(1) Adulthood & Old Age Death & Dying

Young adult age range

20-40 yo

 Peaking biological development 

Young adult

Assumption of major social roles and establishing an identity congruent with new roles 

Young adult

 Evolution of adult self and life structure 

Young adult

Successful transition required satisfactory resolution of childhood and adolescent crises 

Young adult

Characterized by real and intrapsychic separation from the family of origin and engagement of new, phase-specific tasks 

TRANSITION FROM ADOLESCENCE TO YOUNG ADULTHOOD 

Childhood dependency to self-reliance 

TRANSITION FROM ADOLESCENCE TO YOUNG ADULTHOOD 

YOUNG ADULTHOOD: DEVELOPMENT TASKS OF YOUNG ADULTHOOD 

● To develop a young adult ____

● To develop adult ____ that does not to be nourished by ____ presence 

● To develop the capacity for ____, to become a ____ 

● To become a ____ and ____ parent 

● To develop a relationship of ____ and ____ with parents when facilitating their ____ development 

● To establish an adult work ____ 

● To integrate new ____ towards ____ 

YOUNG ADULTHOOD: DEVELOPMENT TASKS OF YOUNG ADULTHOOD 

● To develop a young adult sense of self 

● To develop adult friendships that does not to be nourished by physical presence 

● To develop the capacity for intimacy, to become a spouse 

● To become a biological and psychological parent 

● To develop a relationship of mutuality and equality with parents when facilitating their midlife development 

● To establish an adult work identity 

● To integrate new attitudes towards time 

Establish a self that is separate from parents 

Young adulthood

can both be a source of frustration or can enhance self-esteem

Work identity

can damage one’s core identity 

Unemployment

Primary source of emotional sustenance

Young adult: Developing adult friendships

Substitute siblings and parents until more permanent replacements are found (own spouse, children)

Young adult: Developing adult friendships

Search for intimacy

Young adult: Sexuality & marriage

Increases desire for marriage

Young adult: Sexuality & marriage

increases bond between new parents 

Young adult: parenthood

 Expands their internal image of each other to include thoughts and feelings emanating from the role of a parent 

Young adult: parenthood

Continuing process of letting go 

Young adult: parenthood

Separation from children and enhancing their independence

Young adult: parenthood

Middle Adulthood Age

40-65 yo

 Golden age of adulthood 

Middle Adulthood

Normative sense of satisfaction and well-being 

Middle Adulthood

Middle Adulthood Normative Sense

• Gratifying ____ 

• ____ health  

• ____ maturity 

• ____ and ____ at ____

Middle Adulthood Normative Sense

• Gratifying relationships 

• Physical health

• Emotional maturity 

• Competence and power at work

Some experience gap between earlier aspirations and current achievements 

Middle Adulthood: Work

“Is it worth continuing? I would like to live in a more satisfying way.” 

Middle Adulthood: Work

Usually do not have sense of urgency or the need to be frequently or nearly in constant physical presence of friend 

Middle Adulthood: DEVELOPING MIDDLE FRIENDSHIPS

Constant sources of gratification through: spouse, children and colleagues 

Middle Adulthood: DEVELOPING MIDDLE FRIENDSHIPS

Reappraising relationships - settle for what they have or search for greater perfection (affair, trial separations, divorce)

Middle Adulthood: DEVELOPING MIDDLE FRIENDSHIPS

• Providing a safe place for conflict and difference = acceptance 

• Holding a double vision of each other (understand that your spouse is not perfect) 

• Maintaining a healthy sexual life

Middle Adulthood: DEVELOPING MIDDLE FRIENDSHIP — REAPPRAISING RELATIONSHIPS

focused on maintaining intimacy in the face of pressures 

Middle Adulthood: SEXUALITY

Diminished ability of this is compensated by feelings of love and tenderness generated over years by a satisfying relationship

Middle Adulthood: SEXUALITY

Acceptance of partner's middle-aged body, find it stimulating and accept normative changes in sexual function

Middle Adulthood: SEXUALITY

decreased biological and physiological functioning 

Middle Adulthood: CLIMACTERIUM

both happens to male and females but more common in male 

Middle Adulthood: CLIMACTERIUM

sudden drastic change in work or marital relationships, severe depression, increased drug or alcohol use and shift to an alternate lifestyle 

Andropause mid-life crisis 

accompanied by significant, ongoing emotional turmoil for the individual and others 

Andropause mid-life crisis 

Menopause

Middle Adulthood: CLIMACTERIUM

 A depression that occurs in some when the youngest child is about to leave home

Middle Adulthood: EMPTY NEST SYNDROME

EMPTY NEST SYNDROME is more predominant in?

More predominant in females - especially those whose predominant role in life is motherhood and those that stay in unhappy marriage "for the sake of children"

a mental state, not age 

Middle Adulthood: ADULT MATURITY

Mental state found in healthy adults 

Middle Adulthood: ADULT MATURITY

characterized by detailed knowledge of the parameters of human existence, a sophisticated level of self awareness based on honest appraisal of one’s own experience and the ability to use this intellectual and emotional knowledge and insight caringly in relation to one’s self and others

Middle Adulthood: ADULT MATURITY

Emergence of wisdom

Middle Adulthood: ADULT MATURITY

Learned from past experiences

Wisdom

Fully engaged in life in the present 

Wisdom

Understanding and acceptance of person’s place in the order of human existence (circle of life)

Wisdom

May develop qualities that enable them to express emotions and recognize their dependency needs, traits that are considered feminine

Males in Middle Adulthood

No longer need to nurture young children 

Females in Middle Adulthood

Release the energy into independent pursuits 

Females in Middle Adulthood

Competitive and assertive 

Females in Middle Adulthood

 Considered masculine

Females in Middle Adulthood

3 things middle-aged adult should have

• Generativity

• Wisdom

• Self-actualization

Developmental Theories for Middle Adulthood

• Robert Butler

• Erik Erikson

DEVELOPMENTAL THEORY: ROBERT BUTLER

Features Salient to Middle Adulthood

Issues	Positive  Features	Negative Features
	Responsible use of power, maturity; productivity	Winner-loser view; competitiveness  Pulling down other people
	Possibility; alternatives; organization of commitments; redirection	Closure; fatalism
	Commitment to self, others, career, society; filial maturity	Hypocrisy; self-deception
	Naturality regarding body, time	Obscene or frenetic efforts (e.g., to be youthful, hostility and envy of youth and progeny; longing)
	Matters understood; continuity; picking up to where left off; large social network; rootedness of relationships, places, and ideas	Repetitiveness; boredom; impatience; isolation; conservatism; confusion; rigidity

Issues	Positive  Features	Negative Features
Prime of Life	Responsible use of power, maturity; productivity	Winner-loser view; competitiveness  Pulling down other people
Stock taking; what to do with the rest of one’s life	Possibility; alternatives; organization of commitments; redirection	Closure; fatalism
Fidelity and commitments	Commitment to self, others, career, society; filial maturity	Hypocrisy; self-deception
Growth-death (to grow is to die); juvenescence and rejuvenation fantasies	Naturality regarding body, time	Obscene or frenetic efforts (e.g., to be youthful, hostility and envy of youth and progeny; longing)
Communication and socialization	Matters understood; continuity; picking up to where left off; large social network; rootedness of relationships, places, and ideas	Repetitiveness; boredom; impatience; isolation; conservatism; confusion; rigidity

Proponent for Generativity vs. Stagnation

Erik Erikson

Process by which persons guide the incoming generation or improve society 

Middle Adulthood: Generativity

Raising children (wanting and having children does not ensure this) 

Middle Adulthood: Generativity

If has no children:

• Helping others 

• Being creative 

• Contribute to Society

Middle Adulthood: Generativity

 stops developing; being in a cocoon of self concern and isolation

Middle Adulthood: Stagnation

Late adulthood age

65 yo

Young old age range

65-75

Old-old age range

75 and beyond

Shift from pursuit of wealth to maintenance of health 

Late adulthood

Central concern is the aging body

Late adulthood

Development Tasks of Late Adulthood

• To maintain the ____ and ____

• To conduct the ____

• To maintain ____ interests and activities

• To deal with the ____ of signicant loved ones

• To accept the implications of ____

• To accept the genetically ____ of ____ systems

• To divest oneself of the attachment to ____

• To accept changes in the relationship with ____

Development Tasks of Late Adulthood

• To maintain the body image and physical integrity

• To conduct the life review

• To maintain sexual interests and activities

• To deal with the death of signicant loved ones

• To accept the implications of retirement

• To accept the genetically programmed failure of organ systems

• To divest oneself of the attachment to possessions

• To accept changes in the relationship with grandchildren

Old Age Developmental Theories

• Sigmund Freud

• Erik Erikson

• Heinz Kohut

• Bernice Neugarten

• Daniel Levinson

“Increasing control of the ego and id with aging results in increased autonomy. Regression may permit primitive modes of functioning to reappear”

OLD AGE DEVELOPMENTAL THEORISTS - Sigmund Freud

Central conflict in old age is between:

• INTEGRITY

• DESPAIR

OLD AGE DEVELOPMENTAL THEORISTS - Erik Erikson

Contentment in old age comes only with getting beyond narcissism and into intimacy and generativity.

OLD AGE DEVELOPMENTAL THEORISTS - Erik Erikson

the sense of satisfaction people feel reflecting on a life lived productive

Integrity

the sense that life has little purpose or meaning

Despair

Old people must continually cope with narcissistic injury as they attempt to adapt to the biological, psychological, and social losses associated with aging process

OLD AGE DEVELOPMENTAL THEORISTS - Heinz Kohut

The maintenance of self-esteem is a major task of old age.

OLD AGE DEVELOPMENTAL THEORISTS - Heinz Kohut

The major conflict of old age relates to giving up the position of authority and evaluating achievements and former competence.

OLD AGE DEVELOPMENTAL THEORISTS - Bernice Neugarten

It is a time of reconciliation with others and resolution of grief over death of others and approaching death of self.

OLD AGE DEVELOPMENTAL THEORISTS - Bernice Neugarten

Age 60-65 is a transition period. People who are narcissistic and too heavily invested in body appearance are liable to become preoccupied with death.

OLD AGE DEVELOPMENTAL THEORISTS - Daniel Levinson

Creative mental activity is a normal and healthy substitute for reduced physical activity.

OLD AGE DEVELOPMENTAL THEORISTS - Daniel Levinson

Healthy older persons usually maintain a level of social activity that is only slightly changed from that of earlier years 

Psychosocial Aspects of Aging: Social Activity

Continued intellectual, emotional, and psychological growth 

Psychosocial Aspects of Aging: Social Activity

pass on cultural values and provide care services to the younger generation and thereby maintaining a sense of usefulness that contributes to self-esteem 

Psychosocial Aspects of Aging: Contact with younger persons

refers to discrimination towards old persons and to the negative stereotypes about old age 

Ageism

Prevalence of major depression and dysthymia is actually less than in younger age groups 

Psychological Problems of Older Persons

Depression often accompanied by physical symptoms or cognitive changes that may mimic dementia 

Psychological Problems of Older Persons

 High incidence of suicide (40/100,000) 

Psychological Problems of Older Persons

• Dementia 

• Psychotic disorders 

Psychological Problems of Older Persons

End of Life Issues

1. Death

2. Dying

 absolute cessation of vital functions 

 Death 

process of losing vital functions 

Dying

one that is free from avoidable distress and suffering for patients, families, and caregivers and is reasonably consistent with clinical, cultural, and ethical standards 

Good death 

needless suffering (an avoidable or treatable disease leading to death), a dishonoring of the patient or family's wishes or values, and a sense among participants or observers that norms of decency have been offended 

Bad death

5 Stages of Death and Dying

1. Shock and Denial

2. Anger

3. Bargaining

4. Depression

5. Acceptance

KUBLER-ROSS 5 STAGES OF GRIEF 

1. Denial

2. Anger

3. Bargaining

4. Depression

5. Acceptance

“This cannot be true.” Feelings of isolation. May search for another health care professional who will give a more favorable opinion. Might seek unproven therapies

Denial

can be an adaptive response, providing a buffer after bad news

Denial

It allows time to mobilize defenses but can be maladaptive when it prevents the patient or the family from seeking help or when denial behaviors cause more pain or distress than the illness or interfere with everyday functions. 

Denial

“Why me?” Feelings of rage, resentment, or envy directed to God, health care professionals, family and others.

Anger

can be very isolating, and loved ones or clinicians may withdraw

Anger

“I just want to see my grandchild’s birth then I’ll be ready…” Patient and/or family plead for more time to reach an important goal. Promises are sometimes made with God,

Bargaining

Terminally ill patients are sometimes able to outlive prognoses and achieve some future goal. 

Bargaining

“I just don’t know how my kids are going to get along after I’m gone.” Sadness, grief, mourning for impending loves

Depression