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Journal of Religion, Spirituality & Aging
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An Exploration of Health and Religion
in Elderly People Through the Lens of
Scriptural Reminiscence
Elizabeth MacKinlay
a
& Colin Dundon
a
a
Charles Sturt University , Canberra , Australia
Published online: 10 Jan 2012.
To cite this article: Elizabeth MacKinlay & Colin Dundon (2012) An Exploration of Health and Religion
in Elderly People Through the Lens of Scriptural Reminiscence, Journal of Religion, Spirituality &
Aging, 24:1-2, 42-54, DOI: 10.1080/15528030.2012.632714
To link to this article: http://dx.doi.org/10.1080/15528030.2012.632714
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Journal of Religion, Spirituality & Aging, 24:4254, 2012
Copyright Taylor & Francis Group, LLC
ISSN: 1552-8030 print/1552-8049 online
DOI: 10.1080/15528030.2012.632714
An Exploration of Health and Religion
in Elderly People Through the Lens
of Scriptural Reminiscence
ELIZABETH MACKINLAY and COLIN DUNDON
Charles Sturt University, Canberra, Australia
An extensive body of quantitative research associates well-being in
later life with religious involvement. This article reports on a pilot
study of one specic aspect of religious involvement hitherto insuf-
ciently investigated, namely, Scriptural Reminiscence (SR). SR is
the interpreting of biography in the light of Scripture in recognition
of Scriptures unique place in the self-as-narrative of older people
of faith. The study was of two small groups of older people meet-
ing weekly over a six-week period with a follow-up focus group to
explore SR, their faith journey, practice of religion, and mental
health. The qualitative ndings are reported in this article.
KEYWORDS Ageing, religion, Scriptural Reminiscence, mental
health
INTRODUCTION
An extensive body of quantitative research associates well-being in later life
with religious involvement. Yet, little is known of the reasons for these nd-
ings, particularly because religious involvement is too broad a category for
ready analysis. We aimed to study one specic aspect of religious involve-
ment hitherto insufciently investigated, namely, Scriptural Reminiscence
(SR) (Anstey, 2008). SR is the interpreting of biography in the light of
Scripture in recognition of Scriptures unique place in the self-as-narrative
of older people of faith. This article reports on a pilot study of SR, consisting
of two small groups of older people meeting weekly over a six-week period
Address correspondence to Elizabeth MacKinlay, Centre for Ageing and Pastoral Studies,
15 Blackall Street, Barton, ACT 2600, Australia. E-mail: EMackinlay@csu.edu.au
42
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Scriptural Reminiscence 43
with a follow-up focus group to explore SR and their faith journey, practice
of religion and mental health. Pre- and posttests revealed signicant decrease
on the Geriatric Depression Scale (GDS) scores, slight decrease in religious
practices, and self-reported agitation (anxiety) and negative religious cop-
ing decreased, whereas a positive attitude to ageing and positive religious
coping increased. It is important to note that this was a pilot study with
small numbers thus statistical analysis cannot be relied upon. The qualitative
ndings are reported in this article.
To what extent do older Christians engage with Scripture? Is there a link
between engaging with Scripture and health? Often it is assumed that adult
Christians have a good grasp of Scripture and can readily apply Scripture
as a guide to living. A comment from a participant in the focus group held
after completion of this pilot study was typical of the participants in the two
groups: Speaking personally, I mean Im not used to engaging in Scripture
at all, and therefore it was a learning experience for me to even nd out that
there are three ways that you can do it. And I certainly found the method
that we used helpful.
LITERATURE
The Relationship Between Scripture and Health
The effects of religion on health are still not well understood in spite of
the abundant literature from epidemiological data and increasing evidence
from clinical trials that there is a positive relationship between religion and
health (Koenig, 1998; Koenig, McCullough, & Larson, 2001; Moberg, 2001).
As yet, little is known of the reasons for these ndings, particularly because
religious involvement is too broad a category for ready analysis. Further,
caution has been urged in the too-ready inclusion of religious activities as a
means of medical treatment (Sloan et al., 2000; Sloan & Bagiella, 2002).
Knowing what about the practice of religion makes a difference to the
health of older people is much more difcult to discover. While measures
of church attendance have shown correlations of health and religion, it is
still difcult to account for the differences between churchgoers and those
who do not attend. The actual nature of the relationship between health and
the practice of religion needs to be more fully understood to be of value in
clinical settings.
A way of understanding the differences, at least in the Abrahamic faiths,
may be through examination of the relationship of individual believers and
their God. Joel Green (2003) describes the way that Western societies have
come to consider relationship of health, in isolated ways, for instance (my
need, my treatment, my health) and in ways more segregated (spiritual,
physical, relational versus genetic) (Green, 2003, p. 6061). Green goes on
to assert that it is:
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44 E. MacKinlay and C. Dundon
precisely here that the witness of scripture holds out its promise and
challenge. Rather than begging to be applied to our lives, seeking for its
message to be molded to the contours of our worlds, the scriptures yearn
to reshape and reconstitute the categories by which we comprehend our
lives, our worlds, even our greatest needs. Reading scripture, we enter
into its evaluation of our condition, but also encounter its promise of
restoration, its hope of health. (Green, 2003, p. 61)
This constitutes a re-evaluation of life challenged by scripture, Green
calls this an autobiographical reconstruction (Green, 2003, p. 116), noting
that this generally comes through understanding ones place within the
history of Gods purpose (2003, p. 116).
Scripture contains the central stories of faith, it is through linking these
stories of faith with the life of the person journeying in their faith that healing
and health can come.
Recognition of the central place of story in the lives of human
beings is one of the important developments being seen in the early
years of the twenty-rst century. Reminiscence, life review, autobiography,
narrative gerontology, spiritual reminiscence, and spiritual autobiography,
reminiscence therapy, spiritual reminiscence work, whichever term is
applied, there is growing interest in human story (Coleman, 1994; Gibson,
1998, 2004; Haight & Webster, 1995; MacKinlay, 2006; Webster & Haight,
2002).
In the current busyness of work and social spheres of Western societies,
story has been neglected until relatively recently. Without these connections
of story between generations we are lessened in our humanity and in our
communities. Kenyon, Clark, and de Vries (2001) note that a basic assump-
tion of narrative gerontology is that storytelling and story listening are not
just things we do occasionally, rather they constitute the process by which
we create and discover our personal identity as human beings (Kenyon,
2003, p. 30). He enlarges on this to include the function of story-telling and
listening, to not only ideas, but emotions and behaviour. As well, we are
each a part of the larger stories of our families, our faith, our communi-
ties, our nation and our own story is interwoven with each of these larger
stories. Reminiscence is the general term that refers to remembering events
from the past and it is a naturally occurring event (Butler, 1995). Coleman
(1999) describes the characteristics of a successful story as being one that
bears on the subject of reconciliation or harmony between the past, present,
and future.
Spiritual reminiscence is reminiscence that focuses on life meaning in
remembering and in particular, this strategy seeks to consider the persons
story in relation to his or her spiritual life journey, that is, ones life journey
as an individual, with family and community, and with God (MacKinlay,
2006, Moberg, 2001).
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Scriptural Reminiscence 45
Reminiscence is now used as a therapy by Haight and Webster
(Webster & Haight, 2002). Faith Gibson (1998, 2004) has used the term
reminiscence work in her study and research. This view of reminiscence is a
valuable one as it places reminiscence as a process for engagement by older
adults. In our work (MacKinlay, Trevitt, & Coady 20022005
1
) with people
who have dementia, we have chosen to use the term reminiscence work as
it seems to more accurately reect the interaction with the participants in the
study; the participants do work with their memories. In fact we have further
rened the term in our work to focus on spiritual reminiscence work; in
that perspective, we are examining issues of meaning in later life, including
relationship with others and/or God.
Coleman describes four characteristics of story: the need for coherence,
assimilation of life events into the story, a convincing structure, and a truth
value that is, story has an ethical dimension (Coleman, 1999). These four
characteristics t well into a spiritual understanding of being human and
ageing. First, to say that we are story, is to acknowledge that story connects
us to our deepest points of being, to our souls. Story is deeply tied to our
individual identity, to the core of our being. Second, stories being composed
of both facts and possibilities leaves open the possibility of spiritual journey
through the life span. Conversion, change, and renewal of being may occur;
the future is open and remains so as long as we live.
Third, the meaning and nature of time can also be considered at a
spiritual level. At the spiritual level it is suggested that story time becomes
more relevant than clock time; again, there is an air of openness to the
future and the possibility of connection to our past. Fourth, the interrelated
dimensions of both the personal and the larger story link very well to the
spiritual dimension. We are individuals, but we are part of a larger whole,
and we yearn for connections with others, with the stories of others and
with God, or a sense of otherness, however perceived by the person.
Thus reminiscence, or narrative gerontology, is a central component
of being human, and part of the spiritual journey in life. Increasingly this
is being recognised in our ageing society and in residential aged care.
A biomedical model for ageing simply does not paint the whole picture;
story lies at the centre of what it means to be human and growing older.
Butler notes that in later life people tend to have a particularly vivid
imagination and memory for the past and can recall with sudden and
remarkable clarity early life events (Butler, 1995, p. xvii). He writes that the
personal myths of invulnerability and immortality are no longer satisfying
and this results in reassessment of past life that may result in depression,
acceptance, or satisfaction. Butler contends that this process occurs in all
older people in their nal years, while Coleman (1986) found in his research
that some older people did not appear to engage in reminiscence. There
may be various reasons for this; perhaps they have already processed their
life story, perhaps very privately or perhaps they feel unable to deal with
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46 E. MacKinlay and C. Dundon
some aspects of their story and a blockage to reminiscence may be experi-
enced. However, Butlers assumption of the universal nature of reminiscence
seems now to be well accepted.
Possibilities for Health and Well-being Through Story
Application of Erikson, Erikson, and Kivnicks (1986) stages of psychosocial
development, lead to an inclusion of all life experiences, and the struggle
that occurs in the nal stage of life development between integrity and
despair may enable the person to review and reframe earlier life experiences.
In fact, the remembering and reprocessing of earlier negative memories may
enable the person to move towards ego-integrity in later life.
To deny the existence of disturbing or negative memories may move
the person towards a blockage of psychosocial and spiritual growth in
later life (MacKinlay, 2006). Taking this perspective, Coleman found that
normally reminiscence is rewarding for both the speaker and the listener;
however, this is obviously not so with painful memories (Coleman, 1999).
Coleman notes that the healing and reconciling activity of life review has
been neglected, despite Butlers early work in the 1960s. In a study of older
people and their war memories (WWII) Coleman noted that where disturb-
ing memories remained unintegrated it was necessary to make the original
experience explicit by categorizing and understanding it, for it to lose its
power to haunt us (Coleman, 1999, p. 136). The techniques needed to do
this may be found in reframing. Birren has developed a process of guided
autobiography over the past 25 years that is valuable in this process (Birren &
Cochran, 2001).
Scriptural Reminiscence
Reminiscence is already established as a valuable means of assisting older
people to nd meaning in their later years; our work with spiritual
reminiscence has taken this further (MacKinlay, 2006; MacKinlay & Trevitt,
2006). We propose to take this already established work to develop a pro-
cess of scriptural reminiscence that will harness the naturally occurring
reminiscence with the story of Scripture. Thus we intend to intentionally
link the peoples story with Gods story to assist older people to come to a
sense of the purpose and meaning of their lives.
Faith Stages Among Older People
It is assumed that the older people in the study may be at different stages
of their faith development, based on the work of Fowler and subsequent
study of stages of faith development (Fowler, 1986; Fowler, Nipkow, &
Schweitzer, 1992). Thus participants in a study may respond to engage-
ment with scripture at different levels. Some guidance for these stages may
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Scriptural Reminiscence 47
be given. Fowler has asserted that meaning, relationships, and a sense of
othernessthe supraordinate valuesare at the centre of his framework
of faith. This framework assumes the possibility of progression through a
number of stages of faith development. It is assumed that not all people will
progress through all stages, and, according to Fowler older people are more
likely to be at stages 3 to 5 of his 7-stage model (0-VI) (Fowler, 1986).
2
These
stages are: Stage III: Synthetic-conventional faith, a faith stance of late child-
hood that may remain through life, where the judgments and expectations
of others are important and it is accepted without question and is con-
formist. Next, Stage IV, Individuative-reective faith, which sees a relocation
of authority in the self, with a critical distancing from previously held value
systems, may be a nal stage for some. Stage V: Paradoxical-consolidative or
conjunctive faith is described as balanced faith, inclusive faith, a both/and
faith (Astley & Francis, 1992, p. viii) and may be found among older adults.
Finally, Stage VI, the so-called Universalizing faith, is described as a seless
faith and involves relinquishing and transcending of the self. It is seen by
Fowler (1981) as being rare.
It is noted, however, that this stage of spiritual development is seen
in numbers of frail elderly people and has been reported by numbers of
authors. Fowler did not interview people in the fourth age of life and this
may account for his view that this nal stage of faith or spiritual development
is rare. A more recent article by Fowler (1986) responds to critique from a
postmodern perspective and in it he argues the place of stages and types of
faith, suggesting that stages may be relevant for perhaps half of the picture
seen in faith development. How relevant is it to consider faith stages in this
study? In later life, it is argued that spiritual development is a dynamic pro-
cess with individuals being able to respond to the deep stirrings of spirit; to
life-meaning and choice-making in their spiritual lives. Further, there may be
blockages to continued spiritual development that may include such things
as a sense of meaninglessness or hopelessness in life, resentment, anger,
unforgiveness, or unresolved grief. Conversely, these factors may also serve
as triggers for spiritual growth (MacKinlay, 2006). It is asked how much of
this understanding of faith development might be relevant for older people
intentionally linking study of scripture with their faith journey? How might
this affect their mental health?
Research Questions
The questions for the pilot study were:

What is the relationship between mental health, religious practices, and


beliefs of the study group of elderly people?

Does scriptural reminiscence increase a small groups capacity to foster


trust and connectedness between members?

Rene the method of scriptural reminiscence for a larger study.


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48 E. MacKinlay and C. Dundon
MATERIALS AND METHODOLOGY
Recruitment of Participants
All members of two separate Christian congregations of 65 years and over
were invited to participate, making it clear that this was a pilot study, and
only one group from each congregation could be formed. The study was
advertised during the notice time of the weekly church services, and infor-
mation sheets and consent forms were distributed to interested people. The
full study, of which this study was a part, had been approved by the Ethics
Committee of Charles Sturt University.
Characteristics of the Group Members
All over 65 (one about to turn 65) and all practising members of a Christian
community of faith, they were able to speak English, and were cognitively
competent. All participants were living independently in the community.
The Study
A mixed-methods study was used to provide an evaluation of the men-
tal health and religious and spiritual well-being of participants. The items
used were Geriatric Depression Scale (GDS), short form; Philadelphia Morale
Scale (PMS), Religious scales: Fetzer Daily Spiritual Exercises, Fetzer Private
Religious Practice Scale, Fetzer Religious Coping Scale and Fetzer Religious
Support Scale. Analysis was by Statistical Package for the Social Sciences
(SPSS).
The GDS and PMS were both used to provide a broad perspective on
participant affect, both depression and positive morale. The religious scales
were used to examine the religious practices used by the participants; these
asked questions that provided richer data than typical questions used in
study of religion, that have traditionally only asked frequency of church
attendance and frequency of prayer. It was recognised that these measures
used over such a short time frame of the pilot study could not be relied
upon for as justication of results. The religious measures were all designed
in the United States and have not been previously used in Australia. It was
important to test these in the pilot groups before attempting to use them in
a wider study.
Qualitative measures of the weekly meetings over the six sessions
were taken by audiorecording and transcribing all sessions, and a research
assistant keeping a journal of nonverbal interactions of participants.
Qualitative data were analysed using NVivo8. Each of the two groups was
facilitated by an experienced, but different facilitator.
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Scriptural Reminiscence 49
STRUCTURE OF THE SESSIONS
Group Themes
The themes for the Scriptural Reminiscence were all stories from the New
Testament, with a focus on Advent, as the groups were conducted in
the Advent season of the Christian liturgical year. The six sessions were
titled Becoming Who We Are, Accepting Healing, Facing Our Fears, Being
Response-Able, Finding Sight, and Taking Our Time.
3
Length of Groups
Two groups met for approximately one hour each week for six weeks (one
group had a preliminary information and orientation meeting, while the sec-
ond group only met six times, with the orientation incorporated into the rst
session). Both groups participated in their own focus group meeting after
the conclusion of the sessions. The reason for group two having the orien-
tation in the rst session was to allow the whole exercise to be completed
prior to Christmas, after which it was anticipated that numbers of the group
members would be unavailable.
The short duration of only six weeks of the two group sessions meant
that it could not be expected that any of the quantitative measures would
change over the duration of the study; however, it was decided that the short
group sessions would provide valuable information on the nature and faith
experience of the group members and the way that they were able to use
the process of Scriptural Reminiscence to address life issues.
RESULTS
Quantitative
PARTICIPANTS
A total of 13 participants contributed responses to the questionnaires of the
Pilot Study, of which 4 were male and 9 were female. Average age of the
participants was 75.15 years, with a range of 65 to 91 (SD = 7.57).
Analysis of the pilot study data showed signicant decrease on the
Geriatric Depression Scale from the pretest to the posttest session. This result
is remarkable as only 6 of the 13 participants could be included in this
analysis (due to participants being removed from the analysis if they had
missing responses anywhere in the GDS on either the pretest session or the
posttest session). Therefore, from pretest to posttest, a signicant decrease
in depression scores was observed, on average, for the 6 participants with a
complete set of responses on the GDS. It is noted however, that none of the
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50 E. MacKinlay and C. Dundon
scores of the participants were indicative of having depression, only that the
scores changed signicantly over the six-week period.
A signicant difference was also observed on the Private Religious
Practices Questionnaire (PRP) of the Multidimensional Measurement of
Religiousness/Spirituality for Use in Health Research scales. This scale
was reversed for interpretation such that a high score indicates frequent
engagement in religious practices (PRP). On this scale a small but sig-
nicant decrease in religious practice was observed between pretest and
posttest.
All scales have been scored, except the Daily Spiritual Experiences
(DSE) questionnaire. The failure to score the DSE is due to the fact that
item responses vary from 1 to 4 on some items, and 1 to 6 on others,
and so neither adding item responses nor averaging item responses (as was
undertaken with other scales) would be appropriate.
It is noted that these results were found on a study of a very small
number of participants. A larger study is needed to obtain useful data. With
only 13 participants, the current pilot study did not have sufcient statistical
power to detect even moderate effects in the data. Thus, it is important to
note between pretest and posttest that self-reported agitation (anxiety) and
negative religious coping decreased, whereas a positive attitude to ageing
and positive religious coping increased.
Comparison of these gures suggests that the signicant improvement
between pretest and posttest can be attributed to higher ratings of life sat-
isfaction and an engagement (or re-engagement) in (unspecied) activities.
Despite the overall decrease in depression levels, and specic gains in some
areas, there was a decrease in overall energy levels reported by partic-
ipants between pretest and posttest, which cannot be explained from the
data.
Qualitative
Qualitative analysis of the weekly sessions of Scriptural Reminiscence, using
NVivo8 produced themes of identity and faith, relationships, wisdom and
meaning, vulnerability and transcendence, mental health and faith, and
identifying with the text as being important.
The two groups responded differently in the sessions and it is noted that
the different facilitation methods of the group leaders could be a factor in
these differences. Another factor to be considered is the faith development
stage of the participants, in line with faith development stages identied by
Fowler (1986, 1992), so that older people could be expected to be in any of
the last four stages of faith development from stage four through to the nal
seventh stage (Stage VI, in Fowlers stages of 0 to VI), described earlier in
this article.
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Scriptural Reminiscence 51
Focus Groups
A focus group was held for each of the study groups, after the completion
of all six sessions. The focus groups were led by a research assistant. Group
members found all themes for the sessions helpful. When asked: Which
ones (themes) were most meaningful for you? The rst responses from
the one group were on accepting healing. With the participant saying that:
SB07: Um, my memory has gone. It was, no, it, it was comforting for me.
Another participant said: SB05: The theme, . . . that I remember most
distinctly, and it was the theme of loneliness and addressing loneliness. And
I dont think its in the, quite in the set, and its actually forgiveness that is the
important factor, forgiving others and forgiving yourself. The members of
the one group noted that forgiveness had not been the focus of a session and
believed that it would be important to include in future work. In response
to the questions by the facilitator of, Why did they think that forgiveness is
important to include, SB05 replied:
We were having a joke before about cultural awareness, and I think its
part of the Australian character, particularly the male character, not to
address your emotions . . . kind of run away from your emotions and
pretend they dont exist. And whats been helpful in this process has
been to have people talking about their experiences. And becoming
aware that, you know, you can actively engage in a forgiveness exercise
which will, in fact, relieve some of the emotional pressures that exist
for you.
In response to the question: How do you understand your own biogra-
phy, your own self, in relation to Scripture? Has that changed as a result
of these sessions? SB07: It was delicious and pleasing and brought every-
thing together on past experiences within Scripture. SB06: I found week
4, actually, Being Response-Able, about, um, Anna and so on, Simeon, that,
and the whole idea of the wisdom of the age, I found that good. Did that
impact on my biography? I suppose the thinking about my own wisdom or
whatever. Yeah, that was good.
Further reecting on health, the life story and faith, SB03 responded:
I think those two and health, not necessarily in the state of being in
abundant physical health, but in being, I suppose, in the frame of mind
and body, health in that sense, even if you might be physically sick. You
know, I think its not being contradictory to say that you can, there can
be a sense of health, even if youve got a terminal illness. I think, might
say its quite subjective, but the three of them are integrated, you cant
put them into nicely measured doses; its more of a state of being than
anything.
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52 E. MacKinlay and C. Dundon
DISCUSSION
This study should be replicated to examine the factors in mental health and
ageing, associated with the use of Scriptural Reminiscence. The depression
measures used in this study would not be expected to show any change
in such a short study, however they did show signicant changes. If this
can be shown in a larger study, this kind of program may have important
application in the alleviation of depression and raising levels of well-being
in older adults.
Other elements of this study lacked the statistical power to provide
meaningful results. Yet this leaves some important issues in religious prac-
tice and spirituality in older people unresolved, especially the role of SR in
fostering trust and connectedness, the qualitative materials suggest a fruitful
research eld. Furthermore, those materials also suggest that it may now be
possible to explore the extent to which Fowlers (1981) Stage VI is found
among older people and how SR may contribute to that.
This study was conducted with two small groups (total participants =
13) all of whom were Christians. The content of the program used Christian
Scriptures to engage with the life journey. In a larger study, other ways of
engaging with the story of the ageing person will also be developed and
comparisons made of the use of Christian Scriptures and other major faith
groups with their Scriptures, and for people without a faith, an attempt will
be made to connect with secular values and stories.
CONCLUSION
The small pilot study showed surprising and unexpected results. In this
short study, two groups of older adults engaged in Scriptural Reminiscence
in weekly sessions over six weeks. All participants said that they found the
sessions helpful, and despite most of the participants having been members
of Christian congregations for many years, few had any knowledge of the
methods used to deepen their knowledge and understanding of Scripture
and engaging with it in living their daily lives. Statistically signicant results
from this short study would need to be replicated in a much larger study.
If they can be, there are clear implications for mental health of older people
who actively engage with their life stories and Scripture. Story goes to the
very core of what it means to be human; it is closely connected with identity
and its formation in a context that creates a structure of meaning and value.
Would this be the case for other older people who do not hold a faith? Can
a similar process be used to engage older adults with their life story and a
process of life meaning that will be effective in alleviating depression and
increasing well-being in older people. At this stage, it is not possible to say.
Further study into both these areas may produce important results for the
well-being of older adults.
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Scriptural Reminiscence 53
NOTES
1. Finding meaning in the experience of dementia: The place of spiritual reminiscence work. ARC
Linkage grant # LP0214980.
2. Fowler (1986) wrote that few older people reached the nal stage of his faith development
model, that of Universalising Faith. In my studies I have interviewed numbers of older people whose faith
perspective ts into this stage. I would thus disagree with Fowlers writings, that his studies contained
perhaps too few older people to draw this assumption.
3. Program designed by Dr. Elizabeth West, LCM.
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