ABSTRACT
As the number of older adults with mental retardation, dementia, and other fourth-age diseases grows, so does the need to develop functional responses to losses, dying, and death. A composite case is used to demonstrate strategies to address the issues related to losses and death for people with mental retardation and the diagnosis of dementia and for their families and staff. Dealing with the diagnosis and the changes are explained in the framework of the stages of death and dying as developed by Kubler-Ross. The responses to the losses of dementia that are manifested by affected individuals and members of their personal networks are reflective of a number of factors. The dilemma related to personal value systems, professional roles, and philosophies of care is explored in the context of ethical concerns. The impact of program considerations such as rules, regulations, policies, and economics is examined. Bereavement work for peers and housemates 331 can be further developed for carers , family, and staff. Recommendations for research and interventions for public policy are given.
