Here is the thing about grief – though we think of it as something that happens after a death, it often begins long before death arrives. It can start as soon as we become aware that death is a likelihood. Once death is on the horizon, even just as a possibility, it is natural that we begin to grieve.
Though this is different than the grief that follows a death, anticipatory grief can carry many of the symptoms of regular grief: sadness, anger, isolation, forgetfulness, and depression. These complicated emotions are often coupled with the exhaustion that comes with being a caregiver or the stress of being left alone when someone goes to war or is battling addiction. We are aware of the looming death and accepting it will come, which can bring an overwhelming anxiety and dread. More than that, in advance of a death we grieve the loss of person’s abilities and independence, their loss of cognition, a loss of hope, loss of future dreams, loss of stability and security, loss of their identity and our own, and countless other losses. This grief is not just about accepting the future death, but of the many losses already occurring as an illness progresses.
When we know a death is imminent our bodies are often in a state of hyper-alertness – we panic whenever the phone rings, an ambulance must be called, or when our loved one deteriorates. This can become mentally and physically exhausting. The same is true of watching a loved one suffer, which is almost always part of a prolonged illness. Caring for them as they suffer takes an emotional toll on us. These things (and others) can contribute to a sense of relief when the death eventually comes, and a guilt that can come with that relief. These feelings are common and totally normal when someone has experienced an anticipated death. And yet we feel guilty for this relief, thinking it diminishes our love for the person. It doesn’t, of course, but this relief can be a confusing feeling. We sometimes need to consciously remind ourselves that the relief does not change the deep love we had for the person, rather it is a natural reaction to the illness.
There have been numerous studies showing that anticipatory grief can reduce the symptoms of grief after a death but, as always with grief, there are no rules. There will be times that anticipatory grief may reduce the intensity of grief following a loss, then there are many times that the grief following a death is not impacted at all. What is important to keep in mind is that if you are grieving with less intensity or for shorter duration than other losses because of the anticipatory grief you experienced before the death, that is totally normal! On the flip side, if you do not feel your grief is diminished despite it being an anticipated death, that is totally normal too! There is no formula for how an anticipated loss will impact us because we all grieve differently.
I am the daughter and my Mom has been ill with congestive heart failure, kidney problems, and more, and finally, dementia. This has been going on for ten years and I thought all the above feelings were abnormal and I felt guilt. Now I know better and I hope that this will be of help to some of you

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My older sister has been showing many signs of dementia and having seen my mother go through this I know what this (dementia) is. My sis will not go to a doctor and I have not brought up the subject. I haven't had a conversation with her about the dementia for several reasons. One, I know her so well and I know she will say it's just a normal part of aging and not dementia...denial. Two, she has always had an aversion to mom was the same way. I just play along with her when she forgets things...she will laugh and make a joke about her forgetfullness and I laugh right along with her. Her reasoning abilities have diminished drastically so our relationship has changed. I no longer try to explain a situation two or three times as I know she will only become exasperated further. We have always been very close...she's my best friend and I love her dearly. The subject of anticipated grief is one I am very familiar with. With every passing holiday, birthday, etc., I realize it may be the last one we share because as the dementia takes hold she may not even remember who I am. I have begun to imagine my life without her so yes, I am anticipating the grief of losing her. I try to make her as happy as possible but watching her become increasingly frustrated and confused is heartbreaking. Together, we experienced this decline in our mother. I will continue to do what I can for her, although she won't let me do much as she has always been so independent. Anyway, yes, the anticipation of grief is a very real emotion and long lasting because one never knows how long before your loved one may slip away altogether before she dies. I find myself in tears as I write this just thinking of the eventuality of this sad outcome.

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