Annals of Long Term Care

A systematic review was conducted to document all articles addressing spirituality among residents with dementia in long-term care (LTC) facilities. Three major themes emerged: (1) the spiritual needs identified included preserving a sense of purpose, fostering meaningful connections with the surrounding world, and retaining a relationship with God; (2) effective strategies for assessing individual spiritual needs were identified (eg, 2-level method); and (3) clinical guidelines suggested the use of formal religious interventions (eg, prayer, spiritual reminiscence). These strategies increased recall ability and mood, and decreased agitation. This article is the first review on spirituality and dementia to focus strictly on LTC residents. The lack of methodologically rigorous studies underlines the need for future research. This review reveals the importance of policies and programs of Homes for the Aged to increase awareness of the spiritual needs of residents with dementia. (Annals of Long-Term Care: Clinical Care and Aging 2010;18(10):41-47).

Introduction
The growth of the aging population emphasizes the importance of examining factors that impact the quality of life for older persons. According to the U.S. Census Bureau, in 2009 there were 39 million older adults living in the United States.¹ The number of older adults age 85 years and over is projected to increase threefold by 2050.¹ The prevalence of dementia increases exponentially with age from 1% at age 60 years to 30% at age 85 years.^2,3

Currently, in the United States there are 5.3 million individuals living with Alzheimer’s disease and related dementias.4 By 2050, this number is expected to rise to between 11 and 15 million.⁴ The annual cost of Alzheimer’s disease and dementia in this country is $172 billion.⁴ Additionally, there are 10.9 million unpaid caregivers providing assistance to persons with dementia.⁴ Dementia is a key determinant of long-term care (LTC) placement, with two-thirds of residents possessing a cognitive impairment.⁵ In 2008, 3.2 million Americans with cognitive impairments lived in LTC facilities.⁴ With the projected increase in the number of individuals living with dementia, there will be a corresponding demand for LTC facilities.

Many LTC facilities offer activities to engage residents and promote social inclusion. Individuals with cognitive impairments who participate in recreational therapy experience fewer behavioral issues, lower medication use, greater alertness, and fewer falls.⁶ Recreational therapists are employed to encourage residents to participate in a wide variety of activities, including social gatherings, board or card games, music therapy, and pet therapy.⁷ Many of these activities are modified to enhance the abilities of individuals living with dementia.

Caregivers have the ability to create or diminish an individual’s personhood in the ways in which they interact with individuals.⁸ Overall, the care provided to individuals with dementia has shifted toward a person-centered approach. This approach recognizes the uniqueness of each individual and his or her personal abilities and preferences. As the merits of person-centered care are recognized, more facilities are considering how to best implement this approach. Researchers have found evidence to suggest that some of the negative consequences associated with dementia may be mitigated or delayed by this approach to care.⁹ It is essential that a holistic approach is employed to address individual care needs, but the spiritual needs of individuals in LTC settings are often overlooked.

Spirituality extends beyond religion to include a person’s values or beliefs.