02/15/2018

4:00-5:00 Middle Adulthood

Th Psychiatry
Anatomy Bldg Maria Corazon Jardiolin, M.D.


OUTLINE
• Emotional maturity
• Competence and power in the work situation
I. Middle Adulthood
• Gratifying relationships (Spouse, children, etc.)
II. Transition: Young to Middle Adulthood

III. Developmental Theorists
• People begin to experience the gap between early aspirations and
IV. Developmental Tasks current achievements
V. Adult Maturity
• Parental roles change and redefine their roles as husband and

VI. Physical Development
wives
VII. Cognitive Development
and Leisure
VIII. Work, Careers
Important Gender-Specific Changes
IX. Factors Affecting Health

X. Reappraising Relationship
• Women: Energy is focused from nurturing young children to
XI. Sexuality
independent pursuits that require assertiveness and a competitive
XII. Challenges
spirit (Masculine traits)
XIII. Midlife Crisis and Transition
• Men: Develop qualities that enables them to express their
XIV. Other Tasks of Middle Adulthood
emotions and recognize dependency needs (Feminine traits)
XV. Divorce
o The balance in traits make the person able to relate more
XVI. Reference
effectively to the other sex

MIDDLE ADULTHOOD (40-65 YRS. OF AGE) • Is the age period in which gains (growth) and loss (decline)
balance each other
• Golden age of adulthood • Transition, people’s perspectives change in a major way “last
• Similar to latency years in childhood, but much longer chance” to do certain things
• Middle adulthood is a developmental period beginning about 40 • 2nd period of reassessment: “midlife crisis”
and extending to 60-65 years • It is the ability to create, originate, and produce. According to
• It is a period of declining physical skills and increasing Erikson, mind generativity adds meaning to the lives of adults and
responsibility it helps them to maintain and enhance their self-esteem
• Is a time of both gains and losses • Relates to middle adulthood by people often in positions in which
• Span of middle adulthood can be defined chronologically, they can perform exercises that are particularly important
contextually, or biologically • In some people this could be a second period of reassessment. A
• Most middle-aged people are in good physical, cognitive, and middle aged person who see’s younger people advancing in their
emotional condition. lives might feel depressed
• They have heavy responsibilities and multiple roles and feel
competent to handle them. Late Midlife (55 to 65)
• Middle age is a time for taking stock and making decisions about
the remaining years. • Death of a parent
• Is currently defined as the period of development after early adult • Last child leaving the parental home
years but before retirement. • Becoming a grandparent
• Is influenced by genetics and the environment • Preparation for and actual retirement
• Transition from “how many years do I have left?” on crisis vs age
mastery to deciding what to do with the remainder of their lives on TRANSITION: YOUNG TO MIDDLE ADULTHOOD
“middlescence” search for new identity
• Declining physical skills and increasing responsibility • Slow and gradual
• Awareness of the young-old polarity • No sharp physical or psychological demarcation
• In some people this could be a second period of reassessment. A • Aging process becomes a little faster and becomes a powerful
middle aged person who see’s younger people advancing in their organizing influence on intrapsychic life
lives might feel depressed • Mental change is also slow and imperceptible
• Transmitting something meaningful to the next generation
• Reaching and maintaining career satisfaction Transition

Normative Sense of Satisfaction and Well-being Stems From
• Widening concern for the larger social system

• Differentiation of one’s own social, political, and historical system
• Physical health
from others


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 DEVELOPMENTAL THEORIST Calvin Colarusso and Robert Nemiroff

Robert Butler • Suggests that the developmental stages in adult is similar with the
child due to the ongoing dynamic process, continually influenced
• Described several underlying themes in Middle Adulthood that by a constantly changing environment, body, and mind
appear to be present regardless of marital and family status, • Adult development is concerned with the continuing evolution of
gender, or Economic level. existing psychic structure and with its use
• These themes include: • Attempts to explain all adult behavior and pathology in terms of the
• Aging: As changes in bodily functions are noticed in middle experiences of childhood are considered reductionist
adulthood • The adult past must be taken into account in understanding adult
• Taking stock of accomplishments and setting goals for the future behavior, similar to how childhood past is considered.
• Reassessing commitments to family, work, and marriage; dealing • The aging body is understood to have a profound influence on
with parental illness and death psychological development; the growing midlife recognition and
• Attending to all the developmental tasks without losing the capacity acceptance of finiteness of time and inevitability of personal death
to experience pleasure or to engage in playful activity

Erik Erikson: Generativity vs. Stagnation

• Generativity
o The process by which persons guide the oncoming generation or
improve society. This stage includes having and raising children
o The ability to create, originate, and produce or maintain and
enhance self-esteem, career, family, and community
o Adds meaning to the lives of adults and helps them maintain and
enhance their self-esteem
o No generativity: stagnation or lack of achievement or
development
o Childless person can be generative by:
§ Helping others
§ Being Creative DEVELOPMENTAL TASKS
§ Contributing to society
o Parents must be secure in their own identity
• Helping one’s children make the transition from home life to the
outside world
• Stagnation
o Means that a person stops developing • Achieving mastery in one’s career
o “Within a cocoon of self-concern and isolation” • Adjusting to physical changes
o Adults without any impulses to guide the new generation or those • Making decisions on how to spend “second adulthood”
who produce children but don’t care for them. • Coping with one’s aging parents
o Because they are unable to negotiate the developmental tasks of
middle adulthood, they become unprepared for the next stage of The Main Task or Crisis of Middle Adulthood: Generativity vs
the life cycle Stagnation
o Lack of advancement which can lead to feelings of emptiness and
meaninglessness • Generativity has been defined as contributing in a positive way to
family or community. It improves self-image and promotes
George Vaillant
subjective well being
• Failure to achieve generativity result in stagnation which is total
• Found a strong correlation between physical and emotional health
in middle age concern of self and denial of the developmental process
• Those with the poorest psychological adjustment during college • Other tasks:
years had a high incidence of physical illness in middle age o Managing a career and finances
• An overall sense of stability at home predicted a well-adjusted o Managing a household and nurturing marriage and family
adulthood relationship
• Close sibling relationship during college years was correlated with o Maintaining a positive self esteem
emotional and physical well-being in middle age
Developing Midlife Friendship
• Adult mental health and good interpersonal relationships were
associated with the capacity to work in childhood.
• Midlife friendships do not usually have the sense of urgency or
• His studies are ongoing and represent the longest continuous study
need for frequent or nearly constant physical presence of a friend.
of adulthood ever performed
• Individuals neither have the need to build new psychic structure
nor the need to find new relationships

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 • Midlife adults are easily able to initiate and sustain friendships with
individuals of different ages
• Friendships may quickly become vehicles for the direct expression
of impulses in some situations (e.g. Disrupted marriage, intimacy,
pressure of other midlife developmental themes)
• They may have many sources of gratification available through
relationships with spouse, children, and colleagues.
ADULT MATURITY
• Success and happiness are made by achieving a more mature
mental state
• Maturity:
o Maturity is the ability to adapt to the inevitable changes that
happen in life
o A mental state found in healthy adults characterized by:
§ Detailed knowledge of the parameter of human existence
§ Sophisticated level of awareness
§ Ability to use intellectual and emotional knowledge
o Achievement of maturity in midlife leads to the emergence
of the capacity for wisdom
• Wisdom: learning from the past, fully engaging in life in the
present, and anticipating the future
• Success and happiness in adulthood are made possible by
achieving a modicum of maturity - a mental state not an age
• The capacity for maturity, however, is a direct outgrowth of the
engagement and mastery of the developmental tasks of young
and middle adulthood
• From a developmental perspective, maturity can be defined as a
mental state found in healthy adults that is characterized by
detailed knowledge of the parameters of human existence
• a sophisticated level of self-awareness based on an honest
appraisal of one’s own experience with those basic parameters
• the ability to use this intellectual and emotional knowledge and
insight caringly in relation to one’s self and others
• The achievement of maturity in midlife leads to emergence of the
capacity for wisdom. Those who possess wisdom have learned
from the past and are fully engaged in life in the present
• They anticipate the future and make the necessary decisions to
enhance prospects for health and happiness.
• A philosophy of life has been developed that includes
understanding and acceptance of the person’s place in the order
of human existence.
• Unfortunately the joys of midlife does not last forever. Old age
lies ahead.
• Although the hope and statistical expectation is for many years of
mental competence and independence, physical and mental
decline, increased dependence and eventually death must be
anticipated.
PHYSICAL DEVELOPMENT • Exercise, weight control, and diet rich in fruits, vegetables, and
• The most obvious changes associated with middle years are
physical
• Physical abilities peak in early adulthood
Visible Physical Changes
• Wrinkling and sagging of skin
• Appearance of aging spots
• Hair becomes thinner and grayer
• Nails become thicker and more brittle
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• Yellowing of teeth
• Skin becomes elastic
• Interest in plastic surgery, botox, weight control, and vitamins may
reflect the desire to take control of the aging process
Individuals Lose Height and Gain Weight
• Both men and women continue to gain weight in middle adulthood
• Body fat makes up 20 percent or more of weight in midlife as
compared to 10 percent in adolescence
• Almost 1/3 of adults (40-59 yrs) are classified as obese which
increases probability of other health issues
• After age 55, bones become less dense and ultimately women
lose 2 inches and men lose 1 inch in height
Strength, Joints, and Bones
• Sarcopenia: age related loss of muscle mass and strength
• Strength and coordination decline by age 45
• Cushions for bone movement become less efficient, often leading
to joint stiffness and more difficulty in movement
• Loss in bone density
• Throughout middle adulthood, strength gradually decreases - in
the back and leg muscles
• By age 60, people have lost about 10% of their maximum strength
Vision and Hearing
• Accommodation of the eye: ability to focus and maintain image
on the retina declines between 40 and 59 years
• More need for glasses or bifocals
• Difficulty in viewing close objects
• Reduced blood supply decreases visual field
• Near vision / presbyopia / distance vision: nearsightedness,
myopia
• Dynamic vision (reading moving signs)
• Sensitivity to light
• Visual search
• Hearing also declines after age 40
• Sensitivity to pitches (high pitched sounds are typically lost first)
• Men lose sensitivity earlier than women resulting from exposure to
occupational noise
Cardiovascular System
• High blood pressure, high cholesterol, and cardiovascular disease
• Metabolic syndrome: a condition characterized by hypertension,
obesity, and insulin resistance
whole grains can often help
• Women ‘s blood pressure rises at menopause and typically
remains higher than men’s
• Exercise, weight control, proper dietary patterns can help
decrease problems
Lungs
• Lung tissue becomes less elastic at about age 55 decreasing the
lung’s capacity
 • Little change in lung capacity during middle adulthood o Developmentalists call these forms of aging primary,
• In late 50’s, proteins in lung tissue became less elastic decreasing meaning that the changes are inevitable and happen to
lung capacity everyone regardless of race, ethnicity, culture, or socioeconomic
• Smoker’s experience most significant changes (lung capacity class.
improves when one quits smoking) o Exercise slows many primary aging changes such as
physiological changes taking place in the vital organs
Sleep o Secondary aging however is the result of unhealthy
behaviors, such as smoking, drug use, unhealthy eating, alcohol
• Beginning in 40’s, wakeful periods are more frequent and less abuse, obesity, and lack of exercise
deep sleep o Developmentalists also study individual’s vitality or “joy of
• More time lying awake results in feeling less rested living” during the middle adult years as they have found high
• Sleep problems are more common for those who use a higher correlations between positive, upbeat attitudes and mental
number of prescription and nonprescription medications, are health
obese, depressed, or have cardiovascular disease o These researchers have found that negativity caused by
stress or conditions such as depression or anxiety can
Health and Disease eventually lead to chronic physical conditions in otherwise
healthy bodies
• Chronic disorders: a slow inset and a long duration
• Rare in early adulthood but increase in middle age Physiologic Changes

Stress and Disease • Metabolic needs decrease (by age 40) during middle adulthood
and if diet and exercise are not part of a healthy lifestyle, excess
• The immune system and stress weight begins to accumulate
• Stress and the cardiovascular system • A decrease in energy and perceived physical attractiveness may
• Culture and health occur
• Less sweat
Mortality Rates • A loss of muscle tone and skin elasticity may result in less firm
appearance of body contours
• Chronic diseases are the main cause of death during middle • Eye changes common to middle age can be easily corrected with
adulthood glasses, contact lenses, or laser surgery
• Heart Disease and Cancer: In 2005, cancer was the leading • Loss of calcium
cause of death in 45-64 year olds followed by cardiovascular • Smoking, alcohol, poor diet speed up bone loss
disease • Osteoporosis begins around 30 for women and men
• Analysis from a 2006 report by the nonprofit group Life Insurance • Sensitivity to taste and smell declines. Women loose sweet tooth /
Foundation for Education finds that the leading causes of death men things not sour enough
for males ages 45-56 is heart disease, followed by cancer. For • Decrease sensitivity to touch (after age 45)
females ages 35-64, the leading cause of death is cancer. • Decrease sensitivity to pain (age 50)
• Researchers have proven, however, that exercise alone reduces • Loss of estrogens and progesterone in women
the risk of almost every serious illness in middle adulthood - • Improved by regular weight-bearing exercise
especially heart disease and cancer • Tasks involving choice of response and complex motor skill
• Add healthy eating and the elimination of tobacco and alcohol in decline
middle-age lifestyles, and major illnesses can literally be halted • Most middle-aged adults compensate well for gradual, minor
altogether declines in sensory and psychomotor abilities, including age-
• Death rates for this age group remain relatively low related conditions as: Presbyopia and presbycusis
• Increases in myopia
Changes in Capabilities • Loss of endurance due to slowing of basal metabolism

• Sensation COGNITIVE DEVELOPMENT

• Motor skills and reaction time
• Internal changes • In their prime. No significant reductions in most abilities until 60s
• Increased sense of competence in solving problems
Inevitable Aging • Experience, information processing and fluid intelligence
become encapsulated to specific types of knowledge
• By age 64, visible signs are apparent: • Processing time may slow but competence remains
o Gray and thinning hair • Engaging in activities requiring thought, strategy, and recall will
o Wrinkles help retain memory and skills longer
o Need for reading and bifocal eyeglasses • Creativity remains intact
o Hearing loss • Becoming expert in one area may hamper creativity and
• Decline of major organs, including lungs, heart, and digestive versatility
system; additionally women undergo menopause sometime
between the ages 42 and 51

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 Fluid Intelligence Practical Problem Solving
• Ability to solve problems requiring little or no previous knowledge
• Ability to reason abstractly
• Begins to decline in middle adulthood and continues to decline
with age
Crystallized Intelligence • Cognitive processing less selective and react slower to cognitive
• ability to remember and use information acquired over the lifetime
• refers to skills that depend on accumulated knowledge,
experience, verbal skills, good judgement, and mastery of social
conventions
• skills are acquired because they are valued in our culture
• tested by vocabulary tests, general information tests, verbal
analogies, logical reasoning tests
• type of intelligence that increases through middle adulthood, as
adults are always adding to their knowledge and skill at work and
in leisure activities
• they are practiced daily
ex: mathematical or chemical formulas, vocabulary size, and
history dates
Intelligence of moral development called postconventinal morality
• The Seattle Longitudinal Study: study of intellectual abilities in
adulthood years (Schaie)
• Peak performance on vocabulary, verbal ability, inductive
reasoning, and spatial orientation was attained in middle age
• Decline in numerical ability and perceptual speed
• When studying intelligence, whether data is collected cross-
sectionally or longitudinally makes a difference in results
• Information Processing - perceptual speed begins declining in
early adulthood and continues to decline in middle adulthood
Expertise
• Expertise involves having extensive, highly organized knowledge
and understanding of a particular domain as a result of many
years of experience, learning, and effort
• Expertise often shows up more in middle adulthood than in early
adulthood
• Rely on accumulated experience
• Process information automatically and analyze it more efficiently
• Have better strategies and shortcuts to solving problems
• Are more creative and flexible in solving problems
Memory • Pleasant times after work when individuals are free to pursue
• Verbal memory declines during middle adulthood according to
most researchers
• Memory controversy about whether memory declines in the
middle years: most experts agree there is some decline, at least
in late middle age
• More time is needed to learn new information.
• This slowdown has been linked to working memory: the mental
“workbench” where individuals manipulate and assemble
information when making decisions, solving problems, and
comprehending written and spoken language
• Memory decline is more likely to occur when individuals do not
use effective memory strategies
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Remains stable in early and middle adulthood, then declines in late
adulthood
Cognitive Changes
tasks
• Less ability to control attention inhibits responses to irrelevant
stimuli
• Sensory stimuli processed differently
• Subjective experience of forgetfulness
• Signs of Cognitive Change
o Some improve while others decline
o Crystallized intelligence often increase
o Ability to reason peaks
o Tend to forget episodic (day to day things like where the car
keys are) memories and remember semantic memories (like
how to change a tire)
o Adults can continue to improve their language, memory, and
reasoning skills
o According to Kohlberg, middle aged adults are in the final stage
o They become more interested in establishing and living by their
own personal values
CAREERS, WORK, AND LEISURE
Work in Midlife
• The role of work is central during middle age
• In the U.S. about 80% of people aged 40-59yrs are employed
• A time evaluation, assessment , and reflection about work
• Current challenges and changes faced by middle aged
workers in the 21st century:
o globalization and exporting of jobs
o rapid developments in information technologies
o downsizing organizations
o early retirement
o pensions and health care
• Reach peak of position and earnings
• May experience age discrimination
• May have multiple financial burdens
• Some career changes are self-motivated while others are a result
of job loss
Leisure
activities and interests of their own choosing
• Compares with those who never took vacations, men who went
on annual vacations were 21% less likely to die over the 9 years
studied, and 32% less likely to die of coronary disease
• Adults in midlife need to begin preparing for retirement and
leisure can be a part of this preparation
Signs of Socio-emotional Change
• Erikson called this stage of socio-emotional development the
generativity versus stagnation (how to leave legacies)
• When children leave home, the household is an empty nest.
Parents often become grandparents during middle adult years
 • Biological changes involves raising children
• Parental is giving back to future generations by participating in
children’s lives
• Work involves passing on work knowledge and cultural includes
communicating values to larger society
• Supportive relationships are healthy relationships that include
give and take between those involved
• People often question whether they want to continue in their
chosen career
• Leisure activities help define self-identity outside of career and
family
• Retirement is often on their minds
• Special needs can develop as a result of aging
• Late adulthood has its own great pleasure, when there is a focus
on continued mental and physical activity, a dominant
preoccupation with the present and the future, and involvement
with the facilitation of the young.
• Then, death can be met with feelings of satisfaction and
acceptance, the natural end point of human existence that follows
a life lived and well loved
Religion and Meaning in Life
• More than 70% of middle-aged adults are religious and consider
spirituality a major part of their lives
• Increase in spirituality tends to occur between late middle
adulthood and late adulthood
• Women have consistently shown a stronger interest in religion
than males
• Religion is positively linked to health
• Religion and health researchers have found that religious
attendance is linked to a reduction of blood pressure &
hypertension and increased longevity
• Franki (1984) identified the three most distinct human
qualities as:
o spirituality
o freedom
o responsibilty
• Baumeister and Vohs (2002) argue that the quest for the
meaning of life may be understood in terms of four needs:
o need for purpose
o need for values
o need for sense of efficacy
o need for self-worth
Mortality Rates
• In middle age, many deaths are caused by a single, readily
identifiable cause
o Leading causes
o cancer
o cardiovascular disease
• Men have higher mortality rates than women for all of the leading
causes of death
WHAT FACTORS AFFECT HEALTH AT MIDLIFE? • Diabetes is also a major cause of death
• What are health habits that can contribute to lower vitality? How
is it lowering vitality? Think of a bad health habit that you or
someone you know exhibits and think of ways to change or
manage the habit to become healthier
Health and Disease Frequency of Accidents Decline disease and bone loss leading to osteoporosis.
• Individuals are less susceptible to colds and allergies
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• Stress is found to be factor in disease
• Chronic disorders are rare in early adulthood
• Culture is found to affect cardiovascular disease
Disease and Health
• As people age, they become more vulnerable to disease
• Most deaths in middle age are from cancer and heart attacks
• Women are generally more healthy than men
• Poor habits especially smoking and over eating take their toll in
middle age
Smoking, Alcohol and Obesity
• Nearly 25% of adults smoke
• Smoking is responsible for more than 25% of all deaths among
people ages 35 to 64
• Alcohol consumption is the third leading cause of preventable
death in the US
• Today 65% or US adults are overweight or obese
Stress and Health
• Stress is a normal part of life, but excessive stress plays a role in
many diseases of middle adulthood
• Extreme or prolonged stress weakens the immune system
• An accumulation of minor, everyday stressors can be more
harmful than major life changes. Everyday hassles tend to
decrease with age, perhaps because people learn strategies for
managing stress.
• Adults who live in poverty or who are members of disadvantaged
minority groups have higher stress levels, poorer health, and
earlier death.
• Personality and negative emotionality can affect health
• Causes of occupational stress include work overload,
interpersonal conflict, sexual harassment, a combination of high
pressure and low control, and inability to “unwind”.
• Continual stress may lead to burn out
• Unemployment creates psychological as well as financial stress.
Physical and psychological effects may depend on coping
resources
• Most middle aged people are healthy and have no functional
limitations
• Diet, exercise, alcohol use, and smoking affect present and future
health. Preventive care is important.
• Hypertension is a major health problem beginning in midlife.
• AIDS tends to be more severe in older people because of
weakened immune functioning
• Leading causes of death in middle age are cancer, heart disease,
liver disease, and stroke.
• Low income is associated with poorer health, in part because of
lack of insurance
• African Americans elevated health risks may be due to a
combination of hereditary factors, lifestyle factors, poverty, and
stress caused by discrimination
• Postmenopausal women become more susceptible to heart
 • Chances of developing breast cancer also increases with age, and Pressures: Long-standing Relationship
routine mammography is recommended beginning at age 40.
• About one in three U.S. women has a hysterectomy by age 60, • Real and imaginary concerns about diminished sexual capability
usually because of uterine fibroids, abnormal uterine bleeding, or • Emotional withdrawal due to preoccupation with developmental
endometriosis. Many experts believe this procedure is overused. tasks
• Realistic pressures related to work and providing for dependent
REAPPRAISING RELATIONSHIPS children, and elderly parents

• Midlife is a time of serious reappraisal of marriage and committed

Pressures: Relationships that Began in Midlife
relationships
• Individuals struggle with whether to settle for what they have or to • Absence of a common past
search for greater perfection with a new partner
• Age and generational differences in interest and activities
• For some, the conflict rages internally and is kept from others;
• Difficulties involved in forming a stepfamily
express it through actions like:
o Affairs
Pressures: Actions to Continue Sexual Intimacy
o Trial Separation
o Divorce
• Accept the appearance of the partner’s middle-aged body
• Recent research on happy marriage indicates that these couples,
• Continue to find it sexually stimulating
despite internal and real conflict, have found or achieved a special
• Accept the normative changes that occur in sexual functioning
goodness-of-fit between their individual needs, wishes, and

expectations. In the eyes of these couples, marital success is
Sexual Attitudes and Behavior
based on the ongoing, successful engagement of a number of
psychological tasks. • Sexual activity occurs less frequently than in early adulthood
• The decision to leave a long-standing, committed relationship • Middle aged men are more interested in sex than middle-aged
affects: women
o The Two Individuals –The abandoned spouse experiences the • Living with a spouse or partner makes all the difference in terms
severe effect of engaging in sexual activity
o Friends
For Men
o Parents – Severe effect

o Children– Effects are profound and extending far beyond
• Greater difficulty in getting and sustaining erections
childhood
• Experience a longer refractory period after ejaculation
• Various therapeutic interventions:
• Erections slow and orgasms less frequent
o Marital Counseling
• Longer to ejaculate
o Individual Psychotherapy
• Longer refractory erectile dysfunction may/may not occur
o Psychoanalysis
• Hypertension is common
• Prominent problem in outpatient clients:
o Intimacy For Women
o Love
o Sex • Diminished estrogen production leading to:
o Thinning of vaginal mucosa
SEXUALITY o Decreased secretions
o Fewer orgasmic contractions
• Midlife individuals are focused on maintaining intimacy in the face
• Reaches sexual prime by mid-30s which leads to greater capacity
of deterring physical, psychological, and environmental pressure
for orgasm
• Mastering these, the individual will still find the partner’s body
• More vulnerable to narcissistic blows to their self-esteem as they
sexually stimulating
lose their youthful appearance
• Inability to deal with changes in body image prompts many midlife
• Feel less sexually desirable and less entitled to an adequate sex
individuals to undergo cosmetic surgery in an effort to maintain
life
their youthful appearance
o Aging
• Patients with deeply rooted problems with sexuality or o Work
relationships may use the following as a means of rationalizing
o Relationships with children or elderly parents
their conflicts and refusing to analyze them.
• Fertility declines though sexual enjoyment remains
• Menopause: less estrogen
Normative Changes
• Hot flashes may occur as metabolism slows
• vaginal dryness
• Diminished sexual drive • Urinary infections
• An increase in mechanical problems • Urinary dysfunction may occur

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 • Sexual desire usually remains
• Sometimes psychological problems
Sexual Dysfunction heightened in a society that places a premium on youth
• A persistent disturbance in sexual desire or sexual response
• Forms of dysfunction:
o lack of interest
o painful intercourse
o difficulty in arousal
o premature ejaculation
• For sexual intimacy to continue, the participants must:
o accept the appearance of the partner’s middle aged body
o continue to find it sexually stimulating
o accept the normative changes that occur in sexual functioning
• For those who master these developmental issues, the partner’s
body remains sexually stimulating
• Diminished sexual ability is compensated for by feelings of love
and tenderness generated over the years by a satisfying
relationship
• Those who cannot accept the changes in the partner’s body or
their own stop having sex, begin affairs, or leave the relationship,
usually in search of a younger partner.
• Erectile dysfunction: inability to achieve and maintain an
erection
o May stem from psychological problems
Reproductive Health divorce, separation or widowhood.
• Is a term used to describe the health of the reproductive organs in
all persons
• Climacteric for both men and women
• Menopause: menstrual period cease
o ovulation stops
o estrogen, progesterone, & testosterone drops
• Men’s health - although women’s health has become a specialty
in medicine, a specialty in men’s health is rarely seen
• In each leading cause of death in adults, men have a higher rate
of mortality
• The morbidity rate is generally higher for women in both acute
and chronic conditions
• Generally men remain in the workforce longer than women and
may partake in activities that pose a higher potential for injuries
• Attitudes toward menopause and symptoms experienced may
depend on personal characteristics, past experiences, and
cultural attitudes
• Although men can continue to father children until late in life, they
experience a decline in fertility and in frequency of orgasm
• Sexual activity generally diminishes only slightly and gradually,
and the quality of sexual relations may improve. Among women,
sexual dysfunction increases with age
• Hormonal Changes in middle aged men:
o Most men do not lose the capacity to father children
o Modest decline in sexual hormone level and activity (male
menopause / andropause) has less to do with hormonal
change than with psychological adjustment to overall decline
o Testosterone levels decline and can reduce sexual drive
o Most erectile dysfunction stem from physiological problems
o Treatment has focused on drug therapy
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• “Double standard of aging” - causes women to seem less
desirable as they lose their youthful appearance
• For both men and women, anxiety about getting older is
Essential Health Screening for Middle Aged Men and Women
• Vision testing
• Dental check-ups
• Blood pressure monitoring
• Lipid screening (cholesterol & triglycerides)
• Cardiovascular screening
• Colorectal cancer screening
• For women:
o Breast examination
o Mammogram
o Papanicolau (pap) testing
• For men:
o Testicular examination
o Prostate cancer screening
CHALLENGES
• Maintaining optimum cognitive functioning is necessary to
prevent a decrease in problem solving skills
• Women at midlife are at high risk for social isolation due to
• Empty nest syndrome - occur when grown children start to leave
home for the first time may increase the feeling of isolation
• Some mothers may feel lonely and depressed when their children
leave home. They should be allowed to set new personal goals
• Especially difficult to mothers who never worked outside of home
Gains and Losses
• Late midlife may be characterized by the loss of a parent, the last
child leaving the home, becoming a grandparent, preparation for
retirement, and actual retirement
• Overall, gains and losses may balance each other in midlife but
losses may begin to dominate gains for many individuals in late
midlife
• Midlife is characterized by individual variations
Climacterium
• The period in life characterized by decreased biological and
physiological functioning
• The midlife transition in which fertility decline
• It refers to the time in life which hormonal changes result in
cessation of reproductive ability in the female and a
corresponding decrease in sexual activity in males.
• For women, the menopausal period is considered the
climacterium
• Menopause can extend over several years. Some women
experience anxiety and depression, but women who have a
history of poor adaptation to stress are more predisposed to the
menopausal syndrome
 Physical Qualities and Changes à negative side effects: increased risk of stroke and
• During middle adult years, reproductive capacity declines or is
lost for both men and women, which is climacteric
• For men, a decrease occurs as the male hormone testosterone
declines
• Women experience a decrease in estrogen and progesterone.
The first stage of reduced fertility is called perimenopause
• Continue to need between 7 to 9 hours of sleep each night
• Symptoms from inadequate sleep may include reduced ability to
concentrate, solve problems and be productive
• Regular health, eye and dental examines are recommended
• Chronic diseases overtake accidents as the leading cause of
death. They start slowly and lasts for years, if not a lifetime.
• Cancer as leading cause of death
• Heart diseases 2nd leading cause of death
• Women
o Happens between 40-50 years of age
o Some women feels sexually freer after menopause
o Bernice Neugarten studied this period and found that more than
50% of women described menopause as an unpleasant
experience, but a significant portion believed that their lives had
not changed in any significant way, and many women
experienced no adverse effects
o Because they no longer had to worry about becoming pregnant,
some women report feeling sexually freer after menopause than
before its onset
o Female climacterium has been stereotyped as a sudden or
radical psychophysiological experience, but it is more often a
gradual experience as estrogen and progesterone levels
decrease with changes in the flow, timing, and eventual
cessation of the menses
o Estrogen secretion decreases
o Menses change in flow, timing, and eventual cessation
o Vasomotor instability (Hot Flashes) can occur
o Some experience anxiety and depression and a history of poor
adaptation to stress can predispose women to menopausal
syndrome
o Menopause
§ Considered the climacterium
§ Decrease of estrogen and progesterone
§ No longer produce eggs that can be fertilized
§ Osteoporosis - one of the side effects of menopause in
women
§ involves:
ü Physical changes and symptoms
ü Emotional effects
§ Treating Effects of menopause:
ü Hormone replacement therapy (HRT)
à Is controversial and long term use should be seriously
reevaluated
à Usually estrogen and progesterone
à minimizes menopausal symptoms
à reduces risk of osteoporosis
à involves health risks
à augments declining levels of reproductive hormone
production by the ovaries usually estrogen and
progesterone
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cardiovascular disease
à decreased use of HRT has shown a related decline in the
incidence of breast cancer
o Perimenopause
§ transitional period, often takes up to 10 years
§ first stage of reduced fertility
§ heredity and experience influence the onset of
menopause
§ hot flashes, nausea, fatigue, mood swings, heart
palpitations, headache, decreased vaginal lubrication and
insomnia
§ not the negative experience it once was
• Men
o Male hormones decline gradually in middle age and may suffer
erectile dysfunction
o For men, the climacterium has no clear demarcation, male
hormones stay fairly constant through the 40s and 50s and
then begin to decline
o About age 50, a slight decrease in healthy sperm and seminal
fluid occurs, not sufficient however to preclude insemination
o Decreased testosterone level can lead to fewer and less firm
erections and decreased sexual activity
o Men must adapt to a decline in biological functioning and
overall physical vigor
o Some men experience a so called midlife crisis during this period
o Crisis can be mild or severe, characterized by a sudden drastic
change in work or marital relationships, severe depression, and
increased use of alcohol or drugs, or a shift to an alternate
lifestyle
o Andropause
§ male menopause
§ drop in testosterone
§ reduced sexual desire, erections and muscle mass
§ effectiveness of HRT is questionable
The Sandwich Generation
• Middle adults are known to be the sandwich generation
• That means that they must deal with increased financial and
emotional responsibilities related to their children in addition to
increased demands placed on them by their older and possible
dependent parents
• These stressors contribute to the challenges of middle adulthood
• Sources of Satisfaction:
o Relationships with family and friends
o Work
o Leisure
o Finances
o Physical and mental health
o Religious / spiritual lives
• Most middle aged individuals say that they are in meaningful
intimate relationships, including those who have been married for
several years
• For those who divorce and remarry, many report satisfying
intimacy although most report that remarriage brings a new set of
challenges
 • Developmentalists have found that most people in this age group
have less problems with their children and also better
relationships with their own parents
MIDLIFE TRANSITION AND CRISIS • Individuals have a clear definition of what they want from work,
Midlife Transition • Men who undergo career plateau may experience disillusionment
• An intense reappraisal of all aspects of life precipitated by the
growing recognition that life is finite and approaching an end
• Characterized by mental turmoil
• Reappraisal results in decisions to keep most life structures
(Marriage, career) which have been built over time
• Major changes are considered
• Every patient in this age group is engaged in a midlife transition
Midlife Crisis • Developmental crisis may also occur when a person feels
• True midlife crisis is a major, revolutionary turning point in life,
involving changes in commitments to career, spouse, or both,
accompanied by a significant, ongoing emotional turmoil
• An upheaval of major proportions
• Period of internal agitation followed by a flurry of impulsive actions
• Efforts by family members or therapists to get the individual to stop
and reconsider usually fails
• Individual’s overwhelming need:
o Avoid anyone who counsels restraint
o Ignore therapists
• Usually, the therapist is left with the painful job of helping those
who have been left to deal with shock and grief
• Can be characterized by:
o Sudden drastic change in work or marital relationships
o Severe depression
o Increased alcohol and drug use
o Shift to an alternate lifestyle
Empty-Nest Syndrome
• A depression that occurs in some parents when their youngest child
is about to leave home
• Most parents perceive the departure of the youngest child as a
relief
• Depression stems from lack or no compensating activities
developed
• Women who invest themselves completely in mothering leaves
them with no suitable identity after the children leave home
• Mostly affected are mothers
Changing Midlife marital problems
• Today, many 50yr olds are in better shape, more alert, and more
productive than 40yr olds
• Middle age is starting later and lasting longer
• Jung - “Midlife is the afternoon of life”
• Age identity - as adults become older, their age identity is
younger than their chronological age
• An increasing percentage of the population is made up of middle
aged and older adults
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• “Rectangularization” of the age distribution
OTHER TASKS OF MIDDLE ADULTHOOD
family, and leisure by age 50
or frustration
• Social rules become rigidly established
• Lack of freedom in lifestyle and a sense of entrapment can lead to
depression and loss of confidence
• Unique financial burdens can occur: pressure to care for the aged
parents and children at the same time
• Daniel Levinson described a transitional period between the ages
50-55 by which the physiological changes that appear may have a
dramatic effect on a person’s sense of self
incapable of changing an intolerable life structure
• The satisfaction that individuals express about their network of
friends predict positive mental health
• Some social ties may be a source of stress when demands cannot
be met or assault a person’s self-esteem
Middle-aged People Possess
• Power
• Leadership
• Wisdom
• Understanding
• Middle aged people who has their health and vitality intact
describes middle age as the “Prime of Life”
• No single event characterizes the transition, the physiological
changes that begin to appear may have dramatic effect on a
person’s sense of self. For example, a person may experience a
decrease in cardiovascular efficiency that accompanies aging.
• Chronological age and physical infirmity are not linear, however
those who exercise regularly, who do not smoke, and who eat
and drink in moderation can maintain the physical health and
emotional well-being
DIVORCE
• A major life crisis
• Spouses often grow, develop, and change at different rates. One
spouse may discover that the other is not the same as when they
first married. In truth, both partners have changed and evolved,
not necessarily in complimentary directions.
• Frequently, one spouse blames a third person for alienation of
affections and refuses to examine his or her own role in the
• Aspects of marital deterioration and divorce seem to be related to
specific qualities of middle life - need for change, weariness with
acting responsibly, and fear of facing up to oneself.
• Qualities of middle life related to aspects of marital
deterioration and divorce:
o Need for change
o Weariness with acting responsibly
o Fear of facing up to oneself
 Types of Separation (Paul Bohannan) • Child support payments are more likely to be made in joint custodies
• Psychic Divorce
o a period of anticipatory mourning that sets in before the divorce
o The love object is given up, and a grief reaction about the death
of the relationship occurs
o Separation may be difficult to achieve if one or both parties are
used to being dependent on each other. It forces a person to
become autonomous from a position of dependence
o Feelings of depression, ambivalence, and mood swings at the
time of divorce
o Studies indicate that recovery takes about 2 years; by then, the
ex-spouse is viewed neutrally, and accepts his or her new
identity as a single person
• Legal Divorce
o Involves going through the courts so that each parties is
remarriageable
o 75% of divorced women and 80% of divorced men remarry
within 3 years of divorce
o No-fault divorce: neither person is judged to be the guilty
party, and has become the most widely used legal mechanism
for divorce
• Economic Divorce
o Involves major concerns to the division of property between the
couples and economic support for the wife
o Many men who are ordered by the courts to pay alimony or
child support disregard the order and create a major social
problem
• Community Divorce
o Social network of the divorced couple changes markedly
o Only a few relatives and friends are retained and new ones are
added
o The task of meeting new friends is often difficult for divorced
persons due to their realization of dependence on their spouse
for social exchanges
• Coparental Divorce
o The separation of a parent from the child’s other parent
Custody o Lesser social pressure to remain married
• Parental Right Doctrine: a legal concept that awards custody to the
fit natural parent and attempts to ensure that the best interests of
the child are served
• About 15% of custody are given to fathers
• Mother who are granted custody have a better chance of being
awarded with child support.
• Types of custody:
o Joint Custody
§ A child spends equal time with each parent; most common
practice
o Split Custody
§ Siblings are separated and each parent has custody over one
or more children
o Single Custody
§ Children lives solely with one parent and the other parent has
limited visitation rights
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or when the noncustodial parent is given visitation rights
• Problems that arise with the custodial and noncustodial
parent:
o Absence of the noncustodial parent in the home represents the
reality of divorce
o The custodial parent may become the target of the child’s anger
about the divorce
o The custodial parent who undergo stress may not be able to deal
with the child’s increased needs and emotional demands
o Emotional distress between the child and the noncustodial
parent
• Noncustodial parent must cope with the limitations on time spent
with the child, which loses day-to-day gratification and parental
responsibilities
• Joint custody offers a solution but requires substantial maturity on
the part of the parents
• Parents must separate their child-rearing practices from post-
divorce resentments, and must develop a sense of cooperation in
rearing the child
Reasons for Divorce
• Tends to run in families
• Rates are highest in couples who marry as teenagers or from
different socioeconomic backgrounds:
o Divorced parents
§ a person may resolve marital problems through divorce if
his/her parents are also divorced
o Unrealistic expectation of the spouse
§ an all-giving mother or a magically protective father
o Parenting experiences
§ places the greatest strain on a marriage
o Death of a child through illness or accident in more than 50% of
marriages end in divorce
o Sex and Money
§ may be used as means of control; withholding sex or money
entails expression of aggression
§ easing of divorce law and declining influence of religion and
extended family makes divorce socially acceptable
o Adultery
§ Voluntary sexual intercourse between a married couple and a
third party
§ Often associated with wife’s pregnancy
§ Rarely account for divorce but can serve as a catalyst for basic
dissatisfaction in the marriage, which leads to dissolution
§ Potentially fatal STDs serve as sobering deterrents to decline
adultery
REFERENCES
• Kaplan and Sadock’s Synopsis of Psychiatry, 11th ed.
• Dr. Jardiolin’s ppt