Grieving the midlife loss of a parent

Coping with the loss of a parent who has lived a long life may appear to be easier compared with the death of a parent at a more unexpected, younger age, sometimes described as an “off-time” death. But that doesn’t make the grief and other ripple effects of this common experience any easier to navigate, according to psychologists and researchers who study parental loss.

“If you are 60 years old and you’ve lost your parent, you’ve spent 60 years of your life with this person,” said Debra Umberson, PhD, author of Death of a Parent: Transition to a New Identity.

“You are always the child to your parent,” said Umberson, a sociology professor who directs the Center on Aging and Population Sciences at the University of Texas at Austin. “But also, for a lot of people, you become close friends, confidantes. They give you advice about your own children. They take care of you when you get sick. So there’s a lot to lose.”

By age 49, fewer than half of Americans, 44%, have lost at least one parent, but nearly 76% have by age 59, according to U.S. Census Bureau data. However, research shows that adults from at least one racial group are more likely to experience the death of a parent starting at a younger age: By age 40, Black adults are nearly twice as likely to have lost their mother and 20% more likely to have lost their father compared with White adults (Umberson, D., et al., Proceedings of the National Academy of Sciences, Vol. 114, No. 5, 2017opens in new window).

Psychologists can better support those suffering these midlife losses by exploring the context of the parental death, including how it occurred and whether it was anticipated. They can work with grieving adults to process related regrets and other unfinished business, including how the death has impacted their physical health and interactions with family members. And in other scenarios, such as when dementia means the parent is still alive but may not be psychologically present, the therapy can address issues surrounding ambiguous loss.

[Related: With dementia, grief may start long before a parent’s death]

For adults at midlife, the death of one or both parents also can carve away a layer between themselves and their own inevitable death, potentially shifting their self-identity, said Bert Hayslip Jr., PhD, Regents Professor Emeritus in the Department of Psychology at the University of North Texas in Denton and a longtime researcher in grief and bereavement. “It’s not just a loss—it causes you to redefine who you are,” he said.

The loss of the second parent can be particularly challenging. This death is “so much more symbolic,” said Umberson, and can be “really jolting for a lot of people,” putting them in the front seat of their own mortality. “As long as you’re a kid to a parent,” she said, “it’s like you’re going to live forever.”

The passing of one’s parents also may provide “a developmental push,” said Kenneth J. Doka, PhD, senior vice president for grief programs at the Hospice Foundation of America, who has authored numerous books about grief, including Grief Is a Journey: Finding Your Path Through Loss. “You have to go on now and do things that maybe you counted on your parents to do,” he said, such as perhaps leaning on them for financial guidance.

Moreover, this heightened sense of mortality can spur a renewed focus on life goals, even for midlife adults who anticipate living another 30 or 40 years, Doka said.

“I think for some it gives a renewed zest, a revitalization and reestablishment of priorities,” he said. “‘What do I really want to do?’ For some, it renews their spirituality. The question, ‘What happens after life?’ takes on a new significance now.”

Adults who are well into middle age when a parent dies are more likely to have peers in their age group who have already weathered a parental death, said Karen Fingerman, PhD, director of the Texas Aging and Longevity Consortium at the University of Texas at Austin. They may be able to reflect on the positive elements—the deceased parent enjoyed a full life span, living long enough to witness various milestones such as their adult child’s marriage or career achievements.

“But that doesn’t mean that you don’t grieve just as much,” Fingerman cautioned. “Grief is an inherent part of loss. And there’s really no way to avoid that when you’ve lost someone, no matter how prepared you are for it.”

Theresa Lussier felt like she had been grieving for at least a year before her father died in 2021. Lawrence “Larry” Smith, a retired aeronautic engineer and an avid competitive golfer, was married for 55 years and had three children and seven grandchildren before he died at age 89. Lussier had watched him gradually deteriorate cognitively over nearly a decade following his diagnosis with Alzheimer’s disease, until he increasingly couldn’t recognize her or other loved ones.

“There was an element of ‘this is better’—he would not have wanted to continue in the state that he was in,” said Lussier, who is 54 years old and lives in Massachusetts.

It wasn’t until about a month after her father’s death that the full force of her grief washed over her, when she needed to take his ashes from her home to the cemetery service. “I approached the piano and I picked him up and I said, ‘OK, Dad, it’s time to go.’ And that moment was when I just began sobbing and sobbing hysterically.”

Researchers are still learning how men and women react emotionally and physically to the death of a parent. One analysis, which looked at data from the National Survey of Families and Households, found that a mother’s death was associated with decreased levels of psychological wellness for both daughters and sons. But daughters appeared to be more negatively affected, exhibiting a greater decline in self-esteem and higher likelihood of binge drinking (Marks, N. F., et al., Journal of Family Issues, Vol. 28, No. 12, 2007opens in new window).

Yet, despite the commonality of parental loss in midlife, there have been relatively few studies focused on the emotional and other effects in that age group, said Yijung Kim, PhD, a research scientist at MedStar Health Research Institute who has studied parental loss and familial relationships. That paucity, she noted, aligns with other research about midlife. She cited one research overview that reported that “strikingly little” is understood about developmental milestones and challenges faced by adults in their midlife years (Infurna, F. J., et al., American Psychologist, Vol. 75, No. 4, 2020opens in new window). Parental loss at this age “is normative; it’s common,” Kim said. “We tend in research to focus on nonnormative events. At the same time, losing a parent at whatever time in your life course is a significant event.”

Hayslip and his colleagues conducted one of the few analyses comparing grief and adjustment between young and midlife adults, 247 adults in the younger age group and 155 middle-aged adults, ages 50 to 65. They found that the young adults, ages 18 to 35, reported more emotional distress than middle-aged adults after a parent died, likely because of the off-time nature of the death. However, regardless of age, adults who were single or separated reported more overall distress and intense grief, Hayslip said (OMEGA - Journal of Death and Dying, Vol. 71, No. 1, 2015opens in new window).

Kim and Fingerman, along with other colleagues, studied how a parent’s death impacts another key relationship: that between midlife adults and their own children (Journal of Marriage and Family, Vol. 81, No. 3, 2019opens in new window). The study involved prospective data from two waves of the Family Exchanges Study, which studied the latticework and interactions of family members, including their influence on physical and psychological health.

Researchers found that the quality of the grieving adult child’s relationship with their own children didn’t improve after the death of their first parent, but it did following the passing of the second. Those findings may indicate that adult children redirect their focus on the surviving parent, assisting with everything from supporting their grief to increased caregiving and coordinating related life changes, such as moving to a new home, Kim said. After their second parent dies, the adult moves up the generational ladder, potentially leading to a shift in their own thinking, she said.

“You’re reflecting back on your role as a parent,” Kim said. “Am I being a good parent to my offspring? Your perspective changes. And it could lead to the growth, in this case, of increased positive relationship qualities with grown children.”

In their grief, midlife adults may revisit a parent’s legacy, even subconsciously, which can lead to positive and negative behaviors, Umberson said.

They may commit to emulating the parent more, such as being kinder or doing more good works, Umberson said. But there’s also the risk that they can channel their late parent’s more negative tendencies, such as by becoming more critical or engaging in excessive drinking. A therapist can encourage bereaved adults, she said, to honor their parents in positive rather than negative ways.

Bereaved adults with largely positive memories about their parent don’t harbor as many regrets after they are gone, but their emotions can become more complicated in some circumstances, said Umberson, who interviewed 73 adults ages 25 to 67 for her book Death of a Parent. She recounted the story of one middle-aged adult whom she interviewed, a retired military man in his 50s who became emotional when discussing how he would never be able to mend a hole in his relationship with his father.

“He said, ‘I was always waiting for him to tell me he was proud of me. And he never did. And then when he died, I knew he was never going to.’”

Even when adult children have long been estranged from their parents, and reconciliation is unlikely or unwelcome, a parental death can still leave those children wrestling with feelings of guilt, shame, or remorse that the schism was never repaired, said Elizabeth Schandelmeier, LCSW, a bereavement counselor for University of Pittsburgh Medical Center’s Family Hospice Program who also has a private practice. In turn, they may find it difficult to integrate their grief experience with their own sense of self, as they may question their identity as a caring and competent adult, she said.

In addition, how an elderly parent dies, along with the circumstances surrounding that death, can shape the adult child’s bereavement trajectory, leaving them with lingering emotions, Schandelmeier said.

For instance, in retrospect the adult child might wonder if the parent would still be alive if they had chosen more aggressive intervention near the end of life, such as dialysis or mechanical ventilation. In other circumstances, she said, the son or daughter might revisit the circumstances of the parent’s death and worry that “something went wrong with the medical care that caused their death.”

Lussier remains angry about the circumstances surrounding her father’s death, which occurred during the pandemic. After years of being cared for at home, he had begun to become aggressive with loved ones and was hospitalized while family members searched for a bed in a memory care community.

The family’s visits to the hospital were highly limited by pandemic restrictions, and it was difficult to reach staffers by phone. Her father became so dehydrated that clinicians couldn’t get an intravenous line into him. He was sent home for hospice care, where he died shortly afterward.

“When I talk about that, I get so angry,” she said. “It was just the most helpless feeling. I probably should try to come to terms with that in some way.”

Regrets and unfinished business are common even if the child’s relationship with their parent was positive, Hayslip said. “They have to learn to forgive themselves,” he said. One approach is for psychologists to encourage patients to write a letter to the departed parent, expressing what they would say if they could. They can then set the letter aside to read and reflect on later, including possibly sharing its contents with a therapist or someone else whom they trust, he said.

During therapy sessions, mental health clinicians can listen for the what-ifs and help patients work through where they have become mentally stuck, Schandelmeier said. “When people are going back and thinking, What if...?, they tend to stop at the place where they think that they failed.”

A therapist can also discuss with patients the various ways they advocated for their parent’s best interests, even during potentially stressful times and challenging decisions amid their final days, Schandelmeier said.

“You try to help them get a little bit of context,” she said. “And you do it in a way that demonstrates and affirms how supportive they were.”