老年学与老年病学研究

抽象的

Challenging Aspects of Bereavement and Grief in Older Adults with Dementia: A Case Series and Clinical Considerations

Tan Lay Ling

Introduction: Bereavement is commonly experienced among older adults and has been shown to predict adverse health outcomes and may be linked to cognitive impairment. There is a paucity of literature on the impact of bereavement on older adults with dementia, contrasting extensive research on how dementia carers cope with their grief. Methods: 5 case studies of older adults with dementia and their bereavement reactions to losses are reported. The description of the phenomenology of bereavement distress in the case series help to shed light on its unique manifestations and how we can better understand this highly vulnerable group in their grief. Results: Normal grief reactions of denial, anger, bargaining, depression and acceptance can be experienced in early dementia. As the disease progresses, persons with dementia (PWD) may be too cognitively impaired to experience and express their grief. A vague sense that something is wrong with inner distress may manifest as behavioural disturbances, for although cognition declines, feelings and states of emotional pain remain. PWD may not be aware of the loss or may confuse the present loss with earlier losses. Seemingly nonreactions of mourning were noted to be much more common than those found among persons with normal intellectual ability. Conclusions: PWD and their families can be supported through the stages of grief by society and other support systems. Ethically, PWD have the right to grieve and mourn but the experiencing of acute grief and distress multiple times with ‘re-traumatization’ when the truth is revealed each time may be considered cruel and insensitive. It may be understandable why some family members and care staff try to shield PWD from reality. There may be questions as to whether or not to tell, how to tell and how the revelation will impact on their psychological well-being as well as their caregivers. PWD need to be approached differently when they experience bereavement and loss. If the grief response of the PWD is not sufficiently understandable in the context of the loss, there is the risk of them being inadvertently excluded from their family’s cycle of grief. Professional and family caregivers need to appreciate that PWD can be capable of grieving and we need to see how we can best support them and their loved ones in their grieving process.