Longevity and Reilgion/Spirituality

A rare study--where a group of individuals born in 1920s were followed over several decades looking at their spiritual beliefs--reported that significant increase in spirituality was evident from late middle age (mid-50s to late 60s) to older adulthood (late 60s to mid-70s). This was irrespective of gender. Similar snapshots of people's beliefs have been substantiated by survey research and public opinion polls since the 1930s. The consistent finding is that older means that you are likely to become more religious/spiritual.

Because aging is correlated with spirituality it is not surprising to find that spiritual people are older and that older people are spiritual. Aging is correlated with spirituality. Spirituality does not, by itself, confer increased longevity. Being spiritual or religious is not a good predictor of how old you will live to, although it might tell us how old you are now. This is despite anecdotal “secrets” for longevity that people older than 85 years, gave for their good health and long life, which were "faith in God" and "Christian living." All valid responses but perhaps not accurate in this diverse society of today.

Allison Sullivan from the University of Pennsylvania published a study in 2011 showing that Jews have lower mortality than the rest of the USA. All other religions were comparable or, as with Black Protestants, had a life expectancy as much as five years lower than the average US citizen. So religion by itself is not a good predictor. 

Religious affiliation follows other variables. For example, those that reported being Jewish reported lowest prevalence of drinking alcohol, were mainly women (comparable only to Catholics), were nearly exclusively White, and were the richest by a very wide margin. These are all factors that by themselves, regardless of their religious affiliation, promotes higher life expectancy. Religion and spirituality, by themselves, are not very good predictors of long life. Where religion and spirituality show distinct advantage is in coping with imminent death. 

In an Australian study, which conducted detailed interviews of older adults in nursing homes and independent living homes, it was reported that religious older adults reframe memories and experiences linked with final meanings, transcend their losses and suffering, reported intimacy with God and others, and found hope. God for them was the ultimate consolidator.

Reporting religious beliefs is also associated with how your caregivers treat you. Nursing assistants who held similar beliefs as their elderly long-term clients, expressed more meaningful connections with them which resulted in better care. Which brings up the issue of what happens when societies are becoming more diverse both in terms of culture and religion and also in term of sexual preferences?

Spirituality does not confer longevity although having meaning in life does--not necessarily spiritual. Especially if you compare people’s religious participation with other older adults participating in other social events, the difference in longevity between religious and non-religious participants disappears. Being religious by itself does not promote longevity, but it might help how you are treated should you lose your independence.

Depression without Sadness

Depression is a seriously debilitating disease that increases your chances of early death. In a report that looked at twenty five separate research studies the conclusion was that depressed people are nearly twice as likely to die early when compared to non-depressed people.

Depression affects about fifteen in every hundred older adults. There seems to be less of a difference between gender than at younger ages and affects different ethnicities equally. Although these studies find that depression is less common in older age, it might be argued that we are not measuring depression correctly among older adults.

An emerging argument is that depression in older adults is more subtle and remains undetected. While on the other hand depressive symptom checklists are inflated as they include symptoms that are directly linked to a physical illness or bereavement, both of which increase in frequency with age. How good are we at identifying depression among older adults?

Although we normally associate depression with sadness, studies are now showing that older adults are generally less likely than young adults to report sadness--dysphoria--when they are depressed. Joseph Gallo from John Hopkins University and colleagues reported that in a number of different studies older adults were less likely to report being sad than younger persons.  And this seems to be an aging effect rather than to a particular generation. People who might have expressed sadness with depression when they were young, as they get older they are less likely to express sadness with their depression. Depression among older adults is related more to listlessness and lack of interest in life rather than sadness.

It could be that older adults are better at separating sadness from depression. However studies show that older adults are not very good at identifying facial expressions showing anger, fear, happiness, and sadness. And it is the more subtle expressions of emotions that older adults have trouble with.  Andrew Mienaltowski and his colleagues in Bowling Green, Kentucky show that in general, older adults have more difficulty discriminating between low intensity expressions of negative emotions than did younger adults.

The issue is that older adults not only do not express sadness with their depression but that they are less likely to see sadness in others. With health care professionals getting older, it is not just depressed older adults that we need to be concerned about but also their physicians. If older physicians are less likely to see sadness then they are less likely to notice depression. Depression without sadness is not only difficult to detect by physicians it is also a silent killer. In a 13-year follow-up, older adults who reported  depressive symptoms without dysphoria--nondysphoric depression--were at increased risk for death, functional limitation, cognitive impairment and psychological distress. Among suicide victims 55 and older, 58 percent visited a general physician in the month before the suicide. In fact, 20 percent see a general physician on the same day and 40 percent within one week of the suicide.

Depression among older adults is a serious issue and it is not part of the aging process. The lack of expression of sadness and the diminished ability by others of perceiving sadness further hides this silent early killer.

Painful Religion at End-Of-Life

In the United States nearly eight out of every ten hospital deaths have no formal pain management. More than eight out of every ten older long-term care facility residents experienced untreated or under-treated pain at the time of death. While seven out of ten people on Medicare who are dying, regardless of their age or where they died, received inadequate amount of pain management. People in the United States are dying in pain.

Most Americans--three of every four--do not fear death as much as we fear being in pain at the time of death. Despite these clearly stated and seemingly universal preferences, too many of the 3 million Americans who die in health care settings each year suffer needlessly in pain at the end of life.

Persons dying from prolonged illnesses can, and should, experience a “good death”. And we know exactly what that means. For most of us a good death consists of dying at home, surrounded by family, and free from pain and suffering. And our preference to die in such a dignified manner is consistent regardless of one’s age, gender, ethnicity, or religious background.

However, by following Christian and Protestant fundamentalist beliefs people who are dying are less likely to have access and select methods for hastening the process of dying. In the United States, approximately 25% of all U.S. deaths occur in the long-term care setting, and this figure is projected to rise to 40% by the year 2040.

The belief in an afterlife--and the support from caregivers who share the same belief--must contribute to the fact that being religious is negatively associated with fear of death.  But there is also the worry that some religious beliefs, because of their emphasis on natural death, preclude you from pain medication that might hasten death and taking control over what for most of us will be a painful final passage through life.

Although religious doctors were significantly less likely than their non-religious colleagues to provide treatment with at least some intent to shorten life, when religious doctors did provide such treatment they were significantly less likely to have discussed this with their patient. And this is the unspoken secret of hospitals.

Physicians prescribe pain medication that hastens the final passage of death in a clandestine manner. We live (or die) in an atmosphere of silent favors to alleviate pain.

The Universal Declaration of Human Rights: Article 5 “No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.” The renowned physician Jack Kevorkian’s final push to bring this issue to the Supreme Court--where it should be legitimately decided and which they arrogantly refused to hear—only resulted in pushing him into jail. Because  of religious self-censoring we are not approaching the issues head-on. We are therefore resigned to repeating the same mistakes. Older adults in the United States will continue to die in pain.

As Susan Imhof and Brian Kaskie have argued,  “we can only conclude that public policies will fall even further behind the advancement of evidence-based pain-policy guidelines, and the number of Americans who continue to suffer needlessly in pain at the time of death will only increase.”

© USA Copyrighted 2013 Mario D. Garrett
In memory of Uncle Freddie who died after a protracted illness.