This communication will focus on the presentation of CG in the older subgroup after reviewing some features of CG that apply to all grieving adults. The case vignette of Sophia will illustrate the presentation of

CG and its successful treatment with a new specialized treatment called complicated grief therapy or CGT. Finally, new research findings and the combined use of medication will also be addressed. The annual incidence of spousal loss is 1.6% for men and 3% for women, resulting in over 800 000 new widows and widowers each year in the United States.1 Although the terms are often used interchangeably, bereavement refers to the state of having lost Inhibitors,research,lifescience,medical someone emotionally important (literally meaning “robbed of something valuable”) whereas grief is an instinctual response to bereavement that includes the person’s “symptoms,” thoughts, feelings, and behaviors. Seventy percent of bereaved people will cope adaptively with the pain of their loss and the restorative process to a new Inhibitors,research,lifescience,medical state of function without their lost loved one, either by virtue of their own innate coping ability or

in addition to the support provided to them by family, friends, and/or spiritual leaders. Thirty percent of grievers will face a complication such as major depression (15%), post-traumatic stress disorder-PTSD (depending upon the circumstances of the Inhibitors,research,lifescience,medical death), or complicated grief (10% to 20%).2 Major depression secondary to bereavement and CG are often comorbid, but each can also exist without the other.3 The natural course of grieving in late life When comparing grievers, the Inhibitors,research,lifescience,medical only discernable pattern is the variability in intensity and course of grief over time with periods of relative quietude as well as periods of reactivation, like the ebb and flow of the tides. Periods of renewed intensity are often triggered by painful reminders, such as anniversary dates. The twin concepts of acute grief and integrated grief are very useful in differentiating

adaptive from complicated grievers. To assess Inhibitors,research,lifescience,medical this in the context of the immediate aftermath PDK4 of the death of an important relationship, Eric Lindeman catalogued the reactions of a large group of surviving grievers of victims of the Coconut Grove Fire that killed 500 people in Boston in 1942.4 He found the similarities among grievers, outlined in Table I, that have stood the test of time in subsequent research, and these symptoms are now referred to as acute grief. The intensity of this phase can be affected by: the age of the victim; the suddenness of the death or the chronicity of Gefitinib illness leading up to the death; the quality of the relationship between the deceased and the griever; any past psychiatric history in the griever (particularly anxiety, depression, or substance abuse); coping style and the adequacy of support systems.