Religiosity and Function Among Community-Dwelling Older Adult Survivors of Cancer

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<ul><li><p>This article was downloaded by: [New York University]On: 06 December 2014, At: 13:33Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK</p><p>Journal of Religion, Spirituality &amp; AgingPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/wrsa20</p><p>Religiosity and Function AmongCommunity-Dwelling Older AdultSurvivors of CancerLee S. Caplan a , Patricia Sawyer b , Cheryl Holt c &amp; Richard M.Allman ba Morehouse School of Medicine , Atlanta , Georgia , USAb University of Alabama at Birmingham , Birmingham , Alabama ,USAc University of Maryland, College Park , Maryland , USAPublished online: 24 Sep 2013.</p><p>To cite this article: Lee S. Caplan , Patricia Sawyer , Cheryl Holt &amp; Richard M. Allman (2013)Religiosity and Function Among Community-Dwelling Older Adult Survivors of Cancer, Journal ofReligion, Spirituality &amp; Aging, 25:4, 311-325, DOI: 10.1080/15528030.2013.787575</p><p>To link to this article: http://dx.doi.org/10.1080/15528030.2013.787575</p><p>PLEASE SCROLL DOWN FOR ARTICLE</p><p>Taylor &amp; Francis makes every effort to ensure the accuracy of all the information (theContent) contained in the publications on our platform. However, Taylor &amp; Francis,our agents, and our licensors make no representations or warranties whatsoever as tothe accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor &amp; Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. 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Terms &amp;Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions</p><p>http://www.tandfonline.com/loi/wrsa20http://www.tandfonline.com/action/showCitFormats?doi=10.1080/15528030.2013.787575http://dx.doi.org/10.1080/15528030.2013.787575http://www.tandfonline.com/page/terms-and-conditionshttp://www.tandfonline.com/page/terms-and-conditions</p></li><li><p>Journal of Religion, Spirituality &amp; Aging, 25:311325, 2013Copyright Taylor &amp; Francis Group, LLCISSN: 1552-8030 print/1552-8049 onlineDOI: 10.1080/15528030.2013.787575</p><p>Religiosity and Function AmongCommunity-Dwelling Older Adult</p><p>Survivors of Cancer</p><p>LEE S. CAPLANMorehouse School of Medicine, Atlanta, Georgia, USA</p><p>PATRICIA SAWYERUniversity of Alabama at Birmingham, Birmingham, Alabama, USA</p><p>CHERYL HOLTUniversity of Maryland, College Park, Maryland, USA</p><p>RICHARD M. ALLMANUniversity of Alabama at Birmingham, Birmingham, Alabama, USA</p><p>Aspects of religiosity/spirituality are important to health andquality of life of cancer patients. The three components of religiosityof the Duke Religiosity Scale, organizational (religious affiliationand attendance); non-organizational (prayer, meditation, andprivate study); and intrinsic religiosity (identification with a higherpower and integration of spiritual belief into daily life) are used todetermine whether religiosity was associated with physical and/ormental functioning among older cancer survivors of the UAB Studyof Aging. Church attendance was independently associated withlower ADL and IADL difficulty and fewer depressive symptoms,while intrinsic religiosity was independently associated with lowerdepression scores.</p><p>KEYWORDS aging/ageing, bible study, church, religion, prayer</p><p>This research was funded in part by NIA grant numbers R01 AG15062 and3P30AG031054-06S1. The content is solely the responsibility of the authors and does notnecessarily represent the official views of the National Institute on Aging or the NationalInstitutes of Health.</p><p>Address correspondence to Lee S. Caplan, Morehouse School of Medicine, Departmentof Community Health and Preventive Medicine, 720 Westview Drive, SW, Atlanta, GA 30310,USA. E-mail: lcaplan@msm.edu</p><p>311</p><p>Dow</p><p>nloa</p><p>ded </p><p>by [</p><p>New</p><p> Yor</p><p>k U</p><p>nive</p><p>rsity</p><p>] at</p><p> 13:</p><p>33 0</p><p>6 D</p><p>ecem</p><p>ber </p><p>2014</p></li><li><p>312 L. S. Caplan et al.</p><p>The incidence rates of most non-skin cancers increase as people age (SEERCancer Statistics Review 19752009: www.seer.cancer.gov). Cancer is the sec-ond leading cause of death in people 65 and over. African Americans are atincreased risk of developing most cancers and usually present later in thecourse of disease than whites (American Cancer Society, 2011).</p><p>Previous research has shown that components of the spiritual context,conceptualized in terms of spirituality, religiosity, and faith are used as cop-ing mechanisms among individuals with cancer (Holt et al., 2009; Schulzet al., 2008) and are important to the health and quality of life in can-cer patients (Laubmeier, Zakowski, &amp; Bair, 2004; Mytko &amp; Knight, 1999).Cancer patients often draw meaning from their suffering (Kappeli, 2000) andfind prayer to be helpful, despite it sometimes being associated with reli-gious conflicts when prayers are considered unanswered (Taylor, Outlaw, &amp;Clements, 1999). They may use religious beliefs to cope with the diagno-sis and subsequent issues (Bowie, Curbo, Laveist, Fitzgerald, &amp; Pargament,2001; Gall, 2000; Jenkins &amp; Pargament, 1995). Among individuals with ter-minal cancer, those reporting higher levels of faith had higher quality oflife (Swensen, 1993). Religion may be particularly important as a copingstrategy to mediate the unique burden not only of a terminal diagnosis butsurvival after a cancer diagnosis during which the threat of recurrence is everpresent.</p><p>There are multiple dimensions of spirituality and religiosity, opera-tionalized differently in research. The conceptualization of religiosity usedin this manuscript is based on the Duke Religiosity Scale, which describesan organizational component (religious affiliation and attendance), a non-organizational component (prayer, meditation, and private study), andintrinsic religiosity (identification with a higher power and integration ofspiritual belief into daily life) (Koenig &amp; Bussing, 2010; Koenig, Parkerson, &amp;Meador, 1997).</p><p>Religiosity is an important part of African American culture, becomingespecially meaningful as people age, and is therefore integral to AfricanAmericans ability to cope with illness (Schulz et al., 2008). It is notablethat religiosity and health are closely linked in African American culture,with explanations of illness and healing being associated with G-d and faith(Stroman, 2000). It would be expected that religiosity would be of particularsalience among African Americans who have a diagnosis and/or treatmentof cancer.</p><p>RELIGIOSITY AND PHYSICAL FUNCTIONING</p><p>Although a well-established positive association has been demonstratedbetween the spiritual context and cancer coping, association of the spiritualcontext on functional ability has not been as well defined, particularly among</p><p>Dow</p><p>nloa</p><p>ded </p><p>by [</p><p>New</p><p> Yor</p><p>k U</p><p>nive</p><p>rsity</p><p>] at</p><p> 13:</p><p>33 0</p><p>6 D</p><p>ecem</p><p>ber </p><p>2014</p></li><li><p>Older Adult Survivors of Cancer 313</p><p>those with cancer. Yet functional ability is a key factor in quality of life.In a population-based, cross-sectional, stratified, random sample survey of701 community-dwelling elders with diabetes in two rural North Carolinacounties, health and functional status were not associated with private reli-gious practice (Arcury et al., 2007) but were associated with public religiouspractice, as those with limited functional status participated less in publicreligious practice. A study using the Assets and Health Dynamics Among theOldest Old Survey data found that more frequent religious service attendancewas associated with fewer functional limitations (Benjamins, 2004).</p><p>RELIGIOSITY AND DEPRESSION</p><p>Much work has been done in the area of religiosity and depression. Onestudy examined the associations of dimensions of religiousness with thepresence and severity of depression in 476 psychiatric patients with a currentepisode of unipolar major depression and 167 non-depressed comparisonsubjects, 58 and above (Hayward, Owen, Koenig, Steffens, &amp; Payne, 2012).The presence of depression was related to less frequent worship attendance,more frequent private religious practice, and moderate subjective religiosity.Among the depressed, less severe depression was related to more frequentworship attendance, less subjective religiousness, and having had a born-again experience. The results were only partially explained by effects ofsocial support and stress buffering.</p><p>A large study of medical inpatients over age 50 at Duke UniversityMedical Center and three community hospitals was done to compare reli-giosity between patients with major depression, minor depression, and nodepression (Koenig, 2007). Religious involvement among both depressedgroups was widespread, but not frequent as in the nondepressed patients.Depressed patients were more likely to indicate no religious affiliation, lesslikely to affiliate with neofundamentalist denominations, more likely to indi-cate spiritual but not religious, less likely to pray or read scripture, andscored lower on intrinsic religiosity, after controlling for demographic andphysical health factors. Among the depressed, there was no relationshipbetween religion and depression type, but depression severity was associ-ated with a lower religious attendance, prayer, scripture reading, and lowerintrinsic religiosity. These relationships were only partially explained bysocial factors.</p><p>A systematic review of articles dealing with religion and mental healthfound that religious beliefs and practices were consistently associatedwith greater life satisfaction and psychological well-being, increased hopeand optimism, less anxiety and fear, and decreased depression (Sternthal,Williams, Musick, &amp; Buck, 2010). One study examined several potentialmechanisms linking religious involvement to depressive symptoms, major</p><p>Dow</p><p>nloa</p><p>ded </p><p>by [</p><p>New</p><p> Yor</p><p>k U</p><p>nive</p><p>rsity</p><p>] at</p><p> 13:</p><p>33 0</p><p>6 D</p><p>ecem</p><p>ber </p><p>2014</p></li><li><p>314 L. S. Caplan et al.</p><p>depression, and anxiety. It found attending services once a week to be asso-ciated with fewer depression and anxiety symptoms than attending servicesless than once a month or never. The study tested five sets of hypothesizedreligion mediators and found that several, including meaning, interper-sonal and self-forgiveness, congregational criticism, social attendance beliefs,and negative coping were independently associated with one or moremental health outcomes. A study examined the relationship between depres-sion symptomatology and functional impairment among elderly whites andAfrican Americans and investigated the effect of race, religiosity, and socialsupport on this relationship (Cummings, Neff, &amp; Husaini, 2003). AfricanAmerican elderly people were more impaired in performance of activitiesof daily living (ADL) and instrumental activities of daily living (IADL) thanwhite elderly people, and they also reported significantly higher levels ofreligiosity and social support.</p><p>OUR STUDY</p><p>Although much work has been done on religiosity and depression, littlehas been done on religiosity and functionality based on self-reported dif-ficulty in basic and instrumental activities of daily living (ADL and IADL)(Lawton &amp; Brody, 1969) among persons who have survived cancer. Thepurpose of this secondary data analysis was to examine the associationbetween religiosity and functional health and depression of study partici-pants with a nonskin cancer diagnosis using data from the University ofAlabama at Birmingham (UAB) Study of Aging. This dataset provides uswith a unique opportunity to study the role of religiosity in older cancersurvivors in a community-based setting as opposed to clinic-based sam-ples. The longitudinal data make it possible to gain insight on persons whodeveloped cancer during the study period. In addition, the study popula-tion is from the southeastern United States, an area where religion is highlyimportant to much of the population (Newport, 2006; Rogers, Krueger, &amp;Hammer, 2010). Finally, the dataset incorporated questions from the Dukereligiosity scale, providing measures of three components of religiosity: orga-nizational; non-organizational; and intrinsic. These measures were collectedlongitudinally, at baseline and 48 months later. We hypothesized that thecomponents of religiosity would be differentially associated with physicalfunction and depression, specifically that organizational religiosity would beassociated with better functional health because a certain level of functionis required to enable people to attend church, but that non-organizationalreligiosity and intrinsic religiosity would not be associated with functionalhealth. We also hypothesized that all three components of religiosity wouldbe associated with fewer symptoms of depression. We hypothesized that per-sons with greater religiosity would have better function and fewer symptoms</p><p>Dow</p><p>nloa</p><p>ded </p><p>by [</p><p>New</p><p> Yor</p><p>k U</p><p>nive</p><p>rsity</p><p>] at</p><p> 13:</p><p>33 0</p><p>6 D</p><p>ecem</p><p>ber </p><p>2014</p></li><li><p>Older Adult Survivors of Cancer 315</p><p>of depression at the follow-up interview. Because cancer potentially car-ries an emotional burden in addition to a physical impact, religiosity couldbe expected to have particular salience as a coping mechanism. Such find-ings would highlight the role of religion in the maintenance of physical andmental health among cancer survivors.</p><p>METHOD</p><p>The UAB Study of Aging, a study of mobility among African American andwhite community-dwelling older adults, has been described in detail previ-ously (Allman, Sawyer, &amp; Roseman, 2006). Briefly, baseline recruitment forthe study began in December 1999 and extended to February 2001. A randomsample of Medicare beneficiaries 65 and older living in five central Alabamacounties was selected from a list of Medicare beneficiaries provided by theCenters for Medicare and Medicaid Services (CMS), stratified by county, race,and sex. Specific rural counties were selected for their proximity to UABand their proportions of African American and white residents. In 2000, theAlabama population 65 and older was 80% white, 60% female, and 9% rural(United States Census Bureau, 2003). By design, rural, African American, andmale older adults were oversampled to achieve a balanced sample (50%African American, 50% male, and 51% rural) for the study.</p><p>Potential subjects were mailed a letter from CMS (3,100 letters weremailed), followed by a phone call asking if the potential participant wouldbe willing to complete an in-home interview. Of 2,188 persons contacted bytelephone, 1,000 participants were enrolled (43.7%...</p></li></ul>

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