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Family Life Cycle
Dr Ogechukwu Mbanu
Department of Family Medicine
AKTH
8-12-2016
Presentation outline
• Definition of the family
• Types of families
• Function of the family
• Definition of family life cycle
• Duvall's family life cycle stages for the two parent nuclear family
• Variations of the family life cycle
• Criticisms of the family life cycle
LEARNING OBJECTIVES
 Define the family ,types and function.
 Define family life cycle, stages and tasks.
 Identify the stages of family life cycle, tasks and health challenges
of a two parent nuclear family, divorced parent family and
stepparent family
 Knowledge of the criticisms of family life cycle
Pre-presentation Test
1. One of these is not directly related to family life cycle development
a) Duvall
b) Miller
c) Feldman
d) Erikson
2. Duvall’s family life cycle stages does not include
a) Child Bearing Family
b) Families with school children
c) Families in Retirement
d) Between Families
e) Middle aged Parents
3. Usually Reliable predictions can be made regarding the common health
concern and forces that are at play within a family if the family physician
knows
a) The developmental task at each member
b) The family life cycle stage
c) Where the family lives and their social class
d) The number of children in the family
e) The occupation of the breadwinner.
4. The stage in family life cycle is defined by Duvall in terms of
a) The age of the oldest child
b) The ages of the parents
c) The age at the middle child
d) The years of marriage
e) The health condition of bread winners
Definition of Family
The family has been defined as
• That group of individuals who are related to a patient biologically,
legally or by choice (Pequegnat and bray 1997) , from whom the
patient can reasonably expect a measure of support in the form of
food, shelter, finance and emotional nurturing and that share a past,
present and a future.
• Any person who plays significant role in an individuals life
irrespective of biological or legal relationship (Wikipedia)
• A group of people who are closely related by birth, marriage or
adoption.
• An open and developing system of interacting personalities with
structure and process enacted in relationships among the individual
members regulated by resources and stressors and existing within the
larger community (Smith & Maurer, 1995).
• Two or more people who live in the same household (usually), share a
common emotional bond, and perform certain interrelated social tasks
(Spradly and Allender 1996).
• An organization or social institution with continuity, having a past, present
and future, in which there are certain behaviors in common that affect each
other.
TYPES OF FAMILY
• There are different types of families. They change overtime as a
consequence of Birth, Death, migration, separation and growth of family
members.
A. Based on Structure
 Nuclear – A father, a mother with child/children living together but apart
from both sets of parents and other relatives.
 Extended – Composed of two or more nuclear families economically and
socially related to each other. It is multigenerational including married
brothers and sisters and the families.
 Single parent – These are divorced or seprated, unmarried or widow
male or female with at least are child.
 Blended / Reconstituted – A combination of two families with
children from both families and sometimes children of the newly
married couple. It is also remarriage with children from previous
marriage.
 Compound – One man/woman with several spouses.
 Communal – More than one monogamous couple sharing resources.
 Cohabiting/Live-in-unmarried couple living together.
 Dyad – Husband and wife or a couple living together alone without
children.
 Gay/Lesbian- homosexual couple living together with or without
children.
 No-Kin – A group of at least two people sharing a relationship and
exchange support who have no legal or blood tie to each other.
 Foster- Substitute family for children whose parents are unable to
care for them.
B. Based on Functional Type:-
 Family of procreation – Refers to the family you yourself created.
 Family of Orientation:- Refers to the Family where you came from.
C. Based on Decisions in the Family (Authority)
 Patriarchal- Full authority on the father or any male member of the
Family e.g. eldest son, grandfather.
 Matriarchal- full authority on the mother or any female member of
the family e.g. eldest sister, grandmother.
 Egalitarian- husband and wife exercise a more or less amount of
authority, father and mother decides.
 Matricentric- The mother decides, takes charge in absence of the
father (e.g. father is working overseas).
 Patricentric- the father decides/takes charge in the absence of the
mother.
D. Based on Descent:-
This has to do with cultural norms, which affiliate a person with a
particular group or kinsmen for certain social purposes.
 Patrilineal- A pattern of descent where the children belong to the
kin group of their father seen in patrilocal societies
Bilateral- both parents
Matrilineal- opposite of patrilineal
E. Based on Residence:-
 Patrilocal- Family resides with or stays near the parents of the husband.
 Matrilocal – Family live with or near the domicile of the parent of the wife
 Noelocal -- Their own separate residence independent of their parents.
FUNCTIONS OF THE FAMILY
According to Nathan Ackerman the functions of the family can be summarized
as thus:-
1. Insuring the physical survival of the species.
2. Transmitting the culture thereby insuring man’s humanness.
 Physical functions of the family are met through parents providing food,
clothing and shelter, protection against danger, provision for bodily repairs
after fatigue or illness, and through reproduction.
 Affectional function- the family is the primary unit in which the child tests
his emotional reactions.
 Social functions- include providing togetherness, fostering self esteem and a
personal identity tied to family identity, providing opportunity for observing
and learning social and sexual roles, accepting responsibility for behavior
and supporting individual creativity and initiative.
• The Universal Function of the Family by Doode are
 Reproduction- For replacement of members of society to perpetuate
the human species.
 Status placement of individual in society.
 Maintenance of the young and dependant members.
 Socialization and care of children.
 Social control.
FAMILY LIFE CYCLE
A cycle is by dictionary definition (Merriam-Webster), a set of events or
actions that happen again and again in the same order: a repeating
series of events or actions.
Family life cycle is a dynamic process of change that occurs in a family
involving stages of development which reflect the biological functions
of raising children.
Family Life Cycle as will be discussed today will deal more with the
nuclear family.
Evelyn Duvall and Reuben Hill, Beginning in the 1940s were the two
family scholars who first developed the theoretical aspects of the
family Developmental theory (Burr 1995).
This theory describes family life overtime as divided into a series of
stages.
 A family stage is an interval of time in which the structure and
interaction of role relationships in the family are qualitatively and
quantitatively distinct from other periods (Klein and White, 1996).
 Family transitions are shifts from one stage to another and can be
viewed over time as consisting of paths taken and not taken (Klein
& White).
 Family stages cover sizable time spans and although transitions link
one stage to another, there are breaks that give each stage its
distinctive character.
 Staging in family life cycle assumes that there is high family
interdependence
The three basic assumptions of family developmental theory as outlined
by Aldous(1996) are:
1. Family behavior is the sum of the previous experiences of family
members as incorporated in the present and in the future.
2. Families develop and change over time in similar and consistent
ways.
3. Families and their members perform certain time –specific tasks that
are set by them and by the cultural and societal context .
• In 1962 Duvall was among the first to divide the family life cycle
into 8 stages with developmental tasks at each stage.
• These stages were based on the following criteria of :-
a. Major change in Family size
b. The developmental stage of the oldest child (with the exception
of the last two stages of family life cycle when children are no
longer present in the family), and
– c. The work status of the Breadwinner.
• Family developmental task refer to growth responsibilities that
must be achieved by a family during each stage of its development
so as to meet
a. Its biological requirements
b. Its Cultural Imperatives and
c. Its own aspirations and values (Duval, 1977; Klein & white,
1996)
• If the carrying out of any task is incomplete,
Impeded or disturbed, the family development may be delayed or
suspended
•Thus these tasks help in accomplishing the functions of the family
as earlier enumerated.
•Family life cycle is also part of family medicine tool – used to
assess family development.
Other family assessment tools used in Family Medicine include :-
1. Family Anatomy- Genogram
2. Family function - APGAR, FACES, FES
family ecomap, family life spiral, family circle
Life Line
SCREEM
•Apart from Duval other theorists of the family developmental stages
include Feldman (1961), Rogers (1964) Zilbach (1989) Carter &
McGoldrick (1980) and Rankin (1989) who talked about
1. The Emerging Family
2. The Solidifying family
3. The Reconstituting Family and
4. The Contracting Family
TWO PARENT NUCLEAR FAMILY LIFE
CYCLE
• Duvall and Miller (1985) Described 8 stages of Family life cycle.
• Carter & McGoldrick (1989) added a ninth stage “Between Families
Stage”
• This addition was to give a more comprehensive depiction of
changes in family life.
• These family life cycle stages portray the intact nuclear family but
are limited in their applicability to single, divorced and stepparent
families.
DUVALL’S EIGHT-STAGE FAMILY LIFE CYCLE
 Stage I -- Beginning Families (or the stage of marriage).
 Stage II -- Childbearing families (the oldest child is an infant
through 30months)
 Stage III -- Families with preschool school children (Oldest child is
2½ to 6years of age.
 Stage IV -- Families with school children (oldest child is 6 to 13
years of age).
 Stage V Families with teenagers (oldest child is 13 to 20 years of
age).
 Stage VI -- Families launching young adults (Covering the first
child who has left through the last child learning home).
 Stage VII -- Middle aged parents (empty nest through retirement).
 Stage VIII -- Family in retirement and old age (also referred to as
aging family members or retirement to death of both spouses).
TRANSITIONAL STAGE: BETWEEN FAMILIES
(THE UNATTACHED YOUNG ADULT).
 This stage refers to the period of time when individuals are in their
20s, have become financially independent and have physically left
their families of origin but have not begun their own family of
marriage.
 Duvall and some of the other theorists do not consider this a family
life cycles stage but this stage is important because of the impact of
the stage to all the successive stages to follow (Aylmer 1988).
• This stage is also commonly experienced these days since
adolescents do not go directly from their family at origin to a family of
marriage; as was more frequently seen in the past.
•How the young adult goes through this stage affects his or her choice
of marriage partner and when as well as how marriage occurs.
Development Task
 Developing intimate peer relationships.
Establishing work and financial independence
Separating from family of origin without cutting off ties to the
family members or without attaching reactively to an emotional
surrogate.
 Developing responsible sexual relationships which includes
 Family planning
 Safe sexual practices
 Preventing sexually transmitted diseases e.g. HIV, Hepatitis
B & C.
Health Care Concerns
 Prevent accidents
 Good mental health
 Suicide
 Good health practices e.g. sleep, nutrition, exercise.
Family Life Cycle
• Beginning Family = Newly weds
Stages I
The Beginning Families
• This is the stage of marriage.
• The formation of the couple marks the beginning of a new family
with the movement from the former family of origin to the new
intimate relationship.
Developmental Task
 Establishing a mutually satisfying marriage.
 Relating harmoniously to the kin network.
 Planning a family – Decisions about parenthood.
Health Care Concerns
 Family planning education and counseling.
 Prenatal education and counseling.
 Sexual and marital role adjustment.
 Counseling should be provided premaritally.
 Lack of information often results in sexual and emotional, problems,
fear, guilt feelings, unplanned pregnancies and veneral disease either
before or after marriage.
 These unfortunate events do not allow the couple to plan their lives
and begin their relationship with stable foundation.
STAGE II
• Child Bearing Family = expanding
Stage II
Child Bearing Families
 Stage II begins with the birth of the first child and continues through
the infants 30th month.
 The transition to parenthood is a key one in the family life cycle.
 With the birth of the first child, the family is now a threesome,
making it a permanent system for the first time (i.e. the system
endures regardless of the outcome of the marriage( McGoldrick,
Heinman and Cater 1993).
 Although parenthood is a very important goal for most couples,
most find it a stressful life transition.
Developmental tasks
 Setting up the young family as a stable unit. This involves integrating
of the new baby into the family.
 Reconciling conflicting developmental tasks and needs of various
family members.
 Maintaining a satisfying marital relationship.
 Expanding relationships with extended family by adding parenting
and grand parenting roles.
Specific Parenting Tasks
 Establishing routines in daily care activities.
 Fostering trust by maintaining consistent interactions.
 Modifying the home environment to meet the growing infants needs.
 The division of labour among family members in providing for the
infants needs.
 Developing effective communication patterns to accommodate
emerging differences in parental role expectations.
 Support the Childs growing autonomy in a safe environment.
Health Care Concerns
 Issues related with pregnancy e.g. morning sickness, PIH
 Preparation for birth experiences.
 Transition to parenthood.
 Infant care.
 Prompt recognition and appropriate handling of physical health
problems with the child
 Immunizations.
 Normal growth and development.
 Safety measures
 Family planning
 Family interaction issues
 Good health practices (sleep, nutrition, exercise).
 Healthy relationship between parent and child
 Parenting role (Issues such as child abuse and neglect).
Families with pre-school children
Stage III
Families with Preschool Children
• This stage commences when the first born child is about 2½ years
old and terminates when he or she is 5 years of age.
• The family now may consist of three to five persons with the paired
positions of husband-father, wife-mother, son-brother, daughter-
sister.
• The family is becoming more complex and differentiated (Duvall
and Miller, 1985).
• The family life during this stage is busy and demanding for the
parents.
• Both parents have greater demands on their time, as it is probable
that the mother is working also either part or full time.
Family developmental tasks.
• Socializing the children
• Integrating new child members while still meeting needs of other
children
• Maintaining healthy relationship within the family (marital and
parent-child)and outside the family (extended family and
community)
• Meeting family members needs for adequate housing , space,
privacy and safety
Specific parenting tasks
 Support the development of creativity and problem-solving skills
 Help the children to understand each other's view points.
 Define socially acceptable behaviors .
 Teach safety around the home and neighborhood
Health care concerns
 Accident prevention and home safety (e.g falls, burns, poisoning)
 Sibling relationships
 Family planning
 Communicable diseases of children
 Growth and development needs
 Parenting issues
 Child abuse and neglect
 Good health practices (e.g sleep, nutrition, exercise,)
 Home safety
 Family communication problems
Families with school aged children
STAGE IV
FAMILIES WITH SCHOOL- AGED
CHILDREN
• This stage begins when the first born child enters school fulltime
,usually at the age of 5 years and concludes when he or she reaches
puberty ,around 13 years of age
• Each person is working on his or her own developmental tasks ,just
as the family attempts to fulfill its tasks
• According to Erikson (1950),parents are struggling with the twin
demands of finding fulfillment in rearing the next generation (the
developmental task of generativity),and being concerned in their
own growth ;at the same time, school-aged children are working at
developing a sense of industry– the capacity for work enjoyment –
and trying to eliminate or ward off a sense of inferiority .
• Families usually reach their maximum numbers at the end this stage
(Duvall& Miller1985)
• The children have their own activities and interests in addition to the
mandatory activities of life and school, and the parents also have
their own different activities .
• Peer relationships and outside activities play larger roles in the
school aged child.
• Parents who have interest outside of their children will find it much
easier to make the gradual separation unlike in instances where the
mothering role is the central and only significant role in a womans
life.
Developmental task
 Socializing the children, including promoting school achievement
and fostering of healthy peer relations of children.
 Maintaining a satisfying mental relationship
 Meeting the physical health needs of family members.
 Learning to deal with the child's separation or more simply letting
the child go.
Specific Parenting Task
 Promote cognitive development
 Maintain discipline
 Foster a sense of social responsibility
 Learn to accept rejection as child assumes greater self sufficiency.
 Encourage involvement in appropriate interest . and activities
outside the family
Health care concern
 Health challenges to children (e.g. vision, hearing , speech.)
 Dental health
 Child abuse and neglect
 Substance abuse
 Communicable diseases
 Chronic conditions
 Behavior problems
 Good health practices
Families with teenagers
STAGE V
FAMILY WITH TEENAGERS
• This stage starts when the firstborn turns 13years of age and usually
last about six to seven years, although it can be shorter if the child
leaves the family early or longer if the child remains home later than
19 or 20 years of age.
• The main goal at this stage is that of loosening family ties to allow
greater responsibility and freedom for the teenager in preparation for
becoming a young adult ( Duvall and miller 1985).
• Parents no longer maintain complete authority, nor can they abdicate
authority either.
• There are rule changing's limit setting, and role renegotiations.
• The major challenges in working with a family at this stage revolves
around the mental changes adolescents undergo in terms of cognitive
changes, identity formation and biological growth (Kidwell, Fischer
Dulham and Baranowski 1983)
Developmental Tasks
 Balancing of freedom with responsibility as teenagers mature and
become increasingly autonomous
 Refocusing the marital relationship
 Communicating openly between parents and children
 Maintaining the families ethical and moral standard.
Specific Parenting Task
 Maintenance of open lines of communication.
 Granting of greater responsibilities to the children
 Negotiating and consistently apply home rules
 Affirming the adolescent’s developing sense of self and identity
 Balancing freedom with responsibility as teenagers mature and
emancipate themselves
 Parents should learn to accept rejection without deserting the child.
Health Care Concerns
 Accidents
 Sports injuries
 Drug and alcohol misuse
 Sex education
 Unexpected pregnancies
 Marital relationship
 Adolescent parent relationship
 Good health practices.
Families launching young adults
STAGE VI
Families Launching Young Adults
• This stage begins when the first child leaves home and ends when
the last child has left home.
• This stage could be quite short or fairly long, depending on how
many children are in the family or if any unmarried children remain
at home after finishing university or college.
• the usual length of this stage is six or seven years, though in recent
years the stage is longer in some families due to more older children
living at home after they have finished school and may have started
working– usually due to economic reason
• parents as they let their children go are relinquishing 20 years or so
of the parenting role and returning to their original marital dyad.
• The major family goal is the reorganization of the family into a
continuing unit while releasing matured young people into lives of
their own (Duvall and Miller, 1985).
• The marital pair may take on grandparent roles which creates another
change in both roles and their self image.
• This stage has been characterized as the “caught” period of life caught
between the demands of youth and the expectations of the elderly and
caught between the world of work and the competing demands and
involvement of the family
• It is usually challenging meeting the demands of both realms
• This period may be associated with menopause, it is a stage also when
men in their middlescence face crisis such as
a) The drive to get “ahead” in their careers with the realization
that they have not succeeded or have not reached their
aspirations.
b) Financial worries
c) Signs of diminishing masculinity such as lower energy levels
and lessened potency and sexual excitation as well as figure ,
hair and skin aging signs.
• The frequency of extramarital affairs, divorces , mental illness,
alcoholism may increase at this stage.
Developmental Task
 Expanding the family circle to young adults including new family
members acquired by marriage
 Continuing to renew and readjust in the marital relationships
 Assisting aging and ill parents of the husband and wife.
Health Care Concerns
 Communication issues between parents and young adult
 Role transitional problems for husband and wife
 Emergence of chronic health problems
 Family planning for young adults
 Menopausal concerns
 Effects associated with prolonged drinking, smoking and poor
dietary practices
 Wellness lifestyles
 Challenges of decreasing masculinity
 Preventive medical screening for some diseases
Middle aged parents
STAGE VII
MIDDLE AGED PARENTS
• The seventh stage begins when the last child departs from the home --
“empty nest” and ends with retirement or death of one of the spouses
• The marital couple in their middle years constitute a nuclear family,
although still interacting with their aging parents and other members of
families of origin, as well as with the new families of marriage of their
children.
• Many middle class workers suffer from the “plateau phenomenon” in
which salaries and promotions are no longer available leading to
feelings of discontentment, boredom and stagnation.
• On the other hand in this times of company downsizing, the threat of
occurrence of being laid off or retirement significantly influence a man’s
stress level and general health status
• At this stage the couple become more aware of the needs for healthier
lifestyles
• The motivation of the middle aged persons to improve their lifestyle
appears to come from the following.
a) feelings of susceptibility or vulnerability to illness and disease generated
when a friend or family members of the same age group has health
challenges such as a heart attack, stroke or cancer
b) A belief that regular checkups and healthful living habits are effective
ways to reducing susceptibility to various diseases
• Although “better now than never” it may be difficult or late to
reverse certain pathological changes that have taken place such as
arthritic changes due to inactivity, moderate to severe weight gain,
high blood pressure due to atherosclerosis , lack of exercise,
prolonged stress, poor dietary habits and vital lung capacity
diminution due to years of smoking etc.
• “Generational Squeeze” – many women find themselves in a
generational squeeze as they attempts to balance the needs of their
aging, frail or ill parents, their children and grand children
Developmental Task
 Providing a health-promoting environment
 Sustaining satisfying and meaningful relationships with aging
parents and children
 Strengthening the marital relationship
 Accepting and welcoming grandchildren into the family.
Health Care Concerns
 Promoting good health practices such as adequate rest , leisure
activities, sleep, good nutrition, regular exercise programme,
reduction of weight to optimum , cessation of smoking, reduction
or cessation in the use of alcohol
 Maintaining good marital relationships
 Communicating with and relating to children , in-laws, grand
children and aging parents.
 Care giving issues and concern
 Issues relating to social isolation and financial difficulties
 Adjustment to physiological changes of aging
 Coping with emergence of chronic illness eg. Arthritis, HTN, obesity
 Preventive health screening examinations – prostrate CA, colorectal
CA, breast CA.
Families in retirement and old age
STAGE VIII
FAMILIES IN RETIREMENT AND OLD AGE
• The last stage of the family life cycle begins with the retirement of one
or both spouses, continues through the loss of one spouse and ends with
the death of the other spouse (,Duvall and Miller 1985).
• As a result of improved disease prevention and health care more people
are expected to survive into their 9th and 10th decade of life especially in
developed countries.
• Perceptions of this stage of the life cycle differs significantly among
aging families.
• Some persons are miserable while others feel that these are the best
years of their lives
• Although much is dependent on the adequacy of financial resources and
the ability to maintain satisfactory home, one’s health status has been
identified as a primary predictor of the of the well being of older
persons (Brubaker, 1990, Quinn 1993).
• The more health difficulties experienced, the more likely the
presence of negative feelings towards old age
• Those who have lost their independence due to ill health have low
morale and poor physical health and these often leads to behavioral
and psychological problems (Chilman, Nunnally and Cox 1998)
• Conversely those elders who have maintained their health, kept
active, and have adequate economic resources usually feel positive
about this stage of life.
Losses Common to Aging People and families
 Economic – adjusting to a substantially reduced income, later perhaps
adjusting to economic dependency (depending on family or government for
subsidy)
 Housing – often moving to smaller quarters
 Social – loss (death) of siblings, friends and spouse
 Work – voluntary or involuntary retirement and loss of the work role and a
sense of productivity
 Health – declining physical, mental, and cognitive functions, care giving for
the less healthy spouse
Developmental Task
 Maintaining a satisfying living arrangement
 Adjusting to a reduced income
 Maintaining marital relationship
 Adjusting to loss of spouse
 Maintaining intergenerational family ties
 Continuing to make sense out one’s existence (life review and integration)
Health Care Concern
 Increasing functional disabilities
 Mobility impairment
 Chronic illness
 Diminished physical vigor and function
 Long term care services
 Care giving
 Social isolation
 Grief / depression
 Cognitive impairment.
Summary of Duvall's eight stages of family life cycle
and tasks
STAGES
1. Beginning family
2. Child bearing family
3. Families with pre-school
children
4. Families with school children
5. Families with teenagers
6. Launching center family
7. Middle aged families
8. Ageing families
TASKS
1. Physical maintenance
2. Allocation of resources
3. Division of labour
4. Socialization of members
5. Recruitment and release of
members
6. Maintenance of order
7. Placement of members into
the larger society
8. Maintenance of motivation
and morals
Variations in the family life cycle
Divorced family life cycle
• The single parent, divorced family passes through the same life
cycle stages, with most of the same responsibility as the two - parent
nuclear family
• The basic difference in this case is the absence of the second parent
to carry his or her (mostly his) share of the family task with respect
to support, child rearing, companionship, and gender role modeling
for the children.
• Cater and McGoldrick (1989) conceptualizes divorce as an
interruption or dislocation of the traditional family life cycle.
• Divorce brings about losses and shifts in family membership and as
a result it creates major family destabilization and disequilibrium
• There are crucial changes in roles and relationships and important
family developmental tasks to be completed in order for the divorced
family to move forward developmentally ( Carter and Mc Goldrick,
1989)
• After divorce, family systems research has found that it takes about one
to two years for the family to restabilize itself but some take longer
• The impact of divorce on the family varies depending on when the
divorce occurs.
• Other factors which also make a difference on impact include ethic,
social and economics and issue of custodialship.
• Divorce is least disruptive during the first stage of family life cycle as
there are fewer people involved, fewer traditions established, and fewer
couple – bases social ties (Peck and Manocharian, 1988), and no child
yet.
• The impact is much greater during the third and fourth stages but the
family is also at high risk for divorce during these periods.
• In later stages of the family cycle , children are likely to be affected less
profoundly than in previous family stages because they are older and better
able to cope and function more autonomously.
• In these later family life cycle stages, divorce is typically profoundly
traumatizing to the divorced partners.
• This is because years of shared possessions, memories and habits have
created a “couple identity”.
• Single parenting is often very challenging for the mother, who struggles both
economically and emotionally.
• The father may loose his sense of connection to his children and because of
the mother’s anger at the father, she leaves no room for him ,yet
maintaining both the mother – child and father – child relationships is very
important for both parents and children
• Unfortunately for both father and children, a large proportion of children
virtually lose contact with their fathers after divorce (Hagestad 1988).
• TABLE FOR LIFE CYCLE OF DIVORCED
FAMILLIES(CARTER AND McGOLDRICK)
Developmental Task for children in Divorced Families
(Thompson and Rudulph 1992)
 Resolving feelings of anxiety, abandonment and denial
 Disengaging from parental conflict and distress and resuming their regular
activities.
 Resolution of loss
 Resolving anger and self blame
 Accepting the performance divorce
 Developing realistic hopes regarding relationships
Family Life Cycle in Stepparent Families
 Divorce is sometimes a transitional state followed by remarriage,
 If early death of a spouse occurs, the one left behind may also remarry.
 The family’s emotional process at the transition to remarriage is
typically one that involves
a) struggling with fears about investment in a new relationship
and a new family
b) Dealing with hostile or upset reactions of the children,
extended families and the ex-spouse
c) Feeling guilt and concern over the welfare of the children.
d) Renewing or establishing of attachment (negative or
positive) to the ex-spouse or new spouse.
• The stepparent - stepchild relationship is generally
considered to be the most problematic and stressful
relationship in stepfamilies requiring considerable
strategies to develop warm and affectionate bonds
between family members (Ganong, Coleman and Fine,
1995).
Table of family life cycle
Family Life Cycle of Domestic Partner
Relationship
 Domestic Partnership refer to gay, lesbian and heterosexual
cohabitants who have an intimate relationship and are financially
interdependent (Ames, 1992)
Gay/Lesbian Family Life Cycle
• Slater's model of the lesbian/gay family life cycle reflects the rich
diversity and points of common experience among lesbian/gay
families.
• Slater (1995) describe five stages which are sequential and with
limited duration, some stages enduring for longer than others. The
couples adaptations to the challenges of previous stages become
incorporated into their relationship and strengthen or diminish their
capacity to confront subsequent obstacles
For an in depth discussion of lesbian family life cycle – see slater’s
book - The Lesbian family life cycle .
–FAMILY LIFE CYCLE
Impact of Illness and Disability on family life
Cycle Stages
 When a family member is seriously ill or has long term disability the
functioning of the family is significantly affected, just as the behavior of the
family and its members simultaneously affects the course and characteristic
of the illness or disability (Bahrsan 1987)
 Often when a family is delayed in meeting its family developmental task, it
is the interaction of the developmental demands / stress and a situational
demands / stress that compounds and over loads the family
 The added family stress created by the pressure of both types of stressors
often result in lowered family functioning, where by mastering of family
developmental task becomes impeded or retarded.
 The extent to which family developmental task are affected depends on
several factors such as -
a) The stage in family life cycle.
b) Which family member is seriously ill or disabled
c) The formal and informal resources the family is utilizing e.g.. Family,
friends , health and psychosocial supports.
 Some particulars stages are more developmentally challenging than others
and completing family developmental task of a some stages are more
crucial for certain family members for instance - in a family with a
teenager, if the adolescent sustains a serious injury and is left in a
dependent state, this will greatly impede the adolescents own mastery of
the developmental task of becoming more independent from the family.
Likewise, the family’s task dealing with balancing freedom with
responsibility so as to assist the teenager to become increasingly
autonomous will also be impede.
The challenge for the family therefore is to attempt to resume working
on normal developmental family task as soon as possible
 when working with a family with a member who has a serious
illness or disability, it is useful to compare the “ideal” family
developmental task within the appropriate family life cycle stage
with the family’s actual behavior (Friedman, 1987), this type of
comparison is useful in evaluating the probable impact of the illness
or disability on the family.
Criticisms of Family Life Cycle
1. Its assumption of homogeneity i.e. it’s lack of adequate attention
to family diversities.
2. It has a middle – class bias
3. It assume stability at each stage
4. It does not explain the process that occur between stages that
allow families to change.
5. Families don't always experience stages in sequential order.
6. Major life events can disrupt stages e.g. natural disasters.
7. All families are not nuclear families.
conclusion
• The basic notion of family life cycle is that families need to
be assessed as a dynamic unit .
• Family life cycle focuses on normative events such as
marriage , child bearing, children education etc
• One way the family physician understands families is to
become familiar with issues that arises at various
developmental stages of the family life cycle, the
developmental tasks of each stage as well as health challenges
associated with the stage
• These stages differ, depending on the kind of family and
understanding these issues enable’s the family physician help
families cope with changes, stresses and strains that occur as
the families mature.
Clinical Application
Mrs. Ifiok is in your clinic with her 16year old son, she and her husband both in
their early 60s, feel they are having a difficult time raising their third child
Joshua who is an active adolescent , Joshua has two siblings :- 18year old
Mary who has just left for university and 28year old Anthony, who will be
getting married in 6 months time. Mrs. Ifiok and her husband are feeling
quite stressed by Anthony’s wedding plans, Anthony is living at home and
has been living at home even through his university years, Mary is the first
child to leave the home as her university is far away, Joshua has teamed
with a group of friends who are known in the community for the rough
behavior, he is now addicted to Indian hemp.
Mrs. Ifiok is confuse by his recent attachment to this group as he has always
been a compliant child and dedicated to his studies.
Questions:
1. Identify the life cycle stage of this family and state your reasons
2. State the developmental task this family must achieve during this
stage and give your assessment
3. What steps can you take to help this family.
• THANK YOU
Reference
• Lee Gen ,Azor A , wonodirekso.Family practice
Singapore , 2004 section 3 chapter 3 pp 58 – 64.
• Bowden V , Dickey s, & Greenberg C. 1998 .Children
and their families : the continuum of care p 105.
• Cater B & McGoldrick M .1989.The changing family
life cycle :A frame work for family therapy pp 22– 24.
• Slater 1995 The lesbian / gay family career

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Family life cycle

  • 1. Family Life Cycle Dr Ogechukwu Mbanu Department of Family Medicine AKTH 8-12-2016
  • 2. Presentation outline • Definition of the family • Types of families • Function of the family • Definition of family life cycle • Duvall's family life cycle stages for the two parent nuclear family • Variations of the family life cycle • Criticisms of the family life cycle
  • 3. LEARNING OBJECTIVES  Define the family ,types and function.  Define family life cycle, stages and tasks.  Identify the stages of family life cycle, tasks and health challenges of a two parent nuclear family, divorced parent family and stepparent family  Knowledge of the criticisms of family life cycle
  • 4. Pre-presentation Test 1. One of these is not directly related to family life cycle development a) Duvall b) Miller c) Feldman d) Erikson 2. Duvall’s family life cycle stages does not include a) Child Bearing Family b) Families with school children c) Families in Retirement d) Between Families e) Middle aged Parents 3. Usually Reliable predictions can be made regarding the common health concern and forces that are at play within a family if the family physician knows a) The developmental task at each member b) The family life cycle stage c) Where the family lives and their social class d) The number of children in the family e) The occupation of the breadwinner.
  • 5. 4. The stage in family life cycle is defined by Duvall in terms of a) The age of the oldest child b) The ages of the parents c) The age at the middle child d) The years of marriage e) The health condition of bread winners
  • 6. Definition of Family The family has been defined as • That group of individuals who are related to a patient biologically, legally or by choice (Pequegnat and bray 1997) , from whom the patient can reasonably expect a measure of support in the form of food, shelter, finance and emotional nurturing and that share a past, present and a future. • Any person who plays significant role in an individuals life irrespective of biological or legal relationship (Wikipedia) • A group of people who are closely related by birth, marriage or adoption. • An open and developing system of interacting personalities with structure and process enacted in relationships among the individual members regulated by resources and stressors and existing within the larger community (Smith & Maurer, 1995).
  • 7. • Two or more people who live in the same household (usually), share a common emotional bond, and perform certain interrelated social tasks (Spradly and Allender 1996). • An organization or social institution with continuity, having a past, present and future, in which there are certain behaviors in common that affect each other. TYPES OF FAMILY • There are different types of families. They change overtime as a consequence of Birth, Death, migration, separation and growth of family members. A. Based on Structure  Nuclear – A father, a mother with child/children living together but apart from both sets of parents and other relatives.  Extended – Composed of two or more nuclear families economically and socially related to each other. It is multigenerational including married brothers and sisters and the families.
  • 8.  Single parent – These are divorced or seprated, unmarried or widow male or female with at least are child.  Blended / Reconstituted – A combination of two families with children from both families and sometimes children of the newly married couple. It is also remarriage with children from previous marriage.  Compound – One man/woman with several spouses.  Communal – More than one monogamous couple sharing resources.  Cohabiting/Live-in-unmarried couple living together.  Dyad – Husband and wife or a couple living together alone without children.  Gay/Lesbian- homosexual couple living together with or without children.
  • 9.  No-Kin – A group of at least two people sharing a relationship and exchange support who have no legal or blood tie to each other.  Foster- Substitute family for children whose parents are unable to care for them. B. Based on Functional Type:-  Family of procreation – Refers to the family you yourself created.  Family of Orientation:- Refers to the Family where you came from. C. Based on Decisions in the Family (Authority)  Patriarchal- Full authority on the father or any male member of the Family e.g. eldest son, grandfather.  Matriarchal- full authority on the mother or any female member of the family e.g. eldest sister, grandmother.  Egalitarian- husband and wife exercise a more or less amount of authority, father and mother decides.
  • 10.  Matricentric- The mother decides, takes charge in absence of the father (e.g. father is working overseas).  Patricentric- the father decides/takes charge in the absence of the mother. D. Based on Descent:- This has to do with cultural norms, which affiliate a person with a particular group or kinsmen for certain social purposes.  Patrilineal- A pattern of descent where the children belong to the kin group of their father seen in patrilocal societies Bilateral- both parents Matrilineal- opposite of patrilineal E. Based on Residence:-  Patrilocal- Family resides with or stays near the parents of the husband.  Matrilocal – Family live with or near the domicile of the parent of the wife  Noelocal -- Their own separate residence independent of their parents.
  • 11. FUNCTIONS OF THE FAMILY According to Nathan Ackerman the functions of the family can be summarized as thus:- 1. Insuring the physical survival of the species. 2. Transmitting the culture thereby insuring man’s humanness.  Physical functions of the family are met through parents providing food, clothing and shelter, protection against danger, provision for bodily repairs after fatigue or illness, and through reproduction.  Affectional function- the family is the primary unit in which the child tests his emotional reactions.  Social functions- include providing togetherness, fostering self esteem and a personal identity tied to family identity, providing opportunity for observing and learning social and sexual roles, accepting responsibility for behavior and supporting individual creativity and initiative.
  • 12. • The Universal Function of the Family by Doode are  Reproduction- For replacement of members of society to perpetuate the human species.  Status placement of individual in society.  Maintenance of the young and dependant members.  Socialization and care of children.  Social control.
  • 13. FAMILY LIFE CYCLE A cycle is by dictionary definition (Merriam-Webster), a set of events or actions that happen again and again in the same order: a repeating series of events or actions. Family life cycle is a dynamic process of change that occurs in a family involving stages of development which reflect the biological functions of raising children. Family Life Cycle as will be discussed today will deal more with the nuclear family. Evelyn Duvall and Reuben Hill, Beginning in the 1940s were the two family scholars who first developed the theoretical aspects of the family Developmental theory (Burr 1995).
  • 14. This theory describes family life overtime as divided into a series of stages.  A family stage is an interval of time in which the structure and interaction of role relationships in the family are qualitatively and quantitatively distinct from other periods (Klein and White, 1996).  Family transitions are shifts from one stage to another and can be viewed over time as consisting of paths taken and not taken (Klein & White).  Family stages cover sizable time spans and although transitions link one stage to another, there are breaks that give each stage its distinctive character.  Staging in family life cycle assumes that there is high family interdependence The three basic assumptions of family developmental theory as outlined by Aldous(1996) are:
  • 15. 1. Family behavior is the sum of the previous experiences of family members as incorporated in the present and in the future. 2. Families develop and change over time in similar and consistent ways. 3. Families and their members perform certain time –specific tasks that are set by them and by the cultural and societal context . • In 1962 Duvall was among the first to divide the family life cycle into 8 stages with developmental tasks at each stage. • These stages were based on the following criteria of :- a. Major change in Family size b. The developmental stage of the oldest child (with the exception of the last two stages of family life cycle when children are no longer present in the family), and – c. The work status of the Breadwinner.
  • 16. • Family developmental task refer to growth responsibilities that must be achieved by a family during each stage of its development so as to meet a. Its biological requirements b. Its Cultural Imperatives and c. Its own aspirations and values (Duval, 1977; Klein & white, 1996) • If the carrying out of any task is incomplete, Impeded or disturbed, the family development may be delayed or suspended •Thus these tasks help in accomplishing the functions of the family as earlier enumerated. •Family life cycle is also part of family medicine tool – used to assess family development.
  • 17. Other family assessment tools used in Family Medicine include :- 1. Family Anatomy- Genogram 2. Family function - APGAR, FACES, FES family ecomap, family life spiral, family circle Life Line SCREEM •Apart from Duval other theorists of the family developmental stages include Feldman (1961), Rogers (1964) Zilbach (1989) Carter & McGoldrick (1980) and Rankin (1989) who talked about 1. The Emerging Family 2. The Solidifying family 3. The Reconstituting Family and 4. The Contracting Family
  • 18. TWO PARENT NUCLEAR FAMILY LIFE CYCLE • Duvall and Miller (1985) Described 8 stages of Family life cycle. • Carter & McGoldrick (1989) added a ninth stage “Between Families Stage” • This addition was to give a more comprehensive depiction of changes in family life. • These family life cycle stages portray the intact nuclear family but are limited in their applicability to single, divorced and stepparent families.
  • 19. DUVALL’S EIGHT-STAGE FAMILY LIFE CYCLE  Stage I -- Beginning Families (or the stage of marriage).  Stage II -- Childbearing families (the oldest child is an infant through 30months)  Stage III -- Families with preschool school children (Oldest child is 2½ to 6years of age.  Stage IV -- Families with school children (oldest child is 6 to 13 years of age).  Stage V Families with teenagers (oldest child is 13 to 20 years of age).  Stage VI -- Families launching young adults (Covering the first child who has left through the last child learning home).  Stage VII -- Middle aged parents (empty nest through retirement).  Stage VIII -- Family in retirement and old age (also referred to as aging family members or retirement to death of both spouses).
  • 20. TRANSITIONAL STAGE: BETWEEN FAMILIES (THE UNATTACHED YOUNG ADULT).  This stage refers to the period of time when individuals are in their 20s, have become financially independent and have physically left their families of origin but have not begun their own family of marriage.  Duvall and some of the other theorists do not consider this a family life cycles stage but this stage is important because of the impact of the stage to all the successive stages to follow (Aylmer 1988). • This stage is also commonly experienced these days since adolescents do not go directly from their family at origin to a family of marriage; as was more frequently seen in the past. •How the young adult goes through this stage affects his or her choice of marriage partner and when as well as how marriage occurs.
  • 21. Development Task  Developing intimate peer relationships. Establishing work and financial independence Separating from family of origin without cutting off ties to the family members or without attaching reactively to an emotional surrogate.  Developing responsible sexual relationships which includes  Family planning  Safe sexual practices  Preventing sexually transmitted diseases e.g. HIV, Hepatitis B & C.
  • 22. Health Care Concerns  Prevent accidents  Good mental health  Suicide  Good health practices e.g. sleep, nutrition, exercise.
  • 23. Family Life Cycle • Beginning Family = Newly weds
  • 24. Stages I The Beginning Families • This is the stage of marriage. • The formation of the couple marks the beginning of a new family with the movement from the former family of origin to the new intimate relationship. Developmental Task  Establishing a mutually satisfying marriage.  Relating harmoniously to the kin network.  Planning a family – Decisions about parenthood.
  • 25. Health Care Concerns  Family planning education and counseling.  Prenatal education and counseling.  Sexual and marital role adjustment.  Counseling should be provided premaritally.  Lack of information often results in sexual and emotional, problems, fear, guilt feelings, unplanned pregnancies and veneral disease either before or after marriage.  These unfortunate events do not allow the couple to plan their lives and begin their relationship with stable foundation.
  • 26. STAGE II • Child Bearing Family = expanding
  • 27. Stage II Child Bearing Families  Stage II begins with the birth of the first child and continues through the infants 30th month.  The transition to parenthood is a key one in the family life cycle.  With the birth of the first child, the family is now a threesome, making it a permanent system for the first time (i.e. the system endures regardless of the outcome of the marriage( McGoldrick, Heinman and Cater 1993).  Although parenthood is a very important goal for most couples, most find it a stressful life transition.
  • 28. Developmental tasks  Setting up the young family as a stable unit. This involves integrating of the new baby into the family.  Reconciling conflicting developmental tasks and needs of various family members.  Maintaining a satisfying marital relationship.  Expanding relationships with extended family by adding parenting and grand parenting roles. Specific Parenting Tasks  Establishing routines in daily care activities.  Fostering trust by maintaining consistent interactions.  Modifying the home environment to meet the growing infants needs.  The division of labour among family members in providing for the infants needs.
  • 29.  Developing effective communication patterns to accommodate emerging differences in parental role expectations.  Support the Childs growing autonomy in a safe environment. Health Care Concerns  Issues related with pregnancy e.g. morning sickness, PIH  Preparation for birth experiences.  Transition to parenthood.  Infant care.  Prompt recognition and appropriate handling of physical health problems with the child  Immunizations.  Normal growth and development.  Safety measures  Family planning  Family interaction issues
  • 30.  Good health practices (sleep, nutrition, exercise).  Healthy relationship between parent and child  Parenting role (Issues such as child abuse and neglect).
  • 32. Stage III Families with Preschool Children • This stage commences when the first born child is about 2½ years old and terminates when he or she is 5 years of age. • The family now may consist of three to five persons with the paired positions of husband-father, wife-mother, son-brother, daughter- sister. • The family is becoming more complex and differentiated (Duvall and Miller, 1985). • The family life during this stage is busy and demanding for the parents. • Both parents have greater demands on their time, as it is probable that the mother is working also either part or full time.
  • 33. Family developmental tasks. • Socializing the children • Integrating new child members while still meeting needs of other children • Maintaining healthy relationship within the family (marital and parent-child)and outside the family (extended family and community) • Meeting family members needs for adequate housing , space, privacy and safety Specific parenting tasks  Support the development of creativity and problem-solving skills  Help the children to understand each other's view points.  Define socially acceptable behaviors .  Teach safety around the home and neighborhood
  • 34. Health care concerns  Accident prevention and home safety (e.g falls, burns, poisoning)  Sibling relationships  Family planning  Communicable diseases of children  Growth and development needs  Parenting issues  Child abuse and neglect  Good health practices (e.g sleep, nutrition, exercise,)  Home safety  Family communication problems
  • 35. Families with school aged children
  • 36. STAGE IV FAMILIES WITH SCHOOL- AGED CHILDREN • This stage begins when the first born child enters school fulltime ,usually at the age of 5 years and concludes when he or she reaches puberty ,around 13 years of age • Each person is working on his or her own developmental tasks ,just as the family attempts to fulfill its tasks • According to Erikson (1950),parents are struggling with the twin demands of finding fulfillment in rearing the next generation (the developmental task of generativity),and being concerned in their own growth ;at the same time, school-aged children are working at developing a sense of industry– the capacity for work enjoyment – and trying to eliminate or ward off a sense of inferiority . • Families usually reach their maximum numbers at the end this stage (Duvall& Miller1985)
  • 37. • The children have their own activities and interests in addition to the mandatory activities of life and school, and the parents also have their own different activities . • Peer relationships and outside activities play larger roles in the school aged child. • Parents who have interest outside of their children will find it much easier to make the gradual separation unlike in instances where the mothering role is the central and only significant role in a womans life. Developmental task  Socializing the children, including promoting school achievement and fostering of healthy peer relations of children.  Maintaining a satisfying mental relationship  Meeting the physical health needs of family members.  Learning to deal with the child's separation or more simply letting the child go.
  • 38. Specific Parenting Task  Promote cognitive development  Maintain discipline  Foster a sense of social responsibility  Learn to accept rejection as child assumes greater self sufficiency.  Encourage involvement in appropriate interest . and activities outside the family Health care concern  Health challenges to children (e.g. vision, hearing , speech.)  Dental health  Child abuse and neglect  Substance abuse  Communicable diseases  Chronic conditions  Behavior problems  Good health practices
  • 40. STAGE V FAMILY WITH TEENAGERS • This stage starts when the firstborn turns 13years of age and usually last about six to seven years, although it can be shorter if the child leaves the family early or longer if the child remains home later than 19 or 20 years of age. • The main goal at this stage is that of loosening family ties to allow greater responsibility and freedom for the teenager in preparation for becoming a young adult ( Duvall and miller 1985). • Parents no longer maintain complete authority, nor can they abdicate authority either. • There are rule changing's limit setting, and role renegotiations. • The major challenges in working with a family at this stage revolves around the mental changes adolescents undergo in terms of cognitive changes, identity formation and biological growth (Kidwell, Fischer Dulham and Baranowski 1983)
  • 41. Developmental Tasks  Balancing of freedom with responsibility as teenagers mature and become increasingly autonomous  Refocusing the marital relationship  Communicating openly between parents and children  Maintaining the families ethical and moral standard. Specific Parenting Task  Maintenance of open lines of communication.  Granting of greater responsibilities to the children  Negotiating and consistently apply home rules  Affirming the adolescent’s developing sense of self and identity  Balancing freedom with responsibility as teenagers mature and emancipate themselves  Parents should learn to accept rejection without deserting the child.
  • 42. Health Care Concerns  Accidents  Sports injuries  Drug and alcohol misuse  Sex education  Unexpected pregnancies  Marital relationship  Adolescent parent relationship  Good health practices.
  • 44. STAGE VI Families Launching Young Adults • This stage begins when the first child leaves home and ends when the last child has left home. • This stage could be quite short or fairly long, depending on how many children are in the family or if any unmarried children remain at home after finishing university or college. • the usual length of this stage is six or seven years, though in recent years the stage is longer in some families due to more older children living at home after they have finished school and may have started working– usually due to economic reason • parents as they let their children go are relinquishing 20 years or so of the parenting role and returning to their original marital dyad. • The major family goal is the reorganization of the family into a continuing unit while releasing matured young people into lives of their own (Duvall and Miller, 1985).
  • 45. • The marital pair may take on grandparent roles which creates another change in both roles and their self image. • This stage has been characterized as the “caught” period of life caught between the demands of youth and the expectations of the elderly and caught between the world of work and the competing demands and involvement of the family • It is usually challenging meeting the demands of both realms • This period may be associated with menopause, it is a stage also when men in their middlescence face crisis such as a) The drive to get “ahead” in their careers with the realization that they have not succeeded or have not reached their aspirations. b) Financial worries c) Signs of diminishing masculinity such as lower energy levels and lessened potency and sexual excitation as well as figure , hair and skin aging signs.
  • 46. • The frequency of extramarital affairs, divorces , mental illness, alcoholism may increase at this stage. Developmental Task  Expanding the family circle to young adults including new family members acquired by marriage  Continuing to renew and readjust in the marital relationships  Assisting aging and ill parents of the husband and wife.
  • 47. Health Care Concerns  Communication issues between parents and young adult  Role transitional problems for husband and wife  Emergence of chronic health problems  Family planning for young adults  Menopausal concerns  Effects associated with prolonged drinking, smoking and poor dietary practices  Wellness lifestyles  Challenges of decreasing masculinity  Preventive medical screening for some diseases
  • 49. STAGE VII MIDDLE AGED PARENTS • The seventh stage begins when the last child departs from the home -- “empty nest” and ends with retirement or death of one of the spouses • The marital couple in their middle years constitute a nuclear family, although still interacting with their aging parents and other members of families of origin, as well as with the new families of marriage of their children. • Many middle class workers suffer from the “plateau phenomenon” in which salaries and promotions are no longer available leading to feelings of discontentment, boredom and stagnation.
  • 50. • On the other hand in this times of company downsizing, the threat of occurrence of being laid off or retirement significantly influence a man’s stress level and general health status • At this stage the couple become more aware of the needs for healthier lifestyles • The motivation of the middle aged persons to improve their lifestyle appears to come from the following. a) feelings of susceptibility or vulnerability to illness and disease generated when a friend or family members of the same age group has health challenges such as a heart attack, stroke or cancer b) A belief that regular checkups and healthful living habits are effective ways to reducing susceptibility to various diseases
  • 51. • Although “better now than never” it may be difficult or late to reverse certain pathological changes that have taken place such as arthritic changes due to inactivity, moderate to severe weight gain, high blood pressure due to atherosclerosis , lack of exercise, prolonged stress, poor dietary habits and vital lung capacity diminution due to years of smoking etc. • “Generational Squeeze” – many women find themselves in a generational squeeze as they attempts to balance the needs of their aging, frail or ill parents, their children and grand children
  • 52. Developmental Task  Providing a health-promoting environment  Sustaining satisfying and meaningful relationships with aging parents and children  Strengthening the marital relationship  Accepting and welcoming grandchildren into the family. Health Care Concerns  Promoting good health practices such as adequate rest , leisure activities, sleep, good nutrition, regular exercise programme, reduction of weight to optimum , cessation of smoking, reduction or cessation in the use of alcohol  Maintaining good marital relationships  Communicating with and relating to children , in-laws, grand children and aging parents.  Care giving issues and concern  Issues relating to social isolation and financial difficulties
  • 53.  Adjustment to physiological changes of aging  Coping with emergence of chronic illness eg. Arthritis, HTN, obesity  Preventive health screening examinations – prostrate CA, colorectal CA, breast CA.
  • 54. Families in retirement and old age
  • 55. STAGE VIII FAMILIES IN RETIREMENT AND OLD AGE • The last stage of the family life cycle begins with the retirement of one or both spouses, continues through the loss of one spouse and ends with the death of the other spouse (,Duvall and Miller 1985). • As a result of improved disease prevention and health care more people are expected to survive into their 9th and 10th decade of life especially in developed countries. • Perceptions of this stage of the life cycle differs significantly among aging families. • Some persons are miserable while others feel that these are the best years of their lives • Although much is dependent on the adequacy of financial resources and the ability to maintain satisfactory home, one’s health status has been identified as a primary predictor of the of the well being of older persons (Brubaker, 1990, Quinn 1993).
  • 56. • The more health difficulties experienced, the more likely the presence of negative feelings towards old age • Those who have lost their independence due to ill health have low morale and poor physical health and these often leads to behavioral and psychological problems (Chilman, Nunnally and Cox 1998) • Conversely those elders who have maintained their health, kept active, and have adequate economic resources usually feel positive about this stage of life.
  • 57. Losses Common to Aging People and families  Economic – adjusting to a substantially reduced income, later perhaps adjusting to economic dependency (depending on family or government for subsidy)  Housing – often moving to smaller quarters  Social – loss (death) of siblings, friends and spouse  Work – voluntary or involuntary retirement and loss of the work role and a sense of productivity  Health – declining physical, mental, and cognitive functions, care giving for the less healthy spouse Developmental Task  Maintaining a satisfying living arrangement  Adjusting to a reduced income  Maintaining marital relationship  Adjusting to loss of spouse  Maintaining intergenerational family ties  Continuing to make sense out one’s existence (life review and integration)
  • 58. Health Care Concern  Increasing functional disabilities  Mobility impairment  Chronic illness  Diminished physical vigor and function  Long term care services  Care giving  Social isolation  Grief / depression  Cognitive impairment.
  • 59. Summary of Duvall's eight stages of family life cycle and tasks STAGES 1. Beginning family 2. Child bearing family 3. Families with pre-school children 4. Families with school children 5. Families with teenagers 6. Launching center family 7. Middle aged families 8. Ageing families TASKS 1. Physical maintenance 2. Allocation of resources 3. Division of labour 4. Socialization of members 5. Recruitment and release of members 6. Maintenance of order 7. Placement of members into the larger society 8. Maintenance of motivation and morals
  • 60. Variations in the family life cycle Divorced family life cycle • The single parent, divorced family passes through the same life cycle stages, with most of the same responsibility as the two - parent nuclear family • The basic difference in this case is the absence of the second parent to carry his or her (mostly his) share of the family task with respect to support, child rearing, companionship, and gender role modeling for the children. • Cater and McGoldrick (1989) conceptualizes divorce as an interruption or dislocation of the traditional family life cycle. • Divorce brings about losses and shifts in family membership and as a result it creates major family destabilization and disequilibrium
  • 61. • There are crucial changes in roles and relationships and important family developmental tasks to be completed in order for the divorced family to move forward developmentally ( Carter and Mc Goldrick, 1989) • After divorce, family systems research has found that it takes about one to two years for the family to restabilize itself but some take longer • The impact of divorce on the family varies depending on when the divorce occurs. • Other factors which also make a difference on impact include ethic, social and economics and issue of custodialship. • Divorce is least disruptive during the first stage of family life cycle as there are fewer people involved, fewer traditions established, and fewer couple – bases social ties (Peck and Manocharian, 1988), and no child yet. • The impact is much greater during the third and fourth stages but the family is also at high risk for divorce during these periods.
  • 62. • In later stages of the family cycle , children are likely to be affected less profoundly than in previous family stages because they are older and better able to cope and function more autonomously. • In these later family life cycle stages, divorce is typically profoundly traumatizing to the divorced partners. • This is because years of shared possessions, memories and habits have created a “couple identity”. • Single parenting is often very challenging for the mother, who struggles both economically and emotionally. • The father may loose his sense of connection to his children and because of the mother’s anger at the father, she leaves no room for him ,yet maintaining both the mother – child and father – child relationships is very important for both parents and children • Unfortunately for both father and children, a large proportion of children virtually lose contact with their fathers after divorce (Hagestad 1988).
  • 63. • TABLE FOR LIFE CYCLE OF DIVORCED FAMILLIES(CARTER AND McGOLDRICK)
  • 64. Developmental Task for children in Divorced Families (Thompson and Rudulph 1992)  Resolving feelings of anxiety, abandonment and denial  Disengaging from parental conflict and distress and resuming their regular activities.  Resolution of loss  Resolving anger and self blame  Accepting the performance divorce  Developing realistic hopes regarding relationships
  • 65. Family Life Cycle in Stepparent Families  Divorce is sometimes a transitional state followed by remarriage,  If early death of a spouse occurs, the one left behind may also remarry.  The family’s emotional process at the transition to remarriage is typically one that involves a) struggling with fears about investment in a new relationship and a new family b) Dealing with hostile or upset reactions of the children, extended families and the ex-spouse c) Feeling guilt and concern over the welfare of the children. d) Renewing or establishing of attachment (negative or positive) to the ex-spouse or new spouse. • The stepparent - stepchild relationship is generally considered to be the most problematic and stressful relationship in stepfamilies requiring considerable strategies to develop warm and affectionate bonds between family members (Ganong, Coleman and Fine, 1995).
  • 66. Table of family life cycle
  • 67. Family Life Cycle of Domestic Partner Relationship  Domestic Partnership refer to gay, lesbian and heterosexual cohabitants who have an intimate relationship and are financially interdependent (Ames, 1992) Gay/Lesbian Family Life Cycle • Slater's model of the lesbian/gay family life cycle reflects the rich diversity and points of common experience among lesbian/gay families. • Slater (1995) describe five stages which are sequential and with limited duration, some stages enduring for longer than others. The couples adaptations to the challenges of previous stages become incorporated into their relationship and strengthen or diminish their capacity to confront subsequent obstacles For an in depth discussion of lesbian family life cycle – see slater’s book - The Lesbian family life cycle .
  • 69. Impact of Illness and Disability on family life Cycle Stages  When a family member is seriously ill or has long term disability the functioning of the family is significantly affected, just as the behavior of the family and its members simultaneously affects the course and characteristic of the illness or disability (Bahrsan 1987)  Often when a family is delayed in meeting its family developmental task, it is the interaction of the developmental demands / stress and a situational demands / stress that compounds and over loads the family  The added family stress created by the pressure of both types of stressors often result in lowered family functioning, where by mastering of family developmental task becomes impeded or retarded.  The extent to which family developmental task are affected depends on several factors such as -
  • 70. a) The stage in family life cycle. b) Which family member is seriously ill or disabled c) The formal and informal resources the family is utilizing e.g.. Family, friends , health and psychosocial supports.  Some particulars stages are more developmentally challenging than others and completing family developmental task of a some stages are more crucial for certain family members for instance - in a family with a teenager, if the adolescent sustains a serious injury and is left in a dependent state, this will greatly impede the adolescents own mastery of the developmental task of becoming more independent from the family. Likewise, the family’s task dealing with balancing freedom with responsibility so as to assist the teenager to become increasingly autonomous will also be impede.
  • 71. The challenge for the family therefore is to attempt to resume working on normal developmental family task as soon as possible  when working with a family with a member who has a serious illness or disability, it is useful to compare the “ideal” family developmental task within the appropriate family life cycle stage with the family’s actual behavior (Friedman, 1987), this type of comparison is useful in evaluating the probable impact of the illness or disability on the family.
  • 72. Criticisms of Family Life Cycle 1. Its assumption of homogeneity i.e. it’s lack of adequate attention to family diversities. 2. It has a middle – class bias 3. It assume stability at each stage 4. It does not explain the process that occur between stages that allow families to change. 5. Families don't always experience stages in sequential order. 6. Major life events can disrupt stages e.g. natural disasters. 7. All families are not nuclear families.
  • 73. conclusion • The basic notion of family life cycle is that families need to be assessed as a dynamic unit . • Family life cycle focuses on normative events such as marriage , child bearing, children education etc • One way the family physician understands families is to become familiar with issues that arises at various developmental stages of the family life cycle, the developmental tasks of each stage as well as health challenges associated with the stage • These stages differ, depending on the kind of family and understanding these issues enable’s the family physician help families cope with changes, stresses and strains that occur as the families mature.
  • 74. Clinical Application Mrs. Ifiok is in your clinic with her 16year old son, she and her husband both in their early 60s, feel they are having a difficult time raising their third child Joshua who is an active adolescent , Joshua has two siblings :- 18year old Mary who has just left for university and 28year old Anthony, who will be getting married in 6 months time. Mrs. Ifiok and her husband are feeling quite stressed by Anthony’s wedding plans, Anthony is living at home and has been living at home even through his university years, Mary is the first child to leave the home as her university is far away, Joshua has teamed with a group of friends who are known in the community for the rough behavior, he is now addicted to Indian hemp. Mrs. Ifiok is confuse by his recent attachment to this group as he has always been a compliant child and dedicated to his studies.
  • 75. Questions: 1. Identify the life cycle stage of this family and state your reasons 2. State the developmental task this family must achieve during this stage and give your assessment 3. What steps can you take to help this family.
  • 77. Reference • Lee Gen ,Azor A , wonodirekso.Family practice Singapore , 2004 section 3 chapter 3 pp 58 – 64. • Bowden V , Dickey s, & Greenberg C. 1998 .Children and their families : the continuum of care p 105. • Cater B & McGoldrick M .1989.The changing family life cycle :A frame work for family therapy pp 22– 24. • Slater 1995 The lesbian / gay family career