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Vandersman P, Chakraborty A, Rowley G, Tieman J. The matter of grief, loss and bereavement in families of those living and dying in residential aged care setting: A systematic review. Arch Gerontol Geriatr 2024; 124:105473. [PMID: 38728822 DOI: 10.1016/j.archger.2024.105473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/23/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024]
Abstract
The grief, loss and bereavement needs of the families of those living and dying in residential aged care setting is not very well understood. This systematic review examines grief, loss, and bereavement experience of, and interventions relating to, family caregivers of those entering, living and dying in residential aged care. Out of 2023 papers that were identified, 35 met the inclusion criteria which included (n=28) qualitative and (n=7) quantitative intervention studies. The qualitative findings indicated quality of care provided to the resident at the end of their life, and after death care influenced family caregivers' grief reactions. The intervention studies revealed that educational interventions have the potential to lead to some benefits in the context of grief loss and bereavement outcomes. Recognizing the emotional experiences and support needs of families and carers may enhance the understanding of the ageing, caring, dying, grieving pathway for older people and their families.
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Affiliation(s)
- Priyanka Vandersman
- Research Centre for Palliative Care, Death, and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
| | - Amal Chakraborty
- Faculty of Medicine and Health, University Centre for Rural Health, The University of Sydney, Sydney, Australia
| | - Georgia Rowley
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Jennifer Tieman
- Research Centre for Palliative Care, Death, and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Ng YH, Jiao K, Suen MHP, Wang J, Chow AYM. The role of the social environment on dementia caregivers' pre-death grief: A mixed- methods systematic review. Death Stud 2024:1-20. [PMID: 38497324 DOI: 10.1080/07481187.2024.2329755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
This systematic review examined the role of social environment in pre-death grief experiences of dementia caregivers. Ninety-three Chinese and English articles were included from a comprehensive search of empirical studies using nine databases. Six social environment domains were generated: the person with dementia, dyadic relationship, family members and the wider community, health and social care services, place of care, and social-cultural contexts. A complex interplay between caregivers and their social environments that aggravate and attenuate pre-death grief experiences is evident. Research has focused mainly on the effects of people with dementia and dyadic relationships and has paid modest attention to the effects of family, relatives, and health and social care services. Caregivers' experiences with their friends, fellow caregivers, the wider community, and social-cultural norms are influential but understudied. Future research could adopt a systems thinking approach with sociological perspectives to generate a comprehensive and nuanced understanding of pre-death grief experiences.
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Affiliation(s)
- Yong Hao Ng
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Keyuan Jiao
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Margaret H P Suen
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Juan Wang
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Amy Y M Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Huggins M, Puurveen G, Pesut B, Rush K. Competency development for a volunteer navigation program to support caregivers of people living with dementia: A modified e-Delphi method. Dementia (London) 2024; 23:69-90. [PMID: 37976553 PMCID: PMC10797849 DOI: 10.1177/14713012231216768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Caregivers of people living with dementia are pillars of the care community. Providing them with adequate support throughout their caregiving journey is essential to their quality of life and may also contribute to improving the care of people living with dementia. Nav-CARE (Navigation - Connecting, Advocating, Resourcing, Engaging) is a volunteer-led navigation program that provides support to older adults with life-limiting illnesses who are living in the community. However, Nav-CARE does not provide support directly to caregivers of people living with dementia. To adapt Nav-CARE to support caregivers, we needed to establish caregivers' needs and the competencies volunteer navigators should be trained in to support caregivers to meet these needs. To do so, a modified e-Delphi method was utilized, which consisted of administering three sequential questionnaires to a panel of 35 individuals with expertise in a variety of dementia related domains. Through this, two final lists of 46 caregivers' needs and 41 volunteer competencies were established to inform the development of volunteer navigator training curriculum. Findings suggest that trained volunteer navigators may be able to support caregivers of people living with dementia throughout the disease trajectory and can be used to inform the development of future dementia navigation programs.
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Affiliation(s)
- Madison Huggins
- Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna BC, Canada
| | - Gloria Puurveen
- Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna BC, Canada
| | - Barb Pesut
- Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna BC, Canada
| | - Kathy Rush
- Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna BC, Canada
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Bermejo Gómez I, Gallego-Alberto L, Losada Baltar A, Mérida Herrera L, García Batalloso I, Márquez-González M. [Anticipatory grief in family caregivers of persons with dementia. Psychosocial correlates and impact on caregiver's health: A literature review]. Rev Esp Geriatr Gerontol 2023; 58:101374. [PMID: 37246011 DOI: 10.1016/j.regg.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/08/2023] [Accepted: 05/02/2023] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Taking care of a relative with dementia may be linked to negative consequences for the caregiver. One of the processes that can be experienced is anticipatory grief, that is defined as the feelings of pain and loss that appear in the caregiver before the death of the person cared for. OBJECTIVES The review aimed to conceptualize anticipatory grief in this population, to study the related psychosocial variables, and to know the repercussions for the health of the caregiver. METHOD A systematic search was made under the directives of PRISMA statement in the ProQuest, PubMed, Web of Science (WOS), and Scopus databases, including studies published in the last 10 years (2013-2023). RESULTS A total of 160 articles were obtained, 15 being finally selected. It is observed that anticipatory grief is defined as an ambiguous process since it appeared before the death of the sick family member. Being a female caregiver, spouse of a family member with dementia, having a closer relationship with him and/or having an important responsibility in care, are associated with a greater chance of experiencing anticipatory grief. In relation to the person cared for, if he or she is in a severe phase of the disease, is younger, and/or presents problematic behaviours, there is also greater anticipatory grief in the family caregiver. Anticipatory grief has a significant impact on caregivers' physical, psychological, and social health, being associated with greater burden, depressive symptomatology, and social isolation. CONCLUSIONS Anticipatory grief turns out to be a relevant concept in the context of dementia, being necessary to include it in intervention programs for this population.
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Affiliation(s)
- Isabel Bermejo Gómez
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España.
| | - Laura Gallego-Alberto
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España
| | - Andrés Losada Baltar
- Departamento de Psicología, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, España
| | - Laura Mérida Herrera
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España
| | - Inés García Batalloso
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España
| | - María Márquez-González
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España
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Alves S, Paúl C, Ribeiro O. Transition to bereavement: A prospective longitudinal study of health-related quality of life in informal caregivers of oldest-old individuals. Front Med (Lausanne) 2022; 9:1031143. [PMID: 36530892 PMCID: PMC9748087 DOI: 10.3389/fmed.2022.1031143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/10/2022] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION Experiencing bereavement may be challenging. Despite the oldest-old population increase, a subgroup at greater risk of death, few studies focus on the grieving process of informal caregivers (ICs). This study analyzed the transition to bereavement of ICs of oldest-old individuals (≥80 years) over 1-year and compares the evolution of the health-related quality of life (HrQoL) between those experiencing bereavement and those who continued care through the study period. MATERIALS AND METHODS A prospective longitudinal observational study was conducted enrolling 204 ICs of the Metropolitan Area of Porto (North Portugal), of which 36 experienced the death of care receiver (CR). ICs' health profile and burden were assessed. CRs' functional and cognitive status were also appraised. RESULTS Bereaving caregivers were mostly female, CRs' children, and had on average 60.4 years at baseline. Caregivers spent a mean of 10.1 h/day (SD = 7.7) caring, for 80.6 months (SD = 57.5). The time elapsed since CR's death was 6 months (SD = 3.5) from entering in the study. CRs who died had a mean age of 88.3 (SD = 5.4) years at baseline, and were very dependent. Over a 1-year follow-up, bereaving caregivers showed a significant decrease in mental health following CR's death; on the other hand, caregivers who continued caring improved mental health [F(1, 159) = 4.249, p = 0.041]. DISCUSSION Ending the caregiver career was marked by a decline in mental health whereas to continue caring was marked by an improvement in this outcome. While it is highly expected that the CR's death will be perceived as a relief considering both the caregiver's characteristics (e.g., medicines) and the CR condition (e.g., high dependence levels), the results suggest an opposite direction. CRs' death seems to arise an emotional burden for IC, at least during the first year, possibly triggering feelings of loneliness and a life without purpose that seems to aggravate mental health issues. CONCLUSION The transition to bereavement among ICs seems to lead to a caregiver mental health decline while those who continued caring (and thereby, experiencing caregiving stressors) seems to improve in this outcome. Ceasing caregiving stressors does not seem to contribute better experiencing bereavement among ICs, suggesting the need for support throughout this phase.
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Affiliation(s)
- Sara Alves
- Center for Health Technology and Services Research (CINTESIS@RISE), ICBAS, Porto, Portugal
- Abel Salazar Institute of Biomedical Sciences – University of Porto (ICBAS-UP), Porto, Portugal
| | - Constança Paúl
- Center for Health Technology and Services Research (CINTESIS@RISE), ICBAS, Porto, Portugal
- Abel Salazar Institute of Biomedical Sciences – University of Porto (ICBAS-UP), Porto, Portugal
| | - Oscar Ribeiro
- Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro, Aveiro, Portugal
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
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Mahomed A, Pretorius C. Understanding the lived experiences of family caregivers of individuals with dementia in Soweto, a South African Township. Dementia 2022; 21:2264-2287. [DOI: 10.1177/14713012221118441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This study was undertaken to understand South African family caregivers’ lived experiences of individuals living with dementia in a predominantly Black African township. A homogenous sample of thirty family caregivers was recruited using purposeful sampling methods and interviewed using a semi-structured approach. Reflective Thematic Analysis (RTA) yielded four broad themes: Understanding Dementia, Struggles and Sacrifice, Mental Health and Protective Factors. Findings reflect how dementia is understood by family caregivers and their community, the struggles and sacrifices that they endure, the impact of caregiving on caregiver mental health and the protective factors that enable caregivers to cope, despite their difficulties. Our findings lead to new insights regarding dementia caregiving amongst family caregivers in South Africa. First, there appears to be a shift in perception – away from a cultural/spiritual paradigm – and a lack of pressure to conform to community conceptualizations of dementia among individual caregivers. Second, dementia caregiving had a negative effect on caregiver mental health and elicited stress, anxiety and grief reactions. Third, caregivers did not feel emotionally supported and expressed not receiving any assistance with their daily practical tasks. Fourth, before receiving a diagnosis, family caregivers were viewed as the perpetrators of abuse and/or neglect against their family members with dementia, instead of individuals with dementia being stigmatized by the community due to their behavioural symptoms. Additionally, help-seeking was not hindered by fear or stigma, but was motivated by caregiver distress as dementia-related behaviours began to manifest and caregivers feared being perceived as perpetrators of abuse. Psychoeducational interventions should be tailored to targeted population groups that are in need of further training to address the lack of awareness in communities, insufficient knowledge of dementia amongst healthcare professionals and the practical, emotional and psychological difficulties that family caregivers endure to facilitate mental health care and resilience.
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Singer J, Roberts KE, McLean E, Fadalla C, Coats T, Rogers M, Wilson MK, Godwin K, Lichtenthal WG. An examination and proposed definitions of family members' grief prior to the death of individuals with a life-limiting illness: A systematic review. Palliat Med 2022; 36:581-608. [PMID: 35196915 PMCID: PMC10098140 DOI: 10.1177/02692163221074540] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research has extensively examined family members' grief prior to the death of an individual with a life-limiting illness but several inconsistencies in its conceptualization of related constructs, yet significant conceptualization issues exist. AIM This study aimed to identify and characterize studies published on family members grief before the death of an individual with a life-limiting illness, and propose definitions based on past studies in order to initiate conceptual clarity. DESIGN A mixed-method systematic review utilized six databases and was last conducted July 10, 2021. The search strategy was developed using Medical Subject Headings. This study was prospectively registered on PROSPERO (CRD42020166254). RESULTS One hundred thirty-four full-text articles met inclusion criteria. This review revealed across studies a wide variation in terminology, conceptualization, and characterization of grief before the death. More than 18 terms and 30 definitions have been used. In many cases, the same term (e.g. anticipatory grief) was defined differently across studies. CONCLUSIONS We found grief occurring before the death of a person with a life-limiting illness, which we termed pre-death grief, is comprised of two distinct constructs: anticipatory grief and illness-related grief. Anticipatory grief is future-oriented and is characterized by separation distress and worry about a future without the person with the life-limiting illness being physically present. Illness-related grief is present-oriented and is characterized by grief over current and ongoing losses experienced during the illness trajectory. These definitions provide the field with uniform constructs to advance the study of grief before the death of an individual with a life-limiting illness.
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Affiliation(s)
- Jonathan Singer
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Kailey E Roberts
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Elisabeth McLean
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Carol Fadalla
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Taylor Coats
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Madeline Rogers
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA
| | | | - Kendra Godwin
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wendy G Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Skantharajah N, Barrie C, Baxter S, Carolina Borja M, Butters A, Dudgeon D, Haque A, Mahmood I, Mirhosseini M, Mirza RM, Ankita A, Thrower C, Vadeboncoeur C, Wan A, Klinger CA. The Grief and Bereavement Experiences of Informal Caregivers: A Scoping Review of the North American Literature. J Palliat Care 2021; 37:242-258. [PMID: 34860618 PMCID: PMC9109594 DOI: 10.1177/08258597211052269] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Informal caregivers are a significant part of the
hospice and palliative care landscape as members of the interdisciplinary care
team. Despite this, little is known about the impact this responsibility has on
informal caregivers’ experiences of grief and bereavement.
Objective: To address this, a scoping review of the literature
was conducted to explore the current state of knowledge toward grief and
bereavement of informal caregivers of adult/geriatric patients in the hospice
and palliative/end-of-life care realm within North America.
Methods: Using Arksey and O’Malley's 5-step framework, key
electronic health care and social sciences databases (eg, CINAHL, MEDLINE,
ProQuest Sociological Abstracts, PsycINFO) alongside gray literature sources
were searched and screened against inclusion and exclusion criteria. A thematic
content analysis was used to identify key themes. Results: 29
articles met the final inclusion criteria with 3 central themes emerging: (1)
mediators of grief, (2) grief experiences, and (3) types of grief.
Discussion: Informal caregivers encounter unique grief and
bereavement experiences: The range of psychosocial outcomes, both negative and
positive, can be affected by various mediators such as caregiver burden,
demographics, disease type of the patient being cared for, etc. Bereavement
interventions must be designed with the mediators of grief in mind.
Conclusions: Understanding the nuances of informal caregivers’
experiences with grief and bereavement will inform and advance practice, policy,
and research. Practitioners/clinicians should be further educated on how to
properly acknowledge the complexity of grief and bereavement for informal
caregivers, specifically paying attention to mediators. Further research needs
to consider the role of culture.
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Affiliation(s)
| | - Carol Barrie
- Canadian Frailty Network (CFN), Kingston, Ontario, Canada.,Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada
| | - Sharon Baxter
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada.,Canadian Hospice Palliative Care Association (CHPCA), Ottawa, Ontario, Canada
| | | | | | - Deborah Dudgeon
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada.,Canadian Partnership Against Cancer (CPAC), Toronto, Ontario, Canada.,Queen's University, Kingston, Ontario, Canada
| | | | | | - Mehrnoush Mirhosseini
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada.,College of Family Physicians of Canada (CFPC), Mississauga, Ontario, Canada.,University of Alberta, Edmonton, Alberta, Canada
| | - Raza M Mirza
- University of Toronto, Toronto, Ontario, Canada.,National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada
| | | | | | - Christina Vadeboncoeur
- Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada.,Canadian Network of Palliative Care for Children (CNPCC), Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew Wan
- University of Toronto, Toronto, Ontario, Canada
| | - Christopher A Klinger
- University of Toronto, Toronto, Ontario, Canada.,Quality End-of-Life Care Coalition of Canada (QELCCC), Ottawa, Ontario, Canada.,National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada.,Pallium Canada, Ottawa, Ontario, Canada.,McMaster University, Hamilton, Ontario, Canada
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Holm M, Weber Falk M, Alvariza A, Sveen J, Kreicbergs U. How parents of dependent children reason about their partner's impending death due to cancer. Death Stud 2021; 47:1-6. [PMID: 34787534 DOI: 10.1080/07481187.2021.1992807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This paper explores how bereaved parents with dependent children reasoned about their partner's impending death due to cancer. Questionnaires were used to collect data from 42 cancer-bereaved parents of dependent children in Sweden. The results showed that most of the parents had thought, at least once, that death would be best for their partner's own sake. A few parents had also thought that it would be best for everyone if their partner died. Many parents had a wish to keep up hope, no matter what. However, living with a partner with advanced illness and dependent children was described as extremely stressful.
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Affiliation(s)
- Maja Holm
- Department of Nursing Sciences, Sophiahemmet University, Stockholm, Sweden
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Megan Weber Falk
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Anette Alvariza
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Josefin Sveen
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Ulrika Kreicbergs
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women and Child's Health, Karolinska Institutet, Stockholm, Sweden
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Nathanson A, Rogers M. When Ambiguous Loss Becomes Ambiguous Grief: Clinical Work with Bereaved Dementia Caregivers. Health Soc Work 2021; 45:268-275. [PMID: 33184671 DOI: 10.1093/hsw/hlaa026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/10/2019] [Accepted: 10/29/2019] [Indexed: 06/11/2023]
Abstract
The experience of caring for someone with dementia can be heartbreaking. The losses inherent to caregiving itself can be difficult to reconcile after the death of a person with dementia, causing challenges in the bereavement stage. Although there is often significant social support to help people process the death of someone close to them, clinicians can struggle to help bereaved dementia caregivers integrate their ambiguous losses from caregiving, such as loss of roles, functions, and relationships, into a postdeath bereavement process. Many socioeconomic, personality, and family functioning factors impact an individual caregiver's experience, and there are more global influences from the nature of dementia caregiving itself that must be understood to best support a caregiver. Using the lens of the dementia grief model and examples from a case study, this article seeks to illustrate the dynamics inherent in integrating ambiguous losses following the death of a person from dementia, and it proposes clinical goals for working effectively with this population.
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Affiliation(s)
- Abigail Nathanson
- adjunct faculty, Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003
| | - Madeline Rogers
- assistant research coordinator and interventionist, Weill Cornell Medicine, New York
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Abstract
OBJECTIVES To understand how bereaved spousal caregivers of persons with dementia perceive and respond to changes over the course of their spouse's disease, from diagnosis into bereavement. DESIGN Qualitative interview study with convenience sampling and thematic analysis approach. PARTICIPANTS Participants included eight women and two men (n=10) who had been spousal caregivers for a person with dementia prior to his/her death. Participants were older adults who self-reported good health and were bereaved longer than a year. SETTING Data collected in a small Canadian prairie city between fall 2014 and winter 2015. FINDINGS Two overarching themes were developed as important components of participants' caregiving journey: emotional reactions to change and variation in social connectedness throughout the caregiving and bereavement journey. Four key sub-themes developed through the analysis of emotional reactions to events: memorable grief overshadows persistent grief, a progressive feeling of hopelessness and overwhelmed, relief is common but hidden and gratitude is a milestone in a constructive bereavement. Three key variations of social connectedness throughout the caregiving and bereavement journey were developed: the importance of social inclusion throughout a caregiving and bereavement journey, the repeated loss of companionship and withdrawing from social interactions is contingent on needs. CONCLUSIONS The findings suggest that emotional changes throughout caregiving and bereavement are not linear. The need for support from family, friends and new social supports is influential in enabling the caregiver to move forward during caregiving and bereavement.
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Affiliation(s)
- Kirstian Gibson
- College of Arts and Science (Psychology), University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shelley Peacock
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Melanie Bayly
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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