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On this page:

• What is grief?
• Why should we care about grief in older people?
• What is prolonged grief disorder?
• How many people are affected?
• What are the risk factors?
• What is the difference between grief and depression?
• Useful links and further resources

What is grief?

Grief is the natural response to a significant loss, such as the death of a person. This response can vary and can affect people’s health, wellbeing and quality of life. Most people adjust to a loss over time. However, for some grief can persist, resulting in complicated or prolonged grief. This is when grief symptoms remain severe and impairing for longer than 6-12 months. Grief can even begin before the death of a person. This is called anticipatory grief, i.e. grief in anticipation of a loss.

Why should we care about grief in older people?

Older people are more likely to encounter the death of a loved one than any other age group and that alone should put them at the centre of bereavement support services. For example, 71% of adults over the age of 65 years have experienced at least one bereavement in the last 2.5 years, so it’s a very common experience for this age group. Contrary to the assumption that older people are used to grief and loss, our MARC research found that the repeated exposure did not necessarily make them more resilient or prepared. Instead, the accumulation of losses had a compounding effect on their physical and mental health. Since the number of bereavements will further increase over the next years as a result of the COVID-19 pandemic and the ageing population, we must direct the attention of clinicians, researchers and the public to the bereavement needs of older adults.

What is prolonged grief disorder?

Prolonged grief refers to grief that remains severe and impairing for a prolonged period of time. According to the International Classification of Diseases (ICD-11), the loss needs to be longer than 6 months ago, while the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) suggests a time period of longer than 12 months. Symptoms need to be present nearly every day for at least the last month to a clinically significant degree. Symptom of prolonged grief can include:

• Intense longing for the deceased
• Persistent preoccupation with the deceased
• Identify disruption, sense of disbelief, avoidance of reminders
• Difficulty reengaging with one’s life, activities or relationships
• Intense emotional pain, loneliness, or emotional numbness
• Feeling that life is meaningless
• Significant distress or impairment in personal, social, or occupational functioning after the loss.

DSM-5-TR criteria for prolonged grief disorder for clinicians

Source: ICD-11 and DSM-5

How many people are affected?

According to the DSM, the prevalence of persistent complex bereavement disorder is approximately 5%. However, MARC research shows that the prevalence of prolonged grief may be as high as 20% in adults over the age of 65 years, due to their frequent exposure to grief and loss. They should therefore be considered a high risk group.

What are the risk factors?

The risk for persistent complex bereavement disorder is heightened by increased dependency on the deceased person prior to the death, by the death of a child and by the bereaved person being female.

What is the difference between grief and depression?

Grief and depression can look similar and sometimes one can trigger the other or they can occur at the same time. It is, however, important to consider in which ways grief and depression are different. Both grief and depression often come with feelings of sadness but in grief these feelings are often focussed on the bereavement and associated with a strong yearning for the deceased, whereas in depression there is more of a generalised sadness. Feelings of guilt are also common in both grief and depression but in grief guilt feelings again focus on the bereavement or the circumstances surrounding the death, whereas in depression there are often more generalised feelings of guilt and worthlessness. One of the most noticeable differences is that grief comes in waves and people who are grieving are often still able to experience moments of joy and happiness despite their sadness. In contrast, feelings of depression are often more consistent and may present in continuous levels of low mood and sadness.

Useful links and further resources

• Brief overview of prolonged grief disorder
• Summary of diagnostic criteria
• Differentiate grief from depression/PTSD
• Interactive Prolonged Grief Screening Tool in multiple languages