Complicated grief and how to avoid it (NYT, 2-16-15)

This recent New York Times article is about complicated grief —

“an extreme, unrelenting reaction to loss that persists for more than six months… Symptoms…commonly include intense yearning, longing or emotional pain; frequent preoccupying, intrusive thoughts and memories of the person lost; a feeling of disbelief or inability to accept the loss; and difficulty imagining a meaningful life without that person.”

Apparently there are things we can do now to help our loved one’s avoid complicated grief:

“Among the factors that increase the risk is the failure of the deceased to have done advanced care planning, which can result in close family members having to make painful decisions about end-of-life care with no guidance from the dying person.  Should treatment for the underlying disease be continued until death? Should the person be attached to a ventilator or feeding tube when there is no hope for recovery? Should CPR be attempted if the heart stops? Such choices are best made when the person is mentally competent and able to discuss choices with next of kin and one’s physicians.”

A person interviewed for this article estimates that 7 to 10 percent of those experiencing loss have complicated grief.  In my experience with the local support group, I think the number is a bit less — perhaps 5 percent.  Perhaps our group members are better at addressing end-of-life planning?

The author notes that two researchers have developed a “Grief Intensity Scale.”  The researchers call “complicated grief” by another term — “prolonged grief disorder.”  The scale is available online here:

Here’s a link to the New York Times website:

Personal Health
When Grief Won’t Relent
New York Times

By Jane E. Brody
February 16, 2015 5:45 am


Four Caregiver Coping Strategies

In a short article on caregiver burden — “caregiving is an overwhelming job” — these four coping strategies were listed for caregivers:

  • Primary caregivers may do a lot, but they can’t do it all. Get additional help from friends, siblings or other family members. If you don’t get this extra support, you’ll likely burn out much more quickly, which could affect your ability to provide quality care. Also, look into and take advantage of low-cost or free community resources, including adult day care centers, home health aides, respite care, meal delivery and transportation services.
  • Take a few minutes every evening to write about your feelings — good and bad. Doing so may help you gain better understanding and control of your emotions.
  • Seek support groups or professional counseling services. [Disease-specific] support groups are wonderful because they allow you to connect with people experiencing very similar caregiving situations. You can share your frustrations and concerns in a nonjudgmental environment, receive encouragement, exchange practical information on problems and solutions and learn about resources you never knew existed. One-on-one therapy with a counselor skilled in caregiver stress may be helpful as well.
  • Learn to relax. Do whatever it takes to release tension and maintain a sense of calm. Meditating, doing yoga or tai chi, exercising, reading and engaging in a hobby or enjoyable activity can all help to melt stress and release feel-good endorphins.

Here’s a link to the article but what is listed above is all there is on coping strategies:


Medical Treatments – Potential for Benefit and Harm

This email isn’t directly related to caregiving or any neurological disorder, but the thought-provoking articles about being a good healthcare consumer are worth sharing.  I found that reading these articles required attention; they probably aren’t meant to be read by stressed-out caregivers.

“The Upshot” is a New York Times blog that covers public policy issues.


Last Monday, there was a blog post about whether a given medical treatment can help someone.  The basic point is that “many fewer people benefit from medical therapies than we tend to think.” See:

There is a metric known as the NNT or number needed to treat. “An N.N.T. of one would mean every person treated improves and every person not treated fails to, which is how we tend to think most therapies work.  What may surprise you is that N.N.T.s are often much higher than one. Double- and even triple-digit N.N.T.s are common.”  I don’t think most of us are aware of this.

The article reviews several examples.

Example #1 – daily aspirin for heart attack prevention.  The NNT is 2,000.  “According to clinical trials, if about 2,000 people [take a daily aspirin] over a two-year period, one additional first heart attack will be prevented. … Of course, nobody knows if they’re the lucky one for whom aspirin is helpful. So, if aspirin is cheap and doesn’t cause much harm, it might be worth taking, even if the chances of benefit are small. But this already reflects a trade-off we rarely consider rationally.”  The authors note that “N.N.T.s as calculated from clinical trial data are probably lower than those based on real-world medical care, not higher.”

Example #2 – Mediterranean diet for heart attack prevention.  The NNT is either 61 or 30, depending on which group you are considering.  “In people who have never had a heart attack, but who are at risk, the N.N.T. is 61 to avoid a heart attack, stroke or death. And that is for people who adhere to the diet for about five years. For those at higher risk, who have already had a heart attack, to avoid one additional death, the N.N.T. is about 30. That’s the number of people who would have to adhere to the diet for four years…”

The authors point out that an NNT of 30 is “pretty good.”  But they go on to say:  “When you hear that the diet prevents heart attacks, then it might sound worth it. But does it still sound worth it when you consider that 29 out of 30 people who stick to the diet for several years see no benefit at all? Will you stick to it for years and be the lucky one for whom that matters?”


Two clinical researchers have put together a website of NNT data from clinical trials.  You can take a short tour of the reviews here:

Or see a list of the reviews, organized by specialty, here:

Each treatment is rated as to whether the benefits outweigh the harms, or vice versa.


Tomorrow’s blog post is about a complementary number – the NNH or number needed to harm.  See:

Back to our aspirin for heart attack prevention example:

Example #3“[The] N.N.T. for aspirin to prevent one additional heart attack over two years is 2,000. Even though this means that you have less than a 0.1 percent chance of seeing a benefit, you might think it’s worth it. After all, it’s just an aspirin. What harm could it do?  But aspirin can cause a number of problems, including increasing the chance of bleeding in the head or gastrointestinal tract. Not everyone who takes aspirin will bleed. Moreover, some people will bleed whether or not they take aspirin.  Aspirin’s N.N.H. for such major bleeding events is 3,333. … Granted, one out of 3,333 is a pretty tiny risk. But remember that the chance of benefit is pretty small, too.”

The authors encourage us to consider the NNT and NNH when making decisions about medical treatment for ourselves or others.