Adulthood and the Family
Upon completing this chapter, you should be able to:
1 List three stages of adulthood.
2 Explain Schaie’s theory of cognitive development in young and middle adults.
3 Discuss Erikson’s stages of psychosocial development in young and middle adults.
4 Describe the physical and psychosocial development and changes of young and middle adults.
5 List at least three functions of families.
6 Describe the effects of divorce on involved persons.
1 Identify at least three health concerns of young adults.
2 Identify at least four health concerns of middle adults.
3 Design an educational program to help adults maintain a healthy lifestyle.
4 Explain how caring people can nourish the cognitive and psychosocial development of adults.
achievement stage (p. 156)
baby boomers (p. 162)
boomerang children (
, p. 160)
career (p. 157)
empty nest syndrome (
, p. 164)
executive substage (
, p. 157)
generativity (
, p. 157)
intimacy (
, p. 157)
libido (
, p. 163)
maturity (
, p. 158)
menopause (
, p. 163)
mentors (p. 165)
presbycusis (
, p. 162)
presbyopia (
, p. 162)
responsibility stage (
, p. 157)
sandwich generation (p. 165)
stagnation (
, p. 157)
vocational (p. 160)
THEORIES OF DEVELOPMENT
Do you remember wanting to be a “grown-up” so that you would have all the answers to life’s questions? Young children, especially, pretend to be grown-ups as they play; older children become a little more skeptical, and adolescents often think adults are not very bright. It can be a surprise to realize one day that you are an adult and you still don’t know the answers!
Chapter 11 discussed growth and development from conception through adolescence. This chapter continues the story of our maturation as young and then as middle adults. Chapter 13 tells about development of older adults. It will help you appreciate your patients’ attitudes and behaviors when you can identify their stage of life and the kinds of challenges they may be facing.
ADULTHOOD AS CONTINUING CHANGE
Adulthood usually begins around the age of 19, although people may continue some adolescent behaviors into their 20s. Adults continue to grow and develop throughout the life span. As their bodies change, they become more susceptible to health disorders and must work harder to maintain health. Thinking patterns and life goals also change as time goes on.
For the purposes of study, adulthood will be divided into three segments. The first is young adulthood, which is ages 19 to 45. Second is middle adulthood, ages 46 to 64 years of age. Older adulthood is the third stage, 65 to 75 years of age. Advanced age is 76 to death (see Chapter 13). As with younger people, the boundaries should be considered flexible when considering an individual.
SCHAIE’S THEORY OF COGNITIVE DEVELOPMENT
Piaget thought that adolescents and adults think in the same ways (see Chapter 11). Contemporary theorists believe that formal operational thinking becomes more refined in adulthood. Several stages of cognitive development in adults were identified by K. Warner Schaie, who expanded on Piaget’s ideas.
Schaie called the young adult stage of cognitive development the achievement stage (needing to learn and successfully use your abilities). He felt that young adults are optimistic and strive to improve themselves. They want to use what they have learned, continue learning, prove their competence, and increase their choices of career (work that requires specific training).
The responsibility stage (concerned with real-life problems, in charge of self and others) occurs in middle adulthood. He stated that these adults are responsible for themselves, a job, often a family, and perhaps some aspect of the community. This includes attention to the needs of a spouse, children, co-workers, and others.
For some middle adults, Schaie identified the executive substage (responsible for major corporations, the country). He states that many middle adults with multiple responsibilities learn to function as executives in their lives. They delegate appropriately, juggle roles, and manage complex situations.
ERIKSON’S STAGES OF ADULT PSYCHOSOCIAL DEVELOPMENT
Erikson called the young adult stage intimacy (close, meaningful relationships) versus isolation (see Table 11-2). Intimacy means more than only sexual relationships. Young adults want to give of themselves and to be committed to others. They establish close, intense relationships with other people. Close family ties is another positive example.
Generativity (guiding the lives of younger people) versus stagnation (inactivity, self-absorption) is the psychosocial stage of development seen in middle adults. Many are willing and eager to help young people, their own children and grandchildren, and others in their community. Middle adults are productive people who accept the interdependence necessary for satisfactory living. People who are stagnant may have trouble keeping a job, are not interested in volunteering, and are self-involved.
FAMILIES
Because people are social beings, one cannot study an individual’s development without knowing about the family environment that influences it. “Family” is defined as a group of individuals who care about and for each other (Figure 12-1).
Families are important because in families children learn basic values and how to relate to other people. Functions of families are listed in Box 12-1. A family’s cultural and ethnic background also influences children. The support of family remains important throughout the life span.
TYPES OF FAMILIES
There have always been different kinds of families, but there is more awareness of differences as we move into the 21st century. Some types of families are given in Box 12-2.
HISTORICAL CHANGES IN FAMILIES
Sociologists have identified many changes in American family life in the past 50 years. Varieties of families are one example. Others include
• Urbanization: Rural families of the past were more self-sufficient than today’s city dwellers. Only a small percentage of the population now lives on farms.
• Mobility: Many families do not stay in one community, usually because of a changing job market. Some children attend four or five schools before they finish high school. This also affects relationships among the extended family.
• Size: The average size of families is decreasing. As living expenses increase, people realize they can’t afford as many children as their parents or grandparents raised. The use of contraception helps people plan family size.
• Use of paid caregivers: Nearly 70% of two-parent families have two wage earners. Most single parents are employed. Children are cared for by others for part of every workday.
• Fathers’ roles: Since the 1980s, men are taking a greater role in their children’s lives. Whether married or single, many men enjoy participating in child care. It is also more common for single fathers to be custodial parents than it was in earlier decades.
• Increased longevity: Health care advances contribute to longer life spans. Some families have four or five living generations.
DIVORCE AND FAMILIES
Divorce ends nearly 36% of marriages, according to 2006 U.S. Bureau of the Census figures. People expect a great deal from marriage; partners expect each other to be best friends, confidantes, and perfect lovers. Some factors that increase the risk of divorce are listed in Box 12-3. It is easy to see that some factors may coexist.
Divorce early in a marriage, especially before there are children, may seem the least harmful. However, the people involved may be deeply affected. There may have been abuse or infidelity. Often, counseling is necessary for a person ending a difficult relationship.
Studies have shown that divorce is usually harder on children than it is on their parents. Young children may feel that they are to blame for the family breakup; they often harbor guilt feelings. They may fantasize about reuniting the family.
Older children and adolescents can sometimes understand that their parents’ problems are not the fault of the young person, but they are still affected by the divorce. It may influence the way they relate to other people, especially as they begin dating, and may affect their ability to trust others.
Some couples discover that they have little in common after their children are grown. Approximately 25% of divorces occur among couples over 40 years of age. Their adult children often have trouble understanding why this happens.
Divorce also affects the parents and other relatives of the divorcing couple. Sometimes grandparents lose opportunities to be with their grandchildren. The increasing incidence of divorce in the latter half of the 20th century is viewed as a major cause of poverty because so many divorced women have low incomes. Divorce occurs between two people, but the effects ripple into their extended families and their community.
YOUNG ADULTS
The 2 to 8 years after high school are a time of transition for young people. Most are completing adolescent developmental processes and moving into the roles and responsibilities of young adults. Several major events usually occur during this time. Decisions young adults make during these years will influence the rest of their lives.
In our culture, there are two significant milestones signaling that a person is a young adult. The first is economic independence, which usually happens when a person is employed full time. Many young people in college or technical education programs cannot reach this milestone until later. The second is independent decision making.
Some theorists say that maturity (being fully developed) is a significant marker of reaching adulthood. It is probably more accurate to say that we are all growing toward maturity. Mature people have established a philosophy of life based on their own belief system and personal ethics. Other characteristics of mature behaviors are listed in Box 12-4.
PHYSICAL DEVELOPMENT
Most young adults are physically at their peak. Their strength, endurance, and energy are at high levels. Most report their general health as good; very few have chronic health concerns. Young adults usually have fewer colds and minor illnesses than when they were children. Good physical health at age 30 is considered an indicator of good physical health in later years as well (Patient Teaching 12-1).
Skeletal development is completed when young adults reach their full stature. For women this often occurs by age 18 or 19; men continue to grow until their later 20s. The physical differences between men and women are significant. Generally men are taller, heavier, and stronger than women. They have broader shoulders, narrower hips, and larger hands and feet.
Dental maturity is achieved with the eruption of wisdom teeth. Regular dental care is important to maintain healthy teeth and gums.
Physical growth of the brain continues into the mid-20s, peaking during these years, and memory is acute. Learning seems easier for young adults because they often can learn quickly. Growth of neural connections continues into later years. Middle and older adults continue to learn but often at a slower pace.
The early young adulthood years, ages 19 to 26, are physically the best years for reproduction. Many young adults choose to delay childbearing until they are economically and emotionally prepared for parenting.
The validity of studies about sexual behavior is often questioned because the results are based on self-reporting. During young adulthood, sexual preferences are identified and there may be numerous partners. Promiscuity increases the risk of sexually transmitted diseases, especially human immunodeficiency virus (HIV).
HEALTH CONCERNS OF YOUNG ADULTS
Because young adults are generally healthy and feel well, they may feel invincible and engage in risky behaviors. Examples of such behaviors include chemical abuse, overeating, inadequate sleep, an inactive lifestyle, and sexual promiscuity. The abuse of chemicals often contributes to other risky behavior.
Young adults die primarily because of accidents, suicide or homicide, and acquired immunodeficiency syndrome (AIDS). Motor vehicle accidents are the primary cause of death for white males; homicide is the leading cause of death for African American males.
Stress-Related Illness
Some stress-related illnesses are headaches, gastric ulcers, and hypertension. The incidence of these conditions increases as people get older. Young adults over 30 begin to be affected by these illnesses. Sometimes people use alcohol and/or other drugs in unhealthy attempts to relieve stress.
Early Disease
The third health concern for young adults is development of diseases, especially cancer. Young women should learn to examine their breasts and perform monthly breast self-examinations. They should see a physician if they find any changes. Mammograms every 2 years are recommended for all women beginning at age 40; women with breast cancer in their family should have annual mammograms beginning at age 35. Women should also have annual pelvic examinations, including a periodic Papanicolaou (Pap) test to screen for cervical cancer.
Men should learn and perform regular self-examination of the testicles. They should see a physician if they detect any growths or changes.
Both men and women should have annual physical examinations to screen for hypertension and assess weight management (Figure 12-2). Periodic Mantoux tests are advised to screen for tuberculosis. Immunizations should be kept current.
COGNITIVE DEVELOPMENT
In the achievement stage of Schaie’s theory, young adults apply their intelligence to higher education and to early career development. Young adults are no longer egocentric. They are more able to reason, solve problems, and set reasonable goals (Patient Teaching 12-2).
Cognitive development of young adults is aided by the support of others. Young adults may need guidance to identify their goals clearly and continue striving toward them. Helping them understand their stage of development may provide encouragement.
Continuing Education
Many young adults continue their education after high school. Higher education can help people understand their world, learn to manage their time, and prepare for a career.
It is generally believed that 1 or 2 years of higher education, even if career goals are unclear, can help young adults learn more about themselves and the world. Not everyone wants to continue school once high school is finished, however. Many kinds of careers are best learned on the job or in vocational/technical schools and do not require college degrees.
Careers and Work
The ability to earn a living is an important accomplishment of young adulthood. Working provides the means of personal, social, and financial survival. It can also give a person a sense of identity and increase self-worth and respect. Some view their work as a service to others.
Exploration of vocational (trade, profession, or occupation) choices is expected in late adolescence and early adulthood. Some counselors encourage young adults to try several kinds of jobs to better select one that will provide satisfaction. It is common for individuals to have up to seven different jobs throughout their work life. Disillusionment about the ideal job is frequent as realities of the work world are identified.
What do young adults want from their work? Of course adequate money must be considered, but it is not always most important. A main priority is that they want the work to be interesting. They also want the opportunity to use their skills and abilities. The fourth concern is the chance for advancement.
Unemployment can be the result of many factors, but is often viewed as personal failure. Prolonged and unwanted unemployment can cause financial crisis, loss of self-esteem, and depression.
The roles of employed women in the United States continue to stimulate discussion. Gender equality is the movement for equal opportunity and equal pay for women and men. Young women often have a dilemma when choosing a type of work. Some may prefer to be full-time homemakers and mothers. That option may be impossible because of the economic pressures facing young families.
Concerns about career versus family may cause personal or family conflict. Family-friendly employment policies are becoming more common and benefit both women and men. The kinds of work available to women remain restricted in some fields. The U.S. Bureau of the Census stated that the earning power of women overall in 2007 continues to be about 75.7% of what men earn in similar work (McCombs School of Business, 2007).
PSYCHOSOCIAL DEVELOPMENT
Independence from the parental family is a primary achievement during young adulthood. This is interpreted as living on your own and making your own decisions. The trend toward young adults being boomerang children (children who return to the parental home for a period of time) has grown considerably as children find it difficult to make sufficient money to establish a successful home of their own. Sometimes returning young adults bring their children along. This is commonly due to economic hardship.
Erikson called the young adult stage of psychosocial development intimacy vs. isolation. It is important that people continue the development of meaningful relationships with others. If this task of developing intimacy is not accomplished, the young adult might not trust others and may be hesitant to share himself or herself. This could lead to withdrawal and depression.
According to Erikson, adolescents should find identity, which helps them become more independent. Independence precedes the need for developing intimacy and sometimes may conflict with it. A secure and independent person is ready to be intimate with another and can allow the other person to be independent.
Personality development continues throughout the life span. Most theorists agree that your early life is significant in forming your basic personality. Major personality changes in adulthood are not likely to occur. The person who is usually happy will remain so; the opposite is also true. Changes that a person wants to make require self-analysis and a lot of work.
DEVELOPMENTAL TASKS
Deciding whether to marry is a major concern in young adulthood. Ninety-five percent of Americans do eventually try marriage. The average age at first marriage is 25.1 for women and 26.7 for men (U.S. Bureau of the Census, 2006). These ages are increasing as more people choose to delay marriage. Selection of a marriage partner is a critical decision; there are no foolproof rules for mate selection. Although opposites may attract, successful marriages often involve partners who share basic values and philosophies about life. Young love is romantic and intense. Marriage requires mutual respect, sharing, and commitment. The fear of making a poor choice is one reason people decide to cohabit before or instead of marrying. Married people are generally healthier and happier throughout their lives.
Single adults include those who have never been married and those who are widowed, separated, or divorced. In the United States, approximately 26% of adults of all ages live alone, according to government figures. The role of single adults in society is another aspect of adult development.
Many singles live full, happy lives. There are positive and negative aspects to living alone. Single people can be independent with their time and money; they don’t have to be concerned about a partner’s ideas or desires. However, they have no one to depend on when trouble occurs. They have to be responsible for their own decisions. Many single adults report that they are often lonely.
Parenting
Becoming a parent occurs for many people during young adulthood. Some couples carefully discuss and plan decisions about having children. Others choose not to use birth control measures. U.S. Bureau of the Census 2003 data demonstrate that the average age of first-time mothers is about 25.1 years, although many women have a child when they are younger.
Some women delay having children in favor of career development. There might then be concerns about their “biologic clock” running out, meaning they may have trouble conceiving after age 30 as fertility lessens. The option of in vitro fertilization is available then, but is very expensive. By age 40, a woman is statistically at high risk during a pregnancy. Technological developments have made it possible for some women to become pregnant in their mid-40s and 50s.
Childbearing is only the beginning of parenting. The issues of day care, discipline, and other child-rearing aspects continue for years. Many young parents discover they imitate their own parents in dealing with their children. Most people learn about parenting from the examples seen in childhood.
In the past, young families were often geographically near older relatives and had the emotional support of extended family. Many young families today don’t live near other family members and may struggle with child-rearing issues. Some areas have developed Early Childhood and Family Education (ECFE) programs through schools or community organizations where young adults can share concerns and learn about successful parenting.
Home Management
The tasks involved in making life run smoothly need regular attention. Having groceries on hand, keeping things in order, and remembering to have the oil changed in the car are examples of home management. Money management, laundry, and cleaning the refrigerator are tasks.
Developing a Social Group
Having friends who share values is vital for socialization. Friendships beyond the extended family are valuable. For young adults, this can be a challenge when they go away to school or take a job in a new locale. They may have always lived in one area until this stage, and now have to make new friends in a new part of the world. Young adults who are confident, outgoing, and willing to be active in their community have a good chance of being successful.
Community Responsibility
Beginning involvement in community affairs is another mark of young adulthood, as people begin to think about the world beyond their family. Examples of this include joining a service organization, being involved in a religious community, or becoming active in local government. Young adults with healthy psychosocial development begin to reach beyond their own needs to be concerned with others. Sharing your expertise in a voluntary way is good for society as a whole.
MIDDLE ADULTHOOD
People ages 46 to 64 are categorized as middle adults. Images of middle age are varied. Middle adults are viewed as in the best years of their life; they are the wise, powerful leaders. Negative generalizations are also made about middle age. Stereotypes about people growing older begin to appear. Life is portrayed as all downhill and unhappy. Some people are reluctant to admit they are middle aged because of such negative views. These can be challenging years, too, as people expand their personal and social involvement.
The oldest baby boomers (people born between 1946 and 1964) reached middle age in the 1990s. This large group of people (76 million) has had a major impact on U.S. society at every stage of their development. They have challenged traditional beliefs and forged new ways of thinking about and living every stage. Their viewpoints about middle and older adulthood may become quite different.
PHYSICAL DEVELOPMENT
Physical changes that may be considered declines begin to appear during the middle years of life. The rate of change, even changes of aging, varies among individuals. Not every middle adult will experience all of these changes; most normal changes occur so slowly that they may be unnoticed for years. Middle adults often seek ways to slow the aging process. Individuals who exercise regularly, eat sensibly, and take care of their bodies can often delay some of these changes (Complementary & Alternative Therapies 12-1).
During the middle adult years there is a natural redistribution of body weight, which changes the contours of the body, even if weight remains fairly constant. Men commonly add inches around the waist as body fat increases by about 30%. Women’s body fat increases by nearly 40% and is often added to hips and thighs. It becomes more difficult to lose weight. Some middle adults may try to look and act younger to deny their aging.
One common occurrence is presbyopia (decreased flexibility of the eye lens). This makes near vision more difficult, and leads to the need for reading glasses. By age 60, some people may have retinal damage as a result of lessened blood flow, which leads to visual problems. Cataracts may develop during the middle years. Regular eye examinations and the use of corrective lenses can help maintain vision.
Presbycusis (loss of hearing) begins in early adulthood, but rarely becomes apparent until later (Health Promotion Points 12-1). The ability to hear higher- pitched sounds is lost earlier than the ability to hear lower sounds. Men seem to lose this sense at younger ages than women. Noisy work settings and loud music can contribute to eventual hearing loss by causing damage to auditory nerve endings.
Gradual compression of the spinal column occurs as intervertebral disks shrink; this can cause the loss of up to 1 inch of height by age 60. It may surprise middle-aged people to realize that they have suddenly become shorter (Health Promotion Points 12-2).
Muscles throughout the body lose tone and elasticity during these middle years. Fatigue arrives earlier with physical labor. Reaction time may also slow. Muscle changes also affect internal muscles; heart and lungs become less efficient. Blood pressure increases when arteries become less elastic. The skin becomes less resilient and wrinkles appear. Changes in the muscles of the digestive system may cause disturbances and food intolerances.
Many people in middle age begin to have graying hair. Thinning of scalp hair can occur in both genders. Increased hair growth in men is seen in bushier eyebrows and hair occasionally in noses and ears. These events may be related to heredity.
Both males and females produce sex hormones. Women produce greater amounts of estrogens, and men produce greater amounts of testosterone. As middle age proceeds, this balance shifts slightly as hormone production slows. This is most obvious in women; the decrease in estrogen production causes menstrual changes and eventually menopause (cessation of menstruation).
The average age of menopause is 51. This ends the reproductive years and may be accompanied by minor physical and/or psychological signs and symptoms (Box 12-5). Some women see menopause as a natural event and the beginning of new freedoms and choices; other women have a negative view. Women can learn about their bodies and the natural changes from a variety of sources. They can discuss their feelings with others in order to better understand and cope. Many women seek new ways to contribute to their profession and/or their community.
The shift in hormone balance also occurs in men, although there is not as obvious a physical change. Sexual ability does not decline in either sex. Some people report a lessening of libido (the sex drive). People who are concerned about this should discuss it with a physician.
HEALTH CONCERNS
Health status becomes a greater concern in middle adulthood. Lifestyle, heredity, and use of the health care system are major influences on the state of health. People who make efforts to take care of themselves are generally healthier than those who do not. This includes controlling one’s diet and remaining physically active. Health screening for diabetes, risk factors for heart disease, hypertension, colon cancer should occur at regular intervals (Health Promotion Points 12-3).
Leading causes of death in the 50s and 60s are heart disease, cancer, vascular disease, and accidents. The major health problems of middle adults include accidents, alcohol abuse, obesity, diabetes, heart disease, hypertension, and mental illness. Healthy stress management at all ages contributes to improved general health.
COGNITIVE DEVELOPMENT
Schaie’s stage of responsibility is seen as middle adults manage the complexities of their lives. Studies show that intellect remains stable in middle adulthood. Early signs of illnesses may cause the impression of slight mental declines. People who are active and use their intellect remain bright and interested in life.
Creativity is believed to peak during middle adulthood. However, there are many examples of people who are creative and productive in their older years as well. Creative people are often creative throughout their lives. Men and women are equally creative and intelligent.
One aspect of cognition that may change in midlife is memory. Middle adults often need to work harder at remembering things, and many find lists and notes helpful. It is easier to remember important information than incidental information (Health Promotion Points 12-4). Older persons should not be overly concerned about forgetfulness; it is more likely related to a busy life than to cognitive problems.
Work Life
Satisfaction with work is a part of cognitive development. It appears to increase throughout life for both men and women. Many people spend more of their time in work-related activities when they reach the middle years. Increased income and responsibilities accompanying career growth explain increased satisfaction. Most career advancement occurs during the 50s.
Middle adults may make a conscious decision to make a midlife career change. Some begin evaluating their desires and accomplishments. If a dream is unfulfilled, perhaps a change will help it come true. Middle adults begin to realize that their own life spans are limited, and they want to try new areas of interest while they have time. Some adults are willing to change their lives entirely by starting a new career. The changes occurring in midlife are handled best when the person has a good support system.
Some middle adults change careers because of labor market demands. Job loss resulting from downsizing, and the need for retraining, are serious concerns. Changes in technology may create new work opportunities. Middle adults forced to make changes may have a difficult time adjusting.
Past studies report differences between men and women regarding career paths and responsibilities. Many of those studies have focused on white men. As more women and minorities move into leadership positions, previous differences should become less significant. Women, and more recently men, who choose to place family concerns ahead of career goals may find their career advancement is slowed since they are not totally focused on the job.
Many baby boomers are finding that as retirement age approaches, they have not saved the financial reserves necessary to support them and they must continue working. Some do retire and then run short of money and have to try to reenter the job market.
The use of leisure time is also important. Middle adults should develop interests outside their work. Leisure activities can be healthy ways to reduce stress. Hobbies can also help people prepare for retirement by providing fulfillment
Lifelong Learning
Many adults discover that returning to college is rewarding and challenging. They may enroll in one or two classes, or may undertake an entire program of study. There can be many reasons for this. It may fulfill a lifelong goal, it may be to keep a job, or it may be to prepare for a career change.
Women who chose to raise a family prior to developing a career are especially likely to prepare for new jobs and new lives in midlife. Rather than think of this stage as downhill, they think of it as an opportunity to try another path.
PSYCHOSOCIAL DEVELOPMENT
Relationships with other people remain the focus of psychosocial development in middle adults. People in these years also begin to think more globally about life and their roles.
Marriage
The marital relationship often grows from romance and passion into the affectionate love of middle adults. The steady companionship of a partner is important for social and psychological support. Some marriages improve as children leave home and child-rearing responsibilities lessen. Couples may find more time for each other. It is vital that they have and develop mutual interests and activities.
A couple who has been unhappy for years may decide to divorce when the children are gone. A woman who had been at home when children were younger may discover a new world if she begins a job or returns to school. Changing roles and responsibilities can create or intensify marital problems.
The empty nest syndrome (children have left home, causing a sense of loss and sadness) affects some middle adults who have centered their lives on their children. They may need guidance in finding additional interests. Conversely, many adults look forward to more freedom when children are no longer dependent on them.
Friendships
Whether single or married, middle adults need to have close friends. Friendships that have endured for years continue to be vital. Many middle adults find new importance in relationships with siblings. Friends and siblings find more time for each other once the time-consuming work of parenting is past.
Parenting
Most studies of middle adults involve those whose children are leaving or have left the parental home. Couples who had children later in life will enter midlife with children who are younger. Therefore, parenting concerns will vary.
Those with adult children can find this stage rewarding. Parents gain satisfaction in realizing thattheir child is a responsible young adult. If grandchildren arrive in the family, another dimension is added. Grandparents usually enjoy baby-sitting at times and inclusion in the younger family’s life (Figure 12-3).
Caring for Parents
The relationship with aging parents is another concern in midlife. If the relationship has been mutually supportive, these can be satisfying years. As adults mature, they may become more appreciative of the struggles their own parents experienced. Family ties will sometimes improve as children realize the sacrifices and guidance their parents provided.
Some middle adults find themselves in the sandwich generation (dependent children at home, dependent elders needing caregiving). As longevity increases, more older adults will need assistance and support, usually from their own children. Daughters and daughters-in-law often become primary caregivers for elderly parents.
Caring for aging parents can be stressful when combined with personal careers and family responsibiltiies. Families must make important decisions. Open communication within the family can ease the necessary adjustments. Community resources are available to assist families who need support and help with caregiving.
Generativity
Erikson’s middle adult psychosocial stage of generativity vs. stagnation is most easily seen in parents whose children have become young adults. However, people who are not parents, or those whose children live far away, often get involved in the nurturing of younger people. Most middle adults are self-confident regarding the knowledge they have accumulated. They are concerned for others and want to contribute to the community. They may do this through social activities, leadership roles in community or religious organizations, and career involvement. Middle adults are often mentors (teachers or coaches) to younger adults in these settings.
Some adults are said to experience a midlife crisis. Most psychologists say that is not true. There are many changes in midlife, and some of them may create a crisis situation for some people, but there is no single event that causes a crisis for all middle adults.
Middle adults realize that they are no longer young. They begin to evaluate their self-concept and their role in the world. There may be times of pain or stress due to physical decline or financial problems. They must explore many questions in order to continue healthy development. Middle adults accept that life is not simple and that instances occur over which they have little control.
In every stage of life, the sincere listening and caring of other people can help individuals develop to their full potential. Education about the changes people experience as life evolves helps everyone understand and aids in coping with challenges. There are support groups for people in all kinds of crises, such as chemical abuse, divorce, and parenting issues. Learn about such groups in your locality and make necessary referrals when needed.
NCLEX-PN® EXAMINATION–STYLE REVIEW QUESTIONS
Choose the best answer(s) for each question.
1. Types of families include nuclear, extended, step, blended, and partner. Because of the high incidence of divorce and remarriage, many more ________________ families have emerged. (Fill in the blank.)
2. Young adults are likely to spend leisure time in activities that are:
1. calm and quiet, alone or with only one or two others.
2. inclusive of their parents and grandparents.
3. The psychosocial task for the young adult is to seek:
4. Failure to develop through Erikson’s stage of young adulthood will cause the person to be:
5. The “sandwich generation” refers to:
1. couples who care for both children and grandchildren.
2. elderly who prefer sandwiches over a hot meal.
3. people who do not have time to cook.
4. people caring for both elderly parents and their own children.
6. People who eat nutritiously, rest adequately, and exercise regularly can:
1. live to be more than 100 years old.
2. continue to bear children until they are 60 or 70.
7. When working with depressed middle-aged adults, and following Erikson’s theory, you encourage them to find meaning in life by:
1. developing intimate relationships with spouses.
2. caring for their elderly parents.
8. A 58-year-old man complains that he has difficulty remembering everything he wanted to buy when he gets to the store. Your best response would be:
1. “Forgetting some things is a common occurrence with aging.”
2. “Do your siblings have similar problems?”
3. “You should always take a list with you to the store.”
4. “Life is so busy that everyone forgets things now and then.”
9. The psychosocial task of generativity refers to:
10. Successful coping with midlife changes are likely when the individual:
CRITICAL THINKING ? Read each clinical scenario and discuss the questions with your classmates.
As a clinic nurse, you are interviewing a new patient, a 34-year-old high school French teacher who complains of irregular menstrual periods. She has been married for 2 years and has no children.
Scenario B
Another clinic patient is a 52-year-old man who has recently been diagnosed with type 2 diabetes mellitus. He is 5–11” tall and weighs 245 pounds. His BP is 160/100 at this time. He works as a computer consultant and travels about 3 days each week.
1. How will you begin exploring any health concerns he may have? What will you say to determine how much of his diagnosis he understands? How can you encourage him to follow the prescribed regimen for maintaining or improving his physical health?
2. What is his expected stage of cognitive development? Where would you expect him to be in the occupational cycle? What are some questions you might ask?
3. You learn that he is divorced and shares custody of three adolescent children. How can you tactfully determine whether he is at the appropriate stage of psychosocial development?