Bereavement - Components Of Normal Grief, Pathological Grief, Risk Factors For Pathological Grief, Treatment

For older Americans, the loss of a loved one is a relatively common occurrence, yet it is often severely distressing and can have dire implications for mental and physical health. Over two million people die in the United States each year. Each of those deaths leaves behind a wake of grief that ripples through a web of surviving family Photographer Edward S. Curtis called this 1924 photograph "Old Woman in Mourning—Yuki;" it shows a bereaved elderly woman from the Yuki Indian tribe in California holding a bone against her right temple as she conducts an elaborate mourning ritual. (Library of Congress) members and friends. Older people are especially likely to experience such losses. Of the nearly one million people who are widowed each year, about 70 percent are over age sixty-five. For older people this highly prevalent occurrence is also one of the most painful. In a study of widowed people over age fifty, Dale Lund and colleagues found that 72 percent of participants reported that the death of their spouse was the most stressful event they ever experienced. Other studies of older adults have found that bereavement magnifies the risk of psychological disturbances, such as increased symptoms of anxiety, depressive symptoms, and major depressive episodes, as well as new or worsened physical illnesses, greater use of medication, and poorer self-rated health. These health complications, in turn, may result in more frequent use of health care services, such as visiting a doctor or receiving care in a hospital, thus making the issue of bereavement important in discussions of controlling health care costs. In addition, researchers have found that suicide and death in general are more likely to occur in the period following a significant loss.

This entry begins by addressing the concept of the "normal" grieving process and the various dimensions of which it may be composed. It then examines what are considered pathological reactions to loss, how these are related to and differentiated from the dimensions of normal grief, the rates at which they occur, and the extent to which these disorders overlap. Next is a discussion of the factors that have been found to influence whether a person will suffer a pathological bereavement response. Last is a review of the current pharmacological and psychotherapeutic treatments found to be effective in ameliorating bereavement-related distress.

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