Understanding Dynamic Loss And Grief In Elderly Individuals

Defining Bereavement and Grief

Discuss about the Dynamic Loss and Grief.

Bereavement has been identified to cause devastating effects on the immune systems of elderly individuals and even lead to depression a psychological illness. Scientist claim that these effects may explain why a majority of elderly spouses die after the death of their loved ones. A majority of individuals can conquer their grief without any form of intervention. However, some do not. This is the reason why support needs to be given to the elderly to avoid the effects stated above. When a husband, wife or partner dies, one loses their counterpart and companion and they feel loneliness that may be overwhelming. Furthermore, couple friends may drift away, and the survivor is left with the burden of having no one to discuss and commiserate about everyday events. They also lack a person to share the responsibilities of the home (Stroh Becvar, 2003). To be able to offer effective support for the elderly who suffer grief and bereavement as a result of partner loss one needs to comprehend the complex nature of grief better. Grief is complex in nature and is not only shaped by a person’s culture or the social context but also the sort of bond that the survivor shared with the deceased. This paper will define and discuss grief and its categories, the mourning or bereavement process with the aim of providing insight into how the elderly individuals can be assisted to cope with the death of their partners.

Bereavement is that state of an individual who has suffered a loss while grief is the individual’s response to the loss. This means that bereavement is defined as the loss itself excluding the survivor’s reaction to the loss. Grief, on the other hand, is that reaction of the survivor to the loss (DeSpelder & Strickland, 2011). This reaction can be expressed spiritually, physically or emotionally and may be influenced by one’s culture and ethnicity. The symptoms of grief differ from one person to another without following any particular pattern. Some suffer from depression or anxiety while others experience euphoria. Emotions associated with grief are specific to the relationship with the deceased, time of death and also the way by which the person died. The feelings may include guilt, relief, anger, loneliness, helplessness, fatigue, anxiety, and sadness among others. Cognitions may include confusion, disbelief, sense of presence, hallucinations and preoccupation among others. Physical reactions, on the other hand, may include insomnia, appetite disturbances, absentminded behaviour, crying, wondering aimlessly and social withdrawal among others (Byrne & Raphael, 1997). So as to give efficient support to the elderly, consideration must be given to the broad categories or manifestations of grief.

Categories or Types of Grief

The bereavement period is stressful for everyone. However, a majority of individuals are able to come to terms with their grief while in others the grief becomes complicated or prolonged. A study indicated that compared to the young, elderly individuals aged around 75 and 84 years are more prone to develop grief (Newson, Boelen, Hek, Hofman, & Tiemeier, 2011). Morbidity associated with complicated grief include depressive illness, poor quality of life, anxiety disorder and also the risk of suicide. A study also indicated that bereavement may have an impact on the cognitive function of the elderly and that they were most likely to function poorly in relation to verbal fluency, processing of information and attention (Shear, Ghesqueire, & Katzke, 2013).

To better understand grief in detail, here are the categories or types of grief.  Majority of individuals fall under the normal or acute type of grief (Morris & Block, 2012). This type includes healthy reactions and those identified include individuals exhibiting numbness or withdrawal from others, shock and denial proximately after the death of their partner (Goldman, 2000). Additionally, normal grief is seen to be characterized by a type of somatic or bodily distress, a preoccupation with an image of the deceased, hostile acts, guilt associated with the circumstances of death and not being able to operate as one did before the loss occurred. This becomes a hard time due to the fact that one has to fight the need to react so as to make arrangements for the funeral.

The other type or category of grief is the middle stage characterized by longing for the deceased and anxiety (Morris & Block, 2012). During this stage, some individuals replay the final moments wondering what they would have said or done differently. Support is hard to find during the first few months or weeks after the death of the partner. It is evident that individuals will come for the funeral briefly and return to their lives swiftly. Though the symptoms of grief differ from one person to another without following any particular pattern, a common pattern can be derived that a majority of individuals follow. A short time after the death of a partner, an individual experiences severe sways of emotions usually at high frequencies. Time passes and these swings of emotions are experienced less severely and less frequently. The sways of feelings occur as a result of triggers of anything connected to the deceased like a birthday or anniversary. Getting to understand these waves of emotions assists families sympathize with the survivor. Furthermore, they can assist the griever to identify triggers and thus be able to control their responses to loss and emotions. It proves difficult to define the duration of grief because the reaction to grief is different and dependent upon various aspects such as one’s emotional health and relationship to the deceased among others. If grief persists beyond the normal time that is a socially accepted time, it should be classified under abnormal grief.

The Impact of Bereavement on the Elderly

When acute grief exhibits severe symptoms, the person suffers complicated grief.  Generally, complicated grief portrays similarities to acute grief, but the symptoms are endured longer than expected. Complicated grief is associated with symptoms such as unbearable and strong yearning, inability to accept the loss, crying, searching, and confusion of an individual’s role in life (Spall & Callis, 1997). In addition, symptoms like disbelief and preoccupation with images and thoughts of the deceased are also manifested (Morris & Block, 2012). At times these symptoms can be delayed coming at a later time, and mostly hopelessness may develop. Other features of complicated grief may include somatic symptoms like chest pain, palpitations, and headache. It is critical to look out for depression when an elderly person presents multiple somatic complaints after the loss of a partner. For those dealing with complicated grief, handling triggers becomes difficult, and they end up grieving continuously during yearly anniversaries and birthdays.

To be able to offer efficient support for the elderly after the loss of their partner, one must fully understand first who the person that died was. It is worth having some information about the deceased especially the dead individual’s relationship to the one who was left behind (Spall & Callis, 1997). In this case, such a relationship is that of a partner or spouse. The loss of a partner will definitely be grieved differently from the loss of, for example, a distant cousin.

Secondly, be familiar with the nature of their fondness and connection. Knowing something about the strength of the bond is important, for it is practically obvious that the intensity of grief suffered is influenced by the intensity of the love shared by the couple. Grief increases severely proportionally to the greatness of the love shared. It is crucial to comprehend the reassurance of the attachment, for example, how necessary was the deceased to the sense of well-being of the survivor? Furthermore, did the survivor need the deceased for his or her own sense of self-confidence? Asking these questions indicate a more grief response. For a majority of people, esteem and security needs are met by their spouse. After the death of the partner or spouse, the requirements remain the same, but the resources are not available (Worden, 2009). Also be aware of disputes with the deceased. This does not mean the conflicts that occurred around the time of death. Include also the history of their differences. Conflicted relationships carry with them unfinished business that has not been resolved by the time the partner dies. This is mostly common where sudden death occurs. Lastly, one should also try to understand the dependent relationships. These connections usually affect the individual’s adaptation and reaction to the death. Adjusting will be difficult for a person who depended on the deceased for the fulfillment of several day to day activities like meal preparation, driving and bill paying among others than for the individual who depended on the deceased less.

Offering Support for the Elderly After the Loss of a Partner

Thirdly, it is also vital to know the means by which the partner died for it carries some weight on how the survivor will handle mourning. Usually, deaths are categorized under accidental, homicidal, suicidal and natural. For example, an accidental death of a spouse might be grieved quite differently than if it was a natural death, where death would be seen as occurring at a more appropriate time. Other elements associated with the death that can affect bereavement are proximity that is whether it happened near the survivor or far away from them. Deaths occurring far away might leave the loved one with an unreality feeling concerning the death. They can assume that the person is still there, which would affect the mourning process (Worden, 2009). Also unexpectedness or abruptness of the death, traumatic deaths whereby the trauma can be long lasting and often leads to complicated mourning. Additionally, when the death is seen as preventable, issues of fault, guilt, and liability arise. Stigmatized deaths too such as suicide and death by aids affect bereavement. Where such stigma is evident, social support for the griever might be less than enough. Stigmatized deaths are related to socially unspeakable and negated losses.

Fourthly, so as to understand how an individual is grieving, one should identify whether they had suffered prior losses and how they grieved those losses. That is whether they grieved satisfactorily, or the individual brings to the recent loss a lack of resolution from a prior loss (The Joanna Briggs Institute, 2006). Also, the person’s mental health history may be important at this point. The ones who bring a history of major depression existing before the death of their partner are exposed to chances of great depression that follows spousal bereavement (Worden, 2009).

Lastly, it is key to understand the personality and social variables of the survivor. Some of the personality variables are gender. The reason as to why women and men mourn differently can be associated with the fact that girls and boys are socialized differently. It is argued that since women received more social support than the men and that is why they might grieve differently and have varying bereavement outcomes.  Coping style is another personality attribute to consider. Grief is facilitated by an individual’s coping choices. That is, how well they handle anxiety, how inhibited they are with their feelings and how they cope with or handle stressful circumstances. Coping styles differ from one person to the other. The reasoning style is also a key attribute to watch. Every person has a unique cognitive style. One can be more optimistic than the other and likely to see the glass half empty rather than half full. The ability to find something redemptive or positive in a bad circumstance is associated with such optimism (Worden, 2009). On the other hand, depressed individuals have negative views of life, themselves, the world, and the future. Some interventions can be useful to help them, for example, increasing their social contacts and, helping them stay connected without making the pain their point of connection, and go on with their lives without the deceased.

Understanding the Relationship Between the Deceased and the Grieving Individual

When considering social variables, undertaking to grieve as a social experience, and that there is a need to grieve with others is crucial. Considering the degree of recognized social and emotional support given by other individuals both from the family and also from outside the family is also critical in the bereavement process. Research portrayed that individuals who do not do well with bereavement have not had adequate support or have experienced conflicted support (Worden, 2009). Social support can play a difficult role as it can also be destructive. A few months down the line after the death of a partner, the survivor may lack encouraging persons and have individuals merely telling them to move on and get over it. It is important to have supporters who include religious resources and bereavement groups while also undertake in social role involvements.

Attempting to rush an individual through grief can worsen their feelings of distress and further result to more isolation. Continued support of the elderly throughout the process of grieving assists them in coping with their grief. Evaluating the characteristics of the person’s life is critical in understanding, diagnosing and treating complicated grief for the elderly. Mental health, pre-loss emotional health, education status, financial status and cultural considerations are among the crucial factors that have to be considered when trying to support or treat complicated grief. In the case of pre-existing depression, one can be able to differentiate between bereavement-related depression and complicated grief after the loss of a partner. An individual may have suffered some emotional turmoil or loss during their childhood that must be identified so as to offer the best treatment. For the elderly, having suffered a loss as a child may cause them to become vulnerable and insecure and thus have difficulty in setting up emotional and physical boundaries during their adulthood (Collins Logan, 2009). Losing a partner at their elderly age may further lead to severe grief. Failure to identify the past experiences of the elderly may hinder the practitioner from fully supporting or treating the grief suffered by the individual.

Different cultures have different ways in which they respond to death and grief. Furthermore, individuals in the same culture may perceive death and react to grief differently (Jalland, 2006). It is evident that some cultures respond well to grief at a societal level. A good example is the Jewish culture that enacts customs after deaths like the sitting Shiva and Kaddish prayer (Dekel & Tuval-Mashiach, 2012). They offer the mourners with expected and routine support. Failure to look into the society of the individual may leave out a potential source of treatment.

A study conducted illustrated that the elderly with complicated grief have more success when they attend therapy support groups (Ghesquiere, 2012). Practitioners can also assist by identifying the need for and intensifying referrals to the particular mode of support that suits the griever best. During therapy it is crucial to concentrate on the loss, talking through it and relieving it helps the person with complicated grief a great deal. A majority of family and friends may avoid talking about the death of the loved one fearing that they may trigger an emotional response or dampen the mood of a particular ongoing event. It is, therefore, fundamental to educate family members and friends to talk about the loss.  For the elderly, psychotherapy is greatly recommended. Religion has also been identified to help the elderly when it comes to loss. That belief in a higher power, developing a social network through the attendance of services and having hope all assist the elderly grieve without enduring crippling and persistent symptoms. It is also advisable to continue the leisure activities the survivor was doing as reducing the activities increases the chances of depression. Positivity and confidence should not also be forgotten (Graneheim & Lundman, 2010). The survivor should be helped to focus on the positive emotions and also stay healthy.

It is evident that research has been carried out on grief and bereavement and the complications they bring about after the loss of a partner. It shows that lack of awareness is eminent in the care of the individuals in bereavement especially the elderly. By understanding the complex nature of grief its categories and the mourning or bereavement process, insights are manifested as to how the elderly individuals can be assisted to cope with the death of their partners. As indicated above, the best methods of treating or coping with complicated grief in the elderly should be identified, for example, where a study suggested therapy support groups. Their symptoms are unique and so are their responses to therapy. In addition, various factors should not be ignored when determining the treatment plan, like culture and their past experiences. It is vital to understand these when identifying a treatment plan or coping mechanism. Though it might be difficult to identify whether the elderly are more likely to suffer complicated grief when compared to the younger population, based on the factors like they are more susceptible to higher risk factors like accumulation of multiple losses as they age, it can be concluded that they are more likely to suffer complicated grief. Their mental and emotional health may be affected over time. Furthermore, the outcomes of unsettled complicated grief may become severe for the elderly, becoming detrimental to their health and lead to their death as well. It is evident that there is a need to know something about the deceased and the dead person’s relationship to the survivor as information about the strength of the bond between the deceased and the survivor is important in identifying the intensity of grief. Additionally, knowing how the person died has an impact on how the survivor deals with mourning. For example, an accidental death of a spouse might be grieved quite differently than if it was a natural death.

Understanding the personality and social variables of the survivor such as gender is also critical. The reason as to why women and men mourn differently can be associated with the fact that girls and boys are socialized differently. It is argued that since women received more social support than the men and that is why they might grieve differently and have varying bereavement outcomes. The best strategy for the elderly would be to use an integrated approach that involves identification of grief and its categories, what entails the mourning or bereavement process and thus integrate therapy for complicated grief with coping mechanisms for cumulated loss. As this focusses on complicated grief, it is good to also consider the other levels of guilt that include the acute grief and middle stage grief. They should also be treated to avoid them turning into complicated grief, which has more detrimental effects.

References

Byrne, G. J., & Raphael, B. (1997). Psychological symptoms of the conjugal bereavement in elderly men in the first 13 months. International Journal of Geriatric Psychiatry, 240-252.

Collins Logan, T. (2009). The Vital Mystic: A guide to emotional strengths and spiritual enrichment. Integral Lifework Centre.

Dekel, R., & Tuval-Mashiach, R. A. (2012). Multiple losses of social resources that follows collective trauma. Psychological Trauma: Theory, Research, Practice, and Policy, 56-65.

DeSpelder, L. A., & Strickland, A. L. (2011). Understanding experiences of loss. In The Last Dance: Encountering death and dying, 333-375.

Ghesquiere, A. (2012). Patterns and outcomes of bereavement support-seeking among older adults with complicated grief and bereavement-related depression. Colombia: Columbia University.

Goldman, L. (2000). Life and loss: A guide to help grieving children. Taylor & Francis.

Graneheim, U. H., & Lundman, B. (2010). Experiences of loneliness among the old: The Umea 85 project. Aging & Mental Health, 433-438.

Jalland, P. (2006). Changing ways of death in twentieth century Australia. UNSW Press.

Morris, S., & Block, S. (2012). Grief and bereavement. In L. Grassi & M. Riba, Clinical psychooncology: An international perspective. West Sussex: UK: Wiley-Blackwell.

Newson, R. S., Boelen, P. A., Hek, K., Hofman, A., & Tiemeier, H. (2011). The prevalence and features of complicated grief in older adults. Journal of Affective Disorders, 232-337.

Shear, M. K., Ghesqueire, A., & Katzke, M. (2013). Bereavement and complicated grief in older adults. New York: Oxford University Press.

Spall, B., & Callis, S. (1997). Loss, bereavement and grief: A guide to effective counselling. Stanley Thornes Ltd.

Stroh Becvar, D. (2003). In the presence of grief: Helping family members resolve death, dying, and bereavement issues. Guilford Press.

The Joanna Briggs Institute. (2006, January). Literature Review on Bereavement and Bereavement Care. Retrieved from The Robert Gordon University: https://www.rgu.ac.uk/files/dmfile/bereavement-and-bereavement-care-literature-review.pdf

Worden, W. (2009). Grief counselling and grief therapy: A handbook for the mental health practitioner. London: Routledge.