Elizabeth MacKinlay is an Anglican priest, Director of the Centre for Ageing and Pastoral Studies in Canberra, Australia, and Chair of the Australian Ministerial Advisory Council on Ageing. This book follows the author's The Spiritual Dimension of Ageing, published in 2001 also by Jessica Kingsley. It explores the spiritual dimension of ageing for frail older people, coping with diminishment and end-of-life issues, and is aimed principally for nurses, care workers, pastoral-support professionals and others working with older people. MacKinlay acknowledges that there is a very personal agenda in her wish to write another book on the care of older people. She relates, movingly, the story of her experience of a grandmother dying in a care home. This gives her writing a practical edge. She is concerned not only to broaden the reader's theoretical horizons, but also to ensure that theory gives rise to good practice. The book is informed by a specific piece of research, in which MacKinlay used in-depth interviews with nursing home residents as part of an investigation into how best to assess the spiritual needs of older people. This grounding in qualitative data provides many useful insights into the struggles that face older people in this particular part of their journey.
Chapter 1 outlines the latest research in the growing field of ageing, spirituality and religion. Chapter 2 outlines the research and methodology that lie behind the book, and Chapter 3 discusses spiritual assessment. Chapters 4 and 5 describe the two spiritual tasks of ageing, the search for ultimate meaning and how we respond to it. Chapter 6 deals with spiritual reminiscence and the next two examine important areas of mental health and dementia in later life. Chapter 9 considers worship and the use of ritual amongst older people, and reports a survey of multi-faith and multi-cultural western ageing societies. Chapters 10 and 11 tackle the important topics of vulnerability and transcendence. Chapter 12 addresses the need for relationships and intimacy amongst nursing home residents. Chapter 13 is about grief, death and dying relating to the latter part of life and, finally, Chapter 14 brings together the main ethical issues, many of which have been addressed implicitly throughout the book. MacKinlay's conclusions offer the components of the model of spiritual tasks considered within a holistic frame.
MacKinlay locates spiritual development and life tasks in development theory, principally in the psycho-social theories of Erikson, who argued that the seventh stage of man involves a crisis between integrity, or oneness or wholeness (in God), as opposed to despair, resulting from inability to come to terms with death. This theory is satisfactory for many but has been rejected by some on the grounds that it over-simplifies, with a tendency to universalise, given the sheer complexity of the world of social and cultural variety within which we live. Feminists have long criticised such development theory as reflecting essentially masculine concerns. The relationship between religion and spirituality is complex not least when set against what sociologists describe as an increasingly secular society. At points in the book, I wondered whether MacKinlay does justice to what I have found in my own limited experience – which indicates that much of the theory and practice relating to spiritual care is more closely integrated with the Christian religion than some of that theory suggests. Given the marginalisation of religion in Britain today, my experience of working with health and care staff is that the concept of spirituality is both hard to define and even harder to put into practice. In many settings, there is little enough time for being with the person, let alone for support and reflection on meaning in life and responding to that meaning through God and others. This is an agenda that care staff themselves have hardly begun to address, let alone have the skill to help others. MacKinlay's work is valuable and I shall attempt to put some of it into practice in my own work, but her framework is less helpful than she claims. This is an area of work for those of us committed to ‘whole person care’ that requires much more collaborative research and concerted thought.
While it is impossible for any book to deal comprehensively with the variety of social, economic and political systems that organise the support of older people, no one should under-estimate the difference that people's financial resources make to the care received. MacKinlay offers a convincing case for the positive value of residential care. She makes a contribution to the discussion about the environment within which residential care is organised and delivered and the particular importance of motivating good, trained staff. Australia is much more generous than Great Britain in the funding of ‘age-care’. Those involved in social policy should continue to make a contribution to maximising choice for older people. Such choice should include the various benefits of residential care for those living in the fourth age of life and especially to work with other agencies in acknowledging how poverty limits choice and therefore quality in old age. Living well in old age may literally depend upon geography or chance, and more certainly on available wealth.
