DOCUMENT RESUME

ED 364 818 CG 025 141

TITLE Loss and Grief in Later Life.INSTITUTION Idaho State Univ., Pocatello. Cooperative Extension

Service.; Oregon State Univ., Corvallis. CooperativeExtension Service.; Washington State Univ., Pullman.Cooperative Extension Service.

REPORT NO PNW-439PUB DATE Mar 93NOTE 32p.; A publication of Pacific Northwest

Extension.AVAILABLE FROM Agricultural Communications, Oregon State University,

Administrative Services A422, Corvallis, OR97331-2119.

PUB TYPE Guides General (050)

EDRS PRICE MFOL/PCO2 Plus Postage.DESCRIPTORS Aging (Individuals); Anger; *Coping; *Death;

*Emotional Adjustment; "Grief; Guilt; Loneliness;*Older Adults; Social Support Groups

IDENTIFIERS *Loss

ABSTRACTThis guide is designed to help readers understand

loss and grief, and to sensitively respond to the grief of others.Although emphasis is on losses experienced in later life, mostinformation is equally applicable to grief throughout adulthood. Asection on understanding loss in later life lists a number of lossesthat are associated with aging. The grief process is explained in thenext section, followed by a section on accepting the reality of theloss. A section on experiencing the pain notes physical, behavioral,emotional, cognitive, and spiritual responses to grief, and discussesanger, guilt, and loneliness. The next sections focus on adjusting tothe changes that accompany loss and the reinvestment of emotionalenergy. A section on influences that affect the impact of lossdiscusses the significance of the loss to the person and considerscharacteristics of the loss. The section also considers a person'sability to cope and the role of social support. The next sectionexplains how to help someone who is grieving. A sidebar offers simpleguidelines for writing a condolence note. A brief summary is followedby a list of publications for further readings on the topics of lossand grief. (NB)

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Reproductions supplied by EDRS are the best that can be madefrom the original document.

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LOSS AND GRIEF IN LATER LIFE

PNW 439March 1993

A Pacific Abrthirest Extension PublicationOregon Washington Idaho

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CONTENTS

INTRODUCTION

UNDERSTANDING Loss IN LATER LIFE

THE GRIEF PROCESS

ACCEPTING THE REALITY OF THE LOSS

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4

6

7

EXPERIENCING THE PAIN

ADJUSTING TO THE CHANGES

REINVESTING EMOTIONAL ENERGY

WHAT INFLUENCES THE IMPACT OF LOSS

HELPING SOMEONE WHO IS GRIEVING

SUMMARY

FOR FURTHER READING

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LOSS AND GRIEF IN LATER LIFE

rs. Barker's health is failing. Shemust sell her home of 50 yearsand move to a care facility.

Mr. Finch, 78, has to quitdriving because he no longer sees well.Driving has meant freedom, mobility, andindependence for him. Public transportationis not available where he lives.

Mrs. Tennyson. 70, has experiencedseveral deaths over the past 2 yearsherhusband after an extended illness, two closefriends. and her dog. She says, "My worldhas collapsed."

Mr. Johnston, 60, was forced to retirebecause his position was terminated. Hesays, -My work has been my life."

Mr. Veal, 68, who recently had a stroke.says to you. "How does it feel to meet half aman?"

Mrs. Kroon, 87, lives in a nursing home.She is devastated because she can't find hermost valued possessiona necklace herhusband gave to her on her welding day 63years ago.

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V.L. Schrnall

All of these situations involve a loss.Although the death of a loved one generallyis considered the most difficult loss, wegrieve whenever we lose something signifi-cant and in which we have invested our-selvesour time, energy, affection, money,or dreams and hopes.

Most people cope well with loss. Someeven report experiencing personal growthand learning new skills. Other people aredevastated and have great difficulty adjust-ingsometimes for years. Some may neverhave coped well with loss or lack the re-sources to cope with such changes.

This publication is designed to help youunderstand loss and grief, and to sensitivelyrespond to the grief of others. Althoughemphasis is on losses experienced in laterlife, most information is equally applicable togrief throughout adulthood.

Vicki L. Schinall, Extension gerontologyspecialist Oregon State University.

4

UNDERSTANDING LOSS IN LATER LIFE

are:

oss is a common experience formany older people, particularly asthey become older and more frail.Some losses often related to aging

death of a spousedeath of friendsloss of job through retirementloss of rolesloss of healthloss of control and decision-makingloss of home and communitythrough a moveloss of a body partloss of the ability to driveloss of independencetoss of status in a youth-oriented societyloss in the ability to see or hear

White these losses can happen at anyage. they are even more likely in the lateryears. On the average, older adults experi-ence more losses than other age groups.Frequently, losses occur in rapid succession,with one loss triggering others.

Think about the situations at the top ofpage 3. What additional losses migat thesepeople experience as a result of the majorlosses described?

A change in living arrangements, nomatter how practical, can he difficult. Inaddition to losing a home, a move to a carefacility or a relative's home may mean losing

familiar surroundings, long-time friends, andpossessions, and having less control overone's environment and schedule.

Loss of eyesight and being unable todrive often means having to rely on others.This can he particularly difficult for theperson who has always taken pride in beingself-sufficient.

Retirement can have a tremendousimpact on self-esteem for the person whosework was a primary source of identity andworth. Retirement also may mean a loss ofstatus, friends, and routine, as well as re-duced income.

People's belongings are a part of whothey are. To lose something of sentimentalvalue, even if it is worth very little money,can mean the loss of a symbolic tie to asignificant time. place, or person. Posses-sions tend to support our memories.

The death of a pet also can be verytraumatic. Pets are "family" for some olderpeople. And, unfortunately, as one personsaid. "Society doesn't support pet loss as itdoes human loss. If your aunt dies, you cantake a day off from work, but you can't takea day off from work because your pet died."When a loved pet becomes ill and theperson cannot pay for the needed care, guiltmay be a predominant emotion.

Because loss is a common theme inlater life, it's important to understand itspotential significance, to he able to identifythe subtle as well as the dramatic lossesolder people experience, and to recognizewhen a person's behavior may be a response

45

to such losses. Mental confusion, disorienta-tion. and withdrawal can result when anolder person experiences emotional overloadimposed by losses.

Certain losses are obvious. However,the cumulative effect of many gradual andmore subtle losses can be equally difficultfor an older person.

Over the past few years, Mr. Stevens,77. has lost his hearing. He finds it difficultto be in large groups. Even at family gather-ings he feels like an "outsider." He doesn'thear the jokes, but sees everyone laughing.The highlight of his week had been cardgames with four former work buddies. Whileworking they played monthly. but when theyall retired 15 years ago, they started playingweekly. Four months ago, they abandonedthe group when one man (Mr. Stevens' bestfriend) was placed in a care facility; thefailing eyesight of another made playingdifficult; a third player frequently missed theweekly game because of his wife's illness.

Maggie, 83, says that one of the mostdifficult adjustments for her has been "notbeing able to count on my body." Herfingers, gnarled by rheumatoid arthritis, areno longer able to do the fine stitchery thathas always been her pride. Painful jointsmake it difficult to move. She hesitates toleave her home unless she is sure she will benear a bathroom. She fears another episodeof incontinence, which she experiencedrecently at a shopping mall.

Sometimes when we think an olderperson needs to make a change, for examplemove to a retirement home or give updriving, we feel the change is "for the hest."Even when this is true, it doesn't mean thechange is easy. The older person generallyfeels a sense of loss, a loss which needs tobe acknowledged by others. All too often thesense of loss is not acknowledged becauseothers are focused on the change as only"being for the best."

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THE GRIEF PROCESS

Grief is perhaps best described as along roller coaster ride that gradu-ally levels out. It does not have aset of rules. No timetable can he put

on the grief experience. The time needed forthis process of adjustment varies from personto person.

There is no one "normal" or "right" wayto grieve. Just as we live in different ways,we grieve a loss in different ways. A varietyof feelings and behaviors may he experi-enced. One person may have an outpouringof tears. Another might show no emotion yetfeel just as much pain. When people do notunderstand these differences, misunderstand-ings can occur between family members andbetween friends. One 76-year-old womanwrote:

For awhile I would write to my sonin California to inform bini aboutwhat I was experiencing as he isnot here to see or talk. But I easenow because he rebukes me Pr mygrief.

It's often cliff, for family members tosupport each other nen each person isgrieving. Communication with each otherand respect for each family member's way ofgrieving are important to coping and grow-ing as a family through grief.

While the experience of grief is uniquefor each person, there are common reac-tions. Knowing them can be helpful. Al-though there are several ways of looking atthe grief process. a person must accomplishfour tasks to regain balance in life:

1. Accept the reality of the loss.2. Experience the pain of grief.3. Adjust to the changes.4. Withdraw emotional energy from

what was lost and reinvest it inpeople and/or other activities.

(Adapted from Grief Counseling and GriefTherapy, by J.W. Worden)

If the grieving process is blocked oravoided, further growth can he impaired andthe person can become physically andioremotionally ill.

ACCEPTING THE REALITY OF THE LOSS

The firs t task a person faces followinga significant loss is accepting thereality of that loss. The first reactiongenerally is shock and disbelief, a

feeling "this cannot really he happening.- Asone person said, "Everything inside shouts'no.'" Following a stroke, another personsaid, "I thought it was a nightmare fromwhich I would awaken." It's natural not toaccept a significant loss right away. Also,with a loss of healthfor example, from astrokethe extent of the loss may not heknown for a period of time.

People are emotionally numb, tempo-rarily anesthetized. This numbness is said tohe nature's way of helping us through anexperience that otherwise would be over-whelmingly intolerable and painful. It servesto deaden the pain and give us time toabsorb what has happened, mobilize ourinternal resources, and prepare for thedifficult times ahead.

During this period, people often func-tion in a robot-like manner. They may feeldetached from events happening aroundthem and almost "out of their body." asthough they are observing what is going onrather than experiencing it. Therefore, it's amistake to judge that someone is doing justfine because he or she appears composedshortly after a major loss or at the time of afuneral. The real anguish and distress mayhave not yet begun, or simply may not beobvious.

Shock can even be experienced when aloss is anticipated or considered a "blessing.-such as when a family member dies after a

long illness or after suffering intense pain.Following the death of her mother, who hadAlzheimer's disease, a daughter stated, "Eventhough I had expected Morn to die for 2years, I was stunned when she actually died.It was a week before I absorbed the details.We're never quite ready for this step in life."

Shock, disbelief, and denial last forvarying amounts of timefrom minutes toweeksfor different people. Generally, themore traumatic and unexpected the loss, themore likely a person will deny its reality.Feelings may fluctuate between denial andopen awareness. Six months after the deathof her 80-year-old husband, Martha wrote:

The latest event or change in moodfor me is to realize I am a widowfor life. Anyone could say, Rowstupid can you he? Everybodyknows that.' But it just comes oz.,eryou.

People need adequate time to face thereality of their loss. Funerals, memorialservices, and viewing the body are all waysof reinforcing the reality of a death. Theyalso create a climate for receiving supportfrom family and friends.

Some people refuse to believe that aloss is real and become stuck in this part ofthe grieving process. They may deny thefacts of the loss, its meaning, or that the lossis irreversible. If this type of behavior contin-ues, professional help may be needed tohelp the person become "unstuck" and movethrough the grief process.

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8

EXPERIENCING THE PAIN

As the numbness lifts, the reality ofthe loss makes its impact. Theperson experiences anguish andemotional pain. The pain comes

from the growing awareness of the finality ofthe lossthe unused pillow, the missingtelephone call, the inability to use one's arm.the inability to return "home." Although noteveryone feels the same intensity of pain orfeels it in the same way, it's nearly impos-sible to lose a loved one or experience asignificant loss without feeling some level ofemotional pain.

It may appear as though the person is"getting worse." Be aware this is often due tothe reality of the loss hitting the personweeks or months after the loss has occurred.It's when this reality sets in that support ismost needed, Yet, support is often lessavailable.

One of the biggest obstacles to movingthrough grief for many people is their effortsto avoid the intense emotional pain. Yet,pain activates the other parts of the adjust-ment process. People need to feel and workthrough this pain so they can Netter managetheir grief and go on with other aspects oftheir lives.

All kinds of emotions may grip a personat one time or another. There may he erraticshifts in mood. The feelings can he confus-ing to the person and to those who try tohelp. In talking about the grief she experi-enced following her daughter's death. Anne,age 74. said:

I felt angrier than I had ever feltand sadder than I had everthought possible. My thoughts werefrightening I wanted revenge. Ifelt I was losing my mind andgoing crazy.

People sometimes feel they are losingtheir mind. Some widows call this a "crazy"period during which they may have dis-played out-of-character behavior or had-bizarre" experiences. For example, Bobbiewrote:

I was in the mall one day and sawRed walking ahead of me. It was awhite-haired man of his build,wearing a one-piece brown romperlike Red always wore. It startled mefor a moment . . . and I did have towalk closer to see his face.

Mary said:

I was sure I was going crazy when1 awoke in the night and 'saw' Ivhusband, who had died, sitting atthe edge of my bed and telling me'everything will be all right.'

Many people who have lost a lovedone also report rece,ving comfort from suchexperiences. Such feelings and experiencesare common. As long as they occur for alimited time and are not disruptive to theperson's health and well-being. they arenot harmful. If such behaviors becomeexaggerated, prolonged, or disruptive to

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relationships, then professional counseling isgenerally necessary to help a person tomove forward.

Wishful thinking is common. Theperson may explore fantasies of restoring thelossbeing able to return home when it'snot possible or driving again. even thoughlegally blind.

RESPONSES TO GRIEFGrief causes tremendous turmoil in

every aspect of life and involves a widerange of physical, emotional, and spiritualresponses. Many people find themselvesoverwhelmed and frightened by the feelings,thoughts and emotions. Any of the followingcan be characteristicand are normal.

PHYSICAL

Reactions to grief can cause physicalsymptoms. Our bodies "feel" the emotionalloss. Many older people actually will hurtrather than complain of emotional pain.

Knot in the stomachChanges in appetiteTightness or lump in the throatFrequent sighingShortness of breathTightness in chest

Fatigue or lack of energy.unrelieved by sleepMuscle weakness

Dry mouthNausea, diarrhea, indigestionFeeling "hollow" or "emptiedOut"

Feeling weak or faintHeadaches

General achinessOversensitivity to noise

BEHAVIORAL

Being immobilized, unable toact

Restless overactivity (unable tosit still or stay with a task)Forgetfulness

Sleeplessness or oversleepingUnable to begin and maintainnormal daily activity

Lack of motivation or energyCrying. sobbing (often at unex-pected times)Talking to the person who hasdiedSocial withdrawal

FEELINGS

Shock, numbness, disbeliefAnxiety, panic

Anger

Guilt

Intense sadness

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10

DepressionHelplessness, powerlessnessEverything is unreal, feelingdetachedFears: of "going crazy," of thefuture

Envy of others who have notexperienced a loss (still havetheir spouse, their home, theirhealth)

Relief (that the person's suffer-ing is over; burden of caregivingis over)

Loneliness

Indifference

THOUGHT PATTERNS

Many different thought patterns occurduring grief. When not understood as nor-mal. some people fear they are going crazy.

Denial (difficulty believing theloss is real)

Poor concentrationDisorganizationConfusion

Preoccupation with the lossand/or circumstances surround-ing it

Seeing or hearing the personwho diedDreams (about the ioss)Repetition (retelling detailsabout the loss over and over or

thinking about it as if replayinga tape)Yearning and longing for personwho died or for "what was"

SPIRITUAL

Anger directed toward God,clergy or religion in generalConsolation provided by beliefor scriptureExamining the meaning of lifeSeeking meaning in the lossitself

Doubts

Strengthening of beliefsWavering of faith

Searching for evidence ofafterlife

Change in priorities (such asincreased or decreased tolerancefor minor irritations in life)

Not all of these responses %yin beexperienced by every person. Symptoms willvary by individual and the nature of the loss.Most important is to understand the widerange of responses that are -normal," andallow their expression. We also can providereassurance to those people who may bedisturbed by their reactions.

Everything may seem to he a reminderof the loss. Those who have lost a spouseoften notice every couple holding hands.Happy people may seem to he everywhere.

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which intensifies the sense of isolation. Suchfeelings are typical.

Anger and guilt are emotions that tendto he particularly difficult. Both ,tre quitecommon. Its important to remember thatfeelings are neither right nor wrong, goodnor bad: they just are.

Anger. It's common to feel anger whenwe lose something important. Anger usuallyresults from frustration and may range frommild to rage. Anger is caused by a profoundsense of injustice"What did I do to deservethis? Its not fair"compounded by notbeing able to control what happens.

Fear about the future often gives rise toanger. Sometimes anger is directed towardsoneself: "If only I hadn't done this, Iwouldn't have been fired." "If we hadn'tfought before he left the house, maybe hewouldn't have had the heart attack."

Anyone can be the target of the anger.even though a person hasn't done anythingto deserve it. It's common to look for some-one or something to blame. Anger may bedirected toward doctors. God. family mem-bers, or the person who died.

Anger at the deceased is not unusual."How dare you leave me!" Sometimes peoplefeel guilty or that they are "awful" people ifthey feel anger toward a person who died.Feelings of desertion, deprivation, andresentment are to he expected.

Expressing the anger usually relievesthe anguish. Bottled-up anger festers andgenerally will he expressed in negative wayssuch as poor performance or relationshipproblems. If anger is turned inward. help

may he needed to prevent we person fromsinking into depression or engaging in self-destructive behavior.

Efforts to comfort may be met withintense hostility. In healing Grief, Jensenstates, -Terrible grief demands a scapegoat.Even good relationships can suffer stressfrom this anger." If anger is expressedeffectively, it clears the air, changes thesituation and feels good. If expressed with-out resolution, the anger may he simplyreinforced and strengthened,

Guilt. There is frequently some senseof guilt. People often think of the manythings they felt they could have or shouldhave done. Feelings of guilt, regret, and self-reproach are common. The person maysearch for evidence of his or her neglect orresponsibility for the death or loss. Feelingsof guilt following a suicide often are thestrongest and most overwhelming becausethere are so many unanswered questions. Ifguilt feelings are not resolved, they can beharmful physically and mentally.

A man diagnosed with cancer says, "Ifonly I hadn't smoked, then maybe . Thewoman whose husband has died thinks. "If Ihad only forced him to go to a doctor whenhe wasn't feeling well, then maybe he'd bealive today."

Most guilt is largely irrational, butpeople need help to shed the feeling thatwhat happened was their fault. The personneeds a trusted friend who will listen pa-tiently to how he or she feels.

Sometimes guilt arises from feelings ofrelieffor example, when a family member

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dies after a long illness. If a relationship hasbeen stressful or restrictive, death can he arelief. Survivors may experience a feeling ofshame or guilt because they feel relieved,and find it difficult to express their feelings.Feelings of relief do not mean we loved theperson any less. For the person burdened byguilt, professional counseling often isneeded.

Loneliness. Loneliness and sadnesstend to be the longest Lasting feelings ofgrief. A feeling of emptiness is commonamong the recently widowed, especiallywhen family and frier i 'lave returnedhome. Evenings and L r ends can heparticularly lonely. Everything seems magni-fied at night. One woman, following thedeath of her husband after a long illness,

said, "I don't know which is worsehavinghim sick or being lonely."

Loneliness frequently is intensified bypoor health, which limits the person's oppor-tunity to get out and interact with others. Butloneliness is not managed simply by beingsurrounded by other people. As one 72-year-old woman said, "I am lonely, but i am notalone."

Remember, the most difficult aspects ofgrief occur once the numbness of the losswears awayironically, at the same time,support usually declines. Experiencing thepain is what has to happen for people toseparate from the emotional energy theyhave put into the person, job, home, orwhatever it is they have lost. This musthappen before they are able to "reinvest- inlife.

ADJUSTING TO THE CHANGES

oss confronts people with newdemands. Adjusting successfullyinvolves restructuring one's life toaccommodate the changes. adapting

to secondary losses, learning new skills, andsometimes taking on new roles.

A person's ability to cope dependspartly on accepting the changes and chal-lenges. This may mean coining to terms withliving alone; managing finances; makingmajor decisions; and taking on the house-keeping, shopping. food preparation. andlaundry. If the person had relied on his orher spouse to maintain relationships withadult children, relatives and friends, he orshe now may have to learn to reach out tomaintain and develop relationships. Georgewrote to his daughter:

Mercy! It is surprising about inci-dents as Igo along. As I begin towrite this card suddenly fromnowhere the thought rings me, ifMillie were here, she world hewriting this note!

For the person who has lost the use ofhis or her legs, it may mean learning to livelife from the wheelchair. After cancer surgeryin which her voice box and part of herwindpipe were removed. Sancti

I now breathe, cough, and sneezethrough a hole in my throat. It wasa terrible blow, and it's takingsonic adjusting not to he able totalk considering how I was alwaysrunning off at the mouth. It's beena tough time . . . but l am adjust-ing to this change in iv life.

The person may need concrete direc-tion to get out of the house, to develop newskills, or to get involved in new activities.Most older people adjust to the changesquite successfully, and frequently reportdeveloping new strengths, sensitivity, andindependence as well as feeling better aboutthemselves.

Failure to accomplish this task mayresult in helplessness, overdependence onothers, social withdrawal, and/or the inabilityto cope.

REINVESTING EMOTIONAL ENERGY

ne benchmark that grief is beingworked through is when theperson is able to think about theloss without the -stabbing pain" and

can reinvest his or her emotions hack intolife. This phase begins slowly, usually afterseveral months or sometimes even longer.The person begins to feel a sense of renewaland may feel, "It's time for me to move on."

During acute grief most of the person'senergy is turned inward. In this phase. theperson begins to turn outward again. Newfriendships may be developed, previouslyenjoyed activities resumed, or new activitiesundertaken. Emotional balance returns. Thismay occur in a few months, or not for 2Years or longer. Lynn Caine inWiclou' de-scribed this phase for herself:

i wanted to taste life again. To live.to work. to love. Soddenly. I wasimpatient with my whole . . .

More and more I wanted to clearaway the worries and problems.There Were days when I felt morewhole, more capable than i everhad been in my whole

Successful adjustment to the death of aloved one or other loss does not mean theperson becomes the "same old self again."The person can become whole, but ischanged by the experience. Caine continues:

Acceptance finally comes. Andwith it peace . . . T od a y I am moreindependent. I have more under-standing. morn' srmpathy. I hate aquiet lovelor Martin. I bury pas-sionate, poignant memories. 110will ala'ars he a pail of me . . but

Martin is dead. And I ant a differ-eni WoMan. And the next time Ilove. if I ever do. it will be a differ-ent man . a dillerent

Anxiety and guilt may reappear. espe-cially for the person whose spouse has died.Guilt may he felt for again enjoying life,being happy. or loving another. Somepeople feel withdrawing their emotionalattachment from the deceased means dishon-oring the person's memory. Sometimesothers will give such messages.

Some people are afraid to reinvest theiremotions in another relationship becausethey don't want to experience the pain of"losing again." Encouragement. support, andpermission to "live and love again" can heparticularly helpful.

When these grief tasks are not com-pleted, a person's further growth can beimpaired. Successful grief work requirestime, effort, and energy on the part of theperson experiencing the loss. Time alonedoes not heal. For some older people.however, there may not be the time, energy,or mental capacity to cope with the loss_ Or.they may have outlived the people whoprovided support to them during difficulttimes. Even when a person has made asuccessful adjustment, there can be timesand events when sadness will be triggeredgoing by the home you were forced to leave.seeing a car like the one you had beenforced to give up, seeing someone whoexperienced the same medical problem buthas fully recovered and you never will,looking through photo albums, or hearing acertain song or smelling a certain colognethat you always associated with your spouse.

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WHAT INFLUENCES THE IMPACT OF LOSS

lthough it's difficult to know whowill cope well with loss and whowill have difficulty, a person'sability to cope tends to he influ-

enced by several factors. Considering thesefactors can help determine the impact a lossis likely to have on a person. the intensityand length of the grief process, the assis-tance the person may need. and the degreeto which the person may be at risk forproblems. Four major factors are:

1. Significance of the loss2. Characteristics of the loss3. Person's ability to cope4. Social support

As you think about helping a personwho is grieving, consider the many variableswhich come into play in that person's situa-tion.

SIGNIFICANCE OF THE LOSS

Generally, the more important a person,object, or activity, the more profound thesense of loss and the more intense the grief.For example.

Sam, whose identity and statuswas closely tied to his work,experienced a stronger griefreaction to retirement than Joe,who was not dependent on workfor identity and self-esteem.

Marcel le had great difficultymoving from her home because ofher strong attachment to it. "It'swhere John and I lived during our

40 years of marriage, where Iraised my children." Ruth, on theother hand, viewed her home as"keeping me tied down."

Sherm grieved profusely follow-ing the death of Ryder, his dog.saying, "She has been my primarycompanion and "my best friend."Grace, Sherm's wife, had nodifficulty with Ryder's death.primarily because she viewedRyder as "just a dog.-

Nic. Simpson's marriage hadbeen an unhappy one with few, ifany, rewards. She had remainedmarried only because she felt shehad no other choice. `when herhusband died she telt "releasedfrom that man's selfishness." ForMrs. Creston, however. herhusband's death meant she lostnot only her husband, but also herbest friend and companion.The ending of an unhappy relationship

can he even more complicated to resolvethan the loss of a relationship filled withhappiness. Why this is true is not entirelyclear. Some spouses who viewed theirmarriages as unhappy report missing thearguments with their deceased spouses andhaving their spouse around. It may bedifficult to understand these reactions;however, such responses are common. It'simportant to support these feelings bylistening. Be cautious about remarks such as"Ile was awful to you. You're better without

15

la

him." Even though this may seem to be trueto you, the person may not feel this way.

High dependence on what was losttends to complicate grieving. The wife whohas always depended on her husband foremotional support, to make decisions, andhandle the finances is likely to have moredifficulty with the grieving process than amore independent woman.

High ambivalence can make the griefprocess more difficult. A person may ideal-ize. put the deceased on a pedestal, andrecall memories as being better than theyactually were. The person who died maybecome bigger in death than in life.

CHARACTERISTICS OF THE LOSS

A person's reaction may be affected bywhether the loss was unexpected or antici-pated, the manner in which the loss oc-curred, and the perceived timeliness of theloss.

Natural versus unusual circum-stances. A violent death generally provokesthe most traumatic grief. Adjustment andacceptance are more difficult for survivors.In drunk driving crashes, the fact that some-one chose to be negligent or reckless can bedifficult to understand.

Suicide is particularly difficult forsurvivors because there tends to he manyunanswered questions. Feelings of guilt oftenare strong and overwhelming. Survivors mayfeel guilty for not being aware the personwas contemplating suicide ("Why did I notsee the signs or take him seriously when hesaid .. . "), for not fulfilling the needs of the

deceased (What did I do or not do thatcaused her life to be so unbearable thatsuicide was seen as the only way out?"), fornot having done something differently ("DidI do all I could?"), or for feeling relievedafter an ordeal of suicide threats and at-tempts. Family and friends often assumeresponsibility for an action over which theyhad no control.

Unexpected versus anticipated. Asudden and unexpected loss initially leavespeople more vulnerable than an anticipatedloss. Imagine the different reactions to:

A spouse dying suddenly from amassive heart attack versusdying after a lengthy illness.Losing your home following afire versus leaving it becauseyou can no longer keep it up.Having to move to a care facilityfollowing a major stroke versusmoving as a result of a gradualdecline in functioning.Waking up in the morning andnot being able to see versuslosing your vision over severalyears.

A sudden and unexpected loss is oftenassociated with longer-term distress. It'sgenerally more difficult to accept what hashappened and to adjust. And it's often moredifficult for a person to find meaning in whathas happened.

When a loss is expected, a person maygo through "anticipatory grief," a psychologi-cal preparation for the loss before it actually

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occurs. For example, one woman NVI10 caredfor her husband who suffered fromamyotrophic lateral sclerosis (ALS) said:"With every loss in his ability to function, Iexperienced a little death . .. and so did he."

When a loss is anticipated, grief tendsnot to be as intense as when it's sudden.Although still painful, an anticipated deathprovides opportunities to address unfinishedbusiness and to express feelings of love andforgiveness. With an unexpected death, thereis no chance to say "Good-bye," "I'm sorry,"or "I love you."

Although anticipation may diffuse someof the shock, most of us do not fully preparefor a loss, even when it is expected. At thetime of the actual loss, acute grieving gener-ally occurs. A prolonged terminal illness initself does not necessarily prepare a personpsychologically for a loved one's death. Asone man said following his wife's death,ending a 2-year battle with cancer, "I'dknown for months she was dying. Yet, whenthe end finally came I reacted with 'Oh, noShe can't be dead.' You think you prepareyourself, but you don't."

A lengthy illness and long-termcarcgiving also can wear down the survivorand make grief more complicated. Margaretsaid:

.1h' husband required 24 -bour carefrom me for nearly 4 years, Duringthat lime. I only kfl our home toget the necessities --food and hismedications. JO. life revolvedwound caregiring. When be died,

I was worn oul nol only physicallyand emotionally, but I had no lifeoutside of caring forliM.

Timeliness. Grief is likely to be longer-lasting when a loss is viewed as untimelyand "out-of-sync" with the expected rhythmof life. Events viewed as "on time" or "to beexpected" tend to have less impact on oursense of well-being. When a loss is viewedas appropriate (for example, an adult childleaving home), the adjustment is generallyeasier.

We usually have certain expectations asto when negative events should occur in thecourse of our life, For example, when doyou tend to expect

. . . people to die?

. .. health to decline?. .. adults to need assistance with

personal care acti\ ities such asbathing, dressing, or eating?

. . . a person's mental abilities todecline?

For most people. the answer to theabove questions is "in old age." In general,we tend to view the death of an olderperson as less traumatic than the death of achild or young adult. A stroke, chronic ordisabling condition, disfiguring surgery, or aterminal illness is often considered lesstraumatic in later life than earlier. When thisorder is disturbed, as when a 40-year-old hasa stroke, the grieving process can be moredifficult and prolonged.

The 70-, 80-, or 90-year-old person,however, may not view the death of a

I7

8

spouse, the loss of health, giving up driving.or having to depend on others for assistanceas any more "timely." The sense of loss andgrief can he just as intense as if it had oc-curred earlier in life. Yet, we sometimesexpect an older person to have an easieradjustment, and we may not give the sameattention to the person's sense of loss thatwe would give to a young person. Wordssuch as, He had such a long life," or -Bethankful for the many years you had to-gether," may be no more comforting to asurviving spouse who is 78 than to one whois 38.

The death of a son or daughter is oneof the most difficult losses for most peoplewhether the child is 5 or 70 years old.Regardless of age, as parents we expect ourchildren to outlive us. In addition to itsemotional impact, the death of an adult childmay leave the older person without his orher primary source of support. Now thatmany people live into their eighties, nineties,and beyond, it is nt: longer unusual tooutlive one's children in addition to one'sspouse and friends. Pat said:

My mother and I were close. Whenshe died 5 Fears ago, it was recall,hard. Even though she was 92 andI was 67. I felt orphaned . . but Ialso expected that someday I wouldbe at her funeral. But what / ?everexpected was to bury my son. whodied 2 yews ago at age 47 from aheart attack. He should haveburied me. I realized my parents

belong to the past. but I neverpictured a future without no.,children.

Jack said:

My wife and I had a child die 40years ago when he was age 3. Thedeath of Mary, our oldest child, atage 52, last year is just as difficultand I think even more so. It doesn'tnatter bow old a child is whendeath occurs . . . It feels terriblywrong for.your child to die beforeyou die.

Sometimes older persons feel guiltywhen a son. (laughter, grandchild. or otheryoung family member precedes them indeath. Following the death of her 23-year-old grandson, Marsha wrote: "Why didn'tGod take me? It's better I should have died."

Permanent versus temporary. A lossviewed as temporarya temporary paralysisof one's arm or a temporary stay in a nursinghomeis easier to adjust to than when thechange is permanent.

A death is generally more difficult thana temporary separation. The most difficultseparations, however, tend to be those inwhich the "ending" is not knownwhen ason is missing in action, a grandchild runsaway from home, a spouse with Alzheimer'sdisease walks away and is not found, orfamilies arc separated during war.

Multiple versus single loss. Multiplelosses can severely strain a person's ability tocope. As one person said, "When you have a

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series of losses, its like a physical wound inwhich the scab continually gets pulled off.-A person's physical and emotional resourcescan become depleted, resulting in "bereave-ment overload,- a circumstance in which aperson experiences consecutive losses,preventing him or her from adequatelyworking through the grieving process for each.

Older people are more likely to experi-ence bereavement overload. Their lossesoften are multiple, and their opportunitiesand resources for replacing losses generallyfar fewer than for younger people. One lossoften can initiate a chain reactiona loss ofhealth may mean giving up driving, havingto rely on others for assistance, or movingf'rom one's home.

Even persons who have coped success-fully with earlier losses may experience aprofound grief reaction when losses begin to"pile up.- Feelings of helplessness andpowerlessness often are increased whennumerous losses are experienced. Somenegative or difficult behavior often thoughtto be associated with old age actually maybe the result of bereavement overload. Theemotional overload imposed by numerouslosses can result in mental confusion, disori-entation, and withdrawal.

PERSON'S ABILITY TO COPE

A person's previous style of dealingwith crisis and loss will it fluence how he orshe copes with current loss. People whohave a history of poor coping strategies tendto have a more difficult time.

If a person has dealt with previous lifecrises by using drugs or alcohol, seekingdistraction, or running away, the tendency isto use these same strategies when a new lossis experienced. People who have a history ofdepressive illness or who are in poor healthare particularly vulnerable to negative healthconsequences.

People who have low self-esteem tendto have greater difficulty coping with loss.They are more likely to feel they deserve theemotional pain and are less likely to engagein activities to mobilize their resources andchange their circumstances. In general,people who feel good about themselvesmake efforts to adjust and to find ways tomanage a difficult situation. One of the bestways to enhance self-esteem is to learnneeded skills.

SOCIAL SUPPORT

Social isolation makes adjustment moredifficult. A person who does not have thesupport of at least one other person facesthe greatest risk of complicated and pro-longed grief.

People with a close network of friendsand relatives to share their grief tend to copebetter. Just one supportive person who is agood listener can help ease the pain.

Some older people do not have astrong support system because they neverbuilt supportive relationships. Others mayhave outlived family and friends with whomthey have had the closest relationships.Members of the older person's support

''

system may he in poor health or experienc-ing life changes which limit the support theycan provide.

A common myth is that people whohave a strong religious faith are less likely togrieve following a loss and do not needsupport. Faith can he a powerful coping toolby providing some meaning to a loss. How-

ever, faith is not a substitute for socialsupport or for grief itself. One person said."My faith helped me to get through the pain.It gave ine hope and strength. And throughprayer, I felt support." Another person said."My faith didn't help me. I felt God haddeserted me."

How SERIOUSLY WILL A LOSS AFFECT A

PERSON?

Yes No

Is the loss permanent?

Was the loss traumatic andunexpected?

Has the loss caused a majordisruption in the person's life?

Has the person's identity, senseof security or self-confidencebeen affected?

Was the person in poorhealth before the loss?

Has more than one loss occurredat the same time or closetogether?

Has it been difficult for theperson to cope with losses inthe past?

Is the person coping alonewith his or her loss?

Are additional changes likelyto be triggered by the loss?

Are there severe financialproblems as a result of the loss?

The more questions you answered "Yes," themore difficult it is likely to he, and thelonger it is likely to take, for the person tocope with the loss.

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BEST COPY AMAMI

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HELPING SOMEONE WHO IS GRIEVING

aye you felt uncomfortable andawkward in the presence of some-one who experienced a significantloss? Did you ever avoid the person

because you did not know what to do, whatto say, or how to comfort the person?

Such feelings are common. It's far betterto reach out than to do nothing. It hurts tohe avoided, to be abandoned. According to apsychologist who studied men and womenwho had cancer, almost every person had afriend who never called them again afterhearing about the cancerwho disappearedlike the person never existed. Loss of contactwith family and friends is yet another losswhich adds to the experience of grief.

Helping a grieving person has nothingto do with "making it all better." "takingaway the pain," or "fixing it." You can't takeaway the pain or protect the person from it.People have to experience the pain to getthrough it and come out healthy. Your goalis to assist the person to work through thepain and feelings associate with the loss.Your efforts will make a difference, even ifat times it may not seem so. Here are waysyou can make a positive difference.

COMMUNICATE CARING

Words aren't necessary to communicatethat you care. Your presence, a hug, caringtouch, or an arm around the shoulder cangive comfort and a sense of understanding. Itdoesn't matter so much what you say or do,but that you are there. Simply saying, "Icare," or "This must be painful" is enough.

If you live at a distance or are notemotionally close to the person, send awritten note. Such notes can be read againand again and he an important source ofsupport. Recalling special memories. ashared event, a special quality of the personthat stands out in your mind, or how theperson touched and influenced your life canbe particularly meaningful and comforting tosurvivors. For example, "I'll never forget thetime . . ''... meant so much to mebecause .. or. -There will never heanybody with Mary's ability to . Curtwrote to the wife of a friend:

On cc' in a while. as we rushthrough life, we receive the exquis-ite, wondelful blessing of sharing a

.few memorable experiences withanother human being. Mese arepeople who accept and love us inreturn. unconditionally. eventhough aware of our real andperceived feelings. What a rare andbeautiful gift that .your husbandwas one of these people, the onlyman I bate ever been blessed toknow with whom I could share mydeepest, personal p,hosts.

BE A GOOD LISTENER

A good listener does just thatlistens.It's more important to listen than to talk.People who have experienced a loss needsomeone \vho will listen with acceptance,allowing them to express whatever they feel.As one woman said, "You need ears and

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shoulders." Expressing thoughts and feelingshelps to reduce the emotional pain.

People often need to tell and retell theirstory without fear of correction or contradic-tion. This is part of the adjustment processand helps people to make the loss real.clarify feelings, put the loss into perspective,and accept it. You can encourage the personto talk by saying, -Tell me about it," ''Wouldyou like to talk?" 'How are you feelingabout it?" Don't try to change the subject ordivert the person by talking about somethingelse. Following her divorce at age 65,Katherine said:

I was angry. After all these yews ofmarriage. he divorced me for ayounger woman just when Iexpected we would he travelingand enjoying life together. I reallyappreciated my friend who let mehe angry and didn't try to lilyShe was there to hear me out andjust he with me.

The impact of someone "just listening"is exemplified by this letter from Juliet to afriend who spent the afternoon with herfollowing the death of her husband:

When you arrived today, I said.'My legs will hardly carry me. The)

feel like cement.' Well, my deandiscover the delight after you leftmy legs did not ache and they docarry me easily.

Most important is not to judge theperson's feelings. It's also important to be

comfortable with silenceit signifies accep-tance. If the person doesn't feel like talking.don't force conversation.

ACKNOWLEDGE THE PERSON'S FEELINGS

Allow the person to say how rotten orangry he or she may feel. Do not try to talkthe person out of his or her feelings. Do notsay. "You shouldn't (or don't) feel that way,""You shouldn't talk like that," -You don'tmean that."

Feelings are real. People need to tellhow badly they feel and know they won't berejected. This helps them work through thegrief.

Provide reassurance that feelings arenormal. Your calm acceptance of expres-sions of anger, hostility, or profound sorrowis one of the most helpful forms of assis-tance. Do not take expressions of anger orhostility personally or react with anger.

If you can, help the person to expresshis or her anger without directing it towardpeople. Anger needs to be discharged, but itcan create greater problems when it isdirected at others or inward toward oneself.

When the person is struggling withguilt, do not say, "You shouldn't feel guilty."or argue about whether the feelings arejustified only inhibits the grief process. It'sbest to encourage the person to talk aboutsuch feelings. Talking about the "if onlys" isimportant to letting them go and releasingthe guilt feelings. Sometimes it's helpful toexplore gently where the "if onlys" lead. Forexample, asking, "What would you have saidor clone if you had been at the bedside?"

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allows the person to explore unfinishedbusiness or other emotions.

If a person asks, "Why?" it is best to say."I don't know why." or "There are so manythings in life that can't be explained and thisis one of them." It is a question without ananswer. If you can't think of a response.don't he afraid to say, "1 don't know what tosay." You don't need to have an answer forevery concern that's raised.

When a death occurs by a suicide, youmay be able to help most by helping survi-vors to understand that taking one's own lifeis a complex decision and that it was thedeceased person who made the choice andis responsible for the suicidenot theperson's family or friends. A helpful com-ment might be, "The suicide was a decisionhe made. You did not make it. He must havefelt it was the right choice."

Do not respond to a loss as though it isreplaceable. Using public transportation isnot the same as having and driving one'sown car. Living in the home of a son ordaughter or moving to a retirement home orcare facility is not the same as the home inwhich a person has lived for many years.Getting another dog is not the same as theone which just diedno matter how muchthe new puppy may look like the dog thatdied. What we lose cannot he replaced.although a person may eventually findsomething to fill the gap created by the loss.

One word of caution: a loss can havevaried meanings. One p.m-son may feeltremendous relief. while another experienc-ing a similar change may feel great sadness.

The meaning of the loss to the person ismore important than the actual lossit's themeaning to which we need to respond.

Before you can truly validate a person'sfeelings, you need to know what thesefeelings are. Ask open-ended questions:"How are you doing?" "How are you findingliving along -!?" -How do you feel about nolonger working?" Such open-ended questionscan open the door to the expression offeelings. Avoid pre-conceived ideas abouthow a person is doing.

PROVIDE CONTINUING SUPPORT

Grief often makes reaching out difficult.That is why "reaching in" is so important. Itcan prevent the older person from becomingisolated.

Family, friends, and neighbors can helpthe person in numerous ways to "getthrough each clay." If, as a family, you are"miles away." consider making arrangementswith a neighbor, a telephone reassuranceprogram. or volunteer program to monitorregularly how your family member is doing.Important times for support are:

After friends and relativeshave left.

Significant clays and dates.

Anniversary (1 month, 6months. 1 year, 2 years. etc.)of the death

Birthdays (survivor anddeceased)

Wedding anniversary

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SIMPLE GUIDELINES FOR WRITING

A CONDOLENCE NOTE

There is one type of correspondence thatshouldn't be avoideda condolence note.A handwritten note can he a sincere wayto express sympathy. However, somepeople are uncomfortable when they sitdown to write. Their minds are blank andthey can't express themselves. Followingare a few guidelines to help you write anote of condolence.

Be personal. Try to remember somethingspecial about the person who has died orabout a memorable occasion you spenttogether, and when you're writing, be asspecific as possible. For example, "Iremember when I started my new job, Iwas so nervous, but Ann helped byinviting me to lunch on my first day. Welaughed, talked and reminisced the entirehour. She was so caring, I'll never forgetthe many times she went the extra mile tohelp me through some tough times."

Be honest. Don't write a gushy note ifyou don't mean it or if you didn't know aperson very well. Grief often heightens

perceptions. That means the person mayrealize when you are insincere. "Ourdeepest sympathy is with you during yourtime of loss" may be appropriate forsomeone you know well, but not for acasual acquaintance. You can simply sayyou're sorry about the death. That'sconcise and honest.

Be yourself. Don't try to write in a poeticstyle, but rather use the same words youuse in your everyday conversations. Alsouse first person to express your sentiment.For example, "I learned yesterday thatyour mother died. I'm sorry." There aren'tany flowery words, and it isn't an ex-tended sentence that rambles on.

A condolence note doesn't need to belong. A couple of sentences may besufficient to express yourself. In closing,offer your help. That way the person whoreceives the note will know you're therefor him. Finally, follow the note with aphone call. It's another way to say youcare.

Adapted with permission from the Order ofthe Golden Rule, PO Box 3586, Springfield.IL 62708. Materials from The Golden RuleLeisure Digest, Summer 1988 issue.

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HolidaysAny other days that were

personally significantWeekendsEvenings

It feels special to be remembered atthese times. Support tends to taper offmarkedly after a few days or weeks follow-ing a significant loss. Yet that is when theloss may he felt the most intensely.

Continue to express support throughoutthe grieving process, not just immediatelyafter the loss. Frequent written messages,telephone calls, and invitations that commu-nicate "I'm thinking of you," and "I care," arehelpful. As one widow said:

Al first you are absolutely floodedwith relatives and friends, flowers,kindness, and sympathy. And thenpeople's lives take over. Theyhaven't time to continually nurseyou and he so sympathetic.

Even if you don't hear about the deathor loss until some time after it has occurred,its never too late to make contact. Athoughtful note weeks or even monthsafterwards is meaningful.

SHARE YOUR FEELINGS

Speak from the heart. Expressing yoursadness and sorrow about the loss experi-enced by a person can make the person feelunderstood and reduce the sense of isola-tion. Don't be afraid of tearsthe otherperson's 01 your own. Crying together is

okay. It's far better than forced cheerfulness,which makes the person feel he or sheshould not be grieving.

If you have had a similar experience,discuss your story only when asked or if thetime feels right. Your sharing can providevalidation; however, its important to remem-ber another person may not experience alosseven if similar to yoursin the sameway you experienced it. Acknowledge this,for example by saying, "I wonder if you feellike I didlost and alone," or "You'll haveyour own feelings."

OFFER SPECIFIC HELP

Vague invitations such as "Call mewhen you feel like getting together," "Giveme a call if I can help," or "Let me know ifthere's anything I can do" rarely get a re-sponse. If you wait for a call, usually nothingwill happen. People who are grieving gener-ally are too immobilized to initiate activitiesor to ask for help when they need it. Saying,"Can I come over on Thursday and bringdinner?" is a hetter approach. Do somethingrather than simply make an offer.

Invite the person to do something withyou. Set a date. Try to think of the person's"down times." If you invite a grieving friendout to dinner and are refused, ask againlater. When the person is ready to acceptinvitations, your invitation will he accepted.

The minds of people who are grievingoften are too overloaded to think of waysothers can help. Suggest that the personwrite needs on a list as they come to mind.

2 6

Identify specific tasks you and others can do.Examples include:

preparing mealscleaning the housedoing yard workproviding transportationshopping for groceriesrunning errandshelping with letter writing

One man said:

I know I hate to eat, but it's sohard to cookespecially Sil7Ce Iseldom did before. The meals thatwere given to me made those first

few weeks following my wife'sdeath much easier.

Do only the basics. Cleaning closetsand rearranging furniture are intrusive andlikely will be resented.

GIVE THE PERSON TIME

Great emotional investments are noteasily made. nor are they easily lost. It takestime to separate oneself from a person whois no longer with us, or from other losses.Give the adjustment process the time itrequires. Grief can be shared. but eachperson walks an individual path. Expectingunrealistic, rapid adjustment can causedepression and complicate the grieving.Expect slow, gradual improvement withoccasional setbacks.

Encourage the person to postponemaking major decisions, if at all possible,

until after the period of acute grief. Deci-sions made during a time of emotionalupheaval frequently are regretted later.Whatever can wait should wait.

AVOID GIVING ADVICE

Advice suggests a standard of behaviorto which a person is expected to measureup. It might be taken as a criticism. Avoidsaying, "If I were you . . ." When peopleinitially experience grief, they need empathy,not advice. Also, what worked for you maynot he the best solution for another person.If advice is requested, consider phrasingsuggestions along the lines of, "You mightconsider .. .

DON'T MINIMIZE THE LOSS

Cliches, easy answers, and false reassur-ances are likely to be resented. They seldomare helpful or comforting and serve only toincrease the distress. As one person said,"Telling a person 'time heals all wounds' islike telling a starving man he will eatsomeday." Statements such as the followingdiscount a person's feelings and should beavoided:

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"He had a good life.""You were so lucky to have had somany years together.""Things always work out for the best.""Everything will he all right,""It's better now. She's no longer suffer-ing and is at peace.""Feeling that way won't help a thing.""It could have been worse if . . ."

27

Telling a person, "You must he strong"is likely only to complicate grie..ing. To hetold, "It's such a blessing she didn't suffer"doesn't feel like a blessing when you arelonging for the person who died. Followingthe amputation of his leg because of diabe-tes. Toni said:

It seemed like evegone was sayingto me, 'You're so lucky to he alive.'I did not feel lucky . . . I felt I wouldbe better off dead. To me. losing myleg meant I was not going to beable to do so many of the things Iused to dowade in the stream to

fish, walk with my buddies on thegolf course and play tennis. Iwanted to y(?11 back, 'Do :Ion thinkFarr would feel so lucky if it wereyour

Attend to the feelings of the person. Trysaying, "It must he very painful for you," or"It's okay to be angry." Such responsescommunicate understanding, acceptance,and respect.

Spiritual phrases such as, "It was God'swill," "God needed a beautiful flower for hisgarden," or -All things have a purpose" canalso provoke anger and frequently addtorment to torment. Although you may gainstrength from your spiritual beliefs, noteveryone does; therefore, be careful not topress your beliefs on others.

Two of the worst things you can say tosomeone who has lost a pet are "It's just aclog" (cat, bird, etc.) and "Why don't you getanother one?"

Do not attempt to tell the person howhe or she feels. "You must be relieved thathe is no longer in pain," and "I know justhow you feel" are presumptuous. Becausegrief is so personal, you cannot know howanother person is feeling. Even if you havehad a loss similar to that of the person youare comforting, your feelings and thatperson's may not he the same. Such state-ments actually may discourage the personfrom opening up to you.

KNOW YOUR LIMITS AS A HELPER

Know your personal limits regardingwhen and how you can help. Learn torecognize when your body and emotions arestrained. If you find yourself being "pulleddown" by a person's grief, feeling "at wit'send," or not knowing what to do, the personlikely needs more assistance than you canprovide.

Serious problems need the help of aprofessional. If the person is losing orgaining a significant amount of weight,spending clays at a time in bed, becomingdependent on prescription medicines, orincreasing his or her intake of alcohol. theseare warning signals that what the person isexperiencing has gone beyond normal grief.

Sometimes the best thing you can do isto say, "I don't know what to do to help youfeel better, but I know someone who canhelp." Of course, this means knowing theprofessionals and other resources in yourcommunity wl,o can help. You can make iteasier by getting information and providingdirect assistance, such as calling for an

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78

appointment and taking the person to theappointment.

Recognize that it's not always easy toassist an older person to get professionalhelp. For some older people, seeing acounselor represents a personal failure orweakness, a sign of losing one's mind or"going crazy."

If you answer "yes" to any of the following questions, the person may need more helpthan you can provide.

Yes No

L.1 L:11 Has the person withdrawnfrom people and activities?

Does the person expressfeelings of being over-whelmed and unable to goon much longer?

Is the person engaging inself-destructive activitiesdrinking more, not takingmedications, increasing use ofdrugs?

L:1 Has the person expressedthoughts of suicide?

Yes No

[:1 Do you feel within yourselfthat things are not quite rightwith the person?

L:11

{:11

{:11

Has the person's feelings ofanger, sadness, or guilt onlydeepened over time?

Does the person seem stuckin bitterness and living in thepast?

Does the person have lowself-esteem and lack confi-dence in his or her ability toadjust?

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F

SUMMARY

or emotional healing to occurfollowing a loss, grieving is neces-sary. One of the most importantactions you can take is to listen in

supportive ways. Let the grieving person talkabout his or her loss and feelings. Thesignificance of a supportive friend is re-flected in Chris' words:

Nothing takes the place of that onespecial friend, the person who willhe there when needed: listenwithout judgment; encourage theexpression of grief ask the difficultquestions and give honest feed-back: and share the tears, laughter,and silence as the journey throughgrief is made. Such a friend notonly makes the journey easier andmore meaningfid, but ensures thatit is completed.

As you reach out to help someone whois grieving, remember:

No time limit can he put on thegrief process.Each person's grief is unique.Grief involves a wide range offeelings and behaviors.Grieving is hard work. It canleave a person with little or noenergy for anything else.A key to adjustment is experi-encing the pain associated withthe loss.The acute and stabbing painloss creates does decrease:however, a sense of loss willlikely always he present onsome level.You can make a difference!

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FOR FURTHER READING

In July 1992 the OSU Extension Servicepublications warehouse was destroyed byfire. We are replacing our supplies. Thepublications listed below may be available inthe office of the OSU Extension Service thatserves your county. Check with that officefor current prices.

You also may call Agricultural Communica-tions at Oregon State University, (503) 737-2513, to learn the availability and currentprice of the publications.

Publications OrdersAgricultural CommunicationsOregon State UniversityAdmnistrative Services A422Corvallis, OR 97331-2119

Alcohol Problems in Later Life by V.L.Schmall, C.L. Gobeli, and R.E. Stiehl. PacificNorthwest Extension publication 342, OregonState University, Corvallis, Oregon, 1989.75e.

Coping With Your Loss and Griefby V.L.Schmall. Pacific Northwest Extension publi-cation 438, Oregon State University.Corvallis, Oregon, 1993. $1.00.

Depression in Later Life by V.I.. Schmall, L.Lawson, and R.E. Stiehl. Pacific NorthwestExtension publication 347, Oregon StateUniversity, Corvallis, Oregon, 1992. $1.50.

Grief ia Children by J. Hare. Pacific North-west Extension publication 391, Oregon StateUniversity, Corvallis, Oregon, 1992. 75c.

Using Medicine Safely in Later Life by V.L.Schmall. Pacific Northwest Extension publi-cation 393. Oregon State University,Corvallis, Oregon, 1992. 75c.

Pacific Northwest cooperative Extension bulletins are joint publications of the three Pacific Northwest statesOregon.Washington, and Idaho. Similar crops, climate, and topography create a natural geographic unit that crosses states lines. Since1949 the PNW program has published more than 400 titles. Joint writing, editing, and production has prevented duplication ofeffort, broadened the availability of faculty specialists, and substantially reduced the costs for participating states.

Published and distributed in furtherance of the Acts of Congress of May 8 and June 30, 1914, by the Oregon State UniversityExtension Service, O.E. Smith, director Washington State University Cooperative Extension, Larry G. James, interimdirector; the University of Idaho Cooperative Extension System, LeRoy D. Luft, director; and the U.S. Department ofAgriculture cooperating.

The three participating Extension Services offer educational programs. activities, and materials without regard to race,color, national origin, sex, age, or disabilityas required by Title VI of the Civil Rights Act of 1964. Title IX of theEducation Amendments of 1972, and Section 504 of the Rehabilitation Act of 1973. The Oregon State University ExtensionService, Washington State University Cooperative Extension, and the University of Idaho Cooperative Extension Service areEqual Opportunity Employers. 1,00/1.00/1.00

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