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 ( 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 Problems of disturbed attachment
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 cont’d.
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 cont’d
Maturational crisis
Negative sexual body image
Negative self concept
Anxiety, tension, guilt
Low self-esteem
Helplessness

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

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

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

16. 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.

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

18. Adult’s crisis cont’d. 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. Psychosocial theories of aging
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 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

22. 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.

23. 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

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
Person’s cognitive & emotional complexities, areas of expertise & competencies, including experience in family life & person’s 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 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

26. 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

27. 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

28. 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)

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

30. 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

31. 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

32. 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

33. 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
Cognition
Relatively stable
Fluctuates greatly

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 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

36. 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?

37. 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?

38. 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

39. Specific interventions related to Elderly 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.

40. Specific interventions related to Elderly 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)

41. Specific interventions related to Elderly 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

42. Specific interventions related to Elderly 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

43. Specific interventions related to Elderly 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

44. Specific interventions related to Elderly 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

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.