Mark BREENAN and Deborah HEISER, editors, Spiritual Assessment and Interventions With Older Adults: Current Directions and Applications. New York: Haworth Press, 2004. pp.150. pb. ISBN 13: 978-0-7890-2748-1
Reviewed by Nathan KOLLAR, St. John Fisher College, Rochester, NY 14618

Once you grant “spiritual,” both as an independent variable and as a necessary dimension of everyone’s life, this is an excellent introduction to questions to ask about what spirituality is, how to assess it among the elderly and how to act upon the results of your assessment. The topic of assessment is an important one for those who come at spiritual life from a rational and, in particular, scientific perspective. Simply put: if prayer is a spiritual practice, how do we assess it? How do we know it “works”? Or, in the case of frail elderly in hospice care, if we say spirituality is a necessary part of caring for the whole person, what is that “spiritual care” and how do we know what it does for people? How do we demonstrate that “faith” based institutions differ from “secular” ones in caring for the elderly? These types of assessment questions are what concern the authors in this volume.

Spiritual Assessment and Intervention with Older Adults is the same as Volume 17, Numbers ½, 2004 of the Journal of Religion, Spirituality, and Aging. The two editors are well versed in thinking about the nuances of the topics presented. Five of the seven articles were presented at a symposium on spiritual assessment and intervention at the annual meeting of the Gerontological Society of America. Their perspective is that of the social sciences and, many times, that of practitioners in the field of gerontology. The samples in all the research articles are small

The seven articles begin with an excellent introduction to spiritual assessment and intervention with older adults. It provides an argument for distinguishing religion and spirituality and a claim that “… for most individuals spirituality is expressed through religiousness.” The definitions of spirituality, as usual, are multiple and variable. Religion is the pattern of external practices that express this spirituality. If we are to be clear as to how to assess spirituality among the elderly, we better be sure of what we are assessing, thus the necessity of discussing definitions. The variety and multiplicity of these definitions reveal that, while the academic argument may go on about what spirituality is, there seems to be some intuitive, still unarticulated, description lurking in the professional subconscious that necessitates this category, its use and assessment. While the authors present an excellent summary of the state of the question, they have not advanced the clarification necessary for scientific usage. Indeed there are several modes of assessment presented and referred to, which give the sense of professionalism every field needs, but they all still are based on different definitions of spirituality. This does not, in my opinion, mean we should shy away from trying both definition and assessment. Professionalism many times becomes charlatanism without assessment. The introduction offers several summaries of the literature which are helpful in assessing as well as intervening in elderly spirituality.

The articles themselves are best described by providing their titles together with a necessary clarification of their claims. These are the following. Spiritual, Religious, Non-Spiritual and Non-Religious Narratives in Marginalized Older Adults: A Typology of Coping Styles. This demonstrates the use of narrative therapy and provides a typology of copying styles that may be used for assessment purposes. A Feasibility Study of Parent Care Planning Model with Two Faith-Based Communities; Raising Awareness of Abuse of Older Persons. In this Canadian study, 49 clergy were assessed to see if they felt a need for instruments enabling them to discover those experiencing elder abuse. In addition, information materials dealing with elder abuse were reviewed and assessed. Empowering Spirituality and Generativity Through Intergenerational Connections. Four adults were interviewed in depth to discover whether kindergarten students visiting a retirement community contributed to an increase in well being within the community. Spiritual Activities for Adults with Alzheimer’s Disease. Here the author demonstrates the importance of using familiar religious words and activities with Alzheimer’s patients. The CARE Cabinet Intervention: A Perspective from Clinical Practice is a good example of how small items, well considered and team implemented, can help people in times of trial. The CARE cabinet is a mobile cabinet that has items needed by visitors in palliative care settings.

As is probably evident to the reader, what makes the instruments of assessment unique are what they are assessing. The claim is that assessment is seldom done regarding spiritual matters. As one who straddles both the theological profession and the gerontological one, I certainly agree that assessment is necessary but to claim that only current social science instruments answer whether acts of faith “work” is, perhaps, to turn faith into fideism and religious professionals into naïve children.

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