Bereavement in the Time of Coronavirus: Unprecedented Challenges Demand Novel Interventions

ABSTRACT

COVID-19 fatalities exemplify "bad deaths" and are distinguished by physical discomfort, difficulty breathing, social isolation, psychological distress, and care that may be discordant with the patient's preferences. Each of these death attributes is a well-documented correlate of bereaved survivors' symptoms of depression, anxiety, and anger. Yet the grief experienced by survivors of COVID-related deaths is compounded by the erosion of coping resources like social support, contemporaneous stressors including social isolation, financial precarity, uncertainty about the future, lack of routine, and the loss of face-to-face mourning rituals that provide a sense of community and uplift. National efforts to enhance advance care planning may help dying patients to receive care that is concordant with the preferences of them and their families. Virtual funeral services, pairing bereaved elders with a telephone companion, remote counseling, and encouraging "continuing bonds" may help older adults adapt to loss in the time of pandemic.