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Wellbeing: spiritual sources of health?

The authors of a recent review of the literature* noted that they could find no definition of spirituality in residential aged care. While this may signify a lack of interest in spirituality in aged care in the past I believe that situation is changing for the better as there is a marked increase in interest in the concept of wellbeing in aged care. It is beginning to be reflected in accreditation standards.

The increasing focus on wellbeing may provide richer ground in which the consideration of spirituality may take root. The organisation I represent, Dementia Training Australia, delivers Commonwealth funded training across Australia. Our approach is based on the ideas of salutogenesis (sources of health). These focus attention on the provision of meaningful, compehensible and manageable psycho-social and physical environments for people living with dementia. Salutogenesis  is very broad in its scope, able to accommodate a wide range of approaches to the provision of care that supports well-being and its emphasis on meaningfulness encourages consideration of the spiritual aspects of care.

A sense of meaning, which gives rise to the desire to live, to get up in the morning and get on with life, is probably the most important of the three ingredients of salutogenesis. Residential aged care facilities have traditionally operated in the ‘manageability’ space by managing the world for a person with dementia.  Unintentionally, but nevertheless significantly, this can have a detrimental effect on the resident’s experience of meaningfulness and comprehensibility. As we do more for the person we not only reduce their opportunities to manage their own affairs and to comprehend what is going on around them but we may also take away their sense of there being a point to life.

There is a trap here though. It is tempting to see meaning in instrumental terms, i.e. the resident’s life has meaning because they are involved in activities. Activities, particularly those that involve making a contribution to the well-being of others are important in the search for a meaningful life, but are they enough? Many would say that they aren’t. A meaningful life requires a sense of one’s life being part of a bigger picture where personal meaning is put into the context of a larger sense of purpose. Surely this is where spirituality comes in.

A salutogenic approach recognises that what gives our lives meaning is different for every one of us. It addresses the need for activity, guides us to make sure that the activities lead to a sense in the person of being able to manage their own lives as much as they possibly can (manageability) and to provide them with a context that makes sense to them (comprehensibility). But at the same time it obliges us to focus on the meaning of each individual life and, for many, that means opening the door to spiritual experiences.

As we get older, and more physically and mentally frail, opportunities to connect in a meaningful way with other people and the world around us may gradually diminish. For a person living with dementia in an aged care facility, those opportunities may no longer exist. But this is something we can change. The salutogenic approach is widely used around the world; in health, education, workplaces, architectural design. And it has enormous relevance in aged care, particularly dementia care.

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Richard Fleming

*David Jackson, Colleen Doyle, Hannah Capon & Elizabeth Pringle (2016): Spirituality, spiritual need, and spiritual care in aged care: What the literature says, Journal of Religion, Spirituality & Aging,