Grief encompasses a broad range of emotional responses to various personal losses. It includes fading youth, missed opportunities, diminishing health, lost jobs, and disappearing relationships. In this blog post, we focus specifically on the anguish you may experience due to aging and death of a loved one.
What is Good Grief?
Your loved one’s loss of function and independence can deeply affect both of you, touching every facet of your lives—physical, emotional, cognitive, psychological, behavioral, social, and spiritual. In the throes of completing activities of daily living and informal caregiving, it's common to suppress a sense of sorrow about the inevitable march toward greater dependence on others and death. However, this mourning is normal and it may begin before your loved one’s death and continue for another year thereafter.
Conventional Grief is not only about dealing with loss but also about coming to terms with it, integrating this new reality into your life, and finding ways to move forward. This is what we refer to as “Good Grief.” This post aims to expand your understanding of “good” grief, highlighting how grief uniquely affects older adults and those who care for them. By embracing it as a normal part of life, you can begin to see mourning as a process that, while often painful, can lead to growth.
Insights From The Experts on Grief
Sigmund Freud described grief as a necessary experience that involves gradually releasing attachment to a lost "love object" to which you have formed a strong bond. Later, John Bowlby expanded on this by outlining the turmoil that takes place when a bond is severed, progressing through stages of protest, despair, and detachment. Ultimately, successful advancement through these phases allows you to reorganize your connections and return to previous interests.
Elisabeth Kübler-Ross further detailed the process in her renowned model of the five non-linear stages of grief: denial, anger, bargaining, depression, and acceptance. She notes that each phase is not necessarily sequential and you revisit unresolved stages multiple times until settled.
Across all theories, Good Grief typically includes an acute phase lasting up to six months, which is generally recognized as a normal period of mourning. The intensity varies and is unpredictable, but it generally leads to an eventual acceptance of the loss, allowing individuals to resume life without the presence of the loved one.
Grief Is Not Depression
It’s important to know that although grief and depression might share some similar traits, they are fundamentally different experiences. Sigmund Freud first distinguished these differences in his 1917 essay, "Mourning and Melancholia." In his view, while melancholia (an early term for depression) can increase the risk of suicide, while mourning, typically resolves as you adjust to the loss and possibly form new attachments.
When you're grieving, you may feel intense sadness or cry, and you might withdraw socially or suffer sleep disturbances. However, these symptoms are closely tied to your loss. You might find yourself yearning for the deceased or seeking closeness to things that remind you of them. This is quite different from Major Depressive Disorder (MDD), where sadness and withdrawal are more generalized, and there's an overall loss of interest in activities and life that isn't necessarily linked to specific memories or triggers.
Furthermore, the predominant feelings of grief are usually emptiness and loss, which come in waves and can decrease in intensity over time, especially when triggered by reminders of the loved one. In contrast, with MDD, the sadness is more persistent and pervasive, not tied to specific thoughts or situations. While you're grieving, it’s also common to maintain a sense of self-worth and to have moments of joy and laughter amidst the sorrow. You might think about the deceased and even about joining them one day, but these thoughts are typically not driven by feelings of worthlessness or an inability to cope, which are characteristic of MDD.
Lastly, it's crucial to recognize that grief, while painful, usually diminishes over time and allows for moments of happiness and consolation from others. Depression, on the other hand, tends to be a more enduring state that can greatly impair your ability to find comfort in support from others or foresee a time when the feelings might lessen. If you’re feeling overwhelmed by your emotions and unsure if what you’re experiencing is grief or something more, it might be helpful to talk to a professional who can provide guidance and support.
Three Types of Grief You May Encounter
Grief manifests in several forms, each with its unique characteristics and impact on you as you navigate through momentous loss. Appreciating the differences is key for managing your emotional journey following a loss. Here, we explore three primary types of grief you might encounter: Anticipatory, Good, and Complicated.
Anticipatory Grief Preparation for Death Before It Happens
Anticipatory grief occurs when you begin grieving before a loss actually happens. This is common if you are caring for someone with a terminal illness or watching a loved one gradually decline. It involves the emotional struggle of preparing for the eventual death, dealing with the loss of the person’s current state, and contemplating life without them. Anticipatory grief allows for psychological preparation for the loss, but it can be just as intense as the heartache that occurs after a death.
Good Grief Normality
Good Grief represents the typical, healthy process of reacting to a loss of a loved one. Acute Grief is your initial, intense response that immediately follows a death. During this phase, you might feel profound sadness, shock, or anger, often accompanied by a preoccupation with the deceased. This period is characterized by waves of strong emotions and a noticeable effect on your daily functioning. Over time, Acute Grief should transition into Integrated Grief, where the loss is woven into your life without continuous acute distress. By integrating the loss, you adapt to a new normal, where the pain of loss recedes, and you can resume engagement in life’s activities with a new perspective. This phase typically begins six months after the loss and is marked by a return to functionality and the resumption of regular activities while still honoring the memory of the lost loved one.
Complicated Grief’s Prolonged Mourning
Complicated Grief, also known as Prolonged Grief Disorder (PGD), is marked by an inability to progress naturally through the stages. The emotional pain remains intense and persistent, interfering meaningfully with daily life. Symptoms might include continued yearning for the deceased, intense sorrow, and preoccupation with the deceased or the circumstances of the death, leading to considerable impairment in social, occupational, or other important areas of functioning. This incidence may require professional intervention to manage maladaptive thoughts and behaviors, such as self-blame and avoidance, which prevent adaptation to the death of a loved one.
Each bereavement type affects you differently, influenced by your relationship with the deceased, your personal resilience, cultural practices, and available support systems. Recognizing the type of grief you or someone you care about is experiencing can be the first step towards finding appropriate support and beginning the journey to healing. Let’s start with an exploration of Good Grief normality and its distinctive effect on older adults. Subsequent blog posts will address Anticipatory Grief—Grieving Changes in Life Before Death Even Happens—and Complicated Grief—Stuck in Sorrow When Grief Becomes Complicated.
The Good Grief Journey
Good Grief is a dynamic and personal experience that can take place over a year and varies widely from person to person and culture to culture. It starts with the Acute Grief marked by intense emotional and physical reactions to a loss, gradually transitioning into Integrated Grief where you adapt and find new meaning in life. Statistically, between 90% to 93% of adults successfully progress through the Good Grief process. Identifying these stages allows you to handle your pain more effectively, providing a framework for healing and adaptation.
What is Acute Grief?
Acute Grief typically begins with the death of your loved one and can last up to six months. During this initial phase, you are likely to be subjected to powerful feelings of yearning and sorrow. These emotional states often come in waves, accompanied by physical discomforts such as a wrenching gut, shortness of breath, chest pain, and uncontrollable crying. These intense responses can erupt suddenly and unexpectedly, especially in the early days and weeks following your loss. Over time, the frequency and intensity of these emotions tend to diminish as they become more connected to specific memories and reminders of your loved one.
Alongside these intense feelings, you might also experience a mix of other emotions, both positive and negative. You may face disbelief, intrusive thoughts about the deceased, decreased interest in life, and feelings of insecurity, emptiness, or overwhelm. Despite the challenging nature of these episodes, it's not uncommon for positive emotions to surface during this time. You might find yourself feeling warmth, amusement, or pride when reminiscing about your loved one, or depending on your beliefs about death and the afterlife, even a sense of relief at the end of their suffering.
What is Integrated Grief?
After the initial six months of Acute Grief, you may begin transitioning into Integrated Grief, a process that can continue for another six months. This phase involves adapting to the permanence of your loss and finding ways to incorporate the memory of your loved one into your life. You start to establish a new relationship with the deceased through memories and actions that honor their influence on your life. This adaptation process allows you to look forward to a future where life is meaningful again, despite the absence of the person you lost.
Integrated Grief marks a turning point where the intense pain of Acute Grief begins to ease. It becomes a more subdued and manageable part of your life, allowing you to engage with the world around you and find joy and fulfillment once more. Successful mourning means that the disruptive waves lessen, transforming into a bittersweet but no longer overwhelming presence.
How Older Adults Experience Grief
As you age, grief often carries unique challenges and risks that set it apart from the suffering of younger individuals. The later years can bring a cumulative series of losses that are profound both in their frequency and influence.
The Accumulated Losses Effect
Living a long life means you will have more opportunities to face multiple meaningful losses. First, you may outlive many important people, including parents, siblings, spouses, friends, and sometimes even children.
Along with these personal losses, health declines, such as diagnoses of Alzheimer’s, other forms of dementia, and cognitive impairments, mark a substantial loss of independence and autonomy. Moreover, the natural aging process itself entails numerous losses, such as the loss of physical strength, mobility, and the ability to drive and engage in activities that once brought joy and purpose.
Lastly, losing a career, home, personal possessions, and pets can lead to "bereavement overload." This occurs when losses happen so frequently that it becomes nearly impossible for you to process one before another begins.
Heightened Risks of Grief in Older Adults
For older adults, the experience is often intensified by the sheer volume of losses happening in a short period. The death of a partner, for example, can result in multiple secondary losses—financial security, companionship, and social connections. Each loss not only compounds your anguish but can also retrigger past griefs, making the current event even more overwhelming.
You might also encounter what are seemingly minor losses more deeply, as these incidents can evoke memories of past major losses. This heightened sensitivity means that even small changes can have profound emotional effects for seniors.
Finally, the way you express and feel grief may also differ from younger individuals. While some older adults show resilience, others might find it harder to recover from the emotional shock of loss. The coping mechanisms that served the elderly well earlier in life may no longer be effective, and you may require additional support to manage an increasingly complex emotional terrain. Successfully handling grief may require maintaining routines, fostering connections with friends and family, and engaging in activities that can still be enjoyed.
Recognizing How Grief Effects Older Adults
As you or a loved one ages, the experience of grief can present unique challenges and symptoms that differ from those in younger individuals. Being aware of the unique signs and symptoms in older adults can allows caregivers and family members take proactive steps to assist their loved ones in managing their sorrow more effectively. This might include arranging for additional healthcare support, providing nutritional guidance, helping manage finances, or increasing social interaction and support. Here’s a closer look at how it specifically influences older adults across various aspects of their lives, signaling the need for additional monitoring and support.
Physical Health
The natural aging process already places older individuals at a higher risk for severe health problems, and the added strain from grieving can further compromise their physical health. Grief can significantly exacerbate existing health conditions in older adults due to the increased stress levels it brings. For example, an older adult with pre-existing heart conditions may undergo heightened blood pressure or more frequent angina attacks as a result of the emotional and physical stress. Similarly, those with diabetes might find their blood sugar levels harder to control during periods of intense mourning. This heightened stress can lead to more severe complications like increased risk of infections or exacerbate chronic conditions such as arthritis pain due to reduced physical activity during periods of deep sadness.
Appetite Changes
Many older adults undergo a natural decrease in appetite as they age. However, during periods of bereavement, this decrease can become more pronounced. It is not uncommon for grieving older adults to skip meals or even go days without eating and hydrating properly, which can lead to nutritional deficiencies that impact overall health.
Cognitive Effects
Grief often causes confusion, which can be particularly intense in older adults. This confusion may also be accompanied by forgetfulness, disorientation, and disorganization. These cognitive effects are more than just momentary lapses; they can substantially affect an older adult’s ability to manage daily activities and maintain their independence.
Financial Stress
The loss of a spouse or partner can lead to increased financial pressure for older adults. This stress can be particularly acute if the deceased was the primary earner or managed the household finances. The sudden need to handle financial matters can be overwhelming and contribute to the overall stress and anxiety.
Isolation and Loneliness
Isolation and loneliness are already common issues among the elderly, but these feelings can intensify following the death of a loved one. The resulting social isolation can drastically increase the risk of premature death from various causes, akin to the risks associated with obesity, smoking, lack of physical activity, or inadequate access to healthcare.
In traversing the mourning landscape, especially as it pertains to older adults and death, understanding grief’s nature and progression is beneficial. This journey begins with Acute Grief marked by profound sadness and physical discomfort, which gradually transitions to Integrated Grief where the sharpness of pain subsides, allowing for a return to function and engagement in life. It's important to recognize that while heartache can be deeply painful, it is a normal and natural response to loss. By acknowledging and appreciating the various stages, you can better equip yourself to move through this process, finding ways to honor your loved one while embracing life anew. Additionally, knowing the unique impacts on older adults—ranging from physical health challenges to deepened isolation—can guide caregivers in providing the necessary support and interventions to help alleviate the burdens. Ultimately, embracing it as a transformative journey can lead to growth and a renewed sense of purpose in life’s later chapters.
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