Understanding the Spiritual Needs of Older Adults in Chinese Nursing Homes

Background and Purpose: Identifying and addressing the spiritual needs of older adults, particularly those living in nursing homes and other care facilities, is an essential component of holistic service provision. China is home to the world’s largest population of older adults (Lancet, 2022), yet little is known about the spiritual needs of older Chinese adults. Indeed, our survey of literature reviews on spiritual needs failed to identify a single study conducted in mainland China (Britt et al., 2023; Desmet et al., 2020; Palmer et al., 2020). The purpose of this study was to address this gap in the literature by identifying the spiritual needs of older adults living in Chinese nursing homes.

Methods: To conduct this study, we used a qualitative description design in tandem with a purposive sampling methodology. Consistent with research on spiritual needs conducted outside China, we solicited the perspective of nursing home administrators (Britt et al, 2023; Palmer et al., 2020). The study participants (N=21) were, on average 48.95 years old (SD=10.09), primarily female (57.1%, n=12), with the typical administrator serving as a director for approximately four years (M=3.85, SD=3.61), and supervised a nursing home with an average of 115 beds (SD=73.58). The nursing homes—located in 12 different provinces in China—were based primarily in cities (61.9%, n=13), followed by towns (33.3%, n=7), and villages (4.8%, n=1).

Semi-structured interviews were conducted in Mandarin to understand administrators’ perceptions of residents’ spiritual needs. Two researchers, fluent in Mandarin and English, translated the interview transcripts into English. Analysis of the transcripts was informed by a post-positivist epistemological perspective, which guided our interpretive content analysis (Drisko & Maschi, 2016). We used a constant comparative methodology in which the data were examined for similarities and patterns. In a recursive process, the emerging themes were compared to similar phenomena across surveys. The data were coded, organized into themes, and labeled with descriptive titles.

Results: Analysis produced five interrelated themes. The spiritual needs of older Chinese adults can be summarized as the need for: 1) expression of their faith, 2) love and care, 3) contact with adult children, 4) interactions with others, and 5) participation in activities. To identify the needs of residents who were unable to verbally communicate, the two most prominent strategies utilized were observation (e.g., attending to residents’ emotions, and physical movements) and communication with family members.

Conclusion and Implications: As the first study to identify the spiritual needs of older adults living in Chinese nursing homes, this study makes an important contribution to the literature. Understanding the common needs older Chinese adults tend to exhibit provides a working template of potentially relevant spiritual needs. With this knowledge, gerontological social workers might conduct a spiritual assessment to explore the presence of the spiritual needs identified in this study. In working with residents who are unable to verbally communicate, the results highlight the importance of attending to residents’ non-verbal communication to ensure residents’ spiritual needs are identified and addressed in a way that resonates with their felt reality.