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Bereavement

Key Messages

  • Bereavement for older adults after the loss of a partner can be accentuated by other losses such as failing health and increasing dependence on others. [1]
  • Anticipatory grief is the grieving before the physical loss of the person, for the loss of identity, the loss of future plans, or the diminishing relationship with the person as his or her health deteriorates. [2,3]
  • Placement in residential aged care for end-of-life care can increase anticipatory grief symptoms for the carer. [4]
  • Complicated grief is a syndrome which persists for more than 6 months after the death of the person and is characterised by intense yearning for the deceased, grief symptoms and impairment of daily life. [2,3]
  • Bereavement can be associated with a number of negative health outcomes. [5-7]
  • Bereavement experience is improved by self-management strategies which are balanced by resilience and the ability to construct a new identity. [6]

Background

The terms bereavement and mourning are closely related to grief, but they have slightly different meanings. Bereavement is the period of grieving experienced by family and friends after a loved one has died. Mourning is the outward expression of sorrow for the loss, often influenced by cultural customs and rituals. Grief is the internal process of responding to the loss and it can affect all parts of a person’s life. [3,8,9]

Evidence Summary

The terms grief and bereavement are often used interchangeably and are not always clearly defined in the literature. [4] A wide range of studies have identified negative health outcomes for older adults associated with bereavement. [5-7] There is concern for the effects of grief in older adults who are also experiencing declines in physical, mental and cognitive health by virtue of their age. [1]

Grief associated with bereavement may be compounded by an extended period of grieving prior to the physical loss of a person. [1,10] Often termed ‘anticipatory grief’, this can include feelings of loneliness, sadness, pain, remorse, self-blame, anger and betrayal. [1,2,10] The relationship of bereavement with anticipatory grief and of preparedness for death have been investigated since the 1970s. Pre-loss grief and low preparedness appear to be risk factors of adverse bereavement outcomes. [3]

Complicated grief is experienced by a person who feels ‘stuck’ in grief for a prolonged period and finds it hard to manage the tasks of daily living. It is a syndrome characterised by intense yearning, separation distress and a sense of meaningless which persist for more than 6 months after the death. [2,3] At high risk for complicated grief are spousal/partner carers, carers who experience pre-death depression and carers of lower socioeconomic background. [2] These characteristics corroborate with those discussed in the experience of carer burden.

Understanding bereavement and how to support positive health behaviours of older adults is an important endeavour and consistent with the philosophy of palliative care. It is thought that bereavement services pre- and post-loss are helpful in managing grief and resilience [4-6,11] but the exact nature of such strategies is not known. Older adults who demonstrate more resilience in bereavement often employ coping strategies such as keeping busy, maintaining routines, particularly social activities and practising religious beliefs and rely heavily on their social network for support. [2,10]

The experience of bereavement is not well studied in a residential aged care context. It appears for those who place a relative with Alzheimer’s disease or related dementia in aged care, grief is more likely to be associated with feelings of guilt and loneliness. [4] Families of older adults who die in residential aged care are also less likely to be referred for hospice or palliative care services which may also impact on how caregivers experience anticipatory and post-loss grief. [4] Clearly more research on how to support carer grief and bereavement, particularly in an aged care context, is required and may guide development of palliative care services.

Quality Statement

Overall the quality of the nine systematic reviews that contributed to this summary was acceptable, with limitations generally arising from lack of reporting on methodology or quality of included studies.

 

Page updated 23 May 2017

  • References

  • About PubMed Search

  1. Naef R, Ward R, Mahrer-Imhof R, Grande G. Characteristics of the bereavement experience of older persons after spousal loss: an integrative review. Int J Nurs Stud. 2013 Aug;50(8):1108-21.
  2. Chan D, Livingston G, Jones L, Sampson EL. Grief reactions in dementia carers: a systematic review. Int J Geriatr Psychiatry. 2013 Jan;28(1):1-17.
  3. Nielsen MK, Neergaard MA, Jensen AB, Bro F, Guldin MB. Do we need to change our understanding of anticipatory grief in caregivers? A systematic review of caregiver studies during end-of-life caregiving and bereavement. Clin Psychol Rev. 2016 Mar;44:75-93.
  4. Arruda EH, Paun O. Dementia caregiver grief and bereavement: An integrative review. West J Nurs Res. 2017 Jun;39(6):825-851.
  5. Gauthier LR, Gagliese L. Bereavement interventions, End‐of‐Life cancer care, and spousal well‐being: A systematic review. Clin Psychol Sci Pract. 2012 Mar 20;19(1):72-92.
  6. Holm AL, Severinsson E. Systematic review of the emotional state and self-management of widows. Nurs Health Sci. 2012 Mar;14(1):109-20.
  7. Stahl ST, Schulz R. Changes in routine health behaviors following late-life bereavement: a systematic review. J Behav Med. 2014 Aug;37(4):736-55.
  8. PEPA Project Team. The Program of Experience in the Palliative Approach Learning Guide for Nurses and Allied Health Professionals (349kb pdf). Brisbane: Queensland University of Technology; 2016.
  9. Cancer Council NSW. Understanding Grief: A guide for family and friends when someone has died from cancer (414kb pdf). Sydney: Cancer Council Australia; 2017.
  10. Large S, Slinger R. Grief in caregivers of persons with Alzheimer's disease and related dementia: a qualitative synthesis. Dementia (London). 2015 Mar;14(2):164-83.
  11. Sealey M, Breen LJ, O'Connor M, Aoun SM. A scoping review of bereavement risk assessment measures: Implications for palliative care. Palliat Med. 2015 Jul;29(7):577-89.

Bereavement (Definition)

Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. (MeSH)

Searches

Bereavement

(((“bereavement”[mh:noexp] OR bereav*[ti] OR grief[ti] OR grieving[ti] OR continuing bond*[tiab] OR spousal loss[tiab] OR complicated grief[tiab] or prolonged grief[tiab] AND medline[sb]) OR (bereav*[tiab] OR grief[tiab] OR widow*[ti] OR grieving[tiab] OR grieve*[tiab] OR continuing bond*[tiab] OR spousal loss[tiab] NOT medline[sb])))