143 Mental Health Concerns and The Older Adult
THEORIES ON AGING The inevitability of aging and its de- velopmental stages in association with human health have been studied and de- bated over the years. What follows is a summarization of the most common the- ories on older adulthood, from Sigmund Freud, Heinz Kohut, Bernice Neugarten, Daniel Levinson, and Erik Erikson. Health- care workers see aspects of each of these while assessing and caring for the older adult’s mental health needs. Sigmund Freud was focused on the need to control the ego (part of the human psyche that operates in the real world) and id (part of the human psyche that strives to fulfill primal needs) with the superego (internal- ized values and morals that push the ego to act in a more virtuous way). Regression may induce rudimentary methods of cop- ing to resurface in the older adult (Sadock et al., 2015). Heinz Kohut stated that the elderly are constantly faced with narcissis- tic injury as they cope and adapt to the biological, psychological, and social loss- es associated with the aging process. The central task of aging is preservation of self-esteem (Sadock et al., 2015). Bernice Neugarten theorized the major conflict of old age to lie in the release of autonomy and authority; the focus is on accomplish- ments and previous victory. This time is for reconciliation with others and processing grief related to the death of others and the inevitability of death of self (Sadock et al., 2015). Daniel Levinson found that age 60 to 65 is a transition period. Older people, “late adults,” become consumed by the thought of their death and are of- ten narcissistic and heavily engrossed in their body appearance. He found that creative mental activity is recommended and is a healthy substitute for decreased physical activity (Sadock et al., 2015). All the above theorists have aspects of in-
terest for the healthcare worker to note; however, Erik Erickson’s eight psychoso- cial stages of development are especially worthwhile to consume prior to working with an older adult. Erik Erikson created a framework that highlights tasks to be accomplished, vir- tues to be gained, or—conversely—a crisis can occur throughout the life span. He expanded on Freud’s theory by recog- nizing the relationship between the indi- vidual and their environment to include a client’s customs and traditions (Sadock et al., 2015). The healthcare worker should approach each client’s meaning, accep- tance, or toil with life and death with cultural awareness. Erikson’s stages from birth to older adult are a trajectory of de- velopment, an amalgamation of physical, cognitive, instinctual, and sexual realms (Sadock et al., 2015). An interruption or inability to accomplish the tasks in each stage may lead the client to undergo a decision point in their life. The older adult is influenced by each stage along the con - tinuum. The healthcare worker can gain much by capturing the perspective of the older adult client through the lens of the stages of Erik Erikson’s psychosocial stages of development. Stage 1 is trust versus mistrust (usually met in infancy and has an associated virtue of hope); stage 2 is autonomy versus shame (usually met in the toddler timeframe with an asso- ciated virtue of will); stage 3 is initiative versus guilt (usually met in the preschool age and the associated virtue is purpose); stage 4 is industry versus inferiority (usu- ally met during the school age and the associated virtue is competence); stage 5 is identity versus confusion (usually met in adolescence and the associated virtue is fidelity); stage 6 is intimacy versus isola - tion (usually met in early adulthood and
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