Guidelines for a Palliative Approach in Residential Aged Care

The following table outlines other common reactions to grief.
Table 23: Common grief reactions
Mental Emotional Physical Behavioural Spiritual
• Disbelief/
confusion
• Preoccupation
• Sense of the
dead person’s
presence
• Hallucinations
• Anxiety
• Fear
• Sadness
• Anger
• Guilt
• Inadequacy
• Hurt
• Relief
• Loneliness
• Hollowness in
the stomach
• Tightness in the
chest (chest pain)
• Tightness in the
throat
• Digestive and
related problems
• Over-sensitivity
• A sense of depersonalisation
• Breathlessness
• Muscle weakness
• Lack of energy
(or a deep and
total fatigue)
• Dry mouth
• Insomnia
• Loss of appetite
• Crying
• Sleep disturbance (either
a lack or an increased
need for sleep)
• Sighing
• Restlessness and overactivity
• Appetite disturbances
• Absent mindedness
• Social withdrawal
• Dreams of the deceased
• Avoiding reminders of
the deceased
• Searching and calling
out for the deceased
• Visiting places and
carrying reminders
of the deceased, or
treasured objects which
belonged to them
• Feelings of
anger
• Feelings of
alienation from
God
• Feeling that
hope appears
lost
• Feeling that
life has lost its
meaning
(See Chapter 12, ‘Spiritual support’, for further information about spiritual matters)
15.2 EXTREME GRIEF
People naturally experience grief after a death, but for some the reaction is so strong that it
moves beyond ‘normal’ grief to what is known as pathological or ‘complicated’ grief. In recent
years the criteria for complicated grief have been redefined. [411] Horowitz and colleagues
(1997) [411] argue that some prolonged and turbulent grief reactions include symptoms that
differ from the DSM-IV [273] criteria for major depressive disorders. Consequently, the authors
have developed observer-based definitions of 30 symptoms [411] (Level QE). Complicated grief
disorder was characterised by a smaller set of the assessed symptoms. These include bereavement
(loss of spouse, other relative or intimate partner) occurring at least 14 months ago (12 months
is avoided because of possible intense reactions around the anniversary date).
The following common experiences were also identified as characteristic of complicated grief
disorder: [411]
• intense intrusive thoughts;
• pangs of severe emotion;
• distressing yearnings;
• feeling incredibly alone and empty;
Guidelines for a Palliative Approach in Residential Aged Care 175