[3.1] Adulthood and Old Age, Death and Dying

characterized by peaking biological development

young adult

characterized by assumption of major social roles and establishing an identity congruent with new roles

young adult

characterized by 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

• childhood dependency to self-reliance

transition from adolescence to young adulthood

either a source of frustration or can enhance self-esteem

work identity

under work identity

can damage one’s core identity

unemployment

primary source of emotional sustenance

developing adult friendships

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

developing adult friendships

search for intimacy; increases desire for marriage

sexuality and marriage

• increases bond between new parents

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

• continuing process of letting go

  • separation from children and enhancing their independence

parenthood

golden age of adulthood

middle adulthood

some experience gap between earlier aspirations and current achievements

work

men or women

in middle adulthood, become more competitive and assertive

women

men or women

in middle adulthood, may develop qualities that enable them to express emotions and recognize their dependency needs

men

men or women

in middle adulthood, no longer need to nurture young children

women

men or women

in middle adulthood, release energy into independent pursuits

women

process by which persons guide the oncoming generation or improve society

generativity

true or false

wanting and having children does not ensure generativity

true

no children

• helping others

• being creative

• contribute to society

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

stagnation

in developing midlife friendships, constant sources of gratification are through…

spouse, children, colleagues

true or false

in developing midlife friendships, we usually have a sense of urgency to be frequently or nearly in constant physical presence of a friend

false

we usually do NOT

fill in the blanks

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

• providing a safe place for ________ and __________

• holding a ______ ______ of each other

• maintain a healthy ______ ____

• providing a safe place for conflict and difference

• holding a double vision of each other

• maintaining a healthy sexual life

• focused on maintaining intimacy in the face of pressures

• acceptance of partner’s middle-aged body, finding it stimulating and accept normative changes in sexual function

sexuality

under sexuality

compensated by feelings of love and tenderness generated over years by a satisfying relationship

diminished sexual ability

decreased biological and physiological function

climacterium

sudden drastic change in work or marital relationships, severe depression, increased drug or alcohol use and shift to an alternate lifestyle; accompanied by significant, ongoing turmoil for the individual and others

HINT: climacterium for males

andropause mid-life crisis

climacterium for females

menopause

a depression that occurs in some when the youngest child is about to leave home; more predominant in females

empty nest syndrome

true or false

adult maturity is the achievement of maturity based on age

false

adult maturity is a mental state, not age

a mental state found in healthy adults

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

adult maturity

fill in the blank

adult maturity is the emergence of ______

adult maturity is the emergence of wisdom

• learned from past

• fully engaged in lie in the present

• understanding and acceptance of person’s place in the order of human existence

shift from pursuit of wealth to maintenance of heatlh

late adulthood

age ranges for young old and old-old

young old: 65 - 75 y/o

old-old: 75 and beyond

central concern of late adulthood

aging body

under old age developmental theorists, who said this?

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

Sigmund Freud

under old age developmental theorists, who said this?

“Central conflict in old age is between integrity, the sense of satisfaction people feel reflecting on a life lived productive, and despair, the sense that life has little purpose or meaning. Contentment in old age comes only with getting beyond narcissism and into intimacy and generativity.”

Erik Erikson

under old age developmental theorists, who said this?

“Old people must continually cope with narcissistic injury as they attempt to adapt to the biological, psychological, and social losses associated with aging process. The maintenance of self-esteem is a major task  of old age.”

Heinz Kohut

under old age developmental theorists, who said this?

“The major conflict of old age relates to giving up the position of authority and evaluating achievements and former competence. It is a time of reconciliation with others and resolution of grief over death of others and approaching death of self.”

Bernice Neugarten

under old age developmental theorists, who said this?

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

Daniel Levinson

under psychosocial aspects of aging (social activity), true or false

healthy older persons usually have a level of social activity that is much different from that of earlier years

false

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

under 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

contact with younger persons

refers to discrimination toward old persons and to the negative stereotypes about old age (loneliness, poor health, senility and general weakness)

ageism

true or false

major depression and dysthymia is less prevalent in older persons than in younger age groups

true

fill in the blanks

_____ is the absolute cessation of vital functions

_____ is the process of losing vital functions

death is the absolute cessation of vital functions

dying is the process of losing vital functions

type of death that is free from avoidable distress and suffering for pts, families, and caregivers and is reasonably consistent with clinical, cultural, and ethical standars

good death

type of death where there is needless suffering, a dishonoring of the pt or family’s wishes or values, and a sense among participants or observers that norms of decency have been offended

bad death

what are the 5 stages of death and dying? (Kubler-Ross)

1. shock and denial

2. anger

3. bargaining

4. depression

5. acceptance

identify the stage of death and dying

Angelina seeks for another health care professional who will give a more favorable opinion.

(1) shock and denial

identify the stage of death and dying

Kursten feels resentment towards God, her doctor, family, and friends.

(2) anger

identify the stage of death and dying

Gail wishes to spend more time with her family and makes promises to God.

(3) bargaining

identify the stage of death and dying

Joana feels sad about leaving her kids behind after she is gone.

(4) depression

identify the stage of death and dying

Lorelle feels that she has lived a good life and does not have any regrets.

(5) acceptance

subjective feeling precipitated by death of a loved one

grief

process by which gried is resolved

mourning

state of being deprived of someone by death

bereavement

enumerate the normal bereavement reactions

HINT: Please Save Lighter, Dear DR.

1. protest

2. searching

3. loss of hope to reestablish attachment

4. despair

5. detachment

6. reorganization

• grief reactions brought on by slow dying process of a loved one through injury, illness, or high-risk activity

• soften the blow of eventual death

• can lead to premature separation and withdrawal while not necessarily mitigating later bereavement

anticipatory grief

bereavement or major depressive disorder

survivor rarely has morbid feelings of guilt and worthlessness, suicidal ideation, or psychomotor retardation

bereavement

bereavement or major depressive disorder

may consider self weak, defective, or bad

major depressive disorder

bereavement or major depressive disorder

dysphoria often triggered by thoughts or reminders of the deceased

bereavement

bereavement or major depressive disorder

dysphoria often becomes chronic, intermittent, or episodic

major depressive disorder

bereavement or major depressive disorder

onset is within the first 2 months; depressive symptoms last for less than 2 months

bereavement

bereavement or major depressive disorder

onset is at anytime; often becomes chronic, intermittent, or episodic

major depressive disorder

bereavement or major depressive disorder

functional impairment is transient and mild

bereavement

bereavement or major depressive disorder

clinically significant distress or impairment

major depressive disorder

bereavement or major depressive disorder

no family or personal history of major depression

bereavement

major depressive disorder has

refers to providing relief from suffering caused by pain or other symptoms of terminal disease

palliative care

wishes and choices about medical interventions when the patient’s condition is considered terminal

advance directives

3 types of advance directives

1. living will

2. health care proxy

3. DNR and DNI orders