Aging America – Coping with Loss, Dying and Death in Later Life

The United States is in the midst of a major demographic change. The merger of the Baby Boom generation and medical advancement means that most people are getting older and living longer, and often with complex chronic conditions. By 2030, just over a decade from now, those who are 65 and older will make up one-fifth of the population.

As a society, we are behind when it comes to providing optimal care for older adults, and there is an urgency to better understand the care needs for seniors and this rapidly growing population.

In October, members of the community and healthcare professionals had an opportunity to hear from national and local experts on how to better support older adults through their losses and healthcare challenges. The Pathways Center for Grief & Loss hosted an educational program provided through the Hospice Foundation of America, and offered a local panel discussion at the conclusion of the televised session. Here are highlights from the presentation to help patients, caregivers, families and professionals.

Grief Journeys that Come with Age – How to Better Support the Bereaved

  • As individuals age, they experience a range of losses, including the deaths of family members and friends within their intimate networks. It is important to be quick to listen and be slow to speak when consoling a grieving person. Avoid phrases such as, “Well, you had 64 great years together” or “You at least have the grandchildren.” Rather, say “I am sorry,” “I love you,” or “I don’t know what to say.” Grief is a journey and is not about getting over loss, it is helping people learn how to cope better and learn how to deal with loss. Your questions, while with the best intent, are disenfranchising that older person’s grief.
  • The loss of a spouse or life partner is perhaps the greatest loss faced by the aging population, and may be associated with a heightened risk of mortality. Several factors have been found to account for what has been labeled the “broken heart syndrome” in older widows and widowers.
  • After a spouse or partner passes away, the surviving individual may need to go live with family or in a senior living facility, which may not allow for their pet. Keep in mind that having to give their animal companion away may trigger additional grief. Their pets were their family and it may have been their last connection to their deceased loved one. If a family member must give away their pet due to their changed living situation, it’s important that they visit with the animal and talk about the animal with their family.
  • Professionals should also be aware of and employ specific interventions that work well with older clients who are grieving, including individuals with dementia. Policy and practice changes need to be made to accommodate the growing, aging population. For example, if a long-term care facility’s policy is to always be honest with their residents, including those with dementia, perhaps this policy and practice needs to be revisited and changed. For some residents with dementia, repeatedly telling the resident that their spouse has died might serve only to upset and continually retraumatize some residents.
  • Do not repeatedly tell people with dementia that their loved one has died, even if they ask. This can be harmful to them. Don’t lie, but rather, pay attention to the feelings they are having when they are asking where their deceased loved one is – are they scared or anxious? Ask them, “Why are you asking me that now?” or “Do you need something, how can I help?” Ultimately, use your judgement on what the person can handle and if it’s appropriate to tell them about their deceased loved one.
  • Older persons may possess a reservoir of considerable strength to draw upon regarding how they respond to loss. They have likely dealt with significant losses earlier in their lives, so empower them to utilize competencies they have developed throughout life. Grieving is not about moving on, it’s about finding a way to keep the connection in a way that makes sense.

Managing Chronic Illness While Improving the Dying Process

  • Age can sometimes inhibit conversations about advance care planning and end-of-life care decision-making. Often, people wait for their physicians to bring up care planning; and physicians wait until their patients bring it up. Unfortunately, this results in a conversation being had too late in the patient’s illness or not at all.Physicians or nurse practitioners need to start the conversation. They can ease into and revisit the discussion over a period of time to help make the patient feel more comfortable. Also, make sure the family understands their love one’s wishes and the health consequences about not honoring their end-of-life plan.
  • Ethical obligations that should govern all care planning, including the principles of autonomy, beneficence, and justice, are more difficult to apply when the patient has diminished decisional capacity. Given that individuals often suffer from multiple chronic conditions as they age, care of older persons is complicated and medical management at the end of life may be more difficult. Holistic care developed in consultation with specialists in geriatrics, gerontology, and hospice and palliative care is essential.
  • Caregivers need to be sensitive to the significant diversity within the older population. Each cohort of elders has unique characteristics that can influence care needs and responses. It is necessary to recognize diverse histories, personal stories, different cultures and contexts that influence end-of-life care and grief.
  • Family is an intimate network and defined in different ways. Twenty-two percent of older people do not have spouses or children and are known as “elder orphans.” Look to your friends to help fill the gap, your faith community, civic organizations you belong to – any place you feel like is your family. As healthcare professionals, help your patients identify these people in their lives.
  • Intervention techniques, such as life review, dignity therapy, and reminiscence therapy may be extremely useful in aiding older individuals to achieve a sense of meaning as they face the end of their life.