Ego Integrity vs. Despair: A Life Review

Demographics 

Sam Bailey is a seventy-seven-year-old male of African American origin. He is a Christian by religion, who worked as a college professor between the ages of 35 and 65 when he retired. Sam has a Ph.D. in Physics, which he acquired when he was 30 years old. Studying physics was a childhood dream for him, so aside from the commerce degree that he pursued as a minor, all other academic pursuits focused on the study of Physics, including the acquisition of a degree in mechanical engineering and a masters in industrial engineering. Before the age of 35, he held two other main jobs. He worked as a mechanical engineer and as a mechanical engineering consultant. For the 35 years he worked as a lecturer, he worked for six universities in various parts of the US.

Significant Hard and Positive Times 

He explains that the two most significant positive times in his life were his wedding day and the day his only daughter was born. He got married to his high school best friend at age 28, and two years later they had a daughter, their only child. However, Sam has also endured losses that he has successfully worked through in the past. He lost his mother at age 13, after which he lived with his father and siblings. He admits that initially, it was hard to cope, but after a few sessions with his school counselor, he was able to adapt to his new living conditions better. The second loss was the loss of his wife, two years ago. Like his mother’s death, he admits that the death of his wife brought him a lot of grief, but six months down the line, he joined a support group, which he says has made coping with her death much more manageable.

Personal Strengths 

Mr. Bailey is a critical thinker. He takes time to think about his actions before executing them, a trait that he may have perfected through his continued pursuit of physics. Secondly, he is kind and friendly. Unlike others of his age, who tend to be grumpy, he always has a smile on his face. His hospitality also speaks for itself.

Coping Mechanisms 

Aging is accompanied by the need to understand both death and old age. These phenomena are often defined on a cultural basis, making culture critical to gerontology (Cavanaugh & Blanchard-Fields, 2018). Nonetheless, regardless of cultural affiliations, old age is characterized by multiple losses including the loss of youth, health, independence, friends and loved ones. These losses are difficult to cope with, and they are viewed as symbolic deaths. Therefore, aging adults experience death as part of their daily life, and the longer they live, the higher the likelihood of losing essential components of their lives. The said realization may result in high-stress levels, elicited from the lack of control (Ribeiro et al., 2017). Thus, coping with stress becomes critical to the aging process, and the affected individuals must make necessary efforts to handle the stressors that affect their physical and psychological well-being (Stenner et al., 2011).

The healthy coping skills that Mr. Bailey employs are counseling and being part of a support group. Sam saw a counselor for the first time after his mother’s death, but afterward, he expresses that he saw a marriage counselor for about a year when his wife was still alive and is currently seeing a counsellor to help him cope with retirement. Additionally, he is also part of a support group for elderly individuals that have lost their spouses.

Advice to Younger Self 

Sam thinks that if he had the chance to advise his younger self, he would probably advise himself to exercise more. He says that he was never interested in sports, but he wonders if his bone health would have been better if he had picked up regular jogging or a few gym session a week when he was younger. He also thinks that he should have advised himself to live every moment to the fullest. Sam feels that he should have explored his artistic and opened his life up to the possibilities, thereof. Lastly, Mr. Bailey establishes that he would have wanted his younger self to know that his life would turn out fine. He explains that he was under constant pressure as a young man because he wanted to achieve his dreams and circumstances, at times, made him feel like he was never going to make it.

Geriatric Depression Scale Findings 

On the Geriatric Depression Scale, Mr. Bailey has a total of 10 ‘Yes’ answers and 5 ‘No’ answers. Of the 10 ‘Yes’ answers six were in the bold category that required to be scored whereas only 1 ‘No’ answers was in the bold category. Sam’s score on this test was seven which falls in the > 5 category, suggesting that he may be prone to depression. Mr. Bailey’s answers to the questions indicate that he has dropped most of his past interests, he is often bored and feels that something bad is likely to happen to him. Also, Sam tends to feel helpless, prefers to stay home instead of going out and trying new things and thinks that most people are better than him ("Geriatric Depression Scale," 2019).

Fulmer SPICES Assessment 

Mr. Bailey’s responses to the Fulmer SPICES assessment indicate that he has trouble sleeping at least twice a week (2 out of 7 nights). Additionally, he also suggests that he has issues with eating because unless he is in the company of other people, he is never in a mood to eat. Regardless, Sam claims that he is still quite capable of controlling his bowel movements and indicates that confusion does not affect him much unless the few times his memory fails him. He claims that he tends to forget things much faster than he used to before. Moreover, Sam indicates that he does not fall much, but in the past week he lost his footing and hurt his knee. Lastly, Mr. Bailey indicated that his skin has become more brittle than usual and the slightest friction against it causes it to tear (Wallace & Fulmer, 2007).

Patient Stress Questionnaire & Mini Mental State Exam 

The answers on the Patient Stress Questionnaire indicate that Mr. Bailey has lost interest in participating in daily activities and deals with feelings of depression or hopelessness a few times a week. His energy levels are low, and so is his appetite and concentration levels. Moreover, sometimes he thinks that he would be better off dead. His score for the first nine questions was 5 ‘1’ answers and 2 ‘2’ answers, generating a total score of 9. The answers to the questions in table two indicate that Sam is often anxious with 2 ‘1’ answers and 5 ‘2’ answers. His total score on this table was 12. He also reported that he thinks of upsetting past events when he doesn’t want to and feels detached to his surroundings.

Nonetheless, Sam’s drinking levels do not appear to be alarming, and he seems to be in control of the same. On the Mini-Mental State Exam, Sam was able to answer the questions correctly, except one where he scored two instead of three. His total score was 29, indicating that he is currently not suffering from any cognitive impairment ("Mini-Mental State Examination (MMSE)," 2019).

Ego Integrity vs. Despair 

Erikson is a psychologist that established a personality theory that examines aging as a developmental stage. According to him, personality develops in eight key stages from birth to old age. At each psychosocial stage, an individual faces crisis and their resolution of the same elicits a positive or negative outcome. For individuals over 65 years, the conflict they face is ego integrity versus despair. As the aging adults look back on their life events, they evaluate whether they consider themselves as having led a successful life or not (Berzoff, 2011). Mr. Bailey’s score on a scale if 1-10 would be 7. He feels that he achieved most of the things that he wanted to, but he thinks that he should have probably explored other options like art and sports, to establish where those paths would have led him. Additionally, he feels that he should have made more effort in socializing and forming a more extensive social circle. Sam says that in the past his small circle was sufficient because he never had much time away from work, but now that he has retired a few more friends would do him good.

Nursing Diagnosis 

From the analysis of the results of the tests that Mr. Bailey took, it appears that Mr. Bailey is experiencing mild depression. The condition may be a result of coping with both the loss of his wife and his new retirement status. Among the defining characteristics that he exhibits are the mood disorders manifested by his responses in the Patient Stress Questionnaire. Sam indicates that he is often worried; he fears that something bad may happen and has a lot of trouble relaxing.

Secondly, Sam is also suffering from an eating disorder. This may be a result of the changes he is experiencing in his life and the lack of sufficient coping mechanisms. The eating disorder is evidenced by his acknowledgment of his inability to eat much unless he is around other people. Factoring in that he also says that he prefers to stay indoors, he does not meet people a lot. Hence, Mr. Bailey does not eat as often as he should.

Care Plan 

Nursing Goal	Nursing Interventions	Rationale	Goal Evaluation
To reduce the depression Sam is exhibiting signs within the next two weeks and elicit a more positive attitude towards his new life	Advice Sam to enroll in a psychotherapy program. Advice Sam to consider taking up a mild sporting activity.	Psychotherapy programs have been deemed to help the elderly (above 65) cope better with changes in their lives, like the loss of a loved one. It addresses a wide range of social and functional depression consequences (Unützer & Park, 2012). Exercise has been deemed an excellent means of relieving stress and may even improve one’s quality of sleep (Vovkodav & Pasichnyk, 2014).	After two weeks Sam will retake the Geriatric Depression Scale test. If the score is less than 7, the goal will have been met.
To better Sam’s eating habits within the next two weeks and ensure that Sam has at least three main meals a day.	Help Sam create a meal plan, indicating what to eat and when to eat it. Advice Sam to consider taking appetizers to boost his appetite.	Meal plans are essential when dealing with eating disorders because they help regulate eating patterns (LaMarre & Rice, 2016). Drug therapy can be used to boost appetite provided the drugs that are used are federally approved (Gura & Ciccone, 2010).	When Sam takes the Fulmer SPICES Assessment in two weeks and indicates that he has been eating better the goal will have been achieved. If he adds 0.5+ kilograms, the goal will have been achieved
To reduce Sam’s anxiety levels within the next two weeks and achieve better emotional control.	Educate Sam on anxiety disorders and emphasize on their treatability. Encourage Sam’s participation in relaxation exercises like deep breathing and meditation.	The client needs to know that whatever they are suffering from is treatable. Treatment options should also be presented to them so that they can choose how they want to deal with the issue (Ravindran & Stein, 2010). Relaxation exercises are a non-medical way of dealing with anxiety (Simony et al., 2015).	When Sam takes the Patient Stress Questionnaire test in two weeks, and the scores are lesser than 9 and 12 in the first and second tables, respectively, the goal will have been attained.

References

Berzoff, J. (2011). Psychosocial ego development: The theory of Erik Erikson.  Inside out and outside in: Psychodynamic clinical theory and psychopathology in contemporary multicultural contexts , 97-118.

Cavanaugh, J. C., & Blanchard-Fields, F. (2018).  Adult development and aging . Cengage Learning.

Geriatric Depression Scale. (2019). Retrieved from http://www.stanford.edu/~yesavage/GDS.html 

Gura, K., & Ciccone, R. (2010). Drugs and Appetite: An Overview of Appetite Stimulants in the Pediatric Patient.  ICAN: Infant, Child, & Adolescent Nutrition ,  2 (6), 358-369.

Haber, D. (2013).  Health promotion and aging: Practical applications for health professionals . Springer Publishing Company.

LaMarre, A., & Rice, C. (2016). Normal Eating Is Counter‐Cultural: Embodied Experiences of Eating Disorder Recovery.  Journal of Community & Applied Social Psychology ,  26 (2), 136-149.

Mini-Mental State Examination (MMSE). (2019). Retrieved from http://www.heartinstitutehd.com/Misc/Forms/MMSE.1276128605.pdf 

Ravindran, L. N., & Stein, M. B. (2010). The pharmacologic treatment of anxiety disorders: a review of progress.  The Journal of clinical psychiatry ,  71 (7), 839-854.

Ribeiro, M. D. S., Borges, M. D. S., Araújo, T. C. C. F. D., & Souza, M. C. D. S. (2017). Coping strategies used by the elderly regarding aging and death: an integrative review.  Revista Brasileira de Geriatria e Gerontologia ,  20 (6), 869-877.

Simonÿ, C. P., Pedersen, B. D., Dreyer, P., & Birkelund, R. (2015). Dealing with existential anxiety in exercise‐based cardiac rehabilitation: a phenomenological‐hermeneutic study of patients' lived experiences.  Journal of clinical nursing ,  24 (17-18), 2581-2590.

Stenner, P., McFarquhar, T., & Bowling, A. (2011). Older people and ‘active ageing’: Subjective aspects of ageing actively.  Journal of health psychology ,  16 (3), 467-477.

Unützer, J., & Park, M. (2012). Older adults with severe, treatment-resistant depression.  JAMA ,  308 (9), 909-918.

Vovkodav, O., & Pasichnyk, R. (2014). The method of identification of a mathematical model for the cardiovascular system response dynamics to exercise stress.  Journal of Applied Computer Science ,  22 (2), 91-99.

Wallace, M., & Fulmer, T. (2007). Fulmer SPICES: An Overall Assessment Tool for Older Adults | Population Health Learning Network. Retrieved from https://www.managedhealthcareconnect.com/article/6911