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Coping with loss

By Dr. Mohan Isaac

The Hindu Times, October 18, 1998

Malathy was reasonably healthy and well adjusted, leading a comfortable life with her 78 year-old husband Ramakrishna, a retired Government of Karnataka official. Ramakrishna was on regular treatment for hypertension for many years. He was also suffering from a heart condition called unstable angina. Their daughters were well settled. One of the daughters lived nearby and visited them regularly. Life was peaceful for Malathy, till one fine morning, when she woke up to find Ramakrishna in deep distress with severe chest pain and breathlessness. Malathy panicked. Even before she could telephone her daughter or their family doctor, everything was over. Malathy was numb with shock by the suddenness of Ramakrishna's death.

Events followed one after another and within weeks Malathy had to move to her daughter's residence as she was not able to take care of herself. She became quiet, withdrawn, forgetful and could not sleep well. She could not carry out routine household chores as she developed various symptoms. After repeated visits to her family doctor, treatment for her clinical condition - 'depression' - was started. Now Malathy is slowly getting back to normality and is learning to cope with the loss of her husband.

One of the many difficult situations that elderly persons have to face as they grow old is the loss, mostly through death, of loved ones - spouse, close friends of long years and close relatives. Bereavement is considered to be one of the most traumatic experiences in one's life at all ages. This is particularly so with old people. Many elderly persons never fully recover from death of a spouse or a close friend. Bereavement will affect an increasingly large number of the elderly in the coming years. With greater proportion of people surviving to older ages and the steady increase in the average life expectancy even in developing countries such as India, it is important to consider various factors which contribute to ill health of old people.

Advancing age is usually related to increasing disability and growing loss of independence. There may be progressive functional impairments such as difficulty in mobility, sight, hearing and memory. Maintenance of good health and promotion of overall quality of life of the ageing population are all of utmost importance. A variety of factors including balanced and nutritious diet, optimal physical activity, appropriate housing and living arrangements and continued mental stimulation will all contribute to an enhancement of the quality of life. However, elderly persons periodically experience the emotional trauma of losses of various kinds, particularly loss of familiar faces and of dear ones. Inadequate handling of the trauma can often have a deleterious effect on the physical and mental health of the individual.

Loss and bereavement usually produce intense feelings of grief and depression. Depending on the circumstances of the loss, many elderly persons feel in some way personally responsible for the death of their dear ones. Feelings that they have failed their loved ones in many ways often lead to feelings of guilt. Death of persons who previously had provided them with an important source of interpersonal intimacy produces feelings of isolation and loneliness. During the initial period following the loss, many elderly persons experience anger along with despair, sadness and guilt. Some get into a state of being "frozen" without being "able to think or feel." Feelings of profound disruption as well as the role losses associated with losing a spouse can be difficult to cope with. The period of mourning following loss also produces self-recrimination, self-pity and a state of hopelessness.

The long period of transition lasting from several weeks to at times, a few years can often be much more difficult than the period immediately following the loss. After the initial period of active support from other loved ones, the bereaved is often left alone to recover steadily. This transitional period which necessitates reorganisation of one's life pattern as well as a variety of readjustments can be difficult. Many elderly persons coping with loss feel unloved and unappreciated. They are unable to find meaning in life and they consider life as wasteful, empty and futile.

Elderly persons are also likely to become depressed or develop physical illnesses which require active medical or psychiatric intervention. Early symptoms of depressive illnesses consist of easy fatigability, inability to relax, impaired concentration and memory restlessness, disturbed appetite and sleep, social withdrawal, and avoidance of interpersonal contact, suicidal thinking etc. Studies have indicated that conjugal bereavement is associated with higher risk for physical deterioration and death. Many bereaved are also socially isolated and live in relative poverty and neglect without any meaningful social activities.

Protective factors include social support in a wide variety of forms - family (children), peers, informal relationships, neighbours, more formal support groups, responsive health services and opportunities for new productive and meaningful social roles. Talking freely to children, close friends or relatives about the loss as well as fears about loneliness, home maintenance, managing finances etc. can not only be cathartic but also lead to greater personal insight. The following are some tips for elderly persons to cope with loss.

- Anticipate and prepare for the eventual loss of loved ones.

- Accept the loss and learn to gradually face reality - Look ahead

- Initiate the readjustment process as early as possible by trying to get back to normal routine activities - Avoid brooding

- Identify areas and activities of interest in which one can get physically and mentally involved

- Reestablish contacts/relationships with friends/relatives with whom one can relate well.

- Talk to friends, family members about the loss

- Participate in socialactivities

- Continue with activities that one was involved in prior to the loss - Do not withdraw

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