title: Spiritual Pain in Meals on Wheels' Clients.
abstract: BACKGROUND
  Meals on Wheels' clients are at risk for spiritual pain due to advanced age, social isolation, and failing health. They are also prone to stress, depression, and loneliness, placing them at risk for adverse biological disruptions and health outcomes. The purpose of the study was to examine associations of spiritual pain with psychosocial factors (stress, depression, loneliness, religious coping) and salivary biomarkers of stress and inflammation (cortisol, IL-1β) in Meals on Wheels' clients.
  
  
  METHODS
  Data were collected cross-sectionally from 88 elderly (mean age 75.4). Spiritual pain, stress, depression, loneliness, and religious coping were measured with standardized instruments, and salivary biomarkers were assessed with enzyme immunoassays.
  
  
  RESULTS
  Spiritual pain was significantly and positively correlated with stress (r = 0.35, p ≤ 0.001), depression (r = 0.27, p = 0.01), and negative religious coping (r = 0.27, p = 0.01). Correlations with loneliness, positive religious coping, and salivary biomarkers were non-significant.
  
  
  CONCLUSIONS
  Spiritual pain is an important concept in this population. Research should be expanded to understand the significance of spiritual pain in conjunction with psychosocial and biological variables and its potential impact on physical, mental, and cognitive health outcomes in the elderly.
authors.affiliation: School of Nursing, The University of Texas Health Science Center, Houston, TX 77030, USA. lisa.boss@uth.tmc.edu.
authors.forename: Lisa
authors.initials: L
authors.lastname: Boss
authors.affiliation: School of Nursing, The University of Texas Health Science Center, Houston, TX 77030, USA. sandra.m.branson@uth.tmc.edu.
authors.forename: Sandy
authors.initials: S
authors.lastname: Branson
authors.affiliation: School of Nursing, The University of Texas Health Science Center, Houston, TX 77030, USA. stanley.cron@uth.tmc.edu.
authors.forename: Stanley
authors.initials: S
authors.lastname: Cron
authors.affiliation: School of Nursing, The University of Texas Health Science Center, Houston, TX 77030, USA. duck-hee.kang@uth.tmc.edu.
authors.forename: Duck-Hee
authors.initials: DH
authors.lastname: Kang
keywords: aging; biobehavioral; depression; loneliness; salivary biomarkers; spiritual pain; stress