PHILADELPHIA — Loss is inevitable for the elderly, and with loss comes grief.
Losses are not just the deaths of loved ones, friends, and acquaintances. The elderly also experience loss and grief as they begin to have a diminished ability in activities of daily living. This then can cause the elderly to lose a sense of purpose.
Many elderly also have difficulty when they can no longer live independently. They struggle with the loss of their homes, their possessions, their health, body parts, their vocations, not to mention their independence, Vicki L. Schmall, Ph.D., and Patrick Arbore, Ed.D., said at a conference sponsored by the American Society on Aging.
“Anything lost in which a person has invested their emotions, attention, time, energy, or dreams” leads to grief and mourning, said Dr. Schmall, president and gerontology specialist at Aging Concerns, based in West Linn, Ore.
“The psychologic context of loss is different for the elderly, compared with that for younger people,” said Dr. Arbore, director of the Center for Elderly Suicide Prevention at the Institute on Aging in San Francisco. In younger people, losses tend to be sudden and unexpected. For the elderly, losses are not unexpected. And though they are perceived as inherent to living a long life, the accumulation of loss can lead to “bereavement overload,” Dr. Arbore said.
Grief is a natural and expected reaction to any loss, not just another person's death. It is the process of experiencing the psychological, behavioral, social, and physical reactions to loss. Grief has been described as a long roller coaster ride that gradually levels out.
One of the key issues for physicians and other health care providers who care for the elderly is whether people move forward with their grief or get stuck and become depressed. “Grief is an emotional pain that needs to be acknowledged and experienced,” said Dr. Arbore. In contrast, depression is a state where pain is experienced as being useless and meaningless.
In general, after the loss of a loved one, symptoms of depression usually last for up to 2 months, but it's hard to put a timetable on grief. Periods of sadness should not be diagnosed as depression unless they are unusually prolonged, severe, or cause clinically significant impairment.
Normal reactions that individuals experience after the loss of a loved one include denial, confusion, lack of concentration, fatigue, forgetfulness, irritability and anger, sadness and anguish, anxiety, and horror.
Health care workers should not make the mistake of giving patients agents that sedate the pain of grieving, said Dr. Schmall, former director of the program on gerontology at Oregon State University in Corvallis. This prevents people from talking about their loss, an important part of grieving.
A person needs an outlet for their pain by grieving. He or she also needs to be able to work through grief and pain, Dr. Schmall said.
The most effective ways to help someone who is grieving is to listen, be empathic, acknowledge the person's loss, and help the patient experience the event at his or her own pace.
© 2006 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.