Older Americans Experience Spousal Bereavement

¶ … older Americans experience spousal bereavement annually. Bereavement is the state of having experienced a loss, and grief is the generally passive and involuntary reaction to the state of bereavement, and although grief is commonly considered an emotional state, it actually extends well beyond the realm of emotions.

Bereavement often leads to depression, which in turn may cause sleeping disorders, substance abuse, panic attacks, decrease in appetite, and increased risk for suicide as well as other diseases and infections due to the effect of depression upon the immune system and the fact that older adults are particularly at risk for immune disorders.

Late Adulthood and Bereavement In the June 2000 issue of American Scholar, Francine Gray writes in her article, "The Work of Mourning," that there is now a myriad of published volumes on "grief work," that the counseling industry now calls bereavement (Gray pp).

However, she claims that the bulk of this literature that is a subdivision of the "recovery" genre and is filled with such buzz phrases as "coping responses," "task-based grief," "tactics for healing," and "tools for recovery," is more pragmatically inclined, and many are described as "a comprehensive, well-thought-out plan for preparing for death" (Gray pp).

Gray contributes the ship of consciousness to the pioneering work of Elisabeth Kubler-Ross, who has urged, for the last thirty years, to weave the expectation of death into the understanding of life, and to view it as an expected companion rather than a dreaded stranger (Gray pp).

According to Gray, baby boomers are beginning to confront the anxieties of aging and mortality, and believes that the AIDS epidemic, "which makes us cohabit with death more poignantly than at any other time in recent memory, may also be playing a dominant role in loosening our traditional reserve" (Gray pp). Moreover, men are increasingly taking over the role of public mourner traditionally assigned, especially in the West, to women, however, the literature of widowhood is still predominantly a female genre (Gray pp).

Gray writes that according to Freud, mourning is "hard, slow, patient work, a meticulous process that must be carried out 'bit by bit' over a far vaster amount of time than twentieth-century society has allotted to any ritual of grief" (Gray pp).

And crucial to this toil, is careful examination, 'piecemeal,' as Freud puts it, of each association, each place, each belonging once shared with the departed, thus "don't sell the house the first year, don't hasten to put the clothes away, and continue to polish his/her silver (Gray pp). Moreover, equally essential are those traditional gestures of ritualized grief, such as memorial services, visits to a grave or commemorative site, that confirm the absence of the dead one (Gray pp).

In this slow, long-drawn-out, and gradual work of severance, Freud writes, each single one of the memories and situations of expectancy which demonstrate the libido's attachment to the lost object is met by the verdict of reality that the object no longer exists... When this work has been accomplished the ego will have succeeded in freeing its libido from the lost object" (Gray pp).

If the mourning process does not proceed on this detailed course, the enormous energy available for the labor of grief turns inward into a dangerous process of self-devouring, a "pathological mourning," and can metamorphose into what is known as depression, a condition that can give rise to self-hatred and self-destruction (Gray pp).

Bereavement is the state of having experienced a loss, and grief is the generally passive and involuntary reaction to the state of bereavement, and although grief is commonly considered an emotional state, it actually extends well beyond the realm of emotions (Servaty-Seib pp). The complex responses associated with grief span the affective, cognitive, physical behavioral, social and spiritual domains of human functioning (Servaty-Seib pp). Mourning involves the active processes of coping with bereavement and grief, and include "numbness, yearning and searching, disorganization and despair, and reorganization" (Servaty-Seib pp).

The incidence of spousal loss through death has been estimated at 1.6% yearly for elderly men and 3% yearly for elderly women, and overall, it is reported that approximately 800,000 older Americans experience spousal bereavement annually (Khin pp). With the number of elderly in the U.S. population rapidly increasing, it is predicted that by 2020, there will be over one million individuals per year experiencing spousal bereavement (Khin pp).

Loss of a spouse is rated as the most stressful life event across all ages and cultural backgrounds, however, each individual reacts differently when coping with the loss (Khin pp). Aside from general sadness, there may be work-related difficulties, sleep disturbances, behavioral changes, appetite and weight change, poor memory, increased risk of suicide, and an increase in the use of alcohol, tobacco, and tranquilizers/hypnotics (Khin pp).

Moreover, there is an association with prolonged or unresolved grief, traumatic/complicated grief such as searching and yearning, generalized anxiety or panic disorders, and major depression (Khin pp). According tot the DSM-IV, clinicians should diagnose bereaved individuals with major depression disorder if they exhibit the specified depressive symptoms two or more months after the loss, however, the duration and magnitude of elevated depressive symptomatology following bereavement deserves further characterization (Khin pp).

According to researchers, there is an increase in the number of bereaved patients with illness and symptoms, such as "sighing, indigestion, chest pain, palpitations, headaches and psychosomatic medical diseases, and particularly an increase in nonpsychiatric symptoms in those older than 65 years (Khin pp). Bereavement has been associated with altered immune function, and since episodes of major depression are associated with life stressors, such as bereavement, and depression is associated with immune dysfunction, it is important to assess the temporal sequence between these linked events (Khin pp).

Moreover, perturbation of the immune response can lead to increased vulnerability to infection in older adults (Khin pp). Mark Johnson, past president of the Utah Psychiatric Association, says that from a public health point-of-view, "geriatric depression is much more important than many other illnesses, and is one of the most treatable illnesses, however, left untreated, it increases mortality (Sample pp). In fact, "suicide is more prevalent in individuals 65 years and older than in any other age group" (Sample pp).

Depression in older adults is as common as it is in younger adults, with 1-4% of the population suffering from it (Sample pp). For geriatric patients, the statistics change significantly with location: up to 36% of older adults in outpatient clinics will be depressed, compared to 43% of inpatients, and 51% of those in nursing homes (Sample pp). However, many older adults are not diagnosed, and according to one study, physicians identified depression only 15% of the time (Sample pp).

Older adults may complain of fatigue and trouble sleeping rather than a depressed mood, because depression is not as socially acceptable, and is often seen as a moral or spiritual weakness, not a physical manifestation of disease (Sample pp). Emerging evidence suggest that elevated levels of selected hormones may signal a health threat for older adults, and stress-inducing events, such as bereavement, are positively correlated with diminishing health, especially increased morbidity and mortality, in the older population (Cearlock pp).

The effect of stress on the immune function in older adults is critical because of the natural breakdown of the aging immune system, which leaves older adults at greater risk for disease, a higher incidence of infections, neoplasias, and autoimmune disease compared to the younger adult (Cearlock pp). Grief over the death of a loved one presents one of the most frequent and challenging problems mental health counselors face with their clients (Thompson pp).

Death of loved ones is possibly the most penetrating loss individuals experience: "it is a physical, emotional, and spiritual loss" (Thompson pp). Clinicians may help bereaved individuals cope with early negative feelings by inviting them to talk about the death and the circumstances surrounding it (Thompson pp). Bereavement counseling is a highly specialized subject and should not be tackled without formal training (Warren pp).

At least 10 -20% of widows and widowers develop clinically significant depression during the first year of bereavement, and without treatment, such depressions tend to persist, become chronic and lead to further disability and impairments (Older pp). Bereavement-associated depression often coexists with another type of emotional distress, which has been termed traumatic grief, the symptoms of which, although not formalized as a mental disorder in DSM-IV, appear to be a mixture of symptoms of both pathological grief and post-traumatic stress disorder (Older pp).

Such symptoms are extremely disabling, associated with functional and health impairment and with persistent suicidal thoughts, and may well respond to pharmacotherapy (Older pp). The experience and expression of grief are shaped by the.