Complicated and Prolonged Grief in Later Life

Complicated grief (now known as prolonged grief disorder) is much more than just experiencing grief “too long.” It is a type of grief that causes intense longing, impaired functioning, and a sense of being unable to adapt to your loss. Adapting to a loss doesn’t mean forgetting the person or loving them less. Instead, it means learning to accept the loss and the relationship while gradually finding ways to reengage with life.

Losing someone you deeply love can be a devastating experience for many, but it can look different depending on what stage of life you’re in. For older adults, the loss of a spouse, parent, child, sibling, or long-time friend can carry emotional distress, but it can also have unique challenges that are tied to later life. 

Understanding what complicated grief can look like in older adults can help you or a loved one find the right support to start the healing journey.

What complicated grief means

Complicated grief is an older term that has now been replaced by prolonged grief disorder, which is intense and persistent longing after the death of a loved one for more than a year. It can disrupt daily life and affect mental and physical well-being.

Common symptoms of complicated grief can include:

• Sense of disbelief about the death
• Feeling as though part of oneself has died
• Avoiding reminders of the person who has passed
• Intense emotions (sorrow, bitterness, anger) related to the passing
• Difficulty re-integrating into daily life
• Emotional numbness
• Feeling like life is meaningless without the person who has passed
• Severe loneliness

Factors that can contribute to complicated grief include self-blame, avoidant behaviors, inability to manage painful emotions, and lack of social support.

When comparing normal grief to complicated grief, a key difference is adaptation. Normal grief can be a natural, healthy adaptation to loss where intense emotions come in waves and slowly dissipate over time. In contrast, complicated grief disrupts adaptation, with the pain being intense and persistent.

How prolonged grief can look in older adults

Possible signs of prolonged grief disorder in the elderly include:

• Rarely leaving the house
• Withdrawing from relationships 
• Avoiding reminders of the loved one who passed 
• Preserving the home exactly as it was 
• Feeling unable to make decisions without the deceased
• Failing to care for basic needs or routines

Complicated grief can also have a significant effect on a senior’s emotional and cognitive health, including:

• Intense longing
• Disbelief about the loved one’s passing
• Guilt about the death
• Repetitive “what if” thinking
• Emotional numbness
• Bitterness
• Identity disruption
• Sense that life has lost its meaning

Some older adults may hide their emotions after a loss to not feel like a burden to their family and friends. They may complete daily activities as usual and appear composed, but on the inside, they remain internally preoccupied with the grief and feel unable to reconnect with their life. 

Healthy grief vs. complicated grief in older adults

There’s a difference between grief that remains a meaningful bond with a loved one and grief that begins interfering with daily life.

An enduring bond can look like:

• Loving memories that bring comfort and peace
• A warm, lasting inner link to your loved one
• The ability to continue daily activities without disruption
• Having waves of sadness, but the joy remains possible
• Accepting the finality of death

Complicated grief can look like:

• Intense and persistent yearning or longing
• The refusal to accept that the person is gone
• Feeling life is empty and meaningless without the person
• Avoiding reminders because it’s too painful
• The inability to handle daily responsibilities or maintain a social life

Understanding the differences between healthy grieving and prolonged grieving can help you know when professional help may be necessary.

Why grief can be harder to integrate later in life

Complicated grief in older adults after the death of a close loved one can not only remove emotional connection, but also identity, companionship, routines, transportation, financial stability, caregiving, and practical support. These factors can make it more challenging for some older adults to cope with grief in later life.

Certain risk factors associated with later life may contribute to complicated grief in older adults, such as:

• Previous losses
• Death being traumatic or unexpected
• High dependency on the deceased
• Social withdrawal or isolation
• Caregiving strain
• Limited support

Bereavement overload can also be a contributor to prolonged grief disorder. This occurs when you experience too many significant losses — such as multiple deaths or loss of home, health, independence — close together. Grief overload can lead to heavy exhaustion, numbness, and a sense of being overwhelmed. 

Old age doesn’t make the loss of a loved one easier

There’s a common myth that emotional distress is inevitable for older people or that they should be better prepared for death. While the loss of loved ones might be more common in later life, experiencing recurring loss doesn’t necessarily make seniors more resilient. 

Complicated grief, depression, and trauma are different

Prolonged grief disorder can share several characteristics with depression, but they’re completely different mental health conditions. Complicated grief leads to intense, persistent yearning and pain tied specifically to the death of a loved one, lasting more than 12 months. In contrast, depression is more about a general, persistent low mood, self-blame, and complete loss of interest across all areas of life.

The loss of a loved one can be traumatic, but there are some stark differences between traumatic grief and complicated grief. Traumatic grief can occur when a loved one dies in a sudden, unexpected, or violent manner. The shock of the death can merge with the pain of losing them. Complicated grief, on the other hand, happens when the normal grieving process stalls or doesn’t improve over time, lasting for a year or more. 

Additionally, while trauma-related symptoms are often tied to terrifying circumstances surrounding a loved one’s death, prolonged grief centers on the loss of and separation from the person who's passed. A person experiencing trauma may have intrusive memories of the death, avoid reminders of what happened, or feel constantly on edge or alert for danger. Someone experiencing prolonged grief disorder may experience significant separation distress and struggle to imagine life without the person who died.

Prolonged grief disorder, depression, and trauma can overlap, making a clinical assessment from a licensed mental health professional the best route to get a diagnosis.

What can help older adults with prolonged grief

If you’re the adult child, spouse, or friend of an older adult showing signs of complicated grief, you may be wondering what’s the best way to provide support.

Here are some do’s and don’ts to supporting someone dealing with prolonged grief:

Do:

• Listen without trying to “fix” their grief
• Invite them to spend time with loved ones, faith communities, and support groups
• Pay attention to signs that grief may be interfering with their daily life
• Encourage them to seek professional mental health help when possible

Don’t:

• Tell them to “get over it”
• Force them to socialize or engage in activities before they’re ready
• Assume that prolonged grief is a normal part of aging
• Make them think that seeking professional help means that they’re grieving “wrong”

For example, instead of saying “You really need to get out of the house,” a better way to show support is to say “I know things have been hard lately. Would you like to come over and have lunch tomorrow?”

Red flags to watch out for

Complicated grief can affect everyone differently. However, if you’re witnessing any of the following behaviors from your loved one, please seek professional support:

• Severe self-neglect
• Inability to meet basic needs
• Feeling that life has no meaning or purpose
• Increasing substance misuse

More severe signs that require immediate crisis intervention include:

• Talking about wanting to die or saying that they have nothing left to live for
• Engaging in self-harm
• Expressing suicidal intent

Watching a loved one suffer from prolonged grief disorder can be difficult, but you can help them find healthier ways to cope. 

Complicated grief therapy for older adults

Prolonged grief disorder is highly treatable, and it doesn’t require older adults to abandon cherished memories, end the bond, or “get over” the person. 

Talk therapy helps people process deep emotional distress, adjust to life after a major loss, and navigate complex feelings. Grief counseling may include aspects of cognitive behavioral therapy (CBT) and guided exposure to address prolonged or traumatic grief reactions. A licensed mental health therapist guides older adults through exercises like letter writing, grief journaling, sentence completion, and more. 

Therapy for complicated grief aims to help older adults integrate the reality of change, develop flexible coping skills, and find renewed meaning and purpose. Some people may resist feeling better because relief feels disloyal, but grief counseling covered by Medicare can help them overcome that. 

How Sailor Health makes support for complicated grief easier to access

Processing a deep, persistent loss takes time, and seeking support shouldn't feel like another heavy burden to carry. When grief leaves you or an aging parent feeling exhausted, numb, or stuck, therapy can help you process complex emotions, adapt to life after a loss, and rebuild a sense of purpose.

Sailor Health brings that care directly to you. We provide virtual therapy sessions by video or phone call, including landlines, so you can receive support from the comfort of home. This eliminates common obstacles like driving, arranging transportation, or sitting in waiting rooms during a time when simply leaving the house can feel overwhelming.

Our therapists are experienced older adults themselves who understand the unique ways grief, loneliness, and life transitions intersect in later life. We work with Medicare to keep care affordable, and most of our patients have a $0 copay. We aim to make getting started as simple as possible: we’ll match you with a therapist who fits your needs, and appointments are often available within 24 hours of signing up.

If grief has made daily life feel difficult to navigate, support may be closer than it feels. Reach out when you’re ready, and we’ll help you take the first step toward healing.

References

1. Prolonged grief disorder. (n.d.). https://www.psychiatry.org/patients-families/prolonged-grief-disorder 
2. Szuhany, K. L., Malgaroli, M., Miron, C. D., & Simon, N. M. (2021). Prolonged Grief Disorder: Course, diagnosis, assessment, and treatment. FOCUS the Journal of Lifelong Learning in Psychiatry, 19(2), 161–172. https://pmc.ncbi.nlm.nih.gov/articles/PMC8475918/ 
3. Allie, Z., Roux, E. L., Mahlatsi, K., Mofokeng, B., Ramoo, Z., Sibiya, K., Joubert, G., Van Rooyen, J. P., & Brits, H. (2018). Bereavement overload and its effects on, and related coping mechanisms of health care providers and ward administrators at National District Hospital in Bloemfontein, Free State. African Journal of Primary Health Care & Family Medicine, 10(1), e1–e7. https://pmc.ncbi.nlm.nih.gov/articles/PMC6018376/ 
4. Wetherell, J. L. (2012). Complicated grief therapy as a new treatment approach. Dialogues in Clinical Neuroscience, 14(2), 159–166. https://pmc.ncbi.nlm.nih.gov/articles/PMC3384444/