Religious Switching: The Impact on Health Among Older Adults Essay Sample

Religious Switching: The Impact on Health Among Older Adults Essay Sample

The increase in the number of the elderly population led to a greater concern for health. There had been a rise in research that revolved around geriatric health and practices as a result. This population was considered to be in the stage wherein they realize they neared the end of their life. Aging and chronic disease were major factors for such realizations. Individuals in this population increasingly needed to experience life satisfaction and effective coping mechanism. Research had shown correlations between old age, chronic disease and increased coping, as well as life satisfaction (Ellison et al., 1989, Gordon et al., 2002, Helm et al., 2000, Glass et al., 1999).

            Research showed that religiosity was a major provider of life satisfaction and effective coping mechanism for the elderly population. Older adults were observed to be more religious during this stage in their lives (Ryff, 1989; Strawbridge et al., 2001). Studies have shown links between health well being and religiosity among different age groups (Hendershot, 2003; Benjamins, 2006; Glass et al., 1999; Gordon et al, 2002). People who perceived themselves nearing the end of their lives needed to develop coping mechanism in order to help them get through these rather difficult stages in their life. Most of the time, these mechanisms addressed psychological stress that were experienced due chronic illness and aging. Life satisfaction was also needed by this population because of individuals felt they only had a short time to live and they needed to get the best out of what life can give them.

            The existing research focused on one or two measures alone for religiosity. These measures involved frequency of attendance and religious identification. These measures could not provide a sufficient account for an individual’s religiosity. There was such an observed inconsistency between studies when it came to the religion-health link because of the insufficiency of these measures to begin with (Strawbridge et al., 2001). It was important to analyze the religion-health link from different measures to increase the consistency of this connection.

            The measure of analyzing the religion health link from religious-switching was something could provide valuable data. Religious switching was an area of religiosity that needed to be considered when it came to the elderly population as a new perspective for the religion-health link. This would provide a clearer connection between health and religiosity.

            While previous research provided only a description of the demographics based on their church attendance and affiliation, as well as their age and chronic illness, the analysis of sample from this research would include religious switching capacity. This would provide a deeper analysis of the individual religiosity. It would also be reviewed from the perspective of the population’s need for coping mechanisms and life satisfaction.

            Religiosity was presented to have a significant relationship to health. This needed to be understood from physical and psychological impact of religious involvement. It would also be reviewed according to the relationship of the dimensions of religiosity that included religious switching, attendance and affiliation.

            The influence of religious involvement on the pattern of regular health practices that could be described as a lifestyle was determined by numerous studies that emphasized on the religion-health link. It was important to recognize the impact of religion in the attainment of a healthier lifestyle. However, studies shown the decreased association between religious involvement and healthy lifestyles when it came to the elderly population (Hill et al., 2007). This study needed to review whether these claims were consistent. If there were decreasing religion-health link association when it came to this population or if it were increasing, different indicators that impacted such a shift needed to be analyzed and discovered.

                                                          Purpose of the Study

            The purpose of this study was to contribute to existing research on the impact of religiosity on health of the elderly population. Religious involvement was observed to have a positive impact in the lives of individuals when it came to health (Oxman et al., 1995). This research would analyze this connection from a different perspective, which would include the measure of religious switching as a component of religiosity.

            This would reflect the behavior of the elderly individuals as they near the end of their lives as well as the impact of chronic illness on their spirituality. It was important to know the influence of religiosity because if it was proven consistently to be positive religion practices can be used as preventive measures for chronic illness as well as to provide this population with a better quality of life.

            This study would strengthen the low level of consistency regarding the health-religion link. While there was an apparent link, the manner and the measurement of this impact was still not clearly defined. Religious switching was an underutilized method in examining religiosity. It was important to study this perspective because it would involve a more in-depth analysis of religiosity.

            Religious switching required more than the frequency of attendance to religious practices and institutions. It was also more demanding than the usual statement of affiliation. The measurement of religious switching would require the religious history of the individual. It would show the totality of the impact of religion over their lives. It would also show if these persons religiosity was an effect of their chronic illness or aging.

            On the other hand, it could be that they had always held on to religious beliefs and they have switched religions because of their current circumstances. The period by which individuals experienced reaching the end of their life represented different mindsets, emotions and spiritual needs that did not exist in any other period (Prevette Research, 2004). This would provide a broader view of the level of impact religiosity over people’s lives.

                                                       Statement of the Problem

            The research would analyze the religion-health link in the lives of the elderly population. The role of religious components in the lives of the elderly would be analyzed in connection to their health well-being despite of chronic illness or aging. The research would answer the following significant questions:

  1. What level religious involvement did the elderly population have in terms of attendance for religious activities, affiliations and religion switching tendencies?
  2. Was there a significant relationship between the health of the elderly in connection to their religious switching or non-switching decisions?
  3. What impact did religious switching or non-switching have on the health behavior and practices of the elderly?

Hypotheses

            The research was conducted to prove or disprove the following hypotheses:

  1. There is a significant relationship between the religiosity and the well-being of the elderly population’s health.
  2. Religious switching was a major influence for elderly life satisfaction and physical well being.
  3. The measurement of religious switching would provide a deeper perspective as the connection between religiosity and elderly life satisfaction and health well-being.

Scope and Limitations

            This scope of the study involved the link between religiosity, physical well-being and life satisfaction of the elderly population. It would focus on religious switching as a dimension of religiosity and how it provided a greater depth in the determination of religious involvement. The measurements that were used were based from previous studies. The research was limited to the previous research findings in terms of measurement, measure of consistency and significance. It was also limited to the sample of the elderly population that was gathered by student assistants that served as participant recruiters for the gathering of data.

Summary

            This chapter presented the background of religious switching as an important component to measuring the impact of religiosity in the health of the elderly population. The health-religion link was examined in terms of the growing research that was attributed to it and the growing elderly population. There was a need to strengthen the consistency of the religion health link with regards to the indicators of religiosity by including religious switching. The research questions and hypotheses were presented in this section about the measurement of religious switching’s impact in broadening the perspective for the religious-health link and elderly life satisfaction.

            The next chapters would include the literature review to showcase the existing studies that discussed the religious-health link and elderly life satisfaction. It would include the analysis of existing research and the identification of the research gap that made it necessary to further explore religious switching as a measure of religiosity. The third chapter would include the methodology that was employed for this study.

CHAPTER 2

LITERATURE REVIEW

Introduction

            This study was aimed to analyze the religion-health link in the lives of the elderly population. The measure for religiosity was observed to be insufficient because it only revolved around religious involvement and affiliation. There was a need to explore religiosity in another area through religious switching. Literature on the health of the elderly had been increasing due to the growing number in this population group.  Religious switching needed to be explored in its impact on the elderly population’s health behavior and practices.

 This section would include the background for studies that were made concerning religiosity and its connection to health in the elderly population. The population of the elderly people would be described and defined. Religiosity would be clearly defined and understood from past literatures. It was discussed according to the dimensions of affiliation, participation and devotion. This section would also cover religiosity’s general impact in individuals in terms in the areas of their social lives and their ability to cope with life. The religion-health link would be discussed in terms of the physical and psychological well-being, as well as the how religion influenced the aging adult’s perspective towards mortality. Finally, this review of literature would cover the existing research about religious switching.

Religiosity and Health in Aging Adults

Religiosity was examined to have different dimensions. These different dimensions were observed to report life satisfaction in different varieties. Devotional (private) and participatory (public) aspects of religiosity were indicated to provide positive opportunities for life satisfaction (Ellison et al., 1989). This connection paved the way for further exploration for the links between religiosity and psychological and physical health.

There was no consistent set of predictors for the survival of elderly people in terms of physical well-being as well as the provision of life satisfaction (Glass, 1999). Physical activities were assumed to be good for their health; however, the social and spiritual activities were still to be further explored to be declared to have direct correlation for this population’s physical well-being. Enhanced social activities were beginning to emerge as factors that increased the quality and length of life of the elderly population (Glass, 1999).

The Aging Adults

            The demographics of developed nations reflected how the population of those that were over the age of 65 years old would double in the decades to come. Predictions were made that when the year 2050 came, the number of Americans that were over the age of 90 would grow 10 times than what it was in the 1990s, which would be around 10 million people (Glass, 1999).

 The life expectancy of this population had also changed wherein those that instead of living up to the age of 65, members of this population were observed to live until they were 40 years old (Glass, 1999). This was calculated to be a 22 per cent increase since the 1960s. These changes were well-documented. However, the predictors of this changes were not yet clearly understood.

There were already a number of studies that revealed the link between certain activity levels and survival and such studies assumed that better health was attributed to improved cardiopulmonary activities (Glass, 1999).  However, researchers determined that physical activity was not enough to provide health benefits of longer lives. Social, productive and fitness activities were three types of activities that elderly people engaged in to be able to improve the status of their health (Glass, 1999). There were also significant reports that revealed how more active elderly people were less likely to die than those that were less active. Social activities and mortality was then the subject for numerous studies.

Religiosity

Religiosity is multidimensional in nature and includes both behavioral (e.g., attendance) and subjective practices (e.g., prayer, reading the Bible).   Religiosity can be measured using one or more of the following variables:  religious switching, religious commitment, religious maturity, intrinsic religiosity, and private religious practices or public religious practices, among others.

The existing research involved the study of the dimensions of religiosity that included affiliation, participation and devotion (Ellison et al., 1989). Research showed different predictors for the levels and forms of religiosity of individuals. Marital status, income, and education, although on an inconsistent level, were pointed out to be the most important predictors for religiosity (Ellison et al., 1989).

Gender was also an important predictor. However, it was only utilized for measuring the intensity of devotion rather than to predict religiosity. Females were observed to report a higher level of devotional intensity in comparison to males (Ellison et al., 1989). Organizational members and social ties were also predictors of both religiosity and life satisfaction.

Affiliation. The affiliative dimension of religiosity was already given attention from previous research (Ellison et al., 1989). They emphasized on the importance of person’s bond with a religious collectivity. This dimension was measured through denominational identification and the strength of these denominational ties.

Religious affiliation and life satisfaction was a relationship that was explained to be diverse because of the unique organizational profiles of denominations and the different impact of specific trends and events on them (Ellison et al., 1989). The impact of affiliation was observed to be influenced by the societal events by which denominations existed in.  Since different denominations stood for different belief systems and values, different trends and events affect them in various manners. Furthermore, the effect of membership to a specific denomination would have different effects on its members. This point served as the first point by which the inconsistency that religion-health links existed when it was based on the affiliative dimension.

Theological differences were not the only cause of variations between denominations (Benjamins, 2006).  It was more of a combination of different things such as group norms, theology, individual interactions and organizational differences. Differences between denominations and affiliations were subjective to the unique members of the religious group. Theological differences only arose over direct contradictories in their doctrines.

Group norms existed within cultural subgroups and were observed with the potential to explain health and treatment choices for its members (Benjamins, 2006).  Organizational differences could be observed as the initiation of the leaders and policies that were related to the health of the members.

There was also the discussion of the greater degrees of contentment that was from the members of the more conservative denominations (Ellison et al., 1989). This could be analyzed in the perspective that conservatism prevented mere constructions of life satisfaction and promoted the acceptance of the individual and societal status quo. Liberal denominations would encourage people to ask more questions, criticize standards and norms and fight for change (Ellison et al., 1989). This would promote less stability and a larger probability for life dissatisfaction.  There had been studies that had already criticized the strength of affiliation as a variable for measuring life satisfaction (Ellison et al., 1989).

Participative Dimension. Studies found a positive and significant effect when it came to the use of participation as a dimension of religiosity in connection to life satisfaction. Research showed that frequent religious attendance did influence positive psychological well-being (Ellison et al., 1989). Regular attendance for activities that were considered religious fostered well-being and had the quality to bond participants in a distinctive manner.

Religious service attendance was considered as one of the most important aspects of religion because it entailed involvement with a religious organization. One form of participation included attendance that could impact the activities of the members (Benjamins, 2006). For example, churches and synagogues had frequent activities and information about health promotion events and topics that could lead to the more effective use of health services. As a result of church-based programs and extensive social network of member, higher levels of church attendance were more significantly higher levels of church attendance was related to more knowledge about health maintenance activities (Benjamins, 2006).

Devotional Dimension. Research also analyzed the variable of studying the devotional intensity for religiosity and how it impacted the provision of life satisfaction. The devotional variable in religiosity was observed to be stronger than other religiosity variables. It included personal religious feeling and experience to qualify for the improvement over the other variables (Ellison et al., 1989).

Another term that could be related to devotional dimension was religious salience. It was a measure of religion that included the possible effects of personal beliefs, faith and commitment to it. In contrast to the other aspects or dimensions of religiosity, the devotional dimension or religious salience was a measure of private experiences in relationship to personal values (Benjamins, 2006). Religious salience was observed to have a negative effect on health behaviors as well. Some people held that since there was an afterlife, life on earth was not as important and led them to believe health was not as important (Benjamins, 2006). Although studies showed the positive effects outweighed the negative ones.

Overall, public and private religiosity were observed to alleviate the negative impact of life conditions and events and paved the way for life satisfaction. High levels of devotion and religious experiences added to the probability for satisfaction. They were considered to be useful sources for coping with trauma and for integration with religious collectivities (Ellison et al., 1989). Religious collectivities were beneficial for social support and the reinforcement of shared values.

Studies showed the significant relationships between the different dimensions of religiosity with life satisfaction (Ellison et al., 1989). However, there still existed a wide range of predictors that prevented these dimensions from being considered to be consistent measures for satisfactions. These other predictors included demographic variables, individual attributes and secular social integration.

Religiosity and Social Life

            Religiosity was observed to influence the behavior of individuals in different aspects. This was a highly researched, yet incomplete, area of literature because of the inconstancy that existed in the studies concerning the existence and impact of religiosity in individuals in general. Religiosity had a major impact on people’s social lives. There had been growing attention that was given to the impact of religious beliefs, commitments and institutions in the social life of individuals.

Social activities and participation were observed in to influence the physical and psychological well-being of individuals. This would be further explored later on. It would be important to discuss the impact on religion in the social area of an individual’s life because of the importance it held in the person’s well-being. Religion was observed to strongly influence political beliefs and commitments, family relations, health and well-being, and social space as well as social capital (Sherkat & Ellison, 1999).

             Religion and family life was also observed to have a significant connection as well. Religious factors were observed to clearly influence attitudes and behavior of individuals in different areas of their lives. The role that religion played in the family life rooted religiosity’s impact deeper in the health of individuals. Health was an important issue in families. Denominational ties were maintained through certain beliefs and practices that were also valued in family life (Sherkat & Ellison, 1999).  The value of these beliefs and the representation of these denominational ties were practiced in the everyday life of the family. Everyday life included perspectives, practices and behavior that concerned their health. For example, issues that included the use of contraceptives, reproductive behavior and physician assisted suicide were considered to be both family and religious issues.

            Family ties were strengthened or weakened by their religious commitment as well. Marital happiness and adjustment were related to devotion in the church activities. Religion was observed to influence the strength of family ties. When a family was involved within religious communities, it validated the relationship of the couple, encourages values of love, caring and other positive virtues.

            Same-faith marriages were observed to be happier than mixed-faith marriages (Sherkat & Ellison, 1999). This showed that the degree of theological distance separated partners and resulted in marital dissatisfaction. In the same manner, children were also observed to adapt the religious denomination of their parents depending on the degree of their participation and denomination. The religiosity of parents and children could create positive parent-child bonds between them (Sherkat & Ellison, 1999).

Religious Coping

            There was a greater need for religiosity for the elderly population upon reviewing of motivations and religious coping (Wong-McDonald & Gorsuch, 2004). In terms of religiosity, there were different manners by which people achieved life satisfaction. Religious coping was a manner that most members of the elderly population was observed to utilize through three different styles: collaborative, self-directive, and deferring (Wong-McDonald & Gorsuch, 2004).

            Collaborative religious coping involved the approach wherein the individual and God were said to be in active partnership when it came to dealing with problems. On the other hand, self- directive religious coping characterized by the reliance of a person on one’s self rather than on God. The deferring style of coping was when the individual completely left the problem for God to resolve, leaving one’s self-passive and God to be completely active. There was another religious coping style that was determined to be surrender wherein the individual submits to God one’s will through self-relinquishment (Wong-McDonald & Gorsuch, 2004). Religious motivation was also observed in relation to religiosity. It was described as the approach to problem solving or coping. Studies showed how different people adapted different coping styles according to their religious outlooks.

            The internal attributes dictated the behaviors of individuals and these behaviors modified their internal characteristics (Wong-McDonald & Gorsuch, 2004). For believers, their locus of control influenced the style they adopted for coping and the effectiveness of their coping approach and their perception of control. The locus of control, coping and spiritual well-being were regarded to be interrelated with each other.

            Studies have presented that spiritual well-being was the best represented from two dimensions. These two dimensions included the vertical one which involved the relationship with God and the horizontal dimension that include one’s purpose and life satisfaction that existed beyond one’s religion (Wong-McDonald & Gorsuch, 2004). These two dimensions had been labeled as religious well-being and existential well-being respectively. When joined together, they made up the total well-being of a person.

Health-Religion Link

The relationship between religiosity and health received significant attention from researchers.  The research findings revealed that it supported the health-religion link, while others insisted that research findings were still inconsistent in this matter (Idler & Kasler, 1997; Helm et al., 2000; Krause & Wulff, 2005; Musick, 1996; Koenig et al., 1993; Sherkat & Ellison, 1999). Religiosity was commonly assessed using religious participation and affiliation. The less frequently used assessments used the measurement of private religious practices and prayer.

Aging adults were considered to be more religious than those that were younger. Religious groups were the most important organizations by with the elderly population belonged to (Ainlay et al., 1992). This was due to the influence of religiosity on their social activities and how it allowed them to participate in a group and their tendency to cope more with stressful situations.  Religiosity was further established through social connections within the church environment.

The process by which religion influenced health and well-being was classified in different categories such as health behaviors and individual lifestyles, social integration and support, psychological resources, coping behaviors and resources and different positive feelings and healthy beliefs (Sherkat & Ellison, 1999). Religious involvement was seen to promote mental and physical health by encouraging members to engage in activities or behaviors that would decrease their risks of developing diseases.

There was a case wherein a well-documented case of religious attendance and affiliation was related to the avoidance of alcohol, tobacco and substance use and abuse. The use of these things were linked with the development of chronic illnesses. Since membership in religious organization influenced proper and healthy lifestyles, they was less risk for receiving the harmful effects of alcohol, tobacco and substance use and abuse.  There were also other ways by which membership to religious communities had decreased stressful events and conditions and these were due to decreasing deviant behavior such as risky sexual practices and illegal conduct (Sherkat & Ellison, 1999).

Religious groups also held regular events wherein social activity and interaction produced the cultivation of friendships (Sherkat & Ellison, 1999). These groups were then avenues wherein individuals could experience companionship and comfort as well as instrumental aid for proper lifestyles. Studies revealed that through religious activities and membership, self-esteem and personal efficacy were also strengthened (Sherkat & Ellison, 1999).

Hendershot (2003) revealed in a study he had conducted that attendance in religious services also influenced subsequent improvement in the functioning of individuals with disabilities. Religious coping was a conceptual model wherein the relationship between religion and improved outcomes was described. General commitment, religious beliefs, and the application of religious beliefs to personal difficulties were the stages by which religious coping occurred (Hendershot, 2003). For example, prayers were considered as a form of complementary and alternative medicine (CAM) when it came to personal difficulty.

In a survey that was conducted by the National Health Interview Survey (NHIS) in 2003, one adult per family were asked to give the specific CAM services they used with their health care; prayer and spiritual healing was included in those services. The answers involved acupuncture, relaxation, massage, diet, herbs, energy healing, and hypnosis, among other things. People with mobility limitations as a form of disability were more attuned to using prayer as CAM  (Hendershot, 2003).

Strawbridge and his colleagues (2001) conducted a study that was conducted to test the influence of religious attendance on the improvement and maintenance of good health behaviors, mental health and social relationship. They used indicators such as smoking, physical activity, alcohol consumption, medical check-ups, depression, social interactions and marital status. The findings of this research observed that those that attended regularly since 1965 were more likely to improve poor health behaviors and maintain positive ones by the year 1994  (Strawbridge et al., 2001). In the same study, regular church attendance was also related to good mental health, increased social relationships as well as marital stability.

Jenkins and Pargement (1988) studied the link between religion and the ability of patients to cope with it.  This study reflected that limited salience that the variable had for the overall coping process of the participants. This was analyzed to have a limited usefulness in terms of creating clinical interventions using religiosity.  Nevertheless, cancer patients still received positive developments when it came to religious coping in the face of this disease.

            Idler and Kasl (1992) conducted a study of the elderly persons in New Haven Connecticut and how their religious involvement affected different aspects of the status of their health. Results showed that the effects of public religiosity provided protection from the members of religious organizations against disability and private religious involvement brought about protection against depression among the disabled males of that sample group over a three-year period. This study presented the impact of religious involvement on the provision of strong positive effects on the health of the elderly.

            Musick (1996) conducted a study that explored the subjective health for participants from the Black and White elderly communities in the southern region of the United States. The analysis resulted in findings about the link between subjective health and religion. Blacks and Whites warranted differences when it came to their religion and health connections. The effects of religion were greatly observed for participants that suffered greater from physical health problems. Generally, religion was largely observed to comfort participants more than anything when it came to their life satisfaction.

            Benjamins (2005) studied the importance of preventive services in the health care system. She studied the role of religion and other social factors in the provision of facilitation for the use of these services for increasing the well-being of a person’s health. The study was focused on women’s participation in religious activities. The researcher discovered that women who attended religious services more frequently utilized preventive services in a greater degree. The preventive services that were studied came in the form of mammograms, pap smears, and self-breast examinations (Benjamins, 2005).

Psychological Well-Being

In late adulthood, Wink and Dillon (2003) found that religiosity is significantly related to well-being through positive relations with others and involvement in social and community service life tasks.  Private religious involvement was also observed to impact the psychological well-being of a person. There were different studies that regarded religion and faith in God to serve as stress buffers or protection from anxiety and depression.

Krause (2006) designed a study that examined the role of faith in God in the reduction of the deleterious effects of stress in the late life of individuals. Data showed that older women were more likely to have a sense of gratefulness towards God in comparison to men. Findings also showed that the elderly participants who felt more grateful towards God reduced the effects of stress on health. In the same manner, the analyses of this study carried potential stress-buffering properties that came from their gratitude toward God.

Wong-McDonald and Gorsuch (2004) discovered that when the locus of control involved God, participants were observed to have lower rates of depression. Self-dependence was correlated with anxiety, in comparison to participants that depended on God in a certain a degree that experienced less anxiety (Wong-McDonald & Gorsuch, 2004).

Religious involvement and membership provided effective support functions. Support enabled individuals to available self-esteem sources and buffers for life stress and it pathogenic effects (Colin & Hoberman, 1983). The multidimensional measurement of social support was significant and brought about by the measure of interpersonal relationship functions. They offered a type of support resources in terms of coping requirements that prevented those stressors from overcoming the individuals.  The study examined the coping mechanisms and the range of available support resources that was connected with religiosity.

Desirable life events were also a positive stress buffer. The generation of positive feelings enhanced the individual’s capacity to deal with stress (Colin & Hoberman, 1983). These positive feelings and experiences could be achieved from religious participation and membership. These feelings of happiness and satisfaction brought about the provision of rest from stressful situations. Participation in positive activities helped resolved crisis and restore a person’s psychological resources in order to adjust to life stress.

Social support worked as a stress buffer. The high levels of stress that physical symptoms and depressive symptoms provided individuals were wholly and partly defeated due to the availability of support (Colin & Hoberman, 1983). The increase in the perceived availability of support was largely associated with the decrease in depressive symptoms. Religious participation provided individuals with opportunities of positive life events. The sense of meaning and purpose that individuals receive from membership from religious participation enabled the constant availability of the support elderly people needed.

Ryff and Reyes (1995) studied six distinct dimensions of psychological wellness. These dimensions included autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, as well as self-acceptance. This study was related to positive and negative affect and life satisfaction. These dimensions were related to different life events and enduring human experiences. Research revealed linkages of these dimensions with quality of life and the wellness of the mind (Ryff & Singer, 1996). Religiosity provided for most of these dimensions in one way or another through religious involvement, affiliation and devotions. For example, Christian Scriptures encouraged Christians to live for God’s glory. This provided for individuals the purpose for their lives. Self-acceptance, positive relations with others as well as personal growth were also common concepts that were encouraged in different religious organizations.

Religion and Mortality in the Elderly

            Oxman and his colleagues (1995) discovered that individuals without religious strength and comfort experienced fewer emotional close network members and were less likely to be married. Despite the interrelatedness of the dimensions, the absence of strength and comfort was the only variable that was directly related to mortality.  Findings suggested that the receiving little strength and comfort from religion was more beneficial than receiving none whatsoever (Oxman et al., 1995).  The findings from this study reflected how the frequency of church attendance and self-assessed religiosity reflected a source of strength. These were observed to be associated with a two-year mortality of 398 elderly urban residents (Oxman et al., 1995).  These study indicated that religion was not simply a proxy for mood disturbances and was beyond social contacts.

            Cardiovascular disease was regarded as the most frequent single cause of death in the country with members of the population that were over 65 years of age. The severity of diseases and physical functions were influential predictors cardiovascular mortality (Oxman et al., 1995).  Additional risk factors were analyzed in relation to this finding in relation to the importance of social resources and the risk of their deficits in increasing the risk of cardiovascular diseases.

The lack or absence of emotional support increased the risk for death. Social resources were also observed to decrease with age.  On the other hand, the involvement in religion became a durable substitute as well as a supplement for the social and coping resources (Oxman et al., 1995). Religious membership, participation and devotion provided for the needed positive social support that this population needed to overcome the risks of illness and death. The importance of religion was therefore increased with the person’s age within this perspective.

Powell and her colleagues (2003) gathered evidence that linked religion with mortality, morbidity, disability and discovery from illness. Healthy participants displayed a strong and consistent in the reduction of risk mortality for active church members. The reduction was estimated at 25 percent. Religiosity was observed to protect individuals from cardiovascular disease because of the healthy lifestyles that it encourage amongst its members (Powell et al., 2003). However, there were still insufficient evidence that explored the depth of religiosity and physical health. Findings still reflected inconsistencies when it came to the role of religiosity in slowing down the progression of cancer or improved recovery from acute illness (Powell et al., 2003).

There were significant approaches to the study of successful ageing. Implicit negativism was related the neglect of the possibility of growth and development in a person’s old age  (Ryff, 1989). Religiosity encouraged individuals to perceive the positive conceptions of ageing. This provided for the development of autonomy, environmental mastery, self-acceptance, purpose in life and personal growth (Ryff, 1989).

Hummer and his colleagues (2004) also presented a serious interest in the relationship between religious involvement and adult mortality risk in the elderly population in the United States. The findings of their research revealed how religious involvement appeared to influence mortality in terms of social integration, social regulation and psychological resources. It was important to note how the relationship was strongly based on public religiosity in terms of religious attendance and affiliation to a specific religious denomination (Hummer et al., 2004). The evidence was weaker when it came to private religious activities such as Bible reading, prayer and others like these because of the tendency of people to overstate their religiosity.

Assessment of Existing Research

 In the study that Idler and Kasl (1997) conducted, they presented that individuals who participated in church activities had the tendency to be healthier than those who did not. Extensive research was conducted in order to examine this finding. Based on how much time participants spent in prayer, Bible study, or meditation, Helm and his colleagues (2000) reported that private religious activity provided for positive impact on survival, particularly among older adults who have no impairment in activities of daily living (ADLs).

 Similarly, Idler and Kasl (1997) examined the association between attendance for religious services and the course of functional disability.  More specifically, they focused on the effect of church-based social support, which has been identified to be beneficial for one’s satisfaction with health.   Social support associated with religiosity contributed to a sense of belongingness, which research identified as one of the most basic of human needs (Krause & Wulff, 2005).

Furthermore, Helm and his colleagues (2000) reported that private religious activity was significantly associated with gender with females. They were approximately three times more likely than males to be devoted participants in private religious practices.  They reiterated on the study that was conducted by Sherkat & Ellison (1999) regarding the higher degree of intensity that female participation had when it came to church participation. There was also an increased use of preventive health services among women who regularly attended religious meetings (Benjamins, 2005).

In relation to the observation of the degrees of participation, Musick (1996) presented that private religious activities were linked to well-being and coping with chronic disease.  Similarly, he suggested that public religious activity had a significant impact on social integration and support, which have a salubrious effect on health. In relation to this, Oman and Reed (1998) suggested that religious attendance had a persistent protective effect against mortality among elderly adults.

  On the other hand there were also significant research that pointed out how there were inconsistencies with the findings for the religious health links, Koenig and colleagues (1993) failed to find a positive relationship between religiosity and anxiety among adults aged 50 years and older.  Benjamins (2005) indicated that there were inconsistencies in the findings that associated adult women’s use of preventive health services with religion. There were different associations that emerged depending on the type of preventive service and the aspect of religion that was measured. There was also inconsistent evidence that was gathered regarding the role of religion in the protection of individuals from disability (Powell et al., 2003).

Ellison, Gay, and Glass (1989) examined various dimensions of religiosity and their relationships with psychological well-being.  Although Ellison and his colleagues (1989) found significant support for a positive relationship between religiosity and psychological well-being, there is a lack of consensus to support that finding.

Kirby and her colleagues (2004) presented that the link between religiosity and health was not necessarily a direct one because it was more complicated that it is. Prevention (changed lifestyle and behavior), stressor response (increased religiosity), stressor effects (decreased religiosity), moderator (religiosity reduced harmful effects of stressors) and offsetting (religiosity’s independent effects on health) were models by which religiosity’s impact were observed from. Frailty was recognized as a dimension for the link of aging, well-being and religiosity (Kirbly et al., 2004). The older people in Britain with a higher degree of frailty represented a greater role for religiosity in moderating a higher sense of well-being (Kirbly et al., 2004).

Consequently, it is not an easy task to provide a constantly accepted association between religion and health. There were different research that provided direct links between religiosity and health. On the other hand, there were findings that attributed indirect associations, while others presented inconsistent relationship between them. This produced a broader room by which consistency could be developed through the use of new predictors and indicators of religiosity. This was needed in order to provide for a more in-depth perspective for the impact of religion in the life of the elderly population.

Religiosity and Religious Switching

Current studies reflected the opposing perspectives about the link of religiosity to the physical and psychological well-being of the elderly population. A number of these studies supported the greater connection of religion and health. However, the existence of other studies that discovered inconsistencies for this link manifested problems in terms of the finding the right independent variables to measure religiosity with. Religious switching was dimension of religiosity that was understudied. It needed to be utilized as a measure of the depth of religiosity.

Religious Beliefs and Commitments in the United States

            The sociology of religion was undergoing a time wherein it was already experiencing significant organization and intellectual progress. Social science was the area of knowledge that was devoted to the study to religion because of the growth in the attendance and membership for religious denominations (Sherkat & Ellison, 1999). This went against the studies that disregarded religion and perceived it with diminished importance in people’s social life due to waning religious commitment. Studies since the late 1970s up to the present revealed the strong influence of religion in the life of people (Sherkat & Ellison, 1999).

            There were three elements that emerged from the study of religious beliefs and commitments in the United States. The distribution of beliefs and commitments, trends in beliefs and attachments and the predictors of religiosity (Sherkat & Ellison, 1999). The General Social Survey presented that nearly 63 percent of Americans believed in God and there was only 2.2 percent who did not carry this belief. This same survey also showed that a third of the Americans believe that the Bible was the word of God and 80 percent of them believed it was divinely inspired.  There was also more than 75 percent who believed that there was a heaven, 63 percent who believed there was a hell and more than half of the population believed that the devil existed (Sherkat & Ellison, 1999).

            The levels in religious participation and the rates of membership were also considered to be high in comparison to other nations. More than 61 percent of the Americans claimed to be a member of a religious organization and more than 25 percent attended a church service or gathering on a weekly basis (Sherkat & Ellison, 1999). However, researchers acknowledged the fact that people had the tendency to over report their church attendance and actual rates of attendance could only be half of what people claimed in such surveys. In relation to participation, Americans were reported to donate a substantial amount of time and money to religious organization with an average of $440 per household annually in 1994 (Sherkat & Ellison, 1999).

            There were different factors that contributed to religious beliefs and behaviors. Religious commitment was important in order to adequately define religiosity in individuals. Family and denominational socialization, gender, social status and life course events and aging were important predictors of religious beliefs and commitment (Sherkat & Ellison, 1999).

            Parents greatly influenced their children’s religious views and commitment through the socialization of their own beliefs and commitments. They were more likely to transmit the degree of their religiosity and their religious affiliations by engaging in common religious commitments (Sherkat & Ellison, 1999).

            In terms of gender, women participated more frequently in religious organizations. They were less likely to become more irreligious. They were significantly more likely to hold on to orthodox religious beliefs than men did (Sherkat & Ellison, 1999). Religious settings also provided social settings and support that encouraged a greater number of women to participate and allow for leadership opportunities.

            Social status also influenced religious beliefs and commitments (Sherkat & Ellison, 1999). Higher levels of education provided a negative impact in the measures of traditional religious beliefs. They were more likely to question orthodox beliefs and religion. Nevertheless, there were also studies that observed how education also spurred participation in religious organizations (Sherkat & Ellison, 1999). People with high incomes were also people who were in the position to donate more money to religious groups that they belonged to. However, there were individuals that substituted religious contributions for religious attendance. Education had the potential to pull individuals in either direction. Educational attainment could prompt apostasy and religious switching (Sherkat & Ellison, 1999).

            Religious commitment was also related to family formation and childrearing for religious behavior. Marriage and childrearing were observed to encourage religious participation while divorce and cohabitation reduced this (Sherkat & Ellison, 1999). When individuals marry, they benefited more from the social support they gain from it. Religious intermarriage was observed to increase the rate for religious switching or the weakening of commitment for a certain religious denomination (Sherkat & Ellison, 1999).

            Aging was also observed to boost religious participation. Increased integration and desire for social support as well as a heightened need to find the meaning of life increased the commitment of the elderly individuals for religiosity. Scholars investigated the importance of region and geographic morbidity when it came to religiosity. There were certain regional concentration of denominations that were characterized to be “more devoted” than others. The South was considered to be more religious than the irreligious West (Sherkat & Ellison, 1999).

Religious Switching

            There were different factors that were already mentioned to contribute to religious switching in relation to the strength of religious commitment. According to Hoge and his colleagues (1995), there were four motivations by which people switched denominations. The reasons that emerged from his findings were interfaith marriages, the move from one town to another, dissatisfaction with the current church or organization and personal ties and influences. In this study, the dissatisfaction with the current faith or religion was associated with a conversion or the renewal of commitment for another religion (Hoge et al., 1995). In this study Hoge and his colleagues (1995) also observed that religious switchers were observed to be more involved in church activities than that of non-switchers.

            Porterfield (1998) observed the diversification of religion in the United States in terms of the two trends of religious affiliation and the combination of affiliation to one religious group to others. A survey in 1984 reflected that 20 percent of the population in the country switched religious affiliation at least one point in their lives and an estimate of 10 percent experienced this switch at an average of three times (Porterfield, 1998). This trend was said to continue its rise for the years that came after it. There was a tendency to join more than one religious organization and even attend more than one type of religious service activity over a period of time. These trends were highly attributed to the individualist character of the American culture (Porterfield, 1998).

            Individualism was always an American trait in terms of the overall virtues of the country. Since it was a nation that was inhabited by immigrants, there were over millions of people who brought in the United States different religions that diversified the American culture. The spirit of individualism was widely nurtured in the strong emphasis for the individual’s right to choose what to believe in. The development of other religions in the United States was related to the investment for religious freedom.

            The country witnessed decades of cultural commitments to the freedom of religious expression that combined different forms of religious pluralism in the provision of the climate of hospitality in the country. It also paved the way for religious experimentation and cross-affiliation.

Religious choices were usually dependent on religious experiences that enhanced the desires for familiar religious goods and preferences (Sherkat & Ellison, 1999). The familiarity for certain compensators, explanations and organizations created beliefs and commitments that were considered to be valuable in the ability of the person to find value with their religious affiliation. Although, preference shifts did not always support status quo. Individuals learned of alternative preferences when new knowledge were introduced to social ties and changing life circumstances (Sherkat & Ellison, 1999). Changing life circumstances included education, cross-cultural contact, geographic mobility, social movement participation and social mobility. Individuals who search for religion had a great tendency to find it in counter adaptive preferences.

There were considerable evidence from the U.S. and elsewhere that showed the positive effects of pluralism. In the nineteenth century United States, religious pluralism bolstered membership and demand for clergy. In the presence of competition, Catholic churches are more effective in mobilizing high commitment members and are more innovative in their marketing of religious goods (Stark & McCann, 1993).

Stark (1997) argued that the exposure to the religious free market in the United States explained why first generation German immigrants were relatively irreligious, yet by the third generation they were like other Americans. Further, religious deregulation was linked to the preponderance of new religious movements in Europe (Stark, 1993), as well as the flowering of religious groups in the former Soviet Union (Greeley, 1994) and Latin America (Gill, 1996).

The Pew Forum on Religion and Public Life recently published a survey that analyzed the religious affiliation in the U.S. and discovered it to be both diverse and fluid (U.S. Religious Landscape Survey, 2008).  Religious affiliation was assessed by respondents’ self-reported religious identification.  That is, respondents stated their specific religious affiliation (e.g., Roman Catholic, Southern Baptist) or their lack of religious affiliation.  The lack of religious affiliation included atheism, agnosticism, and no religious identification (U.S. Religious Landscape Survey, 2008).  The Pew Forum reported that 28 percent of Americans switched religions, but, if switching was from one religion to another within the same religious family, then the number of individuals who have switched religions increased to approximately 44 percent (U.S. Religious Landscape Survey, 2008).

Religious switching was a relatively unused measure of religiosity (Roof, 1989).   Religious switching referred to the change in religious identification or religious affiliation.  Switching might be within one’s religious family, to another religious family, or to no religious at all.  Thus, examining the stability of religiosity among aging adults could provide important and useful information.  Roof (1989) examined data from the General Social Survey of 1988.  His analysis revealed that almost one-third of Americans switch faiths or denominations, and one-third of these are multiple switchers.  While the family influenced the most commonly religious beliefs and practices, this did not preclude a change in religious beliefs and practices during adult aging and maturing (Wilson & Sherkat, 1994).

Summary

            The literature review covered the connection of religiosity and health. It involved the elderly and why they were the target population for this study. Religiosity was also defined according to define and understand the past literature in connection to its impact on people’s health. The dimensions of affiliation, participation and devotion were also studied according to the depth of religiosity. It was also discussed in the way it affected the social lives of people and their abilities to cope with life difficulties. The religion-health link was also categorized by the physical and psychological health of people. Religious commitment and religious switching were also discussed as a valuable dimension for a broader measure for religiosity.

            The next chapter would discuss the methodology that would be employed in this study. It would provide for the description of the sample and procedures that would be utilized in order to bring about the relationship between life satisfaction and religious switching in the elderly population.

CHAPTER 3

RESEARCH DESIGN AND METHODOLOGY

Introduction

            The impact of religiosity on health on the elderly population received significant attention from research. Religious involvement was also observed according to the positive impact in the lives of the elderly population when it came to health. Research was analyzed in connection to the measurement of religious switching as a component of religiosity.

            The behavior of elderly individual that were at the point in their lives wherein mortality was near provided for a different perspective for their spirituality and the necessity for religion. The general influence of religiosity needed to be explored for its potential to be used as a preventive measure for chronic illness as well as for the coping abilities of those that already developed diseases. It was also something that had the potential to provide the a better quality of life for these individuals.

            This study was perceived to contribute to the literature that had opposing views on the impact of religion on health. It was seen to have the possibility to strengthen the low level consistency of the health-religion link. Religious switching was an underutilized method that could be used to examine religiosity. It would provide for a deeper level of analysis with regards to religiosity.

             Religious switching was a variable that involved more than the frequency of attendance and religious practices. It was more demanding because of the usual statements of affiliation. Religious switching was something that required the history of the individual. It was also something that covered private and public religiosity.  It involved the totality of the impact of religion over the lives of the elderly population.  It would further explore the effect of chronic illness and ageing on the religiosity. Religious commitment was something that explored more of the intensity of a person’s religiosity.

Research Questions

            The research would analyze the religion-health link in the lives of the elderly population. The role of religious components in the lives of the elderly would be analyzed in connection to their health and well-being despite of chronic illness or aging. The research would answer the following significant questions:

  1. What level religious involvement did the elderly population have in terms of attendance for religious activities, affiliations and religion switching tendencies?
  2. Was there a significant relationship between the health of the elderly in connection to their religious switching or non-switching decisions?
  3. What impact did religious switching or non-switching have on the health behavior and practices of the elderly?

Research Hypotheses

            The research was conducted to prove or disprove the following hypotheses:

  1. There is a significant relationship between the religiosity and the well-being of the elderly population’s health.
  2. Religious switching was a major influence for elderly life satisfaction and physical well-being
  3. The measurement of religious switching would provide a deeper perspective as the connection between religiosity and elderly life satisfaction and health well-being.

Participants

            There were 605 adults that participated (258 men and 347 women), with their ages ranging from 50 to 95 years old, with an average of 64 years of age. The diversity of the racial profile could be broken down into Caucasian Americans (89.9%), African Americans (9.1%), Asian Americans, and others (1% did not indicate ethnicity). When it came to the social status of the participant, the majority were married (70.9%), 15.7 percent were either single, separated, or divorced, and 12.9 percent were widowed. The participants had different education attainments: 7.4 percent did not graduate from high school, 24.3 percent had high school diplomas, 26.1 percent had college diplomas, 17.7 percent earned four-year degrees, and 24 percent experienced post-graduate education level.

Table 1 Religious Affiliation of Elderly Sample Participants

Roman CatholicProtestantOther ReligionNo Religion
10.2 %80.0%5.8%4.0%

In terms of religious affiliation, participants were able to indicate their religious denomination through questionnaires. Most of the participants, specifically 484 of them, belonged to the protestant denomination. This include those that belonged to mainline and evangelical sectors. Following this religious group, around 61 participants were Roman Catholic.

Procedures

            There were students from an undergraduate psychology class that assisted the researcher in this study that served as participant recruiters. There were packets that were distributed by these research assistants regarding the instructions for the request of the participation of the adults who were aged 55 and older. These packets contained the information sheets that described the research that was going to be conducted. The participants were received a similar packet.

They sent back these packets with the indication of their consent with no recorded names. The packets that included the questionnaires were completed within 30-45 minutes. Participants were able to directly answer the questionnaires for the reduction of errors from using answer sheets. They were given different periods wherein they could take a break from answering the questionnaires.

Measures

The questionnaire packet included a demographic page that asked for nominal information such as gender, age, height, weight, ethnicity, religious affiliation, frequency of attendance, and highest level of education completed. The questionnaire packet made use of the following measures.

Religious Involvement

The participants provided information on their religious involvement by indicating whether or not they were a member of a religious denomination.  They were also asked to classify their church/synagogue/place of worship involvement. The measure of religious involvement were classified and answerable with “never attend”, “attend occasionally (1-2 services per month)”, “attend often (3-4 services per month)”, or “attend almost always (attend weekly services and special events/evening services)”.  These answers corresponded to codes of 1-4. Participants were asked to describe how often they engaged in prayer as “several times a day”, “once a day”, “several times a week”, “once a week”, “several times a month”, “once a month”, “less than once a month”, or “never”, also coded as 1-8.

Additional Religious Measures

To measure different dimensions of religiosity, questions from the Fetzer Scales (1999) were included.   Specifically, the following religious dimensions were assessed according to daily spiritual experiences, which includes connection with the Transcendent, sense of support from the Transcendent, strength and comfort, perceived love, sense of wholeness (e.g., internal integration), sense of awe, and the longing for the Transcendent; and private religious practices, to include activities that they participated in.

There was a need to measure the individual’s perception of the Transcendent (God or the divine) in terms of the daily lives of the participants as well as their interaction and involvement with it (Underwood, 1999). The attempt for the measurement was to understand the experience of the participants, more than the cognitive constructions of religiosity. The research was structured from the Brief Multidimensional Measure of Religiosity/Spirituality (Underwood, 1999). Religious history was also review and categorized from the data. The classification involved those that had (1) no religion, (2) unchanged religious affiliation, and (3) religious switcher.

Health Outcomes

An abbreviated form of the Scales of Psychological Well-being (PWB; Ryff, 1989; Ryff & Keyes, 1995) was used out of an organized religious setting, and both positive and negative religious coping to measure total psychological well-being. It also provided three subscales: purpose in life (PL), environmental mastery (EM) and positive relations with others (PRO). The shortened form used for the present study consisted of 27 items, divided about equally between positive and negative phrases.

Respondents indicated whether they agreed or disagreed “strongly”, “moderately”, or “slightly” that an item described how they typically thought or felt. Each scale exhibits convergent and discriminant validity and reduced-item versions of each scale (Ryff, 1989). It worked to confirm the proposed theoretical structure of psychological well-being and replicate age and gender differences in nationally representative samples (Ryff & Keyes, 1995).

The reliability of the larger 120-item scale was high (alpha coefficients ranging from .86 to .93) (Ryff, 1989). However, the internal consistency of reliability for shorter versions was shown to drop to low  up to the modest, which was more likely due to the small number of indicators per scale (Ryff & Keyes, 1995). In the current sample, Cronbach’s alpha coefficients were calculated for the total scale (.92), as well as for positive relations with others (.82) and purpose in life (.75). Reliabilities for the remaining scales ranged from .49-.61.

Subjective well-being (SWB) was assessed with the Satisfaction with Life Scale, a widely used measure of life satisfaction with favorable reliability (alpha=.93) and validity data (Diener, Emmons, Larsen, & Griffith, 1985; Pavot & Diener, 1993). Three measures of negative health were also included. The first scale was the Cohen-Hoberman Inventory of Physical Symptoms(CHIPS), which assessed physical symptoms of illness over the last month (Cohen & Hoberman, 1983), using the Cohen-Hoberman inventory of physical symptoms. It assesses 39 common physical ailments that often bring patients into the health care system.  The items were carefully selected in order to exclude those that had a psychological nature (Cohen & Hoberman, 1983).  Respondents rate how frequently various symptoms have been a part of their life over the past month, on a four-point Likert-type scale. The scale has been shown to be reliable with a reported alpha coefficient of .88.

Depression (DEP) was measured with the Beck Depression Inventory (Beck et al., 1961). This scale contains 21 items and measures one’s level of sadness, hopelessness and depression. This measure has been shown to be a reliable measure of depression with an alpha coefficient of .91. The construction of Beck’s inventory was primarily derived from the clinical practice of psychoanalytic psychotherapy of depressed patients (Beck et al., 1961).  The characteristic attitudes and symptoms of the depressed patients were taken into consideration when it came to this measurement.

Health Behaviors

The Health Behavior Check List (HB) (Vickers, et al., 1990) consists of 40 health behaviors selected to represent four major empirical categories that included behaviors related to maintaining and enhancing well-being, behaviors aimed at avoiding or minimizing the effects of accidents, behaviors involving risk taking, primarily as a pedestrian or driver, and avoiding substances that may adversely affect health (e.g., tobacco and alcohol) and to a lesser degree, other factors that might overtax the body’s adaptive capacities (e.g., germs, pollution).

The participants indicated how well each item described their typical behavior using a five point scale ranging from disagree strongly to agree strongly. The coefficient alpha internal consistencies of .65 or greater were obtained for all scales except the brief Substance Risk Taking scale, which had an average alpha of .55. However, the data was computed a total score and not the individual subscale scores.

            The Center for Epidemiologic Studies Depression Scale (CES-D) was developed in the 1970s to assess for major or clinical depression.  The CES-D has been used in numerous studies and has been shown to be a valid screening tool for detecting depressive symptoms in general populations and in psychiatric populations (Weissman et al., 1977).  The target scores range from 0 to 60; a score of 16 or higher has been used by previous researchers (Frerichs et al., 1981; Goldberg et al., 1985) to indicate high depressive symptoms and was used in the analysis of the present study.  The variables, which were assessed in relation to depressive symptoms were gender, age, religious affiliation, and purpose in life.

Summary

            The chapter started with a review of the purpose and the problem of this research. It reiterated the potential of religious switching as a measure of religiosity in relation to health, well-being and life satisfaction. It involved the research questions and hypotheses that guided this research. The participants were described according to their ages, educational attainment, social status and religious affiliation. The procedure was also discussed in detail as to how the researcher conducted this study. It also involved the measurement that were utilized in terms of religious involvement, other measures of religiosity, health outcomes and behaviors. The researcher utilized different models of measurement from existing previous research that tackled the religion-health link.

REFERENCES

Ainlay S., Singleton R.,  and Swigert VL (1992). Aging and religious participation: reconsidering the effects of health. Journal of Scientific Study of Religion 31, pp. 175-188.

Baker, M., & Gorsuch, R. (1982).  Trait anxiety and intrinsic-extrinsic religiosity.  Journal for the Scientific Study of Religion, 21(2), 119-122.

Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. E., & Erbaugh, J. K. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.

Benjamins, M. R. (2006). Religious influences on preventive health care use in a nationally representative sample of middle-age women. Journal of Behavioral Medicine, 29(1), 1-16.

Cohen, S., & Hoberman, H. H. (1983).  Positive events and social supports as buffers of life change stress.  Journal of Applied Social Psychology, 13(2), 99-125.

Diener, E., Emmons, R. A., Larsen, R. J., & Griffith, S. (1985). The satisfaction with life scale.  Journal of Personality Assessment, 49, 71-75.

Ellison, C. G., Gay, D. A., & Glass, T. A. (1989). Does religious commitment contribute to individual life satisfaction?  Social Forces, 68(1), 100-123.

Faith development theories. (2004). Prevette Research, pp. 1-16.

Glass, T. A., Mendes de Leon, C., Marottoli, R. A., & Berkman, L. F. (1999).  Population based study of social and productive activities as predictors of survival among elderly Americans.  British Medical Journal, 319, 478-483.

Gordon, P. A., Feldman, D., Crose, R., Schoen, E., Griffing, G., & Shankar, J. (2002). The role of religious beliefs in coping with chronic illness. Counseling and Values, 46(3), 162+.

Helm, H. M., Jays, J. C., Flint, E. P., Koenig, H. G., & Blazer, D. G. (2000).  Does private religious activity prolong survival? A six-year follow-up study of 3,851 older adults. Journal of Gerontology, 55A(7), M400-M405.

Hill, T. D., Ellison, C. G., Burdette, A. M., & Musick, M. A. (2007). Religious involvement and healthy lifestyles: Evidence from the survey of Texas adults.  Annals of Behavioral Medicine, 34(2), 217-222.

Hendershot, G.E., ( 2003) Mobility limitations and complementary and alternative medicine: Are people with disabilities more likely to pray? American Journal of Public Health 93(7), pp. 1079-1080.

Hill, J.  , (2004). Theorizing religious switching over the life course. American Sociological Association. Retrieved on 26 March, 2009, from http://www.allacademic.com/meta/p109085_index.html.

Hoge, D. R., Johnson, B., Luidens, D. A. (1995). Types of denominational switching among protestant young adults.  Journal for the Scientific Study of Religion, 34(2), 253-258.

Hummer, R. A., Ellison, C. G., Rogers, R. G., Moulton, B. E., & Romero, R. R.  (2004).  Religious involvement and adult mortality in the United States:  Review and perspective.

Jenkins, R. A., & Pargament, K. I. (1988). Religion and spirituality as resources for coping with cancer.  Journal of Psychosocial Oncology, 13, 51-74.

Kasl, S. and Idler, E. (1997). Religion among disabled and nondisabled elderly persons I: cross- sectional patterns in health practices, social activities, and well-being. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 52B(6), pp. S294-2305.

Kasl, S. and Idler, E. (1992). Religion, disability, depression and the timing of death. American Journal of Sociology 97(4), pp. 1052-1079.

Kirbly, S.E.,  Coleman, P.G., & Daley, D (2004). Spirituality and well-Being in frail and non frail older adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 59:P123-P129.

Krause, N. (2006). Gratitude toward God, stress, and health in late life.  Research on Aging, 28(2), 163-185.

Krause, N., & Wulff, K. M. (2005). Church-based social ties, a sense of belonging in a congregation, and physical health status. The International Journal for the Psychology of Religion, 15(1), 73-93.

Koenig, H. G., Ford, S. M., George, L. K., Blazer, D. G., & Meador, K. G. (1993). Religion and anxiety disorder: An examination of associations in young, middle-aged, and elderly adults.  Journal of Anxiety Disorders, 7, 321-342.

Musick, M. A. (1996). Religion and subjective health among Black and White elders.  Journal of Health and Social Behavior, 37, 221-237.

Oxman, T. E., Freeman, D. H., Jr., & Manheimer, E. D.  (1995). Lack of social participation or religious strength and comfort as risk factors for death after cardiac surgery in the elderly. Psychosomatic Medicine, 57(5), 5-15.

Pew Forum on Religion & Public Life / U.S. Religious Landscape Survey (2008).

Pavot, W. & Diener, E. (1993). Review of the satisfaction with life scale. Psychological Assessment, 5, 164-172.

Porterfield, A. (1998). The power of religion: A comparative introduction. New York: Oxford University Press.

Powell, L. H., Shahabi, L., Thoresen, C. E. (2003). Religion and spirituality: Linkages to physical health.  American Psychologist, 58(1), 36-52.

Roof, W. C. (1989). Multiple religious switching: A research noted. Journal for the Scientific Study of Religion 28(4), pp. 530-535.

Ryff, C. D. (1989). Beyond Ponce de Leon and life satisfaction: New directions in quest of

            successful aging. International Journal of Behavioral Development, 12, 35-55.

Ryff, C. D., & Keyes, C. L. M. (1995) The structure of psychological well-being revisited.

            Journal of  Personality and Social Psychology, 69, 719-727.

Ryff, C. D., & Singer, B.  (1996). Psychological well-being: Meaning, measurement, and

            implications for psychotherapy research.  Psychotherapy and Psychosomatics, 65(1), 14-23.

Sherkat, D. and Ellison, C. (1999). Recent developments and current controversies in the sociology of religion. Annual Review of Sociology, p. 363.

Stark, R. and McCann, J. C. (1993). Market forces and Catholic commitment: Exploring the new paradigm. Journal for the Scientific Study of Religion, 32, pp. 111-124.

Strawbridge, W. J., Shema, S. J., Cohen, R. D., & Kaplan, G. A. (2001). Religious attendance increases survival by improving and maintaining good health behaviors, mental health, and social relationships.  Annals of Behavioral Medicine, 23(1), 68-74.

Underwood, L. (1999). Daily spiritual experiences. Multidimensional measurement of religiosity/spirituality for use in health research: A report of the Fetzer Institute/National Institute on aging working group (1999/2003).

Wong-Mcdonald, A., & Gorsuch, R. L. (2004). A Multivariate Theory of God Concept, Religious Motivation Locus of Control, Coping and Spiritual Well-Being. Journal of Psychology and Theology, 32(4), 318+.