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

• Prime of Life Responsible use of Winner-loser view;
power, maturity and Competitiveness
productivity
1. Stock taking: Possibilities; Closure;
what to do with Alternatives; Fatalism
the rest of life Redirections;
Commitments
1. Fidelity and Commitment to self, Hypocrisy;
Commitments others, career, Self-deception
society; Filial
maturity
Features of Middle
Life

Issues Positive Features Negative Features

4. Growth-death (to Naturality regarding Obscene or frenetic
grow is to die); body, time efforts (to be
juvenescence and youthful); Hostility
rejuvenation and envy of youth;
fantasies Longing
5. Communication Matters understood; Repetitiveness,
and Socialization Continuity; Picking boredom, impatience,
up where left off; isolation,
Network conservation,
confusion, rigidity
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. Drastic change in work or marital relationships
b. Severe depression
c. Increase use of drugs/ alcohol
d. 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: 17%
Philippines: 9%
Life expectancy
US & Europe: 76 y/o
Philippines: 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 self-
esteem
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
(dyspareunia)
sexually active an individual is in
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