Identifiable grief responses in persons with Alzheimer's disease

Various dementias alter many aspects of the life and interactions between older adults and their families. This is particularly true even in a context in which the emotion is one that is expected. One such experience is the grief related to the loss of a family member. Physicians, nurses, and family members in long-term care report that they frequently have residents for whom a primary loved one, such as a spouse, has died. Questions quickly surface as to whether or not to tell the senior with dementia, how to tell the person, and how that person's response will impact the family. In two separate focus groups these questions were discussed with a group of family members and an interdisciplinary group of physicians, nurses, nurse aides, and social workers connected to long-term care facilities in one mid-sized community. Three patterns of resident response were identified. "Self-threat" describes situations in which the individual responds to the announcement of the death by questioning who will take care of them now; substitution refers to the individual's inability to remember who has died and substitution with a relative who died years ago; and metaphone, substitution of an object or unrelated item for the loss of a loved one. The authors suggest that persons with dementia should be told in most circumstances that their loved one has died, but that behavioral interventions need to be designed to address the confusion that this announcement can initiate. Families need to be prepared that the senior may not respond in the ways they once would have to this loss.