caregivers, chronic illness, frail elderly, long-term care, meditation, mindfulness, pain



  1. McBee, Lucia CSW, MPH


Physical frailty, chronic pain, and stress often diminish quality of life in the elderly and their caregivers. Health care professionals working with the frail elderly also frequently struggle with feelings of helplessness and discomfort in the presence of this illness and despair. Mindfulness-Based Stress Reduction (MBSR) is a program that has helped patients with a variety of conditions improve their health and quality of life. MBSR and mindfulness practice cultivate an awareness of life, moment by moment, and allow both patient and practitioner to face illness, pain, and loss with presence and equanimity.


SEVEN years ago, I began holding meditation classes and groups modeled on Mindfulness-Based Stress Reduction (MBSR), in a large, urban, multiethnic, multifaith nursing home. The MBSR group model has been shown to reduce pain and stress as well as to improve quality of life in a younger population with a variety of conditions. 1-6 My hope was that the techniques would also offer relief to the frail elderly. In MBSR groups, participants learn the techniques of meditation, gentle yoga, and mindfulness, and discuss ways to integrate these techniques into their day-to-day lives. MBSR groups and mindfulness practice foster an awareness of life, moment by moment, allowing practitioners to face illness, pain, and loss with increased presence and equanimity. Older adults in the nursing home cope with trauma, loss, disability, pain, and life-threatening illness. Initially, I thought that these techniques might be alien to this cohort. I also was aware of the significant challenges of running a psychoeducational group for residents with multiple serious medical conditions, communication challenges, and cognitive loss. Nevertheless, these initiatives were well received. Residents often report that meditation helps them remember their spiritual roots and, when they meditate in groups, their connection to others. MBSR groups at my nursing home have provided solace, support, pain reduction, and even diminished agitation on the dementia units. In this society, and especially in institutional settings, older adults are constantly reminded of their losses and their disability. In mindfulness practice, they find their inner strengths and resources.


The MBSR model has been adapted to many settings including health care, schools, prisons, and community programs. In this nursing home, I adapted this model to meet the needs and abilities of a mixed population, including residents with moderate-to-severe dementia, their informal and formal caregivers, and community-dwelling older adults.


My initial training in MBSR came from participation in introductory and advanced workshops held by the Center for Mindfulness in Medicine at the University of Massachusetts Medical School. In addition, I began my own regular personal practice of meditation and yoga. Health care professionals may find, as I have, that these practices profoundly change their own lives, as well as benefit their clients.


Pain and stress affect the quality of life of older adults and their caregivers. 7,8 Frail nursing home residents are even more frequently at risk for pain. In a study of one nursing home, 71% of the residents were found to experience at least 1 pain complaint, and 34% reported constant pain. 9 In addition, the multiple losses of friends, family, home, and health can lead to despair. 10,11 Traditional treatment models have been medically oriented, often relying entirely on pharmacological approaches. The frail older client is often disregarded as an active participant in the healing process, and yet recent research has indicated that elderly patients with chronic pain can benefit from the use of complementary and alternative, nonpharmacological approaches. 12,13 These nonpharmacological modalities have found increasing acceptance in formal and informal health care systems. 12,14 Complementary and alternative interventions often include a spiritual component, not specifically linked with one religious faith. This "positive spirituality" is an important consideration in understanding successful aging. 15


Health care professionals working with the frail elderly in nursing home settings or the community also face multiple challenges and opportunities. The complex conditions of the elderly are often bio-psycho-social, affecting the mind, body, and emotions. Cognitive loss can confound a traditional therapeutic relationship. Practitioners working with the geriatric patient may also struggle with their own feelings in the face of their clients' losses and pain. For professionals who are trained to "cure," the chronic illness, pain, and disability associated with aging can lead to feelings of helplessness and frustration. At a deeper level, the practitioners must also face their own feelings about death.


For professionals working with the elderly nursing home population, mindfulness practice offers a new paradigm of the helper/helped relationship. "Mindfulness is a quality of the physician [or other health care provider] as person, without boundaries between technical, cognitive, emotional, and spiritual aspects of practice." 16 In working with a geriatric population, the mindful practitioner brings his or her whole self to the relationship and views the client as a whole person, not only as his or her symptom or disease. The practitioner/patient relationship becomes one of reciprocity. Individual existence is viewed as a shared experience, and our interconnectedness becomes apparent.