Body Functions & Structures

Middle Adulthood (40-65 yo)

- period of good physical/mental performance
Definition: - defined by satisfied lifestyle/personal
- individual experiences conflict w demands of roles expectations
and occupations - Menopause in women
- work-lifestyle conflicts
- conflicts between caregiving demands BRAIN & NERVOUS SYSTEM
(sandwich gen) - neurogenesis is continued but balanced by gradual
- associated w/ individuals established in their adult shrinkage in parts of brain
roles
- started a family, persisting in a career,
engagement in civic/community ax
Central development tasks:
- express love wo sexual contacts
- pride from accomplishments
- maintain standard of living
- adjust to physiological changes of middle age

Sandwich generation
- describe conflicts associated w/ caregiving
- caught between providing support to older/younger
cohorts in the population
Baby Boomers (1944-1964)
- Hippocampus: memory
- born in “baby boom” following WWII
- Cortex: language, attention, decision making
- middle & late adulthood
- Cerebellum: movement, balance, muscle tone,
- “gloomiest generation”
equilibrium
- more downbeat about life Note:
- more likely to have financial concerns despite having - healthy diet, genetics, can protect brain tissue loss
the highest income - begins at middle age but extends to lifespan
Generation X - changes may not be enough to affect overall
- born post-baby boom (WWII), remainder of function
individuals in mid adulthood
Cognitive Functions
Types of Ages - performance remain stable even with minor changes
1. Biological Age Period of peak performance in mental abilities of:
- condition of organs and body systems * highest to lowest:
- may be younger than chronological age if 1. Inductive Reasoning: understand patterns/rs
health is well-maintained among variables to solve problems
2. Psychological Age 2. Spatial Orientation: visualize stimuli in 2-3D space
- ability to adapt, solve problems, cope 3. Vocabulary: understand ideas and express them
- mentally active through words
3. Social Age 4. Verbal Memory: encode language/recall units
- habits, beliefs, attitudes 5. Perceptual Speed (↓): quickly make discriminations
** life events experienced in adulthood do not occur in the in visual stimuli
same sequencing/timing for any two people 6. Number (↓): perform mathematical operations

Occupational Balance
- pattern of occupation is perceived to be satisfactory, Men Women
fulfilling, compatible w individual;s values and goals
- reach peak performance - greater improvements in
- finding a cohesive/harmonious lifestyle when
on spatial orie, vocab, overall mental abilities
engaging in obligatory and discretionary ax
verbal memory in their 50s
(10yrs earlier than women)

Other notes for cognitive functions:
- cognitive loss is feared more than physical loss
- education, work, physical exercise can support
persistent high functions
- decline can be reduced through healthy lifestyle,
engagement in cognitively challenging ax, and
cardiovascular fitness
- specific training can improve working memory and
fluid intelligence
- daily cognitive challenges (novelty/problem
solving)
SENSORY FUNCTIONS
- sensory organ function, sensory processing, sensory
perception are all negatively affected by age
- changes in vision/hearing can be easily
accommodated
- significant impairments usually do not emerge until
late adulthood
Vision
- visual functioning is stable enough
- age-related changes beggina approx 50yrs
- absolute threshold (neuroscience): indicate
smallest detectable level of stimulus
- amt of light required to see
- as eyes change, indivs need more light to read;
difficulty at night
- difference threshold: smallest detectable change in
stimulation
- improve lighting, choosing mtrls that offer
greater visual contrast = change is absolute;
difference threshold
Changes in vision
- decrease in:
- transparency, amt of light contracting the
eye, no. of macular neurons by approx half
from the ages of 20-80
Visual accommodation:
- eyes adjust focus to near/far objects to gain visual
clarity
- less effective w aging; secondary to deterioration of
ciliary muscle action
- ciliary movement: necessary in changing
curvature of lens
- decreased accommodation = presbyopia
- decline in ability to focus on near objects
- age 40-50 usually need visual correction
- use of reading glasses/include bifocal feature for
near-focusing
Hearing
- absolute threshold for lowest lvl sound that can be
heard increases w age
- age 30: increased difficulty hearing high-frequency
sounds develops
- presbycusis: age related hearing loss
- not noticeable after 60 yo
- sensorineural hearing loss: poor cochlear hair cell
function (due to dmg from env exposure (loud
workplace wo hearing protection)
- affects sensitivity to sound, speech compre,
maintenance of equilibrium
PHYSICAL FUNCTIONS
- life expectancy of a baby born in US (M 76.3 yrs; F
81.1)
- longer life expectancy = greater percentage of
people experiencing normal-age related physiologic
changes in musculoskeletal system
- phy ax + healthy lifestyle = less phys decline
Musculoskeletal System
- early adhood: skeletal maturity: bones, spine,
skeletal system reaches peak bone mass
- bone remodeling: dynamic balance bet absorption
of tissue (osteoclastic functions) and simultaneous
deposition of new bone (osteoblastic funct)
- both are in a state of equilibrium
- after age 35: bone loss > bone formation
Osteoporosis: body fails to form enough new bone and too
much old bone resorption
- multifactorial w genetic/env causes
- most common bone disorder
- cause: estrogen drop during
menopause/testosterone drop
- F;over 50 & M;over 70 have higher risk
Osteopenia: less severe, early stage of osteoporosis
Arthritis: inflammation of one/more joints
- normal joint surfaces are covered w a smooth layer
of cartilage
- connective tissue that withstands
mechanical stress/compressive loads (shock
absorber)
- provides surface for sliding/rolling bet joints
- when cartilage undergoes mechanical load/
compressive force = fluid + nutrients are pushed out
- needed for lubrication/nutrition of cartilage
- through aging. this process is disrupted =
dehydration, poor nutrition, increased
degradation of weight-bearing surfaces
- when cartilage is worn thin = bones rub against eo =
stiffness, pain, loss of joint movement
(osteoarthritis)
- affects joints in hands, knees, hips, spine
 - risk factors: genetics, overweight, history of
joint injury, age, occ hazards, high-level
sports, illness/infection
MUSCULOSKELETAL CHANGES
- several alterations begin bet 30-40 yo
- increase in BMI (55-59 in US)
- lean body mass + bone density decrease
- degree/rate of loss may vary widely
- influenced by level of physical activity,
genetics, lifestyle factors (drinking/smoking)
- strength training: can delay natural
deterioration in aging muscles
- muscle force production shows slight decline (40-65)
- decline in strength may be due to: decline in
skeletal muscle fibers accdg to size and type
(sarcopenia)
- affects Type II (fast twitch) muscle
fibers the most
- no change in overall strength, but in
speed of muscular contractions
Flexibility
- range of motions available to joints
- allow performance of daily tasks
- decreased due to changes in muscle/fat ratio +
activity levels
- very gradual up too age 49
- can be maintained in late adhood by participating
fitness ax
CARDIOVASCULAR FITNESS
- can protect against BMI changes, sarcopenia, osteoporosis
- Aerobic capacity: maximal amount of physiologic work that
one can do as measured by oxygen consumption
- affected by age/disease related processes
- common measure of cardiovascular fitness
- often measured as a metabolic equivalent unit
(MET)
- 1 MET = approx body utilization of 3.5 ml O2
per kg body weight/min
- ave cost of resting
- walking 2 miles/hr = 2.5 METs
- if functional capacity is only 5 METs, 50% of
functional capacity is needed to walk in pace
- fitness & phys ax strongly influence cardiovas sys in
older men than women (+ effects are greater in men)
HEALTH RISKS
- health & middle age is typically good-excellent, but
many changes occur in this stage
- fertility declines
- women: menopause (late 40s-early 50s)
- changes may be subclinical (almost unnoticeable wo
medical testing) but can develop to worse
(aging-associated disease)
- not a part of healthy aging
- occurs in frequency as people age
- ex: hypertension, cardiovascular disease,
type 2 diabetes, osteoarthritis, cancer
Hypertension
- high BP; increased force in blood flow
- BP: force of blood pushing against arterial
walls as it flows through them
- leading risk for heart disease/stroke
- kidney disease/vision problems if left uncontrolled
- hypertension correlates to other chronic conditions
- ex: higher incidence of cognitive
impairments (late adhood)
- Risk factors: afro-american heritage, obesity,
frequent stress/anxiety, high sat/alcohol
consumption, family history, diabetes, smoking
Cardiovascular Disease
- heart + blood vessels
- most are related to a process called atherosclerosis
- when plaque builds up in arterial walls
- narrows arteries = harder for blood to flow =
heart attack/stroke
- coronary artery disease (narrowing of arteries), heart
attack, abnormal heart rhythms (arrhythmias),
congestive heart failure, heart valve disease,
vascular disease
- leading cause of morbidity/mortality (middle-late
adhood)
Diabetes Mellitus
- metabolic disease of high blood sugar (lack of insulin
production (TYPE 1)/insulin resistance (TYPE 2)
Type 2 Diabetes
- most common (adult-onset diabetes)
- insulin resistance; sometimes combined w insulin
deficiency
- obesity + lifestyle factors
- body fat, liver, muscle cells do not correctly responds
to insulin (insulin resistance) = blood sugar does not
get into cells to be stored for energy; high levels of
sugar build up in blood = hyperglycemia
- can be delayed w lifestyle changes
- more common if Afro-American, Latinos, Native
Americans, Asian Americans, Native Hawaiians,
Pacific Islanders
Cancer
- uncontrolled growth of abnormal cells
- cancerous cells = malignant cells
- can develop in almost any organ/tissue
 - lung, colon, breast, skin, bones, nerve tissue
- likelihood to get cancer increases with age
- cancer diagnosis from age 40-65 (4% M; 6% F)
- survivorship issues: employment; balance
work/family demands w managing illness
- challenge: managing disruption in daily life
- overwhelmed by treatment, kind, prognosis

ACTIVITIES AND PARTICIPATION

- period demonstrating competence in diverse ax
demands, occupations, roles
- decline in function is non normative pattern
Roles: culturally determined guidelines, set of rights/duties,
expectations, norms, behaviors needed to face/fulfill
- formal/informal rolesCritical roles: child, parent,
spouse, friend, citizen, worker, mentor, grandparent
(co-occupations)
- intentional collaborative rs w others
- can add meaningful occ and also add stress (role
strain)
- aka role overload cause by anxiety/tensions
from conflict in demands of roles
- do not agree w assessment of others
concerning role performance
- accepts roles beyond one’s capacity
- form of occ imbalance = distress from
excessive demands/perception of
insufficient capacity to meet role demands
- ongoing problems from social roles (family
rs), caregiving
HANDLING STRESS AND OTHER PSYCHOLOGICAL
DEMANDS
- perceived stress + coping resources = predictors of
life satisfaction (experienced more in older adults)
- highest experience of stress in young adults (18-40)
- stress is more chronic (ex: associated w caregiving/
financial well-being
In mid age, some people will face major life changes (child
rearing, community particip., competitive focus in workplace,
leisure
- Midlife crisis/empty nest syndrome: difficulty in
adapting to these changes
1. Responsible Stage: associated w family
establishment, complex cognitive skills are required
for these responsibilities, sometimes acquired
through job/community
2. Executive Stage: not all adults move to this stage;
must have opportunities to practice leadership skills
3. Self-Efficacy: belief in succeeding a specific life area
- maintained through age
4. Locus of Control: control over a situation
- indicator to understand how people
response to stress
- internalized LOC feels less stressed, fewer
health probs associated w chronic stress
a. Internal LOC: belief of having control over
what happens
- associated with positive health
behaviors
b. External LOC: belief of having no control,
external variables are to blame. Lower
perception of ctrl = affective, behavioral,
motivational, psychological fx, greater
stress/ anxiety
- ctrl shifts to being external through
age
5. Stress: internal sense that one;s resources to cope
w demands are being depleted
- acute stressors decreases through age
- avoidant to stressors
a. Ineffective stress coping = possible
damaging fx on health
b. Can increase heart rate, bp, risk for
cardiovascular diseases
c. Midlife stressors s/a health, workplace,
caregiver stresses that are long-lasting and
out of one’s ctrl
Common Stress Reaction Chronic Stressors

SCHAIE AND WILLIS STAGES OF COGNITIVE > Mental exhaustion
DEVELOPMENT > Depression/anxiety
- Mid adults typically experience responsible stage > Memory problems
>Somatic symptoms
- Can also move to executive stage
> Sleep–related
disturbances
enduring problems, conflict,
threats that are experienced
daily/persist over time
> social network stressor,
emotional distress
> loneliness, poor health,
 financial difficulties
Stress Hardiness
- mindset that makes resistance to negative impacts
of stressful events
- due to combination of interpreted stresses, degree of
one’s feel in control to stresses, stressor reactivity
- “stress-hardy people’ learned to think through
stressful situations and respond to them differently
- planning/enacting specific strategies = occ
balance = positive response to chronic
stress = stress hardiness
How hariness buffers stress
- leads person to be resilient against stress by:
- using + coping strats
- social support from others
- self-care (diet, lifestyle, relaxation)
Lifestyle balance: pattern of occ resulting in reduced stress
and improved wellbeing
Cognitive Appraisal:
- process of trusting personal interpretation of an
event/illness in determining emotional reax
- strategy taught as tool to address stress/mental
health challenges; support positive coping
2 forms of coping
1. Problem-focused/adaptive coping
- attempting to solve problem, master
situation, expand resources to deal w
situation
- used when there’s a realistic chance to
effect change
- ex: changing careers/quitting stressful job
2. Palliative coping
- help person feel better through emotional
response management to a stressful event
- used when one can do nothing to change a
stressful condition
- ex: alcohol, cigarettes as distraction
Note:
- Stressors affect not only health, but also rs w others
- positively biased appraisals of stressful,
uncontrollable events = better MH over time
Self-care
- demands are the most extensive
- needs ADLS & IADLS (home management,
community mobility, financial management, health
management/ maintenance, meal prep/clean up,
safety precautions, emergency responses, shopping,
child–rearing, care of others
- expected to have effective process skills
(occupational competence) proper use of MTEs
- more independent in work/self-care ax
- expected to be goal-directed
Domestic Life
- builds home for themselves (acquiring place to live,
food, clothing, necessities, household objects)
- required more complex ADLs (IADLs)
- Home establishment and management: central focus
of mid adults
- obtain/maintain personal household
possessions/environment
- can be limited by poverty/poor economic
conditions
- inability to provide for children can be a stressor
Homelessness - can occur at any point
- transitory homelessness (younger people)
- periods wo regular residences bet more
stable residential pds
- chronic homelessness: growing problem in mid
adults
- unaccompanied homeless individual w
disabling condition who has been
homeless for a year/more or at least 4
episodes of homelessness in the past 3
yrs
- sleeping in a place not meant for human
habituation/emergency homeless center
- poor access to health care
- Four areas of needs: employment/education,
money management, coping skills, leisure skills
 - skills in stress/anger management, - 2011: 29/1000 divorced/widowed Americans
assertiveness remarry
- enhance employment opportunities through - Cohabitate > Remarry
setting and meeting work/educational goals - Step-parents struggle more with parental rules

Occupational Deprivation Kinship

- inability to engage in valued occ due to external - kinship obligation is normally toward children;
factors followed by parents
- homelessness, chronic poverty, natural - close connection marked by biological, legal,
disasters, situations wherein one loses social ties
capacity to structure their own time/daily - chosen by mutual affection/interest
tasks - family/non family members
- if OD persists = diminished ability to - kinship rs do not exist in isolation, and there is
perform daily ax, reduced self-efficacy, an element of choice in which ties are honored,
loss of occ identity aside from family origin
- closeness w sibling increases with age
- “chosen families” of gays and lesbians (former
spouse , children from hetero marriages,
adoption, use of birth technologies
INTERPERSONAL INTERACTIONS AND
RELATIONSHIPS - Kinkeepers: members from multigen families
that work to keep in touch w one another
- facilitate access of kin network members
- family, workplace, community connections
w one another
- able to have effective interaction w strangers,
friends, relatives, lovers
Relationship with Spouse/Partner
- many valued occ/co-occ are inherently social
- people in midlife have a more egalitarian rs
- if interpersonal interax are affected = person is also
- least egalitarian: hetero couples w children
affected
- sexuality: no longer the center of rs; learning to
express love more than sexual contact
Relationships with Family
- age related phys changes = feel more
- current rs are shaped from earlier rs
vulnerable; less desirable
- ↑ longevity = more common multigen families
- sexuality = sense of
- increase can be fueled by sever social forces
attractiveness/desirability, people go to
- median age of 1st marriage: later than ever
great lengths to reassert
before = more unmarried 20+s
- can be caused by marital infidelity
- when partnership is “out of sync” = marital
Divorce
discord
- happens throughout adulthood
- loss in personal finances, social networks,
Intimate Relationships
social roles, self-concept, mtrl possessions
- Sexual interest: psychological exp of desire to
- Western cultures: more than 90% marry by the
engage in sexual behavior
end of midlife pd; 25% of these marriage end in
- distinct from sexual ax
divorce
- puberty-adult life: sexual interest > sexual ax
- time of pruning unsatisfactory rs from one’s
- frequency of sexual ax did not decrease w
social network
increasing age through 74yrs
- responsible for blended families/single
- sexual activity = (+) self-reported health
parenthood
- may decline for some people
- cardiovascular disease, arthritis, cancer,
Blended Families
depression = decreased sexual ax
- includes children from previous marriage
 - sexual satisfaction highly correlated w
measures of quality of life
Relationships with Children
- boomerang generation = prolonged parenting
Prolonged Parenting
- young adult returns to live with family = parent
continues parental roles
- can be a source of distress
- parents may feel a sense of failure/lowered
sense of wellbeing if their children boomerang
back, have chronic disease, emotional
problems, substance abuse problems
- baby boomer paret’s llifestyles tend to revolve
around their children
- “helicopter parent” pays extremely close
attention to their children beyond the age where
they can already bear their own responsibilities
Stepparenting
- more difficult/less clearly define
- being a stepmother is more difficult that being a
stepfacther
- expected in assuming responsibility for
child care
- stepchildren + biological children =
greater role strain on mother
- resistance from children
- involved in challenges: boomerang children,
extended child care, extended financial support
of adult children
Grandparenting
- can be in 30s-40s; or 70s-80s
- serve as safety net/mediator in times of crisis,
share news to family members as a kinkeeper,
serve as family historians
- grandparent/child rs may extend for 20+ yrs
- family historians: teach ethnic traditions, culture,
history, language reflecting heritage
- race + ethnicity influences this role
- Afro-american > Caucasian
grandparents (involvement in
grandchildren)
- grandmothers are increasingly taking role of
child care providers
- 1.7M grandmothers provide basic care
Relationship with Caregivers
- greater caregiving demands (50% of all
boomers were raising 1/more young children
while also providing financial support to 1/more
adult children
- assuming this role can take a toll on the rs of
caretaker
- women > men assume this role
- adjust work schedules, urn down promotions,
decrease work hrs, unpaid leaves, give up work
Relationship with Friends
- protective influence against many stresses
- important to midlife adults w little-no familial
support
MAJOR LIFE AREAS
- economic self-sufficiency as one approach
retirement age
- educational pursuits may occur within the scope of
employment
WORK:
- establishment begins at mid 20s; progressing to
mid 30s
- ave retirement age (57-61 yo; half of boomers
expect to retire 66 yo/older
- work has in/tangible financial benefits
- being productive contributors to
community/society
- organizing day into work/non working
hrs
- imposes personal routines
- provide opportunities to cultivate
rs/extend social connections
- career progression begins mid 20s-mid
30s

Maintenance Stage
1. Holding on: stagnating/plateauing
2. Keeping up: updating/ enriching
WORK ROLE ATTACHMENT
- the degree to which an individual’s commitment
to their work role influences their desire to
remain a member of the workforce
- Individuals with strong workforce attachment,
that occupational role may serve as a positive
protective influence on midlife adult’s chronic
stressors
- Some may find their work alienating, and more
vulnerable to conflicts and work strain
COMMUNITY LIFE
- Engagement in voluntary activities and
associations contributes to society in many
ways, and generally peaks at age 35 44 y/o
- Usually active In religious organizations, union
halls, political parties, and groups that support
valued sector within their community such as
youth sports/adult literacy
- VOLUNTEERISM = a way to build social integration
- SOCIAL INTEGRATION: the social embeddedness
of individuals, due to multiple social roles
- Engagement & social integration promotes
social support, social interactions, and
psychosocial factors that enhance resilience in
the face of disease
RECREATION AND LEISURE
- Important in maintaining quality of life in
adulthood; they engage in this because they
enjoy them (intrinsically motivated)
- important tool in restoring occupational balance
for adults in midlife
- Can enhance cognitive functions, can reduce
bone loss, improve balance and extend one’s
social network
- Also provides positive emotional and social
support
- Leisure s/a handcrafts, art, music, social games help
reduce social isolation, provide mental stimulation and
offer physical activity that reduces health risk factors
- Through affiliation (sharing oneself with others),
midlife adults will find pleasure in sharing
activities or spending time with family/friends
- Leisure is a way of gaining closeness with
family and friends
- For some, health may limit participation in
action oriented activities
- People begin to anticipate retirement and
activities that they can continue later in life (ex:
from being basketball player to team coach)
RELIGION AND SPIRITUALITY
- Patterns of religious participation are highly
variable in middle adulthood
Increase religious activity = child rearing
Decrease religious activity = divorce, health decline
- Although it does not have a predictable
development progression, it does remain
important to the majority of adults in midlife
POLITICAL LIFE AND CITIZENSHIP
- CIVIC ENGAGEMENT:
- defined as the individual’s interest with the
improvement of community programs, taking
actions to respond to political/public affairs
- Midlife adults tend to pay attention to the news,
have greater identification with political parties
- May be as simple as taking interests with issues
of public concern, participating in activities such
as joining neighborhood associations, or
attending community meetings
- some may have increased political interest and
become more active in local and national
politics