173 Mental Health Concerns and The Older Adult
er adult can feel the loss of identity, loss of autonomy, or loss of functioning. The definition of bereavement is “the process of mourning and coping with the loss of a loved one” (Boyd, 2017, p. 213) This is synonymous with death. The definition of grief is: The anguish experienced after sig- nificant loss, usually the death of a beloved person. Grief is often dis- tinguished from bereavement and mourning. Not all bereavements result in a strong grief response, and not all grief is given public expression. Grief often includes physiological distress, separation anxiety, confusion, yearn- ing, obsessive dwelling on the past, and apprehension about the future. Intense grief can become life-threaten- ing through disruption of the immune system, self-neglect, and suicidal thoughts. Grief may also take the form of regret for something lost, remorse for something done, or sorrow for a mishap to oneself. (APA, 2022e). For the older adult, loss, grief, and be- reavement are topics that are encoun- tered over a lifetime. Loss can be felt over animate and inanimate objects. Old- er adults can experience loss over loved ones, driving privileges, jobs, and au- tonomy on many levels of health, home, and happiness. Cultures and societies have determined an acceptable amount of time to grieve loss. Typical American culture expects people to return to work or school after a few weeks of loss, find a new balance in a few months, and be adept in their coping to establish new re- lationships 6 to 12 months after the loss of a loved one (Sadock et al., 2015). The healthcare worker should assess and rec- ognize that grief is an individual process each time it occurs. One notable frame-
work for understanding grief in marked stages is by Kübler-Ross. However, the stages are not meant to be linear as they are written (Kübler-Ross & Kessler, 2005). Grief is felt uniquely by everyone but is often encountered with proportionally greater impact by the older adult than younger generations. The Kübler-Ross and Kessler (2005) framework allows common terminology and an expression of information with the hopes of a better understanding of the psychological process occurring individu- ally over loss. The stages are written se- quentially but are not always experienced linearly. The stages can last minutes or hours, weeks or months. The stages are a response to loss that is seen and felt by many. There is no normal response to loss; all loss is different. Kübler-Ross and Kessler (2005) hoped by creating the stages it would create a space for grief to resolve, enabling a person to cope with the loss and carry on with their life. Another view of grief comes from the dual process model. It provides the healthcare worker with a way of concep- tualizing how an older adult can cope with loss over time. The exploration of this model can enable a healthcare work- er to identify the coping mechanisms the older adult is utilizing in their journey of healing. The model has two processes working, sometimes simultaneously and other times not, and it focuses on the switch between loss-oriented coping and restoration-oriented coping as oscillation (Boyd, 2017). Both processes may take large amounts of time and effort, or one may take more or less. They are not mu- tually exclusive, but awareness of both is necessary for processing grief and loss. Loss-oriented coping is focused on the loss itself—the relationship—and resto-
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