Spirituality and Healthy Lifestyle Behaviors: Stress Counter-balancing Effects on the Well-being of Older Adults
GRACIE H. BOSWELL
2006 Blanton-Peale Institute
Gracie H. Boswell, Ph.D.,
M.Ed. (Case Western Reserve University) and (M. Ed.- Kent State University). She is a Carolina Program in Health and Aging Research Scientist at the Institute on Aging- University of North Carolina at Chapel Hill. Her research interests have been social gerontology and quality of life
, emphasizing religiosity/spirituality.Eva Kahana,
Ph.D. (University of Chicago) is Pierce T. and Elizabeth D. Robson Professor of Humanities and Director of the Elderly Care Research Center- Case Western Reserve University. Her research concentration has been the sociology of aging (coping & stress and institutionalization).Peggye Dilworth-Anderson, Ph.D. (Northwestern University) is Director- Center for Aging and Diversity, Institute on Aging, Professor- School of Public Health, Department of Health Policy and Administration at University of North Carolina at Chapel Hill. Her research interests have been caregiving and minority on Aging, The University of North Carolina
, 720 Martin Luther King Jr. Blvd.,
Chapel Hill, NC, USA
The goal of this study was to examine stress-ameliorating effects of religiosity, spirituality, and healthy lifestyle behaviors on the stressful relationship of chronic illness and the subjective physical well-being of 221 older adults. We also investigated whether the intervening variables functioned as coping behaviors and orientations or as adaptations in late life. Guided by the stress paradigm, path analysis was used to assess these relationships in a stress suppressor model and a distress deterrent model. No suppressor effects were found; however a number of distress deterrent relationships were detected. Spirituality, physical activities, and healthy diet all contributed to higher subjective physical well-being, as counter-balancing effects, in the distress deterrent model. The findings have implications for future research on the role of spirituality, religiosity and lifestyle behaviors on the well-being of chronically ill older adults. Findings also support the need for studying different dimensions of religiosity and spirituality in an effort to understand coping versus adaptation in behaviors and orientations.
There is a growing body of research investigating the well-being of older
adults, while living with chronic illnesses. This is an important area of
research given the number of people living with chronic illnesses, which
presents a different set of challenges than experiencing episodes of acute
illness (Royer, 1998). Chronic illness is pervasive in American society and may
well be the source of stressors, impacting the subjective physical well-being of
older adults. More than 125 million Americans were estimated to have chronic
diseases in the year 2000 and by 2020 that figure is expected to rise to 157
million (The Robert Wood Johnson Foundation, 2002). Furthermore, chronic
diseases account for about 70% of deaths in America and 75% of the costs of
health care each year (Marks, 2003). These figures are expected to be
compounded over the next 30 years, as the aging of the population over 65 is
expected to double. For these reasons, studying the effects of stress associated
with chronic illness on subjective physical well-being is timely.
Although there has been a great deal of research in the stress literature,
there has not been enough empirical research on the relationships of
religious or spiritual factors and healthy lifestyle behaviors to the well-being of
older adults, while living with chronic illness (Sulmasy, 2002). Some social
scientists believe that the investigation of the effects of religious and
spiritual resources in addition to healthy lifestyle behaviors may be important
(Harris, 1999; Oppenheimer, 1999). Based on a convergence of scientific
interest in social science and medical research, the preponderant view of the
literature has been that older adults tend to take more interest in spiritual
pursuits than younger people (Koenig, 1997; Moberg, 2001; Sheehan, 2001).
Schultz-Hipp (2001) posits that this is true even while controlling for cohort
Problem statement and hypotheses
The purpose of this study was to understand more about how older adults
maintain their subjective physical well-being, while living with chronic
illnesses. We also wanted to know whether maintaining their physical
well-being is due to coping or adaptation, a rarely investigated concept. In
order to study these questions we proposed three hypotheses: (1) Chronic
illness related stressors negatively impact older adults experiences of physical
well-being. (2) Spirituality and private religiosity contribute to higher physical
well-being among older adults.
(3) Healthy lifestyle behaviors contribute to higher physical well-being of
These hypotheses were simultaneously tested in stress suppressor and
distress deterrent models.
Theories of stress and illness, along with supporting methodology, first
evolved out of Selyes (1956) biomedical research. Since social scientists began
to study stress sociologically, there have been three major ways to
conceptualize and measure stressors that threaten well-being: life events, daily
hassles, and chronic stressors. This study investigated chronic stressors, which
are those that may be brought on by long-term illness and may be prevalent
stressors in late life. According to Pearlin (1980), they may be even more
deleterious to the individuals functional state than acute stressors because
they are repetitive and last over a long period of time.
Generally, where chronic illness was experienced (Dekkers et al., 2001;
Pakenham & Rinaldis, 2001), stress research has investigated buffers of stress
in attempting to address factors that affect poor health outcomes.
Furthermore, most of the stress-buffering models have studied how stress affected an
outcome of physical disability instead of outcomes of well-being. Resources
that may buffer the impairment process included medical care, therapeutic
regimens, social support, physical and social environments, lifestyle
behaviors, psychosocial and religious coping (Gall, 2000; Pakenham & Rinaldis,
2001; Stowell, Kiecolt-Glaser, & Glaser, 2001).
Guided by stress theory, both stress suppressor and distress deterrent
models were tested in this study. As shown in Figure 1, the distress deterrent
model is embedded in the stress suppressor model. Because of the
complimentary relationship between these models in understanding stress effects
and ameliorating effects of stressors on outcomes, this study tested both
models simultaneously. The theoretical suppressor model (Wheaton, 1985) is
an additive effects buffering model and is stress responsive (i.e., More
stressors are related to a higher level of intervening resources which may lead to a
higher level of well-being). The distress deterrent model is a stress
counterbalancing model (Aneshensel, 1992; Krause & Van Tran, 1989; Wheaton,
1985) and allows for understanding non-stress responsive relationships (i.e., If
stressors are not related to intervening resources, a higher level of well-being
can still be experienced due to direct effects). In this study the suppressor
model was used to understand the role of coping and the distress deterrent
model was used to conceptualize the role of adaptation in ameliorating the
effects of illness related stressors on physical well-being among older adults.
Coping and adaptation in this study focused on religious and spiritual
orientation and healthy life-style behaviors of chronically ill older adults to help
lessen the effects of illness related stressors on their physical well-being.
Coping is defined here as a subset of adaptation and involves effort
commensurate with the level of stress (Compas, Connor, Osowiechi, and Welch,
1997). It is not an automatic action that takes place regardless of the presence
of stressors. In addition, coping may also be a process that changes over time.
On the other hand, adaptations are defined in this study as rituals and
practices that are automatic, ingrained in the cultural fabric of the society in
Theoretical Model to Test Stress Suppressor and Embedded Distress
Deterrent Relationships. Notes a. For Parsimony of Presentation, the
Sociodemographics and Some Paths are not Shown. b. Paths 2 and 5
Suppress the Relationship of Path 7 in the Directions Shown. c. Paths
4 and 5, & 6 Respectively, Counter-Balance (Distress Deterrent) the
Relationship of Path 7
which individuals have developed over time and may be performed
automatically or without effort as a part of everyday behavior (Lazarus & Folkman,
1991). Adaptations are not stress responsive and may take place regardless of
the presence of stressors.
The suppressor model allowed for analyzing the ways in which the
orientations serve as additive effects buffers. Complementary to this, the distress
deterrent model showed how certain orientations and behaviors directly
ameliorated the negative effects of stress on physical well-being. Using these
two models, we were able to examine how each allowed for explaining whether
religious and spiritual orientations and healthy behaviors, either through
coping or adaptation, resulted in reducing illness related stressors.
Sample and data collection
The sample for this study includes 221 older adults, age 65 and older, who
were part of an NIA funded study R01 AG 01658. That larger study was
randomly selected from Medicare lists and known as the Cleveland Health
Maintenance Study (CHMS). Participants lived in northeast Ohio, and at
baseline in TIME1 1999, 365 older adults were interviewed face-to-face during
the first wave of the study. During the two-year follow-up, 343 respondents
were interviewed, reflecting a response rate at TIME 2 of 94%. However, only
221 of the participants were used in this study, representing those who
responded to a TIME2 follow-up interview.
Table 1 illustrates the characteristics of those respondents who were used in
the follow-up interview and those who were lost to attrition due to death,
refusal, and loss to follow-up. There were significant differences between the
sample characteristics of those respondents who were used in the follow-up
interview and those who were lost to attrition in the demographic categories of
gender and race. More women and African Americans remained in the sample
than were lost to attrition, but these two variables were not variables that
were examined in this study. Additionally, there were no significant group
differences between the retained sample and the attrition group in terms of
age, education, public religiosity, private religiosity, illnesses, or healthy diet.
The sample characteristics
Characteristics of the sample are illustrated in Table 2. Additional descriptive
statistics (not shown) revealed that 86% of the sample data were in the 75 or
older age category, which consisted of 76% females and 24% males.
Approximately 82% of the sample was White and 18% was Black. People in the lower
socioeconomic statuses were notably represented in the sample with about one
third having less than a high school education and 40% having a household
income below $15,000 per year. In addition, a majority of the sample (93%)
reported having been diagnosed with at least 1 chronic disease on the OARS
Chronic Illness Inventory (George & Fillenbaum, 1985).
Characteristics of Follow-up Study Respondents and Those Who Were
Lost to Attrition
Sample (221) Attrition (122)
Gender (% female)
Race (% white)
Illness (total #)
Note. N = 221, df = 2 for each F and v2 (gender; df = 1); HS education, gender,
race are all %s; other values are means and (standard deviations). Attrition
was due to death, refusal, and loss to follow-up.
Descriptive Statistics of the Sample Variables Mean SD Range Skewness Kurtosis
aIncome is a continuous variable in $1000s.
Demographic and other control variables. Age and education were
measured as continuous variables. Race was coded as White = 0 and Black = 1.
Gender was coded as male = 0 and female = 1. Income was recoded with
factors from 2.5 to 75, based on mean values of $5000 increments, and divided
Subjective physical well-being. It was a 3 item composite created from
CHMS survey items and reverse coded on 5-point Likert scales, with a
reliability of Cronbachs a = .78 for the sample: (1) In general, do you consider
yourself to be a very healthy, healthy, fairly healthy, sick, or very sick person?
from 1 (very sick) to 5 (very healthy); (2) Considering your health over the past
year, would you say your health is excellent, good, fair, poor, or very poor?
from 1 (very poor) to 5 (excellent); and (3) Compared to other people your age,
would you say that your health is much better, better, about the same, worse,
or much worse over the past year? from 1 (much worse) to 5 (much better).
Composite scores ranged from 3 (low) to 15 (high), mean = 11.56, SD = 1.99.
Chronic illness. The OARS Chronic Illness Index (George & Fillenbaum,
1985) indicated if participants had any of the following 10 chronic illnesses
over the past year: arthritis, asthma, emphysema, hypertension, heart
trouble, diabetes, urinary tract problems, cancer, stroke, and orthopedic problems.
Similar illness indices were supported in prior research as part of their
research methodologies (Porell & Miltiades, 2001; Shaw & Krause, 2001).
Scores ranged from 0 to 10 diseases, mean = 2.1, SD = 1.25.
Healthy lifestyle behaviors. The two measures used were physical activity
and healthy diet. The term physical activity was used instead of exercise
because many older adults engage in activities that may not be classified as
exercise but may still be a part of an active lifestyle. Physical activity was
measured as a continuous variable based on total hours per week that
participants engaged in: walking as exercise, swimming, golfing, running,
aerobics, stretching, weight lifting, dancing, bicycling or exercise machines,
exercise for therapy or other exercises, household activities, gardening/lawn
care, home repairs, and all other walking and activities. Scores ranged from 0
to 20 hours of activity, mean = 19.06, SD = 16.0. Participants adherence to
healthy diets were assessed using responses from the CHMS questionnaire
and measured on a 5-point Likert scale from 1 (not at all) to 5 (very much),
mean = 3.97, SD = 1.11. Skewness (1.53) or kurtosis (3.01) on physical
activity did not indicate violation of cutoffs (Kline, 1998), especially when you
consider that the average age of the respondents was 80.
Spirituality. Spirituality was defined as experiencing transcendence
through inner peace, harmony, or connectedness to others. Any one or all of
these qualities could be present.
Four items, with an internal reliability of Cronbachs a. = .79 for this
sample, were used from The Daily Spiritual Experiences Scale (Fetzer, 1999).
These four items were reverse coded and used to measure spirituality on
6-point Likert scales from 1 (never or almost never) to 6 (many times a day):
(1) selfless caring for others, (2) connection to all of life, (3) deep inner peace or
harmony, and (4) spiritually touched by the beauty of creation. A composite
scale created from three Likert scales ranged from 6 (low) to 24 (high),
mean = 17.03, SD = 4.04.
Religiosity. Religiosity was defined as the adherence to religious dogma or
creed, the expression of moral beliefs, and/or the participation in organized or
individual worship or sacred practices. Any one or all of these qualities may be
present and the construct was measured in two dimensions as private and
public religiosity. Private religiosity, with a reliability of Cronbachs a = .95
for this sample, was a composite of 4 items. Three items from the Cope
Inventory (Carver, Scheier, & Weintraub, 1989) were each measured on a
5-point Likert scale from 1 (never) to 5 (very often): (1) seek Gods help, (2)
trust in God, (3) find comfort in religion. Also, one item from the CHMS 2001
questionnaire measured on a 5-point Likert scale, from 1 (never) to 5 (several
times a week): (4) frequency of prayer. Composite scores of Likert scales
ranged from 4 to 20, mean = 14.94, SD = 5.75.
Public religiosity, with a reliability of Cronbachs a = .81 for this sample,
was a composite of 3 religious participation items from the CHMS 2001
questionnaire. (1) frequency of attendance at religious services during the past
year measured on a 5-point Likert scale, from 1 (never) to 5 (several times a
week). (2) take part in other activities besides regular services, at your place of
worship measured on a 5-point Likert scale from 1 (never) to 5 (4 + times a
week): (3) frequency of participation in other church or synagogue activities
was reverse coded and measured on a 5-point Likert scale from 1 (rarely or
never) to 5 (several hours a day). Composite scores ranged from 3 to 15,
mean = 6.52, SD = 2.86.
Preliminary data analysis
A number of tests were performed on the data. Limits for influential cases
were computed and cutoffs for outliers were tested and confirmed acceptable.
Diagnostics in the tests for assumptions of multiple regressions reflected
nonlinear patterns for some variables. This is not unusual among mostly
chronically ill older adult populations (i.e., physical activity).
As a preliminary screening for possible multicollinearity in the model, a
Pearson Correlation matrix was examined. Correlation results prompted
running tolerance tests. Sample variable tolerances ranged from .511 to .921
(perfect tolerance = 1.00), illustrating moderate multicollinearity, given there
are no perfect tolerance levels.
Results of face validity for the religiosity and spirituality constructs followed
by Exploratory Factor Analysis (EFA) in SPSS were the basis for using a
briefer version of The Daily Spiritual Experiences Scale (DSES) (Fetzer, 1999)
consisting of only four items. These findings, illustrated in Table 3, support
the work of Underwood and Teresi (2002), whose recent work testing content
validity created a different brief DSES.
Moving forward in the analysis, path analysis was then used (Gogineni,
Alsup, & Gillespie, 1995) to test the three hypotheses in the suppressor model.
As a result of path analysis, the distress deterrent model emerged in the
resulting significant paths, but the suppressor model did not result in
Predicting illness stressors, lifestyle, and religiosity or spirituality on physical
The fit of the statistical suppressor model with the imbedded distress
deterrent model was illustrated as a good fit to the data by the statistic
F(11, 209) = 7.397, p < .001 and is appropriate for testing the hypotheses of
this study. Therefore, the path coefficients, representing the suppressor and
Exploratory Factor Analysis of Religiosity and Spirituality Factored Items I feel a selfless caring for others. I experience a connection to all of life.
I feel a deep inner peace or harmony.
I am spiritually touched by the
beauty of creation.
I seek Gods help.
I put my trust in God.
I find comfort in my religion.
How frequently do you pray?
Attend religious services?
Participation other than
Frequency of participation in church
or synagogue activities?
Private Public Spiritual
Religiosity Religiosity Experiences
Note: Principal axis extraction was used. The rotation method which
converged in 6 iterations was Varimax with Kaiser normalization.
distress deterrent effects on the physical well-being of the older adults in
the sample are illustrated in Table 4. After statistically testing the
hypotheses, we determined whether religiosity, spirituality, or lifestyle
behaviors were suppressors of chronic illness related stressors on physical
well-being or whether they were instead distress deterrent factors which
countered the effects of chronic illness related stressors on physical
Hypothesis 1: Chronic illness related stressors negatively impacted older
adults experiences of physical well-being.
As predicted, chronic illness related stressors had a negative impact
(b = ).326, p < .001) on physical well-being among older adults in the study.
These results confirmed prior research showing the negative effects of chronic
illnesses (Porell & Miltiades, 2001; Shaw & Krause, 2001). Therefore,
hypothesis 1 could not be rejected.
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Hypothesis 2: Spirituality and private religiosity contribute to higher physical
well-being among older adults.
Hypothesis 3: Healthy lifestyle behaviors contribute to higher physical
wellbeing of older adults.
Both of the healthy lifestyle behaviors, physical activities (b = .125, p < .05)
and healthy diet (b = .222, p < .001), as well as spirituality (b = .164, p < .05)
contributed to higher subjective physical well-being of the older adults in the
sample. Figure 2 illustrates that only these direct effects, showing distress
deterrent relationships (Krause & Van Tran, 1989; Wheaton, 1985), were
significant effects of the intervening variables (lifestyle behaviors and
spirituality). Based on theory, these relationships are adaptations, they are not
responsive to stress and may be adaptations; hence they only had direct effects
on physical well-being.
On the other hand, public religiosity was stress responsive (b = ).131,
p < .05). Therefore, it was not a distress deterrent resource. However, the
negative effect and insignificant relationship to subjective physical well-being
indicates that it was not a stress suppressor either. In fact, not only was public
religiosity not found to be a suppressor, but none of the intervening variables
tested (public or private religiosity, spirituality, diet or physical activity) were
found to exert suppressor effects in the model (See Figure 2). Contrast these
findings with Figure 1 which illustrates the necessary positive paths (2 and 5)
leading to and from the intervening variables in order to be considered as
Revealing findings were that neither public nor private religiosity served
any type of stress ameliorating functions; however spirituality (spiritual
experiences) did act as a distress deterrent, counter-balancing the negative
effects of stressors associated with chronic illness on physical well-being.
Nevertheless, because of the stress counter-balancing effects of spirituality
and healthy lifestyle behaviors (diet and physical activity), Hypotheses 2 and 3
could not be rejected.
Three hypotheses were formed for this research. The first hypothesis stated
that chronic illness related stressors negatively impact older adults
experiences of physical well-being. Illness related stress effects on well-being may be
partly due to a burden of stigma associated with ill health that older adults
may carry, according to Baum, Jennings, Manuck, and Rabin (2000), which
poses specific threats due to lasting changes in the physical self. This issue
associated with self-image could compound the stress of having a chronic
Significant Paths Resulting from Testing the Theoretical Suppressor
Model and Distress Deterrent Models. Bold paths and concepts
represent only distress deterrent relationships. (a) Path coefficient of
healthy diet is (b = .222, p .001). (b) Path coefficient of physical
activity is (b = .125, p .05). (c) Path coefficient of spirituality
(spiritual experiences) is (b = .164, p .05)
illness (Charmaz, 2000). Understanding stress effects of illness helps to know
how some people make the most of life, experiencing well-being in the face of
illness. It was useful in conceptualizing both stress and coping and stress
and adaptation in both the suppressor model and the distress deterrent
model, which was embedded in the stress suppressor model of Figure 1 and
illustrated in Figure 2 (Krause & Van Tran, 1989).
The second hypothesis stated that spirituality and private religiosity
contribute to higher physical well-being among older adults. As illustrated by the
negative path 7 in Figure 1, chronically ill older adults with a mean age of
80 years were not expected to exhibit strong public religiosity, and results
supported this. On the other hand, these data neither supported coping by
private religiosity behaviors nor spirituality (e.g., daily spiritual experiences)
as responses to stressors. Because of the absence of these positive significant
relationships as illustrated in the theoretical model of Figure 2, a suppressor
model was not supported as conceptualized in Figure 1. Instead of these
suppressor relationships, distress deterrent relationships emerged in the data
(See Figure 2); and although these results were conceptually different, the
stress-ameliorating outcome was the same, thereby revealing that more
spiritual experiences lead to higher subjective physical well-being. The
conceptual difference was that unlike suppressor relationships, spirituality was
not stress responsive (i.e., no significant positive relationship between chronic
stressors and spirituality). Because of this, hypothesis two could not be
rejected due to the stress counter-balancing effects illustrated in the distress
deterrent relationships of Figure 2 for spirituality.
The third hypothesis stated that healthy lifestyle behaviors contribute to
higher physical well-being of older adults. It was expected that healthy
lifestyle behaviors would be lower, with more chronic illness related stressors;
therefore, suppressor effects were not expected. Findings were that healthy
lifestyle behaviors, diet and physical activity, were not affected by chronic
illness related stressors but still contributed to higher subjective physical
wellbeing. Therefore, hypothesis three could not be rejected because of the positive
impact of the lifestyle behaviors on subjective physical well-being. As
indicated by their spirituality, the healthy lifestyle behaviors of the older
adults in this sample were not dependent upon chronic illnesses. Therefore,
the positive impact of these behaviors on their subjective physical well-being
may be seen as a means of adaptation (i.e., not stress responsiveness). In other
words, the behaviors could have happened with or without illness stressors,
and perhaps illness was not considered a stressor, but a by-product of old age.
These positive effects counter-balanced the negative effects of chronic illness
stressors. According to the theoretical framework used in this study, these
results may illustrate adaptation. Adaptation is viewed as automatic and
directly impacts the outcome (Lazarus & Folkman, 1991; Royer, 1998). This
perspective is also applicable to the distress deterrent effects that were found
for spirituality and healthy lifestyle behaviors on subjective physical
wellbeing. On the other hand, coping intervenes between stressors and the
outcome and has been described as a direct and effortful response to stress
(Compas et al., 1997). These results appear to be consistent, at least in part,
with Krause and Van Trans (1989) findings that religiosity was not stress
responsive, but was counter-balancing (distress deterrent), in an older adult
The suppressor model is one way of illustrating the tenets of coping, while
on the other hand, the distress deterrent model may better illustrate the
characteristics of adaptation. This study revealed that the older adults had
spiritual experiences and maintained their healthy lifestyle behaviors
whether or not they were chronically ill. Therefore, adaptation as opposed to
coping was more indicative of their spiritual orientation and lifestyle
We believe that the results of this study contribute to the literature by
shedding more light on a less explored concept about ways of modeling stress
and coping versus adaptation. Studying stress in this broader context, which
is often overlooked, distinguishes between the different concepts and better
addresses a means of interpreting the findings. The findings of this study are
important in revealing that not only stress responsive coping mechanisms
contribute to well-being, but non-stress responsive effects can contribute to
physical well-being through adaptation to life circumstances. In this study, it
appeared that adaptation was taking place whereby the older adults practiced
healthier lifestyle behaviors through diet and exercise even regardless of their
chronic illnesses. Additionally, this study builds upon stress research with a
positive outcome as the focus (well-being). Focusing on more positive outcomes
in the face of chronic illness, Kahana and Kahanas (1996, 2003) successful
aging model emphasized the effects of lifestyles as proactive adaptations in
ameliorating the effects of disability on subjective physical well-being. It also
advances the seminal work of a prominent stress researcher, Antonovsky
(1982), who wanted to know why some people experience greater well-being in
the face of chronic illness than others.
We submit that the preponderant view of the literature is that older adults
tend to take more interests in religious and spiritual pursuits than younger
people (Moberg, 2001; Schultz-Hipp, 2001). However, this view did not explain
why neither public nor private religiosity (trend or borderline significance)
had significant effects on subjective physical well-being when tested in either
the suppressor or the distress deterrent model. In order to address this
question for public religiosity we considered the mean age (80 years) of
respondents in the sample. With better than 86% of the sample over the age of
75 and an even higher percentage suffering from chronic illnesses, public
religious participation, may not be a means of investigating religious
involvement for the older adults in this study. Also, these data do indicate in
descriptive statistics that most people relied on private religiosity, as evident
by the mean level of public religiosity which was much lower compared to the
mean level of private religiosity. This may be due to disability and lack of
mobility associated with chronic illness. It may also partly explain the absence
of significant effects of private religiosity on the outcome. Yet, since private
religiosity is more intrinsic than public religiosity, not requiring public
involvement, the results in these data do not readily explain the absence of
either suppressor effects or distress deterrent effects on subjective physical
well-being. Two considerations for these results are that the older adults in
this study used negative adaptation in their private religiosity. It also appears
that skew could have contributed to the lack of normal variability in the
sample variable, and age of the sample could have affected the clustering on
the scale and its low variability.
These findings must take into account the limitations of cross-sectional data,
which may prevent accurate causal ordering at times. In addition, the
religiosity measures may not generalize to elders who do not share
Judeo-Christian beliefs. Despite these limitations, this research is an
important start in investigating the impact of spirituality, religiosity, and lifestyle
on subjective physical well-being among older adults, not only from the
perspective of stress and coping but also in terms of stress and adaptation.
Furthermore, this study validates a short form of the Daily Spiritual
Experiences Scale. Underwood and Teresi (2002) found non-generalizability
was true for many items of the Daily Spiritual Experiences Scale (Fetzer,
1999). However, the factor analysis performed in this study helped to explain
more about the construct validity of this measure.
Future studies need to include more emphasis on adaptation as well as
coping. This will offer more avenues toward understanding the findings of
stress research when including spirituality and religiosity in an aging
population. Different dimensions of religiosity and spirituality may be more
effectively explicated when compared in different theoretical frameworks (i.e.,
suppressor and distress deterrent models).
This study was funded by the National Institute on Aging R03AG17682 and
The Hall Award, Case Western Reserve University School of Medicine, Dept.
of Medical Education.