The end of summertime heralds shorter days, with less daylight hours and typical winter weather. The long winter evenings may affect mood, with some experiencing seasonal affective disorder (Magnusson, 2009), a depressive disorder associated with reduced exposure to sunlight for which professional help should be sought. However, many people who experience a dip in their overall mood can be helped by exposure to as much daylight as possible, not only by taking exercise outside, but by sitting near windows when indoors.
Winter evenings appear longer because they are dark, and this especially affected many older and clinically vulnerable people this past year, as they spent more time alone to maintain social distancing in line with Government guidance. Recent losses will be felt more acutely at times of loneliness, and the pandemic has been the cause of increased mortality rates and unresolved grief, with restrictions associated with funerals and postponement of memorial services or thanksgiving events. Additionally, the return of concerns about circulating viruses, including seasonal influenza, will likely increase feelings of vulnerability again.
Prior to the pandemic, prolonged grieving or complicated grief had attracted attention because of its impact on physical and mental health and the quality of life of affected individuals. Newsom et al (2011) contrasted a prevalence of 4.8% of complicated grief in the general population compared with 25.4% among older adults (over 55 years of age) in their large study of older people living in Rotterdam, the Netherlands. It is likely that the COVID-19 pandemic has left many with complicated grief. Drawing on a rapid literature review, Gesi et al (2020) highlighted how deaths in hospital and intensive care units, with the limited, if any, contact between the dying and their families, and restrictions on funerals have increased the risk of unsuccessful normal grieving because the usual opportunities for goodbyes have not been available to the bereaved. Hospitals are now promoting contact between the dying and their relatives, but there will be many who experienced the death of a loved one when no such contact was permitted. Furthermore, some older people died in care homes where no contact was permitted.
‘Widowers and widows desired support to achieve inclusion and togetherness while being reluctant to ask for help, which suggests that both community nurses and families can help identify those who need support.’
Older people are more likely to experience the loss of a spouse or life partner. King et al's (2017) self-controlled case series study found a higher risk of death during the 24 months after the cohabitee's death, with the greatest risk during the first 3 months. Holm et al (2019) revealed how bereaved Norwegian older people, especially with their own failing health, struggled to maintain their pride and dignity in their shattered world of new singleness. Widowers and widows desired support to achieve inclusion and togetherness while being reluctant to ask for help, which suggests that both community nurses and families can help identify those who need support.
The Good Grief Trust (www.thegoodgrieftrust.org/) offers a wealth of resources, including signposts to local support services, with the needs of those aged over 50 years falling under the tab ‘The older generation’ on the website. Those experiencing complicated grief may require a psychological intervention, such as cognitive behavioural therapy, although such interventions are not effective for everyone (Boelen, 2016). Christmas and New Year present a particular challenge for the bereaved with the absence of a loved one.