Adventure and Spiritual Restoration: Older Adult Motivations for Undertaking a Pilgrimage on El Camino de Santiago

A pilgrimage is an intentional journey undertaken for reasons that can increase a sense of well-being. Although originally completed for religious purposes, motives in contemporary times may include anticipated religious, spiritual, and humanistic benefits as well as appreciation of culture and geography. This quantitative and qualitative survey research explored the motivations of a sample subset age 65 and over from a larger study who completed one of the Camino de Santiago de Compostela routes in Spain. Consistent with life course and developmental theory, some respondents walked at life decision points. The analyzed sample was 111 people, nearly 60% of whom were from Canada, Mexico, and the US. Nearly 42% were non-religious while 57% were Christian or a subset, Catholic. Five key themes emerged: challenge and adventure, spirituality and intrinsic motivation, cultural or historical interest, recognition of life experiences and gratitude, and relationships. In reflecting, participants wrote about sensing a call to walk and experiencing transformation. Limitations included snowball sampling, as it is difficult to systematically sample those who complete a pilgrimage. The Santiago pilgrimage counters a narrative of aging as diminishment through positioning identity, ego integrity, friendships and family, spirituality, and positive physical challenge at the center of aging.

Aesthetics and Environment: What is the Role of Beauty in Supporting Ageing Well?

Access to beauty is intrinsic to psychological, social, and spiritual health. Aesthetic sensibility includes awareness initiated in both mind and emotion accessed through nurturing environments (Caspari, Eriksson, & Naden, 2011). While individual tastes vary and aesthetic preferences are culturally conditioned, an appreciation of natural and constructed beauty is fundamental to human meaning-making, creativity, and innovation (Hillman 1998). Beauty is thus an instrumental tool that may support ageing well. We investigated the question of what aesthetics/beauty meant to older adults in England, how they experienced it, and whether experiencing beauty sustained them. Three focus groups were conducted with community dwelling participants aged between 60 and 93 (median age 75) for a total N of 14. Five themes emerged related to experience: an unexpected recognition; an evolving openness to experience; a universal perception available in micro and macro environments; a force that can alleviate depression; and a relational quality of some interactions. The value of beauty was identified through all groups: participants found it difficult to imagine a world with no beauty in it. They wondered if age made discernment capacity greater. Appreciation of beauty in unexpected places like a cracked pot led participants to identify happiness and wellbeing as outcomes of perception. This study suggests that beauty is essential for wellbeing and human flourishing and can emerge in unlikely ways. Implications are that professionals should assist older people to consider the role of beauty in life and develop interventions to consciously keep beauty awakened in normal and aesthetically-deprived environments.

Practice Improvement Projects in an Interdisciplinary Palliative Care Training Program

CONTEXT

Demand for palliative care (PC) continues to increase with an insufficient number of specialists to meet the need. This requires implementation of training curricula to expand the workforce of interdisciplinary clinicians who care for persons with serious illness.

OBJECTIVES

To evaluate the impact of utilizing individual practice improvement projects (PIP) as part of a longitudinal PC curriculum, the Coleman Palliative Medicine Training Program (CPMTP-2).

METHODS

Participants developed their PIPs based on their institutional needs and through a mentor, and participated in monthly meetings and bi-annual conferences, thereby allowing for continued process improvement and feedback.

RESULTS

Thirty-seven interdisciplinary participants implemented 30 PIPs encompassing 7 themes: (1) staff education; (2) care quality and processes; (3) access to care; (4) documentation of care delivered; (5) new program development; (6) assessing gaps in care/patient needs; and (7) patient/family education. The majority of projects did achieve completion, with 16 of 30 projects reportedly being sustained several months after conclusion of the required training period. Qualitative feedback regarding mentors' expertise and availability was uniformly positive.

CONCLUSION

The CPMTP-2 demonstrates the positive impact of PIPs in the development of skills for interdisciplinary learners as part of a longitudinal training program in primary PC. Participation in a PIP with administrative support may lead to operational improvement within PC teams.

Older Adults Walking the Camino de Santiago Pilgrimage: Motivations, Transformations, and Spiritual Perspectives

This mixed-method study describes reasons that older people chose to complete the Camino de Santiago pilgrimage route in Spain and their assessment of how they were changed by the experience. The study is framed in Maslow’s (1988) self-actualization and Tornstam’s (2005) concept of gerotranscendence. We analyzed a subset of 121 participants age 65 and over who completed an online survey. Motivation included five themes: gratitude and transitions, cultural or historical curiosity. relationships, challenge and adventure, and spirituality. Transformations since their return involved greater strength, self-understanding, peace, desire to live lightly and to integrate their experience. Older individuals who walked the Camino have done so for a variety of reasons. Spiritual reasons may be more difficult to disclose. Half responded in the open-ended question, but a later spirituality question added many more respondents. Older people envision many forms of benefit to walking the pilgrimage and find growth in the experience.

Dying alone and lonely dying: Media discourse and pandemic conditions

BACKGROUND AND OBJECTIVES

This paper explores current concerns and practice related to older people dying alone in Intensive Care Units, care homes, and at home through media discussions during the Covid-19 pandemic and before. It addresses the historically-situated concept of a good death and a bad death and suggests why dying alone, whether completely alone or without significant others physically present, may be considered a bad death.

METHODS

As evidence for collective fears about dying alone, we explored the treatment of these deaths in media using headline examples from the US New York Times and the English Guardian newspaper from the 19th century through Sept. 2020.

RESULTS

A search of the New York Times located 39 articles with either lonely dying or lonely death in the headline. The Guardian had 25 articles with use of the term, but unlike the New York Times, no obituaries were included. Although the deaths profiled were deemed unusual, deaths by suicide were only minimally classed as dying alone. The condition of dying alone is represented as a stigmatised death. Themes addressed: 1) dying alone is a nonnormative event; 2) this death matters; and 3) where people die alone, societies should honour the death and learn from it.

DISCUSSION AND IMPLICATIONS

Contemporary dying involves conditions for which we are unprepared as a society. We seldom address our civic obligations to each other. Few people have discussed their wishes about their preferences in dying and whether and how they want to be accompanied at their death, if possible. This is an invisible constraint of modern healthcare. Because of limited discussions and preparation, these deaths may lead to disenfranchised grief for the mourners. Cultural and societal responses to lonely dying are important in easing the emotional burden of dying alone, helping individuals prepare for this possibility and better integrating death with the life course. Recommendations include inclusion of accompaniment/nonaccompaniment at death as part of advance care planning and mitigation if this condition occurs. It is essential for individuals to find their own still point of acceptance within competing societal narratives of privileging the self in dying alone and the value of social connection.

Expanding the Interdisciplinary Palliative Medicine Workforce: A Longitudinal Education and Mentoring Program for Practicing Clinicians

CONTEXT

The disparity between gaps in workforce and availability of palliative care (PC) services is an increasing issue in health care. To meet the demand, team-based PC requires additional educational training for all clinicians caring for persons with serious illness.

OBJECTIVES

To describe the educational methodology and evaluation of an existing regional interdisciplinary PC training program that was expanded to include chaplain and social worker trainees.

METHODS

From 2015 to 2017, 26 social workers, chaplains, physicians, nurses, and advanced practice providers representing 22 health systems completed a two-year training program. The curriculum comprises biannual interdisciplinary conferences, individualized mentoring and clinical shadowing, self-directed e-learning, and profession-focused seminar series for social workers and chaplains. Site-specific practice improvement projects were developed to address gaps in PC at participating sites.

RESULTS

PC and program development skills were self-assessed before and after training. Among 12 skills common to all disciplines, trainees reported significant increases in confidence across all 12 skills and significant increases in frequency of performing 11 of 12 skills. Qualitative evaluation identified a myriad of program strengths and challenges regarding the educational format, mentoring, and networking across disciplines.

CONCLUSION

Teaching PC and program development knowledge and skills to an interdisciplinary regional cohort of practicing clinicians yielded improvements in clinical skills, implementation of practice change projects, and a sense of belonging to a supportive professional network.

Exploring the loss and disenfranchised grief of animal care workers

This article explores the psychological distress of Animal Care Workers (ACWs), and the disenfranchisement of this distress through mixed methods study conducted as an online survey. In all, 139 participants responded about their experiences as an ACW, related psychological distress, and the systemic disenfranchisement of distress. Findings indicate that nearly half of ACWs experienced symptoms of depression in the previous month. Over 66% indicated it was difficult to cope. Limited support often resulted in a disenfranchized loss. Implications suggest ACW distress and disenfranchisement related to animals they serve is similar to that of individuals who lose animal companions.

Remission from Depression in the DSM: Moving from Rhetoric to Restoration

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, uses the term "remission" to describe the reduction of depressive symptoms. This paper argues that by categorizing someone who no longer has depressive symptoms as "in remission," that person may feel indefinitely tied to his or her diagnosis. Considering the unfortunate stigma associated with mental illness, permanent linkage to diagnosis through records and professional memory may cause individuals to internalize pathology. In fact, the language of the diagnosis can affect self-perception in sensitive souls for a lifetime. As an implication for practice, we propose that cognitive and narrative therapy approaches, mood-memoirs, and use of metaphor present alternative uses of language that can reduce power imbalances between clinicians and clients, providing a bridge to healing.

What Constitutes a Good and Bad Death?: Perspectives of Homeless Older Adults

This qualitative study explored perspectives toward a good or bad death among 21 older homeless adults residing in transitional housing. Using grounded theory approach, the themes for a good death were (a) dying peacefully; (b) not suffering; (c) experiencing spiritual connection; and (d) making amends with significant others. Themes for a bad death were (a) experiencing death by accident or violence; (b) prolonging life with life supports; (c) becoming dependent while entering a dying trajectory; and (d) dying alone. Healthcare professionals need to develop approaches for end-of-life care grounded in understanding unique needs of older homeless adults.

Does end-of-life decision making matter? Perspectives of older homeless adults

This qualitative pilot study explored perspectives, needs, and concerns relating to advance care planning among older homeless adults. Twenty-one older adults residing at a transitional housing facility in an urban area of the West coast were interviewed in person. Key emergent themes included discomfort with the topic, trust in God's decisions, physicians preferred as decision makers, and planning is important but not an immediate concern. Further, people who are homeless want to be approached with sensitivity. Instead of simply eliciting life-sustaining treatment preferences of homeless people, health care professionals should assess their unique concerns and needs regarding death and dying, prepare them to consider their possible end-of-life situation, and assist them to plan in accordance with their needs.

Improving the quality of spiritual care as a dimension of palliative care: the report of the Consensus Conference

A Consensus Conference sponsored by the Archstone Foundation of Long Beach, California, was held February 17-18, 2009, in Pasadena, California. The Conference was based on the belief that spiritual care is a fundamental component of quality palliative care. This document and the conference recommendations it includes builds upon prior literature, the National Consensus Project Guidelines, and the National Quality Forum Preferred Practices and Conference proceedings.

Responding to the Hartford Geriatric Social Work Initiative: a multilevel community approach to building aging competency

Infusing age-specific, multigenerational content into social work curricula at both the MSW and BSW levels are key goals in preparing age-competent social workers to meet the needs of our current and future aging populations. The social work profession has a holistic approach and crucial skills that can promote aging well. This article will discuss an innovative, multilevel intervention strategy supported by the Hartford Geriatric Social Work Initiative that formulates, implements, and sustains age-infused curricula and assures the education of age-competent social workers by capitalizing on a "community-focus" strategy.

Spiritual assessment in aging: a framework for clinicians

Older adults may benefit from clinical conversations about the role of spirituality in their lives, but social workers and other helping professionals often do not have an understanding of where to proceed beyond initial questions of whether spirituality and/or religion are important and if so, what religious preference is held. Much has been written about definitions of spirituality and religion, but the literature has not yet provided a clear focus on ways to assess whether these are integrated positively or negatively in the lives of older adults. This article identifies eleven domains in spirituality that might be assessed. Within each domain an explanation is provided as well as a brief discussion of the rationale for including it in the classification. Sample interview questions and an illustrative vignette are included. Together these eleven domains build an important framework and resource for spiritual assessment with older adults.

Religion and coping in older adults: a social work perspective

Religion is an important coping resource for many older adults. This paper briefly describes social work's religious roots, makes a distinction between religion and spirituality for older adults, and presents empirical data showing how older adults employ religious strategies to cope with life challenge. The study reports on religious coping in an available sample of 79 European American and African American older adults residing in urban community dwellings. Implications suggest how social workers and others may support religious coping.