What are grief and bereavement?
Grief and bereavement are natural parts of life. [1] Grief is a physical, cognitive, behavioural, social, cultural, spiritual and philosophical response to loss. [1-3] Bereavement refers specifically to grief following the death of a significant person. Grief is shaped by life experiences, relationships, and culture and can begin before death. [2,4] Pre-death (or ‘anticipatory’) grief is common in older adults facing declining health, identity, and social connections. For most, grief eases over time, but if it persists beyond 6–12 months, it may develop into prolonged grief disorder. [1,4-6]
Why grief and bereavement matter in aged care
Grief and bereavement are central to aged care, affecting older people, families, and staff. Supporting these experiences improves emotional wellbeing. [3-5] The quality of care given before, during, and after death profoundly affects the family's bereavement experience. [5] Transitioning a loved one into aged care can be distressing, and support—both formal (social work, pastoral care) and informal (open communication and family involvement in care)—can help ease grief and loss. [5]
The National Palliative Care Standards highlight the need for grief support, reassurance, and acknowledgment of loss (Standard 6). [7] The Aged Care Quality Standards (Outcome 5.7, Action 5.7.3) also require services to inform families and carers about dying, loss, and bereavement. [8,9] Screening for bereavement needs and offering support are also essential to safe and high‑quality end‑of‑life care. [10]
Loss and grief among aged care residents
Older people often experience multiple losses—physical health, cognitive abilities, independence, and social connections—sometimes in close succession, compounding their emotional impact. [5] In close-knit aged care communities, the death of a fellow resident can be particularly distressing. Reactions vary depending on age, health, and past loss experiences. [3]
Grief among staff in residential aged care
Aged care staff often form meaningful and rewarding relationships with residents, making resident deaths a source of profound loss. Repeated experiences of death can lead to cumulative grief, emotional strain, and an increased risk of burnout over time. [3,11] Providing staff with grief support, education, and debriefing opportunities can help mitigate these challenges.
What does the evidence tell us
Most bereaved people (90%) do not require formal grief counselling, but all benefit from reassurance, acknowledgement of their loss, and access to appropriate information. [5,7] Timely conversations about care preferences, declining health, and expected death can positively impact grief and bereavement. [5] Prepared carers are often less likely to experience complicated grief. [5] Nurse-facilitated discussions can help families manage emotions. [5] Respectful after-death care and rituals, such as blessings, funerals, or memorials, provide emotional and spiritual value, helping family carers, staff, and other residents process their grief while honouring the person’s life. [4,5]
Care of people with dementia
Dementia involves multiple losses for both individuals living with the condition and their carers. [1,4,6,12] People with dementia may grieve their past selves, how others perceive them, and their future, often expressing this grief as depression in early stages or agitation and anxiety later. [4,6] Recognising and supporting this grief can help people with dementia express and cope with their experiences. [4]
Carers of people with dementia may experience grief before death due to ongoing and anticipated losses. This can put them at higher risk of complicated grief, depression, and anxiety during bereavement. [6,12-14] Support throughout the caregiving period, including after the person moves into residential care, can help mitigate these effects. [1,12]
The Marwit-Meuser Caregiver Grief Inventory (MM-CGI) is a self-rated tool that identifies the different types of loss carers experience. [13] Factors such as advanced dementia, behaviour changes, spousal caregiving, and daily caregiving demands may indicate a need to assess carers for pre-death grief. [13] Emerging research identifies 'dementia grief' as a distinct form of grief, [12] with promising interventions available. [6]
Cultural considerations
Culturally sensitive bereavement care acknowledges and respects the diverse cultural backgrounds of older people, incorporating unique mourning practices, rituals, and beliefs about death. This approach helps older people feel understood and supported, reducing isolation and improving their ability to cope with grief. [15,16]
Cultural competence training equips staff to address diverse needs. Using culturally appropriate resources and practices, such as recognising the role of family and variations in communication styles and grief expressions, strengthens bereavement support. [17] Staff should also be aware of relevant community resources.
Implications for families
Families may struggle with grief before, during, and after a relative’s death. [5] Moving a loved one into aged care or providing care at home can be emotionally challenging. Clear communication, involving families in care decisions, and acknowledging their grief can help ease these challenges and provide reassurance. [5,14]
Pre-death grief is common, especially for families caring for a person with dementia or serious illness. Witnessing decline, adjusting roles, and preparing for death can create emotional distress before bereavement itself. [4,5,13,14] Supporting families and carers during this period can help ease their long-term grief. [5]
Considerations for home care
Providing care at home can be emotionally and physically demanding, making access to clear guidance, emotional support, and practical resources essential. [18] Bereavement support in home care includes open conversations about care preferences, preparing families for death, and addressing emotional needs before and after the person’s passing. Carers benefit from grief support, culturally appropriate care, and access to bereavement services. Having these resources may help them feel less alone and better able to manage their loss(es). [18]
Page updated 19 February 2025