Clinical Geriatrics

Case Presentation

Mrs. D is a 78-year-old widowed woman who recently moved in with her daughter, Mrs. F. Mrs. D comes to see Dr. R for a check of her blood pressure and diet-controlled diabetes. Dr. R has been caring for Mrs. F for many years and is pleased to meet her mother. He finds that unlike her daughter, Mrs. D is considerably more critical of his office staff, waiting time, and the cold temperature of his office. When he brings up the fact that her blood pressure is elevated to 150/100 mm Hg and her finger stick blood glucose is nearly 300 mg/dL, Mrs. D takes notes and asks for his recommendations. Dr. R suggests increasing her dose of enalapril from 10 to 20 mg daily for hypertension and starting her on metformin 500 mg twice daily for diabetes mellitus. Mrs. D thanks Dr. R and tells him that she will pray for him. She tells the office staff, “God bless you,” on her way out.

Mrs. F comes to see Dr. R several weeks later. She tells him that her mother was very pleased with his care. He reports that very few patients have ever offered to pray for him. Mrs. F describes that her father was a Pentecostal minister who served a very large congregation. Her mother is a deeply religious person who has always prayed about every situation in her life. Since moving to a large city from a far more rural area, Mrs. D has found a church and attends services regularly. She is disappointed in her daughter, who has chosen not to continue attending services, but still prays with her every morning.

Mrs. F also suffers from hypertension, but even on a regime of multiple antihypertensives, has difficulty achieving good control of her blood pressure. Dr. R refers her to a nephrologist for consultation.

Mrs. F does not keep her appointment with the nephrologist. Several months later, Dr. R receives an emergency telephone call. Mrs. F suffered a large hemorrhagic cerebrovascular accident. She is in the intensive care unit (ICU) with a very guarded prognosis. Dr. R sees her later that day. Mrs. F is on a ventilator with no spontaneous breathing. She does not respond to painful stimuli. The amount of damage done by the stroke is catastrophic, and the attending neurologist and ICU director feel that she may not survive the next 24 hours. Both specialists remark on the “bizarre behavior” of Mrs. D, who has come in to the ICU with several members of her church singing and praying in a loud voice. The ICU director expresses concern that the group will become too loud and that he may have to restrict their visits.

Dr. R goes out to the waiting area where Mrs. D and her friends are holding hands and praying. Mrs. D is very upset with the doctors in the ICU. She feels they are being disrespectful to her and her church. She tells Dr. R, “My baby grew up singing hymns and praying, and if God is going to take her, she will want to hear our prayers before she leaves us.” Mrs. D asks Dr. R to join them in a prayer for her daughter. Dr. R was taught to respect all religious beliefs but personally has never attended any organized religious services on a regular basis. With some initial discomfort, he joins hands with Mrs. D as the group begins to pray for the soul of her daughter. They sing a hymn, which Mrs. D later identifies as her daughter’s favorite. He realizes how vital this is to both Mrs. D and Mrs. F and indicates that he will find a way for the group to quietly spend time with Mrs. F. Dr. R contacts one of the hospital chaplains.

Discussion
Older adults are highly likely to associate themselves with an organized religion and to utilize religious coping skills.¹ This differs from persons born after World War II, who may have strong spiritual beliefs, but are less likely to identify or describe themselves as members of organized religious groups.