The Association of Health and Functional Status with Private and Public Religious Practice among Rural, Ethnically Diverse, Older Adults with Diabetes.

Religion is important in the lives of many older adults.1 Religion is particularly important to the social integration, self-definition, and health beliefs of older adults who live in rural communities in the United States. While some residents of rural US communities are not church members, participating in church-related activities has been one of the major forms of social integration and recreation across the lives of most contemporary rural older adults.2–5 The relationship of different aspects of religion to health and functional status among older adults is of considerable interest in gerontology.6 Investigators have reported associations of religious practice with mental health,7,8 physical health,9,10 and mortality.11 In general, poorer health has been related to indicators of reduced public religious practice, like church attendance.6,12–14 However, poorer health is not related to level of private religious practices, like prayer or use of religious media.12,15 Investigators have examined the causal relationship of greater religious practice to better health and functional status among older adults.12,13,15–17 Few investigators have found a longitudinal relationship of current public religious practice affecting future health and functional status.12 Van Ness and Kasl18 found that religious attendance in 1982 was related to cognitive status in 1985, but 1982 religious attendance was not a predictor of 1988 cognitive status. Rather, high level of cognitive dysfunction in 1982 was a predictor of mortality between 1985 and 1988, suggesting that cognitive function was affecting religious attendance. Hill and colleagues,19 using four waves of the Hispanic Established Populations for Epidemiologic Studies of the Elderly (EPESE) data, found that frequent church attendance was associated with slower decline in functional status. Based on a review of the religious involvement and mortality literature, Hummer and colleagues11 suggest that further research is needed on the associations of public and private religious practices with health and functional status in specific populations. This suggestion is echoed by Benjamins,15 who states that more information on religion and health is needed because existing research is inconclusive, with conflicting results about the salutary relationship between higher levels of religious involvement and health outcomes. This analysis examines the association of health and functional status with the intensity of private and public religious practice among older adults (aged 65 and older) with diabetes who reside in rural, ethnically diverse communities. These communities include significant African American, Native American, and white populations. A focus on the associations of public and private religious practice with health among rural older adults is particularly important. Religion is a central institution in rural communities, especially in the southern US, and religious belief and activity is a major component in the lives of those living in rural communities. Religion is incorporated into the health self-management of older adults in rural communities, and religious beliefs influence understandings of illness, healing and medical care.2–4 The older adults in this study are all ill and must deal with a common chronic disease, diabetes. This analysis will extend existing analyses of religion and health in ethnic minorities,14 and help illuminate the relative importance of ethnicity and rurality in the association of religion and health.2