Tuesday, July 20, 2010

Death of friends in the senior years

Bereavement counseling is quite prevalent, a needed sub-specialty of counseling, of course. There are some grief support groups (including spousal and child loss) in my area, although not as many as I think there ought to be. Then, especially connected with hospital settings, one can find a number of groups for those who have lost a baby or a pregnancy. And now, there are groups and therapists who work with those who have lost a beloved pet. All very necessary and commendable.

I wonder though, how much outreach is there for people whose longtime friends have passed away, especially when the deceased and the survivor are seniors? I'm thinking that, beyond the quick "Oh, I'm so sorry about your friend..." that there isn't much done to help the elderly person process their loss. After all, what do you expect? These folks are old, and old folks die someday. Surely they know that.

I was a case manager to home-bound, frail clients in Pasadena several years ago, and often saw seniors who were lonely and profoundly sad. When the subject came up about any social connections these seniors had, so often I heard, "All my friends are dead now." Their eyes would drift off, as if they could somehow make a U-turn down the road of life, and catch up with these old pals who were no longer making the journey with them. How many people, including me, were too busy to sit for awhile, and ask them to talk about these friendships, which, when gone, took a vital piece of our clients' lives with them?

My mother is now 85, and is one of the surviving members of a close, lifelong group of three friends. One of these ladies, who first met my mother when they were five years old, passed away suddenly about 18 months ago. It shocked my mother and the other friend, because they never imagined that "Betty would be the one to go first." In addition to being an unexpected and painful reminder of their own mortality, Betty's passing underscored how each of us occupies a unique position in others' psyches. When we are then permanently absent, it leaves our survivors with the task of making sense of the void. No more birthday cards or Christmas greetings exchanged, one less person who shares the web of memories that make up our consciousness...

Recently, Mom's other surviving buddy wrote a letter detailing some serious medical events, including a stay in intensive care. Now this once fiercely-independent lady has a visiting practitioner who comes in and assists her tasks with medication and bathing. Luckily, she still has friends (younger) who can do the shopping and transporting to follow-up appointments.

Mom has often expressed concern, as the span between their frequent, lively letters gets increasingly long. She has said, "At our age, it could be any time for either one of us." And, of course, Mom and I both know the "it" to which she is referring--the brief note from someone saying, "I think you're were a friend, and I'm sorry to tell you....". And that's assuming that "someone" does bother to write.

Bereavement
is differentiated from depression in the DSM-IV-R (Diagnostic and Statistical Manual of the American Psychiatric Association)as an appropriate, expected expression of sadness upon the death of a loved one. If not acknowledged by the senior and any involved family, the mood can gradually worsen, and depression can set in, even mimicking mild dementia. For anyone who has been bereaved, you know that your thoughts can dwell upon the loss, impacting concentration as well as mood. If the relationship was less than smooth, the memories of the departed can become all the more complex and volatile.

I propose that those involved with any bereaved seniors test the waters...talk about the dead friend, if and when he or she is willing...look through scrapbooks or photo albums, if they're brought out. Ask about letters, shared classes, common interests, past decades of history...offer to take the senior to a burial site, if it's practical and appropriate to do so. It's risky, especially at first, to know the senior's readiness to engage in such a dialogue, but far better than not acknowledging the loss of someone important to them.

I'm concerned about my mom, especially if she survives this last friend. That's why I want to not be afraid to be there for her, nor do I want to avoid saying something for fear that it's "not the right time." Through any tears and the reminiscing she's willing to show, I'll use my instincts and compassion to let Mom show me parts of her life and her self that were represented by her friend. That's how healing and resolution for our seniors can take place, and we adult children become enriched by the experience.

In my private practice, I invite anyone grappling with the problem of how to support their senior loved ones with bereavement and the fear and depression that may follow. Dialogue is one the most basic means of healing, but it's amazing how much it is avoided. For further information about my services, please refer to www.midlifecrisesrecovery.com.
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