HDFS Final Ch 15 Physical and Cognitive Development in Middle Adulthood

We define middle adulthood as the years from ages

40 to 65.

Unlike the changes that occur in early adolescence, the physical changes that occur in middle adulthood are more ___.

gradual

Most middle-aged adults begin to sense their own ___, often in response to acute or chronic health conditions and especially after experiencing life-threatening health concerns.

mortality

Most middle-aged adults begin to sense their own mortality, often in response to

acute or chronic health conditions and especially after experiencing life-threatening health concerns.

As middle adults progress through midlife, they begin to think of their lives in terms of

years left of life rather than years lived

Dominic’s need to hold the newspaper at a distance in order to read. Why?

It is related to changes in the eye that occur throughout the adult years. The cornea flattens, the lens loses flexibility, and the muscle that permits the lens to change shape, or accommodate, weakens. The result is that most adults in their 40s develop presbyopia, also known as farsightedness—the inability to focus the lens on close objects, such as in reading small print

What is presbyopia?

Known as farsightedness. The inability to focus the lens on close objects, such as in reading small print

By what age do virtually all adults display presbyopia and require reading glasses or other corrective options

age 50

In addition to changes in the accommodative ability of the lens, the ability to see in dim light declines because, with age,

• the lens yellows

• the size of the pupil shrinks

• and over middle age, most adults have lost about one half of the rods (light receptor cells) in the retina

which reduces the ability to see in dim light and makes adults’ night vision decline twice as fast as their day vision

adults’ night vision decline ___ as fast as their day vision

twice

As rods are lost, so too are cones (color receptive cells) because rods secrete substances that permit cones to survive, thus what change happens in our eyes? (aka cones also die as a result of rod loss)

Thus, color discrimination becomes limited, with gradual declines beginning in the 30s

Night vision is further reduced because the vitreous (transparent gel that fills the eyeball) becomes more __ with age, scattering light that enters the eye (creating glare) and permitting less light to reach the retina

opaque

In middle adulthood, about one-third more light is needed to compensate for these changes that reduce ____. All of these changes in vision make driving at night more challenging as headlights from other cars become blinding.

reduce vision

Dominic noticed that he has difficulty hearing, at least in some situations. When he plays with his 4-year-old nephew, Dominic finds that he has to lean in close to hear the boy’s speech. Sometimes he finds himself watching his teenage daughter’s lips while she speaks, especially when they are having dinner in a crowded restaurant. Why does this occur?

Age-related hearing loss, presbycusis (“old hearing”), becomes apparent in the 50s and is caused by natural cell death that results in the deterioration of the ear structures that convert sound into neural impulses.

What is presbycusis (“old hearing”), and how is it caused and when does it become apparent?

Age-related hearing loss, presbycusis (“old hearing”), becomes apparent in the 50s and is caused by natural cell death that results in the deterioration of the ear structures that convert sound into neural impulses.

Hearing loss is first limited to high-pitched sounds, which enable us to distinguish between ____ such as f versus s and p versus t; as a result, what tends to happen?

consonants; the person often can hear most of a message but may misinterpret parts of it, such as names.

Presbycusis hearing deficits tend to be more apparent in settings with _____ ___, such as a dinner party

background noise

Generally, men’s hearing declines more rapidly than women’s, perhaps up to twice as quickly. Why could this be?

Men’s rapid hearing decline can be traced to exposure to intense noise (e.g., headphones and concerts) and loud work environments (e.g., construction, military, and transportation work).

Hearing loss can be lessened and prevented by wearing protective equipment, such as earplugs, and by lowering the volume on electronic audio devices.

What is the most visible sign of aging in middle adulthood?

Changes in the skin are perhaps the most visible sign of aging in middle adulthood.

While most adults in their 30s notice lines developing on their foreheads, by their 40s, these lines are accompanied by ____ ___ around the eyes and lines around the mouth—markers of four decades of smiles, frowns, laughter, and other emotions.

crow’s feet

During middle adulthood the process continues: Skin becomes less taut as the ____, the outer protective layer of the skin that produces new skin cells, loosens its attachment to the thinning ___, the middle layer of skin consisting of connective tissue that gives skin its flexibility.

Declines in elasticity are accompanied by the loss of fat in the ____, the innermost layer of skin composed of fat, which leads to wrinkling and loosening of the skin

epidermis; dermis; hypodermis

Which dermis leads to wrinkling and loosening of the skin?

Hypodermis: Declines in elasticity are accompanied by the loss of fat in the hypodermis, the innermost layer of skin composed of fat, which leads to wrinkling and loosening of the skin

Which gender tend to experience age-related changes sooner and more quickly? Why?

Women tend to experience age-related changes sooner and more quickly than men.

Their dermis is thinner, and as they age they experience hormonal changes that exacerbate aging, particularly a reduction in the female hormone estrogen

What is responsible for most of the changes in the skin that we associate with age?

Exposure to the sun’s rays is responsible for most of the changes in the skin that we associate with age

About 90% of cosmetic procedures are conducted on ____ and, as shown in Figure 15.2, middle-aged ___ (same word) are most likely to obtain cosmetic procedures

women. Nearly three-quarters of women who obtain cosmetic procedures are white.

Muscle strength tends to peak in the __s, followed by a small, gradual decline through the —s, but these changes go unnoticed in most people until the mid- to late —s.

20s; 30s; 40s

The rate of decline in muscle mass and strength tends to accelerate in the __s

40s

By age __, about 10% to 15% of muscle mass and strength are lost, but not all parts of the body age at the same rate

60

What is isometric strength?

Subtle contractions in which the length of the muscle does not change; is maintained through adulthood.

the subtle contractions used to hold a hand grip, push off against a wall, stretch, or practice yoga, is maintained throughout adulthood

the subtle contractions used to hold a hand grip, push off against a wall, stretch, or practice yoga, is maintained throughout adulthood, and this is what type of strength?

isometric strength

Loss of ____ tends to occur after age 40, but the decline is generally proportionately less than that of ___

endurance; strength

Body composition shifts over the course of adulthood as what else slows?

metabolic rate

Declines in muscle and bone accompany an increase in

body fat.

In men, fat accumulates on the back and upper abdomen, while women tend to experience an increase in fat in the

upper arms and around the waist

When adults gradually reduce their caloric intake to match their reduced need for calories, such as by consuming a low-fat diet with lots of vegetables, fruits, and grains, age-related weight gain is ____ for adults, regardless of socioeconomic status (SES) and ethnicity

minimized

What activity can offset midlife losses in muscle?

Physical activity

Normal aging brings some loss of bone tissue that begins around age 40. Bone loss increases in the 50s, especially in women. Why?

Their bones have less calcium to begin with and they lose the protective influence of estrogen on bones after menopause

As the bones that make up the vertebrae in the spinal column become thin and more brittle, the disks collapse and adults lose height, about an __ or more by age 60, and more thereafter

inch

Why is breaking a bone more serious in old age?

Loss of bone density causes bones to break more easily and heal more slowly, making a broken bone more serious as we age.

Summarize the age related change of vision.

Presbyopia affects nearly all adults by age 50.

Structural changes of the eye, including the cornea, lens, and retina, cause a decline in night vision.

Summarize the age related change of hearing.

Presbycusis is common by the 50s, with the loss first limited to high-pitched sounds and settings in which there is background noise.

By late adulthood, it extends to all sound frequencies.

Contextual factors, such as exposure to noise, play a role in age-related hearing loss.

Summarize the age related change of skin.

Fine lines are apparent by the 30s, first on the forehead, and by the 40s as crow’s feet around the eyes and lines around the mouth.

Skin becomes less taut as the epidermis loosens its attachment to the dermis. The resulting loss in elasticity is accompanied by the loss of fat in the hypodermis, which leads to wrinkling and loosening of the skin.

Exposure to sun rays is associated with advanced skin aging for people of all skin types and ethnicities.

Summarize the age related change of muscle.

Peak muscle strength is typically reached during the 20s, followed by a gradual decline. Changes usually are not noticeable until about age 45.

Loss of endurance tends to occur after age 40.

Good nutrition and an active lifestyle can reduce losses and even increase muscular density.

Isometric strength tends to endure throughout adulthood.

Summarize the age related change of skeleton.

Bone density peaks in the mid to late 30s, after which adults tend to experience gradual bone loss, advancing in the 50s, especially in postmenopausal women.

Losses in bone density can be slowed by behaviors such as avoiding smoking and excess drinking and by engaging in weight-bearing exercise.

At about 51 years of age on average, but starting as early as age 42 and as late as 58, women experience ____, the cessation (ending) of ovulation and menstruation

menopause

What is menopause?

the cessation (ending) of ovulation and menstruation

Menopause occurs earlier in women who

• smoke

• have not given birth

• are malnourished

• are exposed to pollutants

• and are of lower SES

A woman is said to have reached menopause __ year after her last menstrual period.

one year

What is perimenopause?

Perimenopause refers to the transition to menopause, extending approximately three years before and after menopause.

It is during ____ that the production of reproductive hormones declines and symptoms associated with menopause first appear

perimenopause

The first indicator of perimenopause is a

shorter menstrual cycle, followed by erratic (irregular) menstrual periods

In perimenopause, ovulation becomes less predictable, occurring early or late in the cycle; sometimes several ova are released and sometimes none. This unpredictability in ovulation can sometimes lead to a

“surprise” late-life pregnancy

The most common and long-lasting symptom of perimenopause is __ _____, in which the expansion and contraction of blood vessels cause sudden sensations of heat throughout the body accompanied by sweating

hot flashes

[Perimenopause] One-third to as many as three-quarters of U.S. women experience __ ____, which may persist for seven or more years

hot flashes

Why is Hormone replacement therapy (HRT) prescribed and who to? (age is important)

Hormone replacement therapy (HRT) is sometimes prescribed to women early in menopause to address perimenopause symptoms.

Younger menopausal women age 50–59 (or within 10 years of menopause) show benefits of HRT, such as the reduction of hot flashes and other symptoms and reduced risk for cardiovascular disease without an increased risk of breast cancer or stroke.

With increasing age, starting at about age __, HRT is associated with increased risk for cardiovascular disease for some women and there is little evidence of benefit for most women. It is ONLY beneficial for women what age?

60; Younger menopausal women age 50–59 (or within 10 years of menopause) show benefits of HRT

The U.S. Food and Drug Administration recommends that physicians prescribe the biggest/smallest dose of hormones needed to reduce menopausal symptoms and for the shortest time

smallest

What kind of emotional differences exist for women who go through menopause?

Women who have children may view menopause as providing sexual freedom and enjoyment without worry of contraception or pregnancy.

In contrast, women who desire a family, but who have not given birth, may view menopause as the end of fertility and the possibility of child-rearing, making menopause a difficult transition.

High levels of education and high SES are both associated with more positive views of menopause and fewer reports of menopausal symptoms.

____ depictions of menopause influence women’s experience of menopause.

Cultural

T/F: recent generations of women have objected to the notion of menopause as a disease and instead view it as a naturally occurring process.

T

Unlike women, men’s reproductive ability changes gradually and steadily over the adult years, with declines in testosterone beginning as early as age 30 in some men and continuing at a pace of about a 0.3% to 1% decrease per year to a total decline in testosterone of about 30% by age

70

Men’s bodies produce less testosterone and they become less fertile, but about __% of men retain testosterone levels in the normal range, with most adult males continuing to produce sperm throughout adulthood; many are able to father children into their 80s and beyond.

75

T/F: most adult males can continue to produce sperm throughout adulthood; many are able to father children into their 80s and beyond.

T.

T/F: most adult males cannot continue to produce sperm throughout adulthood; many are not able to father children into their 50s and beyond.

F. Most adult males can continue to produce sperm throughout adulthood; many are able to father children into their 80s and beyond.

[Male reproductive changes] Stress from problems such as unemployment, illness, marital problems, children leaving home, or sexual inactivity can cause reductions in _____, which decreases sexual desire and responses. Low levels of testosterone may interfere with a man’s ability to achieve or maintain an erection, which can influence anxiety about his sexual capacity, which can lead to further declines in testosterone.

testosterone

Sudden declines in testosterone tend to occur with stress and health problems and do not represent an inevitable ____ transition.

biological

T/F: There is a male menopause.

F. There is no male menopause.

T/F: Most adults view themselves as healthy.

T

T/F: In the United States and Europe, high socioeconomic status is associated with good health.

T

Middle-aged adults are most likely to die by

cancer and heart disease, followed by unintentional injuries, of which unintentional poisoning—drug overdose—is most common

Unintentional injuries is the 3rd leading cause of middle aged adults, which includes unintentional poisoning, the most common, which includes what?

drug overdose

The rapid increase in midlife mortality is attributed to a rise in

fatal drug overdoses, suicides, and alcohol-related liver diseases

Death by ___ overdose is most common.

opioid

Cancer, cardiovascular disease, and diabetes are the leading ___ ______ of middle-aged adults.

health concerns

It is estimated that nearly 15% of adults will develop cancer between the ages of

50 and 69.

Cancer cells undergo uncontrolled growth for three reasons. What are they?

• Cell mutations may cause cancer genes—known as oncogenes—to undergo abnormal cell division.

• Other cell mutations may interfere with tumor suppressor genes that keep oncogenes from multiplying.

• Finally, cell mutations may prevent cells from repairing the DNA errors that occur as a function of cell division, as well as those that occur from exposure to environmental toxins and free radicals.

What is the most common form of cancer?

Skin cancer.

T/F: Following skin cancer, across all ages women are most likely to be diagnosed with lung, prostate, and colorectal cancer, and men with lung, breast, and colorectal cancer.

F. Switch the men with the women.

Women: Lung, breast, colorectal

Men: Lung, prostate, colorectal

Which gender gets diagnosed with cancer more?

Overall, men tend to be diagnosed with cancer at a higher rate than women.

T/F: In cancer, genetics is not destiny.

T. Only about 35% to 50% of women who test positive for the genetic mutation actually develop breast cancer.

Early onset breast cancer happens before what age?

45

T/F: Early onset breast cancers, diagnosed in older adulthood, tend to grow more slowly, are less biologically aggressive, and are influenced by extended exposures to environmental risk factors and the disruptions in cell division that occur with aging.

F. This is T for late-onset breast cancers.

Although it is commonly believed that a diagnosis of cancer is a death sentence, survival rates vary by cancer type and today’s medical advances permit more people to survive cancer, defined as surviving at least __ years after remission, than ever before.

five

About __% of men and women age 40–59 have heart disease.

40

T/F: heart disease, is responsible for over one-half of all deaths of middle-aged Americans each year.

F, one–quarter.

Markers of cardiovascular disease include

• hypertension (high blood pressure)

• high blood cholesterol

• plaque buildup in the arteries (atherosclerosis)

• irregular heartbeat

• and, particularly serious, heart attack (blockage of blood flow to the heart caused by a blood clot occurring within a plaque-clogged coronary artery)

T/F: Cardiovascular disease can also cause a stroke—a blockage of blood flow to brain cells, which can result in neurological damage, paralysis, and death.

T

How does a stroke occur?

A stroke occurs when a blood clot, often originating in the coronary arteries, travels to the brain, or when a clot forms in the brain itself

The most commonly experienced symptom of heart attack is

chest pain, uncomfortable pressure, squeezing, fullness, or pain in the chest that may come and go or last

Cardiovascular disease has been stereotypically viewed as an illness affecting what gender?

Men, as men are more likely to be diagnosed with cardiovascular disease, but women also experience high rates.

T/F: Women tend to show different symptoms of heart attack.

T, surprisingly! Women are less likely to report chest pain than men. When they do, women are more likely to describe it as pressure or tightness than pain.

Why do many women not recognize their CVD symptoms as severe and life threatening?

Because women tend to show different symptoms of heart attack. For these reasons, women are more likely than men to die from cardiovascular disease, especially heart attack.

Risk factors for cardiovascular disease include

• heredity

• age

• a diet heavy in saturated and trans fatty acids

• smoking

_____, or high blood pressure, a risk for heart attack, occurs in over half of U.S. adults aged 40 to 59 and three-quarters of adults over age 60.

Hypertension

Smokers have more than ___ the risk of heart disease.

twice. Chemicals in tobacco and cigarette smoke, including nicotine and carbon monoxide, make your heart work harder by narrowing your blood vessels and increasing blood pressure, leading to atherosclerosis and potentially a heart attack.

Cholesterol contributes to the formation of ___ inside the heart’s arteries, leading to ___.

plaque; atherosclerosis

Research has shown that getting at least __ minutes of moderate physical activity on five or more days of the week can help lower blood pressure, lower cholesterol, and keep your weight at a healthy level.

30

What is the second most common cause of death for middle-aged adults (and third for young adults)?

CVD

What is an Angioplasty?

Angioplasty is a process that involves threading a tube into the arteries and inflating a tiny balloon to flatten plaque deposits against the arterial walls and enabling blood to flow unobstructed.

What does coronary bypass surgery entail doing?

In serious cases of CVD, a health care provider may recommend coronary bypass surgery, in which damaged coronary blood vessels are replaced with those from the leg.