How can I assess the impact of grief on a patient's physical health and what management strategies should I implement?

When assessing the impact of grief on a patient's physical health, it is important to conduct a comprehensive assessment that considers both physical and psychological factors, as psychological distress can exacerbate physical symptoms ¹. You should systematically assess the person's physical needs, enquiring about symptoms rather than waiting for them to be reported ¹. Determine the impact of each symptom on the person's life by asking about the time of onset, exacerbating factors, and effects on everyday life, such as sleep disturbance ¹. Be aware that symptoms can be worsened by insomnia, exhaustion, anxiety, and depression ¹.

While not exclusively linked to grief, physical symptoms that may indicate morbidity and could be present or exacerbated include weakness, fatigue, pain, breathlessness, swallowing difficulties, and incontinence ². New or recurrent somatic symptoms such as palpitations, irritability, and sweating can also be indicators of anxiety, depression, and PTSD-related symptoms, which may accompany grief ².

Be alert to possible depression, especially in patients with a past history of depression or a chronic physical health problem with associated functional impairment ⁶. Consider asking two screening questions: "During the last month, have you often been bothered by feeling down, depressed or hopeless?" and "During the last month, have you often been bothered by having little interest or pleasure in doing things?" ⁶. If a patient answers 'yes' to either, and you are competent to perform a mental health assessment, ask three further questions to improve accuracy: "during the last month, have you often been bothered by feelings of worthlessness?", "during the last month, have you often been bothered by poor concentration?", and "during the last month, have you often been bothered by thoughts of death?" ⁶. Review the patient's mental state and associated functional, interpersonal, and social difficulties ⁶. For patients with significant language or communication difficulties, consider using the Distress Thermometer or asking a family member or carer about the patient's symptoms ⁶.

Management Strategies

Management strategies should involve a holistic approach, addressing physical, psychological, social, and spiritual needs ¹.

• Psychological Support: If the person or their carers have significant levels of psychological distress, offer prompt referral to specialist psychological care services ¹. Professional psychological support is likely to benefit people whatever the severity of their psychological distress ¹. Offer information about sources of emotional and psychological support, including support groups and online forums ⁵. If needed, refer the person to counselling or psychology services for a specialist assessment and support ⁵. Emotional support and information on managing care can be helpful for psychological distress ³.
• Social Support: Assess the person's social needs, which may include emotional support, help with personal care, housework, shopping, practical aids, caring for dependents, and advice on work and employment issues ¹. Offer informed professional assistance to obtain benefits for which they are eligible ¹. Local authorities, NHS, or voluntary organizations may provide respite or day care, support groups, volunteer visitors, assisted transport, and bereavement care ¹. A social care practitioner should discuss the person's needs and preferences for social care, and provide information and support to access personal care, equipment, financial support, and support to engage in work, social activities, and hobbies ⁵.
• Spiritual Support: Assess the person's spiritual needs, which relate to their search for meaning within life ¹. Ensure access to staff sensitive to their spiritual needs, ranging from informal sharing of ideas to formalized religious ritual ¹. Key issues include listening to the person's experience, affirming their humanity, protecting their self-worth, dignity, and identity, and ensuring spiritual care is part of a holistic approach ¹.
• Depression Management (if identified): If a patient with depression and a chronic physical health problem presents considerable immediate risk to themselves or others, refer them urgently to specialist mental health services ⁶. Advise patients of the potential for increased agitation, anxiety, and suicidal ideation in the initial stages of treatment for depression, and ensure they know how to seek help promptly ⁶.
• Bereavement Support: Discuss the bereavement support available with parents or carers and provide written information ⁴. Talk to them about available psychological bereavement support groups ⁴.