Even though a nursing home is a safe place, those who live there can be affected by grief and crisis. They may receive news of a dear friend's death or see their neighbor, who had been such pleasant company, deteriorate in health. Their own health and abilities may also deteriorate, and the loss of abilities can also cause sorrow. Many also struggle with fear of death and feelings of loneliness.

Meeting a person in crisis, grief and loss – Safety, presence and empathy

Meeting a person in crisis, grief and loss is one of the most sensitive and important tasks in elderly care. When a resident or a relative is going through a life crisis, it can be difficult to know how to best respond to them. The crisis can arise upon receiving a message of grief, during a life transition, during a deterioration of health or when a resident is forced to leave their home to move to a nursing home. To be able to provide the right support, we need to understand both the outward signs of crisis and the inner feelings that may be under the surface. How can we as healthcare professionals create safety, support and presence in these difficult moments?

What is a crisis?

A crisis is a natural reaction to a sudden change or loss, where one's own resources are not sufficient to manage the situation. In elderly care, we often meet residents and relatives who are in different stages of crisis. The crisis can be acute - for example, upon receiving a death notice - or long-term, such as a gradual deterioration of health.

Common causes of crisis in elderly care:
Grief after losing a life partner, friend or other relative.
News of a serious illness or deteriorating health.
The adjustment to moving from home to a nursing home.
Experiences of loneliness, isolation or existential questions about the end of life.
Sudden change in condition, for example a stroke or fall accident.
Loss of independence and control over daily life.

How do we notice that a person is in a crisis?

As a nurse assistant, it is important to be able to recognize signs of crisis and grief, especially in the elderly who may sometimes have difficulty expressing their feelings themselves.

Outward, visible signs of crisis:
Changed behavior - A previously social person becomes withdrawn or avoids contact.
Physical symptoms - Headache, stomach pain, muscle tension, dizziness.
Irregular sleep - The person sleeps much more or significantly less than before.
Decreased appetite - The person eats less or skips meals.
Increased irritation or anger - Becomes easily frustrated or reacts strongly to small things.
Tearfulness - The person is close to tears or shows signs of depression.
Difficulty concentrating - Has difficulty focusing, forgets things or appears confused.
Decreased hygiene - The person does not care about dressing or taking care of their personal hygiene.

Meeting a person in crisis and grief

Create safety and presence
- Show that you are there and that you have time to listen.
- Maintain eye contact, but without pressuring the person to talk.
- Ask simple questions: "Do you want to talk?" or "How can I help you right now?"
- Adjust your body language – slow down, sit next to the person and show care.
- Confirm feelings without trying to solve the situation: "I hear that you are having a hard time right now."

Listen actively and affirm feelings
- Allow the person to articulate their grief and crisis at their own pace.
- Show that you are listening by nodding, humming and asking follow-up questions.
- Avoid saying "It gets better" or "You have to think positively" - it can be perceived as if you are not taking their feelings seriously.
- Mirror the person's feelings by saying: "It sounds like you are feeling very lonely right now."

Adapt your support to the individual
- Some want to talk, others just want company - respect that.
- If the person has difficulty expressing themselves, use music, images or touch as alternative communication.
- Sometimes practical things like helping the person with a walk, a cup of tea or just sitting quietly next to them can be of great help.

Dealing with grief and loss

Grief is a natural part of life, but for the elderly it can be particularly noticeable. They often have already lost many loved ones and experience a successive loss of their own independence.

Common grief reactions:
- Fatigue and exhaustion.
- Difficulty finding meaning in everyday life.
- Anxiety and fear about the future.
- Feelings of loneliness and hopelessness.
- Strong longing for the person they have lost.

How can we support a person in grief?
- Allow the person to talk about their loss - over and over again.
- Help to establish routines that provide security.
- Make sure they eat and drink.
- Suggest activities that the person enjoys, but without pressure.
- Remind them that it is okay to feel both grief and joy at the same time.
- If needed, suggest counseling or professional help.

How we as healthcare professionals can take care of ourselves

Constantly meeting people in crisis and grief can be demanding. We must also take care of ourselves in order to provide good support.

Tips for managing your own feelings:
Talk to colleagues - share thoughts and feelings so as not to carry everything yourself.
Take breaks and ensure recovery during the workday.
Have clear boundaries - you don't need to solve everything.
If needed, take support from supervision or group reflection.

Reflection Questions - Crisis and Grief

Care staff:  
- How do you respond to a resident or relative in grief or crisis?  
- Can you recognize signs that someone is mentally unwell?  
- How do you handle your own stress in difficult encounters?  

Manager, nurse, occupational therapist and physiotherapist:  
- Are there routines at the residence to support residents and relatives in grief and crisis?  
- How do you ensure that the staff receive supervision in difficult situations?  
- How can you work to create a safe and supportive environment for everyone?  

Residents and relatives:  
- Do you feel that the staff are responsive and supportive in difficult moments?  
- Do you receive good information and support for losses and changes?  
- Do you feel that you can talk about feelings and grief at the residence?  

Erland Olsson
Specialist nurse
Sofrosyne - Better care every day