Blackburn J.A., Dulmus C.N. (Editors). Handbook of gerontology: evidence-based approaches to theory, practice, and policy

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traumatic loss (Jordan & Neimeyer, 2003). But for most, a more productive effort

would likely focus on enhancing naturally occurring personal and social

processes important to adaptation. We described earlier (in terms of the DPM)

that a mix of loss-oriented and restoration-oriented coping demands will need to

be faced. These will range from having to find meaning in and acceptance of the

death, to dealing with secondary stressors involving finances, household manage-

ment, and changing roles and responsibilities.

Intervention might then best focus on encouraging and enhancing the be-

reaved individual’s family, friends, and community in their efforts to provide

companionship and emotional and instrumental support (Raphael, Middleton,

Martinek, & Misso, 1993). These natural, supportive networks play an important

role in providing a safe and comforting environment for the bereaved individual’s

adaptation. Among the elderly, however, this can sometimes be problematic.

Many older persons, in addition to the stress of the bereavement, will be at in-

creased risk because of chronic health conditions, disability, or cognitive limita-

tions, requiring a more rigorous assessment of their needs and their ability to

function and adapt to their new circumstances (Hansson & Stroebe, 2003). To the

extent that their grief is ambiguous or disenfranchised, we emphasize the identi-

fication of such older persons as being at risk for pathological grief reactions and

stress the importance of timely and continued interventions involving education,

psychotherapy, and social support, to include attention to physical health and

cognitive skills both before and after the death of a loved one.

CONCLUSION

Seven themes from our discussion deserve emphasis. First, bereavement is a natural

phenomenon, not a medical problem. Most older persons experience it as emotion-

ally and perhaps physically distressing, but they eventually find a way to adapt. The

experience tends to make demands for emotional adjustments, but also demands to

deal with secondary stressors that have more practical implications for one’s life.

Second, among older persons, contextual variables have enormous influence on

the nature and course of bereavement. For example, causes of death change, with

implications for degree of related trauma, issues of economic security, and effi-

cacy of family support networks. There is a likelihood that conjugal bereavements

will involve transitions from extended periods of caregiving.

Third, among older adults (as in the young), the bereavement experience reveals

much individual variability and much resiliency in coping with loss.

Fourth, in old age the stress of bereavement interacts with other late-life events

and transitions (e.g., adjustments to custodial grandparenting, retirement, relo-

cation, Alzheimer’s disease, hospice, nursing home environments). In this re-

spect, the losses of such life transitions are often more difficult to deal with than

would appear at first blush and may go unrecognized as important influences on

the health and well-being of older persons and their families.

Fifth, we have proposed elsewhere (Hansson & Stroebe, in press) that at some

point the emphasis might usefully be shifted from the effects of aging on bereave-

ment to a consideration of the effects of late-life bereavement on the aging process.

In particular, we have suggested that unresolved, residual physical symptoms of

bereavement among frail older persons need to be examined with respect to their

implications for the process of disablement.

Grief and Bereavement 387

Sixth, bereavement intervention research thus far has concluded that formal

psychotherapeutic interventions to reduce grief symptoms are not universally ef-

ficacious. They are unlikely to be useful when targeted at bereaved persons not

identified to be at special risk or who have not self-selected into therapy. They are

only occasionally useful for persons selected on the basis of risk factors. But they

are quite useful among bereaved persons who already exhibit complicated be-

reavements or related psychopathology. The existing intervention research is not

large enough to date to systematically consider these conclusions with respect to

varying age groups, but our sense is that there is little reason to expect age-related

differences in these patterns.

Seventh, the intervention research suggests two age-related themes. (1) Many

psychotherapy interventions can be effective with older individuals who exhibit

complicated psychological symptoms. This has been amply discussed by Knight

(2004), who dispels several myths about aging and grief (e.g., that grief necessar-

ily implies “working through” a death, that grief is accompanied by depression),

and who emphasizes the specificity of the grief response in older persons. (2)

Grief interventions should be targeted more broadly, to include attempts to

strengthen and stabilize family and community support networks, in addition to

the focus on reducing psychological and physical symptoms of individuals. In

this respect, there are indeed positive aspects of grieving, wherein relationships

that were formerly lost can be redefined and rediscovered, new roles and direc-

tions in life can be pursued, and not only individuals but also families and com-

munities can grow having coped with the loss of a valued teacher, mentor,

parent, spouse, citizen, or community activist.

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PART IV

EVIDENCE-BASED

FAMILY AND

COMMUNITY PRACTICE