Dying persons in this age group present counseling challenges that defer from the elderly. The middle aged adult with family and work responsibilities who is stricken with terminal illness and the elderly in a nursing home face their deaths with different concerns due to their perceived age differences and social responsibilities. The sense of loss, injustice, and anger is often more intense in the person at this middle stage of life. The major psychosocial concerns in this age group are the loss of identity, work, family and the reality of not being able to support their families or not being able to raise their children.  When compared to the death of an elderly person, the family members and friends of a dying person in this age group have intense psychosocial issues.