Research in recent decades concluded that older people who are more religious are better at coping with the stresses of aging, such as the diagnosis of a terminal illness, death of a spouse, or declines in physical functioning and generally have better health outcomes. But more recent studies question these conclusions and suggest the data was not inclusive enough.
The first study we examined (the 2016 Social Science & Medicine – Population Health article entitled: “Spirituality, religiosity, aging and health in global perspective: A review.”) observed that populations are aging globally and that research has shown that religiosity and spirituality are factors that can improve health in later life. However, their review showed that earlier studies failed to make important distinctions which affected their conclusions.
In particular, many earlier studies took place only in the U.S. and Europe and used only cross-sectional data. This kind of data can establish correlation, but limits the ability to determine religiosity as the cause of better health outcomes in old age. Also, they noted, living longer (longevity) has been studied separately from living longer and healthier, especially in developing countries. A good part of their study, though, was devoted to the drawback that spirituality and religiosity were often considered together and that religiosity received more attention. “Most research around the world to date has focused on the link between religion and health as opposed to spirituality and health (Lucchetti, Lucchetti, & Koenig, 2011). Yet, spirituality and religiosity are often considered together, particularly when incorporating measures relating to meaning of life (Krause, 2003).”
But spirituality and religiosity are difficult to define and their distinction has become far more important both in the U.S. and globally. Nearly one in 4 American adults are religiously unaffiliated, and many older adults now consider themselves “spiritual but not religious” (Pew Research Center 2014 Religious Landscape Study). Also, what about religion and spirituality world wide? The study notes: “Distinguishing the difference between religiosity and spirituality has not been easy for any single culture let alone cross-nationally.” Nor is the difference between religiosity and spirituality clear when you consider more contemplative practices that may be very beneficial to health in old age but are not considered religious: “Moreover, how different individuals practice religiosity varies widely across countries (Koenig, 2001). When contemplative and meditative pursuits are included, the notion of practice can become murkier. It can be difficult to tease out the impacts of religion versus spirituality versus meditation, and effects of public versus private expressions (Helm, Hays, Flint, Koenig, & Blazer, 2000).”
So what is meant by religiosity and what is meant by spirituality? The study suggests “While levels of religiosity around the world are often measured in direct ways, for instance with respect to frequency of activity, such as ritualistic practice and attendance at places of worship, spirituality must be measured in more indirect personal experiential terms, such as the search for meaning, peace and personal fulfillment, contemplation about meaning of life, and the feeling of a personal relationship to a higher power.” Though spirituality and religiosity are not mutually exclusive, it is safe to say that they are now considered sufficiently different that research on healthy aging must distinguish between the two.
The SSM-Population Health Study does point out: “It is also important to note that across the many studies we reviewed and that adjust and control for multiple intervening mechanisms, there is still a residual impact of religiosity on health.” Nonetheless, there are many mediating factors that are associated with traditional religion but may or may not depend on religious beliefs. Important psychosocial mechanisms such as social support, healthy behaviors, and stress reduction contribute to healthy coping in old age.
Data has shown that people who are religious are likely to enjoy social support because of the group dynamics in most religions. Healthy behaviors like moderation in eating and drinking etc. are also encouraged by many religious traditions. There is also a link between the social support that can be provided through religious activity and stress reduction. But these psychosocial mechanisms are not necessarily confined to religion.
So questions remain whether it is religion per se that is the significant difference in an older person’s ability to cope with the stresses of aging. Or can spirituality not associated with a traditional religion be as effective? Further, what would be true for people who are neither spiritual nor religious?
This question was addressed in the second study we reviewed (August 2010 Journal of Aging Studies entitled, “Atheistic, agnostic, and religious older adults on well-being and coping behaviors“) which focused on some different drawbacks in earlier studies. The primary drawback that this study documented was that people who were non-religious had not been included in most of those studies, so there was little data about health outcomes for people who do not use religion to cope with the stresses of aging. And there were other problems.
“In addition, most research studies used Christian religiosity as a standard measure of religiosity. This makes the results less generalizable to the broader population. Another limitation of past research is the use of exclusive measures of religious behaviors, such as attendance at services, as a measure of religiousness. Many people consider themselves religious and believe in God or a higher power, however, without belonging to a particular faith or attending religious services (Hunsberger & Altemeyer, 2006). Therefore, measures of intrinsic religiosity, which is an individual’s religious beliefs, attitudes, and values (Allport, 1950), needs to be included along with measures of religious activities in investigations. These two separate constructs may have differential relationships to well-being. Along with intrinsic religiosity and religious behaviors, an individual’s personal relationship with God or a higher power should be examined; this is a fundamental aspect of an individual’s religion, but is often not included in research studies.”
This study also noted a couple of interesting findings. First, although using religion to cope has been shown to improve psychological well-being, health, and self-efficacy, in fact, improvement was not the only possibility. The study observes: “For example, religious beliefs and ideology may help a person to redefine a stressor as benevolent or even as potentially beneficial. However, it could also cause a person to reappraise the situation more negatively, such as viewing it as a punishment from God (Koenig, Pargament, & Nielsen, 1998). In a study of physically ill hospitalized older adults conducted by Koenig et al. (1998), both positive and negative types of religious coping behaviors were identified.”
Interestingly, the SSM-Population Health review had similar findings: ” . . . religion has been found to induce anxiety when it fosters psychologically harmful feelings such as guilt and shame, when it promotes adverse attitudes towards outsiders or when it encourages unquestioning devotion and obedience or beliefs that step toward ‘fundamentalism’ (Chatters, 2000; Nooney & Woodrum, 2002). It is harmful to rely on faith healing as a substitute for medical care (Pargament et al., 2001). Unfavorable interactions with fellow church members were identified in one study as leading to depressive outcomes among clergy and older church-goers (Krause, Ellison, & Wulff, 1998). Religious doubt, or a feeling of uncertainty towards religious beliefs has been associated with negative mental health outcomes (Krause & Wulff, 2004).”
The second issue noted in the Journal of Aging Studies review was that many earlier studies only compared subjects with strong religious beliefs to subjects with weak religious beliefs and not to nonreligious people. Thus, there is little data about people who cope with old age without religious beliefs. However, in a 1990 study conducted by C.E. Ross on “Religion and psychological distress” he did in fact, include people with no religious beliefs: ” A similar finding was reported by Ross (1990) revealing that individuals who believed strongly in their religious beliefs had lower levels of psychological distress as compared to individuals who endorsed being religious, but had a weak belief. Ross, however, did include a sample of participants who reported no religious beliefs, and found they also had lower levels of psychological distress compared to those with only weak beliefs. The author concluded that individuals wavering in their beliefs, rather than individuals who either completely rejected or strongly embraced religion, had the highest levels of distress. This calls into question the relationship between religiosity and well-being by suggesting that the strength or commitment to a particular belief system is more important than the type of belief (Ross, 1990).”
Both studies demonstrate that the relationship between religiosity, spirituality and healthy aging is murkier than most previous research suggests.
Also, both studies identified the importance of meaning and purpose in one’s life in promoting healthy aging. People with a clear sense of meaning and purpose are often able to positively reframe a stressful situation so as to seem less threatening. While religious beliefs provide meaning and purpose for the majority of people, a spiritual life that is more contemplative and not related to a traditional religion may provide the same thing. The Journal of Aging Studies notes: “Again, like religion and spirituality, there are close connections between prayer and mindfulness meditation and both are thought to elicit physical and mental relaxation (Ivanovski & Malhi, 2007).”
And the SSM-Population Health review also found: “A mindfulness practice is increasingly being seen as effective in controlling stress and anxiety (Koszycki, Benger, Shlik, & Bradwejn, 2007; Ledesma & Kumano, 2009; Roth & Creaser, 1997). Older persons benefit from such activity (Ernst et al., 2008). Studies have indicated mindfulness meditation positively impacts a host of physical health outcomes (Cahn & Polich, 2006; Davidson et al., 2003; Fang et al., 2010; Jevning, Wallace, & Beidebach, 1992; Solberg et al., 2000; Young & Taylor, 1998).”
The Journal of Aging Studies research concluded: “In summary, although specific differences were established, the atheists, agnostics, and religious individuals were more similar than different in their use of coping behaviors. Although religious individuals do often rely on their religious beliefs to cope, the benefit of using religion to cope as compared to other coping mechanisms remains unclear. Literature suggests that the utilization of religion to cope has been shown to improve psychological well-being (Harrison et al., 2001), yet the sample of non-religious individuals who do not use religion to cope, have similar levels of overall well-being. Utilizing religious practices to cope may in fact promote the use of social support, personal control, and meaning-making; however, non-religious individuals utilize social support, control, and reframing techniques in equivalent rates.”
The SSM-Population Health review conclusion was somewhat less specific and advises, like so many studies, that more research is needed: “It can be considered by some to be ‘unscientific’ to consider religiosity among other health determinants, despite evidence cited above. Yet, there does appear to be an intensification of spiritual affectations with aging. At the same time, the global population is getting older and living to increasingly advanced ages. Now for the first time in human history, most people in the world can expect to live into their 60s (World Health Organization, 2015). These facts strongly point toward a requirement and even an obligation on the part of the scientific community to explore the connection between religiosity, spirituality and health in order to more fully understand the determinants of quality of life in old age and in so doing suggest ways for improving human health and the human condition.”
What is clear from both of these studies is that the data thus far is inconclusive whether people who are more religious cope better with the stresses of old age or have longer healthier lives than those who are not religious. People who are “spiritual but not religious” or who are neither spiritual nor religious may face the stressors of aging just as well. For a majority of people, religion provides social support, encourages healthy living habits and stress reduction, and provides meaning and purpose in life. Nonetheless, a large and growing population of religiously unaffiliated in this country may also find these supports outside of traditional religion. Globally, where the difference between religiosity and spirituality is even harder to define, a causal relationship between religiosity and better coping with old age seems even less certain.
What also seems clear from these studies is that, regardless of your religious belief or lack thereof, maintaining good social support, healthy physical habits, on-going stress reduction and finding meaning and purpose in your life are excellent strategies for a healthy old age.