1. A Model for Facilitating Faith-Health Integration in the Church Affiliated Frail Elderly Joann P. Wessman, RN, PhD Nancy L. Olen, RN, EdD Bethel University, St. Paul, MN http://cas.bethel.edu/dept/nursing//

2. Initial qualitative pilot study of ten church-affiliated frail elderly individuals suggested original categories of model (average age = 86) Interviews with 3 pastors, 3 frail elderly persons, 3 scholars, and a focus group of 5 parish nurses confirmed direction of model Qualitative study of 15 frail elders individually and 14 frail elders in 3 different focus groups gave additional support to model (average age = 81.31) Quantitative survey of 115 frail elders provided yet additional support that these were meaningful categories Life-review abilities Church affiliation Integrity of self

3. Review of church affiliation Integrity of self Review of functional abilities Intentional Life-review

4. Past experiences that have built faith Past experiences that have built faith “Well, I think from that earlier illness – I think it gave me an understanding of suffering.” “Well, I think from that earlier illness – I think it gave me an understanding of suffering.” “I sat in his chair [of deceased husband], and I said, ‘Jesus, I’m alone’, I said. And He said, “Jesus and me for each tomorrow” [title of a hymn]. “I sat in his chair [of deceased husband], and I said, ‘Jesus, I’m alone’, I said. And He said, “Jesus and me for each tomorrow” [title of a hymn]. “I was very active, I guess. Soon after I retired, I was on the Council a couple of terms.” “I was very active, I guess. Soon after I retired, I was on the Council a couple of terms.” “I made Jesus the boss in my life six months after I was a Christian. I think that made a difference.” “I made Jesus the boss in my life six months after I was a Christian. I think that made a difference.” “So He answers prayers in different ways; that’s something that comes only with experience.” “So He answers prayers in different ways; that’s something that comes only with experience.” “I remember how God was in my life – I just see a pattern almost…I just love to think about those memories.” “I remember how God was in my life – I just see a pattern almost…I just love to think about those memories.” “It seems to me faith is a result of your experiences.” “It seems to me faith is a result of your experiences.” Intentional Life Review

5. Gifts that have been used in service to others Gifts that have been used in service to others “I taught that God’s grace was sufficient.” “I taught that God’s grace was sufficient.” “I love to write letters.” “I love to write letters.” “A lot of people looked to her as an example of patience and submission to God’s will.” “A lot of people looked to her as an example of patience and submission to God’s will.” “Now I have fun making my own cards on the computer…I send cards to people.” “Now I have fun making my own cards on the computer…I send cards to people.” “We took care of our church nursery.” “We took care of our church nursery.” “We have done visitation for years and we love it.” “We have done visitation for years and we love it.” “I go to the piano and I play and I do a lot of reading and studying.” “I go to the piano and I play and I do a lot of reading and studying.” “I was a deaconess one time…reach out to people within the church.” “I was a deaconess one time…reach out to people within the church.” “I pray for each of them.” “I pray for each of them.” “Some people are natural helpers.” “Some people are natural helpers.” Intentional Life Review

6. It is these experiences and gifts that foster meaning, purpose, roles and responsibilities in the present life context of frailness. It is these experiences and gifts that foster meaning, purpose, roles and responsibilities in the present life context of frailness. It is these experiences and gifts that guide the frail elder’s continuing participation in the life of the faith community It is these experiences and gifts that guide the frail elder’s continuing participation in the life of the faith community It is these experiences and gifts that contribute to integrity of self It is these experiences and gifts that contribute to integrity of self It is these experiences and gifts that may need to be re-framed because of changing functional abilities due to frailness. It is these experiences and gifts that may need to be re-framed because of changing functional abilities due to frailness. Intentional Life Review

7. Definition Definition The energy and competence to engage in life processes such as personal hygiene, eating, walking, and conversing The energy and competence to engage in life processes such as personal hygiene, eating, walking, and conversing Areas of greatest concern Areas of greatest concern Endurance Endurance Pain Pain Balance Balance Review of Functional Abilities

8. Unrelated to medical diagnoses Unrelated to medical diagnoses Comparison of self to others Comparison of self to others Compartmentalization of Compartmentalization of physical, psychosocial, and spiritual physical, psychosocial, and spiritual Prioritization of the spiritual Prioritization of the spiritual Review of Functional Abilities

9. Re-definition of the self Re-definition of the self Dependence on others Dependence on others New role as receiver New role as receiver New patterns of church affiliation New patterns of church affiliation Review of Functional Abilities

10. I am affirmed as a person valued by God and by a loving faith community. I am affirmed as a person valued by God and by a loving faith community. “The whole idea is that we have been redeemed and “The whole idea is that we have been redeemed and we are loved by God.” we are loved by God.” “Dear God, I don’t know who I am. I don’t know where I am. But I’m an old friend of Yours. Please take care of me.” “Dear God, I don’t know who I am. I don’t know where I am. But I’m an old friend of Yours. Please take care of me.” “I saw myself being carried and supported by their [church’s] prayers” “I saw myself being carried and supported by their [church’s] prayers” “I get frequent letters, cards and calls from them. That helps.” “I get frequent letters, cards and calls from them. That helps.” “Wow! My church hasn’t forgotten me. They’re thinking about me in this difficult time.” “Wow! My church hasn’t forgotten me. They’re thinking about me in this difficult time.” Church affiliation

11. I am a person who contributes to the life of the faith community. I am a person who contributes to the life of the faith community. “She will be greatly used of the Lord by her faith and she can minister to others as they minister to her.” “She will be greatly used of the Lord by her faith and she can minister to others as they minister to her.” “It’s a blessing in itself to be able to do that [pray for others]” “It’s a blessing in itself to be able to do that [pray for others]” “Older people do have a place in the church [in reference to talking with younger people].” “Older people do have a place in the church [in reference to talking with younger people].” “Little jobs – and I love it. I’m not just sitting. I need to do that. Why shouldn’t I? I offer.” “Little jobs – and I love it. I’m not just sitting. I need to do that. Why shouldn’t I? I offer.” Church affiliation

12. I experience alienation from the faith community. I experience alienation from the faith community. “I sort of was left stranded.” “I sort of was left stranded.” “So I feel sort of out of the loop now as the expression goes….I wish I could talk to the pastor more.” “So I feel sort of out of the loop now as the expression goes….I wish I could talk to the pastor more.” “But, a general rule, they [frail elderly] kind of feel like they are left out.” “But, a general rule, they [frail elderly] kind of feel like they are left out.” “So many people express disappointment in the church because they didn’t send me a card, or they didn’t do this, or something.” “So many people express disappointment in the church because they didn’t send me a card, or they didn’t do this, or something.” “In the history of our church, I think we’ve been looking at young people primarily.” “In the history of our church, I think we’ve been looking at young people primarily.” Church affiliation

13. A life pattern of faith experiences and personal contributions to the faith community fosters personal integrity in the years of frailty A life pattern of faith experiences and personal contributions to the faith community fosters personal integrity in the years of frailty Functional abilities frame ways in which the frail elder can continue to participate in the life of the faith community. Functional abilities frame ways in which the frail elder can continue to participate in the life of the faith community. The sense of being loved by God contributes to personal integrity and is strengthened through loving relationships with a faith community. The sense of being loved by God contributes to personal integrity and is strengthened through loving relationships with a faith community. Life review abilities Church affiliation Integrity of self