GIVING SPIRITUAL SUPPORT IN A GERIATRIC HOSPITAL

1. GIVING SPIRITUAL SUPPORT IN A GERIATRIC HOSPITAL ד"ר אפרים יאול, ד"ר יקיר קאופמן עו"ס יונית צברי עו"ס דניאל גדז' בית חולים הרצוג בית הספר לרפואה הדסה ירושלים Dr. E. Jaul, Dr. Y. Kaufman, Sw Y. Zabari, Sw D. Gadez Herzog Hospital Hadassah school of Medicine-Jerusalem

2. GERIATRIC HOSPITAL • MULTIPLE CO-MORBIDITIES • MULTIPLE DISABILITIES (IMMOBILITY DEMETIA, FRAIL) • NON ONCOLOGIC-DISEASE • TERMINALLY ILL • LONG TERM CARE • MULTI-DISIPLINARY TEAM

3. The Effect of Spiritual Support Intervention on Rehabilitation Outcomes

4. Background: • In recent years there has been a growing scientific interest in the impact of spirituality and religiosity on health and disease. • This impact is even more prominent when one confronts serious disease when his sense of well-being, and meaning is compromised. • The stroke and orthopedic patient is suddenly confronted with physical, social, financial, psychological and occupational challenges. • Therefore the rehabilitation\sub-acute period is a time where support is needed. This is a time where spiritual support is required for the patient in confronting his various challenges.

5. Objective: • To examine the effect of spiritual support on the objective rehabilitation outcome function and on quality of life during rehabilitation.

6. Methods: • Patients will be randomized into an intervention group or a control group. The groups will be matched for demographic background characteristics. The intervention group will receive 4-6 spiritual support meetings with a spiritual supporter of 30 minutes each session during their admission period (2-3 weeks). • Both groups will be treated by the same multi-professional rehabilitation team care. The groups will be assessed, before and after the intervention, by a blinded interviewer. • Size of study: Our goal to assess 100 patients, 50 in each group.

7. Tools: • Rehabilitation and functional outcomes will be assessed by standard, routine rehabilitation clinical tools such as the Functional Independence Measure (FIM) and ADL\IADL by PT and OT assessments. • Mood and affect will be assessed using the Geriatric Depression Scale (GDS). Quality of life and well-being will be assessed by the SF-12 scale. • Spirituality and religiosity will be assessed using the FICA (faith, importance, community, address) tool.

8. Expected outcome: • To find that patients from the interventional group will have better rehabilitation outcomes, well-being and lower depression results according to standard scales .

9. Study significance: • To date, the efficacy of this intervention has not been assessed. A randomized, controlled, single-blinded study on the effects of spiritual support on objective and subjective rehabilitation outcomes is necessary to understand the effect of these interventions. • The result of this study can affect health policies and trends in the future with respect to spiritual support.

10. Spiritual History Associated with Medical Decision of DNR at the End of Life • The patient's medical and social history (anamnesis) are primary in importance to determine diagnosis and treatment. • Taking a spiritual history is important; namely, obtaining information about the patient's self perceptions of spirituality / religiosity (values, family, acts of God, disposition) • Decisions belonging to the individual patient should take into consideration his diseases, healing and coping style with suffering, dying, and death.

11. Purpose • To determine whether the spiritual history provided bythe family caregiver influences medical decisions regarding DNR. • Methods • The target population was 46 family-member caregivers of non-communicative patients in the ward .The spiritual tool was FICA (faith, importance, community and addressing).

12. The Hypothesis • The hypothesis was verified. • People who perceive themselves as being spirituality/religious opposed the recommendation not to resuscitate (DNR).