Guidelines for a Palliative Approach in Residential Aged Care

follow-up visits to bereaved family members). For example, a simple ceremony, held annually
in the RACF chapel (or lounge) can provide an opportunity for aged care team members to
acknowledge the life and death of the residents who died in the last 12 months. This represents
a public acknowledgment that each resident’s life and death has not passed unnoticed, but
remains recorded in the RACFs history.
These types of bereavement support should take into consideration all personnel that work at
the facility, as well as other residents and families. However, not everyone will feel the need to
participate and this should also be respected.
15.4.4 Bereavement support for residents with advanced dementia
The mourning process is not exclusive to those who are cognitively able to manage the grieving
process. Residents with advanced dementia are also affected by grief and loss, but may not
have the cognitive skills to resolve or make sense of their grief. A resident’s fluctuating lucidity
may make it difficult for the aged care team and family to determine what the resident knows,
understands or comprehends regarding the death of another resident. Benbow and Quinn
(1990) [440] (Level QE) recommended that the aged care team be honest and consistent with
residents, allowing them time to grieve even if they forget the details. Protecting residents from
the truth can create greater confusion, because the story will not match the reality. Residents
with advanced dementia may need bereavement support for an extended length of time before
they can accept the reality of the loss.
15.4.5 Bereavement support for family members
Davidson (2003) [441] (Level EO) formulated an evidence-based protocol for family bereavement
support before and after the death of a resident that includes a number of bereavement support
interventions. One study assessed a range of psychosocial variables on family functioning
covering the experience of the illness, death and funeral, spousal health, family coping, sources
of support, use of ritual, and completion of estate duties [413] (Level QE). The authors concluded
that the nature of family functioning was a key aspect of social support in influencing the
outcome of bereavement [413] (Level QE). In other words, the more social support the family
had access to, the better they could cope with the bereavement [399,414] (Level QE; Level IV).
Grief responses are more likely to be difficult for spouses of residents due to recent multiple
losses such as friends or family [442] (Level QE). Additionally, for those spouses who were not
depressed prior to the death of their partner are more likely to be vulnerable to depression postbereavement
[324,443] (Level III-3; Level IV). A further concern is the development of emotional
loneliness, particularly for those older family members who have difficulty in making new
personal contacts due to social anxiety [444] (Level IV). These studies indicate the importance of
bereavement follow-up for family members, particularly when the resident has a spouse.
Often, listening to and understanding the multiple losses that a family member may have
experienced acknowledges their loss and validates their feelings [409] . Providing families with the
option to stay with the resident during the night can help reduce their concern that the resident
will die alone. Having been present with the resident during the last stages of the illness may
also provide them with a sense of comfort as they will have witnessed the care provided, they
Guidelines for a Palliative Approach in Residential Aged Care 179