Aging and the existential: spiritual wellbeing, quality of life, and psychological morbidity in older adult cancer survivors

Abstract

Background: Despite 60% of cancer diagnoses occurring in elderly adults, in many studies, geriatric survivors appear more resilient to psychological morbidity than younger cohorts, despite other unique burdens. In support of the bio-psycho-social-spiritual model of quality-of-life (QOL), some research suggests this resilience may reflect elevated spiritual wellbeing with age. Aim: Using the 23-item expanded Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-Sp-Ex), we investigated extended subscales subscales to the original FACIT-Sp-12 in geriatric oncology survivors, derived through principal components analysis: Peace, Meaning, Faith, Positive Interaction. Methods: One-hundred-and-thirty-two cancer survivors aged >/-70 years completed a cross-sectional questionnaire including the FACIT-Sp-Ex; the Functional Assessment of Cancer Therapy-General (FACT-G) including Physical, Social/Family, Emotional, and Functional Wellbeing subscales; and the Depression Anxiety Stress Scale (DASS21). Results: Compared to a younger, normative sample of 867 Australian cancer survivors aged 19-69 years (M = 54.4), the geriatric group (M = 77.3 years) showed higher levels of Peace (p = .001, f = .11) and Positive Interaction (p = .000, f = .10), and lower levels of Stress (p = .001, f = .11). For the geriatric group, using an arbitrary cut-off (r >/- .40), Peace evidenced positive correlations with Functional (r = .63), Emotional (r = .55), and Physical Wellbeing (r = .43), and negative associations with Depression and Stress (both r = -.45). Meaning was positively correlated with Social/Family (r = .66) and Functional Wellbeing (r = .62), and negatively associated with Depression (r = -.47). Positive Interaction was associated with Social/Family (r = .48) and Functional Wellbeing (r = .41). Faith showed no associations r >/- .40. Conclusions: Relationships between spiritual wellbeing domains and QOL subscales generally mirrored previous findings in oncology. The newly derived Positive Interaction subscale (assessing forgiveness, gratitude, compassion, etc.) mirrored Meaning's associations with QOL, likely due to their interactional/social underpinnings. Peace and meaning again appeared highly important, demonstrating associations with decreased depression and/or stress, and given being elderly appeared to slightly elevate peace, positive interaction, and decrease stress, future investigations using mediation models may improve/extend interpretations.