Introduction
Iran is one of the countries whose population is rapidly aging. Population aging has many economic, social, cultural, and health-related consequences [
1-4]. Health has various dimensions; in addition to physical, mental and social dimensions, it has a spiritual dimension [
5]. The results of studies have shown that religion and spirituality play an important role in preventing disease and improving health in the elderly. A good planning is needed to design effective and local interventions to maintain or improve spiritual health of the elderly. Considering the importance of evidence-based planning and decision-making, it is necessary to first determine the current state of spiritual health and its dimensions in the elderly using valid tools. Many studies have been conducted in the field of spiritual health of the elderly in Iran, but no national study was found that evaluated the state of spiritual health of the elderly in the whole country. In this national study, we aim to evaluate the spiritual health status and its dimensions in Iranian elderly by using a localized tool.
Methods
This is a cross-sectional study that was conducted in 2022. Sampling was done by stratified random method from 28 provinces of Iran. The criteria for entering the study were age at least 60 years and having Iranian nationality. The exclusion criteria were any cognitive or active psychiatric disorders. In this study, the elder spiritual health scale designed by Ajamzibad et al. in 2016, was used. This tool has 20 items and five subscales of spiritual belief (5 items), centricity of God (5 items), altruism (4 items), spiritual conduct (4 items) and purposefulness of life (2 items). Questionnaires were completed by health experts in the deputy for health of the universities, who were trained for this purpose. The duration of completing each questionnaire was less than 20 minutes. Data analysis was done using SPSS software, version 21. Considering that the variables did not have a normal distribution, the Mann-Whitney U test and Kruskal-Wallis test were used to compare the spiritual health score and its dimensions in different subgroups.
Results
In this study, 548 elderly people from 28 provinces of Iran participated. Their mean age was 67.8±6.6 years ranged 60-94 years. Most of the samples were married and literate and lived with their families. The religion of all participants was Islam. The mean total score of spiritual health was 91.2±10.0. Among the dimensions, the highest score was related to spiritual belief (mean: 95.8) and the lowest was related to the purposefulness of life (Mean: 87).
In
Table 1, the results of assessing relationship of demographic variables with spiritual health and its dimensions are presented. With increasing age, the score of spiritual health increases in total and in all dimensions significantly increased. Regarding the educational level, only in the spiritual conduct dimension, illiterate people had significantly higher score than literate people and those with academic education. Regarding the spiritual belief, illiterate people and those with academic education had significantly higher scores than literate people. Regarding the marital status, the spiritual conduct scores were significantly higher in unmarried people (single, divorced, widow/widowed) than married people.
Conclusion
Based on the results of this study, the spiritual health of the Iranian elderly people in overall and in the dimensions of spiritual belief and centricity of God were at a high level, which can be used as a potential source for improving the health of the elderly in other health dimensions (physical, psychological, and social). Considering that the scores of the dimensions of spiritual conduct, altruism, and purposefulness of life low, it is necessary to develop effective interventions. It is better to provide these interventions first for people at younger ages for both older women and men, married or unmarried.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1397.554).
Funding
This study was funded by the Spiritual Health Research Center of Iran University of Medical Sciences (Grant No.: 97-02-226-33665).
Authors' contributions
The authors contributed equally for preparing this article.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors would like to thank all seniors participated in this study for their cooperation. Also, The authors are grateful to the geriatric health experts in the branch of medical sciences universities of the country who helped in the implementation of this study.
References
- Fuster V. Changing demographics: A new approach to global health care due to the aging population. Journal of the American College of Cardiology; 2017; 69(24):3002-5. [Link]
- Vogelsang EM, Raymo JM, Liang J, Kobayashi E, Fukaya T. Population aging and health trajectories at older ages. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences. 2017; 72(6):1111-2. [DOI:10.1093/geronb/gbx088] [PMID] [PMCID]
- Statistical Centre of Iran. Selected findings of the 2016 national population and housing census. Tehran: Statistical Centre of Iran; 2018. [Link]
- Statistical Centre of Iran. Selected findings of national population and housing census, 2011. Tehran: Statistical Centre of Iran; 2012. [Link]
- Dhar N, Chaturvedi SK, Nandan D. Spiritual health, the fourth dimension: A public health perspective. WHO South-East Asia Journal of Public Health. 2013; 2(1):3-5. [DOI:10.4103/2224-3151.115826] [PMID]
- Dhar N, Chaturvedi S, Nandan D. Spiritual health scale 2011: Defining and measuring 4 dimension of health. Indian Journal of Community Medicine. 2011; 36(4):275-82. [DOI:10.4103/0970-0218.91329] [PMID] [PMCID]
- Daaleman TP, Frey BB. The spirituality index of well-being: A new instrument for health-related quality-of-life research. Annals of Family Medicine. 2004; 2(5):499-503. [DOI:10.1370/afm.89] [PMID] [PMCID]
- Vader JP. Spiritual health: The next frontier. European Journal of Public Health. 2006; 16(5):457. [DOI:10.1093/eurpub/ckl234] [PMID]
- Ghaderi A, Tabatabaei SM, Nedjat S, Javadi M, Larijani B. Explanatory definition of the concept of spiritual health: A qualitative study in Iran. Journal of Medical Ethics and History of Medicine. 2018; 11:3. [PMID] [PMCID]
- Weathers E, McCarthy G, Coffey A. Concept analysis of spirituality: An evolutionary approach. Nursing Forum. 2016; 51(2):79-96. [DOI:10.1111/nuf.12128] [PMID]
- Smith L, Webber R, DeFrain J. Spiritual well-being and its relationship to resilience in young people: A mixed methods case study. Sage Open. 2013; 3(2):2158244013485582. [DOI:10.1177/2158244013485582]
- Ajam Zibad H, Mohammadi Shahboulaghi F, Foroughan M, Rafiey H, Rassouli M. What is the meaning of spiritual health among older adults? A concept analysis. Educational Gerontology. 2016; 42(12):795-808. [DOI:10.1080/03601277.2016.1205349]
- Seyedfatemi N, Rezaie M, Givari A, Hosseini F. [Prayer and spiritual well-being in cancer patients (Persian)]. Payesh. 2006; 5(4):295-304. [Link]
- Zimmer Z, Jagger C, Chiu CT, Ofstedal MB, Rojo F, Saito Y. Spirituality, religiosity, aging and health in global perspective: A review. SSM-Population Health. 2016; 2:373-81. [DOI:10.1016/j.ssmph.2016.04.009] [PMID] [PMCID]
- Rocha AC, Ciosak SI. Chronic disease in the elderly: Spirituality and coping. Revista da Escola de Enfermagem da U S P. 2014; 48(Spec No. 2):87-93. [DOI:10.1590/S0080-623420140000800014] [PMID]
- Len Sperry M. Working with spiritual issues of the elderly and their caregivers. Psychiatric Annals. 2006; 36(3):185. [DOI:10.3928/00485713-20060301-01]
- Faraji A, Khalily M, Naghibzadeh ZA, Kazeminia F, Kazeminia M. The effect of religious-spiritual education and care on the life quality of Iranian elderly: A systematic review and meta-analysis. Journal of Religion and Health. 2023; 62(5):3042-69. [DOI:10.1007/s10943-023-01796-6] [PMID]
- Daaleman TP, Perera S, Studenski SA. Religion, spirituality, and health status in geriatric outpatients. Annals of Family Medicine. 2004; 2(1):49-53. [DOI:10.1370/afm.20] [PMID] [PMCID]
- Taghiabadi M, Kavosi A, Mirhafez SR, Keshvari M, Mehrabi T. The association between death anxiety with spiritual experiences and life satisfaction in elderly people. Electronic Physician. 2017; 9(3):3980-5. [DOI:10.19082/3980] [PMID] [PMCID]
- Budhiraja A, Midha P. Buffering power of spirituality against death anxiety. The International Journal of Indian Psychology. 2017; 4(2):59-65. [DOI:10.25215/0402.146]
- Ezati E, Hosseinikoukamari P, Karimy M, Rawlins J, Akbartabar F, Khalvandi P. The role of spirituality and social support in iranian elderly happiness: A cross-sectional study. Journal of Education and Community Health. 2023; 10(1):16-22. [DOI:10.34172/jech.2023.1856]
- Hajihasani M, Naderi N. [Death anxiety in the elderly: The role of spiritual health and perceived social support (Persian)]. Aging Psychology. 2021; 6(4):309-19. [Link]
- Kashanimovahhed B, Hosseinian-Sarajehloo F, Bahrami A, Shokri-Khoubestani M, Abdoljabari M. Spiritual health in the Iranian elderly: A systematic review. Journal of Pizhūhish dar Dīn va Salāmat. 2020; 6(2):129-47. [Link]
- Zibad HA, Foroughan M, Shahboulaghi FM, Rafiey H, Rassouli M. Perception of spiritual health: A qualitative content analysis in Iranian older adults. Educational Gerontology. 2017; 43(1):21-32. [Link]
- Elham F. [A look at the state of Iran’s religion and population in the last half century (Persian)]. Amar. 2016; 4(5):23-6. [Link]
- Khalili F, Sum S, Asayesh H. [Spiritual health among Isfehanian elderly people (Persian)]. Iranian Journal of Ageing. 2013; 8(1):16-23. [Link]
- Bastani F, Pourmohammadi A, Haghani H. [Relationship between perceived stress with spiritual health among older adults with diabetes registered to the association of diabetes prevention and control in Babol, 2013 (Persian)]. Journal of Hayat. 2014; 20(3):6-18. [Link]
- Saydshohadai M, Heshmat S, Seidfatemi N, Haghani H, Mehrdad N. [The spiritual health of seniors living in sanitarium and home residents (Persian)]. Iran Journal of Nursing. 2013; 26(81):11-20. [Link]
- Aslani Y, Hosseini R, Alijanpour-Aghamaleki M, Javanbakhtian-Ghahfarokhi R, Borhaninejad V. [Spiritual health and life satisfaction in older adults in Shahrekord hospitals, 2013 (Persian)]. Journal of Clinical Nursing and Midwifery. 2018; 6(4):1-10. [DOI:10.29252/jmj.10.3.1]
- Roze des Ordons AL, Sinuff T, Stelfox HT, Kondejewski J, Sinclair S. Spiritual distress within inpatient settings-A scoping review of patients' and families' experiences. Journal of Pain and Symptom Management. 2018; 56(1):122-45. [DOI:10.1016/j.jpainsymman.2018.03.009] [PMID]
- Jadidi A, Sadeghian E, Khodaveisi M, Fallahi-Khoshknab M. Spiritual needs of the Muslim elderly living in nursing homes: A qualitative study. Journal of Religion and Health. 2022; 61(2):1514-28. [DOI:10.1007/s10943-021-01263-0] [PMID] [PMCID]
- Adib-Hajbaghery M, Faraji M. Comparison of happiness and spiritual well-being among the community dwelling elderly and those who lived in sanitariums. International Journal of Community Based Nursing and Midwifery. 2015; 3(3):216-26. [PMID] [PMCID]
- Armitage CJ, Christian J. From attitudes to behaviour: Basic and applied research on the theory of planned behaviour. Current Psychology. 2003; 22:187-95. [DOI:10.1007/s12144-003-1015-5]
- Caldeira S, Timmins F, de Carvalho EC, Vieira M. Spiritual well-being and spiritual distress in cancer patients undergoing chemotherapy: Utilizing the SWBQ as component of holistic nursing diagnosis. Journal of Religion and Health. 2017; 56(4):1489-502. [DOI:10.1007/s10943-017-0390-4] [PMID]
- Mallery ST, Mallery P. Centers of value and the quest for meaning in faith development: A measurement approach. Frontiers in Psychology. 2022; 13:975160. [DOI:10.3389/fpsyg.2022.975160] [PMID] [PMCID]
- Jadidi A, Farahaninia M, Janmohammadi S, Haghani H. The relationship between spiritual well-being and quality of life among elderly people. Holistic Nursing Practice. 2015; 29(3):128-35. [Link]
- Ellison CW. Spiritual well-being: Conceptualization and measurement. Journal of Psychology and Theology. 1983; 11(4):330-8. [DOI:10.1177/009164718301100406]
- Sadrollahi A, Khalili Z. [Spiritual well-being and associated factors among the elderly population in Kashan (Persian)]. Journal of Geriatric Nursing. 2015; 1(2):94-104. [Link]
- Khalili Z, Sadrollahi A, Nazari R. [Factors related and Spiritual Well-being among elderly referring to city parks of Khalkhal (Persian)]. Iranian Journal of Nursing Research. 2016; 10(4):127-35. [Link]
- Gomez R, Fisher JW. Domains of spiritual well-being and development and validation of the spiritual well-being questionnaire. Personality and Individual Differences. 2003; 35(8):1975-91. [DOI:10.1016/S0191-8869(03)00045-X]
- Fisher J. The four domains model: Connecting spirituality, health and well-being. Religions. 2011; 2(1):17-28. [DOI:10.3390/rel2010017]
- Martins H, Dias Domingues T, Caldeira S. Spiritual well-being in cancer patients undergoing chemotherapy in an outpatient setting: A cross-sectional study. Journal of Holistic Nursing. 2020; 38(1):68-77. [DOI:10.1177/0898010119858269] [PMID]
- Orenstein GA, Lewis L. Eriksons stages of psychosocial development. Treasure Island: StatPearls Publishing; 2022. [Link]
- Stefanaki IN, Shea S, Linardakis M, Symvoulakis EK, Wynyard R, Lionis C. Exploring the association of sense of coherence, and spiritual and religious beliefs in a rural population group on the island of Crete, Greece. International Journal of Psychiatry in Medicine. 2014; 47(3):207-30. [DOI:10.2190/PM.47.3.c] [PMID]
- Vitorino LM, Vianna LAC. Religious/spiritual coping in institutionalized elderly. Acta Paulista de Enfermagem. 2012; 25(SPE1):136-42. [DOI:10.1590/S0103-21002012000800021]
- Zareipour M, Khazir Z, Valizadeh R, Mahmoodi H, Ghelichi Ghojogh M. The association between spiritual health and blood sugar control in elderly patients with type 2 diabetes. Elderly Health Journal. 2016; 2(2):67-72. [Link]
- Ilali E, Taraghi Z, Yazdani J, Golmohammadi M, Savasari R, Mosavi Jarrahi A. [The relationship between praying and spiritual health among Iranian older people with cerebrovascular accidents (Persian)]. Iranian Journal of Ageing. 2016; 11(3):424-31. [DOI:10.21859/sija-1103424]
- Kavoosian N, Hosseinzadeh K, Jaliseh HK, Karboro A. [The relationship between spiritual health and loneliness among the elderly in Karaj-2016 (Persian)]. Journal of Pizhūhish dar dīn va salāmat. 2018; 4(2):7-15. [Link]
- Leung KK, Chiu TY, Chen CY. The influence of awareness of terminal condition on spiritual well-being in terminal cancer patients. Journal of Pain and Symptom Management. 2006; 31(5):449-56. [DOI:10.1016/j.jpainsymman.2006.02.001] [PMID]
- Farahaninia M, Jadidi A, Janmohammadi S, Haghani H. The relationship between spiritual well-being and quality of life among elderly people residing in Kahrizak senior house. European Psychiatry. 2011; 28(Supplement 1):1. [DOI:10.1016/S0924-9338(13)77267-5]
- Kandasamy A, Chaturvedi SK, Desai G. Spirituality, distress, depression, anxiety, and quality of life in patients with advanced cancer. Indian Journal of Cancer. 2011; 48(1):55-9. [DOI:10.4103/0019-509X.75828] [PMID]