Differentiating between bereavement and depression Bereavement is a natural, normal response to a significant loss of a loved one, and it shares many of the same characteristics of depression, such as sadness, weight loss, loss of appetite, and insomnia. Bereavement is not a pathological condition itself; however, an older adult may need professional help to cope with the symptoms. The DSM-5 removes the so-called “bereavement exclusion” in the diagnosis of major depression, which has generated controversy among healthcare professionals (APA, 2013). Previously, the DSM-IV and its Text Revision stated that the bereaved individual should present symptoms for at least 2 months after a loss before being diagnosed with major depression. Although some worry that normal grief may now be diagnosed as a mental illness, others feel that many older people will benefit because they are especially prone to suffering bereavement (CDC, 2015). Bereavement often comes on suddenly after the death of a loved one and has several stages (Kübler-Ross, 1969). The first stage is denial – numbness and shock results from the intensity of the loss. This diminishes as acknowledgment of the loss occurs. An anger reaction comes from the feelings of being abandoned; or, anger is directed at a higher power. The bargaining stage occurs when one has thought about what could have prevented the event from occurring. If this stage is not resolved, intense feelings of guilt may persist. The next stage is often described as depression, but it is actually more like a deep and profound sadness for the loss rather than a clinical depression. The final stage is acceptance, when a person comes to terms with the loss and healing can begin. Complicated bereavement occurs when the mourner cannot accept the loss and develops an adjustment disorder, such as depression, anxiety, posttraumatic stress, or substance abuse. Symptoms of complicated bereavement include grief lasting for an extended period, everyday functioning impaired by symptoms, or intense symptoms such as suicidal ideation. Newer models for bereavement have been developed that identify specific patterns and relations in the complex and idiosyncratic grief experience. Two of the most comprehensive and influential grief theories are the Dual Process Model of Stroebe and Schut (1999) and the Task-Based Model developed by Worden (2008). These models offer frameworks that guide interventions and programs to enhance the patient’s self- awareness and self-efficacy. The Dual Process Model of Grief (Stroebe & Schut, 1999) was developed from a cognitive stress perspective and describes Cancer is more likely to occur in older adults than in younger people. Although the chances of surviving cancer are increasingly better today, it remains the second leading cause of death for older adults (Heron, 2016). The key to surviving cancer is early detection and treatment. Older adults may reduce their risk for dying of cancer by living a healthy lifestyle, being aware of warning signs of cancer, and having regular medical checkups Table 3 lists the signs and symptoms of cancer. If one of these symptoms occurs, it may not be cancer; however, it is important to see a healthcare professional to determine the cause. Fear and misinformation may cause older adults not to seek medical attention. They need to be aware that pain may not accompany cancer. Also, many older adults simply disregard these symptoms as normal aging changes.
grief as a process of oscillation between two contrasting modes of functioning. In the “loss orientation” the griever engages in emotion-focused coping, in which he or she explores and expresses the range of emotional responses associated with the loss. In the “restoration orientation,” the griever engages with problem-focused coping, and he or she is required to focus on the many external adjustments required by the loss, including diversion from it and attention to ongoing life demands. The model suggests that the focus of coping may differ from one moment to another, from one individual to another, and from one cultural group to another. On the other hand, Worden (2008) suggests that grieving should be considered as an active process that involves engagement with the following four tasks: 1. To accept the reality of the loss. 2. To process the pain of grief. 3. To adjust to a world without the deceased (including internal, external, and spiritual adjustments). 4. To find an enduring connection with the deceased in the midst of embarking on a new life. Overall, the response to the loss of a loved one often appears as depression. It may be difficult to distinguish between a depressive disorder and either normal or complicated bereavement because they resemble each other, and they can, in fact, coexist. Consider that bereavement commonly turns into depression but not the other way around. When in doubt, a professional consultation is advised. Symptoms that indicate depression rather than bereavement include: ● Unrealistic feelings of guilt. ● Psychomotor retardation – lack of or slowed movement and speech. ● Visual and auditory hallucinations of the deceased and mistaking others for the deceased person. ● Impairment in functioning, or suicidal ideation, thoughts, and plans. ● Suspect bereavement if: ● Symptoms diminish over time. ● Symptoms are exacerbated by events such as a birthday or anniversary, and the level of sadness fluctuates; with depression, sadness is more persistent. Depression should not be dismissed as a natural consequence of the physical, cognitive, social, and economic problems of later life. The healthcare community can help older adults by preventing and treating depression and unresolved grief so that older adults feel satisfied with their lives.
CANCER
Table 3: Cancer Warning Signs • Changes in bladder or bowel habits including frequency and consistency. • A sore on the body that does not heal. • Unusual bleeding or discharge from any part of the body. • A lump or thickening in the breast or any other body part, such as the mouth, testicle, or throat. • Difficulty swallowing or persistent indigestion. • An obvious change in a wart, mole, freckle, or other skin spot. • Hoarseness or a nagging cough. • Unexplained weight change. Note . Adapted from American Cancer Society. (2014). Signs and symptoms of cancer. Retrieved from http://www.cancer.org/cancer/ cancerbasics/signs-and-symptoms-of-cancer.
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