Grief, Bereavement and Loss

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grief2Grief, Bereavement and Loss

A guide to coping with loss after the death of a loved one

Coping with the death of a loved one is a personal experience. There is no normal or perfect way to respond. 

It is our hope that this article will:

  • Help you understand your feelings of grief
  • Offer ways to cope with your grief
  • Give you information and resources you need

What does grief, mourning and bereavement mean?

  • Anticipatory grief is the feeling of grief that can happen before your loved one’s death.
  • Grief is the personal response to a loss
  • Mourning is a process of adapting to the death of your loved one
  • Bereavement is the time spent grieving after your loved one’s death

 

The person loved is no longer alive, but the memories will live on forever. That part of your whole being that loves him/her is embraced when you allow yourself the privilege of remembering.          Alan D. Wolfelt

 

What can grief feel like?

When someone you love dies, your emotions, health, social life and spiritual wellbeing can change. You may feel unusual and upset by these changes.

You may experience:

  • Feeling numb
  • In disbelief that your loved has died
  • Anxiety and distress
  • Loneliness
  • Anger
  • Guilt
  • Sadness
  • Depression
  • Confusion
  • Trouble focusing and making decisions
  • Crying or Sighing
  • Having lucid dreams about your loved one
  • Seeing images of your loved one
  • Feeling relieved
  • Aches and pains
  • Upset stomach
  • Loss of sleep and being tired
  • Changes in sleep and appetite

You may lose interest in:

  • Day-to-day routines
  • Sex or intimacy
  • Relationships

How long will I grieve?

Grieving is a process.       Everyone experiences grief differently. There is no right or wrong way for you to react to the death of a loved one.

Symptoms of grief will occur less often and fell less intense as time passes. As symptoms of grief lessen, you will feel able to return to day-to-day life.

People can have both good and bad days when they’re grieving. Grief can come in waves of strong emotional feelings caused by reminders of your loved one… sometimes for no apparent reason at all.

Feelings of grief can return or feel worse on special days like birthdays, anniversaries and holidays when your loved is especially missed. It is normal to revisit your grief throughout your life… even when you have moved on.

 

Mourning never really ends. Only as time goes on it erupts less frequently – Alan D. Wolfelt

 

How can I help myself?

Body
  • Take care of yourself
  • Talk to your family doctor about any physical concerns
  • Take part in activities you enjoy such as going for a walk, reading or exercising
Social
  • Talk with a friend, family member or a member of your faith community
  • Share memories, stories and photographs of your loved one
  • Join a group or do one-on-one counselling – This can be done in person, by phone or over the internet.
Emotional and Spiritual
  • Be patient – grieving takes time
  • Know that other people have responded in the same way
  • Let yourself experience the pain of grief
  • Know that it is alright to express your feeling
  • Write a letter to your loved one… express yourself and keep it safe
  • Use the resources of your faith and spirituality

 

There is help… Reach out!

Bereaved Families of Ontario:       416-595-9618 .     http://www.bereavedfamilies.net
  • Provides group, one-on-one and phone support for adults, teenagers and children

 

Canadian Virtual Hospice:          http://www.virtualhospice.ca
  • Information and support on palliative and end-of-life care, loss and grief.

 

Respite Services:               http://www.hospice.on.ca/hospiceontario.php
  • Has over 180 associate and individual members who provide free bereavement support across Ontario.

 

University Health Network Bereavement Support Group – 416-603-5836
  • Offers an 8 week bereavement group

 

Wellspring Cancer Support Network:     416-961-1228           http://www.wellspring.ca
  • Community-based cancer support centres that offer a variety of programs to individuals and family members

 

Other Resources:

  • Your faith or spiritual community
  • Your family doctor or health team
  • Your Funeral Home

Grief only becomes a tolerable and creative experience when love enables it to be shared with someone who really understands – Simon Stephens

 

 

5 Things you should know about dementia

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Dementia21 – Dementia is not a natural part of ageing

When someone becomes forgetful or confused, friends are often quick to reassure them that this is just ‘what happens when you get older’. Some of us do struggle with our memory as we age or during times of stress or illness. But dementia is different. Lots of people momentarily forget a friend’s name – someone with dementia may forget ever having met them. They usually experience a range

of other symptoms alongside memory problems and will begin to struggle with daily life. Dementia is not a normal part of ageing. It’s caused by changes to the structure and chemistry of the brain.

Dementia doesn’t just affect older people. Younger people are also susceptible have dementia. This is called early-onset or young- onset dementia.

The chance of developing dementia increases with age. One in 14 people over 65 – and one in six people over 80 – has dementia. It’s more common among women than men.

Help and support:  If you are worried about your memory, or about someone else, the first step is to make an appointment to see the GP. The GP can help rule out other conditions that may have symptoms similar to dementia and that may be treatable. These include depression, chest and urinary infections, severe constipation, vitamin and thyroid deficiencies and brain tumours. The earlier you seek help, the sooner you can get the information, advice and support you need.

2 – Dementia is caused by diseases of the brain

The word dementia describes a group of symptoms that may include memory loss, difficulties with planning, problem-solving or language and sometimes changes in mood or behaviour.

What causes dementia? Dementia occurs when the brain is damaged by a disease. There are many known causes of dementia. The most common is Alzheimer’s disease. This changes the chemistry and structure of the brain, causing the brain cells to die. The first sign is usually short-term memory loss.

Other types of dementia include vascular dementia, mixed dementia (Alzheimer’s disease and vascular dementia), dementia with Lewy bodies and frontotemporal dementia (including Pick’s disease). Each of these diseases affects the brain in slightly different ways. For example, Alzheimer’s disease tends to start slowly and progress gradually, while vascular dementia following a stroke often progresses in a stepped way.


Everyone’s dementia is different: Whatever type of dementia a person has, everyone will experience the condition in their own way. How it affects a person over time is also unique to the individual – their own attitude, relationships with others and surroundings will all have an impact.

People often associate dementia with memory loss. And it does often start by affecting the short-term memory. Someone with dementia might repeat themselves and have problems recalling things that happened recently – although some people easily remember things from a long time ago. But dementia can also affect the way people think, speak, perceive things, feel and behave.

Common symptoms: Dementia often causes difficulties with concentration, planning and thinking things through. Some people will struggle with familiar daily tasks, like following
a recipe or using a bank card. Dementia also makes it harder to communicate.
For example, a person with dementia might have trouble remembering the right word or keeping up with a conversation. Many people have problems judging distances even though their eyes are fine. Mood changes and difficulties controlling emotions are common too. Someone might become unusually sad, frightened, angry or easily upset. They could lose their self-confidence and become withdrawn.

As dementia progresses: Dementia is progressive, which means that symptoms gradually get worse over time. How quickly this happens varies from person to person – and many people stay independent for years. Dementia is a condition that can affect anyone regardless of background, education, lifestyle or status.

There’s no known cure for dementia, but there are ways to help with symptoms and make life better at every stage. The more we understand about the condition, the more we can do to help people stay independent and live the life they want for as long as possible.

4 – It’s possible to live well with dementia

Scientists and researchers are working hard to find a cure for dementia. In partnership with people with dementia and their families, they are also looking into its causes, how it might be prevented and diagnosed earlier, and how to improve quality of life for people living with the condition.

Until we find a cure, there are drugs and other therapies that can help with some of the symptoms, so people can lead active, healthy lives and continue to do the things that matter to them most.

Drug treatments: There are medications available that may help with some types of dementia and stop symptoms progressing for a while. This is one reason it’s important to go to the doctor as soon as you suspect there’s a problem. It can feel like a big step to take, but a diagnosis can open up many opportunities to help overcome problems and find better ways of coping.

Non-drug treatments: People with dementia can also benefit from approaches that don’t involve drugs. For example, life story work, in which the person is encouraged to share their experiences and memories, or cognitive stimulation, which might involve doing word puzzles or discussing current affairs. Keeping as active as possible – physically, mentally and socially – can really help. It can boost memory and self-esteem and help avoid depression.

Dementia35 – There’s more to a person than the dementia

Living with dementia is challenging. When someone is diagnosed, their plans for the future might change. They may need help and support with everyday tasks or to keep doing the activities they enjoy. But dementia doesn’t change who they are. With the right support, it is possible for someone with dementia to live well and get the best out of life.

‘It’s important to carry on doing the things you enjoy, and not sideline yourself from your friends and family. We still go to the pictures and to the theatre.
We keep in touch with family and friends. We still go on holiday. We still go out together and do the things we always did.’ Brenda, whose husband has dementia

‘The art classes, choir and Memory Café are all brilliant for boosting my confidence. I’ve come away from my art classes and choir practice feeling like I’ve really achieved something. The choir has helped with my speech and memory too – I’m amazed that I can remember all the songs.’ Linda, living with dementia

‘Mum still does the things she used to do regularly – she still takes the dog to the woods like she used to. If she does something regularly and carries on doing it, she doesn’t normally forget it. Routine is really important.’ Pip, whose mother has dementia

Senior Care: Elderly Suicide

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Sad older gentleman

Loneliness & depression can bring on other challenges

The Elderly and Suicide

So we’ve all heard of depression. We even seem to be aware of what causes it & how to overcome it, but do we really?

So what’s the big deal with depression?   The deal is…

In 2011 statistical report stated that someone over the age of 65 commits suicide every 90 minutes (16 deaths per day). In 2013 it was reported that this statistic had doubled. Elders, account for one-fifth of all suicides, but it only represents 12% of the population. White males over the age of 85 are at the highest risk and completion of suicide attempts, almost six times the national average. The suicide rate among elders is two to three times higher than in younger age groups. Elder suicide may be under-reported by as much as 40% or more. Omitted are “silent suicides”, i.e., completions from medical noncompliance and overdoses, self-starvation or dehydration, and “accidents.” The elderly have a high suicide rate because they use firearms, hanging, and drowning. The ratio of suicide attempts to completions is 4:1 compared to 16:1 among younger adults. “Double suicides” involving spouses or partners occur most frequently among the aged. Elder attempters have less chance of discovery because of greater social isolation and less chance of survival because of greater physical frailty and the use of highly lethal means.

What are the causes?

Elder suicide is associated with depression and factors causing depression, e.g., chronic illness, physical impairment, unrelieved pain, financial stress, loss and grief, social isolation, and alcoholism. Depression is tied to low serotonin levels. Serotonin, is a neurotransmitter in our brains that regulates and limits self-destructive behaviour.  As we age our Serotonin levels decrease placing us at greater risk. Depression remains under diagnosed and undertreated among the elderly population.

What are some of the key risk factors of elder suicide?

  • Loss of spouse.
  • A late onset depressive disorder.
  • A debilitating and/or terminal illness.
  • Severe chronic/intractable pain.
  • Decreasing independence and self-sufficiency.
  • Decreased socialization and social supports.
  • Risk often accumulates among the elderly. An individual may be white, male, and an alcohol user and then become a widower or depressed.

What are some of the myths of elder suicide?

  • It is the outcome of a rational decision and justified.
  • Elder victims are usually seriously or terminally ill.
  • Only very severely depressed elders are at risk of suicide.
  • Suicidal elders never give any indication of their intent.
  • The suicide of an older person is different from that of a younger individual.

What are the warning signs?

The following may indicate serious risk:

  • Loss of interest in things or activities that are usually found enjoyable
  • Cutting back social interaction, self-care, and grooming.
  • Breaking medical regimens (e.g., going off diets, prescriptions)
  • Experiencing or expecting a significant personal loss (e.g., spouse)
  • Feeling hopeless and/or worthless (“Who needs me?”).
  • Putting affairs in order, giving things away, or making changes in wills.
  • Stock-pilling medication or obtaining other lethal means

Other clues are a preoccupation with death or a lack of concern about personal safety. “Good-byes” such as “This is the last time that you’ll see me” or “I won’t be needing anymore appointments” should raise concern. The most significant indicator is an expression of suicidal intent.

Why aren’t community agencies or providers doing more service involvement with older men?

Community agencies basically serve elderly women who have a suicide rate well under the national mean for all ages. Community agencies may be little concerned because elder suicide is uncommon in their caseloads.

Agency philosophy:

The prevailing value in most services for the aged is to optimize self-sufficiency in terms of individual capability and safety. A commitment to autonomy may cause community agencies to let the client or patient control decisions on referrals to other resources, alerting relatives, or involving available services.

Agency Misconceptions:

  • Community agencies and providers may accept some of the myths about suicide such as:
  • If someone’s determined to commit suicide, no one can stop him or her.
  • Those who complete suicide do not seek help before their attempt.
  • Those who kill themselves must be crazy.
  • Asking someone about suicide can lead to suicide.
  • Pain goes along with aging so nothing can be done.
  • It makes sense for an old person to want to end their suffering.
  • Old people are used to death and loss and don’t feel them like younger folks.
  • Those who talk about suicide rarely actually do it.
  • How many health or human service professionals, other staff, and volunteers believe these statements to be true?

Lack of risk assessment:

A lack of attention to elder suicide and a concentration on client or patient self-determination and self-sufficiency may limit community agencies’ response. Most community agencies do not recognize the problem and consequently do little or no screening for it among their clientele.

What can community agencies do?

Individual prevention must focus on what drives suicide. “Doing something” basically comes down to caring. Community level prevention of late life suicides will require “creative partnerships of primary care providers. This means that senior centers, home care providers, hospices, adult day care, home-delivered meals programs, para-transit, and other organizations serving the elderly are going to have to team up with community mental health centers. This must start soon as the high-risk segment of the aged population is growing rapidly and the oldest baby boomers are within a few years of turning 65. The boomers will arrive in their “golden years” having manifested higher suicide rates on the way than prior generations.

If you think… This cannot be happening here in Canada, Think again!

Canada’s elderly are at high risk of suicide experts say, and Canadian men aged 85 to 89 have the highest rate of suicide. THE CANADIAN PRESS: Dr. Marnin Heisel says public awareness about suicide lets people know their physical and mental health problems can be treated effectively. Studies show that Canada’s elderly are at a much higher risk of suicide than adolescents, and there is growing concern among mental health experts that psychological care may be out of reach for most seniors. Dr. Marnin Heisel, a clinical psychologist and professor at the University of Western Ontario, says lack of public awareness of the issue is a key problem that affects not only the elderly but also their families and the public in general.

“One of the challenges that people face is thinking ‘I’m unique in this, I’m alone, there’s something wrong with me, no one can understand it,’ and then they tend to back away from family, other supports, including professional supports” Heisel said in an interview.

Public awareness lets the people struggling with these issues know that they are not alone and their physical and mental health problems can be treated effectively, he said. It may also cue their relatives into the fact that their older family members who are struggling with depression might be contemplating suicide, he said. “They might, as a result, begin asking their family (member) ‘How are you doing? Are you struggling with some of these things?’ or even asking them if they’ve thought of suicide.” A 2009 report by Statistic Canada states that men aged 85 to 89 have the highest rate of suicide among any age group in Canada, at a rate of about 31 per 100,000, and usually do so through more violent means. A report by the chief public health officer released the following year also showed that men over the age of 85 have on average higher suicide rates than all other age groups. For most Canadians, psychological services — which can easily run $100 or $200 an hour — are not covered by provincial and territorial health-care plans, but psychiatric services and medications generally are. Psychological care is covered only if it’s hospital-based. “But many if not most hospitals, at least in Ontario, typically don’t have very much in the way of psychological services and typically not for older adults,” said Heisel. “One thing we do know is that unless somebody has extremely good third-party health coverage, or they are a child in the school system, or a veteran, or if they have access to psychological services as a result of a motor vehicle collision — most Canadians can’t access psychological services unless they pay out-of-pocket. Heisel says research has shown that 75 per cent of older adults who die by suicide had seen a primary-care physician or provider within a month prior to ending their lives. “That suggests that primary care is a key place where we should be assessing for screening for suicide risk factors and then try to implement aggressive, meaning very focused, interventions,” Heisel said. “And we really don’t see that happening, literature supports that treatments works extremely well; it just requires funding to do that.” There’s also concern that many elderly suicides go undetected due to the way they are reported by coroners across Canada. “I can envision a circumstance, for example, where an elderly male is found (deceased) in a bed alone … maybe with no history of depression or suicidal thinking that he had expressed to anybody, and the coroner could determine that the death was due to natural causes and not even order an autopsy because of the age group,” said Dr. William Lucas, Ontario deputy chief coroner for inquest. “And if the person had used a relatively subtle means like an overdose of medications … that wasn’t obvious … we wouldn’t know,” he said. Heisel says research shows that when the means of death are more ambiguous, then suicide is more likely not to be detected. He goes on to say, “It’s somewhat frustrating because we really don’t know the full scope of the issue”. The frustration stems from the fact that many suicide prevention strategies are largely aimed at youth. That’s why he says he decided to speak publicly about the issue. Victims of depression say that family is what helps them the most in combating episodes of depression, in addition to staying physically active, mentally stimulated, including social companionship in their daily lives with interaction in the community. “Those are the good things in life when periods of depression start to creep in”.  Incorporate them to combat depression and from recurring episodes. One patient says… “Well if the glass is half empty, it must be half full … I try to forget about the half-empty side but what a wonderful half full my life is.” The following posted articles also speak to this issue in the same relative terms… it a bigger problem that we think and about to get bigger. Be sure to also read the posted comments from readers, as it further illustrates the issue in the elderly communities. Suicide rates climb among elderly in Canada. Elderly suicide rates hitting new highs as traditional social networks break down. Over the past years our aging population has skyrocketed. This growth is only expected to increase exponentially over the next 15-20 years. The issues we are currently facing and learning about are just the beginning of the cycle. Growing challenges relating to care of our elderly will continue to provoke our ideals of what is acceptable in our society. Anything that we have an answer for (treatment) is therefore a preventable measure… like the treatment for depression and respectively reduce depression related suicides.

The following graphs illustrate the population growth for the following demographics.

graph1depressionsuicide graph2depressionsuicide

For a more detailed population projection statistical review visit the Canadian Statistics web page.

It is within us to create an environment whereby our elders are cared for in a manner that protects them physically & holistically, paving the way for the future. Our campaign and advocacy to enriching the lives of our elderly should be one of our primary goals… “We ourselves are becoming to ones who will require care in the near future and our actions today will dictate the outcome for ourselves tomorrow”.