Pharmacotherapy of Pathological Grief Responses

What Does Death Preparedness Mean for Family Caregivers of Persons With Dementia?

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118814240 ◽

2018 ◽

Vol 36 (5) ◽

pp. 436-446 ◽

Cited By ~ 1

Author(s):

Pamela Durepos ◽

Tamara Sussman ◽

Jenny Ploeg ◽

Noori Akhtar-Danesh ◽

Harveer Punia ◽

...

Keyword(s):

Family Caregivers ◽

Health Care Providers ◽

Care Providers ◽

Definition Of Death ◽

Advance Care ◽

Understanding Emotions ◽

Antecedents And Consequences ◽

Grief Responses ◽

Definition Of ◽

Constant Comparative Analysis

Purpose: The purpose of this study was to clarify the concept of death preparedness for family caregivers in dementia. Conceptualization was required to support the assessment, promotion, and operationalization (ie, measurement) of death preparedness through palliative care interventions such as advance care planning. Methods: Rodgers evolutionary method of concept analysis was selected to guide this study because of the dynamic nature of death preparedness influenced by context, setting, and time. A comprehensive literature search was conducted. Authors performed constant comparative analysis to identify and interpret surrogate/related concepts, attributes, antecedents, and consequences of death preparedness. Results: Most importantly attributes included (1) knowing and recognizing the symptoms of decline in dementia and what dying looks like; (2) understanding emotions and grief responses; (3) accessing and appraising supports needed to manage and care for dying; (4) organizing affairs and completing tasks in advance; (5) accepting that losses are inevitable and imminent; (6) reflecting on caregiving and finding meaning, “a silver-lining”; and (7) closing, reconciling, and renewing relationship bonds and completing the family member’s life. Discussion: This study contributed a full definition of death preparedness in dementia. Findings aligned with/expanded upon Hebert et al Theoretical Framework of Preparedness for End-of-Life. The use of problem- and emotion-based coping strategies by caregivers with support from health-care providers to promote feelings of death preparedness (including self-efficacy and control) and minimize uncertainty was the implication of this study. Development of a holistic preparedness instrument is underway.

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The Long-Term Effects of Grief on Marital Intimacy following an Infant's Death

OMEGA - Journal of Death and Dying ◽

10.2190/t2c9-fklk-0r4f-2vmb ◽

1996 ◽

Vol 33 (1) ◽

pp. 1-19 ◽

Cited By ~ 18

Author(s):

Laurie N. Gottlieb ◽

Ariella Lang ◽

Rhonda Amsel

Keyword(s):

Home Visit ◽

Sexual Intimacy ◽

Long Term Effects ◽

Emotional Intimacy ◽

Significant Drop ◽

Marital Intimacy ◽

Grief Responses ◽

Changes Over Time

This follow-up study examined how marital intimacy changes over time in bereaved couples and how their marriages are affected by the death of their infant. A group of thirty-one bereaved couples who two to four years earlier had lost an infant (> 20 weeks gestation and < 1 year of age) were revisited in their home twenty-four months after the initial home visit. Couples did report a significant drop in sexual intimacy at follow-up compared to before the loss and at the initial home visit. Moreover, wives reported less emotional intimacy overall, than did their husbands. In contrast to wives whose own initial grief responses predicted their feelings about their marriages two years later, intensity of husband's initial grief response did not affect their relationship with their wives but, rather a more powerful predictor was their wives' initial reactions, the early state of their marriage (whether they had considered separating), and whether or not they had warning of the impending death. Finally, there is some evidence that women are affected in part, by their husbands' grief.

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Supporting bereavement and complicated grief in primary care: a realist review

BJGP Open ◽

10.3399/bjgpo.2021.0008 ◽

2021 ◽

pp. BJGPO.2021.0008

Author(s):

Caroline Pearce ◽

Geoff Wong ◽

Isla Kuhn ◽

Stephen Barclay

Keyword(s):

Primary Care ◽

Complicated Grief ◽

Realist Review ◽

Physical And Mental Health ◽

Prolonged Grief ◽

Causal Explanations ◽

Primary Care Settings ◽

Grief Responses ◽

Bereavement Care

BackgroundBereavement can have significant impacts on physical and mental health, and a minority of people experience complicated and prolonged grief responses. Primary care is ideally situated to offer bereavement care, yet UK provision remains variable and practitioners feel uncertain how best to support bereaved patients.AimTo identify what works, how, and for whom, in the management of complicated grief (CG) in primary care.Design & settingA review of evidence on the management of CG and bereavement in UK primary care settings.MethodA realist approach was taken that aims to provide causal explanations through the generation and articulation of contexts, mechanisms, and outcomes.ResultsForty-two articles were included. Evidence on the primary care management of complicated or prolonged grief was limited. GPs and nurses view bereavement support as part of their role, yet experience uncertainty over the appropriate extent of their involvement. Patients and clinicians often have differing views on the role of primary care in bereavement. Training in bereavement, local systems for reporting deaths, practitioner time, and resources can assist or hinder bereavement care provision. Practitioners find bereavement care can be emotionally challenging. Understanding patients’ needs can encourage a proactive response and help identify appropriate support.ConclusionBereavement care in primary care remains variable and practitioners feel unprepared to provide appropriate bereavement care. Patients at higher risk of complicated or prolonged grief may fail to receive the support they need from primary care. Further research is required to address the potential unmet needs of bereaved patients.

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Conceptualising bereavement in profound and multiple learning disabilities

Tizard Learning Disability Review ◽

10.1108/tldr-09-2015-0035 ◽

2016 ◽

Vol 21 (4) ◽

pp. 186-198 ◽

Cited By ~ 1

Author(s):

Hannah Young

Keyword(s):

Learning Disabilities ◽

Future Research ◽

Emotional Wellbeing ◽

Theoretical Frameworks ◽

Content Type ◽

Making Sense ◽

Cognitive Approaches ◽

Grief Responses ◽

Grief Reactions ◽

Grief Theories

Purpose Bereavement and loss are key factors in poor emotional wellbeing among people with profound and multiple learning disabilities (PMLD). However, little attention has been drawn to this group in the grief and disability literature. The purpose of this paper is to make sense of bereavement and loss in people with PMLD, with reference to theoretical contributions to the field and studies of grief reactions. Design/methodology/approach A systematic review revealed 34 relevant published works. These were analysed for relevant contributions. Findings Three main types of theoretical contributions have been made; traditional grief theories, cognitive approaches and attachment-based perspectives. Although a limited number of case studies exist, a range of grief reactions have been reported in people with PMLD. Traditional grief theories and cognitive approaches are somewhat limited in making sense of grief responses in this group, while attachment-based perspectives may prove useful in providing theoretical and therapeutic direction. Research limitations/implications Further research is required to more accurately describe the nature of relationships in people with PMLD. Practical implications Major contributions to the field point to the value of facilitating engagement with the grieving process, through communication around the loss and training for staff. In addition, attachment-based perspectives are offering routes for establishing therapeutic relationships that may help to resolve behavioural difficulties. Originality/value This paper provides an overview of the perspectives within bereavement and disability, drawing together clear theoretical frameworks for future research and practice.

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Family Estrangement

Encyclopedia of Social Work ◽

10.1093/acrefore/9780199975839.013.919 ◽

2013 ◽

Cited By ~ 2

Author(s):

Kylie Agllias

Keyword(s):

Family System ◽

Family Systems Theory ◽

Structural Factors ◽

Bowen Family Systems Theory ◽

Political Awareness ◽

Parental Alienation ◽

Factors Affecting ◽

The Family ◽

Grief Responses ◽

The Impact

Family estrangement—a concept similar to emotional cutoff in Bowen family systems theory—is the unsatisfactory physical or emotional distancing between at least two family members. It is attributed to a number of biological, psychological, social, and structural factors affecting the family, including attachment disorders, incompatible values and beliefs, unfulfilled expectations, critical life events and transitions, parental alienation, and ineffective communication patterns. Family estrangement is often experienced as a considerable loss; its ambiguous nature and social disenfranchisement can contribute to significant grief responses, perceived stigma, and social isolation in some cases. The social-work profession has a role to play in raising social and political awareness of the prevalence of, contributors to, and effects of estrangement on the intergenerational family, with clinicians working to assess and address the impact of estrangement on individuals and the family system.

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Resourcing Popular Music for Relevant Themes in Music Therapy with Perinatal Loss

Music Therapy Perspectives ◽

10.1093/mtp/miab014 ◽

2021 ◽

Author(s):

John Mondanaro

Keyword(s):

Music Therapy ◽

Popular Music ◽

Belief Systems ◽

Perinatal Loss ◽

Anticipatory Grief ◽

Large Hospital ◽

Hospital System ◽

Perinatal Bereavement ◽

Art Form ◽

Grief Responses

Abstract Perinatal loss poses unique challenges to grief work because of the complexity of dynamics it carries. Historically shrouded in socially and culturally based belief systems often impeding normal grief responses, the barriers to healthy processing have been surmounted in recent decades. The emergence of music therapy in partnership with social work is one such approach to addressing both anticipatory grief and bereavement of parents enduring the death of their infant prenatally. This retrospective article highlights the resourcing of popular music within a clinical music therapy approach to the curation of a perinatal bereavement event within a large hospital system in a metropolitan area. Popular music as a ubiquitous art form lends tangibility and relevance to the complicated themes of perinatal loss in a manner that invites bereft parents into a forum of acceptance and acknowledgment of a loss that for too long has remained in the shadows.

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Bereavement

10.1093/med/9780198821328.003.0075 ◽

2021 ◽

pp. 773-784

Author(s):

David W. Kissane

Keyword(s):

Palliative Care ◽

Complicated Grief ◽

Anticipatory Grief ◽

Desirable Outcome ◽

Bereaved Children ◽

Cognitive Behavioural ◽

Pathological Grief ◽

Post Traumatic ◽

Traumatic Distress ◽

Special Circumstances

The phenomena and trajectory of mourning as a normal adaptive process are differentiated from clinical depression, avoidant and complicated grief, post-traumatic distress disorder, and other forms of pathological grief. Anticipatory grief can be a particular challenge during palliative care. The family is recognized as the major source of social support and the environment in which grief is shared with others. Key risk factors for pathological bereavement outcomes can be identified on admission to palliative care, permitting preventive models of psychological care to be used through palliative care into bereavement. Models of therapy include supportive-expressive, interpersonal, cognitive behavioural, family focused, and specific therapy for complicated grief. Pharmacotherapy can judiciously accompany psychotherapy. Life-cycle issues include bereaved children, siblings, parents, and grief for the very elderly. Grief can be stigmatized and ambiguous in special circumstances, yet positive growth is a desirable outcome from any loss.

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