Elderly living in residential and nursing homes have specific psychosocial and spiritual needs which are in most cases not recognized and can thus not be addressed. As advised by Borg et al. [37] adequate health care for elderly should not only consider decreasing functional capacities of elderly, but also the individual's perception of health and self-esteem. The focus on personal factors seems to be of outstanding importance, and the findings of this study support this recommendation. However, it remains an open issue how these factors can be adequately supported.
Shea [4] advised that pastoral care specialists might be beneficial because they could help finding “inner power that produces hope and character”. However, most of the enrolled elderly had no specific interest in priests or chaplains. Other professions such as nurses, psychologists and social workers might be in charge to care, to listen and to help elderly to review their life which was a strong need among the residents enrolled in this study. Of course they might not be the most appropriate partners (the family seems to be of stronger importance), but they are often those who are more easily available, and they may be able to identify disrupted relationships. It is obvious that there is a need to “develop creative, long-range strategies for providing care” [4] which meet the needs of elderly living in secular societies. One interesting approach could be life reviews or reminiscing interventions. A randomized study by Gonçalves et al. [38] found that a life review decreased depressive symptoms and contributed to improve older womens' life satisfaction. A further randomized controlled study reported significantly lower depressive symptoms in elderly participating an autobiographical writing workshop [39]. In contrast, a randomized controlled study by de Medeiros et al. [40] found that an autobiographical writing workshop may improve the ratings of self-concept among older adults, but not their mood when compared to the outcomes of a reminiscence group (which was an active control intervention) or to a no-treatment control group. At least such life reviews may contribute to connect elderly with their own past, and can function as a “legacy” of life experiences to connect with future generations. This will meet the specific needs to reflect previous life and to pass own life experiences to others, and thus to connect with those who will remember them.
We hope that the current data and reflections encourage a discussion which integrative approaches might be appropriate to support elderly living in residential and nursing homes. Although one may assume that particularly interventions of the wide field of mind-body medicine might be beneficial, this remains to be verified.