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Focusing on loss or maintenance of identity in persons with dementia may affect how they are approached and cared for. We performed a longitudinal study of 17 elderly persons with early-stage dementia with the aim of exploring changes in the experience of living with dementia. The major theme – a struggle to be valued – was clearly present in follow-up interviews. However, we observed a gradual shift in the concept of being valued: a shift from ‘being valued for what you do’ toward ‘being valued for who you are’. This progression represents a shift from performance-related core values of identity to those that are existentially related. These findings suggest that the self can be maintained by adjusting to loss. [ABSTRACT FROM PUBLISHER]

Since 1900, the percentage of Americans 65+ has tripled (from 4.1% in 1900 to 12.4% in 2006), and the number has increased twelve times. Some type of disability, to include mental disability, was reported by 52% of older persons in 2002. The prevalence of DSM-IV based generalized anxiety and a comprehensive medical measurement is needed given the drastic rise in the elderly population and their propensity to experience environmental death and/or serious illness and injury (DSI/I). To analyze the likelihood of having DSM-IV criteria-based generalized anxiety when experiencing DSI/I of a family member or close friend within the last twelve months. Specifically, this study utilized a medical model approach by positively screening the elderly sample while utilizing the exact criteria as outlined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). This study is a cross sectional study and secondary data analysis of the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). A stratified sampling design was required to evaluate those within the NESARC data set who were 65 years of age or older. The data was initially processed with SAS in conjunction with SAS callable SUDAAN to account for the complex design of the survey. Frequency distributions were completed for independent variables by generalized anxiety diagnosis criteria. Bivariate analyses were used to compare DSM-IV criteria-based major depression diagnosis with the independent variables. Multivariate analyses were conducted to assess the relationship between the outcome variables and independent variables while adjusting for covariates. Older persons who had experienced either DSI/I of a close family member or friend within the past 12 months were no more likely to have generalized anxiety than those who did not experience DSI/I of a close family member or friend within the past 12 months. Similarly, older persons who had experienced both DSI/I of a close family member or friend within the past 12 months were no more likely to have generalized anxiety than those who did not experience DSI/I of a close family member or friend within the past 12 months. DSI/I were inconsistent throughout the multivariate analysis when utilizing modeling procedures and controlling for effects associated with demographics, resources, heritage, and symptoms (Table 3). The DSI/I and its environmental effects on the older population are apparent while diagnosable accounts of DSM-IV criteria-based generalized anxiety remain insignificant for those who experience DSI/I. The mixed findings between Models 1-5 suggest that further research is needed given the limited sample size and the variation in results for generalized anxiety within the elderly population and DSI/I. [ABSTRACT FROM AUTHOR]

The loss of the partner is an important risk factor for developing serious psychological problems. In this study the authors examined the effect of the visiting service on the mental health and quality of life of older widowed individuals. They conducted a pragmatic randomized trial. All respondents were randomly assigned to a visiting service (n = 110) or a control condition (n = 106) and were interviewed at baseline, at 6 months, and at 12 months after baseline. The visiting service was not more effective than the control condition in the overall sample. However, socially lonely, physically ill, or low-educated respondents improved more in the experimental group than in the control group. [ABSTRACT FROM AUTHOR]

The intent of this study was to examine if length of caregiving was associated with older widowers' adjustment to bereavement and to identify factors, based on principles underlying the Dual Process Model of Bereavement, that might mitigate the potential adverse effects of time spent caring. Twohundred men over the age of 60 and in the second year of bereavement were identified from death records of older women who had died within a 12-month period. Interviews lasted about 2 hours and focused on widowers' experiences surrounding their wives' deaths along with questions about social support, health, retirement, and other demographic information. The Bradburn Affect Scale was used to measure positive and negative affect. Restoration-oriented coping, such as starting new relationships and activities were measured. These variables included extent of family contact, number of friends, having a confidante, involvement with neighbors, and participation in sports and clubs. Time since death and demographic variables were used as controls. Hierarchical linear regression was conducted on positive and negative affect after which potentially moderating effects were analyzed. Results indicated that the most important influences on negative affect were time since death, ethnicity, and participation in clubs while for positive affect the most significant factors included length of caregiving, number of friends, and having a confidante. Although no interaction effects were significant, patterns emerged. Implications for applying the DPM with older bereaved men are made. [ABSTRACT FROM AUTHOR]

Older widows face challenges regarding domestic instrumental tasks and independence. We asked 21 British widows about traditional male tasks, pre- and postbereavement. We focus on 3 aspects. First, what changes occurred in instrumental independence following bereavement? A typology of 4 was identified comprising: dependent/independent; dependent/dependent; independent/independent; independent/dependent. Second, what was the nature of independence? Third, what factors promoted or hindered independence? These included familial factors, both as aids and barriers, financial security as an aid, and health as a barrier. The results highlight how successfully widows manage instrumental tasks and how their independence could be enhanced. [ABSTRACT FROM AUTHOR]

Complicated grief reactions are relatively common following spousal bereavement. Old-age spousal loss qualifies as a possible traumatic stressor; however, posttraumatic stress disorder (PTSD) as a possible complication of the loss has rarely been explored in this population. This study aimed to investigate the frequency of PTSD in elderly bereaved people across the first 18 months of bereavement. Additionally, risk factors for the prediction of bereavement outcome in relation to four domains of the bereavement process were investigated. Data were collected via self-report questionnaires measuring traumatic stress (Harvard Trauma Questionnaire (HTQ)), coping style (Coping Style Questionnaire (CSQ)), crisis support (Crisis Support Scale (CSS)), and personality (e.g., NEO-five factor inventory (NEO-FFI)). Elderly bereaved people (N = 296, Mean = 73 years) participated at 2, 6, 13, and 18 months post loss. The comparison group consisted of married elderly people who had experienced at least one significant loss (N = 276, mean = 70 years). The frequency of PTSD within the spousal bereaved group was high (16%) compared to the comparison group (4%) and remained stable across time. Each individual domain included in the current analysis was a predictor of PTSD 18 months post loss. Most predictors remained stable across time. A hierarchical regression analysis of the four domains predicted 49% of the variance, indicating a considerable overlap between the domains. Only one predictor, early posttraumatic distress, remained significant. The results confirm that loss of a spouse in old age is traumatic for some and that the effects of the loss remain over the first 18 months post loss. The results therefore underline the importance of further investigation into PTSD in the elderly bereaved. [ABSTRACT FROM AUTHOR]

Examination of the theory base for bereavement and loss is currently just beginning for adults with intellectual disabilities (ID). Yet, as life spans increase for individuals with ID, these adults experience more and more loss and bereavement events. Practitioners, especially grief counselors, are finding it increasingly critical for them to understand best practice principles for working with bereaved adults with ID in their daily work. Practitioners also are asked to guide families and care providers regarding grief and death education. This article provides counselors and other professionals with a review of existing bereavement intervention research for adults with ID. Practice recommendations are made on three levels: informal support; formal intervention; and community education. [ABSTRACT FROM AUTHOR]

Spousal death is one the most stressful life events that seriously affects the psychological well being of widowed. This study examined the mediating effects of social and personal religiosity on the psychological well being of widowed elderly people. The sample for this study was comprised of 1367 widowed and married elderly Muslims from Malaysia. Psychological well being, religiosity, and physical health were measured using WHO-5 Well being Index, Intrinsic Extrinsic religiosity scale, and a checklist of 16 physical health problems, respectively. Data analysis was conducted using the Statistical Package for Social Sciences (version-13). As expected, bivariate correlation analysis revealed that widowhood is statistically and negatively associated with psychological well being. Results of multiple hierarchical regression analyses and Sobel test showed that only the indirect effect of widowhood through personal religiosity was statistically significant (Sobel = -2.79, p < .01). Sobel test for social religiosity was not significant (Sobel = -1.54, p > .05). The results of this study confirmed earlier studies, which found that widowhood negatively affects psychological well being of elderly people. Overall, the findings show that the potential solace provided by religiosity can decrease the negative effects of widowhood on the psychological well being of widowed elderly people. [ABSTRACT FROM AUTHOR]

I examine the ways that bereaved older adults attribute responsibility for their late spouses' deaths, and the consequences of such attributions for psychological adjustment to loss. Data are from the Changing Lives of Older Couples, a prospective study of married persons ages 65 and older Bereaved persons whose late spouse smoked and had a sedentary lifestyle attributed higher levels of blame to the decedent. Persons who believe that their late spouse's stressful lifestyle and poor health care compliance contributed to the death report significantly lower levels of yearning, yet these effects are no longer statistically significant when marital quality is controlled. Bereaved spouses who believe health care providers contributed to the death report significantly more anger symptoms. The findings suggest that older adults adhere to a "secular morality"; deceased spouses who previously maintained unhealthy lifestyles are viewed as partly responsible for their own deaths. [ABSTRACT FROM AUTHOR]

The term «loss» in this article refers to the lack of a significant adaptive resource that is a central part of the affective world of the subject. The absence of such resource can generate psychological distress. Old age is seen as a time in which numerous changes occur that are associated with losses in important areas of life and which, as a whole, constitute a major source of stress. These losses involve a series of physical, social and psychological changes that affect and define old age and that require the subject to develop a process of adaptation to many intense stressors. Loss structure can be defined as a set of significant objects (that can be grouped under different loss categories), perceived as being under threat of being lost, effectively lost, or whose existence is uncertain or ambiguous (conceived of as types of loss), and whose influence continues to define cognitions, affection and behaviors. The unprecedented loss structure found in elderly adults could set up different routes of maladjustment. Maladjustment appear in three fundamental areas: psychological, physical and social. Hence, frustration can lead to depression. Successive losses seen as a series of failures can generate feelings of despair; losses related to sources of affection can produce loneliness, etc. The Loss Structure Scale (LSS), proposed here is an instrument for exploring losses that usually occur in old age. It also allows a systematic exploration of a wide range of losses previously validated in the Mexican context as a first approach to possible psychosocial causes of psychological maladjustment in old age. Method The project was divided into two phases. The first corresponded to the design of the LSS, and the second to a psychometric evaluation. Four samples were used with subjects chosen by availability in Mexico City. One model of the scale was explored that consisted of 60 items linked to experiences of loss with three reply options for each item: No loss, Ambiguous loss, and Definite loss in a final sample of 193 subjects (69.34% women, N = 134). The following instruments were used: The Center of Epidemiological Studies Depression Scale; Beck's Anxiety Inventory; Hunter Opinions and Personal Expectations Scale; the perceived disease subscale of WHOQoL- Brief; The World Health Organization Quality of Life Assessment, Brief; the Lack of Emotional Wellbeing subscale of the Multifaceted Loneliness Inventory and the Anxiety About Aging Scale. Results Factor structure. A factor analysis was carried out using the principal components method with varimax rotation and eigen values greater than one. The final factor structure showed nine well defined factors covering 36 items with an internal alpha consistence of .91 explaining 67.4% of the variance. Alpha values for the internal consistence of the 9 factors fluctuated between .74 and .83. Construct validity. 1) Moderately high correlations were obtained between total score on the Loss Structure Scale and all psychological maladjustment variables (between r=.50 and r=.66; p<.01), with the exception of aging anxiety, which seems to point to the important pathogenic role of losses suffered in most of the maladjustment variables, 2) a negative association was found between the frequency of no losses and the afore mentioned variables, with depression (r=-.70, p<.01) and loneliness (r=-.68, p<.01), 3) ambiguous loss frequency correlated positively with depression (r=.54, p<.01), loneliness (r=.47, p<.01), anxiety (r=.42, p<.01) and aging anxiety (r=.40, p<.01), 4) the frequency of definite losses correlated strongly with loneliness (r=.53, p<.01), depression (r=.50, p<.01) and perceived disease (r=.47, p<.01).… [ABSTRACT FROM AUTHOR]

Older adults diagnosed with cancer face a multitude of psychosocial issues. In addition to coping with common grief and loss responses related to their mortality, finances, role changes within their families, and changes in their cognitive and physical abilities, older cancer patients are often faced with common challenges brought about by advanced aging such as chronic comorbid conditions. At the forefront of addressing the psychosocial impact of cancer among elderly patients are clinical social workers who provide a broad range of services, particularly in the areas of counseling, support, resources, education, and advocacy. [ABSTRACT FROM AUTHOR]

This study investigated gender differences in an emotional disclosure intervention for bereaved older adults. Participants verbally disclosed their thoughts and feelings about the death of their spouse in four 20-minute sessions, in accordance with the Pennebaker (1985) disclosure paradigm. Results showed similar therapeutic benefits for males (n = 13) and females (n = 23) over 3 time periods, but process measures indicated that males experienced a greater upsurge in negative feelings from presession to postsession. Females showed a steady decrease in negative feelings across disclosure sessions, whereas males remained moderately negative. Correlational analyses into dicated differential mechanisms of improvement among males and females. For females, higher levels of negative affect and greater decreases in negative thoughts were associated with greater therapeutic changes. For males, the mechanisms of change were less clear. Despite differences in the way widowers and widows experience the process of emotional expression, both can expect to benefit equally from this intervention. [ABSTRACT FROM AUTHOR]

Offers observations on the care of a bereaved parent by examining the case of an elderly woman who has been widowed two years. Comments from the widow and her physician; Role of the physician in bereavement care; Differences between uncomplicated and complicated grief; Physician contacts with bereaved patients; Intervention and psychiatric referrals; Treatment of bereavement-related complications; Rewards of bereavement care.

Although John Bowlby conceptualized attachment theory as applicable across the life span, researchers have been relatively slow to examine attachment phenomena specifically among older adults. The present article reviews the extant research applying attachment theory to older populations; preliminary findings suggest that attachment issues hold particular relevance for older adults, given the increased potential for separation, loss and vulnerability associated with aging. Although many of the studies reviewed are somewhat limited methodologically,the overall pattern of results suggests that attachment patterns are associated with a variety of outcomes in later life (such as adaptation to chronic illness and caregiver burden among family members, reactions to the death of a loved one, and general well-being) in a theoretically consistent manner.The implications of and questions raised by current findings are reviewed, and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Objective: The goal of this study was to describe the association between conjugal loss and both syndromal depression and depressive symptoms in a prospective cohort study of people aged 70 years or older.Method: A measure of syndromal depression, the shortform Composite International Diagnostic Interview (CIDI), and a revised version of the Center for Epidemiologic Studies--Depression Scale (CES-D Scale) were administered to a group of 5,449 elders in a longitudinal cohort study. The authors compared the rates of syndromal depression (CIDI diagnosis) and depressive symptoms (six CES-D Scale symptoms) in married participants and those who lost spouses between the first and second waves of assessment.Results: The rate of syndromal depression in the newly bereaved was nearly nine times as high as the rate for married individuals, and the rate of depressive symptoms was nearly four times as high. The percentage of the bereaved respondents who had scores above threshold on the revised CES-D Scale was higher for those interviewed up to 2 years after loss of a spouse than for married respondents. Age, sex, prior psychiatric history, and the expectedness of the death did not differ between depressed and nondepressed newly bereaved subjects.Conclusions: Recent bereavement is a significant risk factor for syndromal depression in the elderly. Some widows and widowers experienced high levels of depressive symptoms up to 2 years after the loss of their spouses. Neither demographic variables nor variables concerning the nature of the spouse's death predicted bereavement-related depression. [ABSTRACT FROM AUTHOR]

Focuses on the concept of loneliness with particular reference to old age. Emotional response to the discrepancy between desired and available relationships; Increase in the likelihood of experiencing losses as people grow old; Types of concepts used in reference to loneliness.

The article offers information on the two medical cases presented by author and Long Island University professor Danielle Knafo in the scientific meeting of the American Institute for Psychoanalysis (AIP) on May 9, 2013. The two cases involved middle-aged woman with assertive attitude and a young man with deep depression. Also provided is information on the psychological aspects of threatened extinction, desertion, and loss.

The article offers clinical information on diagnosing bereavement as part of the fourth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM). It discusses the case of an elderly man experiencing grief whose wife of 50 years had previously died. A historical overview of the introduction of bereavement as a DSM exclusion is presented. The principal source of diagnostic confusion relating to bereavement and major depressive disorder (MDD) is also explained.

The article presents a question and answer about whether older men have more trouble than women coping with loss.

Introduces a special issue of "Pastoral Psychology," which was edited by James N. Lapsley. Lapsley's efforts to bring together a remarkable group of people to write about an issue that is largely neglected in our society; Observation that, as the percentage of those over 65 grows, our society is finally beginning to acknowledge the special concerns and issues facing an aging population.