Module 7 Discussion: Initial Post
Integrity Versus Despair: Assessing a 79-Year-Old Widower
I chose Erikson's eighth stage, integrity versus despair, which spans late adulthood. In this stage, older adults look back on their lives. Those who can accept their life as meaningful, including its disappointments, achieve integrity and the virtue Erikson called wisdom; those who see their life as wasted and time as too short to change it experience despair (Erikson, 1963). For a composite example, consider a 79-year-old retired machinist whose wife died eight months ago and who comes in for a Medicare annual wellness visit.
Approach to assessment. I would allow more time, sit at eye level in a quiet room with good lighting, speak clearly, and check that hearing aids and glasses are in use. I would begin with his story, asking how he has been since his wife died and what gives his days meaning now, because his answer reveals where he stands in this stage. The physical examination would include orthostatic blood pressure, vision and hearing, gait and balance, weight trends, skin, and a cognitive and mood assessment.
Developmental considerations. Late adulthood brings losses of spouse, friends, work roles, and sometimes independence, which test the ability to find integrity. Physical changes such as reduced muscle mass, slower reaction time, and sensory decline affect function. Reminiscence is normal and healthy in this stage; listening to it is part of assessment, not a detour from it.
Additional testing and screening. The Geriatric Depression Scale, developed and validated specifically for older adults, avoids relying on somatic symptoms that overlap with physical illness (Yesavage et al., 1982). A brief cognitive screen such as the Mini-Cog would be part of the wellness visit, although the USPSTF found insufficient evidence to recommend routine cognitive screening in older adults without symptoms (US Preventive Services Task Force et al., 2020), so I would pair it with his and his family's observations. Fall risk screening with the Timed Up and Go test, vision and hearing screening, and a review of medications for anticholinergic and sedating drugs complete the picture.
Two possible abnormalities. First, depression after bereavement. Grief is expected, but persistent hopelessness, loss of interest, weight loss, and thoughts that life is not worth living suggest major depression, and older men who have lost a spouse carry a high risk of suicide, so I would ask directly about suicidal thoughts and access to firearms. In this stage, despair is not only a developmental idea; in its severe form it is a treatable illness. Second, mild cognitive impairment or early dementia, which may appear as missed bills, repeated questions, or getting lost while driving. Depression can mimic or coexist with cognitive decline, so both must be assessed together.
I look forward to comparing this with classmates who chose earlier stages, where the balance between development and decline runs the other way.
References
Erikson, E. H. (1963). Childhood and society (2nd ed.). W. W. Norton.
US Preventive Services Task Force, Owens, D. K., Davidson, K. W., Krist, A. H., Barry, M. J., Cabana, M., Caughey, A. B., Doubeni, C. A., Epling, J. W., Kubik, M., Landefeld, C. S., Mangione, C. M., Pbert, L., Silverstein, M., Simon, M. A., Tseng, C.-W., & Wong, J. B. (2020). Screening for cognitive impairment in older adults: US Preventive Services Task Force recommendation statement. JAMA, 323(8), 757-763. https://doi.org/10.1001/jama.2020.0435
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37-49. https://doi.org/10.1016/0022-3956(82)90033-4
How this N 518 Module 7 example is structured
N518 Module 7's discussion typically asks you to choose one of Erikson's psychosocial stages and describe your assessment approach, developmental considerations, additional testing, two possible abnormalities, then compare with a classmate's stage. The module's ShadowHealth work is your own and is not sampled. Aspen revises courses, so check your classroom's prompt. This example follows the prompt element by element with validated tools and current screening evidence.
N518 Module 7 questions, answered
What does N518 Module 7 usually ask for?
The discussion asks you to select one of Erikson's psychosocial stages and describe how you would assess a person in it, developmental considerations, additional testing or screening and two possible abnormalities, then compare with a classmate's stage.
What is Erikson's integrity versus despair stage?
The eighth stage, in late adulthood, when people review their lives. Accepting life as meaningful brings integrity and wisdom, while seeing it as wasted with no time to change it brings despair.
Does the USPSTF recommend cognitive screening for all older adults?
No. Its 2020 statement found insufficient evidence to assess the balance of benefits and harms of screening older adults without symptoms, so screening is paired with concerns raised by the patient, family or clinician.
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