Spiritual Care at End of Life

Person holding the Bible

Author: Ruth Preston

Spirituality and religion are not synonymous with each other. Whilst religious aspects of a person’s life will usually involve and affect their spirituality, there are many people whose spirituality has nothing to do with religion or religious beliefs. Spirituality involves everything which gives purpose and meaning to an individual – whether an emotional response, intellectual stance or belief system; it involves everything about the person, their thoughts and feelings about themselves and the relationships they have with others and with the world.

People are all different and have different spiritual needs – and despite common misconceptions, this is no different in the fourth age (above the age of 80). The spiritual needs of people who are very old will therefore differ, according to their culture, background, education, beliefs, and experiences.

Spiritual Needs Can Include:

  • the need for meaning and purpose in our lives
  • the need to love and feel loved
  • the need to feel a sense of belonging
  • the need to feel hope, peace and gratitude.

Having a terminal illness or a simple acknowledgment of being at the end-of-life, as some people living in the fourth age will have, often causes people to think about death, dying, loss and grief, in ways they may have not before; to think differently about life, love and hope. But reaching the end of a very long life, does not make it less likely that there will be questions or doubts (Goodall 2013). It is therefore important that spiritual support to people in their fourth age allows them to raise questions, explore their doubts, resolve differences or conflicts and find answers.

For Christians living in the fourth age, their spirituality may be strengthened by their beliefs and personal relationship with God. They may be secured in the love of Jesus and the hope from His resurrection. However, for those who have not found a faith or for whom the fourth age brings more questions than answers, there can be much searching and distress at this time. When people are unable to find meaning, hope, or peace they may experience what is termed ‘spiritual distress’. Christian faith organisations need to be prepared to offer support and comfort when spirtual distress is a feature of the fourth age.

Common Signs of Spiritual Distress Include:

  • Searching for meaning – ‘who am I?’ and ‘how will I be remembered?’
  • Feeling personally afflicted -‘why me?’, ‘why is this happening?’
  • Becoming more withdrawn and isolated – not going out, not having visitors
  • Afraid of being alone, being anxious or scared
  • Showing signs of anger or resentment
  • Refusing care, help, or support.


Older lady staring into the distance


Spiritual care for end of life involves meeting the emotional, existential, relational, and religious issues surrounding the end of life. This can include helping people find meaning, acceptance, or reconciliation; deal with relationships, conflicts, and farewells. Spiritual care and support may or may not involve faith issues or religious beliefs. For some people, their religious belief may define their spirituality completely, and thus their spiritual care would involve aspects of their faith, religious acts, or rituals. For others, religion may have no part in their spirituality at all. For many Christians, their personal faith is a fundamental aspect of their spirituality – yet religious rituals may play a relatively small part of their spiritual needs.

Although churches and other Christian faith groups may seem to be obvious places to discuss death and dying, and provide spiritual care to people at the end-of-life, some churches provide little spiritual support to those in the fourth age. The Christian faith is all about the death of Christ and His resurrection, yet few churches enable or facilitate discussions about personal death and dying issues and many still treat end-of-life as a taboo subject.

What Churches Can do to Support People in Fourth Age with End-of-life Discussions

  • Help older people prepare for end-of-life both spiritually, emotionally, and practically.
  • Encourage and facilitate open discussions about Advance Care Planning, choices, and wishes for care and treatment for end-of-life.
  • Identify those people in fourth age who have no family nearby, who may need guidance and support to make alternative arrangements for future care, e.g. Advance Decisions,
  • Lasting Power of Attorneys.
  • Enable discussion and bible study on theological aspects of hope, acceptance, gratitude, and love.
  • Offer pastoral support to those with specific spiritual needs at end-of-life – prayer, confession and conflict-resolution, administration of the sacrament.
  • Provide timely and regular out-reach and pastoral support to those who are sick and
    dying and those who are bereaved.


Blog material taken from ‘Guidance for Christian Faith Organisations in the Support and Value of Older People’ – become a church champion to receive a free copy of the full guidance booklet.