Helping the elderly deal with grief
GRIEF is a necessary process that everyone who has lost a loved one goes through. Being older doesn’t make it easier or harder, and there are no shortcuts in getting through it.
“Grief is a normal response to loss. Hence, it can affect anyone at any age, old enough to feel a sense of loss of someone or something significant to them,” explains psychologist Dr Ng Wai Sheng.
According to her, how people experience grief varies by individual, and may be influenced by the following factors:
- Age (for example, young children tend to show different timing and pace in grieving, than adults);
- Personality (an introverted person may express their grief more privately, whereas an extroverted person may need to be around people in order to express their grief);
- Context of the loss (whether it was anticipated or sudden);
- Prior relationship quality with the lost person;
- Previous history with losses, including multi-generational loss and coping patterns;
- General emotional coping strategies; and
- Support system during and after the loss.
Elderly and grief
With senior citizens, in addition to the grief they may also battle their own fears regarding death. For those who have previously been uncomfortable with the notion of death and dying, the current loss may trigger them to think about their own mortality and their loved ones’. For those who have lost their primary attachment, especially if it is their spouse, they are likely to fear being left alone and they may lose their meaning in life.
“Loss and grief also often challenges the individual’s basic core belief about themselves. Hence, it is not uncommon that grieving people often have to revisit and wrestle with issues relating to their self-worth, sense of significance and belonging, as well as personal adequacy,” explains Dr Ng.
According to her, depression can be part of the normal grief experience, whereby the person experiences deep sorrow, fears and worries, and even anger.
“At the mild level, grieving people can generally still have a positive view of themselves and others, and to some extent the future. Their sadness typically revolves around the loss and any meanings associated with the loss.
“However, when a person becomes clinically depressed, he/she usually shows a pervasive sense of despair, with a strong negative view of oneself, others and the future. As the condition deteriorates, a depressed person may even develop suicidal thoughts and psychosis, such as hearing voices or having delusions.
“Whilst it is not uncommon that the grieving elderly person may express envy of the deceased person (usually an intimate spouse or sibling) and some death fantasies, they do not actively engage in suicidal thoughts, or dwell in a passive death wish. The latter is more typical of someone who is clinically depressed and may require psychiatric treatment,” she explains.
The only way to overcome grief is to go through it. Dr Ng says that any attempt to try to go through a “shortcut”, suppress, deny or avoid the grief experience can only do harm to the individual’s natural emotional system.
At its worst, natural emotions that are distorted can become clinical anxiety, depression and psychosis.
“Inevitably, grief feelings that are neglected or abandoned become stuck in the person’s emotional system, and it becomes harder for people to move on in life,” explains Dr Ng.
She recommends that those going through the loss of a loved one should:
- Learn to embrace the grief experience;
- Feel and acknowledge the complex feelings associated with the loss; and
- Be gentle and kind to themselves even when they find it hard to accept their “bad feelings” or “bad thoughts” that emerge from time to time.
According to her, people are often surprised that the more they practise compassion to their authentic feelings, rather than “switching it off” or trying to rationalise it away, the more they find their emotional pain becoming less intense over time. This will help them develop new meaning and find joy as they move forward in life.
She says that rituals are very important in the grieving process.
“Family members are encouraged to identify and select rituals that would help the surviving spouse or sibling grieve their loss in a meaningful way. This would include rituals to celebrate the life of the deceased and rituals to say goodbye. Rituals can be done in public or in private.
“Rather than merely conforming to some religious or cultural custom/practice, it would be important to allow some space for the surviving spouse or sibling to express their wishes on how they would like to remember the deceased person and how they wish to express their love during the wake or funeral, and after that. Rituals are meant for the living. Hence, performing rituals well can actually bring the family and community closer during times of mourning,” she adds.
Role of family
Family plays an important role in supporting the elderly as they grief.
Rather than constantly asking if they are all right, it would be better if family members are on hand to offer a listening ear so that the elderly person can talk about their memories and feelings.
Dr Ng says it’s better for the grieving person, especially a senior citizen, to ventilate their grief through talking about their experiences, even if they are telling the same story for the 20th time.
“This is how some individuals process their grieving emotions; others may prefer to stay silent for a while. There is no need to say a lot to the grieving person; your physical and emotional presence, demonstrating that you care (eg. through a simple touch, a warm look, a bowl of hot soup), would be more than enough.
“Often out of the eagerness to console the grieving person, family members or friends may say ‘don’t think too much’, or ‘stay strong’. A grieving person should never be pressured to ‘finish off’ their grieving process quickly, or worse, to pretend that they have moved on, when they are really still struggling to let go.
“It would be good for family members to spend time with the grieving elderly person on a regular basis, so that they feel less lonely in the house and have regular activities to look forward to, which gives them a sense of belonging, purpose and familiarity that helps them cope after the loss,” says Dr Ng.
While trying to be helpful, family members may explore the idea of taking the senior citizen out of their home, perhaps for an extended stay with one of the children. It may seem like a good idea to take the elderly person away from the place where they are surrounded by so many memories of their deceased loved one, but Dr Ng says any change is a stress factor.
“A major change of environment means major stress to the elderly person, who is already coping with a great loss. Therefore, any plans to change the grieving person’s living environment, no matter how well-intentioned, should be made gradually with much thought to care for the elderly person’s adaptation to the change.
“Unless the elderly person is demented or unable to care for themselves, it is important to consult their opinions and readiness for a change of environment, even if it’s just a short trip away. Whilst some people may prefer to cope with their grief feelings by going away somewhere, others may prefer to stay with the familiar environment as part of their grieving needs. It is important to respect the grieving person’s choice, as long as they are not posing harm to themselves or others,” she explains.
Support from family and friends is usually sufficient to help an elderly person through their grieving process.
However, if they are showing symptoms of severe clinical depression with psychosis, or suicidal thoughts, or cognitive dysfunctions such as dementia, it is recommended that they be taken to see a psychiatrist, who will typically use psychotropic medications as treatment management.