r way through the grief process to the final stage of acceptance and understanding. The inevitability of the five stages does not mean the death of hope, and it could even be argued that reaching the level of acceptance places the patient in a better mental state to have real hope and to understand his or her options in evaluating treatment and matters related to treatment. K?bler-Ross indicates that the family will have to cope with the issue for a long period of time, even after the death of the loved one, and that this will take a good deal of energy. She also discusses some of the specific problems that will be encountered. She notes: "Family members undergo different stages of adjustment similar to the ones described for our patients" (K?bler-Ross, 1969, 168). They also experience a stage of denial, a stage of anger, and a phase of preparatory grief.
While this creates many problems for the elderly and for those who must care for them, it also appears that longevity can reduce some stresses:
Generally the farther along in the life cycle, the less is the degree of family stress associated with death and serious illness. Death at an older age is viewed as a natural process. In fact coming to grips with one's mortality is a developmental task for the aged (Brown, 1989, 463).
The type of death involved can make a difference in terms of how long it takes the survivors to come to terms with that loss. Farberow, Gallagher Thompson, Gilewski, & Thompson (1992) studied the impact of the death of an older person on the mental health and psychological status of the surviving spouse and assessed this element using five self report scales and a one item self rated mental health questionnaire. The death of a spouse
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