Grief Before and After Bereavement in the Elderly: An Approach to Care

• Published in: The American journal of geriatric psychiatry 2020-05, Vol.28 (5), p.560-569
• Main Authors: Meichsner, Franziska, O'Connor, Monique, Skritskaya, Natalia, Shear, M. Katherine
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; Aged; assessment; Bereavement; Caregivers; Cognitive Behavioral Therapy; Elder care; elderly; Grief; Humans; Mental Disorders - psychology; Mental Disorders - therapy; Older people; psychotherapy; risk factor; Risk Factors; Studies
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2019.12.010

•What is the primary question addressed by this study?—Although bereavement and loss are among the most commonly encountered life events in older age and associated with risks of morbidity and mortality, practitioners are often uncertain about whether and how to intervene.•What is the main finding of this study?—Four forms of grief (predeath grief, acute grief, integrated grief, and prolonged grief disorder, a new diagnosis in ICD-11) are described in this review.—It further summarizes risk factors and comorbidities, suggests validated instruments that aid the identification of patients in need of support, and outlines best practice care of grieving patients.•What is the meaning of the findings?—While grief should not be medicalized, geriatric psychiatrists can provide important support to their bereaved patients. Grief is the natural response to the death of a loved one and is encountered frequently in clinical practice with the elderly; it can also precede the death. Knowledge about four distinct forms of grief can aid clinicians with the conceptualization of grief, and the assessment and care of grievers. First, predeath grief is experienced by many caregivers of terminally ill patients. Second, acute grief arises immediately after the death of a loved one; and third, this normally evolves to a permanent state of integrated grief after a process of adaptation. Finally, failure of adaptation results in Prolonged Grief Disorder (PGD) which has been recently included in ICD-11. The hallmark feature of PGD is intense longing for the deceased or persistent preoccupation with the deceased that lasts longer than 6 months after the death. Validated instruments are available to assist practitioners with assessment of predeath grief and screening for PGD, thereby enabling identification of patients in need of additional support. Increased risks of morbidity and mortality following bereavement are important health issues for clinicians to be aware of. All grievers can benefit from support focused on understanding their grief, managing emotional pain, thinking about the future, strengthening their relationships, telling the story of the death, learning to live with reminders of the deceased, and connecting with memories. A short-term evidence-based intervention for PGD is based upon these seven themes and is efficacious in the elderly. Caregivers of the terminally ill benefit from psychological support that validates and normalizes their grief experiences and helps