Aging is associated with declines in physical and brain health, including decreased brain weight and blood flow as well as increased amyloid plaques and tangles. Some memory problems may occur in normal aging along with changes in sleep patterns and increased anxiety or fearfulness. The process of dying typically involves stages of denial, anger, bargaining, depression, and acceptance according to Kübler-Ross. Bereavement or normal grief generally subsides within 1-2 years, though special occasions may trigger return of symptoms, while complicated bereavement resembling depression is characterized by more severe and long-lasting symptoms.

1. Aging, Death, and
Bereavement
Lijodi Brenda

2. AGING

3. Somatic and neurologic changes in aging
 Strength and physical health gradually decline.
 Changes in the brain occur with aging. These changes include
 Decreased brain weight, enlarged ventricles and sulci, and decreased cerebral
blood flow.
 Amyloid (senile) plaques and neurofibrillary tangles are present in the normally
aging brain but to a lesser extent than in neurocognitive disorder due to
Alzheimer’s disease. Neurochemical changes that occur in aging include decreased
availability of neurotransmitters such as norepinephrine, dopamine, γ-
aminobutyric acid, and acetylcholine. These changes can be associated with
psychiatric symptoms such as depression and anxiety

4. Cognitive changes in aging
 Some memory problems m ay occur in norm al aging

5. Psychological changes
 In late adulthood, there is either a sense o ego integrity (i.e., satisfaction and
pride in one’s past accomplishments) or a sense o despair and worthlessness
(Erikson’s stage of ego integrity vs. despair). Most elderly people achieve ego
integrity.
 Psychopathology and related problems
 Depression
 Sleep patterns change, resulting in loss o sleep, poor sleep quality, or both
 Anxiety and ear ulness m ay be associated with realistic ear-inducing
situations (e.g., worries about developing a physical illness or alling and
breaking a bone).

6. STAGES OF DYING AND
DEATH

7. Stages
 According to Dr. Elizabeth Kübler-Ross, the process of dying involves five
stages: denial, anger, bargaining, depression, and acceptance
 Denial. The patient re uses to believe that he or she is dying. (“The
laboratory made an error.”)
 Anger. The patient m ay become angry at the physician and hospital stay . (“It
is your adult that I am dying.
 Bargaining. The patient may try to strike a bargain with God or some higher
being. (“I will give half of my money to charity if I can get rid o this
disease.”)
 Depression. The patient becomes preoccupied with death and may become
emotionally detached

8. Stages
 Acceptance. The patient is calm and accepts his or her ate

9. Bereavement

10. BEREAVEMENT (NORMAL GRIEF) VERSUS
COMPLICATED BEREAVEMENT (DEPRESSION)
Characteristics of normal grief (bereavement)
 Grief is characterized initially by shock and denial.
 In normal grief , the bereaved m ay experience an illusion that the deceased
person is physically present.
 Normal grief generally subsides after 1–2 years, although some features may
continue longer. Even after they have subsided, symptoms m ay return on
holidays or special occasions (the “anniversary reaction”).
 The mortality rate is high or close relatives (especially widowed men) in the
first year of bereavement.

11. Normal vs abnormal bereavement
Normal Grief Reaction (Bereavement)
 Minor weight loss (e.g.< 5 pounds)
 Minor sleep disturbances
 Mild guilty feelings
 Illusions
 Attempts to return to work and social
activities
 Cries and expresses sadness
 Severe symptoms resolve within 2
months
 Moderate symptoms subside within 1
y
Complicated Grief Reaction
(Depression)
 Significant weight loss (e.g., >5% of
body weight)
 Significant sleep disturbances
 Intense feelings of guilt and
worthlessness
 Hallucinations or delusions
 Resumes few, if any, work or social
activities
 Considers or attempts suicide
 Severe symptoms persist for >2 mo