GROWTH and DEVELOPMENT

Introduction:

Middle adulthood is the most challenging and fulfilling part of the life span for many. It is a
busy, stressful time, full of responsibilities, but is a time when most adult feel that they are at
their peak of competence, productivity and control and able to handle whatever may come. They
are likely to be on their top earning period and in the most secure financial position of their lives.
They are experienced enough to have acquired sound judgment and mature acceptance of life’s
up and down and are less likely to be depressed. This stage is also known as the “command
generation” because they wield authority in societal institution.

DEVELOPMENT TASK THEORY (Robert Havighurst)

• Robert Havighurst believed that learning is basic to life and hat people continue to learn
throughout life. He described growth and development as occurring during six stages, each
associated with 6 to 10 tasks to be learned.
• In later maturity, the tasks are as follows: (1) adjusting to decreasing physical strength and
health; (2) adjusting to retirement and reduced income; (3) adjusting to death of spouse;
(4) establishing an explicit affiliation with one’s age group; (5) meeting social and civil
obligations; (6) establishing satisfactory physical living arrangements
• My patient has undergone several hospitalizations in the past 5 years. She was operated
for myoma last 2004 and had her two of her right toes amputated due to diabetic foot. She
has been diabetic for 2 years. Because of her amputation, she finds it difficult to perform
social roles. She has been non-compliant with her medicines because of financial reasons.
FREUD’S FIVE STAGES OF DEVELOPMENT (Sigmund Freud)
• According to Freud’s theory of psychosexual development, the personality develops in five overlapping stages from birth to
adulthood. The libido changes in location of emphasis within the body from one stage to another. Therefore, a particular
body area has special significance to a client at a particular stage.
• At puberty and after, energy is directed toward full sexual maturity and function and development of skills needed to cope
with environment
• My patient is married for 30 years but claims to have “ok” relationship with her partner. She claimed to have no regret
though.

Introspection and Transition (George Valliant)

• Middle transition “give or take” 40’s
• Midlife is stressful because of the demands to entrance to new life stages
• Pain of facing maturity-suppressed in the past
• Many man reassess their past record, their attitude toward sexuality, find new solutions to old needs
• Most adjusted-most generative, the happiest (35-49)
• Tranquil (calm) 50’s –male more nurturing and expressive
• Client feels calm and stress-free despite of financial constraints. She feels generally happy and calm. She does not easily
gets depressed nor angry.

ERIKSON’S STAGES OF DEVELOPMENT (Erik Erikson)

• Generativity vs. stagnation
• The impulse to foster the development of the next generation-mentors of young adults
• To have children is instinctual-those childless acknowledge their sense of loss and express these generative impulse in other
ways
• Helping to care for other people’s children
• She’s contented with what she has in life. She considers her children as her own and happy with it.
Balancing the personalities (Carl Jung)
• Middle transition
• After child-rearing obligation diminished, can balanced by expressing characteristics previously suppressed
• Become more inner-oriented and pre-occupied with their inner world
• Give up the image of youth and adopt a more appropriate lifestyle and acknowledge that lives are finite
• Inner works creates stress but necessary for healthy adjustment
• Client is still involved with her children because two of her children are still living at home. She sometimes takes care of her
son’s daughter.

PECK’S four adjustments of Middle age (Robert Peck)

• Valuing wisdom vs. physical power
• Socializing vs. sexualizing in human relationships
• Emotional flexibility vs. emotional impoverishment
• Mental flexibility vs. mental rigidity
• She is a housewife and tends the animals. She feels happy being a housewife and can think of no other job than this.
• After she had aamputation, she felt isolated with the society and experienced depression. She claims to have overcome it
however; she still does not attend social functions because she does not feel generally good without her toes. She feels
contented with her life at home.
• She is prepared whatever will happen to her. Despite of her disease conditions, although she is having a hard time
complying to the medicines because of financial reasons.
 COGNITIVE THEORY (Jean Piaget)
• Cognitive development refers to the manner in which people think, reason, and use language. It involves a person’s
intelligence, perceptual ability, and ability to process information.
• An adult uses rational thinking, reasoning is deductive and futuristic
• She knows the whys of things and reasons out appropriately to certain thing even if she only finished grade 4.

Physiological Developmental:
There are a lot of physical changes during the middle-adulthood:

a. Skeletal system

The bone mass decreases as the skeletal growth ceases. Due to the normal fluid loss and thinning of the cartilage
joints, they become prone to stiff joints. Women loss calcium every year, about 1%, from bone tissues after
menopause leading to bone softening which leads to increased risk of softening.

b. Muscular system

Muscle mass begins to reduce due to the reduction in the number of muscle fibres and its diameter, but this is
dependent on heredity, exercise, and nutrition. Middle age spread occurs, which refers to the thickened waistline,
protuberant abdomen and widened buttocks. They may not be overweight because fats weigh less than muscles.
c. Neurological system

Presbyopia, or the gradual decline in the inability to focus on close objects occurs. The size of the pupil becomes
smaller and less light enters the eyes. The lens gradually becomes opaque creating a cataract. Auditory changes
happen as well such as presbycusis, which is the progressive loss of hearing caused by the thickening of the capillaries
that supply the inner ear structure. The sense of taste and smell diminishes due to a decrease in taste buds and
receptor cells. Pharyngeal tonsils almost completely atrophied which lead to injures body parts that take longer to
heal.

d. Cardiovascular system

Left ventricular hypertrophy may occur independently or secondary to arterial hardening. Heart chambers stiffen and
become more collagen-filled which leads to elevated blood pressure. The valves become incompetent to prevent back
flow of blood-varicose veins.

e. Hematological system

The level of cholesterol, lipids, and low density lipoprotein increases but regular exercise helps lower its accumulation
in the blood vessels.

f. Respiratory system

Lung tissues becomes less elastic resulting in the gradual decrease in breathing capacity leading to increase in
respiratory rate.
g. Integumentary system

The skin’s elastic fibers in the dermis become less resilient and the skin no longer stretches tightly across muscles and
bone causing some sagging and wrinkling. There is a loss of subcutaneous fat which leads to the sagging and
wrinkling. Eye bugs become prominent due to the weakening of the underlying muscle and fibrous tissues of the eye.
Both the dermis and the epidermis begin to loss cells at a pace that cannot be replaced. The pores enlarge and the
skin begins to thin and may allow substance to permeate the surface cell more easily. Subcutaneous fats tend to be
deposited in some parts and lost in some parts. The skin also loses its moisture thus becomes dry and easily cracked.
The melanocytes in the epidermis gradually decrease resulting into vitiligo, or the pale patches of the skin, and age
spots which are dark pigmented plaques. Callouses and corn starts to form as well.

The decrease in the number and activity of the hair follicles will lead to generalized and slower growth of hair and gray
hair starts to grow. The nails become dry, brittle, and growth becomes slow.

h. Gastrointestinal system

New oral bacterial attack and secondary decay of teeth will lead to gingivitis and periodontal disease plus receding the
gums will lead to lossening of the teeth. In the stomach, there will be a decreased production of pepsin and
hydrochloric acid and will result in decreased protein digestion, decreased absorption of iron, calcium, and vitamin B.
The sedentary life, more refined foods and decreased motility of the GIT will lead to constipation which may precipitate
hemorrhoids. Lactose intolerance will cause distention, cramping, flatulence, and diarrhea.
i. Urinary system

Thickening of the nephrons in the kidneys occur due to fat deposit which decreases filtration rate in the blood vessels.
The walls of the bladder thicken and loose elasticity. The capacity becomes less than half which leads to increased
frequency in urination. Increase number of adipose tissue decreases the total body fluid, and decrease in number of
body cells, loss of Calcium and Magnesium, occur.

j. Endocrine system

Tyroxime becomes less which result to easy fatigue and gain weight. There is a decrease in the BMR by 2% per
decade after physical growth has stopped. The ability to move glucose to the cell of the body for energy is decreased
as the person ages because high blood glucose level no longer stimulates the release of adequate insulin resulting in
DM.

k. Reproductive system

Menopause period starts and is a gradual process taking 5-20 years, the function of the ovaries begins to diminish and
finally ceases. Estrogen levels starts to go down, the vagina becomes less lubricated during sexual intercourse.
STAGES OF MORAL DEVELOPMENT (Lawrence Kohlberg)
(POSTCONVENTIONAL AND CONVENTIONAL development)
• Interpersonal-living up to what is expected by relatives and friends or what is generally expected of one’s role: being “good”
is important
• Societal-based on law and order (social system and conscience maintenance)
• willingness to sacrifice for the well-being of others
• Patient makes decision based on own judgment and feelings and not on social norms.

STAGES OF SPIRITUAL DEVELOPMENT (James Fowler)

• Describes the development of faith as a force that gives meaning to a person’s life
• After 30 years of age, a person is aware of truth from a variety of viewpoints
• Patient is developed spiritually and is aware of what is reality and not. Thus, she has a positive viewpoint in life. She stopped
going to church after her amputation.