Lifespan Development for Paramedics Flashcards
(121 cards)
1
Q
Human Development
A
Physical, cognitive and psychosocial development of humans throughout a lifespan
2
Q
Physical - baby to adult
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Crawling, running, speach, cordination, fine and gross motor skills
3
Q
Cognitive - baby to adult
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Talking, reasoning, bargain, bribery, logical thinking
4
Q
Psychosocial - Baby to Adult
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Emotional, social roles, relationship, dating and romance
5
Q
Development - continuous and discontinuous
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Continuous: Gradual and cumulative process
Discontinuous: Takes place in unique stages at specific times and ages
6
Q
Nature vs Nurture
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Nature: Biology and Genetics
Nurture: Environment and Culture
7
Q
Igmund Freud
A
Personality forms in the few years as a result of how parents and caregivers impact us
ID - born with it. Instincts (INFANTS)
Ego - Rational part of our personality (1-3)
Superego - social rules and right and wrong. strive for perfection (5+)
8
Q
Erik Erikson
A
Develop through 8 stages in life, not just childhood. Social relationships are important at each stage of development
9
Q
Jean Piaget
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Children’s intelligence differ from adults. Children of different ages interpret the world differently ( schema, assimilation, accommodation)
10
Q
Behavioural Conditioning
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A theory of learning that we respond to events or stimuli rather than internal factors that motivate our actions
11
Q
Classical conditioning
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Learning through association - Ivan Pavlov and his dog
12
Q
Operant conditioning
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Learning through consequence - alters behaviour depending on a reward/punishment system
13
Q
Observational Learning
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Learning through Observation
14
Q
John B watson
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Distinctions between Adults and children.. Human behaviour can be understood in terms of experiences and learning - LITTLE ALBERT EXPERIMENT
15
Q
Information processing theory
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Humans process the information they receive rather than merely responding to stimuli. Mind = computer which is responsible for analysing information from the environment
16
Q
Prenatal development stages
A
Term pregnancy 37-42 weeks.
Trimester 1 - 0-12 weeks
Trimester 2 - 12-28weeks
trimester 3 - 28-40 weeks.
Embyonic period 2 weeks to 3 months.
Less than 23 weeks not viable due to physical immaturity.
FHR - 110-160Bpm
17
Q
Newborn/Infancy Vitals
A
Newborn - younger than 28 days.
Infant - 28 to 1 year
HR: 110-160bpm
Respiratory: 40/60 breathspm
Blood presure: 70mmHg
Temp: 36.7
18
Q
Newborn/infant development (memoriese 2)
A
- Posterior fontanel↔Remains open until 3 months, room for brain growth.
- Anterior fontanel↔Remains open 9-18 months after birth
- Sleep↔Important for brain function. Average 16-18 hours a day. Sleep wakefulness evenly distributed over 24 hours. SLeep pattern gradually decreases, during the day with 9-10 hours at night
- Reflexes↔7 months - sitting up. 9 months - crawling. 12 months - walking. ROutine reflex - turn head to hand. Step reflex
- Nervous system↔End of first year, mature nerve development complete. Muscles matured enough for standing and walking with little to no assistance
19
Q
Toddler (1-3) Vitals
A
- Hr - 80 - 130bpm. Preschoolers 80-100
- RR - 20 - 30 breaths/min
- Blood pressure - 70-100 mmHg
- Temp - 36 deg
20
Q
Toddler development
A
- Cognitive and Psychosocial↔Learn through play, trial and boundaires, pretending.
- Capable of play @ 10months. Capable of cooperation at 18months.
- Language development is key↔babbling, signed and verbal, building sentences.
- Terrible 2’s↔Negativsm. Say no
- Social↔Converse, initiate activities, assert themseles, resolve disputes
21
Q
Early Childhood (3-5) Vitals
A
- Hr - 80-100 bpm
- rr - 20-24 breaths
- bp - 95-110mmHg
- Temp - 36-37.6 degrees
22
Q
Early childhood Development
A
- Muscle mass and bone density increase. Fine motor skills develop.
- Passive immunity no longer protects. More susceptible to minor respirartory and gastrointestinal infections.
- Toilet training.
- Social pretend. Make believe and fantasy play begin.
23
Q
Childhood (6-12)
A
- Hr 80-100bpm
- rr 16-22 breaths
- bp - 100-120mmHg
- Temp 36-37.6
School is vital - for cognition and social interactions. Knowing the meaning of boy and girl. Gender constancy. Development of sex-role stereotypes
24
Q
Adolescence (12-19) Vitals
A
- Hr- 60-100bpm
- RR- 16-20 breaths
- BP - 100-120 mmHg
- Temperature - 36-37.6
25
Adolescence Development
- Physical growth spurt over 2-3 years.
- Pubery (hormonal change). External changes - Breast development, facial and pubic hair.
- Onset of menarche.
- Psychosocial development - may try on identities. Develop adult personality. Emotionally move towards peers
26
Adulthood Vitals
Early - 20-40
Middle - 41-60
late - 61+
- Hr 70bpm
- rr 16 - 20 breaths
- Bp 120/80 mmhg
- Temp - 37 deg
27
Pregnancy duration
av. 266 d ays (38 wks) post ovulation
28
First trimester development (0-12)
Nausea w/ w.o vomiting, brest tenderness, fatigue
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Second Trimester (12-28) development
Uterus becomes abdominal organ. Nausea usually past, foetus moving. Maternal blood increases by 4/50%. Heart rate increases 1/20 bpm
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Third trimester (28-40) development
Episodes of fatigue and increased urinary frequency. Enlarged uterus displaces heart to left. Blood pressure increases slightly.
31
Endocrine system in Pregnancy
Responsible for physiological changes. Causes alteration in hormone production and sectretion.
32
Progesterone
'The' hormone of pregnancy. relaxes smoothe muscle in blood vesles uterus and GIT. - increase bod temp, causes nausea and vomiting.
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Oestrogen
Growth simulator. Hypertrophy and hyperplasia of uterine muscle. Growth and development of breasts.
34
Human Chorionic Gonadotropin (HCG)
Maintains steroid hormones in pregnancy. Maintains preganncy unil placenta takes over (approx 11 weeks) - presence confirms successful fertilisation
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Human Placental Lactogen
Stimulates growth of maternal and foetal tissues. Protects foetus from rejection. Antagonistic to insulin - maintains maternal glucose uptake
36
Relaxin
Made in the placenta and ovaries. Soften elastic ligaments of pelvic bones. . and allows mobilisation and growth of uterus
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Thyroid Gland
Pregnancy mimics hyperthyroidism. BMR icnreases by 20-25%. Increase of appetite. Increase fatigue
38
Uterine Changes
Uterus starts as pear shaped organ. Height of uterus = number of weeks gestation. 12wks, fundus can be palpated. 20wks fundus reaches maternal umbilicus. 36wks reaches xiphisternum (bottom of sternum)
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Braxton hicks contractions
Painless uterine tension felt through adominal wall. Improve uterine blood flow and foetal oxygenation. Prepare body for labour.
40
Cervical changes
Increase in mass, length and width.. Thick secrete mucus to make mucus plug (operculum)
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Circulatory changes
Increase metabolic demand. Expansion of vascular channels. Blood pressure during 2nd trimester decreases. Cardiac output increases 30-50%. Heart swells 12%, displaced up and rotated forward. Blood volumte increase 30-50% (
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Spine hypotension
Impede venous return from inferior vena cava - Decreae maternal and foetal oxygenation
43
Blood volume during pregnancy
Acceptible loss in v. delivery 0.5l
acceptible loss in c section - 1l.
Iron is required for growth of foetus and placenta. Anemia develops if Fe stores <110g/l
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Respiratory changes
Increases o2 requirements to meet metablic rate and tissue growth. Capilary dilation, engorgement of nasopharynx, trachea and bronchi. nasal and sinus stuffiness, epistaxis (nosebleed). Diagram elevated by 4cm.
45
Antenatal Assessment
- Gestation age
- Presence of cramping, bleeding or spotting
- Foetal heart rate
- Position of foetus?
- Foetal movements felt?
- Membranes intact?
- Gravida (How many times they have been pregnant) /parity (How many babies born alive beforehand)
- Maternal Blood pressure
- Pyrexia (Fever)
- Presence of Disease - past medical history
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Placenta
Formed by fertilised ovum. Starts to develop once the ovum implanted in the endometrium. Begins to function by w4, fully functioning by wk10. Maternal surface adhere to uterine wall (rough and dark red). Foetus is shiny and slightly grey.
47
Foetal circulation
Varies significantly fro madult circulation. 3 circulatory shunts
-Ductus Venosus (bypass liver)
- Foramen Ovale (gap between upper chambers of heart)
- Ductus arteriosus (bypass lungs
48
Names for different baby ages
Newborn - first few horus
Neonate - 28days
infant - 28 to 1year
Viability for baby to survive outside the uterus - 223 weeks. Alveoli development. Prior to this, gas exchange not possible
49
Weight esimations
0-12 months = 0.5x age in MONTHS +4
1-5 years = 2x age in YEARS +8
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Immunity
- Passive - From maternal antibodies in the blood (lasts 6 months)
- Breastfeeding through milk. After 6 months childhood immunisation are recommended
51
Infancy Metabolism
Requires more fluids, energy and minetals and vitamins than older children. Loose more fluids via respiratory and inegumentary systems than older children. - Increases risk of dehydration. Increased temperature related illness.
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Infant development milestones.
Checked via child health nurse, hearing tests in hospital. Guthrie test (test for 25 conditions)
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Infant social milestones
4wks - react to adults (esp. females)
2months- smile and vocalise at mum
3months - needs social interaction. (temperament = easy, difficult or slow to warm up children)
4months- form attachment, visually track mum.
9months- separation anxiety, protest and dispare
54
Approach to infants
Gain trust from infant nad parents. involve parents in everything where possible.
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Key differences to consider in children
Weight - medication based of weight
anatomical - size and shape (s/a changes)
Physiological - function of cardiovascular, respiratory
Psychological - intellectual ability
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Key differences to consider in children
Weight - medication based of weight
anatomical - size and shape (s/a changes)
Physiological - function of cardiovascular, respiratory
Psychological - intellectual ability
57
Weight
Most rapid changes in weight during first year of life. Increaes 10kg in first year of age. then 2kg per year. (medication - Dose per kilogram of bodyweight) - SEE REMNOTE FOR BASIC DOSAGE CALCUALTION
58
Weight formula
0-12 months=> weight(kg) = (o.5 x age in months) +4
1-5 years => weight(kg) = (2xage in years) +8
6-12 years => weight(kg) = (3xage in years) +7
59
Toddler vital signs
- Heart rate - 100 to 150 bpm
- Respiratory rate (RR) - 25 TO 25 breaths/min
- Systolic BP - 80 to 95 mmHg
- Temp - 36 to 37.6
60
3-5 year old vital signs
- HR - 95 to 140bpm
- RR - 25 to 30 breaths
- Systolic bp - 90 - 110 mmHg
- Temp - 36 to 37.6
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6-12 year old vital signs
- hr - 90 to 120
- RR - 20 to 25
- BP - 100 to 120 mmHg
- Temp - 36-37.6
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child Anatomical differences - airway
Changes w/ age. The TOngue is relatively large. teeth may become loose. Anatomy can cause different problems
63
child Anatoical differences - breathing
Upper and lower airways relatively small and more easily obstructed. (ten fold increase in airways from birth to childhood)
64
Child causes of breathing distress
- Upper trespiratory infections
- Croup
- (viral), Flu.
- Lower respiratory infections
- Asthma, allergies. foreign bodies (wheezing = lower airway destruction). Grunting
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Child anatomical differences - circulation
Heart develops throughout childhood. P waves and QURS increases. Circulating blood volume per kilo is higher than adult (80ml/kg). actual volume is small.
66
Child body surface area
More at risk for surface area-related injuries - exposure. More skin exposed than adults
67
Higher metabolic Rate.
More susceptible to contaminated food/water. Greater risk of loosing fluid when ill. Medication calculated based on child weight/body size.
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Child immature immune system
Greater risk of infection. Less herd immunity from some infections
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Toddler movement
by 2 nervous system developed. Basic motor skills (walking and balance). Fine motor skills (stacking building blocks). Develop likes and dislikes. Irrational
70
Early childhood movement
Curious and exploring with minimal concept of dangers. FIne motor skills (glue things to paper). clap hands, touch fingers together. doing buttons and zips.
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Middle childhood movement
Confusing time for some. Big difference in peers. Hitting puberty, strength and maturity. some withdraw form sports, others excel. Reach adult height towards 12ish
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The prefrontal cortex of the brain
Bit behind forehead. Helps us think, strategize and control emotion. Control emotional outbursts and understand how to play games. Lessp physical aggression and resist temptation.
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Kids communication
Become less verbal when unwell. Loud when in pain. Dont match energy - stay calm and empathetic. Older kids understand more than younger kids
74
Fear in kids
situations which adults would not classify as emergencies create fear in children. Causes additional distress to the child. Parental anxiety. problematic in pre-school aged children (magical concept of illness)
75
Kids overcoming fear.
Knowledge combats fear. Highlights importants of explaining things as clearly as possible - age appropriate. play can be used to explain. parents stay with kids at all time
76
Middle childhood - brain
Reaches size of adult at age 7. not fully developed by 7. School age kids able to plan and co-ordinate activities using l and R hemispheres of brain and control emotional outbursts.
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Middle childhood - self concept
Sence of self develops throughout middle childhood. Exaggerated sense of self as biggest or smartest or tallest. Strengths and weaknesses. Influenced by peers and family and teachers. Influence child worth.
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Common illness - toddler
- Respiratory (croup, asthma, bronchiolitsis)
- Vomiting and diarrhoea w/ dehydration
- Febrile seizures
- Sepsis
- Falls as learning to walk/climbing
- MVA
- drownings (highest %) and accidental poisoning
79
Autism
Half parents notice unusal behaviours by age of 18 months. 4/5 by 24 months. diagnosis comes later.
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Autism + signs
Half parents notice unusal behaviours by age of 18 months. 4/5 by 24 months. diagnosis comes later.
- No babbling by 12 months
- no gesturing (waving, pointing) by 12 months
- No single words by 16 months
- no two words phrases by 24 months
- loss of language/social skills at any age
80
Common illness - early childhood
Same as toddler but more adventurous and no concept of danger. Pedestrian accident, thermal burns, drownings
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Common illness - middle childhood
Most illness is viral infections - increase in injuries due to physical activities. Bicycle crashes, fractures from fall, sport-related injuries
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Adolecent -12 to 19
RR - 15-20 breaths/min
HR 60-10 bpm
Blood pr - 110-120 mmHg
Temp - 36-37.6
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Adolescent physical characteristics - male
- Pituitary increases testosterone levels
- 6inch height increase on average.
- Increase muscle bulk and strength to joints.
- Pubic, under arm and facial hair.
- Results in penis and testicle enlargement.
- Sexual maturity - onset of night emissions.
- Larynx increases in size (Deeper voice)
84
Adolescent physical characteristics - female
- Growth spurt commences earlier - 10 to 12 years
- Oestrogen levels rise and effect.
- Breast growth and development.
- Pelvis becomes wider
- Menarche commences
- Pubic and underarm hair
85
Adolescent Brain development
- different uses maek and enhance varied connections. - use it or lose it theory
- Music and sport to involve both side of the brain development.
- Can begin to think and udnerstand concept, speculate on possibilities.
- Use symbols that mean something else - algebra.
- Frontal love is still immature - results in risk taking behavior's and poor judgement
86
Adolescent dietary requirements
- Calorie requirements - high to cope with growth demands.
- Nutrient requirements - high to cope with growth and development
- Poor knowledge and immature frontal lobe - results in poor impulse control. Leads to poor food choices
87
Adolescent obesity
- 25% of Australian teenagers are considered overweight or obese.
- Leads to adult obesity, diabetes, bone fractures, and cardiovascular disease.
- Increases risk of weight-based teasing and bullying.
- Lacking physical activity. Cheaper/more accessible fast food options
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Adolescent health problems
18% of teenagers ahve 1 health problem - most common sleep deprivation. Require 8.5-9 hours. Leads to reduced ability to concentrate
Icreased of MVA
Irratibility
depression and poor impulse control
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Adolescent eating disorderes
- Eating disorders
- Binge eating disorder/anorexia nervosa/ bulimia nervosa
- effects 80-85% female vs male.
- Peaks in adolecence. seen in young as 5 years old
- Lose 25% of body weight. irational fear of weight gain. Often related to feelings or control of lack of
- 5% will die from dysfunctional focus on body image. From cardiovascular complication and then suicide
- Often involves frantic exercie. Risk increased for diabetics.
- Treatment↔Cognitive behavioural therapy. NGT. Anti-depressants
90
Egocentrism
An imaginary audience. Belief that other people are as concerned with our appearance and behavior's when they are not. Adolescents are overly concerned with their own thoughts and behaviours.
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David Elkind theory of Adolescence
Personal fable - belief that his or own thoughts, feelings and experiences are unique. More wonderful or awful than anyone else's. Not subject to the consequences others will experience.
Invicibility fable - adolescent egocentric conviction that he or she cannot overcome or be harmed by anything that might defeat a normal mortal.
92
Adolescence Mood swings
- Severity of moods lasting longer periods of time
- Eating more or less
- sleeping more or less
- drugs or alcohol to deal with emotions
- withdrawing from friends and family (family expected)
- Unhealthy thoughts of self harm
- hallucinations. - Phycotic breaks.
93
Gender differences - Adolescence
- Girls surpass boys in their v erbal ability. In reading, spelling and grammar girls also lead. Culture can make an impact on this.
- Visuospatial awareness is an area where males shine - results of the toys they play with?
- Male do better in mental rotation.
- Female do better in verbal tasks. Recognizing visual emotional clues
94
Adolescence Identity
- Psychosocial↔Who am i and what do i want to become?
- Self esteem↔Changes from early childhood - physical comparisons
- Now based more on physchological and social ideas.
- Less influence from parents. more focus on peers. Influenced by the media
- Peers↔Close friends, align with similar interests and goals.
- Peer pressure. Peaks at 17 and drops off
95
Sexual maturity - Adolescence
- Late teens is a time for increased sexual drive
- individuals become sexually active as they begin dating.
- Masturbation and self discovery begin - healthy part of development. more common in males.
- Education - peers and media. Not parents and school
TEENAGE PREGNANCY - Rates lower than 20 yrs ago. better contraception and better education
96
Adolescent suicide
- 350 in australia. (in 2020 per year)
- For each death there is 100-200 attempts.
- LEADING CUASE OF DEAHT 15-44 year olds
- Males are 3 tiems more likely.
- In 2018 leading cause of death in 5-17 year old.
- 100 deaths - 78 of them are 15-17
- Hanging and OD on medicatim
97
Australia adolescent drug and alcohol use
- Smoking cigarettes has declined
- Vaping has now been introduced
- age of first drink was 14.7, now 16.2
- Canabis - 25% have used it in the past 12 months. Increased.
- Methamphetamine - 2.3% used in past 12 months.
- Cocaine and ecstasy has increased in use in the past 5 years by 10%
- 18% of students had deliberately sniffed inhalants.
- Alcohol and illicit drugs use in the leading cause of burden of disease
98
Barriers to communication/treating adolescents
- Technology
- trauma
- trust
- truth
- their own mental health
- time
99
Adult vital signs
- HR - 70Bpm
- RR - 16/20 breaths/min
- BP - 120/80 mmHg
- temp - 37 degrees
100
Early adulthood - reaching physical peak
- Life long habits, routines develop.
- Body systems at optimal performance
- pregnancy most likely to occur
- growing a family
- establish career pathway
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Havighursts developmental tasks
A development task is a task which arises at or around a certain period in the life of an individual, successful achievement of which leads to his happiness and to success with later tasks while failure leads to unhappiness and difficulty with later task
102
Early adulthood 9 developmental tasks
- Selecting a mate
- achieving a feminine or masculine social role
- learning to live with a marriage partner
- starting a family
- Rearing children
- managing a home
- Getting started in an occupation
- taking on civic responsibility
- finding a congenial social group
103
Early adulthood aging done by 40
- slowed reaction times
- hearing loss
- vision deficiencies
- unintentional injury is leading cause of death
- inflammatory processes to the body
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Middle adulthood vital signs
- HR - 70Bpm
- RR - 16/20 breaths/min
- BP - 120/80 mmHg
- temp - 37 degrees
105
Physiological aging aspects are more obvious (Madult)
- Cardivascular health concern
- hearing, vision changes
- periodontal disease may develop
- weight control difficult
- cancer more prevalent
- menopause - 44 to 55 years. marks end of reproductive capacity
106
Middle Adulthood 9 developmental tasks
- Achieving adult civic and social responsibility
- Establishing and maintaining an economic standard of living
- Assisting teenage children to become responsible and stable adults
- Establishing adult leisure-time activites
- relating one self to one's spouse as a person
- accepting and adjusting to the physiologic changes or middle age
- Adjusting to aging parents
107
Biological Ageing
Results from the impact of the accumulation of wide variety of molecular and cellular damage over time
This leads to a gradual decrease in physical/mental capacity, a growing risk of disease and ultimately, death.
These changes are neither linear nor consistent and they are only loosely associated with a person's age in years. Beyond biological changes, ageing is also associated with other life transitions
108
Erik Erikson - young adult
- Stage six.
- 19-40yrs.
- Intimacy vs isolation. Intamite relationships
- am i loved and wanted?
- success- leads to strong relationships
- Failure - leads to loneliness and isolation
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Erik Erikson - Middle Adult
- Stage seven
- 40-65 years
- generativity vs stagnation
- work and parenthood.
- Adults need to create something to outlasts themselves
- success - feels useful and accomplished
- Failure - withdrawal from the world
110
Years of Potential Life lost
- YPLL - how many years a person would have lived had they not died prematurely
- Suicide - highest YPLL (115221), with a low median age at death (43.9 yrs) being a key contributing factor.
- Ischaemic heart disease - second highest YPLL (78052)
- Heart disease accounts for the highest number of premature deaths and has a median age at death 84yrs
- Lung, colon and breast cancer are 3rd/4th/5th leading causes of potential loss and have median ages of death of 74.3,77.6 and 72.3 respectively
111
Homelessness in Australia
- Homelessness in Australia↔51 with a reported mental health condition who had experienced homelessness in the last 10 years reported family violence problems as a reason for their homelessness, similar to people without a mental health condition (45%)
- 30% with a reported mental health condition stated financial issues as a reason for their most recent episode of homelessness similar to people without mental health condition (33)
112
Australian Bureau of stats 2019
- 67% of adults were overweight or obese
- 47% of australians had one or more chronic conditions
- 4.8mil. australians have mental or behavioural condition
- 47.3% of asutralians had one more chronic conditions in 2017/18
- Mental and behavioural conditions (4.8mil people (20.1%))
- Back problems - 4mil
- arthritis -3.6mil
- asthma -2.7mil
- Diabetes mellitus - 1.2mil
- Heart/stroke/vascular - 1.2mil
- Osteoporosis - 924k
- chronic obstructive pulmonary disease - 598800
- cancer - 432400
- kidney disease - 237800
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Daniel Levinson
Theory of the seasons of life
114
Daniel levinson seasons of life
- Early adult transition
- Entering the adult world
- age 30 transition
- settling down
- midlife transition
- entering middle adulthood
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Early Adult transition (17-22)
- Early adult transiton - 17-22↔Leaving home, leaving family, making first choices about career and education
- An individual must leave behind adolescent life and begin to preapre an adult life structure - plan or design.
- Separation from the family of origin, emotional not physical spearation. Modify or end relationships associated with an adolescent life to make way for new adult relationship. Complete education/start work. Make preliminary plans for adult life
116
Entering adult world (22-28)
- Entering the adult world - 22-28↔Committing to an occupation, defining goals, finding intimate relationships
- 4 majour tasks of this period
- form a dream and give it a place in the life structure
- forming mentor relationships
- forming an occupation
- forming love relationship, marriage and family
117
Age 30 transition (28-33)
- Age 30 transition - 28-33↔Revaluating those choices and perhaps making modification or changing one's attitude towards love and work
- Individuals re-evaluate the life structures that they formed in their early twenties to determine whether they are living out their dreams.
- Inner voice - if i am to change my life - if there are things in it that i want to modify or exclude, or things missing i want to add - i must now make a start, for soon it will be too late.
- As individuals adjust their life structures, individuals might choose to marry or get a divorce, have children or to chagne jobs at this time.
- Time to get real, after testing their early choices for a few years before settling down in their 30's
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Settling down (33-40)
- Settling down - 33-40↔Reinvesting in work and family commitments, becoming involved in community.
- What niche would i liek to establish in society
- How would i like to progress in my career and family life.
- What kind of parent would i like to be?
119
Midlife Transition (40-45)
- Midlife transition - 40-45↔Revaluating previous commitments, making dramatic change neccessary. Giving expression to previously ignoring talents or aspiration, feeling more of a sence of urgency about life and is meaning
- What meaning and direction do i want in my life in order to meet my values
- What additional talents would i like to cultivate
- How can i work towards leaving a legacy?
120
Entering middle adulthood (45-50)
- Entering middle adulthood - 45-50↔Committing to new choices made and placing one's energies into these commitments
- What new tasks would i like to take on?
- How can i be at peace with myself and others as i reflect on life
