Grief in older people

The brave openness of journalist Deborah James regarding her deteriorating health and progression to hospice care at home are a reminder that all too often, expected death and end of life care are not widely discussed. The COVID-19 pandemic caused everyone to reflect upon their own mortality and that of their nearest and dearest, with older people being the most vulnerable to the risk of illness and death. Older people were asked to ‘shield’ themselves, which may have exacerbated their fear of dying and deterred usual health seeking behaviours for medical needs, with enforced social isolation resulting in unrequited loneliness. The higher mortality rates among older people and the absence of the usual support systems and the rituals around a death probably increased the feelings of loss during the pandemic; but irregardless of the pandemic, older people will always experience more bereavements than other age groups.

Many older people experience the loss of a significant person such as a partner or offspring, and many will also experience multiple losses, especially if they live very long lives. Grief is a natural response to loss and reflects the ‘love’ which the bereaved person had for the deceased person. Kubler-Ross's (1972) seminal work proposed five stages of grief - initial shock or denial, anger, bargaining, depression and acceptance; sometimes, however, grief persists beyond the expected period of adjustment and becomes ‘complicated grief’ (Supiano and Luptak, 2014) which others refer to as ‘abnormal grief’ or ‘prolonged grief’. Complicated grief, or chronic mourning, is not only a distressing psychological state but it also impacts physical health and quality of life, especially among those with pre-existing conditions (Perng and Renz, 2018).