Meditation and Mindfulness: Resources for Aged Care
Definition and Overview
There are no universally accepted definitions of meditation and mindfulness. Meditation can be thought of as an “umbrella term” for a range of practices to achieve a desired consciousness. Mindfulness is the act of focusing on present experience. Hence, it “is a type of meditation alongside tantra, yoga, sexuality, silence, breathing and emptiness” (Bushak 2016).
While almost every religion practices some form of contemplation, meditation has been developed in the Buddhist tradition. This incorporates three approaches: (a) focused attention on a single object say breath or body scan. (b) Open-monitoring meditation is to open up awareness to whatever is present in experience whether an emotion, a sound, or, for example, a cloud, which is observed from an emotional distance. (c) Heart practices encourage a positive attitude to self or others such as compassion in the loving-kindness meditation (Verhaeghen 2017). Mindfulness is the first approach. Jon Kabat-Zinn, one of the popularizers of mindfulness, defined it “paying attention in particular ways: on purpose, in the moment, and non-judgementally” (Kabat-Zinn 1994, p. 4). Note that mindfulness in the West, and especially in clinical practice, is usually secular and removed from its religious origins (Nilsson and Kazemi 2016).
Key Research Findings
There is considerable evidence to support the benefits of both meditation and mindfulness. Paul Verhaeghen (2017) has provided an extensive review to how both calm the body, increase control over attention, raise awareness of the body, and benefit the sense of self – all of which potentially leave traces on brain structure. It is only natural that such benefits would be relevant to the care of the aged.
An early study of transcendental meditation and mindfulness with groups of older adults found a positive benefit for both, but most benefit was from meditation (Alexander et al. 1989). Yoga was found to help balance (Wooten et al. 2018), to improve physical function (Tew et al. 2017), to reduce falls (Hamrick et al. 2017), and to improve well-being (Ojha and Yadav 2016). Preksha meditation reduced psychological symptoms and increased well-being (Sanchetee et al. 2017). Mantra meditation reduced pain and helped mood (Innes et al. 2018). T’ai Chi Chih was found to increase quality of life and benefit lifestyle issues (Vestal 2017). In a study with the dying, it was found that participants encouraged to do a daily meditation reported enhanced well-being (Candy et al. 2012). There is recent evidence that meditation leads to neural change (Afonso et al. 2017; Shao et al. 2016).
Mindfulness has been found to benefit older people. It can help to reduce emotional reactivity (Mroczek et al. 2013). Other benefits include improving sleep (Gallegos et al. 2018), reducing pain (Zhou et al. 2018), increasing acceptance, and psychological flexibility (Moss et al. 2015). Self-compassion, resulting from mindfulness, reduces self-punishing thoughts (Phillips and Ferguson 2013; Imtiaz and Kamal 2016). Mindfulness and self-compassion were combined with good effect (Perez-Blasco et al. 2016). The idea of “mindful sustainable ageing” has been proposed (Nilsson et al. 2015). A review article examined studies of mindfulness improving cognitive functioning. This was encouraging but within limits, such as small sample sizes (Berk et al. 2017). There are also indications of a positive effect of mindfulness interventions for those with dementia (Berk et al. 2018; Churcher Clarke et al. 2017). But even more encouraging are neurological studies with biological data (Boekel and Hsieh 2018; Malinowski et al. 2017; Chételat et al. 2017). This could lead to a shift in how we approach the ageing brain (Prakash et al. 2014).
Mindfulness can enhance therapeutic approaches to treating older patients (Smith 2004). It has been found to reduce the severity of trauma symptoms in survivors of World War 2 (Glück et al. 2016). A qualitative study reported positive results of mindfulness-based cognitive therapy (Williams et al. 2018). There is also good evidence of effectiveness in treating older adults with depression (Kishita et al. 2017). Sometimes mindfulness has been included in a package of interventions, while this does not isolate an effect, perhaps such results add some support to effectiveness (McCarthy et al. 2018).
There is scant research on any adverse or negative outcomes related to meditation practices. Lindahl et al. (2017) identified that not everyone will respond positively to meditation. Where highly rigorous meditation practices have been evaluated, these have had evidence to suggest that there have been possible adverse outcomes but generally only with longer sessions of practice (Lustyk et al. 2009).
A religion is a set of beliefs about life and the self, is usually associated with established rituals, and is certainly spiritual, but spirituality is harder to define. John Swinton (2001) suggested that it is “the outward expression of the inner workings of the human spirit” (p. 20). It can also include the ideas of inclusiveness and transcendence. MacKinlay (2015) has argued that spirituality lies at the “heart” of being, and meeting the need for it helps the aged to flourish in the last stage of life. The positive contribution of religion, and spirituality more generally, has been widely acknowledged (George et al. 2013). While it is difficult to define and measure spirituality, researchers have found that a sense of transcendence, of being part of something beyond the self, and finding meaning in life contribute to aged people’s sense of well-being (Le and Doukas 2013). Religion and spirituality have a positive effect on cognitive function (Hosseini et al. 2017). In a review article, the spiritual care of the aged was found to be valuable (Jackson et al. 2016).
Can the benefits of religion or more generally spirituality be joined with the advantages of meditation and mindfulness?
Research indicates that meditation and related techniques such as mindfulness can be helpful with the aged. The trend is to practice both in a predominately secular way. This may, paradoxically, have the potential to be an inclusive spirituality, combining the spiritual dimension with therapeutic benefits (Stevens 2016). Perhaps it is easiest to apply this with mindfulness groups. Nilsson (2014) has linked a four-dimensional understanding of mindfulness to physical, mental, social, and existential resilience. The social aspect encourages empathy and compassion with others, perhaps including fellow members of a mindfulness or meditation group, paralleling the experience of “fellowship” in some religious groups, but with arguably more training to be empathic and understanding. The existential aspect of mindfulness builds on ideas from Erick Erikson and Victor Frankl about the importance of a search for meaning, which may be aided by the kind of sustained attention that mindfulness promotes.
Perhaps the challenge is to train people in the four dimensions and to integrate the four dimensions of mindfulness. Mindfulness provides a way that chaplains and activity directors can incorporate an inclusive spirituality for older people. This might be a way of providing the benefits of religion and spirituality in later years to enhance quality of life. A “mindfulness group” is not a hard sell, even with more traditional residents. It can be presented as just another activity to be tried.
Most of those currently in residential aged care, if they consider themselves religious, identify with a faith community. They value services of worship and the support of chaplains. However, that may change as the baby boomers arrive: they have weaker ties to Christianity, and many identify with a more generalized spirituality. How might we encourage them to take a more inclusive spiritual approach in order to reap the benefits identified in the research? The practice of mindfulness might be a way to do it.
Prioritize care delivery by listening and hearing the issues and needs of the aged
Increase assessment capability through focusing on the aged person with more detail gained from being in the moment rather than going through a series of questions or tasks to complete an assessment
Empower and engage the aged person to influence their goals and activities to ones that are important to them at a time, rather than potential assessed needs a year ago or even last week which may not be relevant to the current needs of that person
Practical application of this requires carers and nurses to have greater self-awareness of each moment in care delivery, whereby focused time is allocated to listen, hear, and be mindful to what is occurring for the aged person. Within this time period, a flexible approach to responding to the persons’ current goals, concerns, and needs is reprioritized and redirected to whatever the moment elucidates. The aged person truly becomes the center of care delivery and engages in choice and decision-making to facilitate an optimal partnership.
Meditation in a moment of care delivery may require silence although in practicality it requires a focused point of contact and being present with an aged person. Where silence is afforded, the ability of a carer or nurse to provide a noncomplicated engagement and build an awareness of the aged persons nonverbal responses and signs or symptoms, as well as being cognizant of the environment, is likely to provide some of the most powerful data points and comprehensive assessment opportunities for care delivery.
Organizational culture shifts need to occur to facilitate more flexible care delivery strategies, acknowledgement that assessment is ongoing rather than periodic and staff self-awareness, along with development of capability in emotional intelligence will be critical to the development of this approach.
Mindfulness and meditation are significant opportunities for improving the care delivery and quality of care to an aged person. Fundamentally, the ability of nurses and carers to engage in greater awareness and focus at each moment in care provision is likely to increase the health outcomes, engagement, and shared partnership of an aged person. Opportunity to grow research and data to support this approach should be considered in the future.
- Afonso RF, Balardin JB, Lazar S et al (2017) Greater cortical thickness in elderly female yoga practitioners – a cross-sectional study. Front Aging Neurosci 9(201). https://doi.org/10.3389/fnagi.2017.00201
- Bushak L (2016) Mindfulness vs meditation: the difference between these two pathways to well-being and peace of mind. Medical Daily. https://www.medicaldaily.com/mindfulness-meditation-differences-377346
- Candy B, Jones L, Varagunam M et al (2012) Spiritual and religious interventions for Well-being of adults in the terminal phase of disease. Cochrane Database of Syst Rev (5):CD007544. https://doi.org/10.1002/14651858.CD007544.pub2
- Glück TM, Tran US, Raninger S, Lueger-Schuster B (2016) The influence of sense of coherence and mindfulness on PTSD symptoms and posttraumatic cognitions in a sample of elderly Austrian survivors of world war II. Int Psychogeriatr 28(3):435–441. https://doi.org/10.1017/S104161021500143XCrossRefGoogle Scholar
- Imtiaz S, Kamal A (2016) Rumination, optimism, and psychological Well-being among the elderly: self-compassion as a predictor. J Behav Sci 26(1):32–50. https://search-proquest-com.ezproxy.csu.edu.au/docview/1812970468?accountid=10344Google Scholar
- Innes KE, Selfe TK, Kandati S et al (2018) Effects of mantra meditation versus music listening on knee pain, function, and related outcomes in older adults with knee osteoarthritis: an exploratory randomized clinical trial (RCT). Evid Based Complement Alternat Med 2018. https://doi.org/10.1155/2018/7683897CrossRefGoogle Scholar
- Kabat-Zinn J (1994) Wherever you go, there you are: mindfulness meditation in everyday life. Hyperion, New YorkGoogle Scholar
- Lustyk MKB, Chawla N, Nolan RS et al (2009) Mindfulness meditation research: issues of participant screening, safety procedures, and researcher training. Advances 24(1):20–30. https://pdfs.semanticscholar.org/b2ba/012fc51a682838b28e88c3ded03553c11ded.pdfGoogle Scholar
- Moss AS, Reibel DK, Greeson JM, Thapar A, Bubb R, Salmon J, Newberg AB (2015) An adapted Mindfulness-Based Stress Reduction Program for elders in a continuing care retirement community: Quantitative and qualitative results from a pilot randomized controlled trial. Journal of Applied Gerontology 34(4):518–538. https://doi.org/10.1177/0733464814559411CrossRefGoogle Scholar
- Ojha H, Yadav NP (2016) Effects of some yogic practices on psychological Well-being of the aged: an intervention study. J Indian Acad Appl Psychol: JIAPP 42(2):291–298. https://search-proquest-com.ezproxy.csu.edu.au/docview/1834883388?accountid=10344Google Scholar
- Prakash RS, De Leon AA, Patterson B et al (2014) Mindfulness and the aging brain: a proposed paradigm shift. Front Aging Neurosci 6. https://doi.org/10.3389/fnagi.2014.00120
- Sanchetee P, Jain A, Agarwal H (2017) Preksha meditation and mental health in elderly. J Indian Acad Geriatr 13(3):131–138. http://ezproxy.csu.edu.au/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=127993989&site=ehost-liveGoogle Scholar
- Smith A (2004) Clinical uses of mindfulness training for older people. Behav Cogn Psychother 32(4):423–430. https://search-proquest-com.ezproxy.csu.edu.au/docview/213129980?accountid=10344CrossRefGoogle Scholar
- Swinton J (2001) Spirituality and mental health care: rediscovering a ‘forgotten’ dimension. Jessica Kingsley Publishers, LondonGoogle Scholar
- Tew GA, Howsam J, Hardy M, Bissell L (2017) Adapted yoga to improve physical function and health-related quality of life in physically-inactive older adults: A randomized controlled pilot trial. BMC Geriatrics 17. https://doi.org.ezproxy.csu.edu.au/10.1186/s12877-017-0520-6
- Vestal MA (2017) T’ai chi chih – an evidence-based mindfulness practice: literature review. Altern Complement Ther 23(4):132–138. https://doi.org.ezproxy.csu.edu.au/10.1089/act.2017.29121.mavCrossRefGoogle Scholar
- Wooten SV, Signorile JF, Desai SS, Paine AK, Mooney K (2018) Yoga meditation (YoMed) and its effect on proprioception and balance function in elders who have fallen: A randomized control study. Complementary Therapies in Medicine 36: 129–136. https://doi.org/10.1016/j.ctim.2017.12.010CrossRefGoogle Scholar