GRIEF and LOSS The Shift in the Aging Population By Kenisha Rotibi, LMSW

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Transcript of GRIEF and LOSS The Shift in the Aging Population By Kenisha Rotibi, LMSW

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GRIEF and LOSS The Shift in the Aging Population By Kenisha Rotibi, LMSW Slide 2 Case Study Case Study: Mr. Scott is a 85 year old man who recently had a surgery at a local hospital. The surgery went well but as Mr. Scott was prepared to go home and take care of himself. He was notified that he will no longer be able to go home but instead he would be sent to a nursing home. While in the hospital Mr. Scott was placed on a psychiatric unit, after completion of several test. An Adult Protective Services (APS) report was filed and the state petition for Guardianship for Mr. Scott. He is now under stated custody and now is placed in the same nursing home with his wife of 57 years (Mrs. Scott was placed two weeks prior). Slide 3 Loss Generally we think of loss and in relation to the death of someone. However loss comes in many forms. We are affected by and grieve the loss of anything that we value or are attached to i.e. Loss of health as we age, of our family home as it becomes too big for us or loss of ability (e.g. with a stroke). Slide 4 Grief Grief is the inevitable process we experience as the result of a loss. Grief involves a series of stages including denial or disbelief, fear, anger, depression, and finally acceptance. These stages may overlap, or come in a different order. During this process we may experience myriad emotions, such as confusion, sadness, fear, guilt or hopelessness. These feelings will vary in intensity according to the size or extent of a given loss. Grieving after a loved one's death is known as bereavement. Slide 5 Common grief reactions Anxiety and fear Sadness and loneliness Anger and shock Hurt and guilt Relief and thankfulness Low energy Sleep disturbances Appetite disturbances Absentminded behavior Poor concentration Slide 6 Stages of Grief The Stages of Grief Denial, anger, bargaining, depression and acceptance The Kbler-Ross model continues to be widely used as a means for measuring ones progress through the grief journey, a good foundation for those who are newly grieving and those who are encountering loss again. Slide 7 Symptoms of Grief and Grieving What does it look entail? Grief is expressed physically, emotionally, socially, and spiritually. Physical expressions include crying and sighing, headaches, loss of appetite, difficulty sleeping, weakness, fatigue, feelings of heaviness, aches, pains, and other stress-related ailments. The stress of grieving may also weaken the immune system over time results in more frequent episodes of illness. For persons who have a chronic illness, grieving can exacerbate their condition. Emotional expressions include feelings of sadness and yearning as well as feelings of worry, anxiety, frustration, anger, and guilt All of these feelings are normal reactions to grief. Slide 8 Symptoms of Grief and Grieving What does it look entail? Social expressions include feeling detached from others, isolating oneself from social contact, and behaving in ways that are not normal for the individual. Spiritual expressions include questioning the reason for the loss, the purpose of pain and suffering, the purpose of life, and the meaning of death. After a death, ones grieving process is influenced by how he or she views death. Slide 9 Grief should not be confused with Depression Grief Roll coaster of Emotions Usually person is able to carry out activities obligations of daily living, after the first two or three weeks of grieving numbness, sadness, anger, guilt, anxiety, or fear, people may also find moments of relief, peace, or happiness. Depression Feeling of Emptiness and Despair constant. Intense, pervasive sense of guilt. Thoughts of suicide or a preoccupation with dying. Feelings of hopelessness or worthlessness. Slow speech and body movements. Inability to function at work, home, and/or school. Seeing or hearing things that arent there. Slide 10 Obstacles in the process of Grieving for Aging Population Obstacles that can develop from grieving include depression, anxiety, suicidal thoughts, and physical illness. These are the type of grief reactions that tend to require social work interventions Depression is the most common condition that can develop when a person is grieving. Depression is especially common in adults who experience a divorce or death of a spouse. It is also very common in relation to developing a chronic illness or disability in the Aging Population. Slide 11 Obstacles in the process of Grieving for Aging Population (cont.) Anxiety also is common during the grieving process. However, anxiety can: Last longer than expected Become intense such that it interferes with functioning Include extreme guilt Such disruptive anxiety contributes to a more complicated grief response and can: Make people feel like they are losing control of their emotions. Overwhelming fear is also common. Trigger physical symptoms (anxiety attacks), which might be mistaken for a heart attack. Slide 12 Obstacles in the process of Grieving for Aging Population (cont.) Some older adults may develop unresolved grief or complications associated with grieving. This may occur more often in older adults because they are more likely to experience: Many major losses within a short period of time. The death of their friends, including their spouses. Older adults who lose their spouses may suffer many losses, including financial security, their best friend, and their social contacts. Losses that occur as a part of the natural aging process, such as loss of beauty and physical strength. Loss of their independence or the development of illness and other conditions that are common in older adults. Anticipation of losing someone or something special to them. Slide 13 Aging Population Statics The older population--persons 65 years or older-- numbered 39.6 million in 2009 (the latest year for which data is available). They represented 12.9% of the U.S. population, about one in every eight Americans. By 2030, there will be about 72.1 million older persons, more than twice their number in 2000. People 65+ represented 12.4% of the population in the year 2000 but are expected to grow to be 19% of the population by 2030. Most disturbing among depression statistics is the fact that depression affects upwards of 50 percent of nursing home residents Slide 14 Aging Population Statics When depression occurs in late life, it may be a relapse of an earlier depression. An estimated 6 percent of people ages 65 and older in a given year, or approximately 2 million individuals in this age group, have a diagnosable depressive illness Slide 15 DSM IV vs DSM 5 Slide 16 Under the current DSM-IV criteria, the bereaved would have not qualified for depression unless symptoms persisted for longer than 2 months or were characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation. What criteria does a Elderly meet to have moved from Grief and Loss now to depression. Slide 17 What does the DSM 5 say about Grief and Loss Bereavement Exclusion (why) there have never been any adequately-controlled, clinical studies showing that major depressive symptoms following bereavement differ in nature, course, or outcome from depression of equal severity in any other contextor from MDD appearing out of the blue major depression is a potentially lethal disorder, with an overall suicide rate of about 4%.3 Disqualifying a patient from a diagnosis of major depression simply because the clinical picture emerges after the death of a loved one risks closing the door on potentially life-saving treatment. Slide 18 Comprehensive geriatric assessment of psychosocial factors Mini-Mental State Examination (MMSE)The Geriatric Depression Scale (GDS), The Montreal Cognitive Assessment (MoCA) and the Saint Louis University Mental Status (SLUMS) cognitive assessment tool are all in the public domain. Slide 19 MiniMental State Examination MSSE can no longer be used the risk of infringement is real. Photocopying or downloading the MMSE probably constitutes infringement. A licensed version of the MMSE can now be purchased from PAR for $1.23 per test. The MMSE form is gradually disappearing from textbooks, Web sites, and clinical tool kits Slide 20 The Geriatric Depression Scale (GDS) The GDS questions are answered "yes" or "no", instead of a five-category response set. This simplicity enables the scale to be used with ill or moderately cognitively impaired individuals. The scale is commonly used as a routine part of a comprehensive geriatric assessment. One point is assigned to each answer and the cumulative score is rated on a scoring grid. The grid sets a range of 0-9 as "normal", 10-19 as "mildly depressed", and 20- 30 as "severely depressed". Slide 21 The Geriatric Depression Scale (GDS)(Short Version) No. Question Answer Score 1. Are you basically satisfied with your life? YES / NO 2. Have you dropped many of your activities and interests? YES / NO 3. Do you feel that your life is empty? YES / NO 4. Do you often get bored? YES / NO 5. Are you in good spirits most of the time? YES / NO 6. Are you afraid that something bad is going to happen to you? YES / NO 7. Do you feel happy most of the time? YES / NO 8. Do you often feel helpless? YES / NO 9. Do you prefer to stay at home, rather than going out and doing new things? YES / NO 10. Do you feel you have more problems with memory than most? YES / NO 11. Do you think it is wonderful to be alive? YES / NO 12. Do you feel pretty worthless the way you are now? YES / NO 13. Do you feel full of energy? YES / NO 14. Do you feel that your situation is hopeless? YES / NO 15. Do you think that most people are better off than you are? YES / NO Slide 22 The Montreal Cognitive Assessment (MoCA) The Montreal Cognitive Assessment (MoCA) was designed as a rapid screening instrument for mild cognitive dysfunction. It assesses different cognitive domains: atte