Primary Care Consultations for Grief in Older People – a Missed Opportunity for Mental Health Support

Abstract

ABSTRACT Objectives Bereaved older adults often experience health complications, yet receive limited support in primary care settings. This research explored general practice staff’s exposure to older patients’ grief and identified barriers/enablers to bereavement support. Methods We examined 15 in-depth interviews with general practitioners and practice nurses across Australia. Data were analyzed thematically and via poetic narrative analysis, an innovative arts-based method to meaningfully translate participant’s lived experience and emotions. Results Exposure to older people’s grief and bereavement informed primary care staff assumptions about older people’s grief, their ability to identify signs of grief, their understanding of how culture, gender, and grief intersected, and how grief could be managed in general practice (e.g. mobilizing nurses to provide support). Barriers/enablers to bereavement support included: Communication, access to support, time to discuss concerns, and knowledge/awareness of grief complications. Conclusions Older adults require access to tailored support that addresses their experiences of repeated exposure to grief and loss. Primary care is a key conduit to specialist services but to make such referrals more training is needed on ageism and stigmas surrounding mental health. Arts-based methods can open a dialogue about grief and destigmatize help-seeking among older adults. Clinical implications Clear documentation of grief in patients’ medical records; Destigmatizing mental health support among older patients; and Training primary care staff on grief, age-, culture- and gender-specific needs, and available resources can overcome some of the identified barriers to bereavement support. Primary care providers can use consultations with older patients to enquire about potential recent bereavements and mental health support needs, going beyond the mere assessments of physical symptoms. Timely assessment and documentation of grief in older patients can facilitate appropriate referrals and access to support services; this is a key task for general practitioners, who are gatekeepers to the healthcare system.