Caring for Elderly People with Severe Conditions: Do Religious Education and Values Make a Difference?

Abstract

Western societies are experiencing a demographic shift towards an increased elderly population that is often affected by limiting conditions. This growth is not always balanced by a greater concern and assistance from younger cohorts, which could perceive that demand as a heavy burden, especially under conditions where children often move to work far away from their families. The present research tries to understand this challenging situation by studying the attitudes of preadolescents and adolescents towards the elderly. This study has explored the reactions of students between 12 and 17 years old towards images and experiences around the oldest and most frail. The collected data indicate the positive role of religion and spirituality in their concern, and the moderating factor of empathy, with gender and age being less significant in their attitudes towards the elderly in their social environment.

1. Introduction and Literature

Western societies are experiencing a demographic shift towards an increasingly aged population. People are living longer as life expectation has been growing steadily in the past decades. At the same time, younger cohorts are less represented as fewer children are born. As a clear effect, more people live the most advanced stage of their lives in conditions of inability, dependency, and loneliness (Sardon 2006; Pérez et al. 2020). Abundant literature and even a dedicated industry provides advice and assistance to improve personal conditions and to support forms of ‘active aging’, as an alternative model to a less optimal life stage. However, and despite these laudable efforts, when elderly persons reach a certain threshold, physical and mental conditions decline in a sharp way, rendering more active plans less feasible or practical.

The issue is that advanced aging is a clear case for “life-limiting conditions” and in many cases, these persons need close care and attention by their families, friends, or by professional institutions. We are talking about a growing population with specific demands associated with their age and limitations. In many cases, these needs involve physical care or attention. In most, they require emotional and affective support to compensate for their loneliness and boredom (Thomopoulou et al. 2010; Singh and Kiran 2013; Santini et al. 2020b).

In this landscape, the question arises regarding how much preadolescents and adolescents—no longer children—feel responsible for the attention and wellbeing of very old people in their own familiar circle. This is a reason for concern in a society and culture that cares for equity and sustainability. The reasons are apparent: the sense of responsibility should move in both directions: from and toward the oldest, and to the youngest generations. Then, no society is sustainable when the mature generations do not care for the future of the younger generations and when the younger generations are lax in looking after the needs of the oldest generation. A break in the intergenerational solidarity schema would carry very negative consequences for everybody and for a society as an integrated system. Indeed, it would be risky to differentiate too much the needs, expectations, and conditions of older generations, leading to a possible social disintegration. The two are deeply intertwined as a condition for their intended survival.

Traditional values and societies have pushed for a more integrative model, where new generations feel strongly that their duty is to look after those in worse conditions. However, a commonly observed pattern reveals that less traditional societies loosen those links and younger people feel less responsible or obliged to care for the oldest members of their families (Aday and Kano 1997; Lamb 2014). Then, we need to consider that until recently, children lived near their parents. Today, children move away from where their parents are living. The younger generation is called the “mobile generation”. That itself is the most important factor in whether the younger generation might be taking care of the older generation. The issue is to what extent such trends could at the end discourage the youth to engage more in the attention to the elderly in advanced societies, or whether in progressing, the younger generations in society will have less concern and care for those in the last years of their life. This would present a clear paradox for societies that cultivate welfare and wellbeing for their members as their ultimate raison d’être; socially minded modern policies could encounter less support among incoming generations.

Considering these introductory remarks, it is important to test which are the real sensitivities among the adolescents and to find out to what extent there is any issue regarding their relationship with the elderly in less favorable situations, or in life-limiting conditions, and then to analyze which factors can contribute to correcting possible deficiencies or to helping to improve them. Our goal to keep in mind should be to ensure wellbeing for all population segments once we demonstrate that the wellness of the younger is closely connected to the wellness of the eldest generations.

Several studies draw our attention to the current state of research, especially among adolescents and their felt intergenerational concern. For instance, a study from 2010, relating to the USA, reviews 78 published papers on this topic (East 2010). The way the study highlights the gender factor is interesting. Girls care more than boys, which is a point quite well documented in former research. Girls are more nurturing than boys. Then, the author states, “Some research shows that family caregiving and general family assistance tasks inspire children’s sense of maturity, self-reliance, and empathy” (East 2010, p. 57; Call et al. 1995). In that sense, we can deduce that attention towards the weakest family members does not only benefit the recipients of help, but also affects those who engage in such activities. However, many studies have reported the difficulties associated with an excessive burden in caregiving for family members in need, such as lower self-esteem, accelerated maturation, and worse performance in school studies, a problem affecting underprivileged families more (Dodson and Dickert 2004; Lareau 2003). A very recent survey in the UK during the pandemic’s lockdown confirmed the negative impact of caregiving on wellbeing and other psychological factors of young people (Nakanishi et al. 2022). Gathering the available data, consensus points to the intense impact that caregiving has on the boys’ and girls’ adjustment processes.

More studies have tried to assess the extent to which such activities take place in some specific settings, their motivations and functions. For instance, researchers from South Africa found that motivations to care for elderly family members among adolescents were extrinsic, and linked to some perceived duties, but not intrinsic; this outcome could imply some risks for such endeavors (Stols et al. 2016). Other research observed the perceptions and concerns of American adolescents about grandparents whose health was sharply declining. Using a narrative approach, the researchers were able to better describe the roles and expectations, in this intergenerational context, and how the adolescents project meaning in a different way in these demanding situations (Spira and Wall 2006). Another study of American adolescents caring for grandparents who suffered from Alzheimer’s found that the adolescents’ involvement in caregiving was related to both their parents’ caring attitude—more or less committed—and their affection for the afflicted persons (Hamill 2012). Finally, two recent studies deserve mentioning. The first was conducted on adolescents from six European countries to explore the effects of caregiving on grandparents compared with other caring activities. It was found that those caring for their grandparents reported more positive experiences than those caring for other people, such as a sense of self-efficacy, learning and helping, even if some problems arise in this area, including risks for the balanced maturation of the youth and their wellbeing (Santini et al. 2020a). The second article provides a systematic review of 10 published empirical studies reporting results in areas such as motivation, experiences, performance, and positive and negative effects. Once more, the theme of how much caregiving is related to the quality of family relationships emerges (D’Amen et al. 2021).

More specialized literature on the study of adolescence and elderly caregiving could have been reported. Our aim is just to show that the topic has been explored in several directions, and that a central concern is how such duties or caring activities could impact the adjustment process and wellbeing of adolescents. This was not our concern; we cared more about designing the present research around a possible decline in the responsibility felt by younger people as illustrated in the literature reviewed and in our own context, and about what could assist in a raised awareness of their conscience, to encourage a more committed attitude towards those relatives in life-limiting conditions. Our ultimate aim is to help establish a good intergenerational balance that contributes to equity and sustainability in societies that no longer rely on strong traditions motivating greater engagement in assisting the eldest persons.

Having such an aim in mind, we designed a mixed testing instrument—qualitative and quantitative—to be distributed to students between 12 and 17 years old in two regions in South-East Spain to obtain data that could describe the current sensitivity of that cohort regarding elderly people, and to find out which factors could influence this relationship. The main hypotheses guiding the present research are:

• Concern for elderly persons in one’s own familiar environment is related to self-report of empathy.
• Self-report of religion and spiritual sense are predictors of self-report of positive attitudes towards the eldest family members.
• Gender and development or age play a role in that concern.
• Religious intensity predicts more concern than just religious affiliation.

Beyond these main issues, the method allowed us to explore motives and perceptions in this sample in order to build a better description of such self-reports of feelings and attitudes; it was conceived as a way to raise the adolescent’s conscience and to motivate a greater interest in and sensitivity towards people suffering from life-limiting conditions following a suspicion nourished in the media and many direct testimonies concerning a decline in the commitment of the younger generations towards those in advanced age states.

2. Method and Data Collection

Our team has significant experience conducting surveys—both qualitative and quantitative—on adolescents, especially on topics related to religion and spirituality, with an emphasis on religious and other coping strategies at that critical age (Torralba et al. 2021). Now, the research topic was less self-centered and more related to others, and especially to those more vulnerable in advanced age in their families. After establishing the objectives of the research, the plan and means, we proceeded to build our instrument, keeping in mind the age and cultural background of those to be surveyed. Our project and questionnaire were submitted to the Ethical Committee of Antonianum University, the academic institution that supervised the project.

The instrument was mixed. It offered a first part with four images involving very old people, one of them with a child, possibly a grandchild; the questionnaire asked the respondents to write 3 words that could best describe each of those images, or their feelings and reactions in each case. The purpose of this exercise was for participants to describe in a qualitative way their reactions and attitudes towards such images. Then, a scale of 15 items designed ad hoc asked for issues or ways to show concern and interest regarding the oldest members of their families, such as how much time they spend with them; whether they play games with their grandparents; or how much are they interested in social policy measures to assist and protect them.

Then, the instrument gave 3 short stories or testimonies about elderly people and caregivers, asking about the students’ reactions after reading these texts. Next, some more scales were displayed: a standard scale for self-reporting empathy comprising 6 items; another scale comprised of 10 items for self-reporting religion and spirituality, and then, the usual demographic items. The instrument finished with an open question: “Can you briefly tell us about some personal impressions on the subject of the elderly or very old people with difficulties?”.

The questionnaire was accessible to the students through a Google Drive page. It was offered to the students of three high schools in the area of Murcia and Valencia, in South-East Spain. The main school where the questionnaires were collected was a state school in a rather rural area; then about one-third of questionnaires were collected in two Catholic schools, one in the large city of Murcia and the other in a middle-sized town south of Valencia.

The questionnaires were filled during lesson time and under the supervision of a teacher, after all the pertinent permissions were obtained and the ethical protocols observed. The questionnaire was completed on their smart phones or other similar devices with connectivity, and the data were automatically gathered in a standard dataset. We received answered questionnaires from 400 students, 43% male, 49.3% female, and 2% ‘other’. Of the sample, 4.5% chose not to declare their sex. The average age was 14.61, with a standard deviation of 1.46.

3. Results and Analysis

Since the questionnaire was mixed, we needed mixed techniques to collect and analyze the data both quantitatively and qualitatively. We present in a distinct way both outcomes from a descriptive view, and some analysis and tests we have performed on these data.

3.1. The Quantitative Section

• Descriptive

Factor analysis was used to reduce the number of variables and to render them more manageable. We have included 31 scalable items in this process plus the dummy items of the reactions before 3 short stories. The extraction of the main components applied a Varimax rotation. Twenty-six items were saturated into 6 main factors with an alpha of Cronbach over 0,6. The result of the factor analysis of the main components can be seen in

Table 1. Outcomes from factor analysis with Varimax rotation: 7 factors extracted.

Factor	N. Items	Alpha	Variance	Mean
F1 Religion	6	0.842	14.76	2.6095
F2 Spiritual	5	0.802	6.46	3.1335
F3 Indifference	3	0.836	6.78	1.9922
F4 Empathy	5	0.656	5.10	4.1750
F5 Elderly concern	5	0.687	4.25	3.7942
F6 Encourage care	2	0.617	3.99	2.9014
F7 Hope	2	0.556	3.38	2.6699

.

The most discriminating factor is religious practice: the items gathered asked for levels of attendance at religious services, personal prayer, and self-assessment as a religious person (5 levels in a Likert scale). As in previous surveys, the average is rather low in this cohort, but it clearly indicates what is most differentiating among this sample. The second item, spirituality, indicates a broader sense of self-transcending beliefs or experiences; its average is a little bit higher for this cohort living in a very secularized milieu. The third factor, called ‘Indifference,’ gathers self-reports of the reactions to the short stories whose choice was a “yes” or “no” in response to the option, “It doesn’t tell me anything”. As expected, only about 27% felt that way. The fourth factor gathered the items from the empathy scale; it returned the highest result, as could be expected among adolescents. The fifth factor clustered 5 items from the scale on concern for the elderly, such as, “I would like to spend more time with the oldest members of my family”; “How much time do you spend visiting your relatives (grandparents, great-grandparents or others) who are over 75 years old?”; and “Do you show signs of affection with your grandparents or great-grandparents?”. The last two factors gather positive answers to the suggested stories, such as, “People should engage more with their elders”; and “It gives me a lot of hope”; the means are on average.

b.

Comparing Variables

As a first approach, we applied a bivariate correlation to our data after calculating the means for each factor and including age and sex.

Table 2. Pearson bivariate correlation on 7 factors, age and sex.

	F2	F3	F4	F5	F6	F7	Age	Sex
F1	0.572 (**)	0.008	0.354 (**)	0.298 (**)	0.039	0.196 (**)	0.054	0.040
F2		0.024	0.354 (**)	0.130 (*)	−0.042	0.096	−0.028	−0.020
F3			0.044	−0.024	0.017	0.035	0.013	0.101
F4				0.321 (**)	0.101	0.265 (**)	0.090	0.121 (*)
F5					0.045	0.176 (**)	0.026	0.041
F6						0.247 (**)	0.076	−0.034
F7							0.084	0.032
Age								0.061

* p ≤ 0.05; ** p ≤ 0.001.

reflects the outcomes.

The table reveals several interesting features. The first one, worthy to highlight, is the robust correlation between the religion and spiritual factors (R = 0.572). This is a constant in all the surveys we have previously done: religion cannot be completely disentangled from spiritual sensitivity, even if they merge in separate factors. In other words, it is hard to conceive—in practical terms—a spiritual sense separated from a religious tradition. In any event, it seems hard to conceive young people feeling religious but not spiritual; but it appears more plausible that people who feel spiritual do not deem themselves as religious in a traditional sense; indeed, there are more students in this sample feeling spiritual than those feeling religious.

As in former surveys, we also found a high correlation between the factor of religiosity and the one of empathy (R = 0.354); it is not surprising that this same high correlation is found regarding the item on spiritual sense.

A similar pattern could be described regarding the fifth factor showing concern for elderly. Even if the correlation with religion is now a little bit lower here, it is still quite robust (R = 0.298); curiously, however, it becomes much lower regarding spirituality (R = 0.130); this suggests that that concern is strongly related to empathy (R = 0.321). A possible path could be traced in this case: religion relates to empathy and both relate to a caring attitude towards the oldest people who are more in need.

Later, we performed a test comparing the means of the factors with religious affiliations, as can be seen in

Table 3. Comparing means of factors by religious affiliation.

Religious Aff.		F1	F2	F3	F4	F5	F6	F7
Christian Catholic	M	2.9405	3.3228	2.0360	4.2370	3.8887	2.9059	2.6980
	N	269	272	241	265	266	255	250
	St. Dev.	0.86337	0.94658	0.81058	0.59594	0.74364	0.29591	0.49677
Christian other cofession	M	2.9667	3.2727	2.0417	4.2400	3.6200	2.8750	2.8125
	N	10	11	8	10	10	8	8
	St Dev.	1.05935	1.02478	0.93329	0.61680	0.48488	0.35355	0.25877
No religious	M	1.4515	2.3519	1.9231	4.0255	3.4724	2.9167	2.6091
	N	55	54	52	55	58	54	55
	St. Dev.	0.49760	1.09264	0.73094	0.59635	0.76475	0.27039	0.59075
Other religion	M	1.5833	2.2500	1.6667	3.1000	3.7333	2.0000	1.8750
	N	4	4	3	4	3	3	4
	St. Dev.	0.79931	1.46401	0.57735	0.47610	0.11547	0.00000	0.85391
Prefer not to declare	M	1.9595	2.9459	1.9118	4.0667	3.7474	2.9118	2.6364
	N	37	37	34	36	38	34	33
	Desv. típ.	0.75911	1.02051	0.80113	0.71554	0.90963	0.26026	0.47224
Total	M	2.6095	3.1335	1.9922	4.1750	3.7942	2.9014	2.6699
	N	382	385	344	376	382	360	356
	St. dev.	0.99759	1.03750	0.79678	0.61926	0.77213	0.29739	0.51586

.

An interesting feature emerges when comparing both tables: religious affiliation alone does not reveal any significant difference in the means of empathy or concern for the elderly compared to the non-affiliated or those who prefer not to reveal their affiliation. It is just the religious intensity that matters—i.e., being more than a nominal Catholic. It can be stated that religious commitment together with empathy are the strongest predictors of positive engagement with the elderly.

Furthermore, the collected data reveal that gender is only slightly related to empathy (R = 0.121) but not to other items, and the same is found with age. Our data could be understood as an indication regarding a lack of sexual distinction with respect to the studied sensitivity at this early age. This indication contrasts with other published studies where girls, at a young age, express greater sensitivity than boys towards others, and engage more in caring activities. Then, development in that short age period (12–17 years) concerning empathy and the involved ethical sensitivity appears as changing very slowly, from preadolescence to full adolescence.

Summarizing our findings from the quantitative survey, the first two hypotheses that we formulated and that guided our research found enough support, as a strong correlation emerged between empathy, religion—much less spirituality—and concern for the elderly. The third hypothesis, regarding the possible effect of gender and age, was not supported by the evidence.

3.2. The Qualitative Section

In a section of our instrument, we showed the children 4 images of elderly people, and we asked the students to write 3 words that could describe each image or how they felt viewing them.

Table 4. Main word frequencies distributed in 4 clusters—boys, girls, pray, and do not pray—ordered by frequency of more to less.

Boys [172]	N	Girls [227]	N	Pray [91]	N	Do not Pray [308]	N
Loneliness	153	Love	244	Love	96	Love	289
Love	141	Loneliness	196	Loneliness	79	Loneliness	270
Sadness	126	Care	152	Care	52	Sadness	202
Care	83	Sadness	121	Sadness	46	Care	183
Help	49	Help	74	Help	25	Help	98
Happiness	33	Tenderness	50	Company	22	Happiness	65
Respect	32	Happiness	45	Respect	17	Caring	54
Company	31	Watch out	44	Tenderness	17	Pain	54
Elder	24	Company	39	Happiness	13	Tenderness	53
Watch out	20	Respect	32	Hope	12	Company	48
Hope	20	Hope	32	Caring	10	Respect	47
Tenderness	20	Empathy	31	Pain	9	Trust	43
Disease	15	Disease	15	Empathy	6	Hope	40
Empathy	14	Pain	26	Trust	5	Empathy	39
Amiability	7	Solidarity	18	Amiability	3	Amiability	29

shows the frequencies of the main words the students used distributed in 4 clusters: boys, girls; plus, those who pray more and those who pray less. The sample has been split to include the girls’ cohort, those with “other” sexual orientation, and those who preferred not to answer (6.5% of the total). Considering the item that asked about praying frequency, we made a split between those ranking 4–5 (praying very frequently or quite frequently) and the rest.

A first look reveals that the most used words—translating the Spanish original—were love (385); loneliness (349); sadness (247); affection [cariño] (235); and help (123). This selection of words is linked to feelings showing empathy towards a personal state that inspires both positive (love and care) and negative (loneliness and sadness) emotions, together with—to a lower degree—a call to help those persons in need. Indeed, the Spanish word cariño is hard to translate; it refers to a feeling of tenderness and dear affection towards somebody. This mix of feelings could be the better way to describe the attitudes of this young cohort towards those advanced in age and in vulnerable states.

Looking at the sub-tables, we can appreciate that girls and those who did not reveal their gender used more words like ‘love’ and ‘care’; and in an almost similar proportion as boys, they used words like ‘loneliness’ and ‘sadness’ among the most quoted; then, ‘tenderness’ appears in a much higher ranking among the girls. To some extent, sex (male or female) does not predict the use of negative terms, such as loneliness and sadness, to describe the suggested images; but it moderates positive terms like love and affection. The balance between both positive and negative words showed that in girls, it was 396 positive against 317 negative words, while among boys, it was 224 positive against 279 negative words. The general impression is that girls have a more constructive and encouraging reaction, or change the balance for the better, while boys feel more negatively before such images.

The differences are harder to spot in the other two clusters by which our sample was split: those who pray—which accounted for just 22.8% of the sample, i.e., a fourth. Considering the distribution of those frequencies, we can see that those who pray more frequently use words like ‘love’ a little bit more (105%) compared to those who pray less (93%); loneliness appeared in a very similar proportion (86.8% and 87.6%), as well as care (57 and 59.4%), and the same happens for ‘help’. ‘Happiness’, ‘pain’, and ‘trust’ make some difference as they were ranked higher by those who do not pray. A few lessons can be learned from this exercise contrasting both cohorts: apparently, prayer levels do not significantly influence the expressions these adolescents use to describe their feelings towards the elderly.

From these data, we can arrive at contrasting results regarding the formulated hypotheses: sex plays a subtle role in describing feelings, and religious practice apparently plays no role in that exercise.

The last item in our instrument asked the students to describe their personal impressions and experiences regarding the elderly people they knew. About 2/3 of the respondents offered their opinions. In general, most of them who gave an opinion expressed deep concern and respect for those persons. Some of the answers are touching. For instance, a 15-year-old girl says:

“Once I was in a residence and there was an old man who, with tears in his eyes, said that he felt very lonely, and no one came to see him. That he felt that nobody loves him. Those words have been with me ever since”.

Other testimonies are indicative of their emotions:

“I am very sorry that the grandparents who give us the best, and then that these poor persons are left alone”.

“One day I saw an old man who was blind, and it made me very sad to the point of crying, since they are very precious to me and I love them very much”.

“Since my grandparents are in the country, I can go to eat with them every day and stay in the afternoon to take care of my grandfather with Alzheimer’s, and the smile he puts on when I give him a ride in the wheelchair makes my day”.

In summary, almost all the testimonies agree on the need to provide more assistance to these elderly people and to engage personally and collectively to render their life better and to help them in their loneliness and need. According to the content of these testimonies, the great majority of adolescents in this sample appear to be quite sensitive towards their grandparents and other less related elders in their environment. These testimonies point to a clear commitment in that generation towards these persons, and hence they suggest the possibility of favoring activities and volunteering to help them, especially those who are lonely and in geriatric residences.

4. Concluding Remarks and Discussion

Our survey was designed to assess, in an exploratory way, the self-reported answers of periadolescents that we believe reflect their attitudes towards elderly people in difficult conditions. The main objective of the study was to identify the factors that correlate with and without engagement in this crucial area. The designed instrument collected the data and hopefully also raised the awareness and conscience of this young population. A central issue was to what extent religion and spiritual sense contribute to improving things and to raising sensitivity.

The data showed that standard religion and—in a lower degree—spiritual sensitivity are positively correlated with a greater self-reported concern for the elderly in one’s own family circle. The data showed that empathy is the most statistically significant moderating factor, or the variable that most links religion or spirituality to concern for the elderly, and so, religious forms that encourage empathy or build on more empathic attitudes would be the most fitting to address the challenges arising from this growing population of elderly people.

This result can be understood in different ways. The first possibility is that religious practice and spiritual experience could encourage a greater sensitivity toward other people, especially if the religious form is associated with a responsibility and commitment for others. It could, in a similar vein, be linked to the previously published articles making a connection between religion and prosocial behavior, and even to those who relate religious faith to theory of mind as a related mechanism for expressing empathy or the capacity to feel another person’s pain and joy. This last understanding allows for testable hypotheses in the other direction: empathy comes first, which predisposes people to religious attitudes. In that sense, a religious expression that insists on love of one’s neighbor might be more attuned to that sensitivity; or, in other words, the more empathic could feel more ‘at home’ in an environment that values concern for others.

Then, the qualitative data showed a mix of self-reported feelings among these young students, both positive and negative. This suggests a possible didactic use for images and experiences and how to connect perceptions and a greater commitment that is expected towards people in need.

After analyzing these texts, our general impression from the collected testimonies is that many of the self-reports of adolescents in this small sample showed a great sensitivity and commitment towards the elderly.

The present survey is quite limited in scope and range and was based on a convenience sample. The survey is just preliminary, but an original one, in the sense that we could not find other similar studies testing the same factors and using a similar mixed method combining quantitative and qualitative data. Our expectation is that more research can replicate or confirm these results. Hopefully, it is a start in the study of the role that religious beliefs and practices still play in secularized societies and the extent to which they are a potential help to solving some of the challenges in the field of social care. If religion still plays a vicarious role and helps to fill gaps that appear in the social fabric, here we find a clear sector in which such function and performance can be exercised for achieving the wellbeing and flourishing of the youngest and the oldest members of society.