Download The Middle Aged Adult

The Middle-Aged Adult
Introduction:
By middle adulthood (the years from 35 – 64), physical development is
essentially complete and a very gradual decline in functioning begins. Middle
adulthood is a time of personal growth; however, it is the least researched
and the last understood of the life stages.
In 1900, the average life expectancy was approximately 49 years; in
1976, it was approximately 72 years (DHEW, 1978). Some scientists predict
that life expectancy will reach 100 years by the end of the twentieth century.
Because of this rapid lengthening of the life span, the middle-adult
population continues to grow. Middle adulthood, is the time of launching
children from the home, grand parenting, reaching the peak in one's career,
and preparing for retirement.
Studies have shown that the socioeconomic status of an individual
greatly influences the timing of major life events; in general, those in the
middle and upper classes tend to delay these events. Therefore, to identify
middle adulthood solely in terms of the events that often characterize it would
be as erroneous as regarding chronological age as they only criterion.
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Physiological Changes:
By middle adulthood, physical growth and maturation are completed. Many people
incorrectly perceive middle age as a time when they will develop degenerative processes
and chronic alternations of health, such as arthritis, diabetes mellitus, emphysema, and
hypertension. Between the ages of 35 and 64 years, the incidence of these diseases
increases markedly; beyond the age of 65 years, the rates begin to soar. In the age group of
55 and 65 years, males have a higher rate of coronary heart disease. Most of the normal
changes in the biophysical subsystems are likely to be observed in the latter phase of
middle adulthood rather than in the earlier phase
Integumentary Changes:
Wrinkling and graying are the initial indications of middle adulthood for many.
The age at which these occur seems genetically determined. The skin and its appendages
hair, hair follicles, nails, sebaceous and sweat glands comprise one of the largest and most
important body systems. Its basic functions are to protect underlying structures, to regular
temperature, and to prevent drying of tissue.
Other integumentary changes include drying of the skin, changing complexion,
thinning of the hair, increasing baldness in males, and toughening of fingernails and
toenails. These changes in the integumentary system occur mostly in the dermis (the
intermediate layer of the skin) and in the subcutaneous tissues (the innermost layer). Most
of the integumentary changes of middle adulthood are not physically significant; however,
these changes may have a tremendous psychological impact, especially on those whose
self images are based largely on physical appearance.
Cardiovascular Changes:
The peak of cardiovascular performance is reached at the end of the growth spurt
of adolescence (Smith, Bierman, and Robinson, 1978). After the age of 20 years, cardiac
muscle strength declines at a rate of approximately 1 percent yearly. Generally, this
alteration does not significantly affect cardiac output in the middle years. Changes in the
rate and rhythm of the heartbeat become more evident after age 45. thickening of the
arteries occurs as a consequence of the deposit of lipids and, possible, fibrin in their
intimal linings. Subsequent calcification may also occur. The lumen of the affected
arteries narrows, causing partial occlusion.
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Musculoskeletal Changes:
Aging brigs a gradual loss of bone. Along with other functions, estrogen maintains
a balance between bone formation and bone resorption; as estrogen levels decrease in the
postmenopausal phase of the life cycle, there is an increased loss of bone substance. The
changes in connective and circulatory tissues cause a decrease in the total mass of
muscular tissue, which in turn reduces physical strength. Strength peaks at ages 23 to 27
and thereafter declines slowly until the age of 50 years, when it declines a faster rate. The
total decrement by the age of 60 is between 10 to 20 percent of the maximum (Woodruff
and Birren, 1975). Those who remain active throughout middle age will probably notice
very little loss of strength, since strength and muscle mass can be maintained through
exercise.
Pulmonary Changes:
With aging, the tissue in the alveoli, like tissue in other organs, increase in
collagen formation and decrease in elasticity and permeability. Persons in middle
adulthood will maintain pulmonary functioning; however a gradual diminution of
breathing capacity may be noted by age 55 to 60.
Endocrine Changes:
The endocrine system remains reasonably functional throughout middle adulthood.
The functioning of each endocrine gland is highly dependent upon the central nervous
system, and often on other glands. Some findings about age-related changes suggest that
thyroid function is maintained throughout middle adulthood, level of pituitary hormone
remains fairy constant throughout adulthood, and the Islets of Langerhans in the pancreas
do not decrease in numbers (Hersehy, 1974). The incidence of diabetes mellitus increase
after the age of 40 years, especially among people who are obese or genetically
susceptible.
Gastrointestinal Changes:
Little change in gastrointestinal function occurs in middle adulthood. Although the
mucous membrane lining of the esophagus and stomach thins out, healthy middle aged
people experience no significant changes on account of this. However, other changes that
have a bearing on gastrointestinal function do occur.
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Immunological Changes:
During adulthood, usually late adulthood, the body sometimes losses the ability to
differentiate between "self" and "nonself" substances, and consequently produces
autoantibodies that destroy the body's own tissue. The process, called autoimmunity, can
affect almost all tissues and organs of the body. These autoimmunological process can
lead to the development of autoimmune connective tissue diseases (e.g., Hashimoto's
thyroid disease, rheumatoid arthritis, and myasthenia gravis). It is believed that cancerous
cells that were previously eliminated by an efficient immune system remain in the body
because the lymphocytes fail to recognize cancerous cells as foreign (Woodruff and
Birren, 1975).
Neurological and Sensory Changes:
The peak functioning of the central nervous system occurs at approximately 25
years of age; thereafter, there is a very gradual decline in functioning of this system.
According to Woodruff and Birren (1975), the reflexes remain relatively unaffected from
20 to 80 years of age. Fine coordination tends to show some decline after the age 35.
Among mentally active adults, intellectual skills and productivity are at a very high level
during middle adulthood and are maintained until after the age of 60 years.
During middle adulthood, there are gradual changes in many of the sensory
faculties. Hershey (1974 suggests that after the age of 37, smell is diminished because of a
decrease in the numbers of nerve fibers. A gradual loss of hearing, especially of high
frequencies, begins during adolescence but becomes apparent only after the age of 40
(Woodruff and Birren, 1975). By the age of 65, over half of all people have a decrease in
visual acuity and wear corrective lenses. By the age of 50, many people have difficulty in
seeing at close distances; this is caused primarily by the loss of elasticity of they eye lens
(presbyopia).
Genitourinary Changes:
Normal age-related changes result in a gradual decrease in the number of
nephrons, the functional unit of the kidney. In addition to a decrease in nephrons, the
process of aging affect in the urinary structures.
Reproductive Changes:
In middle adulthood, changes in the production of reproductive cells and the
secretion of hormones from the ovaries and testes occur. This process, the climacteric,
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tends to begin after the age of 35 years and may span a period of 15 to 20 years, depending
on the individual's rate of biophysical change (Mims and Swenson, 1980).
The age at which menopause occurs, believed to be genetically deter mined, has
been reported at as young as 35 years and as late as 60 years (Martin, 1978). Other
biophysiological changes that may occur with decreasing levels of estrogen and
progesterone are atrophy of external genital tissues; decrease in pubic hair; atrophy of the
glandular and fatty tissue of the breast; increases alkalinity of vaginal secretions; atrophy
of the uterus, ovaries, and fallopian tubes; and decreased blood supply to the genital tract.
Sexual drive is not diminished; on the contrary; many women find that sexual drive
increases. Many women may experience transitory "host flashes." Hot flashes are
associated with estrogen deficiency. The arteries of the skin dilate and create a feeling of
warmness accompanied by profuse perspiration. Patches of redness may appear on the
skin, beginning at the chest area and extending to the neck and face. Some women may
experience emotional changes taking the form of depression, crying, and insomnia.
Unlike women, men in middle adulthood do not experience a significant decrease
in sex hormones. After testosterone production decrease in sex hormones. After
testosterone production peaks in young adulthood, it very slowly declines, with a plateau
between the age of 40 and 60 (Jones, Dunbar and Jirovec, 1978). In most men, the
production of testosterone and pituitary gonadotropin is sufficient to maintain
reproductive capacity beyond the age of 80 (Burnside, 1976). However, decreased
secretion of testosterone can result in decreased force of ejaculation, decreasing numbers
of sperm, and the need for a longer time to achieve an erection. Continued decline in the
level of testosterone can cause decreased mucular strength, hot flashes, anxiety depression,
and nightmares (Jones, Dunbar, and Jirovec, 1978).
Cognitive Changes:
Longitudinal studies, in which the subjects were tested at different ages, suggest
that general intelligence increased slightly until approximately age 50 and remained
relatively unchanged until late adulthood (Birren and Schaie, 1977). Orther studies found
that after 50 years of age, verbal skills increased and numerical skills declined.
Fluid intelligence affects the intellectual skills and abilities used for motor-visual
coordination, intellectual speed, memory, and inductive reasoning. Development of these
abilities and skills is dependent upon the functioning of the central nervous system. Fluid
intelligence increase rapidly in adolescence, reaches its peak between the age of 18 and 21
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years, and begins to decline in middle adulthood. Crystallized intelligence depends upon
the acquisition of knowledge and skills through experience, education, and general
acculturation. Crystallized intelligence increases slowly in younger individuals, peaks
between the ages of 41 and 60 years, and continues to develop in healthy adults. The
extent of intellectual development depends greatly upon the individual's motivation.
Personal Changes:
The process of aging has been thought to have a detrimental effect upon
personality. The ability to adapt to the process of aging and the demands of the
environment seems related to the individual's self-concept and to the level of physical
health. The healthy adult has been found to be flexible, resourceful, and optimistic (Butler
and Lewis, 1977).
Erikson's View of Middle Adulthood:
According to Erik Erikson (1963), the developmental task of middle adulthood is
the attainment of generativity versus stagnation. Generativity, in Erikson's terms is a
tremendous and sincere concern for oneself, as well as for the growth and development of
children, peers, older adults, the community, and society. The experiences, personal and
vicarious of the generative adult culminate in mature judgment, greater insight into
oneself, and a more discerning awareness of the needs of society. The mature adult has a
well developed philosophy of life which serve as a basis for leadership, stability, and
objectivity.
Activity Theory:
One implication of this theory is that one's social life space is diminished in
accordance with one's ego energy reserve. Thus, it was concluded that disengagement
fostered a greater sense of psychological well-being because the individual no longer
desires deep emotional involvement in activities and relationships, as was in middle
adulthood. The activity theory maintains that those in late adulthood have essentially the
same psychological and social needs as they had in middle adulthood, except for those
needs created by normal physiological changes or alterations in health status (Havighurst,
Neugarten, and Tobin, 1968). The activity theory holds that the aging adult desires to
remain social active, and that optimal aging occurs when one does so (Butler and Lewis,
1977).
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Role Exit Theory:
Although framed in a more sociological perspective, the role exit theory is
essentially the same as the activity theory. In role exit, or termination of roles (such as in
case of loss of spouse, retirement from work, children lauched from the home, and death
of a close friend), one establishes new roles and new interests in order to maintain
meaningful social interactions, and to prevent shrinkage of the social environment.
Developmental Tasks of Middle Adulthood:
Robert J. Havighurst (1974) identifies seven developmental tasks of middle
adulthood. The first major task is reaching and maintaining satisfactory performance in
one's career. Achieving social and civic responsibility is the second major task. Because
individuals in middle adulthood are near the peak of their intellectual and physical
functioning, participation in social and civic activities is expected. Another task is to
accept and adjust to the physiological changes of middle adulthood. Age-related physical
changes bring about a decline in physical capacity that eventually necessitates adjustment
in physical life-style and psychological adaptation. Finally, Havighurst identifies the task
of developing adult leisure activities. For adults with lessened demands from growing
children and career goals, this is a time not only for increased civic and social activities
but for solely pleasurable activities. Joanne Sabol Stevenson (1977) proposes two sets of
developmental tasks for those in middle adulthood. She subdivides middle adulthood into
two periods: Middlescence I, or the "core years," from ages 30 to 50 years, and
Middlescence II, from 50 to 70.
Social Roles and Role Transition:
Changes in social roles occur throughout the lifecycle, new roles are assumed and
old roles are terminated. When there is a role transition, the individual is expected to learn
the new behaviors appropriate for the new role. Through the process of socialization,
adults learn to perform their social roles. Often, the adult prepares for a transition in role;
this involves identifying the new norms and expectations that will be associated with the
new social role once the transition is made.
Parenting of Adult Children:
After adult children leave the home, the family enters what is commonly referred
to as the "empty nest" or "postparental" phase of the life cycle; both terms are quite
misleading and frequently inaccurate. The "empty nest" label if often used to denote that
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after the children depart, parents, especially the mother, develop a profound sense of loss
and loneliness. However, while this stage of the family cycle often constitutes a difficult
transition, Neugarten (1970) found that, for many middle-aged women, satisfaction with
life improved when the children left the home.
Divorce:
For many couples, parenting is the only goal shared by the husband and wife. One
study reported that while many middle-aged wives and husbands found satisfaction with
their children, few found satisfaction with their spouses (Turner and Helms, 1979).
Another study reported that among couples married 18 years or more, marital problems
were caused by the following: first, ill health (29 percent); second, infidelity (26 percent);
third, incompatibility (23 percent); fourth, sexual difficulties (15 percent); and fifth,
financial problems (7 percent) (Turner and Helms, 1979).
Widowhood:
Widowhood represents the loss of a significant role and a transition to a less well
defined one. While the transition is likely to be difficult, the widowed individual can
eventually establish new social roles and new relationships. Studies suggest that people in
the later phases of the life cycle who remarry after the death of a spouse tend to be happier
than those who remain single (Woodruff and Birren, 1975).
Grandparenthood:
Maintaining meaningful relationships with grandchildren can promote the growth
and development of both the grandparent(s) and the grandchildren. According to
Neugarten and Weinstein (1968), the "fun seeker" and "distant" styles of grandparenting
were the most common among grandparents under the age of 65 years. Two factors may
account for the "distant" style of grandparenting among individuals in middle adulthood:
first, geographical distances between families; sand second, many grandparents are career
oriented and are actively employed. Even though many grandparents are satisfied with
their role as grandparent, not all are necessarily desirous of it.
Leisure:
For adults in middle adulthood who have not cultivated a use of leisure time,
leisure is commonly seen as time free from work, but not all time spent away from the job
is really free time; leisure consists of self-motivated activities, whether physical,
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intellectual, charitable, or creative. Leisure activities can foster a sense of self fulfillment,
stimulate personal growth, and provide service to others.
Relationships with Aging Parents:
Middle adulthood is the time when many individuals assume increasing
responsibility for the physical, social, emotional, and financial well-being of their aging
parents. The extent to which adult children assume responsibility for their aging parents
depends upon several factors, including earlier child-parent relationship, cultural or ethnic
influences, and individual level of growth and development. Improved medical care,
housing for the aged, and better pension or Social Security plans have increased the
physical and financial independency of many aging parents.
Crisis in Middle Adulthood:
While positive view of middle adulthood has been presented, it is not a time of
positive growth for all. Some adults are dissatisfied, unhappy, and do not adapt to this
phase of the life cycle. In Erikson's terms, these people experience stagnation, and,
perhaps, enter late adulthood in a state of despair.
Common Health and Developmental Problems of the Middle Aged Adult:
The gradual age-related physiological changes of middle adulthood affect the
functional and reserve capacities of many body systems; these changes increase the body's
vulnerability to disease. In addition to age-related physiological changes, the stress of such
events as change of occupation, change of residence, marriage, death of a spouse, or
divorce may bring about alterations in health (Woodruff and Birren, 1975).
Obesity:
Excessive eating and decreased physical activity are the two leading causes of
obesity among middle aged adults. A person is considered obese if he or she is 15 to 20
percent above the normal weight range for sex, age, and height. Obesity in middle
adulthood is casually related to diabetes mellitus, hypertension, and osteoarthritis, and
should any of these health problems already exist, obesity can intensity their effect.
Menopause:
For the majority of women, menopause is gradual and the symptoms associated
with it are mild; thus they are gradually adjusted to and at times even ignored. Vasomotor
instability (which causes "hot flushes") results from rapid changes in the diameter of the
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blood vessels and is thought to be caused by erratic swings of estrogen and progesterone.
Hot flushes may last for a few seconds to an hour or more; most women accept and
tolerate them as temporary discomforts that eventually disappear. If the hot flushes are
severe enough, estrogen therapy may be considered.
Menstrual irregularities may take one of two forms: lighter, shorter periods with
decreased flow, or heavier, long periods. Heavy bleeding or intermenstrual bleeding is
abnormal in middle-aged women. While most menstrual irregularities experienced by
menopausal women are normal. Some are not. Any woman with dysfunctional bleeding
should be evaluated by a gynecologist to rule out fibroids, uterine and endocervical
polyps, and cervical, uterine, and ovarian cancer, all of which are more common in women
over 40 years old. Women over 40 should have a Pap smear at least every 2 years; those
with dysfunctional bleeding or a family history of cancer of the reproductive organs
should have Pap smears more frequently.
Because of the increased incidence of cancer of the reproductive organs in women
over 40 years some physicians recommend endometrial biopsy or the endomentrial jet
washer procedure on a yearly basis if there is irregular or intermenstrual bleeding.
Affective changes reported by some women include emotional liability, anxiety, headache,
insomnia, depression, and increased fatigue. It is not yet known whether these symptoms
are related to hormonal changes or to the psychological changes occurring during the
middle years. Only about 10 percent of all women have severe, incapacitating menopausal
symptoms (Martin, 1978).
Hypertension:
Hypertension, a persistent elevation of the systolic pressure above 140 mm Hg and
the diastolic above 90 mm Hg, tends to occur more frequently among older people in
American society, and is primarily attributable to inelasticity of the arteries. An increase in
blood pressure can be secondary to alterations of the cardiovascular, renal, adrenal, and
neurological systems, to stress, and to obesity. Blacks and females have higher rates of
hypertension. A sustained elevation of blood pressure is significant because it can affect
the heart, the kidneys. The brain, and the eyes. Hypertension is commonly referred to as
the "silent killer," indicating very vague or absent symptoms. Some symptoms related to
mild hypertension include anxiety, headache, insomnia, irritability, forgetfulness, fatigue.
And occasional sensations of palpitations (Luckmann and Sorensen, 1980).
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Osteoarthritis:
Most people over the age of 45 have some forms of osteoarthritis. While the cause
is unknown, some predisposing factors include aging, joint trauma, and obesity. The
incidence is greater among women and may first become evident at the time of the
menopause. There is no cure for osteoarthritis. However, drug therapy for symptomatic
relief has been effective, and surgical procedures have successfully restored functioning
the hips and knees.
Visual Changes:
It is estimated that as many as two out of every 100 persons over the age of 40
have glaucoma. It generally develops between the ages of 40 and 65 years, and is caused
by increased intraocular pressure, which can lead to irreversible alteration of the optic
nerve, and to blindness. Family history, eye injury, and diseases of the eye are associated
with the occurrence of acute or chronic glaucoma. There is no cure for glaucoma, but it
can be controlled by drug therapy and surgical intervention. Because glaucoma is the
second leading cause of blindness and is preventable, adults need to know its symptoms.
Cancer:
Smoking, drinking, and suntanning are some of the practices most associated with
the development of cancer. Cancers of the lung and esophagus are strongly linked to
smoking and drinking. Adults must be acquainted with the seven warning signals of
cancer (Persistent cough or hoarseness, change in wart or mole, abnormal bleeding or
discharge, thickening or lump in breast or other body site, change in bladder or bowel
functioning, a sore that heals very slowly, and indigestion or difficulty in swallowing), and
must seek medical attention immediately if any of these appear.
Anticipatory Guidance
Nutrition:
For healthy adults of 50 to 60 years, the daily recommended caloric intake is 2,400
calories for men and 1,800 for women. After age 60, depending on life-style, the caloric
intake may need to be reduced (Howard and Herbold, 1978). The diet needs to include
recommended servings from each of the four food groups: milk, meat, bread, fruits and
vegetables. In selecting foods, individuals in middle adulthood need additional guidelines.
The health care provider must consider the special nutritional needs of each individual
bearing in mind that some dietary preferences may have ethnic origins.
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Physical Exercise:
There is substantial evidence that physical activity reduces the incidence of
alterations in health. Physical exercise and activity are believed to promote physical and
emotional health and are extremely valuable for adults in middle adulthood.
Smoking:
"Warning: the Surgeon General has determined that cigarette smoking is
dangerous to your health" is the message printed on cigarette packages. Yet, statistics
show an increase in smoking among both sexes. Stopping smoking benefits the individual
immediately. The cilia, which are paralyzed by carbon particles, resume their function and
clean the tracheobronchial tree; the smoker's cough decreases, and the lung capacity
(maximum breathing capacity) improves. Smoking habits can be used as a predictive
factor in lung cancer; with one-half pack of cigarettes per day there is one and three tenths
times the average risk; individuals smoking one pack per day have two times the risk, and
two packs per day advances the risk to three times the average risk of developing lung
cancer (American Cancer Society, 1980).
Dental care:
During middle adulthood, there is an increase in the incidence of periodontal
disease, which begins in childhood, its prevalence and severity increasing with age. Dental
plaque is believed to be the cause of periodontal disease, and control measures focus on its
removal. Tooth brushing, flossing, and irrigation with pressurized water are the most
effective methods for removing plaque. Brushing of the teeth after meals is highly
recommended. Because of the seriousness of periodontal disease, all adults should be
assessed to determine their needs for dental education and dental health care.
Drug Abuse and Alcoholism:
Alcoholism is one of the greatest public health problems. It exists at every level of
society and in both sexes. Excessive intake of alcohol leads to physical dependence. Often,
alcoholism is not seen as a problem by the alcoholic individual. In part, this may be
related to how the individual's peers define alcoholism. Because alcoholism is a complex
disease, the individual frequently requires a variety of services to control the compulsive
and abusive use of alcohol.
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The Climacteric:
Menopause marks a major change in the functioning of one aspect of a woman's
body, and the nurse should address this even accordingly. Asking the client how she feels
about approaching menopause is one way to begin. Fears and misconceptions about
menopause can be explored and corrected. For the small percentage of women how have
severe symptoms associated with menopause it is important that the nurse acknowledge
these symptoms, assist the client in locating competent medical treatment, and reassure the
client that the symptoms decrease with time.
Hints on Working with the Middle Aged Adult:
The nurse or other health care worker working with the middle-aged client should
allow the client to make his or her own decisions to as great as extent as possible, and
encourage the client to take responsibility for those decisions. As is true of people of all
ages, the middle-aged client must be treated as an individual; the health care professional
must expect and accept a wide variety of values, perceptions, and aspirations, which may
be influenced solely by the client's personal background, or perhaps by cultural or ethic
efforts. The individual's strengths and insights should be acknowledged whenever
possible. Finally, as always, the privacy and dignity of the middle-aged client must be
respected and upheld by all health care workers, whether in taking a history or performing
direct physical care.
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Conclusion:
Praise be to Allah the Lord of human beings and peace be upon his prophet &
messenger Mohammed and his followers .
Through this humble research we explained the middle adulthood it is from 35 – 64 years
There will be physical development is essentially complete and a very gradual decline in
functioning begins. Middle adulthood is a time of personal growth; however, it is the least
researched and the last understood of the life stages .
We also reached to that the health person functions at almost peak efficiency in the
initial years of middle adulthood .
In Erikson`s terms , the chief developmental task of middle adulthood is to achieve
generativity , a sense of responsibility for others . Failure to achieve generativity results in
what Erikson calls stagnation .
The anticipated events of middle adulthood launching children from the home, age
related physiological changes (e.g. menopause ) grandparenthood, caring for one`s aging
parents are those least likely to cause undue stress .
The two major preventive measures indicated for middle-aged adults are proper
nutrition and a balanced regiment of rest and exercise . If these are observed the years of
middle adulthood can be among the most productive in the life span .
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