LS CH 12 Middle Adulthood PDF

7589_Ch12_183-194 29/08/17 12:00 PM Page 183 12 CHAPTER Middle Adulthood Key Words Chapter Outline benign prostatic hypertrophy cataracts climacteric coitus dermis dyspareunia empty-nest syndrome fibrocystic breast disease generativity glaucoma hormone replacement therapy hot flashes menopause...

7589_Ch12_183-194 29/08/17 12:00 PM Page 183 12 CHAPTER Middle Adulthood Key Words Chapter Outline benign prostatic hypertrophy cataracts climacteric coitus dermis dyspareunia empty-nest syndrome fibrocystic breast disease generativity glaucoma hormone replacement therapy hot flashes menopause presbycusis procreation stagnation Physical Characteristics Height and Weight Muscle and Bone Development Dentition Development of Other Body Systems Vital Signs Developmental Milestones Sexual Development Psychosocial Development Establishing and Adjusting to New Family Roles Establishing Economic Security for the Present and Future Maintaining a Positive Self-Image Evaluating and Redesigning Career Options Cognitive Development Moral Development Nutrition Sleep and Rest Exercise and Leisure Safety Health Promotion Summary Critical Thinking Multiple-Choice Questions Learning Objectives A t th e e n d of th i s ch ap te r , y ou s h ou l d b e ab l e to: • • • • List three physiological changes that occur during middle age. Describe the psychosocial task that Erikson identified for this stage. List three goals unique to this stage of development. Describe three areas of health concern for the middle-aged adult. 183 7589_Ch12_183-194 29/08/17 12:00 PM Page 184 184 Journey Across the Life Span Middle adulthood, or middle age, covers the period from the mid-40s through the early 60s. In the past, middle adulthood was defined as the period of development after traditional childbearing roles were completed. Today, however, many women are entering the workforce and delaying marriage and childbearing to advance their careers. For this reason the more current definition of middle adulthood is a transitional period of development after the early adult years but prior to the retirement years. Images and perceptions about the meaning of middle age are conflicting. Some describe this stage as the peak of life; middle-aged individuals are often considered to be powerful, wise, and in control. Conversely, others believe that life goes downhill after 40 and middle age is a time when there is a decrease in energy and physical attractiveness, along with an unhappy home life. Our belief is that middle age is a natural consequence of development and should be viewed as a time of growth and progression rather than one of decline and regression. During this stage of development, adults should reach their peak performance and maturity level if they maintain a healthy lifestyle. Several goals have been identified for this stage, including establishing and adjusting to new family roles, securing economic stability for the present and future, maintaining a positive self-image, and evaluating or redesigning career options (Fig. 12.1). In addition, adults must maintain healthy lifestyles and physical well-being. PHYSICAL CHARACTERISTICS Height and Weight As individuals age, they may gradually lose 1 to 4 inches of height. Body contour changes because of an increase in fat deposits in the trunk region. Middle-aged adults also note that, even without gaining weight, they may require a larger clothing size because their body weight becomes redistributed. Proper exercise and diet can help slow the effects of aging on the body. Muscle and Bone Development Most physiological changes associated with this stage appear gradually and at different times for different persons. A noticeable change during this stage is related to loss of muscle tone and elasticity in the connective tissues. The loss of muscle tone gives the skin a flabby, less firm appearance in the face, abdomen, and buttocks. As muscle tone decreases, muscle strength also gradually decreases. Wear and tear in joints makes individuals prone to degenerative joint diseases. Exercise, weight control, and diet may help maintain normal joint function. Bone mass peaks at age 35, slowly declines, and then accelerates after menopause. Bones lose mass as a result of demineralization. This results in more porous, brittle bones, producing a condition known as osteoporosis. This condition affects more females than males. Genetics, smoking, alcohol and caffeine consumption, sedentary lifestyle, and poor nutrition are some of the major contributing factors leading to this condition. There is a higher incidence of osteoporosis in white and Asian individuals. Preventive measures are aimed at the modifiable factors, which include exercise, diet, exposure to sunlight, hormone replacement, and adequate calcium intake. Dentition FIGURE 12.1 Family ties are important. Some adults complete their dentition, whereas others may not have room for their third molars (wisdom teeth) to fully erupt. If these impacted wisdom teeth cause pain and problems, surgery may be required. Periodontal disease can be prevented 7589_Ch12_183-194 29/08/17 12:00 PM Page 185 Middle Adulthood 185 with proper mouth care and maintenance (see Chapter 11). Regular checkups and proper brushing and flossing have been shown to help maintain healthy teeth and gums. DEVELOPMENTAL MILESTONES Development of Other Body Systems People continue to live as sexual beings throughout their entire lives. However, advancing age may change a person’s options, opportunities, and means of sexual expression. Many myths still exist with regard to middle-aged sexuality and performance. The middle years are often depicted as a period of decreased sexual activity, pleasure, and interest. Some even portray middle-aged marriage as a loveless, sexless relationship. For many people today, middle age is a time when both partners are actively engaged in the workforce, seeking financial and career rewards. This may leave little time to nurture intimacy in sexual relationships. Many couples complain that they have little time or energy for their sexual relationships. The loss of reproductive capacity, either naturally or surgically, is no cause for the loss of libido (sexual drive) and sexual pleasure. Very often women are at their peak sexual capacities, desires, and pleasures during this period. Sexual concerns for men relate to changing roles, reduced levels of testosterone, and anxieties over sexual performance. Other psychosocial factors, including work-related stress and a general lack of physical fitness or health, may cause men to note diminished sexual responsiveness. The change of life that occurs in both men and women is scientifically referred to as the climacteric. In women this change of life is most commonly known as menopause, the cessation of menses, which results from a progressive decrease in the production of estrogen and progesterone. The completion of menopause results in the end of reproductive ability. There appears to be a strong genetic influence affecting the onset and duration of menopause. A daughter can generally predict the course of her change of life by looking at her mother’s menstrual history. Menopause usually begins between 45 and 55 years of age, with the average age of onset being 51. Menopause usually begins with noticeable changes in a woman’s menstrual cycle. The cycle may become irregular and shorter in duration, with longer intervals between periods. Some women experience spotting between periods. The amount of blood flow may increase or decrease (normal blood loss during menses is between 30 and 60 mL), or The muscles of the heart and lungs lose elasticity, and there is a slight decrease in maximum efficiency—that is, blood pressure increases slightly and efficiency of air exchange decreases somewhat. In general, all muscles show a slight decreased capacity to perform work and require a longer time to recover after exertion. Many changes are noticed in the skin. The cells of the dermis (inner layer) become less elastic, resulting in wrinkling and sagging of the skin. The most obvious changes appear on the face as laugh lines around the mouth, lines around the eyes, and loose skin under the chin. Marked weight loss can further exaggerate these changes. Noticeable hair changes for some individuals include graying, thinning, and slowed growth. Race, genes, and gender all influence patterns of hair growth. There is a decline in both visual and aural acuity (see Chapter 11). The optic lens becomes thicker and more opaque, leading to decreased peripheral vision. The eyes have a decreased ability to focus on near objects (presbyopia) and are less able to adjust to changes from dark to light. Most of the visual changes can be successfully managed with the use of corrective lenses. Laser surgery can correct some of these defects, and recovery is rapid. Many people develop a degree of presbycusis, or loss of hearing acuity. This is related to thickening in the capillary walls of the ear. Lack of proper care and excessive exposure to loud noise can further exaggerate these losses. During the middle years adults may begin to notice a gradual loss of taste discrimination. This usually is a minor change that does not affect appetite or food selection. The general condition of the mouth and teeth will have a more noticeable effect on diet. VITAL SIGNS There should be no significant changes in the healthy middle-aged adult’s vital signs as compared to those of a younger adult. (See Chapter 11 for normal adult ranges.) Sexual Development 7589_Ch12_183-194 29/08/17 12:00 PM Page 186 186 Journey Across the Life Span the menses may come to a sudden stop. Internally, the ovaries, fallopian tubes, and uterus decrease in size. The ovaries no longer secrete reproductive hormones and ova. The vagina may lose some elasticity and become drier. These changes may lead to itching and discomfort (dyspareunia) during coitus (intercourse). Using a lubricant during sexual intercourse will reduce the discomfort caused by increased vaginal dryness. Menopausal women frequently experience hot flashes, which are caused by vasodilatation of the capillaries and a sudden rush of blood to the skin surface. During the hot flash the body becomes very warm; this is followed by excessive perspiration, vasoconstriction, and chilling. The hot flash involves mostly the head and neck region and may be visible to the onlooker. It may last for a few seconds or up to a few minutes and may recur any number of times a day. Frequently the individual also may complain of other symptoms, including night sweats, insomnia, and a general feeling of anxiety. Table 12.1 summarizes menopausal signs and suggested interventions. Hormone replacement therapy (HRT) is an effective treatment for reducing menopausal symptoms. HRT is not recommended for women with a family history of breast disease or cancer. HRT has been reported to reduce the risks of heart disease and osteoporosis when used under proper medical supervision. Some women view menopause as a natural event that will culminate in new freedom and beginnings. Others may view menopause more negatively—as an end to their reproductive years. Education and an exploration of their feelings can help women gain insight into and understanding of their bodies and the changes that they experience at this stage. There is no significant physiological change of life for males. During middle age there may or may not be lower levels of testosterone with fewer numbers of viable sperm. Men with low testosterone levels and symptoms such as lethargy or low sex drive may benefit from testosterone replacement. Men remain capable of producing sperm and of procreation (reproduction) well into their 80s. The main change that men experience during middle age relates to their thinking patterns and self-image. As they notice some of the physical changes associated with middle age, some men try to look and act younger. Problems with male sexual functioning are usually caused by disease or related to mental outlook. Middle-aged men who are threatened by the aging process may find that they are also having difficulties functioning sexually. Some may even attempt to prove their sexual appeal by taking younger sexual partners. This is sometimes referred to as a mid-life crisis. Some individuals at this stage begin to experience a stressful period triggered by many factors that might cause a midlife crisis. Others feel free and fulfilled, are content, and are able to master and enjoy multiple roles. Psychosocial Development According to Erikson, the primary task of middle adulthood is generativity, which refers to an T A B L E 12.1 Me no p au s al S i g n s an d Su g g es t ed Interv entio ns Signs Interventions Hot flashes followed by chills Dress in layers. Avoid high necklines. Wear cotton. Palpitations, nervousness, headache Have routine physical examination to rule out medical problems. Decrease stress. Loss of muscle strength Exercise regularly. Decreased elasticity of the skin Limit exposure to the sun. Increased facial hair Remove with electrolysis or waxing. Decreased vaginal lubrication Use water-soluble lubricants before coitus. Sleep disturbances, fatigue Follow relaxing routines at bedtime. 7589_Ch12_183-194 29/08/17 12:00 PM Page 187 Middle Adulthood individual’s desire and ability to serve the larger community. For many adults, generativity also includes having a positive influence on their own children. However, as Erikson points out, an adult does not have to have children to be generative. With or without children, many middle-aged adults are more self-confident about the skills and knowledge they have acquired over the years. Thus, they may feel more able to expand their nurturing beyond their immediate family circles. They often demonstrate a concern for their communities and look to what they can do to make improvements that will benefit future generations. Examples of generativity include volunteer work in the church, school, hospital, or community. Achievement of their lifelong goals and of larger generative goals usually results in satisfaction about themselves and their lives. Failure to achieve generativity results in selfabsorption and stagnation. Stagnant individuals are preoccupied with themselves and refuse to accept life as it is or to change those things with which they are dissatisfied. Immaturity and self-absorption may lead to depression and acting-out behavior. Establishing and Adjusting to New Family Roles Role changes are a part of middle adulthood, as they are in other life stages. For many, time is no longer primarily spent on child-centered activities but on couple-centered activities. The couple may find more leisure time to devote to pursuing their own interests. Partners who have completed their earlyparenting roles may find that they now have to reacquaint themselves with each other and redefine their new roles and responsibilities. The development of true intimacy is critical to the survival of close relationships. Intimacy promotes trust and mutual caring. The deepening of intimate bonds can allow partners to share their joys and defeats in a mutually supportive, enabling manner. To successfully make the transition required by new roles, each partner needs to appreciate the other’s growth, individuality, and needs. Both individuals in a relationship must be flexible and ready to support each other’s struggle to adapt to new roles. Although respect for the partner’s individuality is needed at any stage in a couple’s relationship, marriages in middle age often show signs of stress caused by earlier unresolved conflicts. These conflicts may be related to finances, role divisions, or intimacy. Problems that resurface, and new problems that may arise, must be discussed and resolved to preserve the relationship. Some couples may seek 187 marriage counseling if they need additional outside help in resolving conflicts. Today, an increasing number of divorces occur in the middle and older years. After many years of marital discontent, men and women finally choose to divorce. For most, these are not impulse divorces but have been contemplated for years. Another adjustment that may be particularly stressful for some couples occurs when the last child leaves home. The empty-nest syndrome, or launching children, occurs when children move on with their lives, leaving the parents to live alone. As a result, parents have a difficult time adjusting to a home without children. This is sometimes especially difficult for women. This phenomenon is less common today than it was in earlier generations because more women manage dual roles in the home and in the workplace. Many middle-aged women find that after their children leave home, they have less stress and more time to pursue their own goals and ambitions. Others may have postponed marriage and childbearing and now, in their middle years, still have young children at home. One result of this trend to postpone childbearing is a decrease in the average number of children per family—the longer marriage is postponed, the fewer children the couple is likely to have after marrying. Parenting at this stage may place additional stress on the parents because their energy levels may not be quite as high as when they were younger. However, young children may bring a new youthfulness and spurt of energy to the lives of middle-aged parents. Many people become grandparents in midlife. Today’s grandparents are different from those of the past. No longer is this role associated solely with advanced age and infirmity. Many of today’s grandparents are youthful in their appearance and outlook. Some are still actively working or fulfilling lifelong dreams. Others assume the child care role, allowing their grown children, the parents, to work or complete their educations. A few grandparents are placed as primary caregiver when their grown child can no longer provide adequate parenting. Still others find pleasure and joy in the role of grandparenting and leave the act of primary care to the child’s parents. Grandparenting may take on different styles, described as formal, informal/spoiler, surrogate, wisdom provider, and distant figure (refer to Chapter 11). The formal grandparent allows the parents to discipline their children while maintaining a close interest in the children. The informal/spoiler grandparent attempts 7589_Ch12_183-194 29/08/17 12:00 PM Page 188 188 Journey Across the Life Span to establish a close, somewhat indulgent relationship with the grandchildren. The surrogate style is assumed by grandparents who tend to most of the child-rearing activities while the parents are at work. Surrogate grandparents may be in the position to make many of the parenting decisions. The wisdom figure role is bestowed by family beliefs and customs that imply that the older person is one of high esteem and regard. Family members look to the grandparent for knowledge and guidance. The distant grandparent role is one in which the grandparents have limited contact with their children and grandchildren. The role may be the result of living arrangements that prevent frequent visits, or it may be the result of earlier family conflicts. Many grandchildren appear to have strong bonds of attachment and affection toward their grandparents (Fig. 12.2). Regardless of the grandparents’ style, their role is important to children of all ages. Just as middle-aged individuals’ relationships with their children change, so do their relationships with their parents. Most middle-aged adults have close relationships with their parents and maintain regular, frequent contact. Some continue to have mutually nurturing relationships, whereas others maintain relationships based on duty and obligation. Middle-aged adults may find that they need to adjust to the role of parenting their parents. During middle age some adults realize that they can no longer rely on their parents for support; instead, their parents now need them for support. Economic problems or failing health may result in the need for a change in roles. Caring for elderly parents can cause added stress on a family. If elderly parents need care, more often the daughter assumes this role. For many middle-aged adults, caring for elderly parents is a major challenge. Sometimes decisions need to be made about helping parents to move to retirement centers or nursing homes or to make their homes with their middle-aged children. All feelings accompanying these changes must be acknowledged. Individuals caring for elderly parents need to arrange for outside support so that they, too, get respite from caregiving. Caregivers need a strong support network to help assist them with the many daily stressors. See Box 12.1 for hints on caring for aging parents. Establishing Economic Security for the Present and Future By middle age, most people are at their peak earning capability and job status. Plans for economic security best begin when people first enter the job market. It is not sufficient to wait until middle age to start to save toward retirement. Economic security may be strained when middleaged parents are paying or helping to pay for their children’s college education. College has a major impact on many middle-aged parents’ financial security plans. If parents have delayed having children, the need to finance their children’s higher education bills may come when their own earning capacity is beyond its peak. Economic security also becomes a special challenge for middle-aged adults who need to help their own parents financially. Maintaining a Positive Self-Image Middle-aged adults need to accept the visible agerelated changes of this stage without losing selfesteem. In our youth-oriented society, so much emphasis is placed on the importance of looks and staying young that individuals may feel threatened by the aging process. Many resort to surgery, cosmetics, dieting, and exercise to preserve their youthful appearances. A balance of mental and B O 12.1 X Caring fo r Ag ing P arents • Recognize and respect older parents’ feelings. • Expect ambivalent feelings in oneself—both a sense of responsibility and a sense of resentment. • Maintain open lines of communication between siblings and other family members. • Establish limits and delegate tasks whenever possible. Include pleasurable activities in your daily activities. • Seek out support services, support groups, home health care, respite care, and senior-citizen centers. FIGURE 12.2 Grandchildren are important at this time. 7589_Ch12_183-194 29/08/17 12:00 PM Page 189 Middle Adulthood physical health and positive social interactions will allow the individual to maintain a healthy sexuality and positive self-esteem. Evaluating and Redesigning Career Options Adults hope to reach their peak career goals by middle age. Those persons who have not done so must come to terms with their accomplishments. This may result in the decision to change careers or go back to school. The concept of a single job or career may be a thing of the past. Most adults today work more than one job to meet the rising costs of living. Some women enter the workforce for the first time when their children are grown and more independent. Others find that they are forced to make job changes because of changes in technology and the job market. Job loss, retraining, and relocation all have an impact on today’s middle-aged workers. B O 12.2 189 X Sug g estio ns fo r the Ad ult L earner • If several years have lapsed since you were last in school, it may take a few weeks to get back into the routine. • Motivation and perseverance are important keys to success in learning. • Keep up with the reading assignments; ask yourself if you understand what you have read. • Try to meet the learning objectives in the text. • Look up words that you don’t understand. • Study the illustrations and tables given in the text. • Summarize what you read. • Complete any end-of-chapter questions and exercises. • Prepare for your examination from the first day of class. • Review your test after it is scored to figure out what you missed. Use these errors as clues to what you must review for future exams. Cognitive Development Mental ability and memory remain at peak performance, as in the earlier adult period. Middle-aged adults are capable of thinking in a pragmatic and concrete manner. They display a unique potential to integrate objective and rational modes of thinking, which is a sign of true maturity. Many middle-aged adults are enrolled in courses to help further their jobrelated knowledge or fulfill personal areas of interest. Individuals returning to school at this time may encounter some difficulty in adjusting to the learning environment. For example, they may have difficulty setting up study schedules, memorizing, and just being in a classroom situation. Once enrolled, adult learners go through a brief period of adjustment but, providing they do not get discouraged and quit, they quickly acclimate to the demands of learning. They may need more time to learn and complete tasks but often do so with much more accuracy than the young learner. Motivation to learn is often greater and is enhanced by life experiences and needs. Box 12.2 has some suggestions for the adult learner. Moral Development Middle age is a time in which many individuals look inside themselves and reassess their values and beliefs. Spirituality may become more important during this stage and may guide the person in making moral decisions. A commitment to improving the welfare of others enhances the individual’s own moral growth. At this stage of development, most people have a clear understanding of what constitutes personal needs, moral duties, and society’s demands. NUTRITION The dietary needs of middle-aged adults are similar to those of adults in their 20s and 30s. All middleaged adults should limit their intake of sodium, caffeine, and fats. The basal metabolic rate gradually slows down during the middle years, possibly affecting weight. It is not unusual to gain 5 to 10 pounds or need a larger clothing size without increasing food intake. This is related not only to the slower metabolism but also to the redistribution of weight. In females redistribution of weight refers to an increase in the waist and hips, while in men weight is redistributed to show an increase in abdominal girth and a decrease in muscle mass in the lower body. To compensate for these changes, middle-aged adults must decrease their caloric intake and increase their amount of physical activity. Healthy eating patterns should continue throughout this stage. Adequate calcium intake is needed and can be achieved by ingesting two or more servings of calcium-rich foods per day. A minimum of 1,500 mg of calcium is needed daily. Calcium is needed to maintain bone mass and muscle contraction and to regulate blood pressure. (See Chapter 11 for specific dietary guidelines.) SLEEP AND REST Sleep requirements for middle-aged adults are less than for people in earlier stages. Many individuals state that they experience more difficulty falling 7589_Ch12_183-194 29/08/17 12:00 PM Page 190 190 Journey Across the Life Span asleep or staying asleep. Stress, poor health, or lack of exercise may contribute to sleep problems. Many middle-aged adults notice that they no longer have an abundance of energy. They may tire more easily and need rest periods following strenuous exercises. (See Chapter 11 for ways to promote sleep.) EXERCISE AND LEISURE Some middle-aged adults are sedentary and need to be reminded of the benefits of exercise, whereas others actively engage in regular exercise. Chapter 11 outlines different types of exercise. Middle-aged adults should engage in regular exercise for at least 30 minutes at least three times a week. Before beginning any exercise program individuals should check with their health care provider. Regular exercise has been shown to increase one’s life expectancy and improve the quality of life. Regular exercise is also helpful in weight control. Suggested types of exercise include brisk walking, swimming, bicycling, and other forms of aerobic exercise. Choice of hobbies varies greatly among individuals. For many adults, leisure activities may center around the home. Travel, gardening, art, and music are just a few of the areas of interest for some in this age group (Fig. 12.3). Some adults develop new interests or talents, whereas others now have the time to nurture old interests. Many people find pleasure FIGURE 12.3 Hobbies and activities promote wellness. in devoting time and service to others in their communities. Volunteering at local hospitals and schools benefits both the doer and the recipients. Filling leisure time with rewarding, pleasurable activities is important in preparing for retirement. When the leisure activities of midlife are continued into the later years, there is a smoother transition into old age. SAFETY Accident prevention is a concern for all ages. Motor vehicle accidents continue to contribute to many injuries and deaths in this age group. Identifying safety issues and reducing risk factors in the workplace help to decrease the number of job-related injuries and accidents. The Occupational Safety and Health Act of 1970 was passed to increase the health and safety of all working men and women. Continuous surveillance and identification of individuals at high risk for injury helps promote preventative strategies. HEALTH PROMOTION It is possible for a person to maintain sound health throughout the middle years despite the general slowing down of body processes. Weight control, healthy lifestyles, and avoidance of accidents help to promote wellness into the later years. Many of today’s middle-aged adults are concerned with appearance and physical fitness. Much media attention has been devoted to diet and health care, making many members of this age group very conscious of wellness and healthy lifestyles. The skin reflects one’s general state of health and age, and recent interest has focused on cosmetic creams, lotions, and injections of a neurotoxin known as Botox. The success of these products is limited. Some individuals attempt to correct the effect of time by undergoing expensive cosmetic surgery. To maintain health and wellness, the middleaged adult must have a yearly physical examination. Weight management should be a goal for this age group. Middle-aged adults should be screened for blood cholesterol levels. Elevated serum cholesterol has been associated with cardiovascular and coronary artery diseases. An elevated high-density lipoprotein (HDL) level is desired, whereas a lowdensity lipoprotein (LDL) level increases the risk for cardiovascular diseases. For some, diet and exercise may maintain desirable blood cholesterol 7589_Ch12_183-194 29/08/17 12:00 PM Page 191 Middle Adulthood levels. Others may need to combine diet and exercise with cholesterol-lowering medications. Middle-aged adults should also have eye screening tests for glaucoma and cataracts. Glaucoma is a condition that frequently begins in middle adulthood. It is caused by the buildup of fluid in the chambers of the eye. This increased pressure may go unnoticed until irreparable damage has been done to the person’s vision. A routine noninvasive eye examination may help detect the onset of glaucoma. Medications or corrective surgery can help prevent further loss of vision. Cataracts result in a cloudy formation on the lens of the eye. Cataracts form gradually and eventually inhibit the passage of light through the lens. They are common after age 60 and may be caused by the presence of other chronic conditions. Once detected, cataracts can be surgically corrected with excellent results. Cancer of the colon is more frequent in middle adulthood than in earlier ages. Much attention has been given to diet and its relationship to colon cancer. A diet high in fiber and low in fat is recommended to decrease the risk of both colon cancer and heart disease. It is now recommended that both men and women have a colonoscopy yearly after age 50 as screening for colon cancer. Early examinations may be recommended for adults with a family history of colon disease. Fibrocystic breast disease, a benign condition, may begin in the 30s and continue until menopause. Ninety percent of women develop some degree of this disease, which is characterized by large, sometimes uncomfortable cysts in the breast tissue. Estrogen has been implicated in contributing to the 191 development of this disease. It is thought that estrogen helps to cause engorgement and swelling of the cells lining the mammary ducts. After menopause, with the decrease in estrogen levels, there appears to be a decrease in tissue swelling and cyst formation. At this time there is no known correlation between the development of fibrocystic disease and the onset of breast cancer. However, all irregularities and lumps found in breast tissue should be investigated thoroughly by a trained examiner. Women older than age 50 should have annual mammograms and Pap screenings. HPV testing should be done every 3 years to age 65. Women with a high risk for cervical cancer may be screened more often. Men older than age 50 frequently develop an enlarged prostate gland. This condition, called benign prostatic hypertrophy (BPH), is common and should be distinguished from cancer of the prostate gland. Early signs of this condition include difficulty voiding, diminished urine stream, dribbling, and frequent need to urinate. A yearly rectal examination after age 40 will help detect an increase in the size of the gland. Blood testing can help detect prostatespecific antigens (PSAs) found at early stages of prostate malignancies. Early detection and prompt treatment can improve the outcome of both BPH and prostate cancer. Heart disease and cancer continue to be the causes of most deaths at this stage of development. The leading chronic conditions affecting middleaged men include heart disease, back problems, visual impairments, and asthma. The leading chronic conditions affecting women include arthritis, hypertension without heart involvement, and depression. SUMMARY 1. Middle adulthood or middle age covers the period from the mid-40s through the early 60s. 5. Most physiological changes appear gradually and at different times for different persons. 2. Today many women in the workforce delay marriage and childbearing to enhance their careers. Thus, many middle-age adults are still active parents at this stage. 6. Loss of muscle tone and elasticity in the connective tissues occur. Demineralization causes the bones to become porous and brittle. 3. Middle age is a natural consequence of development and a time of growth and progression rather than decline and regression. 4. During this stage adults reach peak performance and maturity. 7. Periodontal disease is common and can be prevented with proper mouth care and maintenance. 8. The skin loses elasticity and becomes wrinkled. 9. Hair growth slows; thinning and graying of the hair occur. 7589_Ch12_183-194 29/08/17 12:00 PM Page 192 192 Journey Across the Life Span 10. The eyes lose accommodation and the ability to focus on near objects. A loss of hearing acuity is noticeable at this stage. 11. Goals at this stage include establishing and adjusting to new family roles, securing economic stability for the present and future, maintaining a positive self-image, and evaluating or redesigning career options. 12. The major challenges and opportunities that middle-aged adults experience include a renewed focus on themselves as a couple, the empty-nest syndrome, grandparenting, and parenting the parent. Adults hope to establish economic security and reach peak job status during middle age. 13. Menopause indicates the cessation of menses and loss of reproductive ability. Menopause usually begins between the ages of 45 and 55 years. 14. There is no significant physiological change of life for men. Men remain capable of producing sperm well into their 80s. The main change that men experience is in their thinking patterns and self-image. 16. Mental ability and memory remain at peak levels of performance. Middle age is a time when adults look inside themselves and reassess their values and beliefs. 17. Middle-aged adults have a clear understanding of what constitutes personal needs, moral duties, and society’s demands. 18. The nutritional needs of middle-aged adults remain similar to those of young adults. This age group must pay close attention to diet, exercise, and healthy lifestyles. Weight gain may occur. 19. Middle-aged adults require less sleep than those who are younger. Some adults experience difficulty falling or staying asleep. 20. Leisure-time activities vary and are important in preparing for retirement. 21. Heart disease and cancer continue to be the leading causes of death for this age group. Thorough physical examinations and health screenings must be performed yearly to help detect and treat any existing medical problems. 15. According to Erikson, the task of middle age is generativity. This means that individuals demonstrate concern for and interest in their communities. Nonachievement of generativity results in self-absorption and stagnation. CRITICAL THINKING Exercise #1 Bill and Sue have been married for 35 years. They both have been working throughout their marriage, with Bill in finance and Sue in early childhood education. They have three children and five grandchildren all living nearby. Bill has been talking about retiring and moving to Virginia. Sue is concerned about retiring and moving away from the family. Bill told Sue that she has 6 more months to get used to the idea and then he wants to move and start living again. 1. Discuss what factors may promote a successful retirement. 2. Discuss the differences between men’s and women’s views on retirement. 3. What might help Sue adjust to retirement? 7589_Ch12_183-194 29/08/17 12:00 PM Page 193 Middle Adulthood CRITICAL THINKING 193 (continued) Exercise #2 Mary Jo Frazer, a 52-year-old postal clerk, is having her yearly physical examination. She tells the nurse that during her last menstrual period she noted that she had 2 days of increased blood flow and 2 to 3 days of increased spotting before her period ended. She also complained about having increased anxiety and night sweats. 1. How should the nurse respond to Ms. Frazer’s concerns? 2. What screening test is mandatory for this patient? 3. What patient teaching is indicated at this time? Exercise #3 Mary and Brady have 4 children ranging in age from 8 to 18. Mary’s father, a widower, is suffering from memory problems, confusion, and impaired judgment. He has recently moved into the couple’s home. He is unable to prepare his meals, and he needs assistance with activities of daily living. The couple want him to be cared for within the family setting. Mary is responsible for the care of the children, home, and her dad. She has no time for all of the tasks that she once took for granted. 1. What interaction should you consider? 2. What community resources would you consider for Mary? MULTIPLE-CHOICE QUESTIONS 1. Wrinkling of the skin in late middle age is a result of: a. Increased water and decreased fat in the skin cells b. Loss of elasticity in the dermis c. Increased muscle mass and stretching of fibrous tissue d. Rapid loss of cells from within the dermis and epidermis 2. Which of the following are characteristics of middle age? a. Women are capable of giving birth well into their 60s. b. Men are incapable of producing sperm after the age of 70. c. Sexual needs and desires cease. d. Sexual functioning and sexuality continue throughout this stage. 3. Hot flashes are caused by: a. Nervous system excitement b. Hormonal influx c. Vasodilatation and constriction d. Decreased contractility in the blood vessels 4. The psychosocial task of generativity refers to: a. How one chooses to achieve economic stability b. The task of procreation c. Accomplishing one’s career and ambitions d. Assisting and guiding the next generation 5. Successful coping with midlife changes is best achieved when the individual: a. Has children of his or her own b. Is married c. Has a career d. Has a good support system 6. Cynthia Fox is a 55-year-old woman who has recently been diagnosed with fibrocystic breast disease. She asks the licensed vocational nurse (LVN) if this disease has occurred because she didn’t breastfeed her two children. The LVN’s best response is: a. “Don’t worry. Nothing you could have done would result in this disease.” b. “There is nothing that you can do at this time to halt the course of this condition.” c. “This disease results from hormonal stimulation of the breast tissue.” d. “Breastfeeding your children usually will decrease the risk of this disease.” 7589_Ch12_183-194 29/08/17 12:00 PM Page 194 194 Journey Across the Life Span 7. Adequate calcium is needed in the diet during middle age to: a. Build and repair tissue b. Strengthen nerve conduction c. Maintain bone mass d. Improve eyesight 8. Which of the following best represents the dietary recommendations for the middle-aged adult? a. High carbohydrates, low fat b. High fiber, low fat and sodium c. High protein, calories, and fats d. Follow Atkins, South Beach, or Jenny Craig diets 9. The LPN recognizes that known as the “good” cholesterol. 10. Normal physiological changes common in middle age include: a. Increased cardiac output b. Increased bone density c. Improved glomerular function d. Thinning of vertebral disks Visit www.DavisPlus.com for Student Resources. is