Late Adult Stage of Life

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The following interview was conducted over several sessions with “Jean” who is in the late adult stage of life. Jean resides at an assisted care facility in Sherman Oaks, California. She is a widow, her husband of over 50 years having passed away some six years ago. She had an elder brother who also is deceased. She has three adult children and six grandchildren, four of whom are adults. She is 83 years old and is in Erikson’s eighth and final stage of psychosocial development.

Erikson characterized the psychosocial crisis of this state as “integrity” versus “despair.” The related element in society is “wisdom.” “Integrity” for Erikson has two meanings. The first is “consistency” of actions, values, methods, measures, principles, expectations and outcomes. In this sense it describes or evaluates a person’s ability to achieve her/his goals. The second is a subjective quality of being honest and truthful as motivations for one’s actions. The antonym of this sense is “hypocrisy.” “Despair” is an existential condition characterized by the absence of hope. It acknowledges the contingent nature of one’s existence and the fallibility of human institutions, which are unable to articulate or give it intelligible meaning. One nonetheless must navigate the passage of one’s life and make choices even in an environment of uncertainty. One must rely on factors like one’s personal authenticity and wisdom in order for it to make sense.

Broderick & Blewett suggest several other factors that are pertinent to the assessment of psycho-social development in late adulthood. Two common and debilitating declines are increasing sensory deficits and osteoarthritis. Persons at this stage of life are subject to gradual decrements in fluid intelligence (processing speed slows and inhibitory functions decline). In extreme cases this actually may result in dementia. Dementia also may be caused by stroke or Alzheimer’s disease.

Another declining cognitive function is autobiographical memory, or one’s remembered self. Exacerbating the loss of autobiographical memory is the “shrinking social convoy,” which is the dying or disability of friends and family members who otherwise would be able to provide cues and support. Experiencing loss (facing death, reconciling oneself to the death of others, being bereaved, coping with grief) is one of old age’s most vexing challenges.

Broderick & Blewitt (at p. 473) cite a study by Baltes & Baltes identifying three processes that are key to successful coping in the later years. The first is selection: realistically narrowing one’s goals and limiting the domains in which one expends effort. One can’t remain concerned about everything so the scope of one’s interests necessarily contracts. The second is optimization: enhancing the profile of those goals that remain and only accepting those social-emotional experiences that contribute to one’s growth or development. The third is compensation: dealing with loss by transferring interest and attention to something else. These three processes when successfully implemented significantly increase psychological autonomy and well-being.

Other theorists (p. 473) propose a hierarchy of needs that are particularly salient in old age: autonomy, competence and relatedness. “Autonomy” is defined as being in control of oneself, feeling that one’s behavior is congruent with one’s “true self.” “Competence” is feeling effective in one’s interactions with the social environment and experiencing opportunities to exercise and express one’s capacities. “Relatedness” is the feeling that one is important to others and valued by them. The degree to which these basic needs are met substantially determines a person’s sense of well-being and life satisfaction. As one ages one has less control over this process.

General Assessment

Physical Development: Physical changes, health issues, outstanding abilities. Jean is experiencing gradual physical decay....
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