W12: Adulthood and Midlife

Midlife (40-65 years)

• Common milestones for this stage of life include: parenting, children leaving home, becoming a grandparent, marriage or marital struggles, divorce, new relationships, career prime time or transitions, retirement planning or early retirement, menopause, and physical changes.
• Biological changes in midlife include wrinkles, gray hair, hair loss, weight gain, skin changes (smoking and sun exposure can have an impact), bone mass loss, osteoarthritis, rheumatoid arthritis, vision changes, metabolism changes, and an increased risk of health problems like cardiovascular disease, cancer, and high blood pressure.
• Hormonal and reproductive changes affect both men and women.
  • Women experience perimenopause and menopause. Perimenopause is a transition phase leading to menopause. Menopause is defined as more than 12 months without a period. Menopause occurs typically between the mid-40s and mid-50s and lasts about 7 years. Women experience rapid decreases in estrogen and progesterone during this phase.
  • In men, there's a gradual decrease in testosterone.
• Cognitive changes during this period include a peak in fluid intelligence (reasoning and problem solving) and crystallized intelligence (accumulated knowledge and experiences). Numerical abilities and perceptual speed tend to decrease.
• The "sandwich generation" refers to people in midlife who need to support both their aging parents and their growing children. This can lead to financial pressures, a high caregiving burden, and impact mental health.
• Other social pressure changes include the later receipt of inheritance, which can affect home buying and mortgage payments.
• Erikson's stage of psychosocial development for this period is Generativity vs. Stagnation. Generativity focuses on contributing to the world and leaving a positive mark. Stagnation is characterized by feeling like one has not done anything worthwhile, boredom, and disconnection.
• Generativity is associated with better health, more positive relationships, greater productivity, fulfillment, and connectedness.
• Stagnation is associated with reduced cognitive function (possibly due to depression), poorer health, low quality relationships, and decreased life satisfaction.
• Mid-life crisis and empty nest syndrome are not universal experiences and depend on factors like personality, individual psychology, and societal "social clocks."
• Mid-life correction refers to adjusting one's life because of feeling off-track, which may happen in various domains like work, social life, family, and hobbies.
• Activities that promote generativity include social participation and connections, taking on more responsibilities, mentoring, and volunteering.

Older Adulthood (Over 65 Years)

• Life expectancy is increasing for both men and women, with women living longer than men.
• Older adulthood is categorized into young-old (65-74 years), middle-old (75-84), and oldest-old (85+).
• Transitions in older adulthood include retirement, health conditions, adjusting to physical and sensory changes, maintaining cognitive function, adapting to social and community role changes, and bereavement.
• Ageism is a prevalent issue affecting older people. It can be self-directed, interpersonal, or institutional.
• Some commonly encountered misconceptions about older adults include: they are an economic burden, all older adults are unwell and in nursing homes, depression, and loneliness are normal, dementia is inevitable, older adults cannot learn new things, older adults are asexual, and they should be passive, uncomplaining, happy, and forgetful.
• Ageism can be addressed through policy and law changes, education, and intergenerational activities.
• Successful aging moves away from a deficit focus and emphasizes maintaining high cognitive and physical capabilities, living free from disability and disease, and having meaningful interactions with others.
• Physical changes in older adulthood include brain atrophy, decreased neural processing speed, respiratory and circulatory changes, bone loss (osteoporosis), muscle loss, skin changes, hair loss, and decreased sensory perception.
• Cognitive changes include a normal age-related decline in processing speed, short-term and working memory. Older adults can still learn new things with repetition.
• Dementia affects approximately 1 in 10 people over 65.
• Risk factors for dementia can be categorized as non-preventable (age, genetics, family history) and modifiable (target 12 risk factors to prevent or delay dementia by 40%).
• Wellbeing in older adults is typically higher than in younger adults.
• Erikson's psychosocial stage for this period is Integrity vs. Despair. This stage centers around reflecting on one's life and answering the question, "Did I lead a meaningful life?" Retirement, bereavement, and illness can trigger this reflection. A life review helps create a coherent life narrative.
• Death anxiety is generally lower in older adults.
• Older adults experience better regulation of emotions and lower rates of mental illness (excluding dementia).

Theories of Aging

• Selective Optimization with Compensation (SOC): Baltes (1980) proposed that older people need to select their best abilities and use them to compensate for declines or losses. This includes:
  • Selection: Choosing valued activities, best abilities, and most intact functions (elective or loss-based).
  • Optimization/Compensation: Overcoming limitations through strategic use of resources.
• Socioemotional Selectivity Theory (SST): Suggests that time perception is a key factor in social goal selection.
  • When time is perceived as long, knowledge goals are prioritized.
  • When time is perceived as short, emotional goals are prioritized.
  • Older adults have shrinking time horizons due to their proximity to death.
  • This prioritizes emotion-related goals, meaning and emotional wellbeing, and present-focused goals over future-focused ones.
• Strength and Vulnerability Integration Model (SAVI): Considers both time horizons and life experiences, including wisdom. This model suggests that:
  • Older adults remember positive things better.
  • They are better at regulating emotions through attentional avoidance and finding silver linings.
  • However, they have reduced physiological flexibility.

Mental Health in Older Adults

• Depression and anxiety are the most common mental disorders in older adults (excluding neurocognitive disorders).
• Around 1 in 20 older adults experience either depression or anxiety.
• There's a significant overlap between these two conditions, with up to 50% of cases being comorbid (occurring together).
• Older adults have the highest suicide rate, reaching a peak in males over 85.
• Rates of help-seeking are low, with only 26% of older adults receiving treatment.
• Barriers to treatment include cost, stigma, preference for self-help, concerns about medication, transportation issues, and failure to identify the need for help.
• Under-recognition by healthcare professionals, prioritization of physical problems over mental health, and resource constraints contribute to these barriers.
• Treatments for anxiety and depression include SSRIs and psychotherapy, with CBT and problem-solving therapy showing greater benefits for depression, and CBT showing moderate benefits for anxiety.