August 7, 2026

Anticipatory Grief: Are We Waiting Too Long to Recognize It?

By Roxanne Fuentes, LCSW-C, MSW, RPS, SAP, ACS, Director of Survivor Advocacy and Family Programs, and Matila S. Jones, II, MS, HS-BCP, Executive Director, Roberta’s House

When does grief begin?

We often think of grief as a response to something that has already happened—a death, separation, or another clearly defined loss. But grief does not always begin after a death. Sometimes it begins with a diagnosis, a change in memory, the fear of relapse, the loss of independence, or the realization that life may not unfold as once imagined. What about the grief that begins before the loss is complete? What about the fear, sadness, uncertainty, and emotional preparation that occur when a person knows that life may soon change in a profound and irreversible way?

This experience is commonly described as anticipatory grief: the emotional, psychological, spiritual, and physical response to an expected or unfolding loss. It may occur when a loved one is living with a terminal illness, dementia, declining health, substance use disorder, or another condition that changes the person, the relationship, and the future a family once imagined.

Anticipatory grief may also arise in response to circumstances that do not involve an expected death. People may grieve the possible loss of their health, independence, housing, employment, family relationships, sobriety, or sense of identity. In many cases, the loss has not yet fully occurred, but its possibility is already shaping daily life. How do we grieve someone who is still here? How do we mourn a future that has not yet been lost—or prepare for an outcome we still desperately hope will not occur?

Although Roberta’s House does not currently offer programming specifically focused on anticipatory grief, we increasingly encounter it in the experiences of the individuals and families we serve. Their stories raise a broader and more urgent question: Are our grief-support and human-service systems doing enough to recognize and respond to grief before a death or other significant loss occurs?

Grief in the Midst of Recovery

Anticipatory grief can be especially complicated for individuals in recovery and for families who love them.

A person in recovery may grieve the life they once knew, relationships that have been damaged, years that feel lost, or an identity connected to substance use. They may also fear losing their sobriety, support system, housing, employment, health, or family connections.

Family members may live with a different kind of anticipatory grief. They may fear relapse, overdose, incarceration, estrangement, or death. Even during periods of progress, they may find it difficult to release the expectation that another crisis could occur. They may feel hopeful and afraid at the same time.

This emotional tension can be exhausting. Families may begin grieving a possible future while trying to support a loved one in the present. Individuals in recovery may sense that fear, which can create additional shame, pressure, or distance.

How do we acknowledge these feelings without treating relapse or death as inevitable? How do we help families prepare emotionally while continuing to support hope, recovery, and healing?

These are questions that grief professionals, recovery providers, behavioral health practitioners, human-service professionals, and communities must examine together.

Aging, Independence, and Unspoken Loss

Anticipatory grief also frequently appears in our interactions with older adults and their families.

Aging can bring a series of gradual losses: changes in mobility, health, memory, independence, social connection, and familiar roles within the family. An older adult may grieve the possibility of leaving a longtime home, losing the ability to drive, relying more heavily on others, or watching friends and loved ones die.

Family members may grieve changes in an aging parent, spouse, sibling, or grandparent while that person is still very much present. When dementia or serious illness is involved, families may experience a series of losses over time—the loss of shared memories, familiar conversations, routines, or mutual recognition.

These experiences are not always recognized as grief. They may instead be described as stress, caregiver fatigue, depression, anxiety, or simply “part of getting older.” While each of those descriptions may capture part of the experience, they may overlook the grief at its center.

Are older adults being given enough space to talk honestly about what they fear losing? Are caregivers receiving support before they reach exhaustion or crisis? Are families prepared to name the gradual losses they are already experiencing?

Men and the Grief They May Not Name

Our work with male clients raises another concern. Many men have been socialized to respond to pain by remaining silent, appearing strong, solving problems, or protecting others from their emotions. They may not describe what they are experiencing as fear or grief. Instead, it may appear as anger, withdrawal, irritability, substance use, overwork, relationship conflict, or physical complaints.

A man facing his own declining health may worry about losing his independence, his role as a provider, or his ability to protect his family. A father, son, partner, or brother may be deeply affected by the expected loss of someone he loves but may not believe that he has permission to express that fear.

For some men, particularly those who have experienced violence, incarceration, community trauma, substance use, or repeated loss, anticipatory grief may become layered upon grief that has never been fully acknowledged. The expectation of another loss can begin to feel normal.

How do we create spaces where men can speak about fear, uncertainty, and possible loss without feeling that their strength is being questioned? How do we recognize grief when it is communicated through behavior rather than words?

These questions require more than a clinical response. They require community trust, culturally responsive engagement, strong relationships, and a willingness to meet people where they are.

When the Loss Has Not Yet Happened

One of the most difficult features of anticipatory grief is uncertainty. There may be no clear timeline and no single event that gives a person permission to say, “I am grieving.”

People experiencing anticipatory grief may feel sadness, anxiety, anger, guilt, helplessness, or emotional numbness. They may struggle to concentrate, sleep, or make decisions. They may mourn future plans that may never happen or relationships that are already changing.

They may also experience moments of relief, gratitude, laughter, or hope. These emotions do not cancel one another. A person can hope for recovery while fearing relapse. A caregiver can love someone deeply and still feel exhausted. An older adult can be grateful for life while grieving the loss of independence. A man can remain strong for his family while also needing support himself.

Because the loss is not yet complete, people may question whether they have the right to grieve. Others may encourage them to remain positive or avoid “thinking about the worst.” Although often well-intended, those responses can leave people feeling isolated.

Naming anticipatory grief does not mean abandoning hope or predicting a negative outcome. It means acknowledging that uncertainty itself can produce a genuine grief response.

A Growing Concern for Grief-Informed Care

Anticipatory grief sits at the intersection of grief support, behavioral health, recovery services, aging services, caregiver support, healthcare, and community care. Yet it can easily fall between these systems.

Healthcare providers may focus on treatment. Recovery programs may appropriately concentrate on sobriety and stabilization. Aging services may address safety, housing, and daily living needs. Grief programs have traditionally focused on support after a death.

But who helps individuals and families process the grief that exists between diagnosis and death, between recovery and the fear of relapse, or between independence and increasing dependence?

This is not simply a question about whether a new program is needed. It is a broader question about how grief-informed our existing systems are. Do professionals know how to recognize anticipatory grief? Do families have language to describe it? Are support services available early enough? Are they culturally responsive and accessible to older adults, men, people in recovery, caregivers, and families that have experienced repeated trauma?

Organizations must also consider whether their staff members, volunteers, community partners, and referral networks are prepared to recognize anticipatory grief—even when an organization does not provide a specialized program for it. Greater awareness may help people receive appropriate support earlier and reduce the isolation that often surrounds an unfolding loss.

Beginning the Conversation

Roberta’s House was founded on the understanding that grief should not be carried alone. As we continue learning from the individuals, families, and communities we serve, anticipatory grief is emerging as an area that deserves deeper attention, dialogue, and exploration.

We do not yet have all the answers. However, we believe the questions are important:

What would meaningful support for anticipatory grief look like?
How can grief care be integrated into recovery, healthcare, aging, caregiver, and human-service systems?
How do we support families without diminishing hope?
How can we better reach men and others who may not identify their experiences as grief?
What partnerships, training, and community resources would be needed?
How can we listen to those living through these experiences before deciding what support should become?

These questions invite us to expand our understanding of grief. Grief does not always wait for a death certificate, a diagnosis, or a final goodbye. Sometimes it begins quietly, while families are still hoping, caring, preparing, and trying to make sense of what may come next.

As professionals and as a community, we must ask whether we are prepared to recognize that grief—and whether we are willing to respond before people reach a point of crisis.

At Roberta’s House, our guiding promise is: I care for you, you care for me, and we care for each other. Living that promise requires us to remain attentive not only to the losses people have endured, but also to the losses they fear, anticipate, and may already be beginning to grieve.