Mental Health Concerns and The Older Adult
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Different types of grief can be experi- enced. The type of grief being felt can drive the responses and state of being for the older adult presenting to the healthcare worker. Uncomplicated grief is considered the normal and expected course of grief after major loss triggered by events other than death (Boyd, 2017). When initial news of loss is presented, physical symptoms are often felt such as shortness of breath, a feeling of choking, rapid heart rate, sickness in the stomach, and body weakness (Boyd, 2017). The healthcare worker can help assess and prompt the older adult to assemble their social support system. Although yearning over the loss can occur for two years, most people do not need clinical treatment (Boyd, 2017). Complicated grief can hap- pen when a person cannot move beyond the loss and a degradation of functioning occurs; however, it is only experienced by about 10% to 20% of people (Boyd, 2017). If the older adult cannot move past the loss and is overwhelmed by the change, the healthcare worker needs to intervene. Complicated grief occurs after six months of intense mourning; there is a feeling of being “stuck,” deep yearning is expressed, trust toward other people is apparent, and life become meaning- less (Boyd, 2017). The healthcare worker will assess safety and the social support network to help the older adult over- come complicated grief. Grief that does not follow a normal response in the tim- ing of symptoms can be documented as delayed grief. In delayed grief, there is a lack of initial symptoms of grief but they surface later (Sadock et al., 2015). The healthcare worker can explore the Kübler- Ross cycle of grief to assess for extended denial when the older adult appears sto-
ic in presentation to acute loss. Cultural norms and awareness are cautioned as the healthcare provider works with the client to determine their definition of nor - mal and what an appropriate response to loss and death are. Another form of grief is prolonged grief, which is sometimes called traumat- ic grief because the loss was unforeseen. It is similar to persistent complex be- reavement disorder. Persistent complex bereavement disorder is a clinical diag- nosis that requires the deceased to have a significant connection to the mourner. In addition, there are intense feelings of yearning/sorrow/constant thoughts of the deceased/constant thoughts of the nature of death (one of those), and these difficulties interfere with functioning for more than a year after the death (APA, 2013). Traumatic grief is more difficult to cope with, thus leading to a longer recovery time. It often includes external circumstances such as violence, abrupt- ness, and unanticipated or preventable death (Boyd, 2017). Traumatic grief is often termed prolonged grief due to ex- tenuating forces and an anticipated loss. Therefore, the person experiencing the loss faces a longer period of change and adaptation. Symptoms of traumatic grief/prolonged grief include the following (APA, 2013): ● Last all day (nearly every day) for at least one month. ● Disruption of self (feeling loss of self). ● Extended denial about the death. ● Inability to confront reminders of the deceased person (avoidance). ● Intense outward feelings (emotions such as anger). ● Constant struggle with moving forward with daily activities and social engagements.
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