Anticipatory Grief and Loss:
Implications for Intervention
Dementia, and the concomitant changes in cognitive, interpersonal, and psychological functioning, are a source of chronic stress for individuals afflicted with the disease (LaBarge & Trtanj, 1995) and for family members involved in their care (e.g., Pearlin, Mullan, Semple, & Skaff, 1990). These changes often are experienced as losses for both the person with dementia and the caregiver, particularly within the context of the caregiver/care-recipient relationship. The experience of loss is itself a source of distress (Farran, KeaneHagerty, Salloway, Kupferer, & Wilken, 1991; Gonyea, 1989). The manner in which caregivers experience and manage their grief reactions to these pre-death losses can influence not only caregiving outcomes but also subsequent adjustment to bereavement once the care recipient has died. This interdependence between pre-death grief and post-death adaptation suggests that caregiving and bereavement be viewed on a continuum, as part of a single chronic stressful situation (Bass, Bowman, & Noelker, 1991). This viewpoint argues for greater convergence among caregiving and bereavement interventions (Schulz, Newsom, Fleissner, Decamp, & Nieboer, 1997). However, with few exceptions, interventions for caregivers do not reflect this need. Rarely is management of the caregiver's changing relations with the individual who is demented and the associated losses a specific target of intervention. This chapter will explore issues of pre-death grief and loss in caregivers of patients with dementia and the implications for caregiver intervention.