Midlife crisis is a time period that marks the passage between early maturity and middle age.

1. ASSESSMENT:
1. Commonly occurs between ages 35 and 45.
2. Preoccupied with visible signs of aging, own mortality.
3. Feelings: urgency that time is running out ("last chance") for career achievement and unmet goals; boredom with present, ambivalence, frustration, uncertainty about the future.
4. Time of reevaluation:
1. Reassess: meaning of time and parental role (omnipotence as a parent is challenged).
2. Reexamine and contemplate change in career, marriage, family life.
5. Personality changes may occur. Women: traditional definitions of femininity may be challenged as become more assertive. Men: may be more introspective, sensitive to emotions, make external changes (younger mate, improve looks, new sports activity), mood swings.
6. Presence of helpful elements necessary to turn life's obstacles into opportunities.
1. Willingness to take risks.
2. Strong support system.
3. Sense of purpose.
4. Accumulated wisdom.
2. ANALYSIS/NURSING DIAGNOSIS:
1. Self-esteem disturbance (low self-esteem) related to loss of youth, faltering physical powers, and facing discrepancy between youthful ambitions and actual achievement (no longer a promising person with potential).
2. Altered role performance (role reversal) related to parents who previously provided security and comfort but now need care.
3. Altered feeling processes (depression) related to disappointments and diminished optimism as life is reconsidered in light of the reality of aging and death.
3. NURSING CARE PLAN/IMPLEMENTATION—long-term goal: help individual to rebuild life structure.
1. Help client reappraise meaning of own life in terms of past, present, and future, and integrate aspects of time. Encourage introspection and reflection with questions:
1. What have I done with my life?
2. What do I really get from and give to my spouse, children, friends, work, community, and self?
3. What are my strengths and liabilities?
4. What have I done with my early dream, and do I want it now?
2. Assist client to complete four major tasks:
1. Terminate era of early adulthood by reappraising life goals identified and achieved during this era.
2. Initiate movement into middle adulthood by beginning to make necessary changes in unsuccessful aspects of the current life while trying out new choices.
3. Cope with polarities that divide life.
4. Directly confront death of own parents.
3. Health teaching: stress-management techniques; how to do self-assessment of aptitudes, interests; how to plan for retirement, aloneness, and use of increased leisure time; dietary modification and exercise program.
4. EVALUATION/OUTCOME CRITERIA:
1. Gives up idealized self of early 20s for more realistically attainable self.
1. Talks less of early hopes of eminence and more on modest goal of competence.
2. Shifts values from sexuality to platonic relationships: replaces romantic dreams with satisfying friendships and companionships.
3. Modifies early illusions about own capacities.
4. Shifts values away from physical attractiveness and strength to intellectual abilities.
2. Comes to accept that life is finite and reconciles what is with what might have been; appreciates everyday human experience rather than glamour or power.
3. Through self-confrontation, self-discovery, and change, experiences time of restabilization; is reinvigorated, adventuresome.
4. Develops alternative abilities that release new energies.
5. Tries less to please everyone; others' opinions less important.
6. Makes more efficient and well-seasoned decisions from well-developed sense of judgment.