Modern hospice care began in the 1960’s as a response to the over-medicalization of dying in the West. From its inception, the needs of the family were a key component. The patient and family are the unit of care, not the patient alone as is commonly the case in health care.
As such a core component of the hospice palliative care model is that care extends beyond the death of the patient into the bereavement period.
Families experience a period of mourning leading up to and following the patient’s death. The length of bereavement and a family’s need for bereavement support will vary based on many factors but is a universal part of the human experience. As such bereavement support is considered a fundamental part of hospice and palliative care.
A requirement to provide bereavement support and counseling has been included in every set of standards for hospice since the beginning of the hospice movement.
In 2013 almost 2.6 million Americans died. 46% of these families received hospice care and bereavement follow up leaving the majority of families without this support.
There are important reasons to provide bereavement support to families following a death, depending on need. Evidence supports the fact that surviving spouses are at risk for premature death or illness. Although there remains debate over which subgroups are most vulnerable, it is now well established that the health of bereaved individuals is at risk. Bereaved individuals suffer elevated risks for depression, anxiety, and other psychiatric disorders, somatic complaints, infections, and a variety of other illnesses. They have higher rates of hospitalization, medication use, medical consultations, and more days of disability. Risk of mortality is higher due to many causes including particularly suicide.
While age and health are inversely related in bereavement the opposite is often seen. Younger age groups tend to suffer more health consequences due to bereavement. Mortality statistics show excess mortality among the widowed compared to married in younger more than older age groups in both cross-sectional and longitudinal studies.
A number of biological influences may be involved that impact the health of the bereaved. There is a wealth of evidence that immune, neuroendocrine, and sleep profiles are altered in association with loss.
Bereavement support helps mitigate these health and psychological impacts particularly for those whose reaction to loss is profound and for those who seek support.
Grief is a normal response to loss and most people will get through it without major impacts on social, educational, or occupational functioning with information on what is normal and a modicum of support. However, those with prolonged or complicated grief need to be recognized and given more assistance. Bereavement support provided through hospice and palliative care programs is an important resource for society and for those suffering from loss.
Hospice and palliative care bereavement programs are an invaluable resource for addressing the needs of those suffering from loss, and reflect an enduring commitment to the common good and the health of our society.
By: Stephen R. Connor
PhD. Executive Director, World Palliative Care Alliance