Grief is the biological, natural response to the death of a loved one. Often, time leads to adaptation of the loss. And yet, for some, the grief persists and can become so severe that it interferes with both physical and mental health resulting in impaired function. This chronic condition is called complicated grief (CG) or persistent complicated bereavement disorder. Time after time, among older people, CG is underdiagnosed and undertreated.
Grief is the process of reacting to a loss, while bereavement is the period after a loss during which the mourning occurs. The distinct characteristic of CG is the constant yearning for the deceased. Defined as “a psychological protest against the reality of loss and a general reluctance to make the adaptations to life in the absence of the loved one” , this yearning is complicated with inordinate bitterness, alienation from previous social relationships, and a perceived futility of life. Risk factors for CG include prior loss, traumatic exposure, and quality of the relationship with the deceased.
Older people grieving the death of a spouse or child have been found to have higher prevalence of CG when compared with younger people. For those who have spent a lifetime together, the pain is almost unbearable. Bereavement can have a devastating impact on an older person’s immune system. The extreme distress found in those with CG has been associated with increased risk of chronic diseases, cancer, depression, anxiety, and suicidality. Resulting in higher rates of hospitalisation and a poorer quality of life, complicated grief among older persons must be viewed as a public health concern.
Ageism is prevalent even during the process of grief, with suggestions that the older person should be “used to it” and hence feel emotions less intensely. Loss is a powerful experience at any phase in the life course, and for older people especially, the grieving process can be hazardous. Support must be offered to the grieving older person, and can take the form of social support, one-on-one or group counselling, or even just a phone hotline.
To address the increased need for grief and bereavement support during COVID-19, the South Okanagan Loss Society (SOLS) launched a volunteer program for those who have lost a loved one and are grieving alone. As each person’s grief journey is unique, a variety of programs are offered including a seniors-only group, weekly virtual meetings, and one-on-one counselling.
COVID-19 has caused such devastation on a global scale, that the amount of grief and bereavement caused is immeasurable. A mere three years ago, conversations on death-friendly communities would have been unimaginable, and yet it is now time to rethink how communities feel and act towards death, dying, and bereavement perhaps even through the lens of ageism.
Death-friendly communities ease the fear of ageing and dying. They offer opportunities to improve social inclusion by stopping the alienation of those who have aged and therefore more likely to die. A death-friendly approach could combat, for instance, the ageism experienced among clinical psychology students with death-anxiety who are less willing to work with older people in their practice.
Support for older people who are experiencing grief and bereavement must be viewed through the lens of key action areas and messages of the UN Decade of Healthy Ageing, which emphasize the critical need to combat ageism and create communities that not only foster the abilities of older people but also allows them to age and grieve with dignity and respect. A proactive approach towards preparing communities for death and bereavement must go hand-in-hand with the implementation of policies at country level.
To learn more about advocating for grief and bereavement support for older people, please contact Dr. Regina Roller-Wirnsberger, President, Austrian Society of Geriatric Medicine and Gerontology at the IFA Expert Centre, which is a unique resource for those interested or involved in the areas of death and disability, ageing, vision health, human rights, vaccination, and more. To contribute to the crucial dialogue on grief and bereavement care for older people, please connect with Dr. Supriya Venigalla (firstname.lastname@example.org).
1 Katherine P. Supiano, PhD, Marilyn Luptak, PhD, Complicated Grief in Older Adults: A Randomized Controlled Trial of Complicated Grief Group Therapy, The Gerontologist, Volume 54, Issue 5, October 2014, Pages 840–856, https://doi.org/10.1093/geront/gnt076
2 Prigerson, H. G., Bierhals, A. J., Kasl, S. V., Reynolds, C. F. III, Shear, M. K., Newsom, J. T., & Jacobs, S. (1996). Complicated grief as a disorder distinct from bereavement-related depression and anxiety: A replication study. The American Journal of Psychiatry, 153(11), 1484–1486. https://doi.org/10.1176/ajp.153.11.1484
3 Sadavoy, J., Lazarus, L. W., Jarvik, L. F., & Grossberg, G. T. (Eds.). (1996). Comprehensive review of geriatric psychiatry—II (2nd ed.). American Psychiatric Association.
4 Marcela Mejia, Scott M. Hyman, Samantha Behbahani & Kristen Farrell-Turner (2018) Death anxiety and ageist attitudes are related to trainees’ interest in working with older adults,Gerontology & Geriatrics Education, 39:3, 341-356, DOI: 10.1080/02701960.2016.1247063
Dr. Regina Roller-Wirnsberger President
Professor of Geriatrics and Competency Based Curriculum Development at the Medical University of Graz in the Department of Internal Medicine