Religion, spirituality, and acute care hospitalization and long-term care use by older patients.
BACKGROUND
The impact of religion and spirituality on acute care hospitalization (ACH) and long-term care (LTC) in older patients before, during, and after ACH is not well known.


METHODS
Patients 50 years or older consecutively admitted to the general medical service at Duke University Medical Center were interviewed shortly after admission (N = 811). Measures of religiosity were organized religious activity (ORA), nonorganizational religious activity (NORA), religiosity through religious radio and/or television (RTV), intrinsic religiosity, and self-rated religiousness. Measures of spirituality included self-rated spirituality and daily spiritual experiences (DSE). Primary outcome was number of ACH days during an average 21-month observation period. Secondary outcomes were times hospitalized and number of days spent in a nursing home or rehabilitation setting (collectively, long-term care: LTC). Race and sex interactions were examined.


RESULTS
In the cross-sectional analysis, ORA was the only religious variable related to fewer ACH days and fewer hospitalizations, an effect that is fully explained by physical health status and that disappeared when examined prospectively. The number of LTC days was inversely related to NORA, RTV, and DSE, effects that were partially explained by social support but not by severity of medical illness. Interactions with race and sex were notable but reached statistical significance only among African Americans and women. In those groups, religious and/or spiritual characteristics also predicted future LTC use independent of physical health and baseline LTC status.


CONCLUSIONS
Relationships with ACH were weak, were confined to ORA only, and disappeared in prospective analyses. However, robust and persistent effects were documented for religiousness and/or spirituality in the use of LTC among African Americans and women.
Department of Psychiatry, Duke University Medical Center, Durham, NC 27710, USA. koenig@geri.duke.edu
Harold G
HG
Koenig
Linda K
LK
George
Patricia
P
Titus
Keith G
KG
Meador
D001741:Black or African American; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006760:Hospitalization; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012068:Religion and Medicine; D012737:Sex Factors; D029181:Spirituality