The Middle And Old Age

Middle Adulthood

Simeon M. Marasigan, MD, FPNA, FPPA Associate Professor Department of Neurology & Psychiatry

Introduction Age: 40 – 65 years old Jung: Noon of Life Concerns: Reviewing the past (commitments they chose) Consider how life has gone (will they go on) Deciding what future will be (plan for remaining years)

Introduction

Activities: Change in lifestyle More time for themselves

Features of Middle Life Issues

Positive Features

Negative Features

•

Responsible use of power, maturity and productivity

Winner-loser view; Competitiveness

1. Stock taking: what to do with the rest of life

Possibilities; Alternatives; Redirections; Commitments

Closure; Fatalism

1. Fidelity and Commitments

Commitment to self, others, career, society; Filial maturity

Hypocrisy; Self-deception

Prime of Life

Features of Middle Life Issues

Positive Features

Negative Features

4. Growth-death (to Naturality regarding grow is to die); body, time juvenescence and rejuvenation fantasies

Obscene or frenetic efforts (to be youthful); Hostility and envy of youth; Longing

5. Communication and Socialization

Repetitiveness, boredom, impatience, isolation, conservation, confusion, rigidity

Matters understood; Continuity; Picking up where left off; Network

Developmental Tasks (Themes) Aging: changes in bodily functions Stock of accomplishments: setting goals for future Reassessing commitments: family, work, marriage Dealing with: parental illness/ death

Developmental Tasks (Themes) Attending to: developmental tasks Psychosocial tasks (Erikson): Generativity – guiding incoming generation Stagnation – stopped developing

Middle Life Issues I. Sexuality Major issues Sexual decline Belief – its activity for the young

Males: fear and reality of impotence Major causes: alcohol, drugs, stress, fatigue, anxiety (major cause)

Middle Life Issues I. Sexuality Females: sexual decline, also psychological Fact: Sexual prime is reached mid 30’s Greater capacity for orgasm in middle adulthood

Problem: They lose youthful youth earlier Lowered self-esteem

Middle Life Issues II. Climacterium Decreased biological and physiological functioning (female and male) Women: Menopause, 40 to early 50’s, psychophysiological Described by >50% as unpleasant Decline estrogen secretion Manifestations: Vasomotor instability (hot flashes) Anxiety, depression

Middle Life Issues II. Climacterium Males No clear demarcation Hormones stay fairly constant (thru 40’s and 50’s) then gradual decline (decrease sperm, seminal fluid) Midlife crisis: mild to severe a. b. c. d.

Drastic change in work or marital relationships Severe depression Increase use of drugs/ alcohol Shift to alternate lifestyle

Middle Life Issues A. Midlife Crisis Fact: physical changes with new emotional and psychological demands Most difficult: giving up the fantasy of unlimited possibilities (fantasy offers helpful comfort in dealing with realities of life) Realizations: finite lifespan is real Urgency: to accomplish all before time runs out

Middle Life Issues B. Empty Nest Syndrome Depression with the marriage of youngest child specially for full time mothers Coping up: compensating activities

Middle Life Issues III. Divorce Major crisis Cause: one discovering that the spouse is no longer like before (reality: both have changed) Qualities of middle life related to divorce: – Need for change – Weariness – Fear of facing up to oneself

The OLD AGE

Simeon M. Marasigan, MD, FPNA, FPPA Associate Professor Department of Neurology & Psychiatry

WHO 65 years old and above 65-74: young-old 75 beyond: old-old 85 & beyond: oldest-old In modern countries the most rapidly growing group

US & Europe: Philippines: Life expectancy US & Europe: Philippines:

17% 9% 76 y/o 72 (female) 68-69 (males)

Senescence Aging process; gradual decline in functioning of all body’s systems (cardiovascular, respiratory, GUT, endocrine, immune) Each person, endowed with one or more vulnerable systems; because of environmental stressors or institutional misuse (smoking, alcoholism, excessive food intake, etc) Deterioration of organ may lead to illness

Senescence Myth:

Old age is invariably associated with profound intellectual & physical infirmity FACT: Only a minority of old people experience extreme dependency of senility & physical incapacity 1993 Health Survey in England 65 y/o & above: 14% female, 7% male required daily help to maintain independent living

Aging Theory Each cell has genetically determined life span; it dies after a number of replications Programmed cell death E.g. in the CNS Neurons die at a rate of 1/sec  AAMI Some individuals accelerated  MCI  dementia READ: Biological Changes Associated with Aging . Table 2.6-1

Psychosocial Aspects of Aging

SOCIAL INTERACTION To most: period of continued intellectual, emotional, & psychological growth To some: the death of friends & relatives make one avoid social interaction  depression Solution: maintain social activities for continued physical & emotional well-being  sense of usefulness & self-esteem

Psychosocial Aspects of Aging

AGEISM Refers to the discrimination toward old persons & to the negative stereotypes about old age, usually regarded by younger people Stereotypes: Loneliness, poor health, senilty, infirmity, weakness

FACT: 75% of people (65-74) describe their health is good

Psychosocial Aspects of Aging

AGEISM However, about 4 of 5 people over the age 65 have at least 1 chronic condition Valued by older persons: good health & social contacts

George Vaillant Followed up a group of Harvard freshmen into old age & have the following observations about emotional health at age 65 Having been close to brothers and sisters during college correlated with emotional well-being Early traumatic life experiences; death of a partner or parental divorce DID not correlate with poor adaptation

George Vaillant Being depressed at some point (21-50) predicted emotional problems Personality traits of pragmatism and dependability as a young adult was associated with sense of well being

Socioeconomics Very important aspect of growing old, especially in advanced countries; old people are secured by medicare, social security and private positions (only about 10% live below poverty line) In developing countries: obtaining proper medical care may be specially difficult

Retirement Many older people look forward to retirement: freedom from responsibility & more time for leisure Others, time of stress (especially with economic problems)  loss of selfesteem Why many re-enter work: Negative reaction to being retired (useless) Feelings of being unproductive Economic hardship Loneliness

Sexual Activity

Sexual Activity 70% males, 20% females of older persons are sexually active to many because of loss of sexual partners FACT: Sex drive does not decrease as one ages; some may even report increased sexual activity Masters & Johnson reported sexual activities in people in their 80’s.

Sex ual A ctiv ity

Expected Physiological Changes Males Longer latency for erection to occur Decreased penile turgidity & ejaculatory seepage

Females Decreased vaginal lubrication Significant Finding: the more sexually active an individual is in (dyspareunia) early adulthood, the more likely it Vaginal atrophy (↓ estrogen) is for him to be active in old age

Psychiatric Problems of Older People Loss: predominant theme that characterized emotional experiences of older people Grief: With multiple losses (spouse, friends, family, colleagues) Change of work status (prestige) Decline of physical abilities & health

Psychiatric Problems of Older People 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

Psychiatric Problems of Older People 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

Old Age Developmental Theorists Erik Erikson: 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

Thank You! Simeon M. Marasigan, MD, FPNA, FPPA Associate Professor Department of Neurology & Psychiatry