This article was downloaded by: [b-on: Biblioteca do conhecimento online UL]

On: 07 May 2012, At: 08:43

Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office:
Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Aging & Mental Health

Publication details, including instructions for authors and subscription
information:
http://www.tandfonline.com/loi/camh20

Religious involvement, spirituality and

personal meaning for life: Existential
predictors of psychological wellbeing in
community-residing and institutional care
elders
a
P. S. Fry
a
Trinity Western University, Langley, BC, Canada

Available online: 09 Jun 2010

To cite this article: P. S. Fry (2000): Religious involvement, spirituality and personal meaning for life:
Existential predictors of psychological wellbeing in community-residing and institutional care elders, Aging
& Mental Health, 4:4, 375-387

To link to this article: http://dx.doi.org/10.1080/713649965

PLEASE SCROLL DOWN FOR ARTICLE

Full terms and conditions of use: http://www.tandfonline.com/page/terms-and-conditions

This article may be used for research, teaching, and private study purposes. Any substantial
or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or
distribution in any form to anyone is expressly forbidden.
The publisher does not give any warranty express or implied or make any representation that
the contents will be complete or accurate or up to date. The accuracy of any instructions,
formulae, and drug doses should be independently verified with primary sources. The publisher
shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages
whatsoever or howsoever caused arising directly or indirectly in connection with or arising out
of the use of this material.
 Aging & Mental Health 2000; 4(4):375± 387

ORIGINAL ARTICLE

Religious involvement, spirituality and personal meaning for life:

existential predictors of psychological wellbeing in community-
residing and institutional care elders

P. S. FRY

TrinityWestern University, Langley, BC, Canada

Downloaded by [b-on: Biblioteca do conhecimento online UL] at 08:43 07 May 2012

Abstract
The psychosocial model of mental health postulates that wellbeing in late life is signi® cantly in¯ uenced by several externally
generated factors such as social resources, income and negative life events. More recently, the gerontological literature is
drawing attention to the increasingly in¯ uential role of existential factors such as religiosity, spirituality and personal
meaning in the psychological wellbeing of older adults. This study examined the unique and combined contribution of
speci® c dimensions of religiosity, spirituality and personal meaning in life as predictors of wellbeing in samples of community-
residing and institutionalized older adults. Using hierarchical regression analyses, the results showed that personal meaning,
involvement in formal religion, participation in spiritual practices, importance of religion, degree of comfort derived from
religion, sense of inner peace with self, and accessibility to religious resources were signi® cant predictors of wellbeing for the
combined sample. The pattern of associations between wellbeing and the preceding psychosocial dimensions was, however,
stronger for the institutionalized elders. The ® ndings con® rmed that existential measures of personal meaning, religiosity
and spirituality contributed more signi® cantly to the variance in wellbeing than did demographic variables or other
traditional measures such as social resources, physical health or negative life events.The importance of existential constructs
of religiosity, spirituality and personal meaning in helping older adults to transcend old age stresses and sustain wellbeing are
discussed.

Religion and spirituality are playing an ever-increasing
role in the lives of older adults and in their pursuit of
physical and psychological wellbeing. Despite the
recent growth in gerontological interest in the salutary
and supportive bene® ts of religion and spirituality in
the adaptation and coping with the challenges of
aging and old age losses (Ellison, 1994), very little of
an empirical nature is known about the precise
contribution of religion, spirituality and personal
meaning to the lives of older adults. Previous research
has postulated that sociodemographic characteristics,
particularly income (Krause, 1987), physical health
status (Murphy, 1983) and level of social support
and social resources (Fontana et al., 1989; Holahan
& Holahan, 1999; Mirowsky & Ross, 1986) are
important antecedent conditions of older adults’
wellbeing or depressive conditions.
However, more recent research (e.g. Ai et al., 1998;
Anderson et al., 1993; Levin & Taylor, 1997; Spohn,
1997) sheds new light on the relationship of religious
involvement, spirituality and other existential needs
and concerns to the psychological wellbeing of older
adults. Levin (1994) and Lindal (1990) believe that
antecedent factors of stressful life events and sociode-
mographics may be less in¯ uential in the decline of
late-life wellbeing than has been assumed in the past.
It is now postulated that the presence or absence of
internally generated personal and existential resources
such as accessibility to both formal and informal
religious activities, and spiritual experiences including
frequency of private prayer and devotion, feelings of
closeness to a power greater than oneself (Levin
1995), and a well-developed personal meaning for
life (Lukas, 1992; Reker, 1994) may be potent predic-
tors of psychological wellbeing in late life.
There is increasing consensus among researchers
in medicine, gerontology and mental health that there
is a positive relationship between religiosity and
spiritual experiences with physical health (Wallis,
1996) and with general adaptation and mental health
(Ai et al., 1998; Hunsberger, 1985; Koenig &
Futterman, 1994). Within the context of the theory
and research on gerotranscendence,Tornstam (1989;
1997) further argues that humans are not merely
biological, social or psychological beings, but beings
that have a deeply contemplative nature which

Correspondence to: P. S. Fry, PhD, Research Professor, Graduate Program in Psychology, Trinity Western University, 7600
Glover Road, Langley, British Columbia, Canada V2Y 1Y1. E-mail: Fry@Twu.ca
Received for publication 11th November 1999. Accepted 10th June 2000.
ISSN 1360± 7863 print/ISSN 1364± 6915 online/00/040375± 13 ½ Taylor & Francis Ltd
DOI: 10.1080/13607860020010547
 376 P. S. Fry
struggles to transcend concerns about the self in order
to achieve a higher level of existential wellbeing.
According to Tornstam (1997), wellbeing is based on
meaning and purpose in life and the desire to be
transformed along lines that are cosmic, spiritual and
in communion with a higher entity than oneself (see
also Levin, 1996). More recently, a number of
researchers (e.g. Levin, 1994; Moberg, 1990; 1997)
contend that religiosity and spirituality protect against
anxiety, alienation and loneliness of old age, including
overall morbidity arising from chronic illness (Koenig
& Futterman, 1994).
Many of the losses that accompany the aging
process, including loss of relationship, work
productivity and ® nancial strain, are brought on by
factors external to most older adults, and over which
Downloaded by [b-on: Biblioteca do conhecimento online UL] at 08:43 07 May 2012
they have little or no control. However, the individual’s
sense of personal meaning, the determination to
pursue a religious and spiritual involvement and seek
wholeness of one’s life within oneself (Zinnbauer et
al., 1996) become the means for affirming one’s own
psychological wellbeing. Thus, it makes sense that a
person who perceives life as meaningful and feels he
or she is in close communion with God and one’s
inner self will maintain a much more positive outlook
and will be less vulnerable to depression or old age
morbidity.
A number of gerontologists (Ai et al., 1998; Ainlay,
et al., 1992; Idler & Kasl, 1992) stress the significance
of examining speci® c aspects of the relationship of
dimensions of religiosity, spirituality and self-
transcendence with aspects of psychological wellbeing
in late life. If a positive relationship is con® rmed and
the precise dimensions of religiosity and spirituality
that predict psychological wellbeing of elders are
identi® ed, then such information and knowledge may
be useful for a number of reasons. First, this
knowledge would improve general communications
between professional service agents and elders along
lines of enhancing elders’ religious faith, optimism
and spiritual involvement. Second, a better
understanding of the extent to which elderly persons
use religious and spiritual resources may help profes-
sionals and caregivers of elderly persons to reinforce
their use of religious coping to pull them through
crisis situations. Third, suggestions for how religious
involvement and spiritual resources may be useful
with elders facing severe medical uncertainties may
be incorporated in behavioral programs of self-care
and stress management for older clients.
This view was tentatively adopted in the present
study. The primary interest, however, was to study
the extent to which demographic variables, tradition-
ally accepted variables of physical health, social
support and negative life events and existential vari-
ables contribute in unique ways to the prediction of
wellbeing in later life. Thus, the speci® c purpose of
the present study was to examine the role of existential
constructs of religiosity, spirituality and personal
meaning in predicting psychological wellbeing in
community-residing and institutionalized older adults.
The existential framework or existential paradigm
proposed for this study is based on Frankl’s (1984)
and Yalom’s (1980) notions that individuals strive to
transcend and ® nd meaning in adversity and the strug-
gles of old age through a deeper contemplation of
existential needs or existential life concerns.
The decision to study community-residing elders
and institutional care elders both separately and
together was predicated on the assumption that the
predictors of psychological wellbeing will be different
for these two groups. Since institutionalization, as a
scheduled or non-scheduled life transition, is
frequently implicated in the genesis of late life adapta-
tions and adjustment (Pearlin et al., 1981), it makes
sense to look at existential construct predictors of
wellbeing separately for these groups of elderly.
Two major hypotheses were proposed for the study.
First, based on earlier ® ndings concerning the salu-
tory in¯ uence of religion and spirituality in the lives
of older adults (see Ainlay et al., 1992; Idler & Kasl,
1992; Pressman, et al., 1990), it was hypothesized
that existential variables would be more potent predic-
tors of psychological wellbeing in both community-
residing and institutional elders than would be the
demographic and traditional variables. Second, it was
hypothesized that existential variables such as personal
meaning, religious and spiritual involvement would
contribute more signi® cantly to the prediction of
psychological wellbeing of institutional elders
compared to their community-residing counterparts.
The latter hypothesis is predicated on previous ® nd-
ings suggesting that institutional elders have frequently
suffered more physical and social losses, which make
them more vulnerable to loss of personal meaning for
life, and the will to live.
Overall, however, the present study was designed
to assess the relative in¯ uence of sociodemographic
factors, traditional resource factors, and existential
factors in predicting wellbeing. For the purposes of
this study, broad interpretations of the constructs of
religiosity and spirituality were accepted, even though
these constructs may have some overlapping dimen-
sions. Following Levin et al. (1995), religiosity is a set
of behaviors that re¯ ect public or formal participa-
tion in religious activities and practices such as
frequency of church, synagogue and group worship
attendance. By comparison, Kaye and Robinson
(1994) view spirituality as encompassing private
prayer and devotional subjective activity in an attempt
to establish a relationship with some higher power
greater than oneself. Furthermore, spirituality
encompasses people’s drive for seeking meaning
within the self, in relationships with other people, in
contact with the natural and human-created world,
and in connection with a sacred or transcendent object
or force outside oneself (Prest & Keller, 1993). Thus,
spirituality, as distinguished from religiosity, focuses
 Existential predictors of wellbeing 377

much more on the subjective aspects of life affirma-
tion (Cook, 1983).
Method
Participants
Participants were part of a Time 1 sample of a
longitudinal project comparing changes in purpose for
living and future goals of community-residing and
institutional care adults, aged 60 to 90. Participants
were drawn from three mid-sized cities (populations
ranging from 170,000 to 500,000 individuals) in
Southern Alberta. The cities from which participants
were recruited are home to two major universities,
Downloaded by [b-on: Biblioteca do conhecimento online UL] at 08:43 07 May 2012
Participants came from both urban and suburban
districts. Religious preference was predominantly
Christian Protestant, primarily Baptist 65%, Anglican
10%, Methodist 10%, and the remaining were Catholics
and Mormons.
As seen in Table 1, which details sociodemographic
characteristics of participants, the majority of
participants who volunteered from both the
community and institutional settings were Caucasian
(90%). The sample was approximately two-thirds
female and one-third male. Mean age of respondents
in the community sample and Institutional sample
was 71.9 and 69.2 years, respectively. The modal
level of education for both samples was high school,
and marital status was mixed.

several colleges, medical and hospital centers. Seniors’ Almost all respondents in the community and
lodges, hospice-type quarters and semi-supervised institutional samples reported one or more functional
group living accommodation facilities are available in or physical in® rmity or disability. Primary reports of
most urban and suburban areas of the three cities. health problems from both the community and the

TABLE 1. Sociodemographic characteristics of the community and institutional care elderly sample

Descriptive measures

Variables Community Sample (N=180) Institutional sample (N=160) t

Mean Median SD Mean Median SD

Age (years) 71.9 71.2 6.9 69.2 70.1 5.8 ns

Educational level (years of schooling) 12.4 13.2 3.9 15.1 12.2 4.2 ns
Instrumental ADL scores 6.2 6.4 3.0 6.1 6.0 2.9 ns
MMSE X X X 25.1 27.0 1.75
Length of residence in hospital (months) X X X 16.1 9.2 2.2

Categorical measures Community sample (N=180) Institutional sample (N=160)

N Valid % N Valid %

Self-perceived health status

Excellent 23 13 3 2
Very good 56 31 18 11
Good 43 24 59 27
Fair 45 25 66 41
Poor 13 7 14 19
Sex
Males 67 37 48 30
Females 113 63 112 70
Race and ethnic background
Caucasian 162 90 155 97
Hispanic 14 8 5 3
Asian 4 2 0 0
Religious background
Catholics 29 16 21 14
Christian Protestants: Baptist, United Church, 147 82 129 86
Methodist, Presbyterian, Lutheran
Others: Buddhist, Hindu 4 2 10 0
Current marital status
Single (never married) 7 4 26 16
Married 70 39 51 32
Widowed 81 45 70 44
Divorced 22 12 13 8
Family income range
9,000± 12,000 2 1 0 0
12,500± 15,000 22 12 0 9
15,500± 19,000 40 22 18 11
19,500± 25,000 66 37 64 40
25,000+ 50 28 78 40
 378 P. S. Fry
institutional sample were `recovering from stroke’,
`recovering from pulmonary disease’ , `cardiac
problems’ , `recovering from hip surgery’ and
`chemotherapy’. Almost all community-residing elders
acknowledged the assistance of family members in the
time of recuperating or recovering from health
problems.
In the institutional sample, median length of
residence in the hospital, hospice or nursing home was
9.2 months (range=6± 18 months). There was no
signi® cant difference in self-perceived health status of
the community-residing and institutional care elders,
with a majority reporting health to be fair to good.
All participants from the institutional sample scored
25 or over on the Mini-mental Status Exam (MMSE;
Folstein et al., 1975) (Median score=27), which was
Downloaded by [b-on: Biblioteca do conhecimento online UL] at 08:43 07 May 2012
administered to them by the nursing home administra-
tion at the time of earlier screening and assignment
to nursing care. Thus, all institutional participants
were considered by the staff of institutions to be
cognitively intact. With respect to community-
residing participants, the MMSE was administered
to eight respondents only, where there was some
concern about possible cognitive impairment. Five
community participants showing evidence of cogni-
tive impairment were excluded from the study.
Recruitment procedures
Community-residing older adults were recruited
through local community newspaper advertisements,
posters and newsletters, bulletin boards, notices in
recreational centers for older adults, and by word of
mouth. Institutionalized older adults were recruited
with the cooperation of nursing administrators in
hospices, directors of private nursing homes and
managers of semi-supervised seniors’ lodges supported
by charitable foundations. Recruitment was also
conducted through personal letters and personal contact
with residents in nursing homes and seniors’ lodges.
The help of family members, caregivers and pastoral
and chaplains’ staff was also solicited in recruiting
participants from community and institutional settings.
The ® nal sample was a representative cross-section of
various sociodemographic communities. Sociodemo-
graphic information on both samples of participants is
presented in Table 1.
Measures
Psychological wellbeing. Following Bradburn (1969),
Ainlay and Smith (1984), Holahan (1988) and Ryff
(1995), a composite measure of psychological
wellbeing was developed as follows: (1) depressed
mood was assessed on a nine-point scale (reverse
scored with a higher score re¯ ecting less depression),
with the extremes labeled depressed (score=1) and
cheerful (score=9); (2) anxious mood was assessed on
a nine-point scale (reverse scored with a higher score
re¯ ecting less anxiety), with the extremes labeled
anxiety (score=1) and calmness (score=9); (3) happy
mood was assessed on a nine-point scale (reverse
scored with a higher score re¯ ecting more happi-
ness), with the extremes labeled very unhappy
(score=1) to very happy (score=9) (in rating their
depressive mood, anxious mood and happy mood,
participants were asked to report their mood during
the last four months or so); and (4) self-esteem was
assessed on a nine-point rating of self-esteem scale
items (Rosenberg, 1965) (reverse scored with a higher
score re¯ ecting high self-esteem).
The three mood items (depression, anxiety, unhap-
piness) and the self-esteem items were then summed
to form a composite measure of psychological
wellbeing, with a higher score re¯ ecting more posi-
tive wellbeing. Alpha coefficients were 0.77 and 0.80
for the community and institutional older adults,
respectively.
Personal meaning. This was measured by a composite
index of the Life Purpose (life goals, mission in life,
sense of direction), Will to Meaning (sense of order,
reason for existence, clear sense of identity) and
Future Meaning (future potentialities, ful® llment and
positive expectations concerning one’s future life)
sub-scales of the Life Attitude Pro® le (LAP, Reker &
Peacock, 1981). Scores for each sub-scale (seven-
point) are expressed as a mean and summed across
sub-scales. Scores can range from 3 to 21. Alpha
coefficients for the community and institutional
elderly were 0.82 to 0.79, respectively.
Social support and access to social resources. These
were measured by the Multidimensional Scale of
Perceived Social Support (MSPSS, Zimet et al.,
1988). Three sources of support were measured
through three sub-scales (family, friends and
signi® cant others), with a composite higher score
corresponding to higher support from the three
sources. Cronbach’s coefficients were between 0.90
to 0.95 for the sub-scales. Alpha coefficients were
0.57 and 0.65 for the community and institutional
sample, respectively.
Physical health problems. These were measured by a
26-item physical health checklist of illnesses (OARS;
Duke University Center for Aging and Human
Development, 1978) most commonly encountered
by elderly persons. Participants responded yes/no to
the question, Do you have any of the following
illnesses at the present time? A high score of yes
responses re¯ ects a large number of physical health
problems. Alpha coefficients were 0.52 and 0.69 for
the community and institutional sample, respectively.
Frequency of negative events. This was measured by
means of one question: How frequently do you

encounter negative life events (i.e. events that upset
you, cause you to become angry with yourself or
others, or events that make you sad and depressed).
Choices were: on a daily basis (6) to rarely (1).
Measures of religious involvement. In order to measure
respondents’ extent of participation in formally organ-
ized religious activity, a ® ve-item index of
organizational religiosity was adapted from Chatters
et al. (1992). Item I measured: Taking all things into
account, how important is religion to you in your
daily life? (from very much=6 to not at all=1). Item 2
measured frequency of attendance at church,
synagogue or formal places of worship: How
frequently do you attend religious services or religious
activities? (from daily=6 to never=1). Item 3 measured
Downloaded by [b-on: Biblioteca do conhecimento online UL] at 08:43 07 May 2012
intensity of religious involvement in church,
synagogue membership and related activity from deeply
involved=6 to marginally involved=1. Item 4 measured
respondents’ involvement in diverse forms of informal
religious activity: How frequently do you participate in
informal religious services,for example listen to or watch
talk shows on TV and radio, hymn singing or church
music or bible reading? (from daily=6 to seldom=1).
Item 5 measured respondents’ degree of comfort
derived from religion in times of suffering and distress
(from very much=6 to none at all=1).
Index of spirituality. Two separate items were used
as an index of spirituality. Item 1 measured frequency
of private prayer, meditation and personal contempla-
tion (from daily=6 to seldom=1). Item 2 measured the
level of inner peace and sense of being in touch with
self (from very much so=6 to not at all=1).
Measure of accessibility to religious support services. This
measure had one question: How easy or difficult is it to
get the help of your pastor, minister, religious mentor
or church and synagogue members in a time of need?
The choices were very easy=6 to very difficult=1.
The scores on the various items measuring
organizational religiosity, spirituality and accessibility
to religious support services were summed to form a
composite score for each of the ® ve indices of
religiosity, spirituality, comfort from religion, peace
with self and accessibility to religious support. Higher
scores re¯ ected higher religious and spiritual involve-
ment, higher degree of comfort derived from religion,
higher degree of peace with self, and easier access to
religious support.Alpha coefficients ranging from 0.72
to 0.77 and from 0.76 to 0.86 were found for the
community and institutional elderly samples,
respectively.
It should be noted that all measures administered
to the participants from both the community settings
and institutional care settings were formatted in terms
of language and structure appropriate for adults
having a minimum of an eighth grade education. All
paper and pencil self-report measures used in this
Existential predictors of wellbeing 379
study were previously piloted on a volunteer group of
40 older adults (ages 75 to 85) who had a MMSE
score of 24 and above, and an eighth grade level
education. This procedure was undertaken to ensure
that even those elders who were quite old and had
relatively limited education could validly complete
the measures.
Design and analysis of the study
A step-wise hierarchical regression analysis model
was used in this study, with the expectation that it
will provide estimates of the percentage of variance
in `psychological wellbeing’ accounted for by the four
blocks, respectively, of the sociodemographic vari-
ables (i.e. age, gender, education, marital status and
income), traditional measures (i.e. social resources,
physical health problems and negative life events),
existential measures (personal meaning, participa-
tion in religious and spiritual activity, importance of
religion, sense of inner peace, comfort from religion,
and accessibility to religious support and services)
and interactions of health and key existential vari-
ables. The same step-wise hierarchical regression
analysis was performed on the community-residing
sample and the institutional care sample in order to
observe differences or similarities between predictors
of psychological wellbeing for the two samples (see
purpose and hypotheses for the study in the Introduc-
tion).
Independent of whether the differences in the final
regression models for the community-residing and
institutional samples were salient or trivial, an a priori
decision was made to do a similar regression analysis
on the combined sample of community-residing
participants and institutional participants. The
underlying rationale for studying the predictor vari-
ables in the combined sample was that the ® ndings
regarding predictors of psychological wellbeing would
be generalizable to a heterogenous group of elders
who have experienced both community living and
institutional care (Galanos et al., 1994).
The order of entry of the blocks of variables (socio-
demographics, traditional measures, existential
measures and interactions) was based on
methodological, historical and theoretical considera-
tions indicated in the extant literature (Ai et al., 1998;
Koenig et al., 1997; Levin & Chatters, 1998; Levin &
Taylor, 1997; Picot et al., 1997; Young & Dowling,
1987).
The order of entry of the independent variable
blocks also took into account the general cautions
suggested by Cohen and Cohen (1983). The demo-
graphics were entered ® rst as a control for all study
variables, followed in Step 2 by the three traditional
measures which have been investigated in previous
studies of depression and coping in old age (Barusch et
al., 1999; Fry, 1986, 1992, 1993; George, 1996). The
block of seven existential variables was entered as a
 380 P. S. Fry

later step (Step 3), primarily because these predictor
variables have not been examined in prior studies. By
entering this set of variables at a later stage in the
regression, the assumption was that it should provide a
more stringent test of the unique contributions of the
existential variables to the prediction of psychological
wellbeing over and above the already recognized
contribution of demographics and the traditional
measures. The purpose was to ascertain if additional
variance could be accounted for by the block of seven
existential variables infrequently used in the earlier
research. Finally, the interaction of physical health with
a few select existential variables was studied last of all
in Step 4 of the hierarchical analysis.The Step 4 analysis
was predicated on the assumption that among
individuals who are old and frail, the contribution of
Downloaded by [b-on: Biblioteca do conhecimento online UL] at 08:43 07 May 2012
number of physically disabled community and
institutionalized elders (n=22) who had difficulty in
writing, a research assistant administered the measures
to the participants on an individual basis, and assisted
in recording their responses.
Results
Means and standard deviations on psychosocial vari-
ables assessed for community and institutional elderly
are presented in Table 2. Compared to community-
residing counterparts the institutionalized elderly were
found to be signi® cantly lower on measures of wellbeing.
They also had a lower sense of personal meaning, had
fewer meaningful social resources, higher frequency of

select existential variables (e.g. importance of religion,
access to religious services, personal meaning)
interacting with physical health may hold signi® cant
predictive value (Idler, 1994; Morgan, 1994).
Procedure
As indicated previously, data for the present study
were collected as a part of the present author’s larger
longitudinal study.The present study reports only on
a sub-set of 15 variables: sociodemographics (5),
traditional measures (3) and existential (7),
hypothesized to be predictors of psychological
wellbeing in both community-residing and
institutional elders. The existential variables
hypothesized to be predictors of psychological
wellbeing included personal meaning, and levels of
involvement in religious and spiritual activities.
For a majority of participants in community and
institutional settings,the surveys were self-administered.
Participants completed them at their leisure at home,
in their rooms or in their places of recreation, work or
study, and arranged to drop off their materials at
pre-arranged pick-up centers. However, for a small
negative life events and had signi® cantly more physical
health problems. Their participation in organized
religious activity and spiritual activity was lower than
their community-residingcounterparts, and so was their
sense of peace with the self. However, they attached
signi® cantly greater importance to religion, and also
they reported deriving more comfort from religious
activity during times of stress and crises. They also
reported signi® cantly higher accessibility to religious
support services and resources than did the community-
residing elderly.
The bivariate correlations of psychological
wellbeing with demographic variables and the psycho-
social predictor variables for community and
institutional elderly samples are presented in Table 3.
For community elderly, none of the demographic
variables were signi® cantly related to wellbeing. For
institutional elderly, males were signi® cantly lower in
wellbeing compared to females. Also, among
institutional elderly, there was a stronger association
between higher income and psychological wellbeing.
With the exception of `comfort derived from religion’
for the community elderly, all other existential
variables were signi® cantly related to wellbeing of
elderly in both community-residing and institutional

TABLE 2. Means, standard deviations and t-values of psychological wellbeing and the predictor variables for community and
institutional care elderly sample

Community Institutional care

(N=180) (N=160)
Variables M SD M SD t (df=338)

1. Psychological wellbeing 99.1 8.1 82.3 9.4 17.65**

2. Personal meaning 17.3 2.4 13.2 2.2 16.30**
3. Participation in organized religion 5.3 1.1 3.1 0.7 21.63**
4. Participation in spiritual practices 5.6 0.7 2.8 0.9 32.10**
5. Importance of religion 2.1 0.9 4.1 2.2 11.16**
6. Comfort from religion 1.9 0.8 3.2 0.9 14.06**
7. Sense of inner peace with self 2.8 0.3 1.9 0.4 23.55**
8. Accessibility to religious support 3.4 1.2 6.1 0.7 24.86**
9. Social resources 5.8 0.7 2.3 0.4 55.52**
10. Physical health problems 3.9 2.2 6.4 1.5 12.06**
11. Negative life events 0.7 0.4 2.9 0.5 44.88**

*p<0.05; **p<0.01; ***p<0.001.

 Existential predictors of wellbeing 381

TABLE 3. Bivariate correlations of psychological wellbeing with demographic variables and

predictor variables

Psychological wellbeing

Community Institutional Care

Measures (N=180) (N=160)

Demographics
Age ± 0.04 ± 0.06
Gender (F=1; M=2) 0.05 ± 0.33**
Marital status (S=1; M=2) 0.12 0.11
Education 0.06 0.13
Income 0.09 0.37**
Predictors
Personal meaning 0.42*** 0.57***
Participation in organized religion 0.31* 0.39**
Participation in spiritual practices 0.56*** 0.39**
Importance of religion 0.29* 0.44***
Downloaded by [b-on: Biblioteca do conhecimento online UL] at 08:43 07 May 2012

Comfort from religion 0.10 0.32**

Sense of inner peace with self 0.52*** 0.31**
Accessibility to religious support 0.29* 0.45***
Social resources 0.42*** 0.41***
Physical health problems ± 0.29* ± 0.42***
Negative life events ± 0.28* ± 0.48***

*p<0.05; ** p<0.01; *** p<0.001.

settings.The overall pattern of associations, however,
was somewhat stronger for institutionalized older
adults.
As a test for possible multicollinearity the intercor-
relations among the predictor variables were
calculated. For community elderly, the intercorrela-
tions ranged from 0.17 to 0.36; median=0.08. For
institutionalized elderly, the intercorrelations ranged
from ± 0.17 to 0.49; median=0.11.Thus, multicolline-
arity does not appear to be a concern for this study.
In order to test for the unique and combined
contribution of all of the demographic and psychoso-
cial variables, a four-step hierarchical regression analysis
was performed for the community, institutional and
combined samples. In Step 1, the ® ve demographic
variables were entered as a block, followed by the three
traditional measures (social resources, physical health
problems and negative life events) which were entered
as a block in Step 2. In Step 3, the seven existential
variables were entered as a block. The block in Step 3
included personal meaning, religious involvement,
spiritual involvement, importance of religion, sense of
inner peace, comfort from religion and accessibility to
religious and spiritual resources. The block in Step 4
included interactions of key existential variables x
physical health.
As seen in Table 4, for community elderly, the
demographics entered in Step 1 failed to account for
signi® cant variance in wellbeing, and none of the
individual variables made a signi® cant contribution.
When the traditional measures of social resources,
physical health problems, and negative life events were
entered as a block in Step 2, they accounted for an
additional 13% of the variance, which was a significant
contribution. However, only one of these variables,
social resources (beta=0.30, p<0.01) emerged as a
signi® cant predictor of wellbeing.
With demographic and traditional variables
controlled in Steps 1 and 2, the unique contribution
of the existential variables was more in evidence in
Step 3.The existential variables when entered together
as a block accounted for a sizable signi® cant increase
in explained variance (23%).With all other existential
variables controlled, personal meaning for life
(beta=0.52, p<0.01), participation in spiritual activity
and expression (beta=0.46, p<0.01) and sense of inner
peace with self (beta=0.36, p<0.01) emerged as the
most salient predictors. However, in Step 4, the
existential variables of personal meaning, importance
of religion and access to religious/spiritual resources
by health interactions failed to account for additional
signi® cant variance in psychological wellbeing of
community-residing elders.

Results of the regression analyses for community-residing

elders Results of the regression analyses for institutional care elders

In the regression model, the R 2 change reveals
information on the variance in psychological wellbeing
explained by each of the four blocks of variables.
Within each block, the standardized regression weights
provide information on the relative contribution of
individual variables. Results are presented in Table 4.
A similar four-step hierarchical analysis was done for
the institutional elderly, and a similar pattern of vari-
ance accounted for was observed.The demographics,
when entered together, accounted for 8% of the vari-
ance in wellbeing, a non-signi® cant contribution.
An additional 16% of the variance was accounted
 382 P. S. Fry

TABLE 4. Hierarchical regression analysis of psychological wellbeing, entering demographics, traditional measures and
existential variables

Multiple Change in Change in

Variables entered Beta F R R2 R2 F

Community (N=180)
Step 1: Demographics 0.20 0.04 0.04 <1.00
Age ± 0.08 <1.00
Gender 0.01 <1.00
Education 0.09 <1.00
Marital status 0.16 <1.00
Income 0.11 <1.00
Step 2: Traditional measures 0.41 0.17 0.13 3.77*
Social resources 0.30 9.12**
Physical health problems ± 0.15 <1.00
Negative life events ± 0.10 <1.00
Step 3: Existential 0.63 0.40 0.23 14.49***
Personal meaning 0.52 12.88**
Participation: religious activity 0.19 <1.00
Downloaded by [b-on: Biblioteca do conhecimento online UL] at 08:43 07 May 2012

Participation: spiritual activity 0.46 12.08**

Importance of religion 0.15 <1.00
Sense of inner peace with self 0.36 9.12**
Comfort from religion 0.16 <1.00
Accessibility to religious support and services 0.16 <1.00
Step 4: Interactions 0.68 0.46 0.03 <1.00
Personal meaning3 health 0.51 <1.00
Importance of religion3 health 0.38 <1.00
Accessibility to religious resources3 health 0.32 <1.00
Institutional care (N=160)
Step 1: Demographics 0.28 0.08 0.08 2.42
Age 0.07 <1.00
Gender ± 0.09 <1.00
Education 0.15 2.00
Marital status 0.18 2.00
Income 0.31 9.19**
Step 2: Traditional measures 0.49 0.24 0.16 7.99*
Social resources 0.34 14.11***
Physical health problems ± 0.46 16.21***
Negative life events ± 0.21 5.62*
Step 3: Existential 0.71 0.51 0.27 14.81***
Personal meaning 0.36 10.11**
Participation: religious activity 0.18 2.00
Participation: spiritual activity 0.13 2.00
Importance of religion 0.22 5.71*
Sense of inner peace with self 0.11 <1.00
Comfort from religion 0.38 10.99**
Accessibility to religious support and services 0.45 13.11***
Step 4: Interactions 0.75 0.56 0.01 <1.00
Personal meaning3 health 1.41 2.11
Importance of religion3 health 0.30 1.42
Accessibility to religious resources3 health 0.28 1.36
Combined sample: community and institutional care (N=340)
Step 1: Demographics 0.28 0.08 0.08 5.19*
Age 0.11 1.87
Gender 0.08 <1.00
Education 0.06 <1.00
Marital status 0.21 5.62*
Income 0.24 5.96*
Step 2: Traditional measures 0.42 0.18 0.10 6.09*
Social resources 0.29 8.01*
Physical health problems ± 0.28 7.61*
Negative life events ± 0.16 2.00
Step 3: Existential 0.65 0.42 0.24 12.61**
Personal meaning 0.32 12.29**
Participation: religious activity 0.34 14.27**
Participation: spiritual activity 0.22 5.72*
Importance of religion 0.21 5.60*
Sense of inner peace with self 0.23 5.82*
Comfort from religion 0.39 15.29***
Accessibility to religious support and services 0.23 5.80*
Step 4: Interactions 0.68 0.48 0.01 <1.00
Personal meaning3 health 0.04 <1.00
Importance of religion3 health 0.12 <1.00
Accessibility to religious resources3 health 0.10 <1.00

*p<0.05; ** p<0.01; *** p<0.001.


for when traditional measures of social resources,
physical health and negative life events were entered
into the regression model. This time, physical health
problems (beta=± 0.46, p<0.001) contributed most
to the prediction of wellbeing among institutional
elders; while social resources (beta=0.34, p<0.001)
and negative life events (beta=± 0.21, p<0.05) made a
smaller yet signi® cant contribution.
The addition of the seven existential variables in
Step 3 resulted in a large signi® cant increase in the
variance accounted for (27%). Personal meaning and
comfort derived from religion emerged as potent
predictors (beta=0.36, p<0.01; beta=0.38, p<0.01,
respectively). Additionally, high accessibility to
ministerial, pastoral and synagogue resources and
religious support made a remarkable, signi® cant
Downloaded by [b-on: Biblioteca do conhecimento online UL] at 08:43 07 May 2012
contribution to the variance accounted for in
psychological wellbeing of institutional elders
(beta=0.45, p<0.001). The contribution of
importance of religion (beta=0.22, p<0.05) was also
signi® cant. Lastly, as previously observed in the
community-residing sample, the Step 4 regression of
existential variables by health interactions failed to
account for additional signi® cant variance in
psychological wellbeing of institutional care elders.
Results of the regression analyses for the combined sample
For the combined samples, demographic variables,
traditional measures and existential variables all
combined to contribute signi® cantly to the predic-
tion of wellbeing. Demographic variables accounted
for 8% of the variance which was signi® cant. As seen
in Table 4, when all the other demographic variables
were controlled, marital status and income made a
signi® cant contribution (beta=0.21, p<0.05;
beta=0.24, p<0.05, respectively), suggesting that being
married and having a high income predicted greater
psychological wellbeing among both community-
residing and institutional elderly.The traditional vari-
ables, when entered as a block, accounted for 10% of
the variance. Among the traditional measures, social
resources (beta=0.29, p<0.05) and physical health
problems (beta=± 0.28, p<0.05) made a signi® cant
contribution to the prediction of wellbeing.
When the existential variables were entered into
the regression model for the combined sample (Step
3), these resulted in an additional 24% of the vari-
ance. Participation in religious activity, participation
in spiritual activity, importance of religion, sense of
inner peace with self, comfort derived from religion,
and having high accessibility to religious support
services and resources all individually accounted for
signi® cant variance in psychological wellbeing of the
combined sample. Overall, however, participation in
religious activity and comfort derived from religion
in times of stress and crises were by far the most
potent predictors of wellbeing (beta=0.34, p<0.01;
beta=0.39, p<0.001, respectively), with personal
Existential predictors of wellbeing 383
meaning being the next most signi® cant predictor
(beta=0.32, p<0.01). Most noteworthy is the ® nding
that the existential variables together accounted for
more than twice the variance in wellbeing (24%),
compared to the variance accounted for by the
traditional measures (10%). As a last step, the interac-
tions of physical health and key existential variables
studied in Step 4 of the hierarchical regression were
not signi® cant and did not account for or explain any
signi® cant variance in the psychological wellbeing of
the combined sample of community and institutional
elders.
Discussion
The results of this study demonstrate the importance
of several dimensions of religion, spirituality and
personal meaning in the prediction of psychological
wellbeing in community-residing and institutional care
older adults. Of special note is the fact that present
results which tapped several constructs related to
religiosity and spirituality (e.g. frequency of private
prayer and devotion, comfort derived from religion
during times of stress and crisis, sense of inner peace
with self as related to religion, importance of religion,
and accessibility to religious, ministerial and pastoral
support services and resources) provide empirical
support for the hypothesis that a signi® cant propor-
tion of the variance in psychological wellbeing among
older adults is explained by speci® c dimensions of
religiosity and spirituality.These results have replicated
and extended previous studies suggesting a strong
link between religiosity and successful coping with
the challenges and stresses of old age (Ai et al., 1998;
Idler & Kasl, 1992; Levin, 1995; Maton & Wells,
1995; Pargament, 1997).
The results highlight the signi® cance of the
existential paradigm in which factors such as organ-
ized religious activity, private prayer and devotion,
comfort derived from prayer and religion, sense of
inner peace with self, and importance of religion
were predicted to be potent means of affirming
psychological and spiritual wellbeing in late life.
Earlier studies measuring involvement in formal
organized activity have often concluded that religiosity
declines in old age (Bahr, 1970; Fecher, 1982; Payne,
1981). However, the present results using an expanded
concept and construct of religiosity that includes
measures pertaining to personal spiritual practices,
private prayer and comfort derived from prayer
suggest that these dimensions continue to be means
that affirm the wholeness of life for many older adults,
including those who are very old, disabled and living
in institutions (Levin & Chatters, 1998).
Among the unique features of the present study is
the fact that in addition to sociodemographic vari-
ables and traditional variables of social resources,
physical health problems and negative life events,
several existential constructs were included in the
 384 P. S. Fry
prediction of wellbeing in late life. Consistent with
indications from earlier research (Cataldo, 1994;
Koenig, 1988; Young & Dowling, 1987), the ® ndings
clearly support the position of earlier researchers that
several speci® c dimensions of religiosity and
spirituality alleviate depression, anxiety and distress
of old age and provide comfort in periods of distress
and uncertainty (see Koenig et al., 1993; 1997, for
further discussion). This is especially true of older
adults living in institutions who clearly indicated the
high degree of comfort they derived from religion,
and from the easy accessibility to religious resources
and support services such as the services of pastors,
ministers and rabbis. Thus, this study has added to
our understanding of late-life contributors to
wellbeing by incorporating variables that address the
Downloaded by [b-on: Biblioteca do conhecimento online UL] at 08:43 07 May 2012
existential needs and life concerns of many elderly.
The ® ndings have relevance especially to those elderly
individuals in institutions who are more likely to
experience severe decline in wellbeing as a
consequence of multiple losses, including loss of
health and interpersonal relationships. The ® ndings
highlight the view that although social resources and
physical health continue to be reliable predictors of
wellbeing in late life, existential measures of personal
meaning and several dimensions of religiosity and
spirituality that were not explicitly measured in earlier
studies are, by far, sounder predictors of psychological
wellbeing among both community-residing and
institutional older adults, and especially so for the
institutional sample. Speci® c dimensions of religious
involvement and personal meaning account for 27
and 24%, respectively, of the variance within the
combined samples of community-residing and
institutional care older adults. Although the
institutionalized elders in the present study
demonstrate less optimal health and psychological
wellbeing than community-residing cohorts, the rela-
tive contribution of intrinsic and extrinsic religious-
ness and spirituality dimensions to the prediction of
psychological wellbeing is notably signi® cant (27%).
The ® ndings are consistent with previous ® ndings
concerning the bene® cial effects of religiousness and
spirituality on mental health outcomes of frail and
older adults (Ferraro & Koch, 1994; Levin & Chat-
ters, 1998). The overall ® ndings support a growing
body of extant literature documenting a positive
relationship between psychological wellbeing and
dimensions of spirituality involving inner-
connectedness, purpose and meaning in one’s life,
even in the face of severe stress (Chandler et al.,
1992; Hawkes, 1994; Kaldestad, 1996; Lindgren &
Coursey, 1995).
Implications of the ® ndings for intervention programs in
long-term care settings
The focus on existential constructs in the prediction
of wellbeing in later life provides an explanation for
the kinds of emotional and psychological resources
that elders require to face the challenges of aging.
Given the importance of personal meaning as an
existential predictor for both community-residing and
institutional elderly, and given the importance that
older adults themselves attach to religious and spiritual
activities, professional health providers and caregivers
of older adults may wish to build into their existing
programs diverse provisions for religious and spiritual
support services (Tonigan et al., 1999). Religion and
spirituality are presumed not only to endow older
adults’ lives with meaning and purpose but to give
them hope (Fry, 1998; Reker, 1994; Reker & Butler,
1990;Yahne & Miller, 1999), and the courage to cope
with stressful situations and circumstances (Parga-
ment, 1997; Pargament et al., 1994). Frequently,
however, this hope, optimism and personal meaning
for life, and forms of spiritual coping may have to be
stimulated and reinforced by caregivers and health
providers (Fry, 1999; Miller, 1999).
The results of the present study concerning the
in¯ uence of religion, spirituality and meaning have
special implications for therapy and counseling of
older adults in institutional care. Taking a lead from
notable therapists (e.g. Eisenhandler, 1994; Fry, 1986,
1999; Lukas, 1992; Miller, 1999; Tonigan et al., 1999;
Vogel, 1995), it makes sense to suggest the use of
techniques of spiritual re¯ ection, religious dere¯ ec-
tion and prayer groups for all elderly, no matter how
frail or vulnerable they may be. Spiritual dere¯ ection
may bring freedom from despair and egocentrism
resulting from physical pain and suffering (Gould,
1993; Lukas, 1992).
Assuming that future studies provide similar
evidence concerning the positive in¯ uence of religion
and spirituality, medical professionals and health care
providers in institutions for the elderly should join
hands with pastoral care professionals in providing
emotional resources and support for developing a
`will to live’ through personal meaning. If religiosity
indicators are low, alternate strategies that rely on
spirituality may be explored to enhance meaning for
life. In general, it must be recognized that even among
the socially isolated older adults living in institutions,
the variables of personal meaning, importance of
religion, comfort from religion and accessibility to
religious resources were equally important predictors
of wellbeing, as compared to their community-
residing counterparts. Based on theological and
existential models of health and spirituality, which
propose that spirituality and spiritual growth help to
ameliorate suffering, pain and physical distress, there
is growing pressure on long-term care administrators
to offer older adults some form of existentially-based
interventions that are aimed at promoting personal-
spiritual growth and advancing hope, optimism and a
positive meaning for life (see discussions by Idler,
1994; Koenig et al., 1997; Levin, 1989; Miller, 1999,
on the relationship between mental health, physical

health and the medium and message of programs of
religion and spirituality). Non-religious types of
intervention (along lines of spiritual expression and
shared interactive experience) may be a valuable
supplement to current types of programs of
`reminiscence’ and `reality-intactness’ that are offered
by the staff of long-term care institutions and in
community centers for older adults.
Limitations of the present study
A number of methodological issues may have affected
the veracity of the current ® ndings. As with any study
using volunteer respondents, an important limitation
relates to the sampling frame. A more carefully
controlled sampling procedure may have provided
Downloaded by [b-on: Biblioteca do conhecimento online UL] at 08:43 07 May 2012
somewhat different insights into demographic,
traditional and existential predictors of wellbeing
within each sample. It is conceivable that within a
more strictly controlled sample, traditional variables
of social support, negative life events and physical
health may have emerged as more potent predictors
of psychological wellbeing than is evidenced in the
present ® ndings. The ® ndings, nevertheless, permit
the speculation, if not conclusion, that several dimen-
sions of religiosity, spirituality and personal meaning
are valid and potent predictors of psychological
wellbeing in late life.
The ® ndings of lower levels of psychological
wellbeing and poorer adjustment among institutional
elderly are to be expected. However, the question of
whether these ® ndings re¯ ect the effects of an
institutional environment or are a consequence of
the convenience sample used in this study remains
unanswered, and must be accepted as a limitation of
the present study.
Recommendations for future research
The current ® ndings concerning predictors of
psychological wellbeing of community-residing and
institutionalized elders are limited by the cross-
sectional nature of the study. Future research using a
repeated measures multivariate analyses design model
would be useful to understand the longitudinal
`predictors’ of psychological wellbeing in late life.
Future research in this area using a longitudinal
prospective design might usefully isolate the interac-
tion between spirituality, health and quality of life
following late life frailty and disability. Future research
should also consider multivariate analyses designs
(see Cohen & Cohen, 1983) that would allow a study
of the main effects of religion, spirituality and levels
of personal meaning on psychological health
outcomes in late life, as distinguished from their
buffering effects. In this regard, it should be noted
that Koenig et al. (1997) and Levin and Chatters
(1998) have proposed statistical models to examine
the unique buffering and main effects of existential
Existential predictors of wellbeing 385
variables and the interaction of existential dimen-
sions of religiosity and spirituality by health outcomes.
Future research pertaining to existential predictors
should pursue supplementary qualitative data-
gathering to explore in detail the precise in¯ uence of
religious involvement and spiritual expression on older
adults’ personal meaning for life and their
psychological wellbeing. A combination of qualita-
tive and quantitative methodologies is strongly recom-
mended in future study of existential predictors of
wellbeing among older adults (Prager, 1998). A
qualitative study on the stress-buffering role of
religiosity and spirituality is currently underway (Fry,
1999) and may assist in the formulation of more
speci® c hypotheses for later research.
Acknowledgements
This study was supported, in part, by a Population
Aging research grant to P. S. Fry from the Social
Sciences and Humanities Research Council of
Canada (File 492± 87± 0006), awarded to the author
while on the Faculty of The University of Calgary,
Alberta.
Grateful thanks are extended to Dr Gary T. Reker
for his insightful comments on this manuscript, and
also to the many older adults living in Calgary and
the outlying districts of Airdrie, Cochrane, Cross-
® eld, High River, Lethbridge and Red Deer, in
Southern Alberta, who responded to the call for
subjects.The help of research assistants Evelyn Doyle
and Anne Humanek in recruitment of subjects and
data collection is especially appreciated. Diane
Hussein assisted in tabulation and organization of
data ® les, and Dr Mark Kolodziej helped with the
statistical procedures used in the quantitative data
analysis.
References
AI, A.L., DUNKLE, R.E., PETERSON, C. & BOLLING, S.F.
(1998). The role of private prayer in psychological
recovery among midlife and aged patients following
cardiac surgery. The Gerontologist, 38, 591± 601.
AINLAY, S. & SMITH, R. (1984).Aging and religious participa-
tion. Journal of Gerontology, 39, 357± 363.
AINLAY, S.C., SINGLETON, R., JR. & SWIGERT, V.L. (1992).
Aging and religious participation: reconsidering the effects
of health. Journal for the Scienti® c Study of Religion, 10,
233± 236.
ANDERSON, J.M., ANDERSON, L.J. & FELSENTHAL, G. (1993).
Pastoral needs and support within an inpatient rehabilita-
tion unit. Archives of Physical Medicine & Rehabilitation,
74, 574± 577.
BAHR, H.M. (1970).Aging and religious disaffiliation. Social
Forces, 49, 69± 71.
BARUSCH, A.S., ROGERS, A. & ABU -BADER, S.H. (1999).
Depressive symptoms in frail elderly: physical and psycho-
social correlates. International Journal of Aging and Human
Development, 49, 107± 125.
BRADBURN, N. (1969). The structure of psychological well-
being. Chicago: Aldine.
 386 P. S. Fry
CATALDO, J.K. (1994). Hardiness and death attitudes: predic-
tors of depression in the institutionalized elderly. Archives
of Psychiatric Nursing, 5, 326± 332.
CHANDLER, C.K., HOLDEN, J.M. & KOLANDER, C.A. (1992).
Counseling for spiritual wellness: theory and practice.
Journal of Counseling and Development, 71, 168± 174.
CHATTER S , L.M., LE VIN , J.S. & TAYLOR , R.J. (1992).
Antecedents and dimensions of religious involvement
among older Black adults. Journal of Gerontology: Social
Sciences, 47, S269± S278.
COHEN, J. & COHEN, P. (1983). Applied multiple regression
and correlations for the behavioral sciences (pp. 181± 220).
Hillsdale, NJ: Lawrence Erlbaum.
COOK, T. (1983). The faith establishment and an aging
world. Generations, 8 (Fall), 5± 7.
DUKE UNIVERSITY CENTER FOR STUDY OF AGING AND HUMAN
DEVELOPMENT (1978). Multidimensional Functional Assess-
ment: The OARS Methodology. Durham, NC: Duke
University Press.
Downloaded by [b-on: Biblioteca do conhecimento online UL] at 08:43 07 May 2012
EISENHANDLER, S.A. (1994). A social milieu for spirituality
in the lives of older adults. In: L.E.THOMAS & S.A. EISEN -
HANDLER (Eds), Aging and the religious dimension (pp.
133± 145).Westport, CT: Auburn House.
ELLISON, C.G. (1994). Religion, the life stress paradigm,
and the study of depression. In: J. S. LEVIN (Ed.), Religion
in aging and health:theoretical foundations and methodological
frontiers. Thousand Oaks, CA: Sage.
FECHER, V. (1982). Religion and aging: an annotated
bibliography. San Antonio, TX: Trinity University Press.
FERRARO, K.F. & KOCH, J.R. (1994). Religion and health
among black and white adults. Examining social support
and consolation. Journal for the Scienti® c Study of Religion,
33, 362± 381.
FOLSTEIN, M.F., FOLSTEIN, S. & MCHUGH, P.R. (1975). `Mini-
mental state’ : a practical model for grading the cognitive
state of patients for the clinician. Journal of Psychiatric
Research, 12, 189± 198.
FONTANA, A.F., KERNS, R.D., ROSENBERG, R.L. & COLONESE,
K.L. (1989). Support, stress, and recovery from coronary
heart disease: a longitudinal causal model. Health
Psychology, 8, 175± 193.
FRANKL, V.E. (1984). Man’s search for meaning, revised
edition. New York: Washington Square Press (original
work published 1963).
FRY, P.S. (1986). Depression, stress and adaptations in the
elderly: psychological perspectives. Rockville, NJ: Aspen
Publishers.
FRY, P.S. (1992). Major social theories of aging and their
implications for counseling concepts and practice. Coun-
seling Psychologist (Monographs). 20, 246± 329.
FRY, P.S. (1993). Mediators of depression in community-
based elders. In: P. CAPPELIEZ & R. FLYNN (Eds), Depres-
sion and the social environment: research and intervention
with neglected populations. (pp. 389± 405). Montreal, PQ:
McGill-Queens University Press.
FR Y, P.S. (1998). Spousal loss in late life: a one-year
longitudinal follow-up of perceived changes in life
meaning and psychosocial functioning following bereave-
ment. Jour nal of Personal and Inter personal Loss, 3,
369± 391.
FR Y, P.S. (1999). Linking qualitative and quantitative
methods in longitudinal research on constructs and
structure of psychological well-being in late life (Research
in progress). Unpublished paper, Trinity Western
University, Langley, BC.
GALANOS, A.N., FILLENBAUM, G.G., COHEN, H.J. & BARCHETT,
B.M. (1994). The comprehensive assessment of
community dwelling elderly: why functional status is not
enough. Aging: Clinical and Experimental Research, 6,
343± 352.
GEORGE, L.K. (1996). Social and economic factors related
to psychiatric disorders in late life. In: E. W. BOSSE & D.
G. BLAZER (Eds), Textbook of geriatric psychiatry (pp.
129± 153).Washington, DC: American Psychiatric Press.
GOULD,W.M. (1993). Viktor E. Frankl: life with meaning and
spirituality. Paci® c Grove, CA: Brooks/Cole.
HAWKES, S. (1994). Spiritual health: de® nition and theory.
Wellness Perspectives, 10, 3± 11.
HOLAHAN, C.K. (1988). Relation of life goals at age 70 to
activity participation and psychological well-being in
Terman’s gifted men and women. Psychology and Aging,
3, 286± 291.
HOLAHAN, C.K. & HOLAHAN, C.J. (1999). Being labeled as
gifted, self-appraisal, and psychological well-being: a life-
span developmental perspective. International Journal of
Aging and Human Development, 48, 161± 173.
HUNSBERGER, B. (1985). Religion, age, life satisfaction, and
perceived sources of religiousness: a study of older
persons. Journal of Gerontology, 40, 615± 620.
IDLER, E.L. (1994). Cohesiveness and coherence: religion
and the health of the elderly. NewYork: Garland.
IDLER, E.L. & KASL, S.V. (1992). Religion, disability, depres-
sion, and the timing of death. American Journal of
Sociology, 97, 1052± 1079.
KALDESTAD, E. (1996).The empirical relationship between
standardized measures of religiosity and personality/
mental health. Scandinavian Journal of Psychology, 37(2),
205± 220.
KAYE, J. & ROBINSON, K.M. (1994). Spirituality among
caregivers. Image Jour nal Nursing Scholarship, 26,
218± 221.
KOENIG, H.G. (1988). Religious beliefs and mental health.
In: H.G. KOENIG , L. J. SMILEY & J. CONZALES (Eds),
Religion, health, and aging. Westport, CT: Greenwood
Press.
KOENIG , H.G. & FUTTERMAN, A. (1994). Religion and health
outcomes: a review and synthesis of the literature. Paper
presented at the 49th Annual Scienti® c Meeting of the
Gerontological Society of American, Atlanta, GA.
KOENIG, H.G. & FUTTERMAN, A. (1995). Religion and health
outcomes: a review and synthesis of the literature
(monograph). Bethesda, MD: National Institute on
Aging.
KOENIG, H.G., FORD, S.M., G EORGE, L.K., BLAZER, D.G. &
MEADOR, K.G. (1993). Religion and anxiety disorder: an
examination and comparison of associations in young,
middle-aged, and elderly adults. Journal of Anxiety
Disorders, 7, 321± 342.
KOENIG, H.G., HAYS, J.C., GEORGE, L.K., BLAZER, D.G.,
LARSON, D.B. & LANDERMAN, L.R. (1997). Modeling the
cross-sectional relationships between religion, physical
health, social support and depressive symptoms. American
Jour nal of Geriatric Psychiatry, 5, 131± 144.
KRAUSE, N. (1987). Chronic ® nancial strain, social support,
and depressive symptoms among older adults. Psychology
and Aging, 2, 185± 192.
LEVIN, J.S. (1989). Religious factors in aging, adjustment,
and health: a theoretical overview. In: W. M. CLEMENTS
(Ed.), Religion, aging and health: a global perspective, (pp.
133± 146). NewYork: Haworth Press.
LEVIN, J.S. (1994). Religion and health: is there an associa-
tion, is it valid, and is it causal? Social Science and Medicine,
38, 1475± 1482.
LEVIN, J.S. (1995). Religion. In: G. L. MADDOX (Ed.), The
encyclopedia of aging, 2nd edition (pp. 799± 802). New
York: Springer.
LEVIN, J.S. (1996). How religion in¯ uences morbidity and
health: re¯ ections on natural history, salutogenesis and
host resistance. Social Sciences and Medicine, 43, 849± 864.
LEVIN, J.S. & CHATTERS, L.M. (1998). Religion, health and
psychological well-being in older adults. Journal of Aging
and Health, 10(4), 504± 531.

LEVIN, J.S., CHATTERS, L.M. & TAYLOR, R.J. (1995). Religious
effects on health status and life satisfaction among Black
Americans. Journal of Gerontology: Social Sciences, 50B,
S154± S163.
LEVIN, J.S. & TAYLOR, R.J. (1997).Age differences in patterns
and correlates of the frequency of prayer. The Gerontolo-
gist, 37, 75± 88.
LINDAL, E. (1990). Postoperative depression and coronary
bypass surgery. International Disability Studies, 12, 70± 74.
LINDGREN, K.N. & COURSEY, R.C. (1995). Spirituality and
serious mental illness: a two-part study. Psychosocial
Rehabilitation Journal, 18, 93± 107.
LUKAS, E. (1992). Meaning and goals in the chronically ill.
The International Forum for Logotherapy, 15, 90± 98.
MATON, K.I. & WELLS, E.A. (1995). Religion as a community
resource for well-being: prevention, healing, and
empowerment pathways. Jour nal of Social Issues, 51,
177± 193.
MILLER,W.R. (Ed.) (1999). Integrating spirituality into treat-
Downloaded by [b-on: Biblioteca do conhecimento online UL] at 08:43 07 May 2012
ment.Washington, DC: American Psychological Associa-
tion.
MIROWSKY, J. & ROSS, D. (1986). Social patterns of distress.
In: R. H.TURNER & J. F. SHORT Annual review of sociology,
volume 12 (pp. 23± 45). Palo Alto, CA: Annual Reviews.
MOBERG , D.O. (1990). Religion and aging. In: K. F. FERRARO
(Ed.), Gerontology: perspectives and issues (pp. 179± 205).
New York: Springer.
MOBERG , D.O. (1997). A response. Aging & Spirituality,
Newsletter of ASA’s Forum on Religion, Spirituality & Aging,
9, 8.
MORGAN, J.P., JR. (1994). Bereavement and frailty in older
adults. Journal of Mental Health Counseling, 16, 318± 326.
MURPHY, E. (1983).The prognosis of depression in old age.
British Journal of Psychiatry, 142, 111± 119.
PARGAMENT, K.I. (1997). The psychology of religion and coping.
New York: Guilford Press.
PARGAMENT, K.I., ISHLER, K., DUBOW, E.F., STANIK, P.,
ROUILLER, R., CROWE, P., CULLMAN, E.P., ALBERT, M. &
ROYSTER, B. (1994). Methods of religious coping with
the Gulf War: cross-sectional and longitudinal analyses.
Journal for the Scienti® c Study of Religion, 33, 347± 367.
PAYNE, B. (1981). Religion and the elderly in today’s world.
In: A. CLEMENTS (Ed.), Ministry with the aging. San
Francisco, CA: Harper & Row.
PEARLIN, L., MENAGHAN, E.G., LIEBERMAN, M. & MULLEN,
J.T. (1981). The stress process. Jour nal of Health and
Social Behavior, 22, 337± 356.
PICOT, S.J., DEBANNE, S.M., NAMAZI, K.H. & WYKLE, M.L.
(1997). Religiosity and perceived rewards of black and
white caregivers. The Gerontologist, 37(1), 89± 112.
PRAGER, E. (1998). Observations of personal meaning
sources for Israeli/age cohorts. Aging & Mental Health,
2(2), 128± 136.
Existential predictors of wellbeing 387
PRESSMAN, P., LYONS, J.S., LARSON, D.B. & STRAIN, J.J. (1990).
Religious belief, depression, and ambulation status in
elderly women with broken hips. American Journal of
Psychiatry, 147, 758± 760.
PREST, L.A. & K ELLER, J.F. (1993). Spirituality and family
therapy: spiritual beliefs, myths, and metaphors. Journal
of Marital and Family Therapy, 19(2), 137± 148.
REKER, G.T. (1994). Logotheory and logotherapy: chal-
lenges, opportunities, and some empirical ® ndings.
International Forum for Logotherapy, 17, 47± 55.
REKER, G.T. & BUTLER, B. (1990). Personal meaning, stress,
and health in older adults. Paper presented at the Annual
Meeting of the Canadian Association on Gerontology,
Victoria, BC.
REKER, G.T. & PEACOCK, E.J. (1981). The Life Attitude
Pro® le (LAP): a multidimensional instrument for
assessing attitudes toward life. Canadian Jour nal of
Behavioural Science, 13, 264± 273.
ROSENBERG, M. (1965). Society and adolescent image. Princ-
eton, NJ: Princeton University Press.
RYFF , C.D. (1995). The structure of psychological well-
being revisited. Journal of Personality and Social Psychology,
69, 719± 727.
SPOHN, W.C. (1997). Spirituality and ethics: exploring the
connections. Theological Studies, 58, 109± 123.
TONIGAN, J.S., TOSCOVA, R.T. & CONNORS, G.J. (1999).
Spirituality and the 12 step programs. In: W. R. MILLER
(Ed.), Integ rating spirituality into treatment (pp.
111± 132). Washington, DC: American Psychological
Association.
TOR NSTAM , L. (1989). Gerotranscendence: a meta-
theoretical reformulation of disengagement theory. Aging:
Clinical and Experimental Research, 1, 55± 63.
TORNSTAM, L. (1997). Gerotranscendence: the contempla-
tive dimension of aging. Jour nal of Aging Studies, 11(2),
143± 154.
WALLIS, C. (1996). Faith and healing. Time, 147(26), 58± 68.
YAHNE, C.E. & MILLER, W.R. (1999). Evoking hope. In: W.
R. MILLER (Ed.), Integrating spirituality into treatment.
Washington, DC: American Psychological Association.
YALOM, I.D. (1980). Existential psychotherapy. New York:
Basic Books.
YOUNG , G. & DOWLING ,W. (1987). Dimensions of religiosity
in old age: accounting for variation in types of participa-
tion. Journal of Gerontology, 42(4), 376± 380.
ZIMET, G.D., DAHLEM, N.W., ZIMET, S.G. & FARLEY, G.K.
(1988). The multidimensional scale of perceived social
support. Journal of Personality Assessment 52, 30± 41.
ZINNBAUER, B.J., PARGAMENT, K.I., COWELL, B. & SCOTT, A.
(1996). Religion and spirituality: unfuzzying the fuzzy.
Paper presented at the American Psychological Associa-
tion Annual Conference, Toronto, Canada.