Complicated Grief for Caregivers - Nanette M. Holloway

The heartbreak of grief touches all individuals. Grief differs for all of us.

My grief experience following my dad’s death fueled further research, culminating in my Caregiver Series and my capstone project while working on my masters degree. Today my goal is to share information gleaned from my research of Prolonged Grief Disorder in caregivers.

Research indicates that most people are nearing the end of their grief journey in approximately six months following the death of a loved one. Grief may not be completely over, however sadness and ruminating about the loved one begins to subside. Acute grief is described as a common experience.

Prolonged Grief Disorder

or complicated grief is displayed in several different circumstances surrounding the loss of someone or something significant, including the death of a child, spouse or a traumatic life experience. Research has indicates that approximately 20% of individuals who are bereaved will experience Prolonged Grief Disorder.

Grieving Caregivers

experience unique stressors during the course of their caregiving journey. These stressors contribute to prolonged grief. Physical strain, social, emotion stressors and financial hardship during caregiving lead to an increase in mortality and other physical stress and disease. The state of bereavement also carries with it the risk factor for impaired immunity and poorer overall physical health.

Complicated grief, or prolonged grief disorder is characterized by an increased risk of suicide, loneliness, substance abuse, physical and emotional disability, gastrointestinal issues, sleep disturbance and even death. Symptoms of decline are experienced by older caregivers. Younger female caregivers and those with lower socioeconomic status experience greater emotional stress.

Other physical complications include cancer, high blood pressure, heart disease and increased risk of hospitalization. Individuals suffering from mental disorders such as bipolar disorder and depression have exacerbations. Increased symptoms of anxiety, or panic attacks may occur.

Contributing Factors to Complicated Grief

Sometimes a loved one’s symptoms are difficult to witness and control. Pain, shortness of breath, vomiting, fatigue, general decline, and fear of death contribute to Prolonged Grief Disorder. Perception of care for the loved one as being poor, family conflict and strife at the end-of -life affects the caregiver.

Isolation

during the caregiving process, difficulty finding adequate support and overcoming caregiver exhaustion contribute to bereavement difficulty. Other contributing factors include previous symptoms of depression, a lower socioeconomic status, and a younger age of the caregiver. The inability of the caregiver to forgive also complicates grief.

Caregivers whose loved one has cancer and dementia experience greater physical and psychological burdens than caregivers of diabetes or those caring for frail elderly individuals.

The Grieving Process

Dr. Kubler-Ross formulated a grief theory consisting of five stages: denial, anger, bargaining, depression and acceptance. The stages of grief come and go and often overlap. Stages do not occur in sequence; however most bereaved individuals experience each stage at one time or another during their grief journey. The theory gives structure and meaning to the confusing state of grief and hope for eventual healing.

The first stage, denial, is characterized by the disbelief that the loved one is gone. The death cannot be true.

The second stage of anger includes a variety of emotions. People may blame and direct anger at doctors, self, the deceased, others in the environment and possibly God. Dr Kubler-Ross theorized that anger was a necessary part of the healing process. Other emotions included sadness, panic, hurt, loneliness and emotional pain.

Anger is often difficult to express toward the deceased. Kubler-Ross believed that the bereaved must be allowed to express anger toward the deceased or God in nonjudgmental ways.

The third stage is bargaining. An example of bargaining would be asking God to intervene before and after the death. Asking God to return life to what was previous before the illness or death occurred. Remaining in the past is a way of bargaining to relieve the pain of grief.

Depression is the fourth stage in response to the death of a loved one. Grief from depressions has various degrees of pain and sadness at different times. Depression during grief is necessary and vital to the healing process.

Acceptance, is the final stage. The grieving individual accepts the reality that their loved one is physically gone. The loss is permanent. Acceptance include the reintegration of life without the deceased.

Triggers for Grief

Common triggers for grief feelings include the deceased loved one’s birthday, the anniversary of their death and the Christmas season. During these times the feelings of loss and pain often return.

On my dad’s birthday after he died, we had a party complete with his favorite cake. Later anniversary dates weren’t as difficult. My approach was to celebrate and remember the good times we had.

Grief is messy, painful, difficult work. Putting a time limit on grief is challenging. Each person is unique in their approach to the loss of a loved one. Grieving in American society can be problematic because feelings of depression are not easily accepted. Friends may not be able to relate to your feelings of loss.

You may suffer from Prolonged Grief Disorder, or complicated grief as I did after the death of my dad. I was a young caregiver, and my dad was one of my last living relatives. Grief consumed me for a time and I became very depressed. The Hospice that provided Dad’s end-of-life care provided a grief counselor. I continued counseling for several years following his death.

During this difficult time, find support. Grief counselors can offer nonjudgmental assistance during your journey of loss. Not everyone knows how you are feeling. A counselor can provide a listening ear to express your emotions of loss, anger, guilt, and despair.

Honor your feelings of sadness and memories that bring tears. Honor your loved one’s life and the memories that will always live in your heart. Allow yourself time to heal, yet try to avoid continual despair. These feelings can overwhelm and debilitate us. One person taught me that I could visit those feelings, but I did not have to live there.

Help is available

Reach out. Many churches and funeral homes offer grief support groups. If your loved one is on Hospice a support group following death is usually provided.

If you have feelings of continued grief and depression, consider seeing your physician. Over time, the chemicals in our brains can become unbalanced. Antidepressants can help.

Stay in touch with your primary care physician while you are busy with caregiving and when your role had ended. If you do not have a primary care provider, get one. Caregivers tend to neglect their own physical health.

Your loved one would want you to live life to the fullest. Be sure to take good care of yourself during the grief process just as you did while you were caregiving.

God bless you now and always.