Supporting spirituality is essential to high-quality nursing care of older people with dementia. The aim of this study was to achieve a comprehensive understanding of supporting the spirituality of older people living with dementia in their caring and living environments. First, a narrative literature review on spiritual support of older people living with dementia was conducted. Secondly, in two hermeneutic-phenomenological interview studies the lived experiences of nurses (n=17) and older people (n=10) together with their family members (n=9) were inquired. In the latter sub-study, spiritual-supportive caring and living environment was analysed utilising photo-elicitation. A total of 75 photographs were included in the analysis.

Results revealed that supporting the spirituality of older people living with dementia was concerned with supporting religious activity, enabling connections, nurses’ reflections on their own spirituality, and nonverbal communication. From the perspective of nurses, supporting the spirituality of older people living with dementia was seen as understanding their spirituality within a framework of person-centeredness and individuality. Spiritual needs were met by approaching people with dementia as valuable humans as well as supporting their personal philosophy of life. According to the experiences of the older people living with dementia and their family members, their personalised spirituality can be supported through four elements of spirituality: religion, meaningful relationships, nature, and arts. Personal sense of meaning was central to experiences of spiritual support. Spirituality was seen as a continuum of human life, manifested through caring and living environment even when older person living with dementia was unable to express it. The experiences of the nursing environment that supports spirituality were summarized into three questions: "Where do I belong?", "What remains of me in the world?" and "Where am I going?" Caring and living environment that supports spirituality seeks answers to these questions together with older people with dementia, their family members, significant others, and nursing professionals.

A descriptive theory of supporting the spirituality of older people with dementia in their caring and living environments was derived from this study. This may improve the nursing care of older people with dementia by considering their spiritual needs.