Running head: Grief
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Grief in the Older Adult
Chantal Aubin
Stenberg College
Grief
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Grief in the Older Adult
Grief is a complicated emotion that often goes hand in hand with bereavement (Barker,
2009). It occurs in relation to the loss of a loved one, the decline of health, the loss of
employment, the loss of freedom, or perhaps even due to the loss of independence. A person may
grieve in direct relation to the loss of a dream (Barker, 2009). “Perhaps the experiences of loss
and grief are common because people, in general, have positive expectations about life” (Barker,
2009, p 362). Unfortunately, when examining the grief experienced by the older adult, many of
the emotions are considered by society to be “expected or ‘normative’” (Jeffreys, 2010, para 3).
As grief may occur throughout life due to various traumas, it is important to discuss the crisis
that perpetuates grief, and support one another through the healing process. It is imperative to be
aware of grief, its stages and how it may present itself in the older adult, the various reasons and
types of grief, and be able to identify grief in the older adult, in hopes of being able to provide
the older adult with resources and necessary support.
Grief is defined by Oxford dictionary as being an “intense sorrow, especially caused by
someone’s death” (Oxford dictionary, n.d.). It is expressed in every culture around the world,
although its characteristics of expression may change from culture to culture (Barker, 2009);
“This will influence the way in which we mourn” (Barker, 2009, p 363). There are many
different theories on loss, and its healing processes including a theory by Ms. Elisabeth Kubler
Ross, which describes a series of stages by which a person passes in order to heal from their
grieving process (Barker, 2009).
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According to Ms. Kubler Ross, the first stage to grief is denial and isolation. During this
time, the person including the older adult will deny the loss as a protective mechanism against
the pain and loss (Barker, 2009). The person will face a “conscious or unconscious refusal to
accept facts, information, reality…” (Kubler Ross, 1969, para 5); “Some people can become
locked in this stage when dealing with traumatic change that can be ignored” (Kubler Ross,
1969, para 5).
They will eventually move on to stages of anger, during which the person will wonder
why this has happened to them, and why this person is left facing death (Barker, 2009). This
emotion can be seen as being upset with themselves or others, including the persons most dear to
the grieving (Kubler Ross, 1969).
The third stage of the grieving process is described as bargaining; this is “often described
as an ‘attempt to post-pone’” (Barker, 2009, p 363) the feelings of death. This may be an internal
struggle, a social struggle or a spiritual struggle (Barker, 2009). Unforunately, “bargaining rarely
provides a sustainable solution, especially if it’s a matter of life or death” (Kubler Ross, 1969,
para 7).
The fourth stage of the grieving process is depression. This can manifest itself in various
forms, including sadness, guilt, regret and helplessness (Barker, 2009). Kubler Ross (1969)
refers to this as preparatory grieving, as it is the beginning of the acceptance of the reality of life
after loss.
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The fifth stage experienced in grief is the acceptance of the loss. This can vary due to the
age of the person and the type of loss experienced, “although broadly it is an indication that there
is some emotional detachment and objectivity” (Kubler Ross, 1969, para 9).
When considering the five stages of grief, it is also important to appreciate the different
ways in which they may manifest themselves in different people. In the older adult, grief may be
harder to detect as they may not realize that the grief they are experiencing is not part of the
normal aging process (Poinier & Zisook, 2011a). Typically, the older adult will experience
multiple losses within a shorter period of time (Poinier & Zisook, 2011b). It is also important to
consider that the older adult may not discuss their grief as readily as a younger person (Poinier &
Zisook, 2011a). Signs and symptoms of grief in the older adult may resemble that of a younger
adult’s grieving process; this may include sleep disturbances, appetite changes, difficultly
performing certain tasks, isolation from others, and mixed emotions (Stöppler, 2012). In the
older adult, changes in symptoms of already diagnosed illnesses may also occur (Poinier &
Zisook, 2011b). “Failure to grieve may also lead to a higher incidence of physical disease and
various forms of mental illness” (Gort, 1984, para 1).
Grief can be categorized into major categories. There is uncomplicated grieving which is
the typical grieving process in which a person will be able to move forward and look back on the
loss of the loved one or subject and discuss it without overwhelming discomfort (Barker, 2009).
Complicated grief occurs when the grief does not improve and the person cannot fully heal from
the loss.
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Complicated grief may occur in the older adult, as the loss may be that of a spouse, may
be sudden or untimely, may have occurred in a traumatic manner, and because of the
vulnerability of the older adult (Barker, 2009). The older adult may have health issues of their
own, and may not have the necessary support system to assist them through this difficult time
(Barker, 2009).
If left unresolved, the grief may become considered pathological (Patricelli, 2006). This
occurs when the person is unable to work through their grief after a long period of time
(Patricelli, 2006). “Pathological grief involves maladaptive reactions to bereavement that
manifest as psychological and physical impairments” (Gentile, 2004, p 2).
Anticipatory grief may also occur in the older adult, as it is a grieving process during
which the person grieves the future; for instance their health decline, or death (Barker, 2009).
Regardless of the type of grief, “Grief is necessarily a disorganized and painful process” (Barker,
2009, p 367).
When addressing the different types of grief and grief, in general in the older adult, there
may be obstacles to recognizing it. This could be due to an ailment such as a delirium,
depression or dementia. Dementia in particular can be a major obstacle when trying to recognize
grief in the older adult. “Unfortunately, there is little research that considers how an individual
with dementia copes with loss” (Doka, n.d., p 3). It is important to consider that the absence of
emotion in an older adult with dementia does not signify the absence of grief (Doka, n.d.).
Changes in behaviour may be indicative of grief in the older adult with dementia (Doka, n.d.). It
is difficult to note whether or not the patient with dementia understands the loss of a loved one
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for they may not remember the loss from moment to moment, or may confuse the loss of this
loved one with the previous loss of another loved one (Doka, n.d.). “Herrmann and Grek (1988)
documented two cases where bereaved spouses with dementia delusively believed that a parent
rather than a spouse had died” (as cited in Doka, n.d., p 3).
According to Barker (1999), “The focus of psychiatric/mental health nursing is not on the
origins of the diagnostic categories of diseases but on people’s relationships with their illness or
with their health and unique lived human responses to distress such as grief, anxiety, loneliness,
and other psychosocial behavioral issues” (as cited in ARNNL, n.d.). In other words, the
psychiatric nurse would need to extend support to the older adult who is grieving by utilizing a
person-centered approach, regardless of the origin of their loss (Barker, 2009). The psychiatric
nurse needs to establish a safe environment to enable the older adult to discuss their loss and feel
heard and understood and should avoid giving advice in regards to the grieving process of the
individual (Barker, 2009). Furthermore, the psychiatric nurse must always appreciate that
grieving is a very unique process for each individual, and the nurse must not assume that all
grieving older adults will grieve in the same way (Barker, 2009).
Grief is an unfortunate part of life that persons of all ages will experience. The
psychiatric nurse must be ready for this and must be able to identify its stages, the signs and
symptoms and how it may present in the older adult. The psychiatric nurse must also be able to
appreciate the different reasons for grief, and the different types of grief that may occur, and be
able to provide the older adult with support and resources through the therapeutic relationship.
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References
ARNNL. (n.d.). The role of the psychiatric-mental health nurse working in the community [PDF
Document], Association of Registered Nurses of Newfoundland and Labrador. Retrieved
from
http://www.arnnl.ca/documents/publications/Position_Statement_Role_of_the_Psychiatri
c_Mental_Health_Nurse_Working_in_the_Community_Apr_08.pdf
Barker, P. (2009). Psychiatric and mental health nursing: The craft of caring (2nd ed.). London,
UK: Edward Arnold Ltd.
Doka, K.J. (n.d.). Grief and dementia. Retrieved from
http://www.scribd.com/doc/3785950/Grief-and-Dementia
Grief. (n.d.). In Oxford dictionaries online. Retrieved from
http://oxforddictionaries.com/definition/english/grief
Jeffreys, J.S. (2010). Understanding grief in older adults [PDF Document]. Living with Loss.
Retrieved from http://griefcareprovider.com/images/understandinggrief.10.pdf
Kubler Ross, E. (1969). Five stages of grief, On Death and Dying. Retrieved from
http://www.ekrfoundation.org/five-stages-of-grief/
Gentile, J.P. (2004). Pathological grief [PDF Document], Psychiatry, 8(1), 1-2. Retrieved from
http://www.turner-white.com/pdf/brm_Psy_pre8_1.pdf
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Gort, G. (1984). Pathological grief: Causes, recognition, and treatment [Abstract], Canadian
Family Physician, 30, 914-924. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2154087/
Patricelli, K. (2006). Understanding pathological grief, Grief and Bereavement Issues. Retrieved
from http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=8454&cn=58
Poinier, A.C., & Zisook, S. (2011a). Grief and grieving. Retrieved from
http://www.webmd.com/healthy-aging/helping-older-adults-who-are-grieving
Poinier, A.C., & Zisook, S. (2011b). Grief: Helping older adults with grief. Health Link B.C.
Retrieved from http://www.healthlinkbc.ca/kb/content/actionset/aa122313.html
Stöppler, M.C. (2012). What are the signs, symptoms, and stages of grief? Loss, Grief and
Bereavement. Retrieved
http://www.medicinenet.com/loss_grief_and_bereavement/page4.htm#what_are_the_sign
s_symptoms_and_stages_of_grief