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CHCAC317A Support the older person to maintain their independence

Reading 4: Support the older person who is experiencing loss and grief

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Contents

Reading 4: Support the older person who is experiencing loss and grief 1 Introduction 4 Recognise signs that older person is experiencing grief and report to appropriate person 5 Ageing and loss 5 What is grief? 6 Signs of grief 9 Reporting to supervisor 10 Self care 11 Use appropriate communication strategies when an older person is expressing their fears and other emotions associated with loss and grief 12 Practical approaches 14 Appropriate communication skills 15 Inappropriate communication strategies 16 Provide the older person and/or their support network with information regarding relevant support services as required 17 Professional assistance 18 Local support services for the bereaved person 21

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Reading 4: Support the older person who is experiencing loss and grief

Introduction Change is a natural part of life and a significant part of the experience of ageing. The changes that come with ageing are often associated with loss, and loss can be physical, emotional, physiological and social. Grief is the natural response to loss and is experienced in many ways. There is no right or wrong way to grieve; it is the central part of the healing and recovery process after any loss.

Rather than avoiding or ignoring the issues that people who are ageing may face in relation to grief and loss, it is important that aged care workers become involved in support to the person’s emotional health and wellbeing during such times. People who are ageing and their families need access to good informal and formal supportive networks to help them to look to the future in relation to death and bereavement, and to help manage grief and loss. People who are ageing need to be included in the customs normally associated with death and dying, grief and loss, and emotional responses.

It is important to have a clear idea of the key terms used to describe loss and grief:

Loss: Loss is the ending of our attachment to someone or something. It produces changes in relationships and everyday activities. Losses that involve significant people or things have more powerful effects. Examples of losses include: death, separation, divorce, migration, amputation, imprisonment and chronic ill health.

Grief: Grief is the emotional response to a significant loss. It can involve a wide array of emotions including sadness, shock, anger, guilt and depression. Grief can affect someone physically, psychologically and behaviourally.

Bereavement: Similar to grief, bereavement refers to the emotional reactions experienced after a significant loss such as death. It is often used to describe the period of time when someone is grieving.

The bereaved: The bereaved are the survivors of a recently deceased person.

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Recognise signs that older person is experiencing grief and report to appropriate person

Ageing and loss

As we age we face many changes. Some changes will be experienced as loss and some will not; loss and grief are very personalised processes and different people may attach different significance to similar experiences.

There are different types of loss, including social, physical and psychological.

Social losses can include:  retirement – loss of status and income  loss of home – loss of neighbours, social networks, pets  death of partner, family members and friends  loss of driver’s license and inability to maintain social activities.

Physical losses can include:  illness and hospitalisation  disability or limitations in physical functioning  disruptions to body systems  loss of mobility  reliance on medication  chronic pain.

Psychological losses can include:  loss of independence  loss of physical attractiveness  cognitive changes such as memory loss  loss of individual personality due to dementia  changes to mental health  loss of self esteem  changes to identity  loss of value in society.

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What is grief?

Grief is a normal reaction to significant or multiple losses. According to the Australian grief counsellor McKissock (1998) there are some basic principles for understanding grief:  it is normal and healthy to express intense and painful emotions relating to loss  grief is important for healing the wounds of separation  a bereaved person may experience a wide range of feelings – shock, sadness, anger, guilt and despair as well as hope and acceptance  the painful feelings will diminish with time – if they remain intense and prolonged then professional help may be required  a total absence of grief, when a person carries on as if nothing has happened, is not a healthy sign and may indicate the need for professional help  a bereaved person may be more prone to illness, both physical and psychological.

There are many models (theories) of grief that help us understand what grief is and how we can assist a bereaved person. Most models focus on death but they can equally be applied to other areas of loss.

Kubler-Ross’s stages of grief

Elizabeth Kubler-Ross, a Swiss-born psychiatrist, developed the ‘Stages of Dying’ while working with terminally ill people and their families in the 1960s in the USA. At the time Kubler-Ross’s work was ground-breaking because prior to this very little emotional and psychological support was offered to the dying person and their family.

She conceived grief as a series of emotional stages a bereaved person moves through: denial, anger, bargaining, depression and acceptance. In her later work she emphasised that people vary in how they work through the stages.

Denial: Denial is resistance and avoidance, a pulling away from the present. It is represented by the dying person who says, ‘No! This can’t be true, there must be some mistake’. Denial is functional in that it is a way of protecting ourselves from what is too frightening and painful to handle. Usually, the person gradually lets the truth in, at his or her own pace. ‘I know this is happening, but I can’t believe it’.

Anger: As a person gradually accepts the reality of what is happening, anger is likely to arise. People can feel angry about the unfairness of dying; they may feel anger towards God, family, medical staff or themselves.

Bargaining: Bargaining is a way of gaining some control; it is an attempt to gain time or push back the inevitable. There is more acceptance at this stage

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but still a desire to postpone death by striking a bargain with someone – God, fate, doctors. There are also lots of regrets at this stage: ‘If only I hadn’t done that,’ ‘If only I hadn’t smoked,’ ‘From now on I’ll…’

This from of negotiation offers something in the hope of getting what is wanted in return. Eg ‘If I live til my granddaughter’s birth I’ll give part of my estate to the Church’.

Depression: When the bargaining fails and the reality is unavoidable, the person may slip into depression. Like all the stages this is seen as progressive and part of the overall movement of the person towards acceptance.

Acceptance: Acceptance is seen as achieving peace, adjusting to the present and not fighting or protesting the future. It is not meant to be resignation or forced acceptance, but rather a genuine reflection of our place in the universe.

Journalist Stewart Alsop, who was dying of cancer, described the stage of acceptance in the following way:

‘A dying man needs to die as a sleepy man needs to sleep, and there comes a time when it is wrong, as well as useless, to resist.’ (Aiken 1991, p.211)

Kubler-Ross stressed the importance of not crushing or denying people’s hope; she believed that even at the stage of acceptance people harbour some hope that their fate can be altered. While very supportive of honesty when working with people who are dying, Kubler-Ross was particularly opposed to the practice of giving people a definite prognosis in terms of how many years or months they had left (Kubler-Ross 1969).

Understanding the stages helps us understand what people need and how to respond appropriately. Kubler-Ross felt that most people have a strong need to deal with unfinished business and say goodbye. Many people who are dying are denied this opportunity because of the strong resistance of those around them who may not be able to deal openly with dying.

Unfinished business is what people feel is necessary to complete or come to terms with before they die. It may be practical things like funeral arrangements or financial bequeaths or it may be confronting a long standing relationship problem.

Despite the usefulness of this foundational model, there are a number of drawbacks. People do not necessarily move through these stages in any fixed order. They may miss a stage, revisit a stage, or experience some of the stages at the same time. It would be wrong to use this model to predict how a person should grieve. Kulber-Ross herself acknowledged the individualistic and complex nature of grief.

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McKissocks’ theory of grief

Another model for understanding grief has been developed by the Australian grief counsellors Dianne and Mal McKissock. This model considers grief to be non-linear and individualistic, somewhat like chaos theory.

Chaos theory: Chaos theory has its origins in mathematics, computer science and meteorology. It sees the universe as obeying fundamental physical laws, but with a predisposition for disorder, complexity and unpredictability. The McKissocks felt this view of the universe suited the state of grief.

Their theory helps us understand that there are so many variables in bereavement that no one will be able to predict exactly how someone will respond. McKissock compared the model to predicting the weather. We may know what summer weather is generally like but on any one day, the actual weather will be impossible to predict exactly.

The McKissocks point out that there is no correct way to grieve; we all experience grief in our own individual way and is not possible to reinstate the past although this is the key desire of most grieving people. There are many other factors that affect grief especially family and gender patterns of coping, involvement in rituals around loss, cultural differences, religious and personal beliefs and availability of support networks.

Complicated grief is intense pain over extended periods of time. There are some obvious risk factors which contribute to complicated grief reactions:  suddenness of the death  death of a child  trauma  centrality or importance of the relationship  preventability  ambivalent or conflicting feelings such as love and hate towards the person  pre-existing factors such as disability, ill health or drug and alcohol problems  ongoing crises and changes  overly prolonged death  lack of reality where there is no tangible evidence of the loss such as someone just disappearing.

According to the McKissocks, to support a grieving person you need to be able to sit in the chaotic state of their grief, without trying to control it. The chaos needs to be seen as a normal part of the healing process, a step towards an eventual new order. This process can take a long time and even

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when a new order is reached there can be resurgences of the chaos as the bereaved adjust to the new order.

Signs of grief

Reactions to loss and grief are very individual, and each of us will experience unique responses to change, loss and grief.

Models of grief point out that each of us will experience unique responses to loss. Significant losses will require wide ranging adjustments to daily living and re-orientation to new social roles, relationships, activities and routines.

The process of grief is not without intense pain. It requires considerable ‘work’ and energy to develop new ways of living and perceiving the world.

Worden (2002) called the grief process ‘grief work’ to emphasis that the process of grief is not without intense pain and it requires considerable ‘work’ and energy to develop new ways of living and looking at the world after a loss.

Worden identified a variety of signs that indicate a grief reaction: behavioural, psychological, emotional, and physical.

Behavioural signs: These signs can range from crying, sleep disturbances, sighing, restlessness and over-anxiety, appetite disturbance, absent- mindedness, searching or calling out for the deceased, social withdrawal, dreams of the deceased, treasuring objects to avoidance of reminders of the deceased person, to visiting places as reminders of the deceased.

Psychological signs: Signs of psychological grief may range from disbelief, confusion, preoccupation, sensing the dead person’s presence to hallucinations.

Emotional signs: Signs can vary from sadness, anger, guilt, inadequacy, hurt, relief, and loneliness to anxiety and fear.

Physical signs: Signs of physical grief can vary from lack of energy, over- sensitivity to noise, breathlessness, dryness of mouth, muscle weakness, tightness in chest and or throat to hollowness in the stomach.

Bereaved people can be highly critical of themselves for experiencing some of these reactions, yet it is very important to realise that they are all normal. Our society can make it difficult for bereaved people by dictating how a person should grieve and for how long.

It is common for bereaved people to be given unhelpful advice such as:  ‘You need to get on with your life for the sake of x, y and z’  ‘Try and forget about it’

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 ‘Don’t be sad, he had a good innings’  or the common saying ‘Every cloud has a silver lining’.

These sayings do not demonstrate respect for each person’s unique experience of grief; they also deny the intensity of the feelings associated with grief.

Reporting to supervisor

Grief is an intense emotional reaction and it will be helpful for you to seek advice from your supervisor or members of your team about the best way to respond.

When reporting to your supervisor you will need to appreciate the person’s religious beliefs and any rituals the they need to perform. Rituals are a form of communication. Human beings, unlike most other animals, have developed many rituals around death. These rituals can be important for a number of reasons, they:  help the loss seem more real  bring family and friends together to express their grief in a public and shared way  allow community members to support each other  enable the life of the deceased to be reflected upon and celebrated  allow intense feelings to be ventilated  enable spiritual comfort.

Australia is a multicultural society and with this comes many different religions, social customs and beliefs. The five main religions come from different cultures around the world: Christianity, Buddhism, Islam, Hinduism and Judaism.

Given the multicultural nature of Australian society today, it is important for you to familiarise yourself with the varied death rituals that exist.

Avoid assuming that certain rituals apply to all people of a particular belief – it is important to allow for individual wishes

Religious and spiritual beliefs are important because they can help people who are dying and people who are grieving find answers to difficult life question such as:

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 is there an afterlife  what does it mean to have lived a fulfilling life  what legacy should we leave behind  can death provide release from mental and physical pain  what about forgiveness and peace?

Grief may be particularly distressing for people with dementia. Participation in familiar rituals may play an important role in developing a sense of control and calm as well as an avenue to appropriately ventilate feelings.

Many people with dementia continue to have religious and spiritual beliefs that are very important in their lives. You may need to adapt rituals so that they meet the person’s present needs and respect the beliefs that the person held prior to developing dementia.

Use words they would have been familiar with during their younger years including familiar songs or readings from religious texts. Use familiar objects and symbols to focus attention and emphasise simple repetitive

As an aged care worker you need to report and document any signs of grief that may be evident when caring for the aged person to your supervisor, so appropriate support or care can be obtained. Document and report signs of grief that you observe so that appropriate support can be provided. This is not a breach of confidentiality.

If there any risk factors for complicated grief are present discuss your observations as a matter of urgency.

Self care

When you chose a career in aged care did you visualise yourself working with people who were dying? It is important to develop very effective strategies to care for yourself and at times you may need to support your colleagues as well.

Working with people at the end stage of their life can be very rewarding and at times quite stressful. To work compassionately and effectively in this area you need to look after yourself.

Below are a number of strategies that may be helpful:  It is ‘normal’ to feel emotional about your work at times. Clients will affect you, perhaps remind you of someone you know or you may develop a special connection with them. It is generally helpful to acknowledge your feelings and thoughts to yourself.  Talk with other staff members to share your thoughts and feeling. May be there is a chaplain or staff support person who is available.

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 Develop strong support systems both inside and outside your workplace.  Talk to your supervisor if you are feeling stressed, distressed or not coping when you are caring for someone who is dying.  Rethink what it means to ‘cope’. Coping does not mean to have no emotions in relation to your work.  Maintaining optimal physical health will provide a solid foundation to balance the emotional stressors of caring for people at the end of their life.

Sometimes things will happen that surprise you. This doesn’t mean that you you’ve been less than competent, rather it’s the nature of grief work; intense, complex and unpredictable.

Use appropriate communication strategies when an older person is expressing their fears and other emotions associated with loss and grief Supporting the grieving person does not mean you have to find the right words to take away the pain of the loss. It is more valuable to listen non- judgementally and allow the person to feel and express themselves in the way they need to.

The following are some suggestions that may be of use should you be in a position where you need to support a grieving person:  Be present and available to the bereaved person and encourage them to tell the story of their loss and to talk about the deceased person.  Provide an appropriate environment for the grieving person in which emotions can be expressed freely and privately.  Accept that tears are healthy and normal.  Encourage expression of feelings and thoughts.  Accommodate the individual mechanisms to facilitate the grieving process.  Use appropriate communication skills – listen empathically.  If appropriate, use people like grief counsellors and religious representatives.  Offer practical help if appropriate.  Help the bereaved person to find social support if appropriate.

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 Remember ‘normal’ grief reactions are what are normal to the client, with their ‘normal’ determined by such factors as their family of origin, their culture, and their previous way of being in the world.  If something influences life it will influence grief: for example birthdays, Christmas, anniversaries. It can be useful for the bereaved person to plan what they will do on a milestone, like being with supportive people, visiting the grave, and reminiscing.  McKissock (1998) states the grieving person has the functional ability of an 8-15 year old; it can therefore be advisable to discourage bereaved people from making very important decisions.  Reminisce with the bereaved person; encourage them to tell stories and remember times with the deceased or life before the particular loss. Always use the deceased person’s name.  Remember grief is a stress reaction and responds to both active and passive physical activities like walking, meditating, praying.  Encourage the bereaved person to have structure to their day as it can help to give them a sense of purpose and control.  It is common to feel helpless when supporting a grieving person – this can mean you are feeling empathy for them.  Replacement or the holding onto possessions of the deceased person can be useful, as they are symbols which link the bereaved person to the deceased. They can be useful in dialoguing with the bereaved person about the deceased person.  Sometimes the bereaved person may do things that you don’t understand, but as long as whatever they are doing is not hurting them or anyone else then don’t worry.  It is common for the bereaved person to tell their loss story many times. If you listen closely it will be different each time – this is known as ‘transitional behaviour’ and is healing and healthy.  Grief is a stress reaction and responds to both active and passive physical activities like walking, meditating, praying.  Encourage the bereaved person to have structure to their day as it can help to give them a sense of purpose and control.  It is common to feel helpless when supporting a grieving person; this can mean you are feeling empathy for them.  It is useful to remember the transitional nature of grief – it will change over time.

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Practical approaches

As people experience the emotional chaos of grief, the practical, survival activities of life are often the ones that are neglected. As a carer, consider supporting the grieving person in practical ways such as:  carrying out routine household chores or arranging for these to be done by someone else  preparing nourishing meals  shopping  assisting with legal and financial paperwork, answering letters  encouraging physical exercise – a half an hour of walking or another physical activity everyday will assist the grieving person to maintain their health  answering the phone, talking to friends – it is often difficult for the grieving person to cope with well-wishers around them (they may not have the emotional resources at this time to deal with other people’s expressions of grief, so assist the grieving person to maintain necessary distance from other people).

By taking some of the practical workload from the grieving person you may lessen their experience of stress and give them the emotional space in which to grieve. However, feeling independent and capable are important aspects of healing after a significant loss. If people want to do things for themselves they should be given every opportunity to do so, even when it seems to be a struggle.

Involvement in sorting or cleaning the belongings of someone who has died may be a very practical way to experience and process grief. Sorting through or cleaning the belongings of someone who has died is often very therapeutic. It is a practical way to experience and process grief. The timing of this task is important; it is better to delay this for a while until the grieving person is ready. However take your cues for action from the grieving person; respect their choices and support their individuality. Never dispose of memorabilia without direct consultation with the grieving person. Resist well meaning relatives who think that this is a helpful strategy to ease pain.

Taking responsibility for things that are frightening, such as taking over the payment of bills after the death of a partner, may be a necessary step towards reintegration and acceptance. Take your cues for action from the grieving person; respect their choices, and support their individuality.

In the residential or community centre setting, a number of social and recreational activities may actively assist the grieving process. These activities include:  reminiscing

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 pets as therapy programs  music  gentle exercise  support groups  religious practices.

These are suggestions, not instructions – people need to be treated as individuals.

Appropriate communication skills

Supporting the grieving person does not mean you have to find the right words to take away the pain of the loss – it is more valuable to listen non- judgementally and allow the person to feel and express themselves in the way they suits them.

When communicating with a person who is grieving it is important to remember that their experience will be different from your own, even if you have experienced a similar loss. The following communication skills are worth considering when you are supporting a grieving person:  Create a safe emotional environment in which confidentiality is guaranteed and emotions can be freely expressed.  Listen more – talk less! This is an opportunity for the client to express their feelings. Advice is usually inappropriate.  Listen to the client’s body language and tone of voice. Non-verbal cues may give you more information about their feelings than what they are actually saying.  Accept the person the way he or she is at this moment.  Encourage the safe expression of feelings.  Reinforce personal responsibility and choice.

Some useful statements when listening to a grieving person are:  ‘Tell me…’  ‘Tell me what it’s like for you…’  ‘Hearing that makes me feel…’  ‘I feel I want to know (deceased person)’

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 ‘I’d like to hear about…’  ‘I feel…’

Statements to avoid:  ‘Be brave.’  ‘Let’s not talk about this, what did you do the other day?’  ‘Just remember the good times.’  ‘You’re going through the angry stage, it will pass.’  ‘If I were you I’d…’  ‘You’ll be stronger for this.’  ‘Why don’t you try…’  ‘Time heals all wounds.’  ‘I know just how you feel.’

Reminisce with the bereaved person and encourage them to tell stories and remember times with the deceased person or life before the particular loss. Always use the deceased person’s name.

Generally the first year after a loss is the most difficult and will require the most support.

Reflection: How have you experienced loss?

Consider now a time in your life when you experienced some form of loss. In terms of support, what did you find useful or what would you have found useful in helping you cope with your grief?

Feedback

Everyone will answer this question differently – there is no right or wrong when we are talking about loss and grief.

Inappropriate communication strategies

The following tactics are inappropriate when you are supporting a grieving person:

 If the person starts to talk about their grief, change the topic to something more positive.  Keeping the person very busy at all times as this will help them to avoid difficult emotions.  Discouraging too much crying as the person may become too distressed, it can also be too emotionally draining for the worker.  Avoiding sharing memories as it may bring up some painful memories for the person.  Encouraging the grieving person to move on and focus on their ‘new life,’ and discourage dwelling on the past.  Discouraging a grieving person from the retelling of their ‘loss story’ as it will only upset them.  Telling the grieving person that they will eventually get over their grief.

Don’t:  give advice  Try and take charge.

Provide the older person and/or their support network with information regarding relevant support services as required Grief and loss are stressors, things that cause stress. Stress is defined in very basic terms as strain, tension or a force that exerts pressure. While stress can be positive, it is typically an early warning signal that something is wrong; either that we are in immediate danger or that we are under stress which over time, if not diminished, could have an unhealthy result.

Stress is also physiological; it is intricately connected to body systems such as the endocrine system, the cardiovascular system, the respiratory system, the nervous system and the gastrointestinal system to name a few. When the body detects stress instantaneous messages are sent to the brain that cause multiple reactions throughout the body. Persistent exposure to these effects of stress can cause long term health problems; the source of the stress needs to be understood and responded to.

Sometimes grief related stress can be alleviated by practical measures such as basic domestic support, transport, home modifications, nursing services, meal delivery and respite care.

HOME Hospice at: http://www.homehospice.com.au/ is available to support people who would like to die at home – their site can be accessed from: http://www.homehospice.com.au/

They organise mentors and volunteers to support individuals, families and communities provide essential support services. Their aim is to:  empower people to participate in the care of those who are dying  change attitudes and values through engagement with dying and death.

There are many other support services in the community that could be useful for the older person and/or their support network:  local councils  community health centres  aged care services  social workers at public hospitals  Centrelink advisors  Care Resource Centres  church and religious organisations  Neighbourhood Centres  self help groups.

Professional assistance

It is important to identify when a person may need extra professional assistance. The following are some examples of behaviour that may indicate the grieving person may need some professional help in order to cope with their grieving process.

Normal grief reactions do abate over time. Occasionally some people experience prolonged periods of grief which require professional assistance.

The following indicators suggest that the grieving person may need some professional help in order to cope with their grieving process:

Distress: When painful emotions remain intense and prolonged it may be a sign that the grieving person requires extra help. Remember that there is no set time period for grieving. A mentally healthy person will experience a range of emotions. When the grieving person spends extended periods of time in intense emotional pain without relief, professional help may be required.

A total absence of grief: If the bereaved person carries on as if nothing has happened, professional help may be required. A bereaved person who has

not successfully grieved is more prone to illness, both physical and psychological.

Depression: Intense sadness is a feature of the grieving process. This is not clinical depression and does not require medical treatment. However, if the grieving person remains in a state of deep sadness over an extended period this may indicate that they are developing clinical depression and professional assistance may be required.

Some symptoms of depression to watch for include:  loss of motivation to perform basic survival activities such as personal hygiene, eating, dressing, etc  thoughts of suicide  social withdrawal over an extended period of time  persistent insomnia  persistent feelings of anxiety and hopelessness  agitation and irritability  eating too much or too little  persistent inability to concentrate, remember things and make decisions.

Suicidal tendencies

Suicide risks increase for older people because:  the ageing process poses multiple menaces to physical, social and mental health, and not all people are as resilient as others  older people experience significant and multiple losses  there are fewer people to monitor their psychological health  health workers tend to focus attention on physical health  people from culturally and linguistically diverse (CALD) communities may experience immigration stresses or refugee trauma  what constitutes quality of life is a hugely individualised notion and some older people earnestly believe that they do not have a meaningful existence.

To help protect older people who may be at risk of suicidal behaviour or who have suicidal ideas, it is vital that aged care workers:  acknowledge their own attitudes towards suicide and be non- judgemental  listen and be patient

 take the perspective of the older person not your own, this allows you to build empathy and understand situations from the other person’s perspective  build trust and engage in conversations with older people where it is normal to talk about their feelings and complicated health issues  let them know that you are willing to talk about difficult situations and that their confidentiality will be protected unless you fear there is an immediate risk of harm to themselves or someone else.

You can get a copy of the Suicide Prevention for Older People: Training Manual from the website: http://www.health.nsw.gov.au/pubs/2003/suicide_prevent.html

Physical illness

Physical aches and pains, and increased vulnerability to infection are normal responses to intense stress and grief. However, persistent symptoms should not be ignored. Medical advice should be sought to ensure that there are no other health problems.

Social isolation

Talking about the loss and grief is the most significant tool to assist the healing process. People who do not have the social contacts such as family, friends or community groups, or who for personal reasons do not want to share their feelings with these people, may find it helpful to talk to a professional counsellor or join a self-help group.

It can be useful to identify any services in your community that may be useful to the grieving older person. You will also need to familiarise yourself with the referral process of the agency you are working for.

Alcohol and other drugs

The misuse of alcohol or other drugs (sometimes called substance abuse) in older populations may seem strange; we rarely think of older people as ‘drug abusers’. Yet older people are prescribed a variety of drugs of addiction and may self medicate with legally available drugs such as alcohol and pain killers.

Drug and alcohol use can be used to reduce stress. Medications to calm and induce sleep are not uncommonly prescribed during bereavement, especially during the early stages. Over reliance on alcohol and other drugs can cause serious ongoing emotional and physical health problems and greatly complicate the resolution of normal grieving.

Older people are more at risk of alcohol and drug related harm because:  tolerance for alcohol generally decreases as a person ages, this means that the effects of alcohol on the brain will be greater

 all drugs can interact with prescribed medication  there are increased risks of falls and accidents  alcohol and drug problems may be misdiagnosed because signs such as depression, insomnia, poor nutrition and frequent falls may be attributed to ageing

 alcohol is a seriously hazardous drug that can have multiple effects on the brain, liver, stomach and personal and social relationships.

If you think an older person may be misusing drugs and/or alcohol either to cope with bereavement or for other reasons, you need to talk to your supervisor first. Then raise it with the person in a non-judgemental way so that the person will feel free to talk about their concerns. It is advisable to tell clients that, as a priority, they should discuss their drinking and/or drug use with their doctor to identify possible drug interactions, and that they should drink less than the recommended safe drinking levels.

The prospect of giving up a drug is frightening and attempts to push the person into abstinence will be quickly diverted, ‘I only have a few quiet beers each night’. If harder you push the more likely to are to encounter resistance.

You can telephone a 24 hour support service called ADIS in your local area on 1800 422 599 or visit their website: http://www.nsw.gov.au/package.asp?PID=9538

Local support services for the bereaved person

It is important to identify services in your community that may be useful to the older person and their support networks. You need to familiarise yourself with what each service does and understand the relevant referral processes.

Support services in your area could include counselling services, support groups, workshops, phone services, websites or self help books.