1. Chapter Thirteen Making It in Midlife: The Unique Challenges of Middle Adulthood

2. Changes in Appearance
In middle age, people begin to notice significant amounts of wrinkles, gray hair, and possibly baldness
Most people gain weight between their 30s and middle 50s
People have varying psychological reactions to signs of aging

3. Changes in Bones and Joints
Loss of bone mass is a potentially serious problem in middle age
Bones become weaker and take longer to heal
Osteoporosis may develop, in which bones become porous and easy to break
Osteoporosis is more common in women and may result from decline in calcium and estrogen after menopause

4. Changes in Bones and Joints (Cont)
Deterioration of the bones under the cartilage is 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

5. Caption: Bone mass loss through osteoporosis

6. Reproductive Changes
The reproductive system begins to show dramatic changes for women and less dramatic changes for men
73% of men and 69% of women between 40 and 49, and 67% of men and 48% of women between the ages of 50 and 59 have sex at least several times a month

7. The Climacteric and Menopause
The loss of ability to bear children, called the climacteric, usually begins in the 40s and is complete by the late 50s
During the climacteric, menstruation becomes irregular and eventually stops in the process of menopause

8. The Climacteric and Menopause (Cont)
Two processes are associated with the climacteric and 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

9. The Climacteric and Menopause (Cont)
African American women - more estrogen-related symptoms and less somatic symptoms
Asian women - fewer hot flashes, more headaches, shoulder stiffness, dizziness
Sexual activity may be affected by vaginal wall and external vaginal shrinkage and dryness. Painful intercourse and the absence of orgasm, or the need for increased stimulation for orgasm, may be experienced

10. Treating Symptoms of Menopause
Decline in levels of estrogen is associated with osteoporosis, cardiovascular disease, urinary incontinence, weight gain, and memory loss
Hormone Replacement Therapy (HRT) has been associated with both risks and benefits
HRT has been shown to have positive effects on the above conditions
HRT has been associated with increased risk of endometrial cancer and breast cancer. Lower dosages have been found to be safer, especially when combined with progestin

11. Reproductive Changes in Men
A decline in sperm count of about 30%
The prostate gland enlarges with increasing age in men and may block the urinary tract
Testosterone gradually declines after mid-20s
Older men report less demand to ejaculate, a need for longer stimulation to achieve erection and orgasm, and a longer phase after sex during which erection is impossible

12. Stress and Health
The effect of long- and short-term stress becomes more apparent during middle-age
Stress is highest for occupations that experience less control over their job
Middle-aged people report higher levels of stress than older people.

13. What is Stress?
The stress and coping paradigm is the model for which coping strategies are studied
Stress occurs when you appraise a situation as exceeding your personal, social, or other resources and affects your well-being
Coping is the way stress is dealt with
Avoiding situations, focusing on how they deal with stress, religious approaches, and sometimes by redefining the stressful situation

14. How are Stress and Coping Related to Physical Health?
Chronic stress may have an effect on the immune system
Negative events lowers the immune system, while positive events improves the immune system

15. Personality Types May Play a Role
Type A behavior patterns tend to be more competitive, angry, hostile, restless, and aggressive. Type A personalities may recover from a heart attack more quickly
Type B personalities tend to experience the opposite. Type B personalities may not be as driven to work to recover as quickly

16. Exercise Exercise slows the aging process
Aerobic exercise improves the functioning of the cardiovascular system
Studies show that middle-aged and older men that exercise moderately for 6 to 8 hours per week were less likely to die in the next week
Younger adults tend to exercise to improve physical appearance, while older adults are more concerned with physical and psychological health

17. When Grandparents Care for Grandchildren
In today’s society, grandparents are more likely to live a farther distance from their grandchildren
Many grandparents are the custodial parents for their grandchildren
Lack of legal consideration of the role of grandparents has traditionally made this role more difficult, especially for obtaining records and school-related activities