specialty focus
In our interviews , some older people said that – through the cancellation of a lot of their activities , their social engagements , being able to see friends and families through COVID – they had a lot more time to think about the loss because they were alone at home .
I think the need for bereavement support throughout COVID has just increased a hundred-fold . There will definitely be a need for more targeted and tailored interventions and services in the future .
Your survey found that only 14 per cent of these bereaved older adults had recently sought professional help from their GPs . Why do you think this is ? Many relied on informal help from family and friends . While about 88 per cent had visited their GP in the last six months , only 14 of these visits had been overtly about their grief . Furthermore , only 13 per cent had seen a mental health specialist like a counsellor or psychologist .
The top five reasons for not seeking help through the healthcare system were that they felt that the service would be inadequate , they felt embarrassed or afraid , there were concerns about cost and waiting time , or they had too many other responsibilities that prevented them from seeking help .
I think in that particular generation a lot comes down to the stigma of seeking mental health support . Among older people we often see some hesitation , because they feel they ’ ve been through a lot worse throughout their lives ; and psychological support is for people who are severely unwell .
Of course , this isn ’ t true . Counselling can be a really helpful way of talking about a loss , getting an outsider ’ s perspective and finding ways to carry this grief forward with you . This stigma of seeking mental health support really needs to be addressed .
You also spoke with GPs about their knowledge of prolonged grief . What did you find ? Many didn ’ t know about prolonged grief or persistent complex bereavement disorder . There were also some ageist stereotypes , with people assuming that older adults don ’ t need mental health support because they have had so much experience with grief and loss .
It ’ s important for primary care staff to know that they play an essential role in bereavement support for older adults . They ’ re often the first point of contact and the gatekeepers to the healthcare system , and everything depends on them directing people to the right services .
They also need to know that older people tend to come in with physical symptoms , and that makes it a lot harder to identify underlying grief . It ’ s really important for them to open up this conversation and openly ask about significant life events and encourage these conversations about taboo topics like grief and death .
Could you give us some examples of things that health practitioners and loved ones could look out for that they might not initially identify as grief ? If you see someone who is coming in and they share with you that their family member died 6 or 12 months ago , and they still have trouble sleeping , you notice changes in appetite so they might lose or gain a lot of weight , they might talk about alcohol consumption . A lot of these physical symptoms are really important to look out for .
But then diving deeper into that , asking about the loss and how they feel about this , to see if there ’ s this pervasive longing , this yearning for the deceased , if they ’ re constantly thinking about them . Ultimately , I think it ’ s really important to figure out how this is affecting their ability to function and engaging with day to day activities . Are they grieving for so long and so intensively that they ’ re unable to live life ?
Did you identify any particular cohorts of older people that may have experienced their grief differently compared to others ? Our survey data showed that certain groups were particularly at risk after a bereavement . People with prolonged grief were more often women . We also saw more complicated grief in older people who had experienced the death of their partner or child . For example I remember one mother who had lost her adult daughter saying to me , ‘ It should have been me , not her , who died .’ So the type of loss can really impact your grief .
Traumatic deaths , such as suicide , can be particularly difficult to deal with . And we also found that prolonged grief was more common among older people who had provided full-time care for the deceased .
“ Primary care staff play an essential role in bereavement support .
The loss of that caregiving role can affect people ’ s sense of identity and purpose , and therefore put them at risk for post bereavement complications .
In terms of older people managing their prolonged grief , what are some of the greatest obstacles they face in the health system and the aged care system ? After the death of a loved one , there is often so much to do , families to contact , funerals to organise – so much red tape . Many people have good support from families and friends during this initial phase of grief , but it ’ s surprising how quickly this support fades .
This is the time when the loss really sinks in , when you ’ re alone at home and wherever you look there are reminders of the person you have lost . And you are faced with this enormous task of redefining your identity and restructuring your life without that person . That stress of grief can really affect your wellbeing and your physical health .
Older people are remarkably resilient , but it is so important to know that grief comes in waves . And when one of these waves hits you , it ’ s okay to ask for help . But some of the obstacles that people might face here are finding and accessing the right support and dealing with waiting times and cost of counselling .
What sort of broader changes in the health system do we need to better address the issue of prolonged grief among our older population ? It would be great if we could offer better training to primary care staff to help them notice and respond to signs of grief in their older patients . I also think that practice nurses are an underutilised resource . They should be engaged more . Many of the nurses we interviewed said that grief was often brought up with them as a sideline conversation while they were dressing wounds or giving flu shots , whereas the GP consultation often focused on physical symptoms and they were a bit more rushed . So nurses are in an ideal position to notice grief . Team communication and networking within clinics is a really important aspect to work on . ■ agedcareinsite . com . au 23