and Statistical Manual of Mental Disorder ( DSM-5 ). Diagnostic inclusion for acute stress disorder requires “exposure to actual or threatened death, serious injury, or sexual violation” (not experi- enced through electronic media unless work related) (APA, 2013, p. 280). The healthcare worker must gather sufficient detail about the stressors and their causes in the older adult’s life to offer ap- propriate intervention. A healthcare worker often intercedes in times of crisis. Assess- ment for self-harm or harm to others is needed when an older adult is in crisis and will drive the immediate interventions. If harm is not a factor, the healthcare worker should focus their initial in- tervention on active listening (Corey & California State University, 2013). Allow the older adult the space to verbalize their feelings and experiences. The healthcare worker can meet these expres- Loss, grief, and bereavement Loss, grief, and bereavement are an expected part of life and will be seen in various presentations by the healthcare worker as- sessing the older adult. Statistical analysis suggests that 51% of women and 14% of men older than age 65 years will be widowed at least once in their lifetime (Sadock et al., 2015). The healthcare worker will assess the older adult suffering from loss, grief, and bereavement. Knowing the differences in terminology, the cycle of grief, and the risks to older adults unable to cope are crucial for the healthcare worker. The definition of loss according to the Merriam-Webster dictionary (2022) is “the act or fact of being un- able to keep or maintain something or someone.” Loss is syn- onymous with more than death. For example, the older 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 significant loss, usually the death of a beloved person. Grief is often distinguished from bereavement and mourning. Not all bereavements result in a strong grief response, and not all grief is given public ex- pression. Grief often includes physiological distress, separa- tion anxiety, confusion, yearning, obsessive dwelling on the past, and apprehension about the future. Intense grief can become life-threatening through disruption of the immune system, self-neglect, and suicidal thoughts. Grief may also take the form of regret for something lost, remorse for some- thing done, or sorrow for a mishap to oneself. (APA, 2022e). For the older adult, loss, grief, and bereavement are topics that are encountered over a lifetime. Loss can be felt over animate and inanimate objects. Older adults can experience loss over loved ones, driving privileges, jobs, and autonomy on many levels of health, home, and happiness. Cultures and societies have deter- mined an acceptable amount of time to grieve loss. Typical Ameri- can 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 relationships 6 to 12 months after the loss of a loved one (Sadock et al., 2015). The healthcare work- er should assess and recognize that grief is an individual process each time it occurs. One notable framework for understanding grief in marked stages is by Kübler-Ross. However, the stages are
sions with openness driving for acceptance. Feeling heard can help an older adult in crisis feel grounded (Corey & California State University, 2013). Stability in the midst of a crisis can help deescalate the extremes of emotions such as anger or sadness. Positive mental health support during a crisis opens the door for future intervention. Not all older adults who experience a crisis need mental healthcare. The necessity of crisis intervention will be determined by the ability or inability of the older adult to self- soothe and cope. It is worth understanding that the older adult may value feeling understood and supported during a crisis more than a healthcare worker’s ability to solve the problem (Corey & California State University, 2013). Assessment of coping skills and previous crisis coping will provide the healthcare worker with a plan for present needs and intervention. 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 young- er 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 in- dividually over loss. The stages are written sequentially 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 pro- vides the healthcare worker with a way of conceptualizing how an older adult can cope with loss over time. The exploration of this model can enable a healthcare worker to identify the coping mechanisms the older adult is utilizing in their journey of heal- ing. The model has two processes working, sometimes simultane- ously and other times not, and it focuses on the switch between loss-oriented coping and restoration-oriented coping as oscilla- tion (Boyd, 2017). Both processes may take large amounts of time and effort, or one may take more or less. They are not mutually exclusive, but awareness of both is necessary for processing grief and loss. Loss-oriented coping is focused on the loss itself—the relationship—and restoration-oriented coping is focused on the burden felt from the responsibility from the loss (Boyd, 2017). The older adult might be consumed with thoughts of the loved one who has passed away and consumed with sadness by the void created in their life, thus exhibiting loss-oriented coping. Restoration-orientated coping can be scary and difficult for the older adult if the loss is accompanied with lifestyle changes, for example, related to finances.
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