3.9.1 Bereavement and Adjustment Disorders in Old Age

3.9.1 Bereavement and Adjustment Disorders in Old Age

Bereavement and Adjustment Disorders in Old Age

Bereavement:

Bereavement is a common experience in old age, as older adults are more likely to experience the loss of friends, family members, and spouses. Adjusting to these losses can be difficult and can lead to bereavement and adjustment disorders, which can have a significant impact on an older adult’s mental health and quality of life. This essay will discuss bereavement and adjustment disorders in old age, including their prevalence, clinical features, differential diagnosis, aetiology, management, and prognosis.

Another significant challenge that older adults face when dealing with bereavement is the likelihood of experiencing other concurrent losses, such as the loss of physical and cognitive abilities, social roles, and independence (Hansson, Stroebe, Schut, & Stroebe, 2020). These losses may exacerbate feelings of sadness, loneliness, and helplessness, making it harder for older adults to adjust to the loss of their loved ones. In addition, older adults may be less likely to seek support from others due to stigma or the fear of being a burden to their family and friends (Hanley & Boudreau, 2019).

Bereavement is a common experience in old age, with around 40% of adults over the age of 65 have experienced the loss of a spouse (Moye et al., 2010). The clinical features of bereavement can include sadness, loneliness, tearfulness, and feelings of emptiness. These symptoms are typically most intense in the first few months following the loss but can persist for longer periods, particularly if the individual was highly dependent on the deceased.

Adjustment disorders:

Adjustment disorders are also common in older adults, with prevalence estimates ranging from 4.6% to 9.2% (Grossberg & Soares, 2014). The clinical features of adjustment disorders can include anxiety, depression, irritability, and difficulty sleeping. These symptoms can be triggered by a range of stressful events, including bereavement, retirement, and health problems.

Adjustment disorders are also common among older adults who experience significant life changes or stressors, such as retirement, relocation, or physical illness (American Psychiatric Association, 2013). Symptoms of adjustment disorders may include anxiety, depression, and difficulty coping with daily tasks. Treatment for adjustment disorders in older adults may involve a combination of psychotherapy, medication, and lifestyle changes (Stokes & McBride, 2019).

Differential Diagnosis and Aetiology

It is important to differentiate between bereavement and adjustment disorders, as the former is a normal response to loss, while the latter represents a pathological response to stress. The differential diagnosis should also include other mood and anxiety disorders, such as major depressive disorder and generalized anxiety disorder.

The aetiology of bereavement and adjustment disorders is complex and can be influenced by a range of individual, social, and environmental factors. Factors that may increase the risk of bereavement and adjustment disorders in older adults include a history of mental health problems, social isolation, and chronic health problems.

Management and Prognosis

The management of bereavement and adjustment disorders in older adults typically involves a combination of pharmacological and psychological interventions. Antidepressants, anxiolytics, and hypnotics may be prescribed to alleviate symptoms, while psychotherapy can be used to help the individual come to terms with their loss and develop coping strategies.

Psychotherapy is an effective intervention for older adults experiencing bereavement and adjustment disorders. Several psychotherapeutic approaches have been adapted to better suit the needs of older adults, such as cognitive-behavioural therapy (CBT), interpersonal therapy (IPT), and grief therapy (Rosen et al., 2019). Therapy can help older adults explore their thoughts and feelings about the loss, develop coping strategies, and re-establish social connections.

The prognosis for bereavement and adjustment disorders in older adults varies depending on the individual’s circumstances and the severity of their symptoms. Most individuals will experience a gradual reduction in symptoms over time, although some may require longer-term treatment or develop more chronic mental health problems.

Common Themes

Common themes that arise in therapy with older adults experiencing bereavement or adjustment disorders include a sense of loss of control, fear of death, and existential concerns (Rosen et al., 2019). Therapists must be prepared to address these issues and help older adults find meaning and purpose in their lives despite the challenges they may be facing.

Common Themes There are several common themes that emerge in psychotherapy with older adults who are experiencing bereavement or adjustment disorders. These include:

  • Loss of identity: Many older adults experience a loss of identity following retirement or the loss of a spouse. Psychotherapy can help individuals to find new sources of meaning and purpose in their lives.
  • Guilt: Older adults may feel guilty about their role in the death of a loved one or may experience survivor guilt following the loss of a peer. Psychotherapy can help individuals to work through these feelings of guilt and develop a more balanced perspective on the situation.
  • Loneliness: Social isolation is a risk factor for bereavement and adjustment disorders in older adults. Psychotherapy can help individuals to develop new social connections and find ways to stay engaged with the world around them.
  • Fear of death: Older adults may experience anxiety about their own mortality following the loss of a loved one. Psychotherapy can help individuals to confront these fears and develop a more accepting attitude towards death.

In conclusion, bereavement and adjustment disorders are common challenges faced by older adults. Psychotherapy is an effective intervention that can be adapted to better suit the needs of older adults, taking into consideration issues such as transference, countertransference, and common themes that arise in therapy. With the appropriate support and interventions, older adults can find ways to adjust to significant life changes and find meaning and purpose in their lives.

Reference:

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