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Overview

A rapidly growing literature shows that greater levels of religiousness and spirituality generally lead to better physical and mental health outcomes. The Lighthouse National Survey on Vision Loss (1995) indicates that 13.5 million Americans 45 years and older report significant vision loss, ranging from moderate impairment to total blindness. The current research has taken a broader approach to the study of adaptation to visual impairment by considering the roles played by religiousness and spirituality in terms of both domain-specific and more global psychosocial outcomes. Overall, it was hypothesized that individuals reporting greater religiousness or spirituality would experience less negative impact from vision impairment and other stressful events, and would have more positive rehabilitative outcomes in terms of adaptation to vision loss and psychosocial development. Specifically, two competing hypotheses were tested: 1) social support -- highly religious people, through contact with religious institutions, have increased social contact and exchanges of assistance; and 2) religious consolation -- religious beliefs promote perceptions that lessen suffering and distress. This research has also examined the extent to which religion and spirituality play differential roles among middle-aged adults compared to older individuals in adapting to vision loss.

Method

Participants were 99 middle-aged and 95 older adult applicants for services from Lighthouse International (a vision rehabilitation agency) and whose cases were recently closed (n = 195). Participants were screened on the following criteria: visually impaired; age (45 or older); living in the community; and fluency in English. After obtaining informed consent, respondents were interviewed by telephone for approximately 1 hour. Extrinsic and intrinsic religiousness were assessed with a modified Religiousness Orientation Scale (Allport, 1967). Spirituality was measured with the Spirituality Assessment Scale (Howden, 1992). Covariates included vision loss severity, and sociodemographic, health, life stress, and social support measures. Outcomes consisted of the Adaptation to Vision Loss Scale (AVL) (Horowitz & Reinhardt, 1998), the Inventory of Psychosocial Balance (Domino & Affonso, 1990), and two single-item measures; life satisfaction and depression.

Results and Discussion

After controlling for all other covariates using hierarchical multiple and logistic regression, spirituality emerged as a significant independent predictor of better adaptation, supporting the religious consolation hypothesis. Extrinsic religiousness was associated with lower AVL scores, while higher intrinsic religiousness was related to higher life satisfaction. Although religious involvement was associated with greater levels of social support, the only social support factor to predict better adaptation was the perception of emotional support adequacy. In addition, social support received directly from religious congregations was not significantly related to any outcome. Thus, the social support hypothesis was not supported. Furthermore, additional analyses have not supported the hypothesis that highly religious individuals are advantaged in terms of social support resources resulting from such religious activity. Current findings from this project, one of the few studies that has examined religiousness and spirituality concurrently, suggest that the beneficial effects of religiousness on physical and mental health outcomes have been to-date, somewhat misleading and overstated. Our current results suggest that one's underlying level of spirituality is the more important factor in adaptational outcomes, regardless of whether such spirituality is expressed formally through participation in a religious community. This is not to suggest that religiousness is not related to better outcomes, rather, it is that religiousness demonstrates its beneficial effects on these outcomes because it is a vehicle for the expression of a person's underlying spirituality.

The relation of religiousness and spirituality to psychosocial development was also examined as part of this study. Regression analyses on the effects of religiousness and spirituality on psychosocial development among middle-aged and older adults with vision impairment found that spirituality, but not religiousness, significantly predicted higher levels of development operationalized according to Erikson's theory. In addition, spirituality was found to significantly interact with life event impact and control domain ratings such that this coping resource exhibited a buffering effect on self-reported negative life experiences. These additional analyses allowed a comparison of the stress mediating roles of religiousness and spirituality on both vision impairment and more general life event stress. This comparison revealed that spirituality and religiousness variables exhibit similar mediating effects in terms of both adaptation to vision loss and the more global concept of psychosocial development. That is, higher levels of spirituality were related to both better adaptation and higher levels of development while religiousness, particularly an extrinsic orientation, tended to predict poorer outcomes. Additionally, further work has found evidence for developmental recapitulation in adaptation to visual impairment. Middle age and older adults appear to renegotiate earlier developmental stages during the adjustment process as a way of restoring equilibrium following the onset of visual impairment.

Increased social support availability has been hypothesized as one of the mechanisms responsible for the positive effects of religiousness. Thus, the 182 middle-aged and older adults who reported a denominational affiliation were asked about their experience with tangible social support received from their religious communities. Nearly one-quarter (23%) reported receipt of such help. Persons from Protestant denominations were significantly more likely to report receiving faith-based support (41%) compared to either Catholic or Jewish denominations (10% and 11%, respectively). Among those reporting the receipt of faith-based assistance, emotional support was the most frequently mentioned type of help (19% of responses), followed by getting a ride or escort (17%). Both help with food or meals and receiving a ride to religious services were the next most frequently reported types of help (13% and 13%, respectively). Examining broad categories of support (i.e., emotional, instrumental, religious, and transportation) revealed that all participants reporting faith-based help received instrumental assistance. Receipt of support was not associated with age, gender, race/ethnicity, denomination, or frequency of service attendance. Persons living alone were more likely to receive emotional support compared to peers, but living arrangement was not related to any other category of support. These findings suggest that faith-based social support is an important resource for many middle-aged and older adults, especially in meeting age-related challenges such as chronic disability resulting from vision loss.

Status

Multivariate analyses (i.e., regression analyses and structural equation modeling [SEM]) are continuing. Qualitative analysis of respondents' narrative data is ongoing. Funding is currently being sought to study the relationship of religiousness and spirituality to rehabilitation outcomes among visually impaired adults over time.

Publications

Brennan, M., & Heiser, D. (2004). Introduction: Spiritual Assessment and Intervention: Current Directions and Applications. Spiritual assessment and intervention with older adults: Current directions and applications (pp. 1-20). Binghamton, NY, US: Haworth Pastoral Press.

Brennan, M, & Lee, E. (in press). Untangling the relationships between religiousness, social networks, and the variety and quality of social support among middle-aged and older adults with visual impairment. In A. L. Ai and M. Ardelt (Eds.), The role of faith in the well-being of older adults: Linking theories with evidence in an interdisciplinary inquiry. Hauppauge, NY: Nova Science Publishers.

Brennan, M., & MacMillan, T. (2006). Developmental recapitulation in adaptation to vision loss among middle-age and older adults. Journal of Social Work in Disability and Rehabilitation, 5(1), 45-63.

Brennan, M., & MacMillan, T. (in press). Spirituality, religiousness, and the achievement of vision rehabilitation goals among middle-age and older adults. Journal of Religion, Spirituality and Aging.

DePalo, R., & Brennan, M. (2004). Spiritual Caregiving for Older Adults: A Perspective from Clinical Practice. Spiritual assessment and intervention with older adults: Current directions and applications (pp. 151-160). Binghamton, NY, US: Haworth Pastoral Press.

Brennan, M. (2000). Religiousness and spirituality in vision impaired elders. Final progress report submitted to the National Institute on Aging, National Institutes of Health, Bethesda, MD. New York: Arlene R. Gordon Research Institute of Lighthouse International.

Brennan, M. (2002). Spirituality and psychosocial development in middle-age and older adults with vision loss. Journal of Adult Development, 9 (1), 31-46.

Brennan, M. (2004). Spirituality and religiousness predict adaptation to vision loss among middle-age and older adults. International Journal for the Psychology of Religion, 14 (3), 193-214.

Brennan, M. (2004). How congregations can reach out to older adults with visual impairment. Aging and Spirituality, Newsletter of the Forum on Religion, Spirituality and Aging, American Society on Aging, 16 (2), 1-6.

Brennan, M. (2005). Spirituality and coping with vision loss. Sharing Solutions, Spring 2005, 2-4.

Brennan, M., & Cardinali, G. (2000). Religiousness and spirituality in adaptation to vision impairment among middle-age and older adults. In C. Stuen (Ed.), Vision Rehabilitation in the 21st Century: Proceedings of the Vision '99 International Low Vision Conference (pp. 645-649). Lisse, The Netherlands: Swets & Zeitlinger Publishers.

Brennan, M., & Heiser, D. (in press). Spiritual assessment and intervention: Current directions and applications. In M. Brennan and D. Heiser (Eds.), Spiritual assessment and intervention with older adults: Current directions and applications. Binghamton, NY: Haworth Pastoral Press.

Brennan, M., & MacMillan, T. (in press). Developmental recapitulation in adaptation to vision loss among middle-age and older adults. Journal of Social Work in Disability and Rehabilitation.

Brennan, M., & Mroczek, D. K. (2002). Examining spirituality over time: Latent growth curve and individual growth curve analyses. Journal of Religious Gerontology, 14 (1), 11-30.

DePalo, R., & Brennan, M. (in press). Spiritual caregiving for older adults: A perspective from clinical practice. In M. Brennan and D. Heiser (Eds.), Spiritual assessment and intervention with older adults: Current directions and applications. Binghamton, NY: Haworth Pastoral Press.

McFadden, S. H., Brennan, M., & Hicks Patrick, J. (2003). Charting a course for 21st Century studies of late life religiousness and spirituality. In S. H. McFadden, M. Brennan, and J. Hicks Patrick (Eds.), New directions in the study of late life religiousness and spirituality, (pp. 1-10). New York: The Haworth Pastoral Press, Haworth Press.

Presentations

Brennan, M. (1999, August). Vision impairment and psychosocial development in middle and late adulthood. In C. Park (Chair), Growth and transformation following stressful life experience. Symposium conducted at the annual convention of the American Psychological Association, Boston, MA.

Brennan, M. (1999, November). Religiousness, spirituality, and adaptation to vision loss in middle-aged and older adults. Poster session presented at the annual scientific meeting of The Gerontological Society of America, San Francisco, CA.

Brennan, M. (1999, November). Predictors of religiousness and spirituality in middle-aged and older adults. In D. Mroczek and M. A. Lewis (Chairs), Well being and affect in later adulthood. Symposium conducted at the annual scientific meeting of The Gerontological Society of America, San Francisco, CA.

Brennan, M. (2000, August). Religiousness and social support: Examination of the social support hypothesis. Poster session presented at the annual convention of the American Psychological Association, Washington, D.C.

Brennan, M. (2001, August). Psychosocial development and adaptation to age-related vision loss. Poster session presented at the annual convention of the American Psychological Association, San Francisco, CA.

Brennan, M. (2002, November). A brief measure for capturing significant life events: The Ranked Life Experience Inventory. Poster session presented at the annual scientific meeting of the Gerontological Society of America, Boston, MA.

Brennan, M., & Cardinali, G. (1999, July). Religiousness and spirituality in adaptation to vision impairment among middle-age and older adults. Poster session presented at Vision '99, International Low Vision Conference, New York, NY.

Brennan, M., & DePalo, R. (2004, November). Faith-based social support: Activation of resources in coping with vision loss. Poster session to be presented at the annual scientific meeting of The Gerontological Society of America, Washington, D.C.

Brennan, M., & MacMillan, T. (2005, November). Spirituality and the achievement of vision rehabilitation goals. In A. Ai and K. Branco (Chairs), Faith matters: Health and functioning of older persons. Symposium to be conducted at the annual scientific meeting of The Gerontological Society of America, New Orleans, LA.

Brennan, M., & Shippy, R. A. (2000, November). Spirituality and the religious personality: Constellations of spirituality and religious involvement. In J. Sinnott (Chair), Spirituality and adult development. Symposium conducted at the annual scientific meeting of The Gerontological Society of America, Washington, D.C.

Brennan, M., & Shippy, R. A. (2000, November). Vision impairment and psychosocial development: Adaptation to chronic stress. Poster session presented at the annual scientific meeting of The Gerontological Society of America, Washington, D.C.

Shippy, R. A., & Brennan, M. (2000, August). The effects of vision impairment on psychosocial development in middle age and older adults. Poster session presented at the annual convention of the American Psychological Association, Washington, D.C.

Investigators: Mark Brennan, PhD, Principal Investigator
Gina Cardinali, MSW, Research Coordinator
Thalia MacMillan, MSW, Data Analyst
R. Andrew Shippy, MA, Predoctoral Intern

Funded by:National Institute on Aging

Project Period: 12/1/97 - 11/30/99

 

 

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