While working with individuals with Alzheimer's disease and other dementing disorders presents many challenges for clinicians, none is more difficult than watching an individual who is cognitively impaired mourn the losses of life and those imposed by the dementing illness. There now is a body of literature on grief in caregivers, but little has been written to help clinicians understand or better support affected individuals who are experiencing multiple losses and yet whose insight, autobiographical memory, and connectedness to others is beginning to blur and fade. This article addresses current models of grief, examines the ability or inability of affected individuals to experience and resolve grief, and attempts to formulate questions that may ultimately allow clinicians and caregivers to better recognize and address the difficult issues of the grief response and mourning process in the person with dementing illness.
Get full access to this article
View all access options for this article.
References
1.
BossP. (2002). Ambiguous loss: Learning to live with unresolved grief (3rd printing). Cambridge, MA: Harvard University Press.
2.
BowlbyJ. (1973). Attachment and loss: Separation: Anxiety and anger (vol. 2). New York: Basic Books.
3.
BowlbyJ. (1977). The making and breaking of affectional bonds, I and II. British Journal of Psychiatry, 130, 201–210, 421–431.
4.
BrookmeyerR.GrayS., & KawasC. (1998). Projections of Alzheimer's disease in the United States and the public health impact of delaying disease onset. American Journal of Public Health, 88(9), 1337–1342.
5.
CohenD. (1991, May/June). The subjective experience of Alzheimer disease: The anatomy of an illness as perceived by patients and families. The American Journal of Alzheimer's Disease and Related Disorder, pp. 128–133.
6.
CotrellV., & SchulzR. (1993). The perspective of the patient with Alzheimer's disease: A neglected dimension of dementia research. Gerontologist, 33, 205–211.
7.
DavidP. (1991, July/August). Effectiveness of group work with the cognitively impaired older adult. The American Journal of Alzheimer's Care and Related Disorders & Research, pp. 10–16.
8.
DeBettigniesB. H.MahurinR. K., & PirozzoloF. J. (1990). Insight for impairment in independent living skills in Alzheimer's disease and multi-infarct dementia. Journal of Clinical and Experimental Neuropsychology, 12(2), 355–363.
9.
DiehlJ., & KurzA. (2002). Frontotemporal dementia: Patient characteristics, cognition, and behaviour. International Journal of Geriatric Psychiatry, 17(10), 914–918.
DokaK. J. (2002). Disenfranchised grief. New directions, challenges and strategies for practice. Champaign, IL: Research Press.
12.
FeilN. (2002). The validation breakthrough (2nd ed.). Baltimore, MD: Health Professions Press.
13.
FisherB. M.SegalD. L., & CoolidgeF. L. (2003). Assessment of coping in cognitively impaired older adults: A preliminary study. Clinical Gerontologist, 26(3/4), 3–12.
14.
ForceL. T. (2004). Grief therapy for cognitively impaired individuals. In DokaK. J. (Ed.), Living with grief: Alzheimer's disease (pp. 155–167). Washington, DC: Hospice Foundation of America.
15.
GundelH.O'ConnorM. F.LittrellL.FortC., & LaneR. D. (2003). Functional neuroanatomy of grief: An FMRI study. American Journal of Psychiatry, 160(11), 1946–1953.
16.
GwytherL. P. (1997). The perspective of the person with Alzheimer's disease: Which outcomes matter in early to middle-stage of dementia. American Journal of Alzheimer's Disease and Associated Disorders, 11(Suppl. 6), 18–24.
17.
HanyuH.AsanoT.SakamotoS.KogureD.IwamotoT., & TakasakiM. (1999). Is hippocampal atrophy a specific change for Alzheimer's disease?No To Shinkei, 51(11), 947–951.
18.
HebertL. E.ScherrP. A.BieniasJ. L.BennettD. A., & EvansD. A. (2003). Alzheimer disease in the U.S. population: Prevalence estimates using the 2000 census. Archives of Neurology, 60(8), 1119–1122.
19.
HoworthP., & SaperJ. (2003). The dimensions of insight in people with dementia. Aging & Mental Health, 7(2), 113–122.
20.
HurleyA. C.VolicerL.RempusheskiV. F., & FryS. (1995). Reaching consensus: The process of recommending treatment decisions for Alzheimer patients. Advances in Nursing Science, 18(2), 33–43.
21.
KitwoodT. (1990). The dialectics of dementia: With particular reference to Alzheimer's disease. Ageing and Society, 10, 177–196.
22.
KitwoodT. (1997). The experience of dementia. Dementia Reconsidered (pp. 70–85). Philadelphia, PA: Open University Press.
23.
KitwoodT., & BredinK. (1992). Towards a theory of dementia care: Personhood and wellbeing. Ageing and Society, 12, 269–287.
24.
Kübler-RossE. (1969). On death and dying. New York: Macmillan.
25.
LaiF., & WilliamsR. S. (1989). A prospective study of Alzheimer disease in Down syndrome. Archives of Neurology, 46, 849–853.
26.
LazarusR. S., & FolkmanS. (1984). Stress, appraisal and coping. New York: Springer Publishing.
27.
LindemannE. (1944). Symptomatology and management of acute grief. American Journal of Psychiatry, 101, 141–148.
28.
McKhannG.DrachmanD.FolsteinM.KatzmanR.PriceD., & StadlanE. M. (1984). Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-AADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology, 34, 939–944.
29.
NeimeyerR. P., & JordanJ. (2002). Disenfranchisement and comparative failure: Grief therapy and the co-construction of meaning. In DokaK. J. (Ed.), Disenfranchised grief: New directions, challenges and strategies for practice. Champaign, IL: Research Press.
30.
NoyesL. E. (2002). Loss and Alzheimer's disease. In DokaK. J. (Ed.), Living with grief: Loss in later life (pp. 59–70). Washington, DC: Hospice Foundation of America.
31.
ParkesC. M. (1970). The first year of bereavement: A longitudinal study of the reaction of London widows to death of husbands. Psychiatry, 33, 444–467.
32.
PhinneyA. (1998). Living with dementia: From the patient's perspective. Journal of Gerontological Nursing, 24(6), 8–15.
33.
RandoT. (1984). Grief, dying and death: Clinical interventions for caregivers. Champaign, IL: Research Press Company.
34.
RandoT. (1993). A perspective on loss, grief, and mourning. In RandoT. (Ed.), Treatment of complicated mourning (pp 19–77). Champaign, IL: Research Press Company.
35.
RandoT. (2000). Clinical dimensions of anticipatory mourning: Theory and practice in working with the dying, their loved ones, and their caregivers. Champaign, IL: Research Press Company.
36.
RaushiT. M. (2004). Something was not right. In DokaK. J. (Ed.), Living with grief: Alzheimer's disease (pp. 99–109). Washington, DC: Hospice Foundation of America.
RentzC. A. (1995). Reminiscence: A supportive intervention for the person with Alzheimer's disease. Journal of Psychosocial Nursing and Mental Health Services, 33, 15–20.
39.
RonchJ. (1996). Mourning and grief in late life Alzheimer's dementia: Revisiting the vanishing self. American Journal of Alzheimer's Disease and Other Disorders. 11, 25–28.
40.
SabatS. R., & CollinsM. (1999). Intact social, cognitive ability, and selfhood: A case study of Alzheimer's disease. American Journal of Alzheimer's Disease and Other Disorder, 14(1), 11–19.
41.
SabatS. R., & HarréR. (1992). The construction and deconstruction of self in Alzheimer's disease. Ageing and Society, 12, 443–461.
42.
SammutA. (2003). Developing an appropriate response to emotional pain. Journal of Dementia Care, 11(2), 23–25.
43.
SnyderL. (2000). Speaking our minds: Personal reflections from individuals with Alzheimer's. New York: W. H. Freeman and Company.
44.
SnyderL.QuayhagenM. P.ShepherdS., & BowerD. (1995). Supportive seminar groups: An intervention for early stage dementia patients. The Gerontologist, 35(5), 691–695.
45.
TrabertM. L. (1996). Living in the moment: Support in the early stages of Alzheimer's disease. Activities, Adaptation & Aging, 20(4), 1–20.
46.
VolicerL.RheaumeY.BrownJ.FabiszewskiK., & BradyR. (1986). Hospice approach to the treatment of patients with advanced dementia of the Alzheimer's type. Journal of the American Medical Association, 256, 2210–2213.
47.
WeiskrantzL. (1997). Consciousness lost and found. Oxford: Oxford University Press.
48.
WordenJ. W. (2002). Grief counseling and grief therapy: A handbook for the mental health practitioner (3rd ed.). New York: Springer Publishing Company.
49.
YaleR. (1994). Early stage Alzheimer's patient support groups: Research, practice and training materials. San Francisco, CA: Special Project Press.
