Defining spirituality and spiritual care in aged care
Spirituality is about finding meaning in and of life, purpose, and a sense of connection, whether religious or not. It includes beliefs, values, or practices that bring comfort and can be different for everyone. [1-5] It has been reported to be a valuable resource for frail older people [6] and help older people adjust to losses related to life in residential aged care. [7]
Spiritual care involves helping people find peace with their beliefs. It includes compassion, peace, hope, and empowerment, and identifies and supports the existential or spiritual strengths of the person. [1,5,8] The terms ‘pastoral care’ and ‘spiritual care’ are often used interchangeably. [1]
In simple terms, spirituality can be described as being about ‘who I am’, ‘why I am here’ and ‘what can I hope from this moment’; and spiritual care can be described as meeting a person ‘where they are’ and helping them find meaning in illness or hospitalisation, and to connect or reconnect to things, practices, ideas, and values that are at the heart of who they are. [1,8]
In palliative care, spiritual care and psychosocial care are distinct but interconnected. [9,10] Spiritual care focuses on existential concerns like meaning, purpose, and beliefs, and may include a God dimension, while psychosocial care addresses emotional, psychological, and social needs. [9-11] They overlap when issues such as fear of death involve both emotional and existential dimensions. [9,11] While distinct, both are integral to holistic care. [9,10,12]
Why spirituality and spiritual care matter in aged care
The World Health Organization definition of palliative includes spiritual care. [13] The Strengthened Aged Care Quality Standards, particularly Outcome 5.7, also highlight holistic support for older adults and their families. [14] These standards promote a respectful, culturally safe approach, ensuring each person’s identity, beliefs, and experiences are honoured, ultimately fostering a complete and dignified care experience. [14] In 2016, guidelines were published emphasising spirituality as essential to wellbeing of older people living in residential aged care or receiving care and support at home. [1,15] The guidelines recommend an organisation-wide approach. [1,15]
For many people, spirituality remains deeply important throughout life. This can deepen for older adults nearing end of life and offer comfort and perspective amid ageing and illness. [1,3] Spirituality can provide a sense of identity and belonging, supporting connections and engagement in meaningful activities. [3] Older adults may also experience spiritual or existential suffering, such as feelings of hopelessness, lack of meaning, regret, death-related anxiety, or a diminished sense of identity. [1] Addressing these through spiritual care help address this suffering.
Spiritual care can improve the wellbeing of older adults nearing end of life, improving emotional health and the ability to cope, and reducing anxiety and depression. [1] It can ease the transition into residential aged care, for residents and families, and support a peaceful, dignified end-of-life experience. [1,3,16] Family carers can feel more satisfied with end-of-life care when their relative dies peacefully with physical and spiritual needs met. [16] Therefore, addressing spiritual concerns is integral to providing compassionate and comprehensive end-of-life care. [1,2,16]
What the evidence tells us
Spiritual care can help people with life-limiting illnesses find meaning, a sense of normalcy, connection with others, control, hope, and faith. [5] Supporting a person’s spirituality can involve keeping routines, reflecting on life’s meaning, sharing feelings, setting goals, creating a comforting space, and engaging in spiritual practices. [5] Nurses, social workers, chaplains, doctors, and occupational therapists can all be involved. [1,8]
Offering spiritual care means respecting different beliefs and values, as everyone has unique spiritual needs or may not identify as spiritual at all. [1,5,15] For some, religious practices such as prayer are important, while others find meaning in nature, relationships, or personal reflection. [1-3,5,8] Effective spiritual care involves talking openly with the person, listening without judgement, and respecting cultural traditions. [1,2,5,8,15,17] Privacy and the wishes of the person and their families should always be honoured. [15]
With education, care providers can recognise and address older adults’ spiritual needs by listening compassionately and offering space for spiritual expression. [1,8,16] Referring to and working with chaplains, using spiritual assessments, and integrating spiritual care into ‘usual care’ can create more personalised and meaningful experiences for older people and their families. [1,8,15] Formal spiritual care can include initial screening and in-depth assessments, ideally beginning when the person enters residential aged care. [1,2]
Care of people with dementia
A person living with dementia can still be involved in a search for meaning, connection, and comfort. Connection can be supported by activities like music, art, storytelling and being close to nature. For some, faith practices are meaningful; for others, building trusting relationships provides comfort. Aged care staff and family can offer spiritual support by being present, listening, and showing respect, creating a sense of care and companionship. Spiritual engagement can also help aged care staff and family find purpose and cope with their role. [1,18,19]
Cultural considerations
The multicultural environment of Australia’s aged care services means that staff of diverse cultural backgrounds cater for a diverse group of people and their spiritual needs. [1,20] Spiritual practices vary widely across cultures, so understanding each person’s background is important in providing appropriate care. [1,18,19] In some cultures, spirituality is a family or community matter, while in others, it may be more personal.
Tailoring spiritual care to each culture can build trust and create a more meaningful experience for the person. This may include specific foods and mealtime practices, religious practices or connection to a cultural or faith network. [2,18] Learning about the practices and customs of different cultural groups can help aged care staff provide sensitive spiritual care. [1]
Aboriginal and Torres Strait Islander often have a strong connection to land, community, and ancestors. Important cultural practices surround the time before and after death. [17,19,21,22] Each group will have their own cultural practices, language and a different view on caring for a person at the end-of-life stage. [21] These customs honour the deceased and support the community. [21] Providing culturally appropriate care means respecting these traditions, which can include storytelling, music, dance, and art as forms of spiritual expression. [19] Traditional healers, or Ngangkaris, may also be involved, blending traditional beliefs with Western medicine. [19] This can include helping individuals return to Country to die. [21] Cultural safety training can help aged care staff provide culturally responsive care. [19]
Implications for families
Families play an important role in supporting the spiritual needs of older adults in palliative care by helping maintain connections, rituals, and a sense of purpose, which are valuable at the end of life. [1,3,5] A physical space for families to meet with the older person in ways that are private and uninterrupted can enhance spiritual care. [1,15]
Families may have spiritual needs as they support their relative through end-of-life care. [1,16] Spiritual care can help them find comfort, cope with their own grief, and prepare for the loss. Including families in spiritual care can strengthen their connection with the person, making the experience feel more shared and supportive. [1]
Considerations for home care
Older adults in the community value connections with friends, family, and other people; having something to aim for; and perhaps a chance to be involved in religious activities. [3] Older people who remain connected to their community and have a range of positive relationships may have fewer needs than those who feel isolated. [15]
Providing spiritual care in home settings requires flexibility, as formal spiritual support may be limited. Carers can ask the person what brings them spiritual comfort, even if it’s non-traditional. Families and carers may need guidance on how to support a person’s spiritual needs, such as arranging visits from community religious leaders or incorporating daily practices. In cases where outside support is not possible, digital or virtual spiritual resources can be helpful. [15]
Page updated 06 January 2025