Elderly, Religiosity, and Meaning of Life: A Critical Review
Chamilul Hikam Al Karim
1
and Ika Febrian Kristiana
2
1
Postgraduate Program, Faculty of Psychology, Diponegoro University, Jl. Prof Sudharto, SH, Indonesia
2
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
Copyright
c
2022 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
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.
ICPsyche 2021 - International Conference on Psychological Studies
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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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