Eleanor Feldman Barbera, Ph.D.

Though it was close to 20 years ago, I’ll never forget the reaction of one of my patients to losing both of her legs to diabetes. 

“I’m 81 years old and I’ve traveled and danced as much as I could. I wasn’t sick a day in my life until this happened. I’m satisfied,” Lila told me earnestly.

I was astonished by her acceptance of such a difficult situation. If it had been me, I was sure I would have railed at the injustice of the world.

Residents like her, however, make it quite clear that it is possible to be grateful and to live fully, despite disability.

Lila came to mind recently when I asked a resident, Daisy, how she was doing three years after a debilitating stroke. Her curt reply: “The same old damn thing — I still can’t walk.”

Creating better mood

A 2015 study in Spirituality in Clinical Practice suggests it might be possible to use the tool of gratitude in order to help residents like Daisy.

The study looked at the impact of gratitude and spiritual well-being on a group of asymptomatic heart failure patients with an average age of 66.

The researchers found that “gratitude and spiritual well-being are related to better mood and sleep, less fatigue, and more self-efficacy.” Those positive effects can reduce the chances that an individual will move from being asymptomatic to symptomatic heart failure, which is “associated with a five-fold increase in mortality risk.”

The researchers point to studies that tried to enhance participants’ sense of gratitude. Gratitude is considered part of “positive psychology,” which focuses on the strengths that allow individuals and communities to thrive.

One study, for example, found that a four-day retreat that focused on spiritual interventions such as meditation, guided imagery and journal writing significantly lowered the level of participants’ depression for three months, as compared to the control group where the retreat focused on nutrition education, exercise and stress management.

In other research, spirituality-based interventions showed a trend toward reducing depression in community-based elders with cardiovascular disease.

Gratitude groups in LTC

This line of research led me to consider the possibilities of increasing gratitude within the long-term care setting. Certainly many residents attend religious services that may facilitate thinking about gratitude, but perhaps we could take this a step further by offering recreational activities that focus on gratitude.

The therapeutic recreation department could hold a weekly gratitude meeting where residents are encouraged to share with others the things for which they were grateful. Perhaps one of the residents or a staff member could volunteer as a speaker on the topic of gratitude to start off the meeting. There could be readings on gratitude from various sources, or, taking the lead from the research, the group could include meditation, guided imagery, or journal writing.  Each week the group could focus on a different gratitude tool, so that week 1 would be meditation, week 2 — guided imagery, week 3 — a speaker, etc.

If you already have a group focusing on gratitude in your facility, please share the details and results with us in the comments section.

Individual interventions

Since Daisy, my depressed resident, didn’t have a gratitude group to attend, I tried an exercise with her individually. I asked her to run through the alphabet and come up with something she’s grateful for that begins with each letter. For A, she said “alive,” B was for “Bob” (her husband), and C stood for candy. By the time we got to D, Daisy was laughing and she admitted she was grateful to be herself.

Eleanor Feldman Barbera, PhD, author of The Savvy Resident’s Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.