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Life Span Developmental Crisis

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Title: Life Span Developmental Crisis


1
Life Span Developmental Crisis
Prof.Dr.Zeinab A.Halim
Professor of Psychiatric Mental Health Nursing
Faculty of Nursing-Cairo University
2
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.

3
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

4
Developmental theory
  • Interpersonal views of development
  • regarding Erick Erickson

Developmental tasks Phase (approximate age span)
Trust versus mistrust Infancy
Autonomy vs. shame and doubt Toddler
Initiative vs. guilt Preschool
Industry vs. inferiority School age
Identity vs. identity diffusion Adolescent
Intimacy vs. isolation Adult
Generativity vs. stagnation Late adulthood
Integrity vs. despair Old age
5
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.

6
Life Span Development contd.
Adolescent's crisis
  • 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.

7
Life Span Development contd
Maturational crisis
  • Negative sexual body image
  • Negative self concept
  • Anxiety, tension, guilt
  • Low self-esteem
  • Helplessness

8
Life Span Development contd
Situational crisis
  • Physical illness
  • Substance abuse

9
Life Span Development contd
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.

10
Psychosocial intervention for adolescent's crises
contd.
  1. 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.

11
Psychosocial intervention for adolescent's crises
contd.
b- Skill development
  • Applying the problemsolving 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.

12
Psychosocial intervention for adolescent's crises
contd.
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.

13
Psychosocial intervention for adolescent's crises
contd.
Providing community care (family based care, and
school-based strategies contd.
  • 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.

14
Life Span Development
Adulthoods period
Adults 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.

15
Life Span Development contd.
Adulthoods period contd.
Adults crisis
16
Adulthoods period contd.
Adults crisis
A- Maturational crisis
  • Decision crisis
  • Unplanned pregnancy
  • Occupational change
  • Dependency problems
  • Parenthood issue problems.
  • Lack of meaningful work.

17
Adulthoods period contd.
Adults crisis
Examples
B- Situational crisis
  • Physical disorders.
  • Death and dying,
  • Tasks of mourning,
  • Divorce and separation
  • Substance abuse
  • Sexual abuse.
  • Infertility
  • Divorce

18
Adults crisis contd.
  • Emotional Reaction
  • Eight Typical Phases of Emotional Reaction

19
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

20
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.

21
Elderly Population contd.
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

22
Elderly Population contd.
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.

23
Elderly Population contd.
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

24
Cohort- based, Context, Maturity, Specific
Challenge (CCMSC) model
Factor Consideration
1. Cohort factors Individual cognitive performance, verbal fluency, education, normative course of life, life experience from a social historical view point
2. Context effects Current environmental characteristics such as age adapted accommodations, residential facilities, spare time options. General social health long time care provision
3. Maturity Persons cognitive emotional complexities, areas of expertise competencies, including experience in family life persons accumulated interpersonal competencies
4.Specific challenges Chronic diseases, disabilities, grieving while experiencing deaths of relatives friends, as well as the person dealing with their own end- of- life, including preparation for death.
25
Elderly Population contd.
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

26
Elderly Population contd.
  • 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
27
Elderly Population contd.
  • Common emotional reactions as expressed in old
    age
  1. 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
28
Elderly Population contd.
  • Common emotional reactions as expressed in old
    age
  • Grief mourning reaction scenario contd.

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)
29
Elderly Population contd.
  • Common emotional reactions as expressed in old
    age contd.

30
Elderly Population contd.
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
31
Common Emotional Problems of Aging contd.
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
32
Common Emotional Problems of Aging contd.
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
33
Common Problems of Aging
Comparison of Dementia and Depression
DEMENTIA
DEPRESSION
  • Rapid
  • Insidious, indeterminate

Onset
  • Short
  • Long

Duration
  • Consistently depressed

Mood/ behavior
  • Fluctuates
  • "Do not know"
  • Provides a close, but usually
  • incorrect answer to question

Response
  • Highlight
  • Concealed

Disabilities
  • Relatively stable
  • Fluctuates greatly

Cognition
34
Specific interventions related to Elderly
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.
35
Assessment of psychosocial status contd.
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
36
Assessment of psychosocial status contd.
Psychological State contd.
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?
37
Assessment of psychosocial status contd.
Psychological State contd.
  • 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?

38
Assessment of psychosocial status contd.
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
39
Specific interventions related to Elderly
Population contd.
Life review therapy
This is a nursing intervention that assists the
older adult in an individual basis to positively
resolve Ericksons 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.
40
Specific interventions related to Elderly
Population contd.
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)
41
Specific interventions related to Elderly
Population contd
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

42
Specific interventions related to Elderly
Population contd
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
43
Specific interventions related to Elderly
Population contd
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

44
Specific interventions related to Elderly
Population contd
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

45
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

46
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.
47
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