Читать книгу Transitions in Care - Howard A. Wolpert - Страница 8

Levinson et al. (1978) and Arnett (2004) theorized that, in the U.S., there is frequently a misfit between the developmental tasks of young adults just after high school and the expectations of the various institutions responsible for young adults. Arnett studied individuals between the ages of 18 and 24 years and asked them what attributes made someone an adult. Four specific achievements were cited: 1) the ability to accept responsibility for oneself, 2) the ability to make independent decisions, 3) the ability to become financially independent, and 4) the ability to independently form one’s own beliefs and values. Interestingly, most of the young adults interviewed did not believe that they had achieved these goals. In fact, the majority of young people in the U.S. do not believe that they have achieved these goals until they are in their late 20s.

Several dilemmas confront patients in the first phase of the young adult period. This phase brings desire for independence, yet also fear of independence. Freedom from parental supervision and rules also brings responsibilities than can be quite daunting. The young adult begins to face issues such as, how do you find/keep a place to live, pay your bills, balance a checkbook, manage credit, begin a relationship/keep a relationship that might be “forever,” and choose a career? While young adults are trying to balance all of these new freedoms and responsibilities, they are probably doing this with less help from their parents and less structure in their daily routine. In addition, if young adults have moved away from their hometown, they are making these decisions in a place where few people know them, often removed from their closest friends. Arnett suggests that individuals in this first phase are beginning to “explore the possibilities available to them in love and work and move gradually toward making enduring choices.” He suggests these actions might lead them to feel unsettled, since they do not yet know where these explorations will lead them.

Similarly, the young adult’s family faces several dilemmas as the family begins to address issues such as the following:

Whether the young adult and his or her parents tolerate the separation and increasing independence and still remain connected.

Whether the parents become over-involved or cut off relationships prematurely.

How young adults cope with the potential of remaining dependent on their parents for both tangible (e.g., monetary, housing) and emotional support as they develop their skills and identities as either students or workers.

How the possibility of financial dependence affects the relationship between the young adult and his or her parents and the parents’ ability to treat their older children as adults with separate, independent lives.

How parents cope with the difficult transition from a hands-on role in the care of their child to being a “consultant.” Similarly, the shift from speaking directly to their child’s physician or nurse to now relying on secondhand (if any) information is a transition that raises most parents’ anxiety and concern.

To place the dilemmas young adults and their families face in perspective, the data from the 2000 Census tell us that 56% of men and 43% of women between the ages of 18 and 24 years still live at home with their parents. Moreover, 30% of men and 35% of women in that age-group live with roommates. In fact, only 4% of individuals in this age-group live alone. Therefore, the assumption that individuals in this age-group are independent may be false, both from a theoretical perspective on adult development and also from a fact-based perspective regarding where and with whom they live.

During the early phase of young adulthood, which Levinson et al. (1978) called the “early adult transition,” the person may be transitioning geographically, economically, and emotionally away from the parental home. Furthermore, if the 18- to 22-year-old young adult has also transitioned to a college or trade school, his or her new life will be marked by added changes, distractions, and demands. For most young adults, these competing educational, economic, and social priorities detract from a focused commitment to chronic disease management. Even though young adults are facing these competing demands, most do not believe that they have achieved all of the skills necessary to remain independent and accept these responsibilities on their own. Therefore, it may be unrealistic to expect young adults with diabetes in this first phase of young adulthood to intensify their glycemic control, to learn pump therapy, or even to transition to a new adult diabetes provider. Furthermore, for most patients, this early phase is often marked by feelings of invulnerability and a tendency to reject perceptions of adult control, and this further limits receptiveness to change.