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Grief and Loss Experience for Older Adults

Question:

Dsicuss about the Counselling for Grief and Loss for Condition.

Grief is a multifaceted and intense emotional response to loss which leads to indefinite period of bereavement and suffering for people. The circumstances of loss may be different for different person. Some examples of losses includes death of a loved one, divorce, deteriorating health or physical condition, changes in social position or self respect or certain accidents in life  (Hall 2014). Continuous period of bereavement has a negative impact on people evident by physical signs, emotional symptoms, social changes and unusual thought pattern of people. The perception about losses has a great impact on patient and they go through many traumatic experiences during the grieving process. Bereavement in the elderly is a major concern because their suffering is more pronounced because of significant decline in cognitive function, sudden loss of support and serious risk to quality of life (Hashim et al. 2013). The main purpose of this essay is to critically explore grief and loss experience for older adults and reflect on the experience based on two contemporary theories. It also provides a discussion regarding the benefits of the theories and its practical application in the counseling process for older people with bereavement.

My personal experience related to a period of grief and loss in my life occurred when I witnessed my grandmother’s death in front of me. I was closely attached to my grandmother and spent a lot of time with her. However, in her last stage of life, she was diagnosed with cancer. I directly witnessed how her health deteriorated day by day and she became dependent on life support system for every single breath. One day she died in front of me when I saw her breathing stopped all of a sudden. This close experience of witnessing death of my closed one shattered me completely. I could not come out from grief for a long time. I lost interest in my work activities and spend most of the time crying and remembering the sufferings of my grandmother. I yearned to see her again and had the guilt that I could do enough to save her.  Eventually, it took physical and emotional toll on my health too as I tried to keep to myself and stopped interacting in social spaces. Normally, in complex grieving process, the support from counseling only helps people to rebuild their life. However, for me, my mother proved to be pillar of support and she helped me to cope with the loss and accept the reality of death. The support from my family members helped in my recovery because my grief was not so complicated that it required specialized support. The feeling of loss and grief symptoms was for a temporary period unlike complicated grief which persists for a longer period of time.

Response to Loss for Older Australians

The above experience is my personal experience of loss, however it does not provides any insight into the grieving process and challenges for older adults going through bereavement. However, focusing on the bereavement process in older Australians is important because they are most vulnerable to negative health outcome due to the loss of their loves one (Parkes and Prigerson 2013). The experience of grief is intense and the most common reaction to grief in all age groups mostly include feelings of despair, yearning, shock, intense sadness, guilt and anger. The common physical responses of grief include change in appetite, difficulty in sleeping, illness, crying, muscle tensions and suicidal thoughts in severe cases (Papa, Lancaster and Kahler 2014). Older people show different response to bereavement due to diverse experience of loss. For older people, bereavement is a frequent experience as they endure loss of spouse, family members or close friends. The impact of loss is huge particularly for older women as death of close family members result in reduction of social support networks (Ingham et al. 2017). Hence, death of closed ones becomes a major life stressor for them as they also have to cope with losses associated with old age such as poor health and poor capacity to self care.


For older people, loss of loved ones results in sudden withdrawal of care and support for them. This is because often the person who dies is long term partner and source of care giving for them. This type of loss is mainly defined as loss due to death of a spouse. All of a sudden, the lose independence and support to manage home and negotiate daily livings. Fear of living alone and losing independence overwhelms them and poor health and depression becomes common in such older adults (Naef et al. 2013). Bratt, Stenströz and Rennemark (2017) identified three common bereavement patterns in older people such as short term disruption in functioning caused by illness, depression and cognitive decline, chronic disruptions and relative absence of grief reactions. Hence, it can be said that the severity of loss is dependent on nature of relationship with the person who had died and significance of the loss in terms of practical, social, financial and emotional needs. As spouse is the one who is responsible to support their partner in all dimensions of life, hence impact of loss is huge in such cases.

One study has showed spousal loss plays a major role in the development of depressive symptoms in the elderly. The loss of spouse changes the quality and quantity of social integration in elderly which is a major factor contributing to elevated depressive symptoms. Often the level of severity is such that immediate psychosocial support and early detection of complicated grief is necessary to identify appropriate treatment option for older people (Sikorski et al. 2014). Hence, for counselors, inquiring the bereaved elderly adult about the meaning of loss for them, impact of social and practical life needs, current help or support needed is critical to identify the severity of depressive symptoms and take adequate action. Older people mostly seek bereavement support from their physician to cope with losses, however specialized grief specific service are like cognitive behavioral therapy and pharmacotherapy are the effective treatment option to treat elderly people with bereavement (Ghesquiere, Shear and Duan 2013). As elderly people lose the capability to self care after the loss of their loved ones, there is a need to promote independence and self care in them following bereavement to help them recover from the grieving process.

The Impact of Spousal Loss on Elderly


Other forms of losses experienced by older Australian might be loss of family members due to murder, mismanagement by health care personnel or by car accident. The bereaved circumstances of an individual differs due to unsupportive family, lack of care from family members, loss of independence, lack of social and other supports and low socio-economic status A study revealed that people with low income and low education level fail to access appropriate support following loss of loved ones (Cacciatore, Killian and Harper 2016). In all types of losses, the main grief characteristic is yearning and longing for the person, frequent thought of the person and low interest in routine life activities. Older adults mostly experience acute form of grief where the bereaved person regains interest and pleasure in everyday activities after some time. However, about 7% of the bereaved adults experience complicated grief, a mental health condition resulting from prolonged acute grief (Shear, Ghesquiere and Glickman 2013). The main criteria that differentiate complicated grief from normal grief include severity and duration of symptoms, delayed onset of reactions and level of dysfunction. Negative physical and mental health consequences increase in older people due to complicated grief reactions (Shear, Ghesquiere and Glickman 2013. Hence, counseling is most important in treatment of complicated grief reaction of people.

The whole process of grief and differential response to losses in different circumstance of older adults can also be analyzed according to two contemporary theories of grief. The first theory is the Stroebe & Schut’s Dual process of coping with bereavement and it mainly integrates cognitive stress theory with attachment theory. The main assumption of this theory is that coping style of bereaved individual differs on the style of attachment, however brief complications contribute to insecure attachment styles (Stroebe and Schut 2015). Hence, the dual process model explains the shift in two complimentary sets of processes such as the loss orientation and restoration orientation of people. In case of personal experience with grief as well as different types of grief experiences by older adults, experience of loneliness and social isolation following death of loved ones is an example of insecure attachment styles (Fried et al. 2015). People experience loneliness due to complicated grief reactions such as yearning for the person, extreme depression and inability to trust others. The feelings of loss consequently develop into loneliness and loneliness is the main contributing factor for depression in such individuals too (van Beljouw et al. 2014). Hence, in case of issues of loneliness during the bereavement process, counselors can focus on addressing the restoration orientation of people. This will promote changing identity of people and helping older to people to master certain skills that will help them to cope with the grieving process.


The application of Stroebe & Schut’s Dual process theory is considered in the counseling process of bereaved older adults because it mainly represents grief and discusses the regulatory coping process of oscillation between loss orientation and restoration orientation to promote healing and adaptive coping in people. The dual process model mainly proposes adaptive coping by the confrontation and acceptance of loss and changing perspective related to death of affected person. The main advantage of applying dual process in counseling for older adults with bereavement is that by embracing the idea of confronting the situation, the older people can accept the reality of death and they are able to live their lives with desired stability (Carr 2010). Hence, for counselors, the challenges in treating older people experience grief can be minimized. This is because dual process models help the client to take control over the situation and prepare them to cope with post loss life events.

Counselors engaging in treating older patient with grief experience can apply dual process model to understand the intent and motivation of the person to adjust with losses. Based on this identification, adequate coping process and skills can be developed in older adults to strengthen their self-care skills and reduces feelings of grief. The only constraint and barrier in applying the dual process model in counseling is that many questions related to the model still remains unanswered. For example, family dynamics has a major impact on the personal grief person however the model does not provided adequate guideline to differentiate individual and family approaches in the coping process (Stroebe and Schut 2015). Hence, future research is still needed on the dual process model by extending the family approach. Appropriate guideline will help to determine whether individual or family level approach is needed to develop coping skills in older adults (Stroebe and Schut 2010).

Another contemporary theory that can be considered to address bereavement and griefing related issues in older adults includes the Rubin’s Two Track Model of bereavement. The Two Track Model of bereavement of incorporates biopsychosocial functioning and the nature of the relationship to the deceased. This is recent model unlike the dual process model and focuses on assessment and intervention for clients according to their needs. Use of this model can facilitate understanding bereavement through the dimension of biopsychosocial functioning in people and understanding the relationship to the deceased. The counselors looking to treat older adults with bereavement can assess biopsychosocial functioning in older adults by analyzing symptom of stress, trauma and change in life pattern after the family member’s death. The second dimension of the Two Track Model can guide the counselors to know about relational bonds of client with the deceased person (Rubin and Shechory-Stahl 2013). The Two Track Model of Bereavement has also been studied to understand life functioning and relationship to partner and spouse. Older adults are most vulnerable to negative physical and mental health outcomes due to loss of spouse (Bar-Nadav  and Rubin 2016). Hence, Two Track Model can be a guide to assess level of functioning before and after the death of spouse.

Application of Dual Process Theory in Counseling

According to Bruinsma et al. (2015), the main risk factors for complicated grief in older adults include cumulative losses, being the primary care giver, mistreatment in society, poverty and homelessness and physical decline in health and terminal illness. Due to the consequences of ageing and accumulation of years of living, accumulated loss and vulnerability increase in older adults. Hence, older people are most vulnerable to emotional and psychological distress after the death of the closed member. This kind of risk and vulnerability of older people to bereavement can be identified by the Two Track Model. Another advantage of using this model for bereavement counseling is counselors can use this as a guide to develop questionnaire for clients during the counseling session. This can give useful idea about the complications of grief in older adults.

Study on bereavement experience in older people has mainly revealed experience of negative health effects, loneliness, changed identity and continuing bonds with deceased person. Continuing bond is related to presence on on-going inner relationship with the deceased person. They have dream of the dead spouse or find comfort in memories to stay close to the deceased person (Supiano and Luptak 2013). The application of Two Track Model of Bereavement is also seen in research studies to assess continuing bonds of bereaved parents. The study done with parents who lost their sons in war has revealed that relationship to deceased child continues for all parents, however the bereavement outcome in people is affected by the manner in which the deceased person is recollected (Rubin and Shechory-Stahl 2013). Hence, the main advantage of Two Track Model of Bereavement is that it has addressed the shortcomings in other grief models and balanced the excess of different approach. The understanding of relationship with deceased person and manner of reminiscing can promote critical understanding of the bereavement process and adjusting lifestyle and coping style of older adults. Hence, this model can facilitate bereavement risk assessment process and help counselor to identify the appropriate cognitive or psychological intervention needed to address grief in older adults.

The essay summarized the different types of grief experience and challenges faced by older adults due to loss of close family members. The rational for special focus on identifying bereavement experience of older adult is that consequences of ageing and dependence on others for self-care increase their vulnerability to depression, loneliness and poor physical health in older adults. The importance of counseling intervention in older people bereavement is realized when complicated grief process is present in older adults for longer period of time. The essay compared and critically analyzed the dual process theory and the Two Track Model to identify how application of this theory can support understanding of the bereavement process and determining healthy or negative continuing relationship with deceased individual. The advantage of Two Track model has been proved to change the manner of continuing bond with deceased person and engaging in healthy living by developing positive perception about death of the person. This can facilitate better acceptance of death and brining stability in life.

Conclusion

Reference

Bar-Nadav, O. and Rubin, S.S., 2016. Love and Bereavement: Life Functioning and Relationship to Partner and Spouse in Bereaved and Nonbereaved Young Women. OMEGA-Journal of Death and Dying, 74(1), pp.62-79.

Bratt, A.S., Stenström, U. and Rennemark, M., 2017. Effects on life satisfaction of older adults after child and spouse bereavement. Aging & mental health, 21(6), pp.602-608.

Bruinsma, S. M., Tiemeier, H. W., Heemst, J. V. V., van der Heide, A., and Rietjens, J. A. 2015. Risk factors for complicated grief in older adults. Journal of palliative medicine, 18(5), 438-446.

Cacciatore, J., Killian, M. and Harper, M., 2016. Adverse outcomes in bereaved mothers: the importance of household income and education. SSM-Population Health, 2, pp.117-122.

Carr, D., 2010. New perspectives on the dual process model (DPM): What have we learned? What questions remain?. OMEGA-Journal of Death and Dying, 61(4), pp.371-380.

Fried, E.I., Bockting, C., Arjadi, R., Borsboom, D., Amshoff, M., Cramer, A.O., Epskamp, S., Tuerlinckx, F., Carr, D. and Stroebe, M., 2015. From loss to loneliness: The relationship between bereavement and depressive symptoms. Journal of abnormal psychology, 124(2), p.256.

Ghesquiere, A., Shear, M.K. and Duan, N., 2013. Outcomes of bereavement care among widowed older adults with complicated grief and depression. Journal of primary care & community health, 4(4), pp.256-264.

Hall, C., 2014. Bereavement theory: recent developments in our understanding of grief and bereavement. Bereavement Care, 33(1), pp.7-12.

Hashim, S.M., Eng, T.C., Tohit, N. and Wahab, S., 2013. Bereavement in the elderly: the role of primary care. Mental health in family medicine, 10(3), p.159.

Ingham, C.F., Eccles, F.J., Armitage, J.R. and Murray, C.D., 2017. Same-sex partner bereavement in older women: an interpretative phenomenological analysis. Aging & mental health, 21(9), pp.917-925.

Naef, R., Ward, R., Mahrer-Imhof, R. and Grande, G., 2013. Characteristics of the bereavement experience of older persons after spousal loss: An integrative review. International Journal of Nursing Studies, 50(8), pp.1108-1121.

Papa, A., Lancaster, N.G. and Kahler, J., 2014. Commonalities in grief responding across bereavement and non-bereavement losses. Journal of affective disorders, 161, pp.136-143.

Parkes, C.M. and Prigerson, H.G., 2013. Bereavement: Studies of grief in adult life. Routledge.

Rubin, S.S. and Shechory-Stahl, M., 2013. The continuing bonds of bereaved parents: A ten-year follow-up study with the two-track model of bereavement. OMEGA-Journal of Death and Dying, 66(4), pp.365-384.

Shear, M.K., Ghesquiere, A. and Glickman, K., 2013. Bereavement and complicated grief. Current psychiatry reports, 15(11), p.406.

Sikorski, C., Luppa, M., Heser, K., Ernst, A., Lange, C., Werle, J., Bickel, H., Mösch, E., Wiese, B., Prokein, J. and Fuchs, A., 2014. The role of spousal loss in the development of depressive symptoms in the elderly—implications for diagnostic systems. Journal of affective disorders, 161, pp.97-103.

Stroebe, M. and Schut, H., 2010. The dual process model of coping with bereavement: A decade on. OMEGA-Journal of Death and Dying, 61(4), pp.273-289.

Stroebe, M., and Schut, H. 2015. Family matters in bereavement: Toward an integrative intra-interpersonal coping model. Perspectives on Psychological Science, 10(6), 873-879.

Supiano, K.P. and Luptak, M., 2013. Complicated grief in older adults: A randomized controlled trial of complicated grief group therapy. The Gerontologist, 54(5), pp.840-856.

van Beljouw, I.M., van Exel, E., de Jong Gierveld, J., Comijs, H.C., Heerings, M., Stek, M.L. and van Marwijk, H.W., 2014. “Being all alone makes me sad”: loneliness in older adults with depressive symptoms. International psychogeriatrics, 26(9), pp.1541-1551.

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