedness we all have but was limited from social distancing and social interaction with others.

In other studies among older adults with MCI and dementia aged 73 years and older, 87–96% of non-Hispanic Black and 100% of Hispanic participants reported religion to be very important (Britt et al., 2022c; Britt et al., 2022d). Among Hispanic participants, 67–71% reported attending religious services once or more each week. Interestingly, private prayer was utilized the most with 100% of non-Hispanic Black and Hispanic participants and 88% of non-Hispanic White participants reported praying once or more per week. Higher R/S practices were associated with better cognitive function, lower neuropsychiatric symptoms, and fewer sleep disturbances (Britt et al., 2022c; Britt et al., 2022d).

However, even with all of these findings, more research is needed to examine associations over time. More studies are also needed to examine if R/S support can help older adults with dementia and cognitive impairment maintain their cognitive health and physical functioning longer while decreasing neuropsychiatric symptoms such as depression and agitation. The potential impact on the caregiving burden could be substantial as dementia caregivers report twice as many emotional, physical, and financial problems compared to caregivers of persons without dementia (Alzheimer’s Association, 2021). We need to create more interventions supporting the R/S practices of older adults as they age, as they begin to have cognitive impairment, and even after they are diagnosed with dementia. Given that up to 40% of dementia risk factors are modifiable, establishing education programs and caregiving support groups are important. What better way to address health inequities than to partner with faith-based organizations to increase resources and education which has potential to decrease health disparities. As the 2022 Caregiving Strategy mentioned faith-based organizations taking a role, it is time to partner with religious organizations such as churches, temples, synagogues, and mosques to establish dementia friendly-services and resources to support aging adults to continue to their established coping practices for as long as possible. As procedural and emotional memory are the last memories to diminish in dementia, using familiar and established R/S objects and activities tailored to the individual has potential to improve spiritual well-being even as they progress through the illness. Much work is needed, so let’s get started! AMEN!!!