Q6L4AQB

Middle adulthood

45 to 65 Generativity vs. stagnation

Late adulthood

65+ Ego integrity vs. despair

Common Age-Related Changes: URINARY SYSTEM

Fewer cells in kidney, decreased renal blood flow; less effective filtration; decreased bladder elasticity and capacity; need to void more frequently Observe for signs of urinary tract infections. Observe closely for adverse drug reactions. Observe male for signs of benign prostatic hypertrophy causing impairment of urinary flow.

Common Age-Related Changes: NERVOUS SYSTEM

Fewer, smaller neurons (nerve cells), slowed reaction time, decrease in tactile sensitivity, decrease in pain perception, altered motor coordination Allow adequate time to complete activities. Be alert to danger of and prevent burning and chilling related to diminished sensitivity. Encourage position changes; inspect skin daily.

Autocratic Family Pattern

In the autocratic family pattern, the relationships are unequal. The parents attempt to control the children with strict, rigid rules and expectations. This family pattern is least open to outside influence.

Democratic Family Pattern

In the democratic family pattern, the adult members function as equals. As is often true in other types of families, children are treated with respect and recognized as individuals. This style encourages joint decision making, and it recognizes and supports the uniqueness of each individual member. This family pattern favors negotiation, compromise, and growth.

Matriarchal Family Pattern

In the matriarchal family pattern (also known as the matrifocal family) the adult female (or females of the family) assumes primary dominance in areas of child care and homemaking, as well as financial decision making. In some families of this type, an older female relative provides child care so that the mother of the children is free to work outside of the home.

Patriarchal Family Pattern

In the patriarchal family pattern, the adult male (or males of the family) usually assumes the dominant role. The adult male member functions in the work role, is responsible for control of finances, and makes most decisions.

Late Adulthood Safety (safety alert! Pg 215)

Safety Tips for the Older Adult • Minimize clutter and excess furniture in rooms and hallways. • Remove scatter rugs. • Use hand rails on stairs. • Install grab bars in showers and bathroom. • Use night-lights. • Get up slowly from a lying-flat position. • Use caution in going from well-lighted areas to darkened areas or vice versa. • If self-medicating, use dispensing aids to decrease the risk of error. • Wear properly fitting shoes and clothing. • Allow enough time—do not rush or hurry.

Disengagement Stage of Parenthood

grown children depart from the home

Adolescence

12 to 19 Identity vs. role confusion

Young adulthood

20 to 44 Intimacy vs. isolation

adolescence Sleep, play activity, safety

-pace activities to allow for adequate rest - increased hours of sleep to restore energy levels -Growth spurts cause the bones to grow more quickly than the muscles and tendons. This causes the muscles and tendons to become short and tight. This, combined with the general awkwardness of this stage, accounts for some of the frequent sports-related injuries. -appropriate warm-up and stretching exercises before starting any strenuous sports can lessen the risk of injury -Participating in organized sports at this age helps adolescents learn to work with others, meet challenges, and set personal goals -The greatest number of deaths in this age-group is due to accidents. -Driver's education, water safety training, education about safe sex practices, and drug education are necessary to inform adolescents of the risks and dangers inherent in these activities.

adolescence Emotional health

-period of maturation covering the transition from childhood to adulthood -complexity of the tasks facing them, adolescents go through different moods that are common in this period. -outgoing and gregarious and active participants / offer their opinions and seem to ignore others / moody and loners - It is important for families to recognize and distinguish normal moodiness from signs of depression in adolescents. --Depression is defined as a mood disturbance characterized by feelings of sadness, despair, and hopelessness. -This mood swing potentially signals a decision to carry out the person's suicide plan.

middle adulthood Psychosocial development

According to Erikson, the developmental task of middle age is generativity versus stagnation. This means accepting responsibility for and offering guidance to the next generation. Generativity encompasses productivity, continuity, and creativity (Figure 9-15). If this developmental task is not met, people become stagnant—inactive or lifeless. The middle adult years are a time for vocational, interpersonal, and personal fulfillment. The impulse to foster development of the young is not limited to guiding one's own children and does not cease with their maturation. Many middle-aged adults enjoyably express this desire through activities such as teaching and mentorship, a mutually fulfilling relationship that satisfies a younger protégé's need for guidance along with an older person's need for generativity. Resumption of education, career growth or changes, reentry into the workforce, and involvement with community activities create a multitude of possibilities for personal growth and satisfaction during the middle adult years. Family roles change during this stage. Children are sometimes present in the home, and sometimes not. For most caregivers, a significant change in their lives occurs with the end of daily, active responsibility for children. Relationships between spouses change, and the couple often has to regain familiarity with each other. For many, this offers the opportunity for new or renewed companionship. Survival of the marriage after children leave home possibly depends on the growth, the maturity, and the commitment of each partner. The majority of empty-nest women actually look forward to their emancipation from parenting duties, seeing it as an occasion to further develop their personal and social roles. The role of grandparenting often begins at this developmental stage. Because it often does not have the constraints and responsibilities of child rearing, grandparenting becomes a rich and rewarding experience for many middle-aged adults. The past few decades have probably been the best time ever to be an American grandparent and to enjoy grandparenting as a joyful experience. Grandparents now have the longest, healthiest life spans ever recorded, the best social services, and the most independence. Many still hover just above the poverty line and some are below it; however, many grandparents are prosperous. Many of today's grandparents have lots of grandchildren to enjoy. Many American grandparents are not involved in the upbringing and disciplining of their grandchildren, preferring a "norm of noninterference." Grandparents often refrain from giving their grown children child-rearing instruction, even when they do not like something they see going on with their grandchildren. Most contemporary grandparents value their independence; many are unwilling to exchange their hard-won and long-awaited lifestyles for another round of the hard, often frustrating work of raising children. On the other hand, most adults are not prepared for the increased responsibility of caring for aging parents. Economic stress and emotional pressure are both associated with the role reversal sometimes known as "parenting the parent." Studies have indicated that a midlife daughter is most likely to be involved in elder care with her parents and her husband's parents.

Late Adulthood Ageism—definition

Ageism—a form of discrimination and prejudice against the older adult—is an unfortunate reality. Like racism and sexism, ageism works to prevent people from being as happy and productive as they otherwise have the ability to be. It is passed on from generation to generation by the process of socialization. Society today must relinquish old stereotypes about the older adult and learn to affirm the positive aspects of aging (Figure 9-18). It is a mistake to view aging only as a decline; it involves growth as well.

middle adulthood Physical characteristics

Bone mass decreases as skeletal growth cells are depleted. This bone loss leads to an increased risk of osteoporosis. Women lose calcium from bone tissue after menopause. Men also lose calcium from bones but at a more gradual rate than women, and their risk of osteoporosis is lower. Slight changes in height continue to occur as a result of the compression of the spinal vertebrae and the hardening of collagen fibers. A decrease in muscle fibers results in a reduction of muscle mass. Heredity, nutrition, and exercise patterns account for much of the individual variation commonly seen. Changes in muscle strength are perhaps related more to level of activity than to age. A redistribution of body weight leads to changes in body shape and contour. A decrease in basal metabolism and less activity often necessitates calorie reductions to prevent weight gain. Basic neurologic functioning remains at a high level during this age period. Noticeable changes in vision occur owing to presbyopia (defect in vision in advancing age involving loss of accommodation or the recession of the near point caused by loss of elasticity of crystalline lens and the ensuing change in close vision). Other sensory changes may include presbycusis (a normal progressive, age-associated loss of hearing acuity, speech intelligibility, auditory threshold, and pitch). These changes usually begin around age 40 and occur more commonly in men than in women. One of the most noticeable changes that occurs during this period is in the appearance of the individual's skin. There is a decrease in the elastic fibers and a slight loss of subcutaneous tissue, giving skin a looser, more wrinkled appearance. Hair color often changes with age with the onset of graying. Graying usually begins at the temples. Hair growth and distribution sometimes changes during the middle adult years. Scalp hair tends to become thinner. There is a higher incidence of periodontal (gum) disease in the middle adult years. Preventive treatment programs including fluoride usage, regular flossing, and dental cleaning are important. Hormonal changes include the woman's declining production of estrogen and progesterone. Menopause (female climacteric) is a gradual process that takes about 5 years to complete. A woman's perception of menopause is likely to be affected by her perceptions of her general health. During this process, the functions of the ovaries will diminish and eventually cease. Noticeable signs and symptoms of menopause typically include irregular menstrual periods, flow changes, excess fluid retention, breast tenderness, hot flashes—feeling "hot," flushing, and blushing—palpitations, night sweats, and irritability or mood swings. Some women have very few signs or symptoms related to menopause. Some women receive small doses of estrogen aimed at relieving the complications of decreased estrogen levels. Some suggest that hormone replacement therapy (HRT) offers a way to reduce osteoporosis and the risk of atherosclerosis and heart disease; however, HRT is also feared to increase the risk of stroke, endometrial cancer, and breast disease, as well as raise blood pressure. Therefore it is necessary to evaluate the risks versus the benefits of this treatment on an individual basis. The woman is able to continue to experience positive, satisfying sexuality and sexual responses throughout her middle adult years. With any fears of pregnancy now out of the picture, many women enjoy a period of enhanced sexuality. Possible evidence of the male climacteric includes decreased libido (sex drive), loss of body hair, and delayed erection. Men do not lose the ability to reproduce during the middle adult years. Changes in male sexual function are often more related to psychological than physiologic occurrences. A man's actual capacity to function sexually often has more to do with self-perception and mental outlook and less with the changes he experiences in body appearance, including weight gain, hair loss, and decreased muscle strength. These changes cause some men to go through what is described as a "midlife crisis." During this time, many people may engage in extramarital affairs, often leading to divorce. Many men are unaffected by the physiologic and psychological occurrences of the climacteric.

Late Adulthood Theories of aging: activity, disengagement, biological, autoimmunity, continuity

Disengagement Theory According to supporters of the disengagement theory of aging, a natural withdrawal, or disengagement, between the individual and society is best. This withdrawal is initiated either by the individual or by others in society. Adherents to this belief suggest that such withdrawal prevents older adults from experiencing frustration when they can no longer function adequately, while allowing a younger member of society to fulfill the now-empty role. They characterize this process as a normal, inevitable, universal process. Two major criticisms of the disengagement theory are as follows: • It does not allow for the many active, functional older adults. • The process is not seen in all cultural groups, and it is therefore not universal. Activity Theory According to this theory, the older person who is more active socially is more likely to adjust well to aging. Older adults with more social involvement have higher morale and better life satisfaction and personal adjustment. The number and the quality of the activities are important. If a person gives up activities or roles, advise them to find replacements. Meaningful activities involving close personal contact with others are extremely important. Activities of this nature reinforce our self-concept, which in turn is associated with a higher life satisfaction. Continuity Theory Supporters of this theory suggest that the critical factors in adjustment to old age are the coping abilities we developed previously and our ability to maintain our previous roles and activities. It is often useful to know and understand a person's personality type to predict their response to the aging process. People who were never highly involved will likely maintain the same mild level of involvement in old age. On the other hand, individuals who were highly involved and actively engaged with society need to remain active and involved with similar intensity. Supporters of the continuity theory contend that our adjustment to the aging process will be eased by maintaining roles and interests similar to those we developed earlier in life.

early adulthood Psychosocial development

Erikson identified early intimacy versus isolation as the developmental task of adulthood. Intimacy is the ability to develop one's deepest hopes and concerns in connection to another person. One aspect of intimacy is the capacity to accept the closeness of another person. Intimacy leads to commitment, sharing, and compromise. The "virtue" that develops in young adulthood is the virtue of love, or the mutuality of devotion between partners who have chosen to share their lives. As young adults resolve conflicting demands of intimacy, competitiveness, and distance, they develop an ethical sense, which Erikson considers the mark of the adult. The opposite of intimacy, the distancing of oneself from intimate relationships, is the negative resolution of the task of this life stage and leads to isolation and self-absorption.

Late Adulthood: 65 Years and Older

Older adults represent a rapidly growing segment of the population, and it is important for us all to prepare for and understand the aging process (Box 9-21). There are many approaches to examining the experience of growing old. Aging is a normal condition of human existence and has been studied from sociologic, physiologic, and psychological perspectives. Throughout the life span, all these aspects of the human experience are interrelated. Gerontologists, who study the older adult and the aging process, note that many 70-year-olds today act and think as 50-year-olds did as recently as the 1960s. The fact remains that everyone ages. The physiologic changes are not universal, however, or even necessarily inevitable, and the changes are often amenable to many interventions and treatments. An individual's adjustment to aging is a uniquely complex process. How an individual responds to the age-related changes visible in the mirror has much to do with the person's self-esteem. Successful aging depends on the individual's capacity to cope and ability to change. The process of aging affects the individual, the family, and society at large (see Life Span Considerations for Older Adults box). The sociologically relevant issues of aging have to do with work, retirement, social security, and health care. As more and more people reach late adulthood, it is incumbent on society to recognize and value these individuals' knowledge, skills, and contributions. Preparations and planning for the future that are addressed and encouraged in the early adult years help prepare, support, and enhance adjustments once they are necessary. Implementation of flexible services and financial assistance programs helps people fulfill their goals. The response to getting older is often also related to lifelong health habits, diet, and exercise patterns. Family, love, friendships, and intimate relationships are additional factors important to survival and well-being (Figures 9-16 and 9-17). These relationships are crucial to people's happiness whatever their age. Love relationships vary in intensity and meaning in adulthood. Early on, these relationships usually have an intense physical basis, which leads to intimacy, respect, and commitment. Although intense sexual drive decreases with age, sexual behavior remains an important part of many adult relationships.

P 1102 Osteoporosis "Prevention... www.nof.org."

Prevention begins with children and adolescents. A diet high in calcium and vitamin D as well as regular weight-bearing exercise lays the foundation for later life. Bone density testing helps identify older women at risk for fractures and points the way to instituting measures to prevent fractures. Advise all women to avoid smoking and excess alcohol and limit caffeine consumption. Additional information for osteoporosis education is available through the National Osteoporosis Foundation at www.nof.org.

Late Adulthood Table 9-4 Common Age-Related Changes: respiratory, integumentary, urinary, nervous

RESPIRATORY SYSTEM Ribcage Increase in calcification of thorax; respiratory muscles weaken, producing diminished respiratory efficiency; maximum breathing capacity reduced; more susceptible to respiratory infection; easily fatigued Allow for rest periods. Encourage coughing and deep breathing. Lungs Alveoli (air sacs) thinner, smaller, with decreased alveolar surface for gaseous exchange; decreased cough reflex action; decreased ciliary action, reduced maximum breathing capacity Maintain adequate exercise and nutrition. Encourage regular physical examinations. Avoid overexertion and allow for rest between activities. Discourage smoking. Obtain streptococcal pneumonia (pneumococcal) vaccine.

Common Age-Related Changes: INTEGUMENTARY SYSTEM

Skin Paler, thinner, irregularly pigmented; decrease in moisture; decrease in sweat and sebaceous gland activity; less elastic, more wrinkling; loss of subcutaneous fat; skin more fragile and prone to injury Inspect skin for impairment or signs of pressure. Change position frequently. Wash with water and mild soap as needed. Rinse thoroughly and pat skin dry. Use lotions to replenish moisture. To maintain body warmth, provide adequate clothing.

middle adulthood 2 paragraphs under Middle Adulthood: 40 to 65 Years

The middle adulthood period is arbitrarily designated as occurring between 40 and 65 years of age. Most individuals of this age-group enjoy a healthy body. Some changes result in a gradual shift of balance away from peak performance. The extent of these changes is directly related to diet, heredity, exercise, rest, mental outlook, stress, and disease.

Late Adulthood Psychosocial development

Years of living and our successes, failures, strengths, weaknesses, and all the early experiences influence our emotional stability when we are older. Despite the physiologic changes associated with the aging process, it is most appropriate to view the older years as a time of satisfaction and pleasure. Many older adults choose to work after age 65. These activities provide interest, intellectual stimulation, and added income (Figure 9-19). Older people need to recognize their changing capabilities and begin a process of adjustment. Erikson described the challenge of late adulthood as ego integrity versus a sense of despair. The task here is to evaluate one's life and accomplishments and find satisfaction and meaning in life. The process of reminiscing with others often serves to further validate the meaning and importance of the individual's life. Those who can feel that their lives have been well spent and are satisfied with their decisions and achievements have mastered this task of integrity. This allows the person to continue life with a sense of dignity and peacefulness. Adults who are dissatisfied with their accomplishments often experience conflict and despair. Dissatisfaction contributes to a feeling of restlessness and a sense of panic that time is "running out." Often the individual feels the need for more time and a chance to do things over again differently. Many other factors also affect the older adult's adjustment to this stage of life. Retirement is a major adjustment for the older adult. Health and financial resources are critical elements in determining our life satisfaction after retirement. Generally speaking, our society is relatively unprepared for the phenomenon known as retirement. Retirement creates many changes—some welcome, some not. Examples are changes in roles, self-esteem, support systems, life patterns, and leisure time. Retirement brings more time to spend as one wishes. Therefore individuals need to plan and discuss their hopes and expectations for the retirement period. Planning for retirement helps us identify activities that will be meaningful and promote self-esteem and a sense of usefulness to both ourselves and society.

TRUE OR FALSE?

___ 1. All older people become senile. ___ 2. Most older people live in a nursing home or other institutional setting. ___ 3. Most older people are isolated from their families. ___ 4. Most older people have no interest in or capacity for sexual relationships. ___ 5. Older workers are less productive than younger workers. ___ 6. Intelligence declines in old age. ___ 7. Older people do better to cease exercising and just rest. ___ 8. Marked personality changes occur in the older person. ___ 9. Older people naturally become inflexible and demanding. ___ 10. Older people obtain less satisfaction from life. NOTE: All of these statements are false.

Parenthood Stage

begins at the birth or adoption of the first child

Expectant Stage

begins with conception and continues through the pregnancy relinquishes the parenting rights to the baby's natural father, it is called surrogacy

Engagement or Commitment Stage

couple acknowledges to themselves and others that they are considering marriage

Establishment Stage

from the wedding up until the birth of the first child

Senescence Stage

last stage of the life cycle, which requires the individual to cope with a large range of changes

Early Adulthood: 20 to 40 Years

taking on financial responsibilities, making career choices, beginning social relationships, entering marriage, and becoming a parent Early adulthood, the period of optimal physical condition, is marked by momentous changes in lifestyle.

NUCLEAR

• Consists of married man and woman and their children • Lives in independent household

EXTENDED

• Consists of nuclear plus additional family members living in same household • Provides a sharing of responsibilities

ADOPTIVE

• Consists of usually traditional nuclear-family members, husband, wife, and adoptive child

HOMOSEXUAL

• Involves homosexual partners living together with shared responsibilities

SOCIAL CONTRACT AND COHABITATION

• Made up of man and woman living together without legal commitment but sharing roles and responsibilities

SINGLE-PARENT

• Occurs by divorce, death, separation, abandonment, or choice • More common in recent years • Typically, one adult performs roles of two people

BLENDED (RECONSTITUTED)

• Occurs when adults from previous marriage remarry and combine children within new household

FOSTER

• Responsible for care, supervision, and nurturing of children in their charge