Different ideas about human development have been put forward by different theorists. They believe the factors responsible for the development are whether it being continuous or discontinuous, whether there's one course of development for all or different courses for different individuals, and then the nature and the nurture debate. Taking up the fact that all of these factors are responsible for development, I'll be looking into the development of middle-age adult as a lifelong process, multidirectional, highly plastic, multidisciplinary, contextual and multidimensional. Multidimensional as it consists of biological, cognitive and socioeconomical development i.e. the holistic view on middle-age development (Santrock, 2008). Also I'll be looking into the uncertainty that surrounds hormone replacement therapy as an issue that affects middle-age adult women.
For middle-adulthood, chronological age, 35-55, their physical development includes visual changes, sensory, motor changes and sexual changes. Visual physical changes include graying and thinning of hair, wrinkling and sagging of the skin, thickening of the waist, balding and yellowing of teeth (Crisp & Taylor, 2005). The first theory that Levinson puts forward is young Vs being old, i.e. how well you cope with aging. Mostly men perceive this as positive compared to women as women try to correct this by surgical operation and other cosmetic ways. Other's include losing height (1/2 inch per decade), body fat (20% or more) which leads to obesity, a major cause of cardiovascular disease and mortality in New Zealand. Also there's decrease in muscle strength, less efficient tendons and ligaments and progressive loss of bone ( osteoporosis), hearing loss for high pitched sounds (presbycusis), ability to focus declines, loss of near vision (presbyopia). The heart and coronary arteries change and there's news of high blood pressure and high cholesterol level. Lung tissue becomes less elastic and if you are a smoker it becomes worse. Problems with sleep pattern surfaces as there's lack of sleep (Santrock, 2008). Sexual changes involve going into menopause for women which starts around late 40's to early 50's. There's decline in production of estrogen which is linked to higher risk of osteoporosis and heart disease. Also there are some uncomfortable symptoms of hot flushes. Ability to bear children diminishes. For males the changes begin 10 Years later than women whereby there is enlargement of prostate gland which causes problem with urination. Testosterone level drops, sperm count drops, there's slower motility of sperm, less frequent erection and less powerful ejaculations which takes longer to recover. However they can still father children but have reduced fertility (Berk, 2006).
Socioeconomical development is perceived differently by different theorist as either mid-life as a crisis or a prime of life. My favorite is Erik Eriksons 7th stage of development which is generativity vs stagnation. For generativity it is adult's responsibility to guide and protect the future of mankind by being parents and leaving a legacy to the next generation. Those who do not rise to this challenge become self indulgent resulting in stagnation of development (Kastenbaum, 1993). According to Berk (2006), there are four types of generativity, biological- when genetic makeup is passed on, may either happen in young ...
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Socioeconomical development is perceived differently by different theorist as either mid-life as a crisis or a prime of life. My favorite is Erik Eriksons 7th stage of development which is generativity vs stagnation. For generativity it is adult's responsibility to guide and protect the future of mankind by being parents and leaving a legacy to the next generation. Those who do not rise to this challenge become self indulgent resulting in stagnation of development (Kastenbaum, 1993). According to Berk (2006), there are four types of generativity, biological- when genetic makeup is passed on, may either happen in young adulthood or middle adulthood if you consider conceiving later. Second is parental, providing nurturance and guiding children, thirdly, work where adult's skills is passed on to the others and lastly cultural. Two other theorists who put forward their theories on psychosocial development are Levinson and Valliant. Four theories of Levinson's include first young vs. old, second, being destructive vs. constructive example when the awareness of mortality is there and half your life has gone by you tend to make constructive move towards healthier lifestyle in forms of eating healthy and exercising. Third one is being masculine vs. being feminine i.e. get a better balance of being masculine and feminine parts of self. Last one is attached and being separated which is getting out of your ambitious world and getting more in touch with self. Hence taking up a vacation that you long time promised yourself. For some, midlife is perceived as midlife crisis example when there is career change, sexuality problems, stress of single hood, divorce, transition of the family when children leave home, care for aging parents or death of a spouse. All of this can be defined as midlife crisis and can lead to anxiety and depression which is so common in New Zealand. Valliant's conflict with midlife crisis is that only a fraction of adult experiences it. Most of them feel more in control in their work and more financial security as well as handling daily responsibilities efficiently (Santrock, 2008).
Moving on to cognitive development, a much quarreled topic whereby modern theorist disagrees with Piaget that cognitive development stops at older adolescent. They believe that it continues to develop throughout young and middle adulthood. Quite true for New Zealand as some of them choose to change their career and go back to study. Cognitive development is multidirectional though, that is, there are gains in some areas and losses in others. Two types of studies were done to prove that, and that was cross sectional measures and longitudinal measures which show increase in intelligence over time whereas the latter shows the decrease in intelligence. Horn's proposed theory is based on two types of intelligence, crystallized and fluid. Crystallized intelligence improves, which is the ability to remember and use information acquired over a lifetime. It is this cognitive skill they use in establishing their family and meeting their needs. Those who keep on exploring their cognitive interests through reading, hobbies and conversation experience fewer declines in their cognitive abilities. (Janik & Bank, 1983; Schae, 1983, Siegler, 1983 as cited in Aiken). Fluid intelligence declines, which is the ability to apply mental powers to new problems. As a result of this research middle adulthood faces real life problems of needing to take measures of practical problem solving (Santrock, 2008). On the other hand Schiae and his associates put forward four stages of cognitive development throughout human lifespan. The stage for middle adulthood is the responsible and executive stage. In this stage there is always postformal thought. It relies on subjective feelings and intuition as well as logic (Berger 2005).
There are so many issues relating to this age group and one of it is hormone replacement therapy (HRT) for women going on to menopause. There are so many mixed reactions to it as women are getting more education on this subject. Before going on to HRT one first has to understand what menopause is, the symptoms and the related diseases associated with it. Menopause is hormonal changes resulting in estrogen deficiency. It is a big milestone for women because it is one's last menses, meaning beginning of infertility. This can result in physical and psychosocial problems. It is fortunately, for some women a normal part of life where they see a bright side to it and that is "yeah! No more menses" whereas for some it is traumatic and full of uncomfortable symptoms. There can be heavy and irregular vaginal bleeding due to menstrual cycle changes. Other symptoms include hot flushes and night sweats. It can be minor to unbearable where it may disrupt their work, sleep and daily activities. Psychological symptoms include mood swings, forgetfulness, memory loss and poor concentration. These symptoms though cannot be said to be entirely due to menopause ( Mooren, 2004). A recent study which was done in New Zealand showed there was relatively no connection between HRT and negative moods and the NZ public health guidelines does not recommend HRT as treatment for these. Other problems associated with menopause are vaginal dryness, this is due to low levels of estrogen, and this in turn can lead to dyspareunia (painful intercourse). A factor which can cause loss of libido. Also there is itching, irritation and vaginal atrophy which are the thinning of the vaginal mucosa. Another problem is urinary continence which is brought about by thinning of the urethral mucosa and atrophy of the bladder. This can be controlled by other optional methods other than HRT, like bladder control training, pelvic floor exercise and taking lots of fluid. There are some diseases that have been proved to be aggravated by menopause. Examples include heart disease whereby the risk is doubled due to reduction in estrogen level. Osteoporosis is another one. The bone loss is quite a lot which can cause osteoporotic fracture later in life. Dementia has not been proven to be caused by hormone deficiency but studies has found that it improved after HRT.
Now you, as a nurse have explained what menopause are, its symptoms and diseases the next question your patient may ask is, what hormone replacement therapy is? What's the risk associated with it and the advantages of it? There are two main types of HRT. One is administration of estrogen alone (ERT) and the other one is Estrogen combined with progestin (HRT). It can be given as implants, injections or oral and topical application. If the women haven't had a hysterectomy then progestin and estrogen are given to reduce the risk of endometrial cancer. The advantages of HRT are that it reduces the risk of osteoporosis, it relieves hot flashes and it may protect women from heart disease. The studies though prove otherwise. On the other hand the disadvantages are that it can cause side effects, such as bloating or irritability, nausea, weight gain, breast tenderness. It may increase the risk of breast cancer and heart disease as well. It was reported that after the general practitioners and the public were empowered about the risk of using HRT and getting breast cancer following the WHI (Women's Health Initiative) report, the HRT users dropped to 11% in 2002 compared to 19% uses in 1997. Because of this there was also a 6% decrease in breast cancer (Bilgrami....). It can also cause dangerous blood clots and lastly it may increase the chance of getting gall bladder disease. All the risks increase if you are a long time user.
Now after all this information one may still be confused whether to go on HRT or not especially those who are going through a hard time. Of course you have to do a good counseling of the patient which would include clarifying her symptoms and also the severity of it. Taking of family history is a good advantage like any breast cancer history etc. Suggesting for a physical examination which should be followed with laboratory test should be advised. Other optional treatment should be discussed as well, like herbal. Apart from counseling on HRT other related problems in association with menopause should be discussed like reduction of body weight or prevention as well, stop smoking, less alcohol intake, proper nutrition, regular exercise and sex education should be discussed as well. If the person is really in need for HRT it should be given in a lowest dose, for a shortest period of time. The need for continuing treatment should be revised every now and then. The key point is educating these women. There are a lot of them out there going through his transition that is not aware of the help that can be given to them.
From this assignment it is quite evident that middle -adulthood "is a period of challenges, reward and crisis" (Crisp and Taylor p223). Santrock, (2008) states that like all periods of human life span there is a negative and a positive feature to middle age. Example in empty nest syndrome the emptiness is there when children leave home but there may be an increase in marital satisfaction. Likewise for my issue on menopause the positive feature is no more menstrual cycle as well as the problem of conceiving is not there or there is no need for contraceptives. The drawback though would be the diseases associated with it. Midlife is also a time when you can exhibit expertise and accumulated knowledge. Socioeconomic stability is there but there are pressures on domestic finances, mortgages consumables and other family related expenses. There is also the pressure on assisting the next generation in becoming competent (Crisp and Taylor, 1995). Moreover, as adolescence and young adulthood impacts middle adult-hood, how they handle this age and in the process come out victorious combating stress, will influence how well they cope with their life later in the years.
References
Aiken, L. R. (2002). Human development in adulthood. New York: Khuwer
Academic Publishers.
Berger, K.S. (2005). The developing person through the lifespan (6th ed.). New
York: Worth Publishers
Berk, L. E. (2007). Development through the lifespan (4th ed.). Boston: Allyn
and Bacon
Bilgrami, I., Blower, K., Feng, J., Stefanko. G., & Tan, E. (2004). Changes in
the use of hormone replacement therapy in New Zealand following the publication of the Women's Health Initiative trial. The New Zealand Medical Journal ,117(1206).
Crisp, J., & Taylor, C.(Eds.). (2005). Potter & Perry's fundamentals of nursing
(2nd Australasian ed.). Marrickville, Australia: Elsevier Australia.
Kastenbaum, R. (1993). Encyclopedia of adult development. Arizona, Canada:
Greenwood Publishing.
Mooren, V.D & kenemans, P. (2004). Postmenopausal hormone therapy:
impact on menopause - related symptoms, chronic disease and quality
of life. Australia & New Zealand; Biomedical, 64(8), 821-36. Retrieved
April 6, 2008, from CINAHL database.
Santrock, J. W. (2008). Life-span development (11th ed.). Boston: McGraw-Hill.
Student Id:10722675
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