Strategies to promote hope and spirituality in the elderly: A narrative review


Introduction: Aging is a period of life travel experiences during which elderly people are subjected to potential threats, such as increased risk of chronic diseases, loneliness and isolation, and lack of social support. In some cases, their individual independence is also threatened due to physical and mental disabilities. These factors may result in decreased quality of life and put their physical and mental health at risk. Beneficial effects of positive components (e.g., optimism, hope and spirituality) on physical and mental health has been confirmed in various studies. Methods: The purpose of this study is to review the strategies to promote hope and Spirituality among the elderly people. Available databases were assayed using appropriate keywords, both in Persian and English, during 2000-2016. 78 articles were obtained and finally 46 articles relevant to our desired objectives were selected and analyzed. Similar studies were excluded at the discretion of the author, or merged together as far as possible. Conclusion: Strategies were proposed to promote spirituality and hope among the elderly people.

Keywords: Elderley, hope, older people, spirituality

How to cite this article:
Taraghi Z, Lolaty HA, Mohammadpour RA, Abbasabadi AO. Strategies to promote hope and spirituality in the elderly: A narrative review. Ann Trop Med Public Health 2017;10:1619-26
How to cite this URL:
Taraghi Z, Lolaty HA, Mohammadpour RA, Abbasabadi AO. Strategies to promote hope and spirituality in the elderly: A narrative review. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Dec 10];10:1619-26. Available from:

Positive psychology is a new field of psychology dealing with increasing positive psychological abilities in the society and enabling people to confront psychological stresses. Factors such as hope, happiness, and spirituality can be important factors in improving elderlies’ psychological health. Therefore, positive psychology focuses on the aspect of positive psychological and its augments rather than psychopathological aspects.[1] Hope is considered as one of the most important aspects of mental health. In fact, it represents the achieved results which are evaluated to be uncertain, but possible.[2] Elderlies who are more hopeful see others as supporting sources on which they can rely; they get adapted with the challenges they might confront in life, experience higher level of happiness, and are more satisfied with their life.[3] Spirituality components have a focused subject by psychologists and psychotherapists in recent years (Anikó, 2011). Very few studies have been conducted on elderlies’ spirituality either qualitative or quantitative Iran.[4] The main purpose of this study is to review the strategies to promote hope and spirituality in elderlies, which is discussed as follows:

Concept of hope

Increased longevity of human makes them expect to spend more years in healthiness and be active; so now, the term life expectancy has been replaced with the concept of hope for healthy life, i.e., not of absence of disease but rather living without functional limitations.[5] From Snyder’s perspective (2000), hope is a positive motivational state which is based on a sense of stability and inviolability and is a product of one’s interaction with the environment. In other words, hope is the ability to create paths toward the desired goals and having the motivation to move along these paths.[6] Hope is known as a collection of knowledge based on the feeling of success. This feeling is routed in the different sources (goal-oriented energy) and paths (planning to achieve the goals).[7]

In Snyder’s theory (2000), hope is an individual variable remaining stable during assessment of the potentials attributed to the goal although it is affected by factors such as counseling and training at various levels. Hope is not a passive excitement occurring only in dark moments of life but is a cognitive process through which individuals actively follow their goals. Hope involves a cognitive mental set created based on a dual-derivative sense from success paths and brokerages.[8]

In this regard, hope is different from optimism. Seligman (1996) believes that optimism is more like a descriptive style than a broad personality trait. According to this perspective, optimists attribute negative experiences to external, temporary, and specific factors while pessimists attribute negative events and experiences to internal, stable, and general factors.[9] Optimists seek changes but their planning powers are weak but a hopeful people focus their efforts to the goal and possess a strong desire to achieve their goals.[10] Hope is a pleasant feeling while optimism is a consequence obtained by a thinking pattern and creates a positive attitude in the person. In psychology, this positive attitude or optimism is used for regular treatment of pessimism.[11] In fact, hope represents the extent of achieving results which are evaluated to be uncertain but possible while optimism is the reflection of expectations and is consistent with the goal based on the future results. Passion is totally eliminated in the optimism.[12]

Hope components

Snyder’s theory consists of three main components: goals, broker (operating thought), and pathway and includes a process through which people set the goals, create strategies, and maintain them during the path.[6],[13] Goals are of great importance in cognitive conceptualization of hope.[14]

Clear goals are the cornerstone of the theory that can be short term, medium term, or long term and include anything that an individual desires to achieve, accomplish, experience, or create. In the theory of hope, goals are the main source of excitement. Positive excitement is the results of achieving the goal or imagining approaching it, while negative excitement is routed in failing to achieve a goal or imagining to get far from it. Pathways indicate the ability of people to perform feasible means attributing the goal. The pathway thought is the ability perceived by an individual to identify and create paths toward the goal. Pathways are specified by inner speech (I’ve found a way to do it).[6] Broker is an incentive component guaranteeing the power to start, persistence, and the effort required to follow a specific pathway. It motivates the individual to start and keep moving along the path toward the goal. These three components of hope (goals, broker, and pathway) interact with each other and have a cross effect.[9],[15]

Consequences of hope in life

Joy and happiness

Schwarz and Strack [16] believe that happy people are inclined to optimism and happiness in processing information; therefore, they have a higher life expectancy.

Reduced fear and stress

Whoever loses the hope for improvement and rectification will be subjected to fear and anxiety regarding the future and ultimate results. One thing that can reduce their fear and anxiety is to have hope. Someone who worships God knows that everything is attributed to God’s will. God can bring the human from wretchedness of sin to the climax of dignity and honor by repentance, so there is no reason to be hopeless. Moreover, our expectation from ourselves and the people around us should be rational and commensurate with our effort and work so that we will not fail and become disappointed as a result.[17]

Increased decision-making power and social participation

Increased social interactions, collective participation, and decision-making power can increase spirituality, capability, and hope. In cognitive-social terms, hope is directly related to cognitive decision-making as it can prompt people to make decisions under critical conditions (e.g., taking risks in real situations). In real situations, one’s decisions depend on their perception of the risk (the extent of risk taking) and hope index. This makes the individual decide according to the situation and their expectations from its outcome and benefit.[18]

Concept of spirituality

Spirituality is a psychological quality beyond religious beliefs, which motivates the human and creates feelings such as understanding the majesty of God and respect for creation. Spiritual person has a purpose in life and understands the meaning of life. Even in cases that the individual does not believe in God, the spiritual aspect make him/her think about creation and infinite world. This important aspect of life is highlighted when the human is subjected to emotional stress, severe illness, and death. According to the most recent sociological researches, 95% of people believe in God. Researchers have found no human race that do not have a kind of religion. As a set of beliefs, norms, and specific and generalized values, religion is one of the most effective psychological supports. It is able to provide the meaning of life throughout the moments of life and can rescue an individual from suspense and being meaninglessness by providing explaining supports under certain conditions.[19] Spirituality is a complex concept described in the literature related to health and is considered as the effort of a person to respond ultimate questions about meaning and transcendence.[20] Spirituality can predict both resilience and well-being of the individual against problems.[21] Spirituality is related to human spirit (such as love and compassion, tolerance, contentment and generosity, sense of responsibility, sense of harmony, and conformity) and brings happiness for oneself and others.[22]

One of the scholars has suggested three meanings for spirituality: (1) A capacity for individual to perfection, (2) a religious part of life and methods through which the capacity of individual perfection realizes by God’s will, and (3) a special religious experience resulting in individual perfection, such as Hindu, Islam, Christian, Buddhist, and Jewish religions.[23] Another commentator defines spirituality as releasing from oneself and move beyond intellectual instincts resulting in survival.[24] Spirituality is a merge of structure belief and meaning and is the effort for “deep understanding of being.” This term has been conceptualized as “being” and allows the individual to experience the transcendent meaning of life. This concept is often considered as relationship with God; however, it can be applied in relationship with the nature, art, music, family, society, or any belief giving the person a feeling of being meaningful and purposeful in life.[25] Swinton et al.[26] believe that spirituality is an aspect of human being giving humanity to the individual and believe that spirituality is related to important individual structures and help him to confront life issues (Swinton, 2001,[26] taken from Aminayi et al., 2015). Vaughan [27] stated that spirituality is the highest growth level in areas such as moral knowledge and excitement and considers it as an attitude involving transcendent experiences.[27]

According to a number of studies, spirituality is a strong predictor for hope and psychological health (Davis, 2005;[28] Moss and Dobson, 2006). Elkins et al.(1988) stated that spirituality is a multidimensional structure having 9 major parts: spiritual or supernatural aspect, meaning and purpose in life, having a mission if life, holiness of life, not possessing materialist values, idealistic altruism, knowing the tragedy, and benefits of spirituality.[29]

General perspectives of spirituality

According to the available sources, the spiritualism might be briefly introduced as the following from two perspectives: general view inclined to Islam (did you mean Islam?) and divine religions view.[30]

    1. From general and international perspective,
      1. Purpose in life
      2. Experience of promotion and excellence
      3. Social manifest
      4. Commitment to defined moral norms.
    1. From divine religions perspective,
    1. Knowing God, seeking God, and God centeredness
    2. Understanding the purpose of creation and life
    3. Trying for spiritual development and self-improvement
    4. Reliance (knowing God as the absolute power and wisdom, performing individual tasks while always seeing God in divine and infinite position).

Therefore, it can be generally be argued that the importance and necessity of achieving spirituality and hope by elderlies lies in the fact that by increasing in age, many elderlies turn toward the development of new communications depending on how they react to life challenges, such as death of a spouse, reduced physical function, and changes in roles, for example, retirement.[31] Furthermore, different crisis of this period is a good opportunity for individual in terms of spiritual development among the elderly. An individual does not care for evaluation of spirituality and understanding the internal and spiritual nature of oneself in any period as much as old ages. In this period, one seeks for peace, giving meaning to life and improving their own spiritual relationships as well as finding answers to solve social and cultural problems.[32] Evidence shows that the spiritual capacity of the elderly gradually increases based on the hope of having a perfect life.[33] Greasley et al.[34] also noted the importance of spiritual beliefs as a source of comfort and support during crisis. Culliford [35] pointed out to the abundance of reports regarding the positive effect of religious and spiritual beliefs on health and well-being. Therefore, given the changes resulting from aging which make the elderly prone to isolation and depression, providing strategies to promote spirituality and hope in the elderly can help in adapting to the needs and individual changes in the elderly.

Materials and Methods

The current study is a review on the articles available regarding spirituality and hope in the elderly. In addition, strategies have been proposed to promote hope and spirituality in the elderly. Available databases including Civilica, Ensani, proQuest, SID, Medline, PubMed, Noormags, Magiran, and Science Direct were assayed using the keywords hope, optimism, hope promotion, hope therapy, spirituality, spiritual health, spirituality development, spirituality teaching, spirituality in the elderly. Relevant Persian and English articles from 2000-2016 were used. Seventy-eight articles published from 2000 to 2016 were selected, 46 of which having the highest relevance to the research objectives were selected and analyzed. Similar studies were excluded at the discretion of the author or merged together as far as possible.


Baily and Snyder [36] believe that the elderly experience less hope. They also stated that the level of hope is related to the extent of satisfaction with life and happiness as well which is low in the elderly who have separated, got divorced, or are widows than the others.[36]

The concept of hope in the Quran can be examined in two perspectives: belied and behavior. Since the Quran has addressed enforcement of people’s knowledge, the most important one of which is faith and belief in monotheism, prophethood, and resurrection; the reason for the need to create hope and the spirit of hope development in human is because if an individual is not hopeful about the future, he/she will naturally show a behavior far from common human nature, which will not be ineffective in directing the society toward pessimism. The most important behavioral strategies of Quran in individual area are remembrance of God, vigil, prayer, and recitation of the Quran and in the social area are charity, mercy, forgiveness, enjoin the good and forbid the evil, and to fulfill the promise.[37]

A selection of related articles along with their title and methodology is presented in [Table 1].

Table 1: A selection of articles related to spirituality and hope

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Strategies to promote hope in the elderly

Some of the strategies to promote hope are

    • Quran behavioral strategies to increase and enforce hope:[37]
      • Individual strategies
        • Remembrance of God
        • Fear of God (hope-creating fear)
        • Repent to God
        • Vigil.
      • Social strategies
        • Enjoining good and forbidding wrong
        • Beneficence
        • Forgiveness
        • Fulfilling the promise.
      • Charity
    • Existence of hope (positive thinking): Whether a matter exists or not is the precedence of people believing in it. The same stands for hope. There is no believer whose heart is not enlightened with two lights: light of hope and light of fear, which have equal weights says Imam Sadiq (PBUH). Positive thinking generates energy, capability, and encouragement. If we want to be hopeful in life, we have to see the full half of the glass. In this regard, going along with life beauties and thinking about one’s own properties is useful. Knowing the hardships and commenting on the shortcomings, which is a coin, makes it unnecessary to ignore other coins that are clusters, beauties and gadgets.[37]
    • Introducing love, interest, and purpose into life: taking a look to the purpose of life of people around the world indicates three lifestyles:
      • Useful life: Living to build a better world based on smile, happiness, peace, hope, and bright perspective
      • Harmful life: Living to destroy the world, along with weeping and sorrow
      • Useless life: Living for nothing, neither for destroying nor improving the world, only living to die [11]
      • One of the main reasons leading people to apathy, lack of identity, and disappointment is not having a proper understanding of the purpose and philosophy of life. Therefore, one has to reinforce healthy and logical relationships and pay attention to a philosophy of life based on religion and wisdom to avoid this harm.
  • Removing factors threatening hope in the life: lack of faith, lack of a proper understanding of ourselves and our own capabilities, not having a plan in life to achieve our goals, fear and anxiety (which is like a disease in a person and his life), sorrow and comparing our life with others, demanding and expect too much of ourselves, and emotional and informational poverty.[38]
  • Training positive thinking by focusing on Quran verses and Islamic teachings: A positive way of emphasizing Quranic verses is to make a person more precise with his personal perceptions. Optimist people expect God to help them during difficult situations and use mental coping strategies such as prayer and hope. They evaluate the events related to God and positive and are satisfied with God’s will as they have hope for the future.[39]

Strategies to promote spirituality in the elderly

Elderlies are more prone to chronic illness, bereavement, loss, disability, and dysfunction than other age groups. Therefore, spiritual care is more important in this group. An individual evaluates himself/herself in terms of spirituality during crisis more than any other time and this could be an opportunity for individual in terms of spiritual growth. Spirituality is a critical component of successful elderliness and is considered an important factor to perceive life.

  • Planned life of the elderly: Planning makes the elderly experience different aspects of life, namely, getting familiar with ideological, spiritual, and cultural concepts presented to them during different life programs (Sayed-al-Shohadayi et al., 2013).
  • Living and associating with people of the same age induces the feeling that challenges and problems of life is not only for them because there are other people confronting these problems. This common ground makes them alleviate their internal pressure by screed and retelling problems. It has an important effect on elderlies’ spiritual promotion (Sayed-al-Shohadayi et al., 2013).
  • Learning spiritual behavior: Doug Aumann from Berkeley University stated in the 2006 during the annual meeting on behavioral medicine that spirituality affects health in different ways; however, we do not know how spiritual behavior is learnt. Aumann proposed the theory of spiritual learning based on Bandura’s theory focusing on the theory of social learning and believes that this theory can be easily used in education. We learn spiritual behavior from others: face to face, from the media, through speech, writing, and electronic means. Auman, emphasizes on Bandura’s “social cognitive” theory that: learning through observation and learning along with self-confidence and self-esteem is the core of spiritual learning.[40]
  • Various spiritual interventions: Except teaching and advisory methods and treatments offered by religious and spiritual circles to alleviate elderlies’ pain and worries, research has shown that various scientific and hospital methods are effective in promoting the spirituality of the elderly, including: religious therapy And spiritual, cognitive therapy with a religious and spiritual approach, religious and spiritual counseling, forgiveness therapy, group therapy, family therapy with a religious and spiritual approach, book therapy with the study of holy and spiritual texts, healing and healing in places and religious circles And spiritual.[41],[42],[43],[44],[45],[46],[47],[48],[49],[50],[51],[52]

Elderlies are more prone to chronic illness, bereavement, loss, disability, and dysfunction than other age groups. Therefore, spiritual care is more important in this group. An individual evaluates himself/herself in terms of spirituality during crisis more than any other time and this could be an opportunity for individual and spiritual growth. Moreover, hope has a significant role in human’s psychological health. It gives meaning to the life and prevents one’s psychological collapse during emergence of difficulties and crises of life. The strategies proposed in this study can be useful in promoting hope and spirituality in the elderly.

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Conflicts of interest

There are no conflicts of interest.

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ATMPH.ATMPH_552_17


[Table 1]

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