L ife S pan D evelopmental C risis

Life Span DevelopmentalCrisis Prof.Dr.Zeinab A.Halim Professor of Psychiatric Mental Health Nursing Faculty of Nursing-Cairo University

Learning Objectives • Define the term life span • Describe the specific situational and maturational crises of child, adolescent, adult and old age. • Describe the common responses associated with each developmental stage. • Plan general and specific psychosocial interventions for each group of populations.

Definitions • Lifespan is potential maximum number of years a person can live (110- 125 years) • Life expectancy is the average number of years one can expect to live (72 years for men & 79 years for women) • Centenarian is a word used to denote a person who has reached 100 years of age

Developmental theory Interpersonal views of development regarding Erick Erickson

Life Span Development Childhood period Common situational and maturational crises may be due impaired parent child attachment Problems of disturbed attachment • The disruption and separations have been linked to: • Development of grief, anger, • Denial, and despair, that may lead to • psychopathology.

Life Span Development cont’d. Adolescent's needs: • Needs to find and confirm his/her identity. • Needs to accept his own body • Needs to develop his own body • Needs to develop positive self awareness, insight. • Needs to be independent from adult dominant • Needs to develop effective coping skills to handle the normal changes going on his life. Adolescent's crisis

Life Span Development cont’d Maturational crisis • Negative sexual body image • Negative self concept • Anxiety, tension, guilt • Low self-esteem • Helplessness

Life Span Development cont’d Situational crisis • Physical illness • Substance abuse

Life Span Development cont’d Psychosocial intervention for adolescent's crises The psychosocial aspects of primary care adolescent are best incorporated into the overall care of the adolescent. Not just after specific behavioral problems arise. • The therapists must be acquainted with adolescent, as well as the • adolescent's family, peers, and school. So the intervention will be • divided into two main aspects: • Providing individual care for adolescent. • Providing community care (family based care, and school-based • strategies) for adolescent.

Psychosocial intervention for adolescent's crises cont’d. • Providing individual care for adolescent : a- Building self-esteem • By maintaining eye contact, address the individual by her name, actively listening to her which make adolescent feels more acceptance and valued. • Do not lecture or give advice, because adolescents heat lectures and advices. • Direct them toward problem solving and assuming responsibility for their own feelings. Convey respect by requesting rather than ordering and by thanking them for their help .Praise each small effort toward success, and point out the adolescent's progress.

Psychosocial intervention for adolescent's crises cont’d. b- Skill development • Applying the problem=solving process to actual problems. • Help them in practicing appropriate social skills. • Working cooperatively within group, learning how to listen to others, and exploring new methods for controlling anger and aggression.

Psychosocial intervention for adolescent's crises cont’d. Providing community care (family based care, and school-based strategies Sullivan (1991) cited research that gives us important information about what works best: • One-to-one individual attention. A responsible, invested adult in every young person's life is essential. This can be a parent, teacher, counselor, or health care provider, or another adult who is able to care what happens. • Involvement of parents with adolescents' problems.

Psychosocial intervention for adolescent's crises cont’d. Providing community care (family based care, and school-based strategies cont’d. • Comprehensive programs that include social and mental health services, after school child care, and primary health care should be developed. • Community involvement in developing comprehensive solutions to complex problems. Multiple agencies need to develop collaborative goals and plans, and pool resources where appropriate.

Life Span Development Adulthood’s period Adult’s needs • Needs to be more satisfied in his employment. • Needs to be more sociable with other sex. • Needs to be more independent . • Needs to form a new family unit. • Needs to be more confidence in himself. • Needs to maintain a real intimacy with others.

Life Span Development cont’d. Adulthood’s period cont’d. Adult’s crisis

Adulthood’s period cont’d. Adult’s crisis A- Maturational crisis • Decision crisis • Unplanned pregnancy • Occupational change • Dependency problems • Parenthood issue problems. • Lack of meaningful work.

Adulthood’s period cont’d. Adult’s crisis Examples B- Situationalcrisis • Physical disorders. • Death and dying, • Tasks of mourning, • Divorce and separation • Substance abuse • Sexual abuse. • Infertility • Divorce

Adult’s crisis cont’d. • Emotional Reaction • Eight Typical Phases of Emotional Reaction:

Psychosocial intervention for adult's crises To give appropriate support of the client in one of these crisis situation the helper must understand the following: • The stages of grief when a loss is experienced. • The experience of normal grief. • The principles and procedures for loss interventions

Life Span Development Elderly Population Psychosocial theories of aging • Psychological theories of aging explore the mental process, behavior and feelings of persons throughout the life span along with some the mechanisms people use to meet the challenges they face in old age. Sociological theories address the impact of society and the elderly on each other.

Elderly Population cont’d. Examples Psychosocial theories of aging 1-Disengagement Theory It views aging as a process in which society and the individual gradually withdraw or disengage, from each other, to the mutual satisfaction and benefits of both. • The benefit to individuals is that they can reflect and be centered on themselves, having been freed from social roles. • The value of disengagement to society is that some orderly means is established for the transfer of power from the old to the young making it possible to society to continue functioning after its individual members die

Elderly Population cont’d. Examples Psychosocial theories of aging 2- Developmental tasks theory (Erik Erickson, 1963): • It proposes that healthy psychological aging is the result of the successful fulfillment of developmental tasks. • The challenge or tasks of old age is to accept and find meaning in life; this gives ego integrity that aids in adjusting and coping with the reality of aging & mortality • Feeling of anger, bitterness, depression, & inadequacy can result in inadequate ego integrity.

Elderly Population cont’d. Examples Psychosocial theories of aging Cohort- based, Context, Maturity, Specific Challenge (CCMSC) model • A geronto- psychotherapeutic life span approach by (Knight, 1996). It outlines 4 factors to be considered in psychotherapy

Cohort- based, Context, Maturity, Specific Challenge (CCMSC) model

Elderly Population cont’d. Psychosocial Needs • In general they are six psychosocial needs • For autonomy and independence • For dignity, credibility, and respect • For identity and individuality • For communication • For belonging • For touch

Elderly Population cont’d. • Common psychosocial problems of elderly population: 1- Loss (personal losses, social losses status or prestige change). • Multiple losses compel older persons to expend enormous amounts of physical and emotional energy in grieving, adapting to the changes that result from loss, and recovering from stress inherent in these processes. 2- Life crises (widowhood, marital problems, sexual problems, retirement, financial worries, sensory loss). 3- Rejection. 4- Powerlessness

Elderly Population cont’d. • Common emotional reactions as expressed in old age: • Grief & mourning • Grief & mourning reaction scenario: 1- Loss 2-Inability to accept the loss 3-Shock of reality 4-Physical feelings of emptiness, weakness, perhaps a feeling of suffocation, shortness of breath, & a tendency to deep sighing 5-Experience of great distress 6-There may be a sense of unreality, including delusions & obsessive preoccupations with the image of the lost person

Elderly Population cont’d. • Common emotional reactions as expressed in old age: • Grief & mourning reaction scenario cont’d. : 7- Experience of disorganization, anger, irritability, even toward friends & relatives. 8-Anxiety alternate with depression & despair 9-Acute grief ordinarily lasts a month or2 and then begins to lessen; on the average, it may be largely over in 6 to 12 months. 10-Exaggerated grief reaction may occur 11-Morbid grief reactions are distortions or prolongations of typical grief (months or years)

Elderly Population cont’d. • Common emotional reactions as expressed in old age cont’d. :

Elderly Population cont’d. Common Emotional Problems of Aging Losses Loss of relationships with people Loss of significant others and confidants Loss of peer group and collegial relationships Financial losses Loss of possessions Awareness of declining health Deterioration of own health Discomforts and pain Confinement and immobility Physical changes Monotony of daily encounters Absence of personal privacy Enforced idleness

Common Emotional Problems of Aging cont’d. Powerlessness Powerlessness against others and the world Vulnerability: being a spectator Unreliability of others Unpredictability of others and "the fates" Indignities and dependence Being exposed to propaganda Being "talked into" accepting something That is not wonted Having information withheld Not receiving accurate information

Common Emotional Problems of Aging cont’d. Powerlessness against time Not knowing the duration of confinement Sensing a meaningless existence Sensing threats to life and health Awareness of death Deterioration of significant others' health Confinement Burden of caring for others Refection Feeling forgotten Being forgotten Feeling unworthy or unacceptable

Common Problems of Aging Comparison of Dementia and Depression DEMENTIA DEPRESSION • Rapid • Insidious, indeterminate Onset • Short • Long Duration • Consistently depressed Mood/ behavior • Fluctuates • Provides a close, but usually • incorrect answer to question • "Do not know" Response • Highlight • Concealed Disabilities • Relatively stable • Fluctuates greatly Cognition

Specific interventions related toElderly Population 1- Assessment of psychosocial status Three interrelated dimensions are usually considered in gathering information for a psycho-social assessment of an elderly person- These include: (1) psychological state (2) developmental satisfaction (3) social effectiveness.

Assessment of psychosocial status cont’d. Psychological State Psychological state can be thought of as being composed of five separate facets: (l) The client's view of self (2) His thought content (3) Affect and mood (4) Stress management and coping styles (5) Behavior

Assessment of psychosocial status cont’d. Psychological State cont’d. The questions and statements presented below may be helpful in determining an overall assessment of the client's view of self 1. Tell me what it's like for you to be 72 (or whatever his age). 2. Tell me about what aging is like. 3. Tell me about what your aging has been like. 4. What is the ideal old person like? Tell me what most old people are like. 5. How are you like the ideal old person? How are you different? 6. If you had to describe yourself in three words, what would they be? 7. How do you feel about growing older?

Assessment of psychosocial status cont’d. Psychological State cont’d. • Tell me about the periods when you felt most successful. Do you think you were different then, or much as you are now? • 2. Tell me about your greatest strengths • 3. Tell ire about your happiest times. What about you makes you happy? • 4. What was the most important thing you have done in your life? What personal characteristics of yours made it happen?

Assessment of psychosocial status cont’d. Social Effectiveness The last facet of the psychosocial assessment of an older adult involves gathering data that can be used to determine the elderly individual's social effectiveness. The socially effective elderly person is one who is able to establish, maintain, and use social networks and interpersonal relationships to meet basic human needs

Specific interventions related toElderly Population cont’d. Life review therapy This is a nursing intervention that assists the older adult in an individual basis to positively resolve Erickson’s major developmental tasks for the older adult & gain integrity). The older adult examines his life critically & reviews all aspects. Technique of life review A structured approach is taken with specific time allowed to focus on a review of the different life periods, such as 1 to 2 weeks on childhood, 1 or 2 weeks on the teenage years & so forth.

Specific interventions related toElderly Population cont’d. Reminiscence This is a nursing intervention that encourages the elderly person to recall or remember past events with the purpose of attaining specific goal. It may be formal (1 or twice a week) or informal with individuals or group E.g., the nurse use reminiscence to increase self- esteem or life satisfaction. Technique of Reminiscence 1- Encourage the elderly person to reminisce or discuss memories & past experiences (successes & pleasurable events) 2- Or in a group setting with the nurse acting as a facilitator; participants discuss different topics from their past (significant events, birth of their children, travel, places they have lived, & holidays)

Specific interventions related toElderly Population cont’d Remotivation Therapy Goals • Help achieve sense of belonging • Increase feelings of self-worth, self-reliance, and personal value • Assist individuals to maximize their potential through other-directed communication and stimulating interest in surrounding environment and people Procedures • Welcoming • Create a bridge to reality • Sharing the world we live in • The work of the world • Appreciation

Specific interventions related toElderly Population cont’d Sensory stimulation and training Goals • Help put the regressed person back in touch with surroundings • Improve sensitivity and responsiveness to the environment • Increase discrimination ability Procedures Structured experiences involving the five senses; e.g. visual, looking in the mirror; auditory, listening to tapes; tactile, touching textured objects, olfactory, smelling fragrant, spicy aromas, gustatory, tasting sweet, sour, bitter foods; kinesthetic, moving and dancing

Specific interventions related toElderly Population cont’d Behavior modification and habit training Goals • Give maximum support to appropriate behavior and compensate • for behavioral deficits • Increase functional levels of the elderly and also their sense of • self-control • Reduce anxiety Procedures • Provide an environmental cue (stimulus) that targets, signals, or in some way helps the resident focus on the appropriate, expected behavior • Provide a positive reinforcement (reward) for achievement of the expected behavior

Specific interventions related toElderly Population cont’d Pet therapy Goals • Alleviate depression • Enhance self-image and identity • Help fulfill need to be loved and to love in return • Help restore emotional equilibrium Procedures • Animals (such as dogs, cats, fish, and birds) are used as therapeutic catalysts

Learning Activities Form groups of three students: 1- Choose a target group of adolescents, parents, teachers, or other significant caregivers. 2- With this target group identify an area of need that could be dealt with through planning a program of anticipatory guidance. 3- Plan and implement this program

Learning Activities Identify the local community resources that provide supportive or mental health services to the elderly and their families. Visit one agency and observe the types of services provided, the ages and types of clients served, the prevailing treatment focus of the agency (primary, secondary, tertiary prevention, palliation, and so on) and the prevailing attitudes of the health care providers toward the elderly. Select one client over the age of 65 who is in a general hospital for treatment, of an acute or a chronic physical illness. Perform a comprehensive mental health assessment and then plan an intervention program with the client, the focus of which is primary prevention. Include consideration of personal resources, strengths, family and social networks, and community resources as you both plan the intervention program. Evaluate the plan of care.

L ife S pan D evelopmental C risis