ORIGINAL RESEARCH

Religiosity and spirituality as resources for addressing domestic violence against the elderly

Juliana Bezerra do Amaral^I; Maria do Rosário de Menezes^II; Valdenir Almeida da Silva^III; Cíntia Maria Souza de Oliveira^IV

^I Ph.D. in Nursing. Professor at the Nursing School of the Federal University of Bahia. Member of the Study Center for Appreciation of Aging. Salvador, Bahia, Brazil. E-mail: julianabamaral@yahoo.com.br
^II Ph.D. in Nursing. Professor of the Graduate Program of the Nursing School at the Federal University of Bahia. Coordinator of the Study Center for Appreciation of Aging. Salvador, Bahia, Brazil. E-mail: menezes@ufba.br
^III Ph.D. student by the Graduate Program in Nursing at the Federal University of Bahia. Member of the Study Center for Appreciation of Aging. Salvador, Bahia, Brazil. E-mail: valdenirenf@yahoo.com.br
^IV Master degree in Nursing. Member of the Study Center for Appreciation of Aging. Salvador, Bahia, Brazil. E-mail: cintia_mso@terra.com.br

DOI: http://dx.doi.org/10.12957/reuerj.2016.7126

ABSTRACT

Objective: to describe how religiosity and spirituality are deployed by the elderly in coping with domestic violence. Method: this qualitative, descriptive study was conducted at police stations Salvador (Bahia), between August 2006 and April 2007 by data collection from police reports and semi-structured interviews of nine elderly victims of aggression. The discourses were analyzed using content analysis technique. The project was approved by a Research Ethics Committee (report No. 021/2004). Results: two categories emerged: religiosity or spirituality as relief from suffering; and religiosity or spirituality to help change aggressors' behavior. Conclusion: reference to a divinity emerged as one way of coping with stressful situations, such as the pain and suffering resulting from domestic violence.

Keywords: Elderly; domestic violence; nursing; spirituality.

INTRODUCTION

In recent years, Salvador (BA) has been one of the Brazilian cities with the highest rates of mortality from violence. According to the Map of Violence published in 2015, the number of deaths by firearms in this capital between 2002 and 2012 grew 148.3%¹.

Violence against elderly people is also present in this scenario, as shown by data collected on complaints registered with the Police Special Care for the Elderly (DEATI), inaugurated on July 31, 2006, in Salvador. In June 2007, a year after its implantation, this station already had approximately 2,500 records of complaints of violence involving elderly as victims or agressors².

In old age, religion can be an emotional and motivational resource to cope with adverse situations. Religious involvement increases the sense of a purpose for life, and the human being responds positively to the issues in daily life³.

Given the above, this study aimed to describe how religion and spirituality are used by the elderly in fighting domestic violence.

LITERATURE REVIEW

Some papers^4-6 show that violence against the elderly in Brazil is much more serious and of larger proportions than it might be assumed. There are many types of violence - such as mistreatment in active and passive negligence, omissions, oversights, isolation or punishment by silence, among others - not seen as violence for most people. However, these violations are present often in the lives of elderly².

Neglect and physical, psychological, sexual and financial abuse often perpetrated against older people in their homes do not come to health services. They remain naturalized in everyday family relationships, as a form of social neglect and against the lack of public politicies^2,4.

The increasing aging of the population and the recognized social inequality in the country, especially in Salvador (BA), are factors that together, interfering with family relationships, creating a favorable context for the outbreak of conflicts, aggression, and violence, reflecting in health and quality of life of the elderly.

Given the complexity involving domestic violence, the elderly may have different behaviors to face the adversities of this situation. One of the resources used by the elderly is resilience, behavior considered essential to overcome difficult moments⁷.

The vulnerable elderly imposed in the family violence may have resilient behavior, using mechanisms for processing or maintenance of this condition. In this context, religion and spirituality can be as important support mechanisms for dealing with their everyday problems, acting as a change, challenge or conservation way, through a coping strategy^5,6,8,9. Most of the population profess some religious belief, and authors¹⁰ indicate that adults and, in particular, the elderly, deeply value their beliefs and religious values Most of the time, the elderly talk about their faith and importance in overcoming difficult moments^{5, 6}.

In a research conducted by the International Institute Gallup involving 50,000 people in 65 different countries, about a third of participants said being religious¹¹. Among them, the elderly were the ones that showed the highest percentage of religiosity, around 70%. Thus, it can be said that there is a close relationship between aging and religious or spirituality practices¹².

METHODOLOGY

This is a descriptive study with a qualitative approach, conducted in the metropolitan region of Salvador, Bahia, Brazil, research clipping titled Revealing domestic violence against the elderly in the city of Salvador - Bahia², aimed to identify violence against older people in family environment and developed with the institutional and financial support of the Ministry of Health of Brazil (MS), the National Council for Scientific and Technological Development (CNPq) and the Federal University of Bahia (UFBA).

As reference service to victims of domestic violence in the city of Salvador (BA), the area of the study consisted of four police stations, where participants with residence were identified since the interviews were conducted in the home of the elderly victims of domestic violence.

The inclusion criteria for the study were people age over 60 years old, according to the age parameters established by the Statute of the Elderly¹³; and being a victim of domestic violence, with registration in person or anonymous complaints through the Service Hotline in the surveyed stations. The indicators of domestic violence were: inbreeding, the emotional proximity of the victim with the aggressor and the relationship with the formal caregivers.

Data collection was from August 2006 to April 2007, and the following steps were constituted: a survey of cases of violence involving older people from police reports filed from January 2001 to April 2007. In this first stage, there were 3,350 cases of violence identified involving elderly. Of this total, 1,512 (45.1%) were related to other violence. The remaining 1,838 (54.9%) were related to domestic violence, being selected for the survey, according to the project objective.

The next stage was the interviews. For this stage, the criteria adopted for the selection of participants was the location of households, as the address stated in the police report, and agreement to participate. The process began with the attempt to the location of households located in the most central districts of the city of Salvador and later in the suburbs and the metropolitan area. In the end, there were 892 semi-structured interviews, which corresponded to 48.5% of selected cases of domestic violence against the elderly.

The content of the interviews consisted of a narrative of the situations that led to the violence and the complaint. They were recorded with the consent of the participants, by signing the Informed Consent Form. Among the cases, nine whose abused elderly were identified referring to religion or spirituality in their speeches. Respondents are identified in the text by the letter E followed by the interview number.

In line with the thematic analysis of content proposed by Bardin¹⁴, the corpus organization was preceded, consisting of transcribed interviews, and floating and exhaustive reading of the interviews texts, clipping and performing a general overview. Therefore, the central ideas from the aggregation of the most important speeches on topics were visualized and finally the final analysis of the material, organized into thematic categories, with the theoretical reference related to the theme.

This study followed the requirements of the Guidelines and Regulatory Standards of research involving human beings included in the Resolution 196/96 of the National Health Council. The project was approved by the Research Ethics Committee of the State School of Public Health, through the opinion number 021/2004.

RESULTS AND DISCUSSION

The reference to a deity can be configured as a way to cope with stressful situations. In this research, nine cases of domestic violence against the elderly were identified in which the victims made some allusion to religion or spirituality.

The age of the elderly ranged between 64 and 73 years old, and all were female. Concerning the consanguinity of the nine cases, six aggressors were their children. This data is by the literaturerecords^2,4,6,15,16 that is a higher incidence of assaults on elderly people held by close relatives.

The main motivation for the practice of violence was the use of illicit drugs and alcohol. Alcohol abuse is a strong aggravating physical domestic violence, leading to interpersonal conflicts, financial and legal difficulties¹⁷, thereby contributing to the increased burden of suffering among the elderly. In a study on domestic violence against women in the city of Porto Velho (RO), 45.3% of people with aggression reported that violence was motivated by the use of alcohol¹⁸. Another survey conducted in Rio Grande do Sul, on the relationship of family violence with the abuse of alcohol or drugs also found that these substances can cause conflicts and aggression within their home ¹⁷. Therefore, alcoholism has become a serious public health problem, as a factor to be considered by the policies of prevention of domestic violence.

The types of violence against the elderly participants identified were: the psychological or emotional abuse, financial exploitation, material loss, physical violence and even false incarceration. The practice of psychological and emotional violence against the elderly imprisons them and condemns them to live indefinitely in inhumane contexts of great suffering, hopelessness, and risk for injury and disease development, especially when the abuser is a member of the family¹⁶.

Concerning false incarceration, the Brazilian Penal Code, in Article 148, defines it as a deprivation of liberty imposed on someone by the kidnapping or retention. This type of violence is punishable by incarceration which may vary from one to three years. However, if by mistreatment or nature detention lead to serious physical or moral suffering of the victim, the penalty increases from two to eight years¹⁹.

From the testimonies of the elderly in domestic violence, two categories have been identified for the purpose of this study: religion or spirituality as alleviation of suffering and religiosity or spirituality to promote change in offender behavior.

Religion or spirituality as alleviation of suffering

By using the historical aspects relating to health, it is clear that the lack of knowledge about the origin of certain diseases can lead to attributing the cause to factors related to divinity and (or) to the supernatural. Thus, there is the belief that the gods and the spirits had the power to cause the disease as to cure them²⁰. Verifying the statements obtained, it appears that it is common to the delivery of the violence situation to a higher deity so that it brings a relief or a solution. Also, there was the attribution of the violence to God, linking it often to a divine punishment or as a means of spiritual growth, as can be seen in the following statements:

Domestic violence against the elderly permeates the scenario in which this study was conducted. For a significant portion of victimized elderly, aware that their abusers are precisely their loved ones is a difficult and painful process. Therefore, search for help in the religious sphere becomes an attempt to mitigate the blame for the inability to solve their own and family problems. Many ties, even contradictory, these elderly put the offender on the victim´s condition, as can be exemplified in the following quote:

To better understand the position adopted by the elderly in the domestic violence situation, the concept of coping is necessary. This term refers to the use of cognitive and behavioral efforts toward the management requirements or internal and external demands individually assessed as an effort over the personal resources^8,9.

In this context, spirituality or religiosity emerges in the discourse of the elderly, both as a way to understand and explain the situation of violence experienced and as a means to seek help and support for the aggression, as can be seen in the following statement.

Religiosity and spirituality support various functions, such as relief, comfort, consolation, and the search for meaning for the existence problems. Thus, it becomes part of the coping process for stressed situations^8,9.

Anchored in faith and religiosity or spirituality, these old people find strength to face the pain and suffering resulting from the aggression and significant losses in life. In the cases they cited, even after losing their husbands and children and in the face of aggressions routinely, the elderly still dealing with adversity and facing situations of hardship and suffering a resilient attitude.

In the speeches analyzed, references to religious bodies or even spirituality were identified that can act as a breath before the domestic violence suffered by the elderly. Thus, for a better understanding of the event, a differentiation between religions is necessary, religiosity and spirituality.

Religion is a representational system of beliefs and dogmas by which a person would shape his life and behavior^20,21. Religiosity refers to attributes related to a specific religion, adherence to beliefs and practices related to a church or organized religious institution. Spirituality corresponds to an established relationship with a being or a higher power in which they believe^{8, 9,12,20-24}.

There was no reference to a specific religion, but the elements that may be indicative of certain religious affiliations or, in some cases, just the mention of a divine being superior. The testimonies showed words like God, Lord, Senhor of Bonfim, Jehovah, Santa Barbara, Cosmas and Damião, All Saints and Orishas.

These words give an idea of the diversity of beliefs in Brazil. Data from the Brazilian Institute of Geography and Statistics (IBGE) show that, according to the latest census, there are in the country 64.6% of Catholics, 22.2% Protestants, 2% of spiritualists, 0.3% religions of African origin; and 8% of the population without religion²⁵. In a study conducted in São Paulo, about the influence of religious orientation on the quality of life of the elderly, about 92% of respondents declared themselves religious, with Catholics and evangelicals totaled 83.4%²¹.

In a study in a city in the Recôncavo Baiano, it was also identified the predominance of elderly Catholics (60.2%), followed by Evangelicals (27.7%)¹². In another study conducted in the state of Santa Catarina, on religiosity in the process of living older, 82.3% of respondents who practice some religion²⁶.

IBGE data also reveal strong religious syncretism in the country, particularly in Bahia. Despite the reduction of the contingent of Catholics among all regions of the country, this figure remained higher in the Northeast and South. However, there was still the highest number of individuals who professed Candomblé located in the State of Bahia mainly in Salvador and metropolitan region²⁵, since this is one of the cities with the biggest black contingent out of Africa.

Religiosity or spirituality to promote change in the offender behavior

Some elderly adopted a delegator coping style, to transfer responsibility for the violence to which they are submitted to God or the practice of witchcraft. Thus, the solutions may expect by divine interference. This type of behavior is more typical in people who feel powerless in the face of situations of aggression, due to the sense of external support and power over the problem that this coping style promotes.

The behavior of the attitude of the aggressor in the care of a higher being as the alternative resolution of the problem demonstrates a palliative attitude. Moreover, as citizens, there are questions about what kind of support has been offered to these elderly so that they can cope with the violence they face. More forcefully, also questions about the role of nursing in this reality.

Due to the conditions imposed by the aging process, such as the physical limitation and the unfavorable social, the elderly hardly afford to, alone, facing violence. It is understood that it is essential to support the family, the community and the state, as highlighted by the Statute of the Elderly, which in Article 3 of the preliminary provisions states:

It is family´s obligation, the community, society and the government to ensure the elderly, with absolute priority, the implementation of the right to life, health, food, education, culture, sports, leisure, work, citizenship, freedom, dignity, respect and family and community coexistence¹³.

In this sense, it is evident that the protection of faith often is the last (and only) refuge left to those elderly and therefore characterized as a coping strategy through religion and spirituality.

It was found in this research that the profile of domestic violence by the elderly is characterized by being centered on emotion, with attitudes that can be of removal or remedial and denial or avoidance about the source of stress.

Studies that have examined the association between religious practices and indicators of psychological violence showed that there is a positive association between these items. Religiosity helps in welfare, in coping and quality of life, especially for the elderly, physically challenged and sick people. This behavior can mean the search for religious refuge among the groups exposed to more stressful circumstances^11,12,21.

CONCLUSION

The data analysis revealed that the elderly in domestic violence put their hopes on religion or spirituality. It was observed, in their speeches, that religiosity or spirituality is manifested in two ways: as a relief to the suffering in the face of domestic violence and as a potential catalyst of abuser´s behavior change.

Violence is naturalized in such a way that some older people come to believe that the suffering they experience is determined or permitted by divine will. The religious expressions found to prove the actual attachment of the elderly to religion in search of comfort such as striking and recurring moments.

It can be said that they bolster both in religion and in spirituality to address domestic violence. When reference names of saints, Jehovah or the Orishas they are reporting to their religion. However, when using generic expressions as Lord and My God, they are referring to spirituality.

Some seniors find the way to think of the change of attitude of the aggressor and adopting a culture of peace by their religion.

Affection is expressed intensely about religion. This could be seen when older people talk about their families´ offenders as people who need care, attention, and devotion, hoping that nothing happens to them while under police custody.

Nursing should be attentive to the discourse of these older people since they can hide domestic violence because of the hope that spirituality or religiosity can operate on the violent attitudes of loved ones. Therefore, it is imperative that nursing adopts a positive approach to religion, since their professional ethics and human responsibility. This may assist in the recovery of health and offer better conditions of welfare for the elderly.

The small number of subjects was a limitation of the study, but it was possible to indicate that the relationship between violence and religion should be further investigated by health professionals. This knowledge can contribute to a more humanized care, in line with respect for religious and spiritual values of the people.

REFERENCES

1. Waiselfisz JJ. Mapa da violência 2015: mortes matadas por arma de fogo. Brasília (DF): Secretaria-Geral da Presidência da República; 2015. [cited in 2016 May 17]. Available from: www.juventude.gov.br/juventudeviva

2. Menezes MR. Revelando a Violência Doméstica Contra Idosos em Salvador – Bahia. Relatório de Pesquisa. UFBA/EE/CNPq; 2007.

3. Gutz L, Camargo BV. Espiritualidade entre idosos mais velhos: um estudo de representações sociais. Rev bras geriatr gerontol. [Scielo-Scientific Electronic Library Online] 2013 [cited in 2016 May 17]. 16(4):793-804. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-98232013000400793&lng=en

4. Menezes MR. Da violência revelada à violência silenciada: um estudo etnográfico sobre a violência doméstica contra idosos [tese de doutorado]. Ribeirão Preto: Universidade de São Paulo; 1999.

5. Rocha EM, Vilela ABA, Oliveira DC, Silva DC, Alves MR, Meira SS. Estrutura representacional de profissionais da estratégia de saúde da família sobre violência intrafamiliar contra idosos. Rev enferm UERJ. 2015 [cited in 2016 May 17]. 23(2):178-84. Available from: http://www.epublicacoes.uerj.br/index.php/enfermagemuerj/article/view/7450/12787

6. Garbin CAS, Joaquim RC, Rovida TAS, Garbin AJI. Idosos vítimas de maus-tratos: cinco anos de análise documental. Rev bras geriatr gerontol. [Scielo-Scientific Electronic Library Online] 2016 [cited in 2016 May 17]. 19(1):87-94. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S180998232016000100087&lng=en

7. Fontes AP, Neri AL. Resiliência e velhice: revisão de literatura. Ciênc saúde coletiva [Scielo-Scientific Electronic Library Online] 2015 [cited in 2016 May 17]. 20(5):1475-95. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S141381232015000501475&lng=en

8. Rocha ACAL, Ciosak SI. Doença Crônica no Idoso: espiritualidade e enfrentamento. Rev esc enferm USP. 2014 [cited in 2016 May 17]. 48(Esp2):92-98. Available from: http://www.revistas.usp.br/reeusp/article/view/103112

9. Rocha ACAL, Ciosak SI. Spirituality in the self-management of the elderly chronic disease.

Atas CIAIQ. 2014 [cited in 2016 May 17]. 2:95-101. Available from: proceedings.ciaiq.org/index.php/CIAIQ/article/download/459/455

10. Pereira A, Marques M, Simões S, Cunha M. Relação entre a inteligência espiritual e a saúde mental e física em idosos. Revista Portuguesa de Investigação Comportamental e Social. 2016 [cited in 2016 May 17]. 2(1): 38-52. Available from: http://rpics.ismt.pt/index.php/ISMT/article/view/18

11. James M. Voice of the people 2005: religiosity around the world. Gallup International. [cited in 2013 Feb 29] Available from: http://extranet.gallup-international.com/uploads/internet/Religiosity%20around%20the%20world%20VoP%2005%20press%20release.pdf

12. Santos NC, Abdala GA. Religiosidade e qualidade de vida relacionada à saúde dos idosos em um município na Bahia, Brasil. Rev bras geriatr gerontol. [Scielo-Scientific Electronic Library Online] 2014 [cited in 2016 May 17]. 17(4):795-805. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-98232014000400795&lng=en

13.Casa Civil (Br). Estatuto do idoso: Lei Federal nº 10.741, de 01 de outubro de 2003. Brasília, DF: Secretaria Especial dos Direitos Humanos, 2004.

14. Bardin L. Análise de Conteúdo. Lisboa: Edições 70; 2011.

15. Bes TM, Lopes FAR, Morgan GJ, Ribeiro MS, Duarte WR. Relação da violência intrafamiliar e o uso abusivo de álcool ou entorpecentes na cidade de Pelotas, RS. Revista da AMRIGS. 2013 [cited in 2016 May 17]. 57(1): 9-13. Available from: www.amrigs.com.br/revista/57-01/1108.pdf

16. Menezes MR. Violência contra idosos: é preciso se importar! In: Berzins, MV; Malagutti, W. (org.). Rompendo o silêncio: faces da violência na velhice. São Paulo (SP): Martinari; 2010. p. 25-58.

17. Lopes APAT, Ganassin GS, Marcon SS, Decesaro MN. Abuso de bebida alcoólica e sua relação no contexto familiar. Estudos de Psicologia. 2015 [cited in 2016 May 17]. 20(1): 22-30. Available from: http://www.redalyc.org/articulo.oa?id=26142192004

18. Moreira KFA, Costa AP, Oliveira TS, Andrade MMO, Cruz RLS, Alves MMM. The socio-demographic profile of women and the occurrence of domestic violence. Rev enferm UFPE on line. 2012 [cited in 2012 mar 10]. 6(1):18-25. Available from: http://www.revista.ufpe.br/revistaenfermagem/index.php/revista/article/viewArticle/1896

19. Ministério da Justiça (Br). Código Penal Atualizado - Decreto-Lei 2848 de 07 de Dezembro de 1940. [cited in 2010 Aug 26] Available from: http://www.codigopenal.adv.br/#a148

20. Gomes AMT, Espírito Santo CC. A espiritualidade e o cuidado de enfermagem: desafios e perspectivas no contexto do processo saúde-doença. Rev enferm UERJ. 2013 [cited in 2013 Aug 01]. 21(2):261-4. Available from: http://www.e-publicacoes.uerj.br/index.php/enfermagemuerj/article/view/7214

21. Chaves LJ, Gil CA. Concepções de idosos sobre espiritualidade relacionada ao envelhecimento e qualidade de vida. Ciênc saúde coletiva [Scielo-Scientific Electronic Library Online] 2015 [cited in 2016 May 17]. 20(12): 3641-52. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S141381232015001203641&lng=en

22. Oliver A, Galiana L, Sancho P, Tomás JM. Espiritualidad, esperanza y dependencia como predictores de la satisfacción vital y la percepción de salud: efecto moderador de ser muy mayor. Aquichan. 2015 [cited in 2016 May 17]. 15(2):228-38. Available from: http://www.sci.unal.edu.co/scielo.php?script=sci_arttext&pid=S165759972015000200007&lng=es&nrm=is

23. Lucchetti G, Koenig HG, Pinsky I, Laranjeira R, Vallada H. Spirituality or religiosity: is there any difference? Rev bras psiquiatr. [Scielo-Scientific Electronic Library Online] 2015 [cited in 2016 May 17]. 37(1):83. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S151644462015000100083&lng=en

24. Damiano RF, Costa LA, Viana MTSA, Moreira-Almeida A, Lucchetti ALG, Lucchetti G. Brazilian scientific articles on Spirituality, Religion and Health. Arch Clin Psychiatry. [Scielo-Scientific Electronic Library Online] 2016 [cited in 2016 May 17]. 43(1):11-6. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-60832016000100011&lng=en

25. Instituto Brasileiro de Geografia e Estatística (IBGE). Censo Demográfico 2010. Características gerais da população, religião e pessoas com deficiência. Rio de Janeiro (RJ): IBGE; 2012. [cited in 2016 May 17]. Available from: www.ibge.gov.br/home/estistica?população/censo2010

26. Zenevicz L, Moriguchi Y, Madureira VSF. A religiosidade no processo de viver envelhecendo. Rev esc enferm USP [Scielo-Scientific Electronic Library Online] 2013 [cited in 2013 Aug 01]. 47(2):433-9. Available from: www.scielo.br/pdf/reeusp/v47n2/23.pdf