Middle Adulthood Old Age Middle Life Issues

Simeon M. Marasigan, MD, FPNA, FPPA - Associate Professor I. Sexuality

Department of Neurology & Psychiatry - UST Faculty of Maintaining intimacy
Medicine and Surgery Ambivalence
Sexual decline erection and refractory period
Middle Adulthood Belief its activity for the young
Males: fear and reality of impotence
Introduction Major causes: alcohol, drugs, stress, fatigue, anxiety
Age: 40 65 years old (major cause)
Jung: Noon of Life Females: sexual decline, also psychological
Golden Age of Adulthood Fact:
Activities: Sexual prime is reached mid 30s
Change in lifestyle Greater capacity for orgasm in middle adulthood
More time for themselves Problem:
Concerns: They lose youthful youth earlier
Reviewing the past (commitments they chose) Lowered self-esteem
Consider how life has gone (will they go on) Cosmetic surgery
Deciding what future will be (plan for remaining II. Climacterium
years) Decreased biological and physiological functioning
(both female and male)
Features of Middle Life Women:
Issues Positive Features Negative Features Menopause, 40 to early 50s, psychophysiological
1. Prime of Life Responsible use Winner-loser view; Described by >50% as unpleasant
of power, Competitiveness Decline estrogen secretion
maturity and Manifestations:
productivity Vasomotor instability (hot flashes)
2. Stock taking: Possibilities; Closure; Anxiety, depression
what to do with Alternatives; Fatalism Males
the rest of life Redirections; No clear demarcation
Commitments Hormones stay fairly constant (thru 40s and 50s)
3. Fidelity and Commitment to then gradual decline (decrease sperm, seminal fluid)
Commitments self, others, Hypocrisy; Midlife crisis: mild to severe
career, society; Self-deception a. Drastic change in work or marital relationships
Filial maturity b. Severe depression
4. Growth-death Naturality Obscene or frenetic c. Increase use of drugs/ alcohol
(to grow is to regarding body, efforts (to be d. Shift to alternate lifestyle
die); time youthful); Hostility
juvenescence III. Midlife Crisis
and envy of youth;
and
Longing Fact: physical changes with new emotional and
rejuvenation
fantasies psychological demands
5. Communication Matters Repetitiveness, Most difficult: giving up the fantasy of unlimited
and understood; boredom, possibilities (fantasy offers helpful comfort in dealing
Socialization Continuity; impatience, with realities of life)
Picking up where isolation, Realizations: finite lifespan is real
left off; Network conservation, Urgency: to accomplish all before time runs out
confusion, rigidity
IV. Empty Nest Syndrome
Developmental Tasks (Themes) Depression with the marriage of youngest child
Aging: changes in bodily functions specially for full-time mothers
Stock of accomplishments: setting goals for future Coping up: compensating activities
Reassessing commitments: family, work, marriage
Dealing with: parental illness/ death IV Divorce
Attending to: developmental tasks Major crisis
Psychosocial tasks (Erikson): Marriage and committed relationships
Generativity guiding incoming generation Settle for what they have or to search for greater
Stagnation stopped developing perfection with a new partner
Cause: one discovering that the spouse is no longer like
before (reality: both have changed)
Qualities of middle life related to divorce:
1. Need for change
2. Weariness
3. Fear of facing up to oneself

rainwater@mymelody.com || 1st semester, AY 2011-2012

Old Age George Vaillant
WHO Followed up a group of Harvard freshmen into
65 years old and above old age & have the following observations about
65-74: young-old emotional health at age 65
75 beyond: old-old Having been close to brothers and
85 & beyond: oldest-old sisters during college correlated with
In modern countries the most rapidly growing group emotional well-being
US & Europe: 17% Early traumatic life experiences; death
Philippines: 9% of a partner or parental divorce DID
Life expectancy not correlate with poor adaptation
US & Europe: 76 y/o Being depressed at some point (21-50)
Philippines: 72 (female) predicted emotional problems
68-69 (males) Personality traits of pragmatism and
dependability as a young adult was
Senescence associated with sense of well being
Aging process; gradual decline in functioning of all bodys
systems (cardiovascular, respiratory, GUT, endocrine, Socioeconomics
immune) Very important aspect of growing old, especially in
Each person, endowed with one or more vulnerable advanced countries; old people are secured by medicare,
systems; because of environmental stressors or social security and private positions (only about 10% live
institutional misuse (smoking, alcoholism, excessive food below poverty line)
intake, etc) In developing countries: obtaining proper medical care
Deterioration of organ may lead to illness may be specially difficult
Myth: Old age is invariably associated with profound
intellectual & physical infirmity Retirement
FACT: Only a minority of old people experience extreme Many older people look forward to retirement: freedom
dependency of senility & physical incapacity from responsibility & more time for leisure
1993 Health Survey in England Others, time of stress (especially with economic problems)
65 y/o & above: 14% female, 7% male required daily loss of self-esteem
help to maintain independent living Why many re-enter work:
Negative reaction to being retired (useless)
Aging Theory Feelings of being unproductive
Each cell has genetically determined life span; it dies after Economic hardship
a number of replications Loneliness
Programmed cell death (e.g. in the CNS)
Neurons die at a rate of 1/sec AAMI Sexual Activity
Some individuals accelerated MCI, dementia 70% males, 20% females of older persons are sexually
active to many because of loss of sexual partners
Psychosocial Aspects of Aging FACT:
Sex drive does not decrease as one ages; some may
Social Interaction even report increased sexual activity
To most: period of continued intellectual, emotional, Masters & Johnson reported sexual activities in
& psychological growth people in their 80s.
To some: the death of friends & relatives make one Expected Physiological Changes
avoid social interaction depression Males
Solution: maintain social activities for continued Longer latency for erection to occur
physical & emotional well-being sense of Decreased penile turgidity & ejaculatory seepage
usefulness & self-esteem Females
Decreased vaginal lubrication (dyspareunia)
Ageism Vaginal atrophy ( estrogen)
Refers to the discrimination toward old persons & to Significant Finding:
the negative stereotypes about old age, usually The more sexually active an individual is in early
regarded by younger people adulthood, the more likely it is for him to be active in
Stereotypes: old age
Loneliness, poor health, senilty, infirmity,
weakness Psychiatric Problems of Older People
FACT: 75% of people (65-74) describe their health is Loss: predominant theme that characterized emotional
good experiences of older people
However, about 4 of 5 people over the age 65 have at Grief:
least 1 chronic condition With multiple losses (spouse, friends, family,
Valued by older persons: good health & social colleagues)
contacts Change of work status (prestige)
Decline of physical abilities & health

rainwater@mymelody.com || 1st semester, AY 2011-2012

 Energy loss:
Coping with loss and grief
Major depressive disorder:
Prevalence is unexpectedly less than in young adults
Reasons:
Late onset depression is rare
Depression is associated with higher mortality
Maybe reduced by substance abuse or old age
Depression in old age
Accompanied by physical symptoms and cognitive
changes that mimic dementia
Incidence of suicide is higher (40/100,000 population)
Causes:
Males: physical illness
Females: mental illness

Old Age Developmental Theorists

Sigmund Freud
Increased autonomy because of increased control of the
ego and id with aging
Regression may permit primitive modes of functioning to
reappear

Erik Erikson
Personality continues to grow and develop over the life
span
Process of life review and achieve a sense of peace
The central conflicts in old age is between
Integrity sense of satisfaction people feel reflecting
on a life productivity lived
Despair the sense that life has little purpose or
meaning
Confinement in old age comes only with getting beyond
narcissism & into intimacy & generativity

Coping Mechanisms
Suppression
It is the conscious or semi-conscious postponement
of attention to a conscious impulse or conflict,
deliberately cut-off
Anticipation
Realistic anticipation of future inner discomfort; goal-
directed mechanism
Altruism
Constructive service to others
Humor
Overtly expressing feelings and thoughts without
personal discomfort

Developmental Tasks of Late Adulthood

Maintain body image and physical integrity
Conduct the life interview
Maintain sexual interests and activities
Deal with the death of significant loved ones
Accept the implication of retirement
Accept the genetically programmed failure of organ
systems
Divest oneself of the attachment to possessions
Accept changes in the relationship with grandchildren

rainwater@mymelody.com || 1st semester, AY 2011-2012