1. 1 Young Adulthood

2. 2  The adult phase of development encompasses the years from the end of adolescence to death:  Young adulthood 20 – 40  Middle adulthood 40 – 65  Late adulthood over 65

3. 3 Maturity: the state of maximal function and integrating or the state of being fully developed. Mature persons are open to new experiences and continued growth They can tolerate ambiguity, are flexible, and can adapt to change

4. 4 Mature persons also assume responsibility for themselves, make decisions and accept responsibility for these decisions This is a period of exploration Trying out new possibilities for a career. It is a period of escaping from parental domination (Psychological separation from parents) Substituting friends for family

5. 5 Friendship is important throughout the life span Friendship is a form of close relationship providing people with – Enjoyment – Acceptance – Trust, respect, and mutual assistance – Confidences shared and a sense of understanding

6. 6 Young adults are typically busy people They are expected to assume new roles at work, in the home and in the community and to develop interests, values and attitudes related to these roles. Deciding whether or not to have children

7. 7 Establishing adult relationships with parents Acquiring marketable skills Choosing a career Using money to further development Assuming a social role Adopting ethical and spiritual values

8. 8 Physical development: Twenties The prime years physically The musculoskeletal system is well developed and coordinated This is the period when athletic activities reach their peak All other systems of the body are also functioning at peak efficiency

9. 9 Body shape and proportions finally reach their finished state (physical changes are minimal), with the exception of: – weight and body mass as they may change as a result of diet and exercise – Extensive physical and psychosocial changes occur in pregnant and lactating women

10. 10 Muscles continue to gain strength throughout the twenties and reach peak strength at age thirty depending on exercise and genetic Men have larger muscles that can produce more force than the muscle tissue of women.

11. 11 Dental maturity is finally achieved in the twenties with the emergence of the last four molars called wisdom teeth The reproductive systems are fully mature: best time for reproducing children Brain cell development reaches its peak

12. 12 Physical development: Thirties Physically adults begin to gradually slow down in their thirties Muscle size and strength can be maintained with regular exercise. Without it muscles begin a progressive decline Skin begins to lose its resilience and elasticity. Both women and men begin to notice wrinkles in their thirties.

13. 13 Hair may grow more slowly, be lost or occasionally lose its pigmentation (grey hair) Genetic predisposition toward baldness or early greying Gradual shrinking of the brain cells after about age thirty (not a cause of great concern) While visual acuity remains stable through middle age, hearing begins to decline in the late 20s.

14. 14 Erik Erikson: psychosocial development Establishing Intimacy – Erikson’s stage of Intimacy vs. Isolation is the psychosocial challenge of young adulthood. – Choices must be made about education and employment, marriage and having children

15. 15 Intimacy should occur after one is well into establishing a stable and successful identity – Failure to achieve intimacy results in social isolation – Intimacy’s most important aspect is commitment – Research shows that some women resolve intimacy issues after their children have grown and moved away.

16. 16 What motivates one to be attracted to another? People actively seek out others to associate with – Familiarity is necessary for a close relationship – People seek others who are similar to themselves but opposites do attract in certain instances Physical attractiveness may not be the primary factor in establishing and maintaining a relationship Standards of what is attractive are always changing over time and across cultures

17. 17 Cognitive Development Cognitive structures are complete during formal operation period Piaget: adolescents and adults think qualitatively in the same way – formal operational thought Others believe idealism decreases as young adults enter world of work and face constraints of reality Other researchers have found differences in how adolescents and adults process information.

18. 18 Researchers have suggested a fifth higher stage of cognitive development that may follow formal operations, Post-formal operations: they are able to comprehend the contradictions (love & hate) that exist in both personal and physical reality

19. 19 Postformal operations – Part of postformal thinking is the recognition that individuals’ experiences differ and will therefore result in different ways of thinking about things. – In postformal thinking there is a recognition of the importance of emotion integrated with logic in decision-making.

20. 20 Health problems Accidents: leading cause of death Suicide Hypertension Smoking – Smoking is the leading contributor to health problems. – Nicotine is a known potent teratogen. – Quitting smoking is usually beneficial, regardless of how or when it happens.

21. 21 Health problems Substance abuse Sexually transmitted disease Abuse of women Malignancies Infertility

22. 22 Middle adulthood 40 – 65 years

23. 23 Physical changes Appearance: – Hair begins to thin, and grey hair appears – Skin turgor and moisture decreases – Subcutaneous fat decreases and wrinkling occurs – Fatty tissue is redistributed, resulting in fat deposits in the abdominal area “spare tire” – Nail & hair growth slows – Baldness

24. 24 Musculoskeletal system: – Skeletal muscle bulk decreases at about age of 60 – As the cartilage between the vertebrae starts to degenerate from normal wear, the vertebrae become compressed and the spinal column gradually begins to shorten causes a decrease in height of about 2.5 cm – Calcium loss from bone tissue is more common among post-menopausal women – Bones lose mass and density, break more easily and heal more slowly

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26. 26 Joint pain may be caused by deterioration of the bones under the cartilage in a condition known as osteoarthritis. A more common form of arthritis is rheumatoid arthritis which is a destructive disease of the joints causing pain. During middle age, adults may begin taking anti-inflammatory medications and either steroidal, or non-steroidal drugs. Muscle growth continue in proportion to use

27. 27 Cardiovascular system: – Blood vessels lose elasticity and become thicken – The ability of the heart muscle to contract decreases leading to a lower cardiac output Respiratory system: – Lung and bronchi become increasingly less elastic, causing a progressive decrease in maximum breathing capacity – It takes individuals longer to catch their breaths after exercise

28. 28 Sensory perception: – Visual acuity declines, often by late forties, especially for near vision (presbyopia) – Hearing loss limited first to high pitches sounds (presbyacusis) particularly in men cause persons to stand or sit closer to the source of sound, they may strain to hear or may talk in compensatory louder tones – Taste sensation also diminish

29. 29 Metabolism: – Slows resulting in weight gain commonly in the wall of the abdomen, the hips, thighs and chest wall Gastrointestinal system: – Gradual decrease in the process of digesting, absorbing and eliminating food may predispose the individual to constipation Urinary system: – Nephron units are lost during this time and glomerular filtration rate decreases

30. 30 Reproductive changes: – Hormonal changes take place in both men and women – The reproductive organs of both men and women begin to atrophy – The end of the female reproductive cycle is relatively clearly marked the menopause

31. 31 Menopause: – Usually occurs between age of 40 – 55 years (average 47 years) – Ovarian activities declines until ovulation ceases – Two processes are often seen associated with menopause. Estrogen-related symptoms: hot flashes, night sweats, vaginal dryness, and urine leakage. Somatic symptoms: sleep problems, headaches, rapid heart-beat, stiffness or soreness in the joints. Climacteric (Andropause) – The change of life in men when sexual activity decreases – Less gradual and less obvious than menopause in women

32. 32 Psychosocial development Erikson: Generativity vs. stagnation Generativity: – The concern for establishing and guiding the next generation – Increase concept of service to others and love and compassion: social work, political work, community fund-raising – Marriage can be more satisfying – Feel a sense of comfort in their lifestyle

33. 33 Stagnation: – People who are unable to expand their interests at this time suffer a sense of boredom and stagnation – Have difficulty in accepting their aging bodies and become withdrawn and isolated – Preoccupied with self and unable to give to others – Some may regress to younger behaviour in dress or actions or marrying younger partners

34. 34 Cognitive development Learning continues and can be enhanced by increased motivation at this time The experiences of the professional, social, and personal life will be reflected in their cognitive performance thus approaches to problem solving and task completion will vary considerably

35. 35 Cognitive Development Does intelligence decline with age? Cross-sectional studies - which test people of different ages at the same point in time - clearly showed that older subjects scored less well than younger subjects on traditional IQ tests. – Intelligence peaks at 18, stays steady until mid-20s, and declines till end of life.

36. 36 Many researchers believe there are two kinds of intelligence. – FLUID INTELLIGENCE: is defined as one’s reasoning and problem solving abilities, independent from the culture and the environment. – It is the ability to deal with new problems and situations – Fluid intelligence does decline with age. Crystallized & Fluid Intelligence

37. 37 (Crystallized & Fluid Intelligence, continued) CRYSTALLIZED INTELLIGENCE is the store of information, skills, and strategies that people have acquired through education and prior experiences, and through their previous use of fluid intelligence. Crystallized intelligence includes numerical and verbal abilities, such as solving a crossword puzzle or a mathematical problem. Crystallized intelligence holds steady or increases with age.

38. 38 Changes in Crystallized & Fluid Intelligence

39. 39 Professional success may not rely exclusively on cognitive ability. Older, successful people may have developed expertise in their particular occupational area or SELECTIVE OPTIMIZATION, the process by which people concentrate on particular skill areas to compensate for losses in other areas.

40. 40 Memory in Middle Adulthood According to research on memory changes in adulthood, most people show only minimal losses, and many exhibit no memory loss in middle adulthood. Memory is viewed in terms of three sequential components…

41. 41 Memory in middle adulthood, continued Sensory memory is an initial, momentary storage of information that lasts only an instant. – No decline in middle age. Short-term memory holds information for 15 to 25 seconds. – No decline in middle age. Long-term memory holds information that is rehearsed for a relatively permanent time. – Some decline in middle age. – storage is less efficient – a reduction in efficiency of memory retrieval

42. 42 Nutrition As metabolic rate decreases, food intake should be adjusted accordingly. If wise eating habits were not followed earlier in life, the body may start giving its owner messages of disease. Heartburn, ulcers, colitis, high blood pressure -- all these and more are at least partially caused by poor diet and poor digestion

43. 43 Health problems Life style patterns, aging, family history, developmental stressors, situational stressors are related to health problems CVD Cancer Accidents: Due to decreases reaction time and visual acuity

44. 44 Heart Disease in Middle Adulthood More men die in middle age of diseases of the heart and circulatory system than any other cause. Both genetic and experiential characteristics are involved. – Heart disease runs in families. – Men are more likely to suffer than women, and risks increase with age.

45. 45 According to the American College of Sports Medicine and the Centers for Disease Control and Prevention, every adult should get at least 30 minutes of moderate- intensity physical activity daily. – walking – gardening – climbing stairs – reduces risk of heart disease, osteoporosis, weight gain, and hypertension – psychological benefits of sense of control and well- being

46. 46 Heart disease, continued There are several environmental and behavioral risk factors for heart disease. – cigarette smoking – high fat and cholesterol in diet – lack of physical exercise

47. 47 The Type A’s and Type B’s personality Evidence suggests that some psychological factors are also related to heart disease. – People with TYPE A BEHAVIOR PATTERN, which is characterized by competitiveness, impatience, and a tendency toward frustration and hostility, are more susceptible to heart disease.

48. 48 (type A behavior, continued) They engage in multiple activities carried out simultaneously. They are easily angered and become verbally and nonverbally hostile if prevented from reaching their goals. Heart rate and blood pressure rise, epinephrine and norepinephrine increase. Most experts now say it is the negative emotion and hostility that are the major links to heart disease.

49. 49 Type B’s and heart attack risk By contrast, people with TYPE B BEHAVIOR PATTERN, which is characterized by noncompetitiveness, patience, and a lack of aggression, have less than half the risk of coronary disease that Type A people have. ~ Not all type A’s are destined to suffer heart disease! ~ Can learn to behave differently

50. 50 Stress in Middle Adulthood Stress continues to significantly impact health during middle adulthood Stressors themselves may be different 3 main consequences… – Direct physiological effect – Harmful behaviors – Indirect health related behaviors

51. 51 The 3 Main Consequences of Stress

52. 52 The Threat of Cancer in Middle Adulthood… Cancer is the second leading cause of death in middle age. Many forms of cancer respond well to treatment. 40 % are still alive 5 years after diagnosis. Men at higher risk for lung and bladder cancer Women at higher risk for breast cancer followed by colon, uterus and lung cancer

53. 53 Cancer is associated with several risk factors. – Genetics (family history of cancer) raises the risk. – Poor nutrition, smoking, alcohol use, exposure to sunlight, exposure to radiation, and exposure to occupational hazards such as certain chemicals raises the risk

54. 54 Health problems Obesity: – Due to low metabolic activity associated with physical inactivity – Places adults at greater risk for many chronic illnesses such as DM, HTN Mental health alterations: – Development of stressors such as menopause, retirements, divorce, unemployment, death of spouse can precipitate increased anxiety leading to depression

55. 55 Late adulthood years after 65

56. 56 Late adulthood can be divided into: – Young old 65 – 74 years – Middle old 75 – 84 years – Old old over 85 years Geriatrics: is the term for medical speciality that addresses the diagnosis and treatment of the physical problems of elderly person Gerontology: is a science that study all aspects of the aging process including biologic, psychologic and sociologic factors

57. 57 Biologic theories of aging Wear and tear theories: – Dr. August Weismann, a German biologist, first introduced this theory in 1882. – He believed that the body and its cells were damaged by overuse and abuse. – The organs, liver, stomach, kidneys, skin and so on are worn down by toxins in our diet and in the environment; by the excessive consumption of fat, sugar, caffeine, alcohol and nicotine; by the ultra-violet rays of the sun and by the many other physical and emotional stresses to which we subject our bodies.

58. 58 Biologic theories of aging – Wear and tear is not confined to our organs, however; it also takes place on the cellular level. – When we are young the body's own maintenance and repair systems keep compensating for the effects of both normal and excessive wear and tear – With age the body loses its ability to repair damage caused by diet, environmental toxins, bacteria or a virus

59. 59 Biologic theories of aging The Neuroendocrine Theory – Proposes that changes in hormone production result in organism’s decline – When we are young, our hormones work together to regulate many bodily functions, including our responses to heat and cold, our life experiences and our sexual activity – Hormones are vital for repairing and regulating our bodily functions, and when aging causes a drop in hormone production, it causes a decline in our body's ability to repair and regulate itself

60. 60 The Genetic Control Theory : – We are born with a unique genetic code, a predetermined tendency to certain types of physical and mental functioning, and that genetic inheritance has a great deal to say about how quickly we age and how long we live Cross – linking theory: – Proposes that chemical reactions create strong bonds between proteins these bonds cause loss of elasticity, stiffness and loss of function

61. 61 Autoimmune Theory – Proposes that immune system becomes less effective that incubated viruses in the body damage the body organs. – Also a reduction in immune function will increase autoimmune responses causing the body to produce antibodies that attack itself

62. 62 Integumentary system Skin: – dry, fragile and pale – Wrinkling and sagging in skin, eyelids, ear lobs, breast due to decrease elasticity and subcutaneous fat – Appearance of Lentigo Senilis (brown age spots) due to clustering of melanocytes (pigment cells) – Women may start to have facial hair Hair loses color Fingernails and toenails become thickened and brittle Losses of subcutaneous fat decreases elderly tolerance of cold (hypothermia is a major health problem)

63. 63 Neuromuscloskeletal Steady decrease in muscle fibers and muscle tones Reduction of speed and power of muscle contractions Elderly may experience impaired balance (due to slower reaction time) Loss of overall stature (due to atrophy of intervertebral discs) Stooping posture due to muscle weakness and kyphosis: curved posture, the head down, the back and knees bent, and a forward pitch with small, shuffling steps when walking.

64. 64 The loss of bone density and mass causes a compression of the bones especially in the vertebral area creating a slight decrease in height Osteoporosis due to bone demineralization causing bones break more easily A loss of cartilage makes painful joint complaints more common and contribute to a decrease range of movement and mobility

65. 65 Osteoporosis is a weakening of bones due to loss of bone density. Osteoporosis is preventable to a very large extent by calcium intake and regular load-bearing exercise, such as weight training.

66. 66 Sensory/ perceptual Eyes: – Shrunken appearance due to loss of orbital fat. – Slow blinking reflex – Looseness of the eyelids particularly the lower lid due to poorer muscle tone. – Continue loss of visual acuity, less power to adapt to sudden changes to more or less light or near to far objects (temporary blindness): hazard of night driving.

67. 67 – Difficulty in discriminating similar colors. – May have Cataract Glaucoma Reduce peripheral vision And arcus senilis (white circle around the iris: it is a peripheral corneal opacity caused by a deposition of phospholipid and cholesterol granules in the corneal stroma )

68. 68 Hearing: after age 75, 50% or more have hearing deficits: higher tones are more difficult to hear than low ones Smell and taste: older people, especially men, experience losses in both taste and smell, which may result in decreased appetite. Touch: loss of skin receptors causing decrease sensation of pain, touch and temperature places the elderly at risk for burn or injuries.

69. 69 Pulmonary Decreases inhalation of air due to musculoskeletal changes and calcification of costal cartilage which decreases lung expansion thus decreasing respiratory rate Residual air will be greater (weaker expiratory muscle) Decreased cough efficiency with age thus mucous secretions tend to collect more often causing infection Dyspnoea with exercises

70. 70 Cardiovascular Heart working capacity will decrease especially during exercises Heart rate slow in responding and slow to return to normal after physical activity Decreased the arterial elasticity will reduce the blood supply to legs causing calf pain and to the brain causing dizziness.

71. 71 Gastrointestinal Delayed in swallowing time Increase tendency of indigestion due to decrease digestive enzymes and decrease muscle tone of GI system Low absorption rate of nutrients and drugs due to decrease number of absorbing cells in GI Decreased peristalsis movements causing constipation.

72. 72 Urinary Decreased numbers of functioning nephrons lead to diminished kidney function Urinary urgency and frequency are common in elderly due to enlarged prostate in men and weakness in muscles that support the bladder in women

73. 73 Cognitive development An old adult maintains cognitive skills however, this will be affected with disease processes Memory: age related problems occur in short- term memory Old person needs more time to learn due to problem with retrieving information

74. 74 Health problems Dementia: – is a permanent or progressive organic mental disorder – It is a declining of cognitive abilities, characterized by personality changes, confusion, disorientation and deterioration of intellectual functioning and memory. – The most common type of irreversible dementia is Alzheimer’s disease (AD)

75. 75 Most prominent symptoms of AD are steady decline in memory, learning, attention, judgment, orientation and language skills as well as decline in physical abilities.

76. 76 Health problems in late adulthood: Alois Alzheimer Alzheimer’s disease affects a growing number of older persons—especially those over 80 year. Cause is not known, but involves deterioration of the brain’s abilities to maintain itself.

77. 77 Parkinson’s disease: – Parkinson's disease is a chronic, progressive neurodegenerative movement disorder. Tremors, rigidity, slow movement (bradykinesia), poor balance, and difficulty walking (called parkinsonian gait) are characteristic of Parkinson's disease. – The cause is unknown (idiopathic)

78. 78 – Parkinson's results from the degeneration of dopamine-producing nerve cells in the brain – Dopamine is a neurotransmitter that stimulates motor neurons, those nerve cells that control the muscles. When dopamine production is depleted, the motor system nerves are unable to control movement and coordination. – Parkinson's disease patients have lost 80% or more of their dopamine-producing cells by the time symptoms appear.

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