Life After Loss: Easing Grief for the Surviving Spouse
From Focus on Healthy Aging - February 2008
Experts recommend staying close to family and friends during the grieving process and getting professional help if needed.
When a wife or husband loses a spouse, be it suddenly or after a prolonged illness, the mental and physical stress can be devastating. But if the surviving spouse can turn to relatives, friends, and mental health professionals for support, even the worst days can become bearable.
Caregivers and surviving partners face an increased risk of depression and other mental health and substance abuse disorders, according to a study reported in the September issue of the American Journal of Geriatric Psychiatry (AJGP).
Because of that heightened risk, researchers suggested that caregivers and survivors — particularly those who have a history of depression — be directed toward mental health counseling as early as possible. Such assistance could help prevent later mental and/or physical problems.
It's important to look at symptoms beyond the initial weeks following the death of a spouse, says psychiatrist Judith Neugroschl, MD, director of the Geriatric Psychiatry Fellowship at Mount Sinai School of Medicine.
"Things to watch out for are symptoms of major depression," Dr. Neugroschl says. "These include being unable to care for oneself, not eating or sleeping, wanting to die, and having frank hallucinations — not illusions — of hearing the deceased's voice, or seeing a shadow and thinking it is the deceased. These types of symptoms suggest the need for a consult with a mental health professional and possibly the addition of medication and/or counseling to help the process of bereavement."
Treating depression. Depression is usually treated primarily through psychotherapy, with antidepressants, or a combination of both therapies. A study reported in the October 2005 Annals of Behavioral Medicine suggested that depressed patients have the best results with the therapy they think will be the most effective at the outset. In other words, if you believe that psychotherapy alone will work best for you, then you’re likely to have the most success with that approach.
Among the most common antidepressants are fluoxetine (Prozac), sertraline (ZXoloft), and paroxetine (Paxil). Side effects can include nausea, headaches, and insomnia, but if you report your side effects and responses to your doctor, alternative medications or different dosages can be prescribed.
An estimated 70 percent of depressive patients respond well to a combination of psychotherapy and medications.
The grieving process. Dr. Neugroschl urges surviving partners, as well as their friends and family members, to understand that mourning is normal and differs among individuals. Some people may want to talk about the experience a lot, while others may be quieter or choosier about how often and with whom they share their feelings.
Dr. Neugroschl says it's okay to ask your family and friends to be flexible.
"Let friends know you're not shutting them out by not talking about it today," Dr. Neugroschl says. "It doesn't mean you're rejecting them or their companionship or help."
The key point for everyone involved is not to rush the process.
"It takes time to integrate the loss into one’s life, just as it takes time to reintegrate fully into the community," Dr. Neugroschl says. "That said, it's important to maintain social contacts and accept or reach out for help and support."
Your physical health. Stress, no matter what the cause, can have profound negative effects on your physical health, and caring for a dying partner and facing the world after a spouse's death can be among the most stressful events you can ever face.
Stress has been associated with high blood pressure, obesity, sleep deprivation, diabetes, and other conditions. It can also make you more vulnerable to the flu and other diseases.
Caregiver services, often operated through a local hospital, public health office, hospice, ore senior services office, can help provide a necessary outlet and important information to reduce the stress in your life.
Apart from the stress associated with long-term caregiving and bereavement, surviving a spouse can lead to other negative physical consequences. Caregivers often focus so much of their attention on others that they neglect their own health and fall into poor eating and sleeping patterns. They may also stop taking their medications and getting regular exercise.
The study in the AJGP also noted that among older couples, both spouses may help each other cope with various medical conditions — whether it's reminding each other about medication, helping with physical therapy, or driving to a doctor's appointment. When one of the partners dies, the survivor's relatives should try to evaluate the situation and, if they see a problem, discuss options with the person or step in themselves.
Mending the "broken heart." The loss of a loved one can also lead to a very real medical condition known simply as "broken heart syndrome," in which a person appears to have a heart attack or heart failure. In reality, according to a study reported in the Feb. 10, 2005 New England Journal of Medicine, a surge of stress hormones can temporarily "stun" the heart, leading to chest pain and shortness of breath.
Recovery from such events is obviously faster than from a real heart attack, but researchers determined that the levels of stress hormones in the body were three times that of a person actually experiencing a hear attack.
While the body can recover from the loss of a spouse with proper medical care, the survivor can spend the rest of his or her life coping with emotional good days and bad days.
To help widows and widowers realize how important they can be in the lives of others, Dr. Neugroschl strongly urges a connection to the community. She says research shows that surviving spouses who volunteered with community organizations eventually demonstrated a better quality of life, had less depression, and felt more in control of the events that shape their lives.
"It seems as if the greater the involvement the greater the positive impact," Dr. Neugroschl says.
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