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UNIT ONEIntroduction to Adulthood and Aging Meaning of AdulthoodThe word adult comes from the same Latin verb as the term adolescence-adolescere which means "to grow to maturity." However, the word adult is derived from the past participle of that verb-adultus-which means "grown to full size and strength" or" matured." Adults are, therefore, individuals who have completed their growth and are ready to assume their status in society along with other adults.Various cultures have different ages at which children reach the adult status or the age of legal maturity, in most of the older cultures, they reached this status when their puberty growth was complete or nearly complete and when their sex organs had developed to the point where they were capable of procreation. Until recently, children were not considered legally adults until they reached the age of twenty-one years. Today, adulthood is legally reached at the age of eighteen. With a gradual increase in longevity, adulthood is now by far the longest period in the total life span.Like childhood and adolescence also long periods during which certain physical and psychological changes occur at predictable times adulthood is customarily subdivided on the basis of the times at which these changes take place together with the adjustment problems and cultural pressures and expectancies stemming from them.Adulthood means different things for different people. There are different dimensions of adulthood. These are social dimension, biological dimensions, emotional dimensions and legal dimensions.Social dimension-the primary meaning of adulthood is social. One cannot declare oneself an adult. Inevitably; this perception reflects a mature, rational, and responsible person. It is unthinkable to call an undisciplined, irrational, undependable, socially irresponsible person an adult.Biological dimension-Dictionaries define an adult as one who has attained full size and strength; a fully grown person. This definition implies biological maturity, reaching the limits of physical; development and attaining reproductive capacity. But in biological definition alone, is inadequate. Adolescents in many cultures may attain their full height and strength and become sexually mature but still behave childishly and dependently, with nebulous identities and undetermined stations of life.Emotional dimensions-being an adult also includes emotional maturity. It implies a high degree of emotional stability including good impulse control, a high frustration tolerance and freedom from violent mood swings. Another requirement of adulthood is to break childish dependency ties with parents and to function autonomously.Legal dimensions-Legal rights designate chronological ages at which privileges are granted and duties required.The category adulthood lacks the concrete boundaries of infancy, childhood and adolescence. Even in the scientific literature; it has functioned as a kind of catch all category for everything that happens to the individual after they grow up. For example, Sigmund Freud viewed adult life as merely a ripple on the surface of an already set personality structure; Jean Piaget assumed that no additional cognitive changes occur after adolescence; and Lawrence Kohlberg saw moral development as a reaching life time plateau after early adulthood.1.2 The concept of Age & Successful AgingSo how old is ‘old’, and how adult are you? Probably we all know of younger people who seem set in their ways, old before their time; conversely we also probably know older adults who are busy in their minds if not physically and who have a lively interest in things.Kastenbaum (1979) suggested that we have several ‘ages’ (see Table 1.1 below) with which we coexist, and this certainly has face validity as so many people report acting or feeling older or younger than their years, depending on what they are doing and so on. One 2001 issue of the UK magazine for retired people, Saga, put a photo of the ageing rock musician Mick Jagger on its cover, which resulted in much amusement – and also a statement from Mr Jagger’s team that they were ‘horrified’ at the photograph’s use. This supports the view that adulthood and perhaps older adulthood is a concept interpreted differently by different groups of people.Table 1.1 Kastenbaum’s types of ageChronological age This is how many years you have livedBiological age This is how old your body seems to be, it’s the sort of shape you are in physically.Subjective age This is how old you actually feel yourself to beFunctional age This is the age associated with your job or role, your responsibilities, etc.Social age This relates to the age-group you mix with, how others see you, your personal ‘style’.1.3 Sub-periods of Adulthood Most research divides adulthood stage into three periods: Early /young adulthood (20-40), middle age (40-65), and late or older adulthood (age 65 and more).Young adults are generally at the height of their physical powers and many aspects of their intellectual powers. During these years, they make career choices and form intimate relationships that may be lifelong.Middle aged adults might see some decline in health and physical abilities but develop more mature patterns of thinking based on practical experience. Some middle aged people are at the height of their careers; others have reached dead ends. Many have children who are leaving the nest.Older adults are physically active, independent and mentally alert though they may be having changes in health. Chronic conditions may develop, but these can be controlled by medical interventions.1.4 Research Methodology in Adult Development & Aging This area of psychological development in adulthood has real research difficulties. Adulthood lasts such a long time, six decades and increasing, so that problems with good research build up fast. Longitudinal studies are by their very nature time-consuming and therefore very expensive. Also, people don’t always stay put, and the original sample in such a study may be seriously depleted as some participants move away, lose interest in cooperating with the researchers, or die young.Another set of problems is a person’s adult development will be closely linked with their cultural, social, political and financial context so that many different groups need to be studied if we are seeking a general picture of human adult development. A third group of difficulties comes with the type of research methods being used. Researchers have their own ideas, otherwise they could not be doing the research. But if they are interviewing and observing people, the problems of validity, reliability and bias are bound to be there too. Unit Two2. Early AdulthoodApproximately, age 20 is the beginning of early adulthood. Age alone is not a good criterion for determining when young adulthood begins. Maturity has been identified as the major criterion of young adulthood. From the psychosocial perspective, the time of entry into a new stage is based on a convergence of experiences-including the accomplishments of the previous stage, the resolution of the previous crisis, and the beginning efforts to achieve the tasks of the new stage –rather than on chronological age. In contemporary society, one begins to experience adulthood as several roles emerge, typically, those of worker, committed partner, and parent. As the age of entry into marriage has advanced over the past 20 years, the majority of young people in the United States are unmarried in the age range of 20 to 24. Students take an average of 5 to 6 years to complete college, and young people seem to be involved in a longer period for job experimentation before settling into their occupational career. All of these factors argue for advancing approximate age of entry into adulthood.2.1 Characteristic of Early AdulthoodSome of the major characteristics of early adulthood are summarized below: Early Adulthood is the "Settling-down Age"Childhood and adolescence are the periods of "growing up" and that adulthood is the time for "settling down:" , this means when boys and girls reached the age of legal maturity, their days of carefree freedom were over and the time had come to settle down and assume the responsibilities of adult life. That meant settling into a line of work.Early Adulthood is the "Reproductive Age"Parenthood is one of the most important roles in the lives of most young adults. Those who were married during the latter years of adolescence concentrate on the role of parenthood during their twenties and early thirties; some become grandparents before early adulthood ends.Early Adulthood is a "Problem Age"The early adult years present many new problems, different in their major aspects, from the problems experienced in the earlier years of life. With the lowering of the age of legal maturity to eighteen years, young adults have been confronted with many problems they are totally unprepared to cope with. While they are now able to vote, to own property, to marry without parental consent, and to do many things young people could not do when the age of legal maturity was twenty-one years, there is no question about the fact that "this new-found freedom is creating unforeseen problems for the youthful adults, and often for their parents, too".There are many reasons why adjustment to the problems of adulthood is so difficult.Three are especially common. First, very few young people have had any preparation for meeting the types of problems they are expected to cope with as adults. Education in high school and college provides only limited training for jobs, and few schools or colleges give courses in the common problems of marriage and parenthood. Second, just as trying to learn two or more skills simultaneously usually results in not learning anyone of them well, so trying to adjust to two or more new roles simultaneously usually results in poor adjustment to all of them. It is difficult for a young adult to deal with the choice of a career and the choice of a mate simultaneously. Similarly, adjustment to marriage and parenthood makes it difficult for young adults to adjust to work if they marry while they are still students.Third, and perhaps most serious of all, young adults do not have the help in meeting and solving their problems that they had when they were younger. This is partly their own fault and partly that of their parents and teachers. Most young adults are too proud of their new status to admit that they cannot cope with it. So, they do not seek the advice and help in meeting the problems this new status gives rise to. Similarly, most parents and teachers, having been rebuffed by adolescents who claimed they were capable of handling their own affairs, hesitate to offer help unless they are specifically asked to do so.Early Adulthood is a Period of Emotional TensionWhen people are trying to get the lay of a new land in which they find themselves, they are likely to be emotionally upset. When adults feel that they have not been able to cope with the problems in the major areas of their lives, they are often so emotionally disturbed that they contemplate or attempt suicide.Early Adulthood is a Period of Social IsolationWith the end of formal education and the entrance into the adult life pattern of work and marriage, associations with the peer groups of adolescence wane and, with them, opportunities for social contacts outside the home. As a result, for the first time since babyhood even the most popular individual is likely to experience social isolation, or what Erikson has referred to as an "isolation crisis”.Early Adulthood is a time of commitmentsAs young adults change their role from that of student and dependent, characteristic of adolescence, to that of independent adult, they establish new patterns of living, assume new responsibilities, and make new commitments. While these new patterns of living, new responsibilities, and new commitments may change later, they form the foundations on which later patterns of living, responsibilities, and commitments will be established.Early Adulthood is often a Period of DependencyIn spite of achieving the status of legal adulthood at age eighteen, with the independence this status carries, many young adults are partially or totally dependent on others for varying lengths of time. This dependency may be on parents; on the educational institution they attend on part or total scholarship, or on the government for loans to finance their education. . As a result, their state of dependency is often prolonged into the late twenties or early thirties.Early Adulthood is a Time of Value ChangeMany of the values developed during childhood and adolescence change as experience and social contact with people of different ages broaden and as values are considered from a more mature standpoint. Adults who used to consider school a necessary evil may now recognize the value of education as a stepping-stone to social and vocational success and to personal fulfillment. As a result of such changed values, many adults who dropped out of school or college decide to finish their education. Some find studying so stimulating that they continue to take courses even after receiving high school or college degrees.Early Adulthood is the Time of Adjustment to New lifestylesWhile lifestyles have been in a state of flux since the turn of the present century, at no period in the life span is this truer than in early adulthood. And in no area of early adult life are new lifestyles more prevalent than in the areas of marriage and parenthood.2.2 Developmental Tasks of Early AdulthoodThe developmental tasks of early adulthood are: Selecting a mate Achieving a masculine or feminine social role Learning to live with a marriage partner Starting a family Rearing children Managing a home Getting started in an occupation Taking on civic responsibility Finding a congenial (pleasant and best suited to own interest) social group 2.3 Diversity of Adult LifestylesToday, non- traditional family options have penetrated. Many adults experience not just one, but several options. Some adults make a deliberate decision to adopt a lifestyle, whereas others drift into it. The lifestyle may be imposed by society, as is the case for cohabiting homosexual couples, who cannot marry legally. Or people may decide on a certain lifestyle because they feel pushed away from another, such as a marriage gone sour. In sum, the adoption of a lifestyle can be within or beyond the person's control.SinglehoodSinglehood-not living with an intimate partner-has increased in recent years, especially among young adults. Besides more people marrying later or not at all, divorce has added to the numbers of single adults. In view of these trends, it is likely that most will spend a substantial part of their adult lives single. Because they marry later, more young adult men than women are single. But women are far more likely than men to remain single for many years or their entire life. With age, fewer men are available with characteristics that most women seek in a mate-the same age or older, equally or better educated, and professionally successfulOf the various advantages of singlehood, those mentioned most are freedom and mobility. But singles also recognize drawbacks-loneliness, the dating grind, limited sexual and social life, reduced sense of security, and feelings of exclusion from the world of married couples. Single men have more physical and mental health problems than single women, who usually come to terms with their lifestyle. The greater social support available to women through intimate same-sex friendships is partly responsible. In addition, never-married men are more likely to have conflict-ridden family backgrounds and personal characteristics that contribute to both their singlehood and their adjustment difficulties.CohabitationCohabitation refers to the lifestyle of unmarried couples who have an intimate, sexual relationship and share a residence. Until the 1960s, cohabitation in Western nations was largely limited to low-SES adults. Since then, it has increased in all groups, with an especially dramatic rise among well-educated, economically advantaged young people.Like singlehood, cohabitation has different meanings. For some, it serves as preparation for marriage-a time to test the relationship and get used to living together. For others, it is an alternative to marriage--an arrangement that offers the rewards of sexual intimacy and companionship along with the possibility of easy departure if satisfaction declines. In view of this variation, it is not surprising that cohabiters differ greatly in the extent to which they share money and possessions and take responsibility for each other's children.ChildlessnessSome people are involuntarily childless because they did not find a partner with whom to share parenthood or their efforts at fertility treatments did not succeed.There are couples who choose not to have children as a matter of fact that voluntary childlessness is not always a permanent condition. A few people decide early that they do not want to be parents and stick to these plans. But most make their decision after they are married and have developed a lifestyle they do not want to give up. Later, some change their minds.Besides marital satisfaction and freedom from child-care responsibilities, common reasons for not having children include the woman's career and economic security. Consistent with these motives, the voluntarily childless are usually college educated, have prestigious occupations, and are highly committed to their work. Many were only or first-born children whose parents encouraged achievement and independence. In cultures that negatively stereotype childlessness, it is not surprising that voluntarily childless women are more self-reliant and assertive.Divorce and RemarriageDivorce rates have increased as financial instability increased and marital satisfaction has decreased. Divorces are also common during the transition to midlife, when people have teenage children-a period of low marital satisfaction. About three-fourths of divorced people remarry. But marital failure is even greater during the first few years of second marriages.Factors Related to Divorce The most obvious reason for failure of marriage is a disrupted husband-wife relationship. The problem-solving style could be ineffective. Another typical style involves little conflict, but partners increasingly lead separate lives because they have different expectations of family life and few shared interests, activities, or friends.Wives reported more problems than husbands, with the gender difference largely involving the wife's emotions, such as anger, hurt feelings, and moodiness. Husbands seemed to have difficulty sensing their wife's distress, which contributed to her view of the marriage as unhappy. Regardless of which spouse reported the problem or was judged responsible for it, the strongest predictors of divorce were infidelity, spending money foolishly, drinking or using drugs, expressing jealousy, engaging in irritating habits, and moodiness.Younger age at marriage, being previously divorced, and having parents who had divorced increased the chances of divorce, in part because these background factors were linked to marital difficulties. Economically disadvantaged couples who suffer multiple life stresses are especially likely to split up. Women are twice as likely as men to initiate divorce.Consequences of DivorceImmediately after separation, both men and women are depressed and anxious and display impulsive behavior. For most, these reactions subside within 2 years. Women who were in traditional marriages and who organized their identities around their husbands have an especially hard time. A few women-- especially those who are anxious and fearful or who remain strongly attached to their ex-spouses-show a drop in self-esteem, become depressed, and tend to form repeated unsuccessful relationships. Job training, continued education, career advancement, and social support from family and friends play vital roles in the economic and psychological wellbeing of divorced women.RemarriageOn average, people remarry within 4 years of divorce, men somewhat faster than women. For several reasons, remarriages are especially vulnerable to breakup. First, although people often remarry for love, practical matters-financial security, help in rearing children, relief from loneliness, and social acceptance-figure more heavily into a second marriage than a first. These concerns do not provide a sound footing for a lasting partnership. Second, some people transfer the negative patterns of interaction and problem solving learned in their first marriage to the second. Third, people who have already had a failed marriage are more likely to view divorce as an acceptable solution when marital difficulties resurface. And finally, remarried couples experience more stress from step family situations.Divorce and remarriage, like other adult lifestyles, lead to diverse outcomes. It generally takes 3 to 5 years for blended families to develop the connectedness and comfort of intact biological families. Family life education, couples counseling, and group therapy can help divorced and remarried adults adapt to the complexities of their new circumstances.Variant Styles of ParenthoodDiverse family forms result in varied styles of parenthood. Among these are a growing number of cohabiting and remarried parents, never-married parents, and gay and lesbian parents. Each type of family presents unique challenges to parenting competence and adult psychological well-being.A. Stepparents: Whether stepchildren live in the household or visit only occasionally, stepparents are in a difficult position. Since the parent-child tie predates the blended family, the stepparent enters as an outsider. Too often, stepparents move into their new role too quickly. Because they do not have a warm attachment bond to build on, their discipline is usually ineffective. Stepparents frequently criticize the biological parent for being too lenient. The parent, in turn, tends to view the stepparent as too harsh. These differences can divide the couple. Remarried parents typically report higher levels of tension and disagreement than first marriage parents, most centering on child-rearing issues. Because of more opportunities for conflict, relationship quality is poorer when both adults have children from prior marriages than when only one does.Stepmothers, especially, are likely to experience conflict. Expected to be in charge of family relationships, they quickly find that stepparent-stepchild ties do not develop instantly.Often mothers are jealous, uncooperative, and possessive of their children following divorce.B. Never-Married Single Parents: Single adults occasionally decide to become parents on their own. Births to women in high-status occupations who have not married by their thirties have increased. However, they are still few in number, and little is known about how these mothers and their children fare.Children of never-married mothers who lack the involvement of a father are poor in school and display more antisocial behavior than children in low-SES, first-marriage families. These adjustment problems make life more difficult for mothers. Strengthening social support, education, and employment opportunities for low-SES parents would encourage marriage as well as help unmarried-mother families.C. Gay and lesbian Parents: Several million American gay men and lesbians are parents, most through previous heterosexual marriages, a few through adoption or reproductive technologies. In the past, laws assuming that homosexuals could not be adequate parents led those who divorced a heterosexual partner to lose custody of their children.Today, sexual orientation is irrelevant to custody. In others, fierce prejudice against homosexual parents still prevails. Gay and lesbian parents are as committed to and effective at child rearing as heterosexual parents. Some evidence suggests that gay fathers are more consistent in setting limits and more responsive to their children's needs than heterosexual fathers, perhaps because gay men's less traditional gender identity fosters involvement with children. In lesbian families, quality of mother-child interaction is as positive as in heterosexual families. And children of lesbian mothers regard their mother's partner as very much a parent. Whether born to or adopted by their parents or conceived through donor insemination, children in homosexual families are as well-adjusted as other children. Also, the large majority are heterosexual. When extended-family members have difficulty accepting them, homosexual mothers and fathers often build "families of choice" through friends, who assume the roles of relatives. But most of the time, parents of gays and lesbians cannot endure a permanent rift. With time, interactions between homosexual parents and their families of origin become more positive and supportive.2.4 Physical , Cognitive, Psychosocial Changes in Early Adulthood2.4.1 Physical changesEarly adulthood is, for most people, the time of peak physical capacity. The body reaches full height by the late teens, and physical strength increases into the late 20s and early 30s. Manual agility and coordination, and sensory capacities such as vision and hearing, are also at their peak. In general, people in early adulthood feel robust and energetic, although it is not unusual to see fluctuations around deadlines and exam periods. On the other hand, people in this age group are also legally able to use damaging substances, such as alcohol and tobacco, and many can obtain access to illegal stimulants or narcotics. Young adults also have increasing responsibility for organizing their own eating habits and exercise regimes. Not surprisingly, the health status and prospects of young adults are dependent more than ever before on their own behavioral choices.The young adult years are often referred to as the peak years. Young adults experience excellent health, vigor, and physical functioning. Young adults have not yet been subjected to age-related physical deterioration, such as wrinkles, weakened body systems, and reduced lung and heart capacities. Their strength, coordination, reaction time, sensation (sight, hearing, taste, smell, and touch), fine motor skills, and sexual response are at a maximum.Additionally, both young men and women enjoy the benefits of society’s emphasis on youthfulness. They typically look and feel attractive and sexually appealing. Young men may have healthy skin, all or most of their hair, and well-defined muscles. Young women may have soft and supple skin, a small waistline, and toned legs, thighs, and buttocks.Health and physical fitness during young adulthood are excellent. People in their 20s and 30s perform at exceedingly high levels on tests of endurance and stamina. They generally are at their best in terms of physical conditioning and overall sense of well-being.Death rates during young adulthood are lower than during any other period of the life span. Except for HIV and AIDS in males and malignancies in females, the leading cause of death during the 20s and 30s is accidents. Death rates, however, double during each decade after age 35.2.4.2 Cognitive changesBy the end of adolescence, most people are capable of the levels of reasoning that we would expect for normal functioning in adult society. Although there are wide individual differences in attainment, most young adults are able to deal with cognitive tasks in a more abstract way than before, and to attain solutions to problems by comparing possible explanations. Many young adults—particularly those who have attended college—develop the ability to reason logically, solve theoretical problems, and think abstractly. They have reached Piaget’s formal operations stage of cognitive development. During this stage, individuals can also classify and compare objects and ideas, systematically seek solutions to problems, and consider future possibilities. As young adults confront and work through the gray areas of life, some may go on to develop post formal thinking, or practical street smarts. Developing the wisdom associated with post formal thinking is a lifelong process, which begins in the teenage years and is fully realized in the older adult years.Most young adults aged 18 and over will:Move into adult roles and responsibilities and may learn a trade, work, and/or pursue higher education Fully understand abstract concepts and be aware of consequences and personal limitations Identify career goals and prepare to achieve them Secure their autonomy and build and test their decision making skills Develop new skills, hobbies, and adult interests2.4.3 Psychosocial developmentYoung adulthood is a time when many difficult decisions need to made. These decisions will affect the person for the rest of his life they make decision for themselves, which influence their life-style in their future. They must make choices about: Education, occupation, to marry or remain single, starting a home, children rearing, forming new friendships, & assuming certain community activities. Psychosocial development in adulthood consists of changes in lifestyles and relationships. According to Erikson, the primary task of early adulthood is to establish identity and intimacy (sharing one’s total self with someone else) after wrestling with the intimacy versus isolation psychosocial crisis, which poses commitment to others opposite the possibility of self-absorption. Much psychosocial development occurring during this period is in conjunction with significant life changes, such as leaving home, finding a long-term romantic relationship, beginning a career, and starting a family.An important aspect of establishing intimacy with a partner is first being able to separate from the family of origin, or family of procreation. Most young adults have familial attachments from which they are separating. This process normally begins during Daniel Levinson’s early adult transition (ages 17–22), when many young adults first leave home to attend college or to take a job in another city.By age 22, young adults have attained at least some level of attitudinal, emotional, and physical independence. They are ready for Levinson’s entering the adult world (ages 22–28) stage of early adulthood, during which relationships take center stage. Moreover, dating and marriage are natural extensions of the eventual separating from the family of origin a key process in becoming an adult. Early bonding and separation experiences, then, set the stage for later independence from the family and the ability to form healthy attachments.2.5 Personal and Social Hazards in Early AdulthoodThe most common and serious hazards of early adulthood personal and social adjustments include, physical hazards, social hazards, and social mobility.Physical Hazards: refers to physical defects and poor health. Individual with such problems cannot achieve what they aspire. This is usually followed by stress. Unattractive physical appearance also hurts the individual social competence. Social Hazards: They also face social adjustment problems. The most common one include difficulty in associating oneself, inability to develop friendly relationships and dissatisfaction with the roles the social group expects the individual to play.Social Mobility: is also another hazard of adjustment. That is, one who moves either side faces new social norms and values to adjust with. He/she is expected to do so. Inability to adjust is often followed by stress.2.6 Vocational and Family Adjustments in Early Adulthood OverviewEarly adulthood is a period of adjustments to new patterns of life and new social expectations. The young adult is expected to play new roles, such as that of spouse, parent, and breadwinner, and to develop new attitudes, interests, and values in keeping with these new roles. These adjustments make early adulthood a distinctive period in the life span and also a difficult one. It is especially difficult because, until now, most boys and girls have had someone parents, teachers, friends or others-to help them make the adjustments they are faced with. Now, as adults, they are expected to make these adjustments for themselves. To avoid being considered "immature," they hesitate to turn to others for advice and help when they find the adjustments too difficult to cope with successfully alone.2.6.1 Vocational adjustmentsIn young adulthood, a person’s career or job can become a significant part of a person’s self-identity. Often a person’s self-definition is related to what he or she does. Levinson (1978) describes the process of young adults entering an occupation whereby they must develop an occupational identity and establish themselves in the work world. Each job carries with it a set of components that must be adapted for successful adjustment in the workplace. Newman and Newman (1995) describe these components: The use of technical skills; the development of authority relations; adapting to special demands and hazards; and the development of interpersonal relationship with peers. As young adults make important inroads in their career, they must also be starting a family. Achieving a balance among one’s career, leisure and family life is a developmental task that needs to be addressed during this period.The psychological importance of what people do varies, and it is important to understand the difference between a job and a career. Many people pursue a job in order to earn a living. Therefore; their job may not have much value for them from a psychological perspective. Other people pursue a career more as a way of life .Their career may have significant value to them because it is a central aspect of their life.2.6.2 Marital adjustmentsThere are many sources of tension in a new marriage. If the partners do not have similar, religious, educational, or social class backgrounds, they will not have to compromise on many value decisions. Assumed shared value orientation, certain life style decisions can generate tension. The couple must establish a mutually satisfying sexual relationship. They must also work out an agreement about saving and spending money. As part of adjustment to marriage, the partners must achieve a sense of psychological commitment to each other. There is a period of testing in every marriage, during which each partner is likely to put strain on the relationship to see how strong it really is.2.6.3 Adjustment to parenthoodDuring early adulthood, the issue of reproduction is confronted many times. Young adults make choices to delay parenting, have an abortion, have a child, wait before having another child, or stop having children altogether. Many parents undergo difficult and expensive procedures to conceive a child. Others who are unable to conceive decide to adopt children. Some adults become foster parents, whether or not they have children of their own. Even unplanned pregnancies are the products of some kind of decision making, whether to have sexual relationship knowing that pregnancy is possible, to avoid using effective means of birth control, to abort the pregnancy or to carry the child to term.In contemporary societies, decisions about childbearing are made in the context of other personal and family goals and commitments. Factors such as religious beliefs, career aspirations, ideals about family life, and social expectations in the family and culture all contribute to a couple’s commitment to bearing children and the timing of the first and subsequent pregnancies. Cultures differ in the norms and expectations they convey about the value of having children as well as the appropriate timing and frequency of pregnancies2.6.4 Vocational and Marital Hazards during Early AdulthoodYoung adults have experienced different hazards related to their career and family formation. Some of the common marital and vocational hazards are listed below:Marital Hazards:- Adjustment to a mateRole changesParenthoodRelationship with In-LawsHazards of SinglehoodHazards of divorceHazards of RemarriageVocational Hazards Job DissatisfactionUnemployment UNIT THREE3. Middle AdulthoodCharacteristics of middle ageAs Middle Adulthood is a long period in the life span, it is customarily subdivided into Early Middle Adulthood, which extends from age forty to age fifty, and Advanced Middle Adulthood, which extends from age fifty to age sixty. During advanced Middle Adulthood, physical and psychological changes that first began during the early forties become far more apparent.Like every period in the life span, Middle Adulthood is associated with certain characteristics that make it distinctive. Some of the most important of these characteristics are listed below.Middle Adulthood is a Time of StressRadical adjustments to changed roles and patterns of life, especially when accompanied by physical changes, always tend to disrupt the individual's physical and psychological homeostasis and lead to a period of stress-a time when a number of major adjustments must be made in the home, business, and social aspects of their lives. Categories of Stress in Middle Adulthood are:-Somatic stress, which is due to physical evidences of agingCultural stress, stemming from the high value placed on youth, vigor, and success by the cultural groupEconomic stress, resulting from the financial burden of educating children and providing status symbols for all family membersPsychological stress, which may be the result of the death of a spouse, the departure of children from the home, boredom with marriage, or a sense of lost youth and approaching death.Middle Adulthood is a "Dangerous Age"The usual way of interpreting "dangerous age" is in terms of the male who wants to have a last fling in life, especially in his sex life, before old age catches up with him. It is a time when individuals break down physically as a result of overwork, over worry, or careless living. The incidence of mental illness rises rapidly in Middle Adulthood among both men and women, and it is also a peak age for suicides, especially among men.Middle Adulthood is an "Awkward Age"Just as adolescents are neither children nor adults, so middle-aged men and women are no longer "young" nor are they yet "old." The middle-aged person "stands between the younger 'Rebel Generation' and the 'Senior Citizen Generation'-both of which is continuously in the spotlight and suffers from the discomforts and embarrassments associated with both age groups.Middle Adulthood is a Time of AchievementAccording to Erikson, it is a crisis age in which either "Generativity" -the tendency to produce-or "stagnation" -the tendency to stand still-will dominate. People either become more and more successful or they stand still and accomplish nothing more. If middle-aged people have a strong desire to succeed, they will reach their peak at this time and reap the benefits of the years of preparation and hard work that preceded it. Women, like men, who have worked throughout the years of early adulthood, generally reach their peak during Middle Adulthood. However, this peak, until very recently, was far below that of male workers. Middle Adulthood is a Time of EvaluationAs it is the peak age of achievement, it is logical that it also would be the time when they would evaluate their accomplishments in light of their earlier aspirations and the expectations of others, especially family members and friends. As a result of this self-evaluation, Archer has pointed out, "The mid-years seem to require the development of a different, generally more realistic sense of who one is. . . . In growing up, everyone nurtures fantasies or illusions about what one is, and what one will do. A major task of the mid-life decade involves coming to terms with those fantasies and illusions".Middle Adulthood is the Time of the Empty NestThe time when the children no longer want to live under the parental roof. Except in cases where men and women marry later than the average age, or postpone having their children until they are well established in their careers, or have large families spread out over a decade or more of time, Middle Adulthood is the "empty nest" stage in marital lives. After years of living in a family-centered home, most adults find it difficult to adjust to a pair-centered home. This is because, during the child-rearing years, husbands and wives often grew apart and developed individual interests. As a result, they have little in common after mutual interests in their children wane and when they are thrown together to adjust to each other the best they can. Unquestionably, the empty-nest period of Middle Adulthood is far more traumatic for women than for men. This is especially true of women who have devoted their adult years to homemaking and who have few interests or resources to fill their time when their homemaking jobs lessen or come to an end. Many experience a "retirement shock" similar to that experienced by men when they retire.Middle Adulthood is a Time of BoredomMany, if not most, men and women experience boredom during the late thirties and forties. Men become bored with the daily routine of work and with a family life that offers little excitement. Women, who have spent most of their adulthood caring for the home and raising children, wonder what they will do for the next twenty or thirty years. The unmarried woman who has devoted her life to a job or career is bored for the same reason men are. Developmental Tasks of Middle AgeEach adult typically engages in all of the developmental tasks such as managing a career, nurturing, intimate relationships, and managing the household. Though their roles in the family, in the work place, and in the community, middle adults have broad responsibilities for the nurturance, education, and care of children, adolescents, young adults, and older adults. The strains of middle adulthood result largely from difficulties in balancing many roles and striving to navigate through predictable as well as sudden role transitions.1. Adjusting to physical and physiological changesIn mid-life, people start or increase their doctors’ visits for injuries that take longer to heal or for recurrent or worrisome symptoms. Many of these symptoms are reminders of the aging process, including facial wrinkles, graying or loss of hair, reading glasses, and sleep disorders. There may be weight management issues, especially when obesity is linked with food intolerances and diseases, such as coronary artery disease, hypertension, diabetes, dyslipidemias, and joint degeneration.2. Adjusting to the reality of the work situationMid-life is often a period for vocational evaluation. There may be sadness about not having advanced far enough in career objectives. There may be fear of being replaced by a younger, more capable person. Middle-agers may feel regret about the emphasis on vocation instead of family. Retirement issues will be evaluated. For women who combined motherhood with their career, there may be a fatigue factor derived from a hectic “superwoman” lifestyle. In contrast, for women who deferred their career until later in life, there may be a desire to work harder in order to catch up to friends and colleagues.3. Assuring economic security for old age: There is an accentuated focus on financial planning. Middle-- agers are anxious about planning for future living expenses. They are worried about inflation eroding their life savings and about possible future illness in themselves or family members (with expenses for medication, home care, paramedical services, specialized housing needs, etc.). Changing taxation structures may affect disposable income, and pensions may not be adequate to meet the need. Premature or forced retirement, job closures or lay-offs may limit personal goals, financial security or desired lifestyle.4. Maintaining contact with children and grandchildrenThe reality of grandchildren touches grandparents differently and affects their comfort in their role as grandparents and the style and depth of their involvement in this role. Grandchildren growing up in other locales may have less contact with their grandparents - who in turn may find this situation difficult to accept. Irrespective of where each child lives, there may be friction between a grandparent and his or her own adult child over common issues in child rearing.5. Reorganizing living arrangements: The departure of grown children from the family home may eliminate the need for existing space. Parents may need to move into a smaller home. These changes may elicit emotional loss of property or moments reflective of past family life together.6. Adjusting to being a couple againEmotional and physical intimacies are commonly found in newlyweds. This intimacy may decrease over years of marriage, as children, recreational activities and vocational obligations compete for time. Consequently, the “empty nest” situation may challenge the couple’s relationship since the absence of children as diversions may reveal changes in one or both members of the couple. A loss of intimacy may also be accentuated. A challenge exists to re-establish a relationship as a “twosome” by exploring communication and lifestyle needs and patterns. Failure to take on this challenge may lead to quarrels, sexual dysfunction, and extramarital affairs and, in some cases, divorce.7. Participating in the communityIn the middle age period, women, especially homemakers, appear to be more involved in community activities than men. With the recent trend towards both men and women working outside home, there is a concern that community voluntarism will suffer.8. Ensuring adequate medical supervision for old ageIn mid-life, there may be new or growing anxieties about health and aging. The extent of this concern may be related to whether one is a realist, pessimist or optimist. There is generally an increase in doctor visits as a reassurance that there is a medical system in place that can respond to their medical problems. 9. Looking after aging parentsHealthier lifestyles, more efficient drugs and improved technology have extended lifespan. Middle-aged people are often torn between the needs of their children and their elderly parents. They assist the latter with food shopping, housekeeping, banking and finance, laundry, bathing and hygiene, transportation, and provide accompaniment to medical appointments, and medication supervision or administration.Adult children of aging parents may feel burdened and experience negative feelings. For example, caregivers may deny the existence of a physical, mental or social problem. They may be angry about the situation, at the parent for being ill, at themselves for not handling the situation well, at a sibling for not helping out, and at the reversal of the parent child relationship. Caregivers often bargain with the health and social service system for more care, with family members for help, with spouse and children for understanding, and with themselves over their coping abilities. They may be depressed about the deteriorating health and quality of life of a parent, at the failure to find solutions, and about fatigue and burnout. Eventually, they may be able to accept their situation on emotional and intellectual levels. Major Adjustment in Middle age Adjustment to physical changes & changed interestsIt has been found that the body organ of most persons show a 0.8 to 1 percent decline per year in the functional ability after the age of 30. Part of this decline is normal, some is disease-related, and some is caused by factors such as stress, occupational status, nutritional status and many other environmental factors.Although no longer at the peak level of their young adult years, middle-aged adults still report good health and physical functioning. However, as a result of the passage of time, middle adults undergo various physical changes. Decades of exposure and use take their toll on the body as wrinkles develop, organs no longer function as efficiently as they once did, and lung and heart capacities decrease. Other changes include decreases in strength, coordination, reaction time, sensation (sight, hearing, taste, smell, touch), and fine motor skills. Also common among middle adults are the conditions of presbyopia (farsightedness or difficulty reading) and presbycusis (difficulty hearing high-pitched sounds). Still, none of these changes is usually so dramatic that the middle adult cannot compensate by wearing glasses to read, taking greater care when engaging in complex motor tasks, driving more carefully, or slowing down at the gym.Of course, people age at different rates, so some 40 year olds may feel middle-aged long before their 50-year-old counterparts. Most people, however, describe feeling that they have reached midlife by their mid-50s.The bio-psychosocial changes that accompany midlife—specifically, menopause (the cessation of menstruation) in women and the male climacteric (male menopause) in men—appear to be major turning points in terms of the decline that eventually typifies older adulthood. None of the biological declines of middle and late adulthood needs to be an obstacle to enjoying all aspects of life, including sex.Sexuality in Middle AdulthoodAs?people?age,?they?may experience physical changes, illnesses, or emotional upheavals, such as the loss of a partner, that can lead to a decline in sexual interest and behavior. In women, there is a gradual decline in the function of the ovaries and in the production of estrogen. The average age at which menopause (the end of the menstrual cycle) occurs is about 50. Decreased estrogen leads to thinning of the vaginal walls, shrinking of the vagina and labia majora, and decreased vaginal lubrication. These conditions can be severe enough to cause the woman pain during intercourse. Women who were sexually active either through intercourse or through masturbation before menopause and who continue sexual activity after menopause are less likely to experience vaginal problems. Women can use hormone-replacement therapy or hormone-containing creams to help maintain vaginal health. In men, testosterone production declines over the years, and the testes become smaller. The volume and force of ejaculation decrease and sperm count is reduced, but viable sperm may still be produced in elderly men. Erection takes longer to attain, and the time after orgasm during which erection cannot occur (the refractory period) increases. Medications and vascular disease, diabetes, and other medical conditions can cause erectile dysfunction.The middle years can often lead to problems for marital couples who do not understand some of the changes they are going through during the middle years. Maggie Scarf (1992), notes the different physical changes that men and women go through during the middle years. A man’s aging crisis can be related to the pressure he feels “to make it” and a woman’s aging crisis can be related to concerns and anxiety she feels about her physical appearance. These changes have direct implications for their sexual relationship. Scarf describes how such changes affect the sexual response cycle, which includes three phases: desire, excitement, and orgasm.First, desire, being sexually motivated, can be affected by aging. For example, the side effects of diseases (such as diabetes or hyperthyroidism), of psychological difficulties, (such as depression) or of medical concerns (such as hypertension) that require drug treatment can all negatively affect desire. In general overtime, the sex drive declines, particularly for men. The male sex drive is also affected by a drop in testosterone, the male hormone. Excitement, the second phase; of sexual response cycle is the first physiological reaction to stimulations and results in blood engorgement of the genitals. The last phase of sexual response cycle, orgasm, also changes dramatically, with age primarily in the area known as the refractory period-the time between one orgasm and the physical capability to achieve another orgasm.For the middle life woman, the sexual profile is quite different. Indeed, erotic interest often increases in the desire phase, primarily in response to changes to her biological makeup. When estrogen, the female hormone, declines, it allows her testosterone to have more of an influence. During menopause, the ovaries continue to produce small amounts of testosterone, and given the decline of estrogen, the effect of the testosterone is greater, leading to increased sexual desire. However, in the excitement phase, lack of estrogen often leads to problems with vaginal dryness.There is a strong psychological meaning behind sexual activity-it reaffirms self-esteem, attractiveness, and gender identity.MenopauseMenopause is permanent?ending?of menstruation in women. Menopause marks the end of a woman’s natural ability to bear children. Menopause is usually preceded by 10 to 15 years during which the ovaries gradually stop producing eggs and sex hormones, a period called the climacteric. Perimenopausecompasses this period of changing ovarian activity and also the first few years without menstrual cycling, typically characterized by hormonal and physical changes and sometimes emotional and psychological changes as well.In?the?United?States?most women experience menopause in their late 40s or early 50s—about half by age 51. Menopause before age 35 is called premature menopause and may occur because of certain diseases, autoimmune reactions (in which the body’s immune defenses attack the body’s own cells, tissues, or organs), surgery, medical Menopause occurs when a woman has not experienced a menstrual cycle for one year. Attitudes towards this event vary depending on cultural connotations and women’s individual expectations. In societies where women’s role is mostly reproductive inability to bear any more children is a loss of status. In cultures in which the wisdom and experience of older women is valued, menopause is seen as a positive life event. In general, young women and men view menopause more negatively whereas women who have gone through the experience view it more positively.Individually, some women view the cessation of their monthly period as a sign of impending old age and mourn the loss of youth and beauty. Other women, are glad to be rid of it.Signs and Symptoms The?experience?of?menopause differs among women, depending on differences in diet and nutrition, general health and health care, and even how women are taught to think about menopause. Not all women experience symptoms. All physical symptoms should be discussed with a health-care provider to rule out potential causes other than approaching menopause.For?a?number?of?years before menopause women may notice longer menstrual periods, heavier menstrual flow, spotting, or irregularity. Hormone pills or low-dose birth control pills may be prescribed to control bleeding problems. Hot flashes or hot flushes range from a passing feeling of warmth in the face and upper body to extreme sweating and visible redness of the skin followed by chills. Heart palpitations and feelings of suffocation can also occur.As?estrogen?levels?decline, the vaginal walls become less elastic and thinner. Vaginal secretions are reduced and are less acidic, increasing the chances for vaginal infections. Insufficient vaginal lubrication during sexual activity can make intercourse uncomfortable or painful. Some women report a decreased interest in sex and a decline in sexual activity with menopause that are not due to vaginal problems.Psychological?symptoms may include depression, mood swings, weepiness, and other emotional flare-ups, as well as memory lapses. Although declining levels of estrogen may play a role in these symptoms, a number of other factors and stresses need to be considered as well. Excess alcohol, caffeine, or sugar may stress the adrenal glands and decrease the amount of adrenal androgens available for conversion to estrogen, thereby lowering estrogen and making menopausal symptoms worse. Smoking decreases estrogen production by the ovaries, leading to earlier menopause and osteoporosis. Stressful life events that may contribute to the emotional symptoms at the time of menopause include children leaving home and caring for aging Sexual?Dysfunctions? Sexual?dysfunctions?are problems with sexual response that cause distress. Erectile dysfunction (impotence) refers to the inability of a man to have or maintain an erection. Premature ejaculation occurs when a man is not able to postpone or control his ejaculation. Inhibited male orgasm, or retarded ejaculation, occurs when a man cannot have an orgasm despite being highly aroused.Female?orgasmic?dysfunction (Anorgasmia or inhibited female orgasm) refers to the inability of a woman to have an orgasm. Orgasmic dysfunction may be primary, meaning that the woman has never experienced an orgasm; secondary, meaning that the woman has had orgasms in the past but cannot have them now; or situational, meaning that she has orgasms in some situations but not in others. Vaginismus refers to a spastic contraction of the outer third of the vagina, a condition that can close the entrance of the vagina, preventing intercourse.Dyspareunia?refers?to painful intercourse in either women or men. Low sexual desire is a lack of interest in sexual activity. Discrepant sexual desire refers to a condition in which partners have considerably different levels of sexual interest. These dysfunctions may be caused by physical problems such as fatigue or illness; the use of prescription medications, other drugs, or alcohol; or psychological factors, including learned inhibition of sexual response, anxiety, interfering thoughts, spectatoring (observing and judging one's own sexual performance), lack of communication between partners, insufficient or ineffective sexual stimulation, and relationship conflicts. In such cases, a qualified sex therapist can work with a physicianAdjustment to Mental ChangesMiddle-age adult thinking differs significantly from that of adolescents and young adults. Adults are typically more focused in specific directions, having gained insight and understanding from life events that adolescents and young adults have not yet experienced. No longer viewing the world from an absolute and fixed perspective, middle adults have learned how to make compromises, question the establishment, and work through disputes. Younger people, on the hand, may still look for definitive answers.Many middle-age adults have attained Piaget’s stage of formal operations, which is characterized by the ability to think abstractly, reason logically, and solve theoretical problems. Many of the situations facing adults today require something more than formal operations. That is, the uncertain areas of life may pose problems too ambiguous and inconsistent for such straightforward thinking styles. Instead, middle adults may develop and employ post-formal thinking, which is characterized by the objective use of practical common sense to deal with unclear problems. An example of post-formal thinking is the middle adult who knows from experience how to maneuver through rules and regulations and play the system at the office. Another example is the middle adult who accepts the reality of contradictions in his or her religion, as opposed to the adolescent who expects a concrete truth in an infallible set of religious doctrines and rules. Post-formal thinking begins late in adolescence and culminates in the practical wisdom so often associated with older adulthood.Post formal thoughtDuring the formal operational stage, teens use their considerable reasoning abilities to solve problems, but they are very likely to generate a single solution as opposed to multiple solutions. Disagreement with their solution is usually interpreted by teens to mean that their solution is somehow incorrect.Formal-operational thinking is absolute, and involves making decisions based on personal experience and logic. Post-formal thinking is more complex, and involves making decisions based on situational constraints and circumstances, and integrating emotion with logic to form context-dependent principles. The distinction is a useful thing to understand when dealing with emerging adults.Criticisms of Formal OperationsFormal operations overemphasizes the power of pure logic in problem solvingFormal operations underemphasizes the pragmatic quality of real life cognitive activity cannot sever cognition from affective, social, and pragmatic tiesFormal thinking is only suited for the problems that call for scientific thinking and logical mathematical analyses Piaget assumed - goal of mature adult to think like a scientist Does not apply to real-life social or interpersonal problemsFormal operations is geared for the solution of closed system, well-defined problems - needs controllable, specific variables implies single correct solutions real life - unlimited number of uncontrollable, changeable, and ill-defined variablesFormal operations does not recognize the relative nature of knowledge and the need to adopt multiple frames of referenceCharacteristics of Post Formal ThoughtPost formal thinkers possess an understanding of the relative, non-absolute nature of knowledge Relativistic thinking Accept contradiction as a basic aspect of realityPost formal thinkers capable of dialectic reasoning able to synthesize contradictory thoughts, emotions, and experiencesA contextual approach to problem solving solve problems by continuously creating new principles based on changing circumstance instead of set principles applied to all contextsPost formal thinking tends to be domain-specific people use in some but not all areasA multitude of social, demographic, psychological, and biological factors contribute to a person’s mental health status. Almost all these factors are particularly pertinent amongst adults. Factors such as poverty, social isolation, loss of independence, loneliness and losses of different kinds, can affect mental health and general health. Adults are more likely to experience events such as bereavements or physical disability that affect emotional well-being and can result in poorer mental health. They may also be exposed to maltreatment at home and in care institutions. On the other hand, social support and family interactions can boost the dignity of adults, and are likely to have a protective role in the mental health outcomes of this population.There are older women worldwide than older men. This difference increases with advancing age and has been called “feminization of ageing”. Older men and women have different health and morbidity patterns and women generally have lower income but better family support networks. On the other hand depression, Alzheimer’s disease and dementia are more prevalent among women than men. Early symptoms of these mental problems are shown in middle adulthood period. Social AdjustmentsIn all age groups, friends are a healthy alternative to family and acquaintances. Friends offer support, direction, guidance, and a change of pace from usual routines. Many young adults manage to maintain at least some friendships in spite of the time constraints caused by family, school, and work; however, finding time to maintain friendships becomes more difficult for middle adults. During this period, life responsibilities are at an all-time high, so having extra time for socializing is usually rare. For this reason, middle adults may have less friends than their newlywed and retired counterparts. Yet where quantity of friendships may be lacking, quality predominates. Some of the closest ties between friends are formed and nourished during middle adulthood.3.4. Personality Theories and DevelopmentAdult Stages Theories Adult stage theories have been plentiful, and they have contributed to the view that midlife brings a crisis in development. Two prominent theories that define stages of adult development are Erik Erikson’s life-span view and Daniel Levinson’s seasons of a man’s life.Erikson’s Stage of Generativity Versus StagnationErikson (1968) proposed that middle-aged adults face a significant issue—generativity versus stagnation, which is the name Erikson gave to the seventh stage in his life-span theory. Generativity encompasses adults’ desire to leave legacies of themselves to the next generation. Through these legacies adults achieve a kind of immortality. By contrast, stagnation (sometimes called “self-absorption”) develops when individuals sense that they have done nothing for the next generation.Middle-aged adults can develop generativity in a number of ways. Through biological generativity, adults have offspring. Through parental generativity, adults nurture and guide children. Through work generativity, adults develop skills that are passed down to others. And through cultural generativity, adults create, renovate, or conserve some aspect of culture that ultimately survives.Adults promote and guide the next generation by parenting, teaching, leading, and doing things that benefit the community. Individuals from twenty to thirty they learned how to get along with their wife. From thirty to forty they learned how to be successful at their job, and at forty to fifty they worried less about themselves and more about their children. Generative adults commit themselves to the continuation and improvement of society as a whole through their connection to the next generation. Generative adults develop a positive legacy of the self and then offer it as a gift to the next generation. The middle adult who fails to develop generativity experiences stagnation, or self-absorption, with its associated self-indulgence and invalidism.Stagnation-stagnation suggests a lack of psychological movement or growth. Those unable to cope with managing a household, raising children, or managing their career are likely to feel psychological stagnation at the end of middle adulthoodLevinson’s Seasons of a Man’s LifeAlthough Levinson’s major interest focused on midlife change, he described a number of stages and transitions during the period from 17 to 65 years of age. Levinson emphasizes that developmental tasks must be mastered at each stage.At the end of one’s teens, according to Levinson, a transition from dependence to independence should occur. This transition is marked by the formation of a dream—an image of the kind of life the youth wants to have, especially in terms of a career and marriage. Levinson sees the twenties as a novice phase of adult development. It is a time of reasonably free experimentation and of testing the dream in the real world. In early adulthood, the two major tasks to be mastered are exploring the possibilities for adult living and developing a stable life structure.From about the ages of 28 to 33, a man goes through a transition period in which he must face the more serious question of determining his goals. During the thirties, he usually focuses on family and career development. In the later years of this period, he enters a phase of Becoming One’s Own Man. By age 40, he has reached a stable location in his career, has outgrown his earlier, more tenuous attempts at learning to become an adult, and now must look forward to the kind of life he will lead as a middle-aged adult.According to Levinson, the transition to middle adulthood lasts about five years (ages 40 to 45) and requires the adult male to come to grips with four major conflicts that have existed in his life since adolescence: (1) being young versus being old, (2) being destructive versus being constructive, (3) being masculine versus being feminine, and (4) being attached to others versus being separated from them. Seventy to 80 percent of the men Levinson interviewed found the midlife transition tumultuous and psychologically painful, as many aspects of their lives came into question. According to Levinson, the success of the midlife transition rests on how effectively the individual reduces the polarities and accepts each of them as an integral part of his being.Because Levinson interviewed middle-aged men, we can consider the data about middle adulthood more valid than the data about early adulthood. When individuals are asked to remember information about earlier parts of their lives, they may distort and forget things. Levinson (1978) views midlife as a crisis, arguing that the middle-aged adult is suspended between the past and the future, trying to cope with this gap that threatens life’s continuity. The stage theories place too much emphasis on crises in development, especially midlife crises.Stage theories focus on the universals of adult personality development as they try to pin down stages that all individuals go through in their adult lives. These theories do not adequately address individual variations in adult development. One extensive study of a random sample of 500 men at midlife, for example, found extensive individual variation among men. In the individual variations view, middle-aged adults interpret, shape, alter, and give meaning to their lives.Some individuals may experience a midlife crisis in some contexts of their lives but not others For example, turmoil and stress may characterize a person’s life at work even while things are going smoothly at home.Researchers have found that in one-third of the cases in which individuals have reported having a midlife crisis, the “crisis is triggered by life events such as a job loss, financial problems, or illness”. Let’s now explore the role of life events in midlife development.The Life-Events ApproachAge-related stages represent one major way to examine adult personality development. A second major way to conceptualize adult personality development is to focus on life events. In the early version of the life-events approach, life events were viewed as taxing circumstances for individuals, forcing them to change their personality. Such events as the death of a spouse, divorce, marriage, and so on were believed to involve varying degrees of stress, and therefore likely to influence the individual’s development.Today’s life-events approach is more sophisticated. In the contemporary life-events approach, how life events influence the individual’s development depends not only on the life event itself but also on mediating factors (such as physical health and family supports), the individual’s adaptation to the life event (such as appraisal of the threat and coping strategies), the life-stage context, and the socio-historical context. For example, if individuals are in poor health and have little family support, life events are likely to be more stressful. And a divorce may be more stressful after many years of marriage when adults are in their fifties than when they have been married only several years and are in their twenties, a finding indicating that the life-stage context of an event makes a difference. The socio-historical context also makes a difference. For example, adults may be able to cope more effectively with divorce today than in the 1950s because divorce has become more commonplace and accepted in today’s society. Whatever the context or mediating variables, however, one individual may perceive a life event as highly stressful, whereas another individual may perceive the same event as a challenge.3.5 Vocational and Family Adjustments in Middle Adulthood 3.5.1 Vocational AdjustmentsManagement of career does not necessarily mean remaining within the same occupational structure throughout adult life. Although the rate of job turnover slows down after age 30, people still need to remain flexible about their attachment to specific job.Work activities or work related goals may change for at least five reasons during middle adulthood. One example is the career of the professional athlete whose strength, speed and reaction time, and endurance decline to the point where he or she can no longer compete.Second, some adults cannot resolve conflicts between job demands and personal goals. Some workers recognize that the kinds of contributions they thought they could make are simply not possible within their chosen work structures. Others feel like outsiders within their own corporations.A third explanation for midlife career change is the realization that one has succeeded as much as possible in a given career. Adults may realize that they will be promoted further or that changing technology has made their expertise obsolete. Consequently, they may decide to retrain for new kinds of work or return to school to move to new career directions. Fourth, some women decide to make a greater commitment to career once their children are in high school or college. Many have chosen to withdraw from the labor market for a time in order to fulfill parenting roles. As they return to work, women may continue to expect to combine responsibilities as homemakers with career goals. Fifth, with the restructuring of work force some workers are laid off and cannot be rehired in the same field .They have to retrain for a new line of work or for similar work.Levinson says that in midlife, employed men and women experience a different relationship with their occupational status. They are asking themselves; “is my work satisfying?” there is much greater emphasis on self-fulfillment and satisfaction than on the collection of external rewards. Others ask themselves, “in what ways have I made a contribution or formed a legacy to something outside of myself or my family?” People often want to be appreciated for their contributions at work and likely to offer to mentor others who are coming up in the ranks.however, not everyone experiences satisfaction in their work, and some take ’”psychological retirement”. Some whose work performance is minimally adequate accept “early retirement.” Even though the workplace can be a major source of stress, joblessness can be even more disruptive to personal mental health and family functioning. Some people are alienated from work-they find little satisfaction from the work setting and few opportunities for meaningful labor.Chronically unemployed men have few opportunities to develop competence within the context of work. Because of the cultural emphasis on productive work, they are likely to experience guilt about being unemployed. In addition, unemployment disrupts the self-concept of traditional definition of the adult male role as a breadwinner for the family. As a result of guilt, shame, and anger, these men may find it hard to direct their energy toward creative solutions to life problems.Most middle adults can be categorized as either successful in a stable career chosen during young adulthood or ready for a new career. Career changes are sometimes the result of reevaluation, or a mid-careers assessment, which can certainly be stressful. Such reexamination of one’s vocation can come about for many reasons, such as feeling trapped in a career or even wanting to make more money. One recent trend, however, is for middle adults to leave high-paying professions to take on more humanitarian roles, such as ministers, social workers, or counselors.The greatest source of job stress is unemployment, especially when termination comes suddenly. Besides wrestling with issues of self-esteem, unemployed workers must also deal with the financial hardship brought about by loss of income. As may be expected, unemployed persons who have alternative financial resources and who also cognitively reframe their situations tend to cope better than those who do not.An important problem in middle- age is the adjustments to vocational changes. The changed working conditions are the main cause of the problems of adjustment. One notices sex differences in vocational adjustments though most of the vocational problems are common for men and women. According to psychological researches, the following working conditions affect middle-aged workers: Unfavorable social attitudes, hiring policies, Increased use of automation, group work, role of the wife, compulsory retirement, Dominance of big Business, relocation the conditions influencing vocational adjustment in middle- age include: satisfaction with work, opportunities for promotion, vocational expectations, increased use of automation, attitudes toward co-workers, relocation. The peak of vocational success is generally reached by men during the forties and early fifties. This is the peak of status as well as income. However, some middle-aged men are not satisfied by their success and constantly look for better jobs and even better work. The factors influencing vocational adjustment in middle-age include: assessment of vocational achievements such as income, authority, autonomy, training experience, etc. and the job satisfaction. Job satisfaction wanes with the progress of middle- age because the pressure of work appears of middle – age because the pressure of work appears to be more than their declining capacity can tolerate. Middle- aged women appear to be even more frustrated during the middle-age and they welcome compulsory retirement. According to E.B Hurlock, the following conditions contribute to vocational satisfaction in middle – age:Achievement or near achievement of a vocational goal set earlier.Satisfaction on the part of family members, especially the spouse, with the worker’s vocational achievements. Opportunities for self-actualization on the job.Congenial relationship with co- workers. Satisfaction with treatment from management and direct superiors. Satisfaction with the provisions made by management for illness, vocations, disability, retirement, and other fringe benefits.Feelings of security about the job.Not being forced to relocate to hold a job, advance in it, or get a new job.3.5. 3 Adjustment to changed family patternsPeople tend to regard middle adulthood as a time devoted to future generations. However; another test of one’s capacity for generativity comes in the form of commitments to one’s aging parents. One of the significant challenges of middle adulthood is the struggle to respond effectively to one’s parents as well as one’s children and grandchildren. That is why middle adults are sometimes called “the sandwich generation”, tackled in the middle between caring for one’s children and for one’s own parents.According to Cavan, “the most obvious thing is the withdrawal of children of the family, leaving husband and wife as the family unit.” This shrinking circle stage is more difficult for the women than men. This is further complicated by other changes peculiar to family patterns in middle- age such as: physical changes, loss of parental role, lack of preparation, feeling of failure, feelings of uselessness, disenchantment with marriage, care of elderly relatives. The most difficult problem concerns sexual adjustment and adjustment with spouse. This requires a closer relationship between the husband and wife as they had during the early years of marriage. The causes of poor sexual adjustment during the middle- age have been enumerated as follows. One of the major causes of poor sexual adjustment in middle- age is differences in the sex drive at this time. Poor sexual adjustments often result when men became concerned with the loss of their sexual vigor. During the forties and early fifties, many women lose their earlier inhibitions and develop more interest in sex Some middle- aged women who derive little satisfaction from intercourse or who feel that they are no longer interesting to their husband or a necessary part of their marriage may take the initiative in stopping it. The effect of good sexual adjustments may be seen in increasing satisfaction of the male and female. Adjustment to in-laws:- the adjustments to in-laws include adjustment to mother in-law and father – in-law as well as adjustment to children spouses. Adjustment to singlehood. An important problem in family adjustment is concerned with adjustment to singlehood while the problems of single men and single women are peculiar, the most important problems concern widowhood in the middle- age. These include economic, social, familiar, sexual, residential and practical problems. Some of these are solved by remarriage if the widow is comparatively young. This is also the case in singlehood due to divorce by the spouse. However, singlehood due to loss of spouse by death in the middle-age may not be always solved by remarriage.Middle Adults and ParentsMost middle adults characterize the relationship with their parents as affectionate. Indeed, a strong bond is often present between related middle and older adults. Although the majority of middle adults do not live with their parents, contacts are usually frequent and positive. And perhaps for the first time, middle adults are able to see their parents as the fallible human beings that they are.One issue facing middle adults is that of caring for their aging parents. In some cases, adults, who expected to spend their middle-age years traveling and enjoying their own children and grandchildren, instead find themselves taking care of their ailing parents. Some parents are completely independent of their adult children’s support, while others are partially independent of their children; and still others are completely dependent. Children of dependent parents may assist them financially (paying their bills), physically (bringing them into their homes and caring for them), and emotionally (as a source of human contact as the parents’ social circle diminishes).Support groups and counseling resources are available for adults caring for their older parents. These forms of assistance typically provide information, teach caregiver skills, and offer emotional support. In developed countries other programs, such as Social Security and Medicare, are designed to ease the financial burdens of older adults and their caregivers3.5. 3 Vocational and Martial Hazards of Middle age.Almost everyone manages a career while juggling commitments to spouse, children, parents, other household members and friends. A decision to assume more authority, work longer hours, accept an offer with another company, quit a job, accept a transfer to a new location, or start up one’s own business will touch the lives other household and family members.In thinking about balancing work and family life, it is useful to consider three interrelated concepts; role overload, role conflict and role spillover.Role overload occurs as a result of too many demands and expectations to handle in the time allowed. For example, a parent with three children ages 8,11 and 15 may find that the demands of getting the children ready for school, attending functions at three different schools, picking children up and dropping them off at various places, and trying to be emotionally available for the problem of the day are exhausting.Role conflict refers to ways that the demands and expectations of various roles conflict with each other. For example, role conflict occurs when a worker is expected to stay late at the job and finish a project, but that same night is a spouse’s birth day or a child’s performance.Role spillover, occurs when the demands or preoccupations about one role interfere with the ability to carry out another role. For example, a person may be disrupted at work by worries about an ill parent or distracted at home by a work assignment that is due the next day.The combination of role overload, role conflict and role spillover can lead to reduced satisfaction at work and in family roles, and in a decline in the person’s sense of well-being.Being a parent is a difficult, demanding task that requires a great deal of learning. Because children are constantly changing and are often unpredictable, adults must be sensitive and flexible in new situations in order to cope successfully with their demands. Each period of the child’s development calls for new and innovative parenting strategies. Child rearing experiences are different for each child, and the changing family constellation brings new demands for flexibility and learning. With each successive child however, there seems to be lessanxiety about parenting skills.3.3.4 Assessment of Middle Age AdjustmentsThe middle-age adjustments have been assessed by four criteria: achievements, emotional states, effects of their adjustments on their personality and happiness.Achievements: -Unless the assessment of achievements is realistic, one feels dejected about his success. Therefore, success should be judged only in the light of one’s capacity.Emotional states: - Middle-age brings anxiety, insecurity and stress. Middle-aged persons have more worries. They however generally become adjusted by mid-fifties when the person adjusts to his new roles, interests and activities,Effects on personality: Positive and negative effects on personality show the results of adjustment. Lack of adjustment leads to personality disorganization. On the other hand, those who are well adjusted show even more confidence, stability and maturity than was seen in their youth.Happiness: -Happiness is the surest criterion of successful adjustment. It comes when the individual’s need s and desires are satisfied. It shows good adjustment. It may be the result of success in chosen vocation, prestige, financial regards, improved social status,etc. For women it may be the result of success in homemaking. To be happy in middle-age, as a tall age, the person must be realistic and realize that life has its problems as well as its rewards. If the rewards are adequate to compensate for the problems, the scale will be balanced in Cavour of happiness."UNIT FOURLate Adulthood (Old age)Late adulthood is the closing period in the life span. It is a period when people "move away" from previous, more desirable periods-or times of "usefulness." As people move away from the earlier periods of their lives, they often look back on them, usually regretfully, and tend to live in the present, ignoring the future as much as possible.Age sixty is usually considered the dividing line between middle and late adulthood. However, it is recognized that chronological age is a poor criterion to use in marking off the beginning of late adulthood because there are such marked differences among individuals in the age at which aging actually begins. Because of better living conditions and better health care, most men and women today do not show the mental and physical signs of aging until the mid-sixties or even the early seventies. For that reason, there is a gradual trend toward using sixty-five-the age of retirement in many businesses-to mark the beginning of late adulthood.The last stage in the life span is frequently subdivided into early old age, which extends from age sixty to age seventy, and advanced old age, which begins at seventy and extends to the end of life. People during the sixties are usually referred to as "elderly" –meaning somewhat old or advanced beyond middle age-and "old'" after they reach the age of seventy meaning, according to standard dictionaries, advanced far in years of life and having lost the vigor of youth.During this stage most individuals lose their jobs because they retire from active service. They begin to fear about their physical and psychological health. In our society, the elderly are typically perceived as not so active, deteriorating intellectually, narrow-minded and attaching significance to religion. Many of the old people lose their spouses and suffer from emotional insecurity. However, this may not be true of everybody. Many people at the age of sixty or above remain very healthy and active in life. The life style including exercise, diet, and regular health checkup helps people to enjoy meaningful and active life.Aging, however, is also a psychological phenomenon. There are numerous examples of writers, statesmen, professors and yogis who lead a productive and active life during old age. So it is important to note that old age can be a much happier and fuller time. Mental or physical decline does not necessarily have to occur. Persons can remain vigorous, active and dignified until their eighties or even nineties. This is quite possible if they take adequate care of themselves right from their middle age years. In fact, the older persons have vast reservoir of knowledge, experience and wisdom on which the community can draw.Characteristics of old ageLike every other period in the life span, late adulthood is characterized by certain physical and psychological changes. The effects of these changes determine, to a large extent, whether elderly men and women will make good or poor personal and social adjustments. The characteristics of late adulthood, however, are far more likely to lead to poor adjustments than to good and to unhappiness rather than to happiness. That is why late adulthood is even more dreaded than middle age.Late adulthood is a Period of DeclineAs has been stressed repeatedly, people are never static. Instead, they constantly change. During the early part of life the changes are evolutional in that they lead to maturity of structure and functioning. In the latter part of life, by contrast, they are mainly involution, involving a regression to earlier stages. These changes are the natural accompaniment of what is commonly known as "aging." They affect physical as well as mental structures and functioning.The period during late adulthood when physical and mental decline is slow and gradual. The term "senility" is used to refer to the period during late adulthood when a more or less complete physical breakdown takes place and when there is mental disorganization. The individual who becomes eccentric, careless, absentminded, socially withdrawn, and poorly adjusted is usually described as "senile." Senility may come as early as the fifties, or it may never occur because the individual dies before deterioration sets in. Decline comes partly from physical and partly from psychological factors. The physicalcause of decline is a change in the body cells due not to a specific disease but to the aging process. Decline may also have psychological causes. Unfavorable attitudes toward oneself, other people, work, and life in general can lead to senility, just as changes in the brain tissue can. Individual Differences in the Effects of AgingIndividual differences in the effects of aging have been recognized for many centuries. Today, even more than in the past, it is recognized that aging affects different people differently. People age differently because they have different hereditary endowments, different socioeconomic and educational backgrounds, and different patterns of living. These differences are apparent among members of the same sex, but they are even more apparent when men and women are compared because aging takes place at different rates for the two sexes. Physical aging precedes mental aging, though sometimes the reverse is true, especially when the individual is concerned about growing old and let’s go mentally when the first signs of physical aging appear.The Elderly Have a Minority-Group StatusIt is a fact that the number of old people are growing, they occupy a minority-group status-a status that excludes them to some extent from interaction with other groups in the population and which gives them little or no power. This minority-group status is primarily the result of the unfavorable social attitudes toward the aged that have been fostered by the, unfavorable stereotypes of them. This "second-class citizenship" puts the elderly on the defensive and has a marked effect on their personal and social adjustments. It makes the latter years of life far from "golden" for most people, and it causes them to be victimized by some members of the majority group.Aging Requires Role ChangesJust as middle-aged people must learn to play new roles, so must the elderly. Today, where efficiency, strength, speed, and physical attractiveness are highly valued, elderly people are often regarded as useless. Because they cannot compete with young people in the areas where highly valued traits are needed, the social attitude toward them is unfavorable.Furthermore, it is expected that old people will play a decreasingly less active role in social and community affairs, as well as in the business and professional worlds. As a result, there is a marked reduction in the number of roles the elderly person is able to play, and there are changes in some of the remaining roles. While these changes are due in part to the individual's preferences, they are due mainly to social pressures.Poor Adjustment is Characteristic of Late adulthoodBecause of the unfavorable social attitudes toward the elderly that are reflected in the way the social group treats them, it is not surprising that many elderly people develop unfavorable self-concepts. These tend to be expressed in maladjusted behavior of different degrees of severity. Those who have a history of poor adjustments tend to become more maladjusted as age progresses than those whose earlier personal and social adjustments were more favorable.Elderly people tend, as a group, to be more subject to maladjustments than those who are younger. Due to increased loss of status in a society dominated by the young, a desire to protect their finances for their wives, and a desire to escape partial - helplessness or pain.The Desire for Rejuvenation is Widespread in Late adulthoodThe minority-group status accorded to most elderly persons has naturally given rise to a desire to remain young as long as possible and to rejuvenate when the signs of aging appear. Ancient people used elixirs or potions, witchcraft and sorcery were used to achieve youth. Today, medicine is being taken to replace sex hormones. Sex therapy, such as Gerovital, the youth drug is used popularly.Developmental tasks of old ageThe fact that man learns his way through life is made radically clear by consideration of the learning tasks of older people. They still have new experiences ahead of them, and new situations to meet. At age sixty-five when a man often retires from his occupation, his changes are better than even of living another ten years. ?During this time the man or his wife very likely will experience several of the following things: decreased income, moving to a smaller house, loss of spouse by death, a crippling illness or accident, a turn in the business cycle with a consequent change of the cost of living. After any of these events the situation may be so changed that the old person must learn new ways of living.The developmental tasks of later maturity differ in only one fundamental respect from those of other ages. They involve more of a defensive strategy--of holding on the life rather than of seizing more of it. In the physical, mental and economic spheres the limitations become especially evident; the older person must work hard to hold onto what he already has. In the social sphere there is a fair chance of offsetting the narrowing of certain social contacts and interests by the broadening of others. ?In the spiritual sphere there is perhaps no necessary shrinking of the boundaries, and perhaps there is even a widening of them. 1) Adjusting to decreasing physical strength and health2) Adjusting to retirement and reduced income3) adjusting to death of spouse4) Establishing an explicit affiliation with one's age group5) Meeting social and civic obligations6) Establishing ?satisfactory physical living arrangements: The principal values that older people look for in housing, according to studies of this matter, are: (1) quiet, (2) privacy, (3) independence of action, (4) nearness to relatives and friends, (5) residence among own cultural group, (6) cheapness, (7) closeness to transportation lines and communal institutions --libraries, shops, movies, churches, etc. Major Adjustments in Old age Adjustments to Physical ChangesThe most important hazards of old age are undoubtedly physical. Physical disability increases with age. The disabled percentage of population among age 85and over is 10 percent in America. The percentage of impaired is as much as70. This percentage gradually grows with age. The disability starts in middle-age and proceeds fast after 60.It has been found that the body organs of most persons show a 0.8 to 1 percent decline per year in the functional ability after the age of 30 years. Part of this decline is normal, some are disease-related and some caused by factors such as stress, occupational status, nutritional status and many other environmental factors. The major physical changes associated with aging are described as external changes, internal changes and changes in the sensory capacities and cognitive abilities. Let us understand these changes.1) External Changes: This refers to the symptoms of growing old that can be seen in an individual. With many individuals the symptoms of aging can be seen as graying hair, aging skin shift in posture and appearance of wrinkles and other changes.Key to Longer and Healthier Life(a) Eat healthy diet.(b) Exercise regularly.(c) Reduce stress level.(d) Don’t smoke or drink alcohol and other drugs.(e) Cultivate certain positive qualities.(f) Engage with activities of social welfare.(g) Develop spirituality and faith.2) Internal Changes: These changes refer to the symptoms of growing old that are not visible. These include changes in the respiratory system, gastrointestinal system, cardiovascular system, and central nervous system.3) Changes in Sensory Capacities: With advancing age, there is gradual slowdown in the sensory abilities. As you know we communicate with the outer world through our senses. Losing in any of the senses can have profound psychological and social consequences.Cognitive Functioning in Older AdultsCognition refers to the process by which information is acquired, stored, and used. During adulthood and aging various aspects of cognition like memory, learning, attention and speed of performance get adversely affected. The aged people often report forgetfulness, difficulty in learning new techniques and acquiring skills. Their concentration and responsiveness to environmental stimulus decreases. Dementia and Alzimerare important diseases of old age. In general people become more vulnerable during old age.Several aspects of cognitive functioning including reaction time, visual-motor, and memory show evidence of decline with age. Changes in memory are typical signs of aging. The ability to retrieve newly encountered information seems to drop off. After several hours, days, or weeks, younger adults can remember word pairs or paragraphs or recognize pictures, better than older people can.Encoding problems-in general older adults seem to be less efficient than younger ones at encoding new information to make it easier to remember. For example, older people are less likely to spontaneously arrange material in alphabetical order or create mental associations. Older adults can improve their encoding skills through training or instruction.Storage problems-one plausible explanation for forgetting is that stored material may deteriorate to the point where retrieval becomes difficult or impossible.Retrieval problems-in retrieving learned information from memory, older adults may be able to answer a multiple-choice question but not an open-ended one. While they have more trouble recalling items than younger adults, they do about as well in recognizing items they know. Even then, it takes older people longer than younger ones to search their memoriesPost formal operational thinking-in many areas, older adults perform less well than middle or young adults. They have been described as performing classification and problem solving tasks in a more egocentric, idiosyncratic way than younger adults. Older adults have a particular view that may not make sense to others but that they insist applying since it has worked for them in the past.4.4 Changes in Mental Abilities and InterestMental changes characteristic of old age are found with individual variations. These changes show a general decline of the various mental processes such as learning, reasoning, creativity, memory, recall, reminiscing, sense of humor, vocabulary. Mental rigidity is a sign of old age though it is not universal. Some old people exhibit admirable flexibility and the will to learn new ways. Along with changes in mental processes, there are changes in personal interests such as interest in self, interest appearance, interest in clothes and interest in money. Most of the old people become self- centered. Most of them become more interested in money though there may be some exceptions. Recreational interests also change due to these physical and mental changes. Common recreational activities of older people include reading, writing letters, listening to the radio, watching television, visiting friends and relatives, sewing, embroidering, gardening, travelling, playing cards, going to the theatre or movies, and taking part in the activities of civic, political or religious organizations. These changes in interests are very much influenced by the health, economic status, education, marital status, living condition and interest in sex. Social interests also show a change leading to disengagements, voluntary and involuntary. The sources of social contact affected by ageing include personal friendships, friendship clichés and formal groups of clubs. Generally, social participation declines. However, among elderly people, religious interests definitely show a sign of increase. Some common effects of religious changes during old age are religious tolerance, religious beliefs and religious observances. One notices more interest in death, about its reality, its future date, reason, etc. One finds old people worrying whether they will have a good death or not.Theories of Socio Emotional DevelopmentErikson’s Ego Integrity versus Despair Erik Erikson, who took a special interest in this final stage of life, concluded that the primary psychosocial task of late adulthood (65 and beyond) is to maintain ego integrity (holding on to one’s sense of wholeness), while avoiding despair (fearing there is too little time to begin a new life course). Those who succeed at this final task also develop wisdom, which includes accepting without major regrets the life that one has lived, as well as the inescapability of death. However, even older adults who achieve a high degree of integrity may feel some despair at this stage as they contemplate their past. No one makes it through life without wondering if another path may have been happier and more productive.Disengagement TheoryDisengagement theory views aging as a process of mutual withdrawal in which older adults voluntarily slow down by retiring, as expected by society. Proponents of disengagement theory hold that mutual social withdrawal benefits both individuals and society.Activity TheoryActivity theory, on the other hand, sees a positive correlation between keeping active and aging well. The more active older adults are, the more likely they are to be satisfied with their lives. Greater activity, especially social and productive activity, was related to happiness, better functioning and a lower mortality rate. Socio-emotional Selectivity Theory This theory states that older adults become more selective about their social networks, because they place a high value on emotional satisfaction; older adults often spend more time with familiar individuals with whom they have had rewarding relationships. This theory challenges that adults are in emotional despair because of their social isolation, but rather they choose to only spend time with close families/friends.Older adults become more selective in their social networks They spend more time with people with whom they have enjoyable relationships Studies have found that older adults have smaller social networks than do young adults Late adults are more likely to pursue emotion-related goals, perhaps because they realize that they have less time left to live. They therefore, pursue, emotional satisfaction through relationships Compared with young adults, older adults have a more even emotional life with fewer highs and lowsVocational and Family AdjustmentsVocational adjustmentsRetirement is a major transition of late adulthood. The retired person must eventually accept a more leisurely life, whether desired or not. He or she must also continue to live in a worker’s world, in which retirees are viewed as spent or devalued. Indeed, the psychological impact of retirement on older adults can be significant. Many must contend with feelings of depression, uselessness, and low self-esteem.People who are in good health, are better educated, have few or no financial worries, have adequate family and social networks, and are satisfied with life usually look forward to retirement. Retirees may choose to spend their free time volunteering for charities, traveling, taking classes, or engaging in hobbies. The least satisfied retirees are those who never planned for retirement have limited income, have few or no extracurricular activities, and who stay home day after day with nothing substantial to occupy their time.Retirement may be voluntary or compulsory, regular or early. For most workers, forced retirement is a source of much dejection and loss of face. E.B. Hurlock has mentioned the following conditions affecting adjustment to retirement:1. Workers who retire voluntarily adjust better than those who are forced to retire, especially if they want to continue to work.2. Poor health at the time of retirement facilitates adjustment while good health is likely to militate against it.3. Most workers find that tapering off is better than abruptly ending patterns of work and living established many years earlier.4. Pre-retirement counseling and planning age adjustment.5. Workers who develop interests in substitute activities that are meaningful to them and which provide many to the satisfactions they formerly derived from work will not find adjustment to retirement as emotionally disturbing as those who fail to develop substitute interests.6. Social contacts like those provided in many homes for the aged, aid in adjusting to retirement remaining in their own homes or in the homes of relatives usually cuts retired people of from social contacts.7. The less change in the pattern of living retirement necessitates, the better the adjustment will be.8. A good economic status which makes it possible to live comfortably and enjoy meaningful recreations, is essential to good adjustment to retirement 9. A happy marital status aids adjustment to retirement while a frictional one militates against it10. The more the workers like their work, the poorer their adjustment to retirement. There is an inverse relationship between work satisfaction and retirement satisfaction.11. Place of residence affects adjustment to retirement. The more the community offers for companionship and activities for the elderly, the better they will adjust to retirement.12. The attitudes of family members towards retirement have a profound effect on worker’s attitudes. This is especially true of the attitudes of spouses.Adjustments to changes in family lifeAdjustments to changes in family life:-Adjustments to changes in family life in old age include relationships with spouse, changes in sexual behavior, relationships with children, parental dependency and relationships with grandchildren. Among the common factors affecting sexual behavior in old age, the following are the most important, according to E.B. Hurlock:1. Pattern of earlier sexual behavior: - people who derived enjoyment from sexual behavior and were sexually active during the earlier years of their marriage continue to be sexually more active in old age than those who were less active. 2. Compatibility of spouses: - when there is a close bond between husband and wife built on mutual interests and respect.UNIT SIXDeath and DyingAt the end of the human life span, people face the issues of dying and death (the permanent cessation of all life functions). North American society in recent years has witnessed an increased interest in the thanatology, or the study of death and dying. Thanatologists examine all aspects of death, including biological (the cessation of physiological processes), psychological (cognitive, emotional, and behavioral responses), and social (historical, cultural, and legal issues).Although most young adults have gained a more realistic view of death through the death of some family members or friends, anxiety about death may be more likely to peak in middle adulthood. As people continue aging, they gradually learn to accept the eventual deaths of loved ones, as well as their own deaths. By later adulthood, most people come to accept perhaps with some tranquility if they feel they have lived meaningfully the inevitability of their own demise, which prompts them to live day by day and make the most of whatever time remains. If they do not feel they have lived meaningfully, older adults may react to impending death with feelings of bitterness or even passivity.The concept of searching for meaning in life through death is one of the foundations of existential psychology. Existential psychologists like Rollo May believe that individuals must accept the inevitability of their own deaths and the deaths of loved ones; otherwise, they cannot fully embrace or find true meaning in life. This theory tracks with research that indicates that the more purpose and meaning that individuals see in their lives, the less they fear death. In contrast, the denial of death leads to existential anxiety, which can be a source of emotional troubles in daily life.The terms "death" and "dying" are not synonymous and have no unequivocal definitions. Death may be considered the absolute cessation of vital functions, while dying is the process of losing these functions. Dying may also be seen as a developmental concomitant of living, a part of the birth-to-death continuum.Death is defined as the cessation of all vital functions of the body including the heartbeat, brain activity (including the brain stem), and breathing. It can arrive unannounced at any time and is not the special province of the very aged.From biological point of view, death is the permanent cessation of all vital functions. From broader psychological, societal and cultural perspectives, death is much more than the end stage of a biological process. Concepts of death are highly subjective, are exceedingly complex, and change over time. Furthermore the meanings of death are highly colored by the attitudes of the individuals who hold them as well as the situational context in which these individuals find themselves. Death can occur at any point in the human life span. Death can occur during prenatal development through miscarriages or stillborn births. Death can also occur during the birth process or in the first few days after birth, which usually happens because of a birth defect or because infants have not developed adequately to sustain life outside the uterus. In childhood, death occurs most often because of accidents or illness. Accidental death in childhood can be the consequence of such things as an automobile accident, drowning, poisoning, fire, or a fall from a high place. Major illnesses that cause death in children are heart disease, cancer, and birth pared with childhood, death in adolescence is more likely to occur because of motor vehicle accidents, suicide, and homicide. Many motor vehicle accidents that cause death in adolescence are alcohol-related. Older adults are more likely to die from chronic diseases, such as heart disease and cancer, whereas younger adults are more likely to die from accidents. Older adults’ diseases often incapacitate before they kill, which produces a course of dying that slowly leads to death. Of course, many young and middle-aged adults also die of heart disease, cancer, and other diseases5.1 Issues in determining death Death is the result of the combined influences of multiple biological and social health determinants, public health efforts, and medical care. In fact, both?environment and genetic are important for our health. Genetic factors are known to play a role in nine of the Ten Leading Causes of Death in the United States, most notably chronic diseases such as cancer and heart disease. Most human disease results from the interaction of our genetic susceptibility with environmental and behavioral risk factors, such as diet, physical activity, infectious agents and the physical environment. Genes and non- communicable diseasesMost diseases involve many genes in complex interactions, in addition to environmental influences. An individual may not be born with a disease but may be at high risk of acquiring it. This is called as genetic predisposition or susceptibility. The genetic susceptibility to a particular disease due to the presence of one or more gene mutations, and/or a combination of alleles need not necessarily be abnormal.WHO's department of Non-communicable Diseases and Mental Health (NMH) has done extensive work on major non-communicable diseases, like cancer, diabetes, cardiovascular disease, asthma, and some mental illnesses. In some cases, such as cancer, individuals are born with genes that are altered by lifestyle habits or exposure to chemicals. Cancer, for example, may involve tumor-suppressor genes, genes which suppress tumor formation, which lose their function, thus giving rise to carcinomas. Cardiovascular disease tends to manifest itself in specific ways unique to various communities. For example, African communities tend to have strokes as a result of cardiovascular disease, while south Asians tend to have heart attacks.Understanding genetic predisposition to disease and knowledge of lifestyle modifications that either exacerbate the condition or that lessen the potential for diseases (i.e., no smoking or drinking) is necessary for the public to make informed choices. This section on genetic predisposition to disease aims to provide descriptions of major diseases that have a genetic predisposition. It also contains resources for further information from the World Health Organization and other sources.5.2 Death in different culturesThe way we grieve, commemorate, and dispose of our dead varies greatly from culture to culture. How and when rituals are practiced vary depending on the country of origin and level of acculturation into the mainstream society. The duration, frequency, and intensity of the grief process may also vary based on the manner of death and the individual family and cultural beliefs.In the world, there are some incredible death rituals. As a psychology student, for your understanding read the following death rituals: EndocannibalismFor some cultures, the best way to honor the dead is by eating them. Referred to as "endocannibalism" by stuffy anthropologists, these "feasts of the dead" are a way to forge a permanent connection between the living and the recently deceased. It's also a cathartic way to express the loathing and fear associated with death and its tragic aftermath. Some anthropologists have suggested that endocannibalism is something the dead would have expected from the living — a final gesture of goodwill to the tribe and family. Though no longer practiced (at least not that we know of), cultures who engaged in endocannibalism included the Melanesians of Papua New Guinea and the Wari people of Brazil.Tibetan Buddhist Celestial BurialsBut why nourish yourself with the flesh of the recently deceased when you can use it to feed wild animals? Such is the thinking of Tibetan Buddhists practice ritual dissection, or "Sky Burials" — the tradition of chopping up the dead into small pieces and giving the remains to animals, particularly birds. Sometimes the body is left intact — which is not a problem for advantageous vultures. While this may seem undignified and even a bit disgusting, the ritual makes complete sense from a Buddhist perspective. Buddhists have no desire to preserve or commemorate a dead body, something that is seen as an empty vessel. Moreover, in tune with their respect for all life, Buddhists see it as only fitting that one's final act (even if committed in proxy) is to have their remains used to sustain the life of another living creature; and in fact, the ritual is seen as a gesture of compassion and charity. Today, over 80% of Tibetan Buddhists choose sky burial, a ritual that has been observed for thousands of years.SatiThough now (mercifully) banned in India, Sati was a funerary practice in which recently widowed women immolated themselves on their husband's funeral pyre. The custom was seen as a voluntary act, but there were many instances in which women were forced to commit Sati — sometimes even dragged against their will to the fire. No one is certain how the ritual got started, but one suggestion is that it was introduced to prevent wives from killing their wealthy husbands (typically with poison) and marry their real lovers. Another possibility is that it was seen as a way for a husband and wife to enter into the afterlife together so that they could thwart opportunistic female angels. Interestingly, India was not the first and only culture to adopt the tradition. Other ancient societies that practiced something similar to Sati included the Egyptians, Greeks, Goths, and Scythians.When we see death in different cultures, the most important thing is religion. Our perceptions and understanding about death is strongly influenced by our religion. Grieving and death rituals vary across cultures and are often heavily influenced by religion. Let us see the beliefs, funeral and burial practices of death among the dominant world religions:- ChristianBeliefs:-Christians trust they will go to heaven to be with God once they have died and so in some respects a funeral is a time of joy, although also sadness, as the person will be missed by friends and loved ones.?Preparing: - The church minister may come and visit the person and their family to discuss any concerns and to help the person to prepare for their death. Depending on the form of Christianity (i.e. Anglican, Presbyterian etc.) and the particular church, there may be slightly different customs that will be followed.?At The Time: - The church minister will offer any comfort or assistance the family needs to help them cope with the death and to organize the funeral. Friends will often send their sympathies in the form of cards and/or flowers to the deceased’s family.?Funeral: - A Christian may be either buried or cremated, depending on their preference. The ceremony will typically be held at the deceased person’s church and conducted by the minister, but it could also be held at a funeral home. The ceremony may involve hymns, readings and prayer by both the minister and the deceased’s family and friends. The casket may be present in the room during the ceremony and carried out at the end by pallbearers – usually members of the deceased’s immediate family. There is often the opportunity for people to view the deceased and to say their last goodbyes before the deceased is buried.?Burial: - If the deceased has been cremated the ashes may be scattered. Otherwise, the ashes or body will be buried in a cemetery and marked with a gravestone to remember the deceased.?After: - On special occasions such as the deceased’s birthday, Christmas or anniversary of the death, family and friends may come and visit the grave. Often, flowers or other objects to remember the deceased will be placed on the grave as a sign of respect.JewishBeliefs: - Beliefs may vary depending on whether the Jewish person is Orthodox, Reform or Conservative. Jews believe that when they die they will go to Heaven to be with God. This next world is called OlamHaEmet or ‘the world of truth’. Death is seen as a part of life and a part of God’s plan.Preparing: - Family and friends will gather. A rabbi may be called to offer comfort and to pray for the person who is dying.?At The Time: - The person’s eyes are closed, the body is covered and laid on the floor and candles are lit. The body is never left alone. Eating and drinking are not allowed near the body as a sign of respect. In Jewish law, being around a dead body causes uncleanliness so often the washing of the body and preparations for burial will be carried out by a special group of volunteers from the Jewish community. This is considered a holy act.?Funeral: - Jews may not be cremated or embalmed. In Israel a coffin might not always be used but outside of Israel a coffin is almost always used. The body is wrapped in a white shroud. Mourners have the opportunity to express anguish. Tears are seen as a sign of sadness and show that the mourner is confronting death. Mourners also tear their clothing as an expression of grief.?Burial: - The burial takes place as soon as possible following the death. Pallbearers will carry the casket to the grave. A family member will throw a handful of earth in the casket with the body. This is to put the body in close contact with the earth. Jewish law says each grave must have a tombstone to remember the deceased.?After:- A candle is lit after returning from the cemetery to mark seven days of mourning called Shivah. This is when people can offer sympathies to the mourners. A meal is prepared by friends to help the mourners regain their strength. Each year the anniversary of the death is commemorated according to the Hebrew calendar. This day is observed as a solemn day of remembrance.HinduBeliefs: - Hindus believe in reincarnation. When a person dies their soul merely moves from one body to the next on its path to reach Nirvana (Heaven). So, while it is a sad time when someone dies, it is also a time of celebration.?Preparing: - Family and a priest may come to pray with the dying person, sing holy songs and read holy texts. The priest may perform last rites.?At The Time: - Family will pray around the body soon after death. People try to avoid touching the body as it is considered unclean.Funeral: - The deceased will be bathed and dressed in white traditional Indian clothing. If a woman dies before her husband she will be dressed in red. The procession might pass by places that were important to the deceased. Prayers are said at the entrance to the crematorium. The body is decorated with sandalwood and flowers. Someone will read from the scriptures. The head mourner is usually a male or the eldest son and he will pray for the body’s soul.?Burial: - Hindus are cremated as they believe burning the body releases the spirit. The flames represent Brahma (the creator).?After: - A priest will purify the family’s home with spices and incense. A mourning period begins during which friends and relatives can visit the family and offer their sympathies. After the funeral mourners must wash and change their clothing before entering the house.One year later Shradh occurs. This is either a one-off event or may become an annual event. Shradh is when food is given to the poor in memory of the deceased. Shradh lasts one month and a priest will say prayers for the deceased; during this time the family will not buy any new clothes or go to any parties.MuslimBeliefs: -There are two types of Muslims – Shiite and Sunni, so beliefs and customs may be slightly different for each. Muslims believe that the soul continues to exist after death. During life a person can shape their soul for better or worse depending on how they live their life. Muslims believe there will be a day of judgment by Allah (God). Until then, the deceased remain in their graves but on judgment day they will either go to Heaven or Hell. Muslims accept death as God’s will.?Preparing: -Muslims should be prepared for death at any time, which is partly why daily prayers are so important. A dying person may wish to die facing Mecca, the Muslim holy city. Family members and elders recite the Muslim scripture called the Koran and pray for the person.At The Time: -The eyes of the deceased will be closed and the body is laid out with their arms across their chest and head facing Mecca. The body will be washed by family or friends. It will be wrapped in a white shroud and prayers will be said.?Funeral: - The body will be buried within 24 hours as Muslims believe the soul leaves the body at the moment of death. The funeral will take place either at the graveside and involve prayer and readings from the Koran.Burial: -No women are allowed to go into the graveyard. Before burial a prayer will be recited. Mourners are forbidden from excessive demonstrations of grief. The body will not be cremated as this is not permitted in Islam. The deceased will be buried with their face turned to the right facing Mecca. A coffin is usually not used but a chamber dug into the grave and sealed with wooden boards so no earth touches the body. The grave will usually be simple without any fancy decoration.?After: - Three days of mourning follows where visitors are received and a special meal to remember the departed may be held. Mourners avoid decorative jewellery and clothing. Male family members go to visit the grave daily or weekly for 40 days. There will also be prayer gatherings at the home for 40 days. After one year there will be a large prayer gathering of family and friends. After that, male family and friends visit the grave and everyone remembers the deceased in prayers.5.3 Attitudes towards death at different points in the life spanThe ages of children and adults influence the way they experience and think about death. A mature, adult like conception of death includes an understanding that death is final and irreversible, that death represents the end of life, and that all living things die. Most researchers have found that as children grow, they develop a more mature approach to death (Hayslip& Hansson, 2003).Childhood: - infant has no concept of death; perceptions of death develop in middle/late childhood even very young children concerned about separations and loss. Nagy (1948) reported three stages of development of death related cognitions in children. Stage one present until age five, lacks appreciation of death as final and complete cessation. Separation is the theme most clearly comprehended by the youngest children. Stage two children think of death as final but not inevitable. A strong tendency to personify is noted in this stage. Stage three beginning at age nine or ten is marked by comprehension of death as both final and inevitable. The prospect of personal mortality seems to be accepted. Anecdotal reports suggest that the child’s discovery of death begins much earlier than the most cognitive theorists seem prepared to accept.The affective and cognitive development of children colors their understanding of death and their subsequent fears about dying. At the preschool, preoperational stage of cognitive development, death is seen as a temporary absence, incomplete and reversible, like departure or sleep. Separation from the primary caretakers is the main fear of a preschooler. This fear surfaces as an increase in nightmares, more aggressive play, or concern about the deaths of others rather than in direct discourse. Regression to more infantile behaviors signals increasing dependence on parents. Dying preschoolers need reassurance from their parents that they are loved, that they have done nothing wrong, that they are not responsible for their illness, and that they will not be abandoned.School-aged children manifest concrete-operational thinking and recognize death as a final reality. However, they view death as something that happens to old people, not to them. Between the ages of 6 and 12 years children have active fantasy lives of violence and aggression, often dominated by themes of death and killing. Death may be personified as a skeleton or bogeyman that takes people away. Dying school-aged children ask questions about their illness if encouraged to do so; however, if they receive cues that the subject is taboo, they may withdraw and participate less fully in their own care. Many of us hesitate to talk about death, particularly with youngsters. But death is an inescapable fact of life which we must deal with, and so must our children. By talking to them about death, we may discover what they know and do not know; if they have misconceptions, fears, or worries. We can then help them by providing information, comfort, and understanding.Adolescents develop more abstract concepts of death. Capable of formal cognitive operations, adolescents understand that death is inevitable and final. Their major fears parallel those of all teenagers: loss of control, being imperfect, and being different. Concerns about body image, hair loss, or loss of bodily control may generate great resistance to continuing treatment.Adulthood: - middle-aged adults fear death more than young adults or older adults: older adults think about death more. Unlike children and teenagers, older adults often readily accept that their time has come. Although they may not be happy to die, they can be reconciled to it.According to Erikson, the eighth and final stage in the life cycle brings either a sense of integrity or despair. As elderly adults enter the last phase of their lives, they reflect on their time and how it has been lived. Integrity of the self allows an individual to accept inevitable disease and death without fear of succumbing helplessly. However, if a person looks back on life as a series of missed opportunities or as filled with personal misfortunes, the sense is of bitter despair, a preoccupation with what might have been if only this or that had happened; then death is viewed with fear because it symbolizes emptiness and failure (Zisook, & Downs, 2000).5.4 Causes of death and Expectations About DeathIn the United States, the 5 leading causes of death are heart disease, cancer, chronic lower respiratory diseases, cerebrovascular diseases (stroke), and unintentional injuries. Death is the result of the combined influences of multiple biological and social health determinants, public health efforts, and medical care. In fact, both?environment and genetic are important for our health. Genetic factors are known to play a role in nine of the Ten Leading Causes of Death in the United States, most notably chronic diseases such as cancer and heart disease. Most human disease results from the interaction of our genetic susceptibility with environmental and behavioral risk factors, such as diet, physical activity, infectious agents and the physical environment. Risk factors to healthHealth and wellbeing are affected by many factors, and those that are associated with ill health, disability, disease or death are known as risk factors. Risk factors are presented here individually, however in practice they do not operate in isolation. They often coexist and interact with one another.Behavioral risk factors: - Risk factors that can be eliminated or reduced through lifestyle or behavioral changes include:?tobacco smoking?excessive alcohol consumption?poor diet and nutrition?physical inactivity?excessive sun exposureinsufficient vaccinationUnprotected sexual activity.Biomedical risk factors: - Biomedical risk factors may be influenced by a combination of genetic, lifestyle and other broad factors. Biomedical risk factors include:?overweight and obesity?high blood pressure?high blood cholesterol??impaired glucose toleranceEnvironmental risk factors: - Environmental determinants of health cover a wide array of topics, and it includes Social, economic, cultural and political factorsGenetic risk factors: - Some diseases, such as cystic fibrosis and muscular dystrophy, result entirely from an individual's genetic make-up whereas many others reflect the interaction between that make-up and environmental factors. There are three broad groups of genetic diseases / disorders:single gene (monogenic) disorders, for example hemophilia;chromosomal abnormalities, for example Down syndrome; andMulti factorial diseases, such as asthma.Demographic risk factors: - Demographic factors include age, sex, and population subgroups. Examples of risk associated with demographic factors include:Stroke death rates increase dramatically with age, with 81% of all deaths from stroke occurring among those aged 75 and over.A woman's risk of developing breast cancer before age 75 is 1 in 11, whereas for men the chance is only 1 in 1,426.Aboriginal and Torres Strait Islander people are far more likely to die from rheumatic fever and rheumatic heart disease than other Australians.5.5 Kubler Ross’s stages of DyingThe process people go through when facing imminent death has been described in various ways by different investigators. Perhaps the best known investigator of the process of dying is Elisabeth Kubler –Ross, a Swiss born psychiatrist, who began a systematic study of death and dying at the University of Chicago. After interviewing more than 200 dying patients in the teaching hospital, she identified five stages(not necessarily sequential) in the dying process. These are; (1) denial and isolation,(2) anger,(3)bargaining ,(4)depression, (5)acceptance.Denial and isolation-is the most common response in the initial stage of the process. It is characterized by feelings of shock, disbelief and numbness. In the short run, denial serves as a healthy defense, for dealing with painful, difficult situation. As a buffer, denial provides a brief respite tom people, allowing them opportunity to confront the reality of dying and to mobilize other less radical defenses.Anger-this provides people with the chance to vent their rage and resentment about dying. It is not uncommon for anger to be displaced on loved ones and caregivers, both formal and informal. The displacement typically is not personal, but it is a cry of anguish, perhaps at the untimeliness of death, over enviousness of those who experience good health, or about all that will be left uncompleted and unfulfilled.Bargaining-is an attempt to delay or postpone death’s inevitability. Terminally ill people may believe they can bargain for an extension of life because rewards often follow good behavior (for example, “I will quit smoking, drinking, and lose weight if I can live to see my granddaughter marry).”Depression-it is characterized by a great sense of loss and consists of two types: reactive depression focuses on past losses and may be accompanied by guilt or shame. In contrast, preparatory depression takes into account all the impending losses to come: loss of self, loss of relationship, and all that one has ever known and loved.Acceptance of mortality-this is not a resignation but a state in which people have an opportunity to consider the end of life with some dignity. If enough time is available, to confront death, this stage allows the working through of prior emotional reactions. People during this stage may be weak, withdrawn, and uncommunicative with others.In the acceptance stage, the person accepts the inevitability of death and often seems detached from the world and at peace. “It is as if the pain is gone, the struggle is over, and there comes a time for the ‘final rest before the journey’ as one patient phrased it”.Kubler-Ross pointed out that although the above five stages are typical, they are not absolute. Not all people progress predictably through all the stages, nor do people experience the stages in one particular order. Additionally, these stages do not necessarily represent the healthiest pattern for all individuals under all circumstances. Kubler- Ross and others also have noted that people whose loved ones are dying may progress through the same five stages as the dying person.5.6 Communicating with a Dying PersonInterpersonal communication regarding death, dying, and bereavement has become an increasingly important area in the field of thanatology, wherein research has addressed the critical role of open family communication in facilitating the positive processing of a death loss. In the 1990s, attention started to be given to communicative issues with reference to dying individuals, especially with regard to the need for improved communication between dying persons and their families, their physicians, and their nurses. For many people, the thought of dying evokes as much or more fear and apprehension as does the thought of death itself. Consequently, discussing the dying process, as well as thinking about how one's last days, weeks, and months might be spent, can be very beneficial. Otherwise, the process of dying becomes a forbidden topicA study in the US shows that most Americans view death as "awful," and that dying persons are often avoided and stigmatized because of their condition. In 1987, a group of researchers found that 61 percent of healthy individuals stated that they would avoid cancer patients, and 52 percent of dying persons believed that others generally avoided them. Besides, another study on 9,000 patients with life-threatening illnesses in five teaching hospitals over a two-year period, reflects the difficulties patients have in communicating with their physicians at the end of life, where such persons' wishes regarding end-of-life care were largely ignored. Indeed, efforts to improve communication by educating physicians were not successful. Why People Have Difficulty Communicating with Dying Persons Researchers have suggested several reasons for the difficulty many individuals have in communicating with dying persons: not wanting to face the reality of one's own death, not having the time to become involved, and not feeling emotionally able to handle the intensity of the situation. For some people, the grief that they experience in anticipation of a loved one's death may help to explain their difficulty in interacting with terminally ill individuals. Uneasiness in being with the dying can manifest itself via outright avoidance, or in difficulty in speaking or maintaining eye contact with such persons. It can also be expressed in maintaining a physical distance, uneasiness about touching the dying person, or an inability or unwillingness to listen. This may result in over concern, hyperactivity, or manipulative, impersonal behavior (e.g., "Aren't we looking good today!"), or changing the subject. Significantly, this uneasiness is likely to be perceived by those who are already sensitive to being rejected because they are dying. Characteristics of dying individuals also may affect one's apprehension about communicating with such persons. Because pain frequently accompanies terminal illness, its presence often affects simple communication. Such pain often preoccupies dying individuals' thoughts and may contribute to, along with intense emotional conflict and the effects of medication, an increase in contradictory messages between the individual and others. In addition, those dying violate several of the social standards in place: They are often nonproductive, unattractive, not in control of themselves and of their life situation, and provoke anxiety in others. Not all dying people are alike. Thus, some may evoke more avoidance than others, depending upon whether their death is expected or not, what they are dying of, where they die, and whether their deaths are seen as "on-time" (i.e., the death of an older person), or "off-time" (i.e., the death of a child, adolescent, or young adult). Additionally, some dying individuals are more able to deal with everyday demands than are others, and some prefer to talk or remain silent on matters related to death. Some individuals have more support from friends and families than do others, and some are more tolerant of pain. Some are more willing to communicate their awareness of dying than other dying individuals, and others are more able to discuss what it is they need in order to die peacefully. For those dying and their families, the prospect of their own or a loved one's imminent death can be a terrifying experience. Indeed, dying produces anxiety, leading to both dependence upon other people and defensiveness based upon fears of rejection. Consequently, being able to communicate honestly about the quality or length of one's life, the disease process, and one's feelings about loved family members or friends is of utmost importance. This communication (both verbal and nonverbal) is two-way—each individual is both giving and searching for cues about each person's acceptability to the other. Because preconceptions as "dying person," "hospice patient," or "caregiver" (professional or otherwise) govern or limit what aspects a person reveals about him- or herself, being open, genuine, empathic, and understanding allows this two-way dynamic to evolve beyond these "labels." Communicative Difficulties among Health Care Professionals It could be argued that those persons whose attitudes and actions most influence the quality of end-of-life care are physicians, principally because they have primary control of the information that drives medical decision making. Furthermore, both patients and physicians agree that physicians have the responsibility to initiate discussions regarding advance directives and the use of life-sustaining medical intervention. Many have noted the difficulty physicians experience in communicating with the dying and their families. For example, a recent study suggested that physicians may fear emotional involvement, feel a loss of what to say, or lack knowledge about what the patient has been told. Often physicians may feel that terminal patients are medical "failures," are preoccupied with medical equipment and technical skills, fear the patient's anger, or fear that the patient will die. The benefits of open communication are clear. Relationships that allow for communication about death often precede healthy adjustment. Researchers have found that the emotional impact of being labeled as "dying" is directly related to quality and openness of the communication between the dying individual and others, wherein if open communication is not achieved caregivers operate on preconceptions rather than the dying individual's actual thoughts and feelings. Dying is a distinctly interpersonal event involving a helping person and the dying patient; this "other" person may be a friend, neighbor, hospice volunteer, counselor, one's husband, wife, or one's child. Consequently, ordinary conversations with dying persons may be very "therapeutic" and, in fact, reflect many elements that are typical of formal psychotherapy, including active listening. Active listening assumes the individuality of each dying person's needs, and stresses what is communicated both verbally and nonverbally. One's presence as well as questions that are asked say, "I am trying to understand how you feel." Reassurance and providing nonjudgmental support are critical. Moreover, using the dying person's name throughout the conversation, making eye contact, holding the person's hand, placing one's hand on a shoulder or arm, smiling, gesturing, and leaning forward all communicate genuine interest and caring in what the person is saying (or not saying) and feeling. Asking specific questions such as, "Can you help me understand?" as well as open-ended questions such as, "What is it that you need to do now?" are very important, as is being comfortable with silence. Effective communication with dying people reflects comfort with one's own discomfort, to "do nothing more than sit quietly together in silence". Indeed, communicating involves as much listening as it does talking and doing. Building good communication and listening skills, touching and maintaining eye contact, and projecting a genuine sense of empathy all give the message, "I am here to help and support you. I care about how you are feeling." In short, effective, empathic, and timely communication is embodied in the statement, "Be a friend." 5.7 Dealing with Death and Dying A variety of options are available for individuals seeking to cope with dying and death. Grief therapy counseling, and support groups can help individuals deal with their grief and bereavement. Hospice, which can occur at home or in a hospital or other institution, can provide care for dying persons and their families. Hospices are designed for terminally ill patients to live out their remaining days as independently, fully, and affordably as possible. Death education can also help by providing people with information on dying, legal issues, and various practical matters. Classes on death and dying are available at colleges, hospitals, and community centers. Many people take comfort in bibliotherapy, or reading books about dying, perhaps explaining the popularity of the life-after-life books. These testimonials detail the alleged journeys of people who were clinically dead into the afterlife before they were resuscitated. ................
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