Human Behavior and the Social Environment I Part XI Chapter 25 Physical Development in Middle Adulthood

PART DEVELOPMENT IN MIDDLE ADULTHOOD Learning Objectives I Explore and connect Psychosocial , Cognitive , and Psychosexual Development I Explore and connect another Theory , Approach , or Perspective to work in critical thinking skills for client assessments I Exploring important aspects of a experience and ability to justify why they are important Development in Middle Adulthood 955

Vignette Seth is a 44 Caucasian male . He grew up in a small town with six siblings and his parents worked hard in a factory their whole lives . His parents had little education but had high hopes for their children and always said if you work hard . Photo by Sharon you can achieve anything and he believed this . Seth started working when he was 15 , graduated high school at 18 , and then joined the Air Force . He went to college after serving his term but had to work during this time to afford school and pay his bills . It took years , but he was able to earn a degree in Accounting , and he was very proud of his accomplishment . Seth got married a couple of years after graduating college but divorced after years . They did not have any children . He then began to experience some health issues which caused him to miss so much work that he was eventually laid off Seth struggled to find work with another accounting firm and then suffered a stroke . He had saved up some money and had hoped this would help him remain some financial stability while looking for another job but lost this sense of security after paying for the hospital bills . He then realized he had no other choice but to apply for benefits and financial assistance from the government . Seth decides to seek some support through the VA . He is connected with a Social Worker who helps him apply for the needed resources . He states I can believe it come to this . I never thought Id have to get help like this . It been so hard since I lost myjob last year . The Social Worker recognizes Seth has faced some stressors over the past few years and explores to see if he feels there may be some benefit in seeing a therapist at the Seth states You know , I never thought 956 Development in Middle Adulthood

be asking for financial help like this and its been tough . I could probably use some help to figure out how this has all been affecting me . Critical Thinking . What stage of Theory of Psychosocial Development are they currently in ?

Are they meeting the goals of this stage ?

Examples ?

Are they demonstrating any struggles with their goals in this stage ?

Examples ?

What theory , approach , or perspective from previous Dimensions ( PIE , Sociocultural , or Social Change ) would you use to assess this client ?

Why ?

What do you feel are the most important aspects ( physical development , attachment , sexual development , etc ) to consider for this client ?

Why ?

References , 2019 ) Dimensions of human behavior ( Sixth edition ) Sage Publications , Development in Middle Adulthood 957 Chapter 25 Physical Development in Middle Adulthood Explain the difference between primary and secondary aging Describe sensory changes that occur during middle adulthood Identify health concerns in middle adulthood Explain what occurs during the climacteric for females and males Describe sexuality during middle adulthood Explain the importance of sleep and consequences of sleep deprivation Describe the importance of exercise and nutrition for optimal health Describe brain functioning in middle adulthood Each person experiences physical changes based on many factors biological factors , such as molecular and cellular changes , and oxidative damage are called primary aging , while aging that occurs due to controllable factors , such as an unhealthy lifestyle Chapter 25 Physical Development in Middle Adulthood 959

including lack of physical exercise and poor diet , is called secondary aging ( 1969 ) These factors are shown in Figure Figure . Contributors to Aging . Lun ul ( AGING Luau . I ) up an at I . Getting out of shape is not an inevitable part of aging it is probably due to the fact that aged adults become less physically active and have experienced greater stress . Smoking tobacco , drinking alcohol , poor diet , stress , physical inactivity , and chronic disease , such as diabetes or arthritis , reduce overall health . However , there are things can be done to combat many of these changes by adopting healthier lifestyles . Physical Changes Hair When asked to imagine someone in middle adulthood , we often picture someone with the beginnings of wrinkles and gray or thinning hair . What accounts for these physical changes ?

960 Chapter 25 Physical Development in Middle Adulthood Hair color is due to a pigment called melanin which is produced by hair follicles ( Martin , 2014 ) With aging , the hair follicles produce less melanin , and this causes the hair to become gray . Hair color typically starts turning lighter at the temples , but eventually all the hair will become white . For many , graying begins in the , but it is largely determined by your genes . Gray hair occurs earlier in white people and later in Asians . Genes also determine how much hair remains on your head . Almost everyone has some hair loss with aging , and the rate of hair growth slows with aging . Many hair follicles stop producing new hairs and hair strands become smaller . Men begin showing signs of balding by 30 and some are nearly bald by 60 . baldness is related to testosterone and is identified by a receding hairline followed by hair loss at the top of the head . Figure shows tennis champion Andre Agassi characteristic patterned baldness . Women can also develop patterned baldness as their hair becomes less dense and the scalp becomes visible ( Martin , 2014 ) Sudden hair loss , however , can be a symptom of a health problem . Figure Andre gull Chapter 25 Physical Development in Middle Adulthood 961

Skin Skin continues to dry out and is prone to more wrinkling , particularly on the sensitive face area . Wrinkles , or creases in the skin , are a normal part of aging . As we get older , our skin dries and loses the underlying layer of fat , so our face no longer appears smooth . Loss of muscle tone and thinning skin can make the face appear flabby or drooping . Although wrinkles are a natural part of aging and genetics plays a role , frequent sun exposure and smoking will cause wrinkles to appear sooner . Dark spots and blotchy skin also occur as one ages and are due to exposure to sunlight ( 2014 ) Blood vessels become more apparent as the skin continues to dry and get thinner . The loss of muscle mass and strength that occurs with aging is referred to as ( Mayer , Nair , 2001 ) is thought to be a significant factor in the frailty and functional impairment that occurs when older . The decline of growth and anabolic hormones , especially testosterone , and decreased physical activity have been implicated as causes of ( Proctor , Nair , 1998 ) This decline in muscle mass can occur as early as 40 years of age and contributes significantly to a decrease in life quality , increase in health care costs , and early death in older adults ( Nair , 2005 ) Exercise is certainly important to increase strength , aerobic capacity , and muscle protein synthesis , but unfortunately it does not reverse all the changes that occur . The fat ratio for both men and women also changes throughout middle adulthood , with an accumulation of fat in the stomach area . Lungs The lungs serve two functions Supply oxygen and remove carbon dioxide . Thinning of the bones with age can change the shape of the rib cage and result in a loss of lung expansion . related changes in muscles , such as the weakening of the diaphragm , can also reduce lung capacity . Both of these changes will lower oxygen levels in the blood and increase the levels of carbon dioxide . Experiencing shortness of breath and feeling tired can result ( In middle adulthood , these changes and their effects are often minimal , especially in people who are 962 Chapter 25 Physical Development in Middle Adulthood

smokers and physically active . However , in those with chronic bronchitis , or who have experienced frequent pneumonia , asthma other disorders , or who are smokers , the effects of these normal age changes can be more pronounced . Sensory Changes Vision A normal change of the eye due to age is presbyopia , which is Latin for old vision . It refers to a loss of elasticity in the lens of the eye that makes it harder for the eye to focus on objects that are closer to the person . When we look at something far away , the lens flattens out when looking at nearby objects tiny muscle fibers around the lens enable the eye to bend the lens . With age these muscles weaken and can no longer accommodate the lens to focus the light . Anyone over the age of 35 is at risk for developing presbyopia . According to the National Eye Institute ( NEI ) 2016 ) signs that someone may have presbyopia include Hard time reading small print Having to hold reading material farther than arm distance Problems seeing objects that are close Headaches Eyestrain Chapter 25 Physical Development in Middle Adulthood 963

! Interior of the Human Eye Another common eye problem people experience as they age are , little spots or cobwebs that around the field of vision . They are most noticeable if you are looking at the sky on a sunny day , or at a lighted blank screen . Floaters occur when the vitreous , a substance in the interior of the eye , slowly shrinks . As it shrinks , it becomes somewhat stringy , and these strands can cast tiny shadows on the retina . In most cases , are harmless , more of an annoyance than a sign of eye problems . However , floaters that appear suddenly , or that darken and obscure vision can be a sign of more serious eye problems , such a retinal tearing , infection , or inflammation . People who are very nearsighted ( myopic ) have diabetes , or who have had cataract surgery are also more likely to have floaters ( NEI , 2009 ) During midlife , adults may begin to notice a drop in scotopic 964 Chapter 25 Physical Development in Middle Adulthood

sensitivity , the ability to see in dimmer light . By age 60 , the retina receives only one third as much light as it did at age 20 , making working in dimmer light more difficult ( Jackson , 2000 ) Night vision is also affected as the pupil loses some of its ability to open and close to accommodate drastic changes in light . Eyes become more sensitive to glare from headlights and street lights making it difficult to see people and cars , and movements outside of our direct line of sight ( Finally , some people experience dry eye syndrome , which occurs when the eye does not produce tears properly , or when the tears evaporate too quickly because they are not the correct consistency ( NEI , 2013 ) While dry eye can affect people at any age , nearly million Americans over the age of 50 experience dry eye . It affects women more than men , especially after menopause . Women who experienced an early menopause may be more likely to experience dry eye , which can cause surface damage to the eye . Hearing Hearing problems increase during middle adulthood . According to a recent UK study ( Dawes et , 2014 ) the rate of hearing problems in their sample doubled between the ages of 40 and 55 and tripled by age 64 . Similar statistics are found in US . samples of adults . Prior to age 40 , about of adults report hearing problems . This jumps to 19 among 40 to 69 olds ( American Psychological Association , 2016 ) adults may experience more problems understanding speech when in noisy environments , in comparison to younger adults ( Moore , Stone , 2015 , Besing , 2015 ) As we age we also lose the ability to hear higher frequencies ( 2010 ) Hearing changes are more common among men than women , but males may underestimate their hearing problems ( Ando , 2003 ) For many adults , hearing loss accumulates after years of being exposed to intense noise levels . Men are more likely to work in noisy occupations . Hearing loss is also exacerbated by cigarette smoking , high blood pressure , Chapter 25 Physical Development in Middle Adulthood 965

diabetes , and stroke . Most hearing loss could be prevented by guarding against being exposed to extremely noisy environments . Figure Incidence of Hearing Impairment in UK Adults ' 506 ! Adapted from Dawes . at al ( 2014 ) Health Concerns Heart Disease According to the most recent National Vital Statistics Reports ( Murphy , Xu , Arias , 2019 ) heart disease continues to be the number one cause of death for Americans as it claimed 23 of those who died in 2017 . It is also the number one cause of death worldwide ( World Health Organization , 2018 ) Heart disease develops slowly over time and typically appears in midlife ( Hooker Pressman , 2016 ) Heart disease can include heart defects and heart rhythm problems , as well as narrowed , blocked , or stiffened blood vessels referred to as cardiovascular disease . The blocked blood vessels prevent the body and heart from receiving adequate blood . Atherosclerosis , or a buildup of fatty plaque in the arteries , is the most common cause of cardiovascular disease . The plaque buildup 966 Chapter 25 Physical Development in Middle Adulthood

thickens the artery walls and restricts the blood flow to organs and tissues . Cardiovascular disease can lead to a heart attack , chest pain ( angina ) or stroke ( Mayo Clinic , Figure illustrates atherosclerosis . Figure Symptoms of cardiovascular disease differ for men and women . Males are more likely to suffer chest pain , while women are more likely to demonstrate shortness of breath , nausea , and extreme fatigue . Symptoms can also include pain in the arms , legs , neck , jaw , throat , abdomen or back ( Mayo Clinic , According to the Mayo Clinic ( there are many risk factors for developing heart disease , including medical conditions , such as high blood pressure , high cholesterol , diabetes , and obesity . Other risk factors include Advanced risk for narrowed arteries and weakened or thickened heart muscle . are at greater risk , but a female risk increases after menopause . Chapter 25 Physical Development in Middle Adulthood 967

Family risk , especially if male parent or brother developed heart . disease before age 55 or female parent or sister developed heart disease before age 65 . constricts blood vessels and carbon monoxide damages the inner lining . Pour diet high in fat , salt , sugar , and cholesterol . Excessive Alcohol can raise the level of bad fats in the blood and increase blood pressure stress can damage arteries and worsen other risk factors . Pour good hygiene habits can prevent viral or bacterial infections that can affect the heart . Poor dental care can also contribute to heart disease . Complications of heart disease can include heart failure , when the heart can not pump enough blood to the meet the body needs , and a heart attack , such as when a blood clot blocks the blood flow to the heart . This blockage can damage or destroy a part of the heart muscle , and atherosclerosis is a factor in a heart attack . Treatment for heart disease includes medication , surgery , and lifestyle changes including exercise , healthy diet , and refraining from smoking . Sudden cardiac arrest is the unexpected loss of heart functioning , breathing , and consciousness , often caused by an arrhythmia or abnormal heartbeat . The heartbeat may be too quick , too slow , or irregular . With a healthy heart , it is unlikely for a fatal arrhythmia to develop without an outside factor , such as an electric shock or illegal drugs . If not treated immediately , sudden cardiac arrest can be fatal and result in sudden cardiac death . Hypertension , or high blood pressure , is a serious health problem that occurs when the blood flows with a greater force than normal . One in three American adults ( 70 million people ) have hypertension and only half have it under control ( Yoon , Burt , Gu , 2013 ) It can strain the heart , increase the risk of heart attack and stroke , or damage the kidneys ( Uncontrolled high blood pressure in early and middle adulthood can also damage the 968 Chapter 25 Physical Development in Middle Adulthood

brain white matter ( axons ) and may be linked to cognitive problems later in life ( et , 2012 ) Normal blood pressure is under ( see Table ) The first number is the systolic pressure , which is the pressure in the blood vessels when the heartbeats . The second number is the diastolic pressure , which is the pressure in the blood vessels when the heart is at rest . High blood pressure is sometimes referred to as the silent killer , as most people with hypertension experience no symptoms . Making positive lifestyle changes can often reduce blood pressure . Prawn Undo 121 ! my me not min nu in Slap no run A um . I Risk factors for high blood pressure include Family history of hypertension A diet that is too high in sodium often found in processed foods , and too low in potassium Sedentary lifestyle and Obesity Too much alcohol consumption Tobacco use , as nicotine raises blood pressure ( Cancer After heart disease , cancer was the second leading cause of death for Americans in 2017 as it accounted for of all deaths ( et , 2016 ) According to the National Institutes of Health ( 2015 ) cancer is the name given to a collection of related diseases in which the body cells begin to divide without stopping and spread into surrounding tissues . These extra cells can divide , and form growths called tumors , which are typically masses of tissue . Cancerous tumors are malignant , which means they can invade Chapter 25 Physical Development in Middle Adulthood 969

nearby tissues . When removed malignant tumors may grow back . Unlike malignant tumors , benign tumors do not invade nearby tissues . Benign tumors can sometimes be quite large , and when removed usually do not grow back . Although benign tumors in the body are not cancerous , benign brain tumors can be threatening . Cancer cells can prompt nearby normal cells to form blood vessels that supply the tumors with oxygen and nutrients , which allows them to grow . These blood vessels also remove waste products from the tumors . Cancer cells can also hide from the immune system , a network of organs , tissues , and specialized cells that protects the body from infections and other conditions . Lastly , cancer cells can metastasize , which means they can break from where they first formed , called the primary cancer , and travel through the lymph system or blood to form new tumors in other parts of the body . This new metastatic tumor is the same type as the primary tumor ( National Institutes of Health , 2015 ) Figure 86 illustrates how cancers can metastasize . 970 Chapter 25 Physical Development in Middle Adulthood

Cancer can start almost anywhere in the human body . While normal cells mature into very distinct cell types with specific functions , cancer cells do not and continue to divide without stopping . Further , cancer cells are able to ignore the signals that normally tell cells to stop dividing or to begin a process known as programmed cell death which the body uses to get rid of unneeded cells . With the growth of cancer cells , normal cells are crowded out and the body is unable to work the way it is supposed to . For example , the cancer cells in lung cancer form tumors which interfere with the functioning of the lungs and how oxygen is transported to the rest of the body There are more than 100 types of cancer . The American Cancer Chapter 25 Physical Development in Middle Adulthood 971

Society assembles a list of the most common types of cancers in the United States . To qualify for the 2016 list , the estimated annual incidence had to be 40 , 000 cases or more . The most common type of cancer on the list is breast cancer , with more than new cases expected in 2016 . The next most common cancers are lung cancer and prostate cancer . Table lists the estimated number of new cases and deaths for each common cancer type for 2019 ( American Cancer Society , 2019 ) Table 20 ! ol in an I I stale I Gu Ah . Cholesterol is waxy fatty substance carried by lipoprotein molecules in the blood . It is created by the body to create hormones and digest fatty foods and is also found in many foods . Your body needs cholesterol , but too much can cause heart disease and stroke . Two important kinds of cholesterol are lipoprotein ( and lipoprotein ( The third type of fat is called triglycerides . Your total cholesterol score is based on all three types of lipids ( see Table ) Total cholesterol is calculated by adding plus plus 20 of the Triglycerides . 972 Chapter 25 Physical Development in Middle Adulthood

Table Normal Levels of Cholesterol Total Cholesterol Less than Less than or higher Triglycerides Less than level In In ( I ) of cholesterol per ( ill ) of Mood . Source adapted from ) cholesterol makes up the majority of the body cholesterol , however , it is often referred to as bad cholesterol because at high levels it can form plaque in the arteries leading to heart attack and stroke . cholesterol often referred to as good cholesterol , absorbs cholesterol and carries it back to the liver , where it is then flushed from the body . Higher levels of can reduce the risk of heart attack and stroke . Triglycerides are a type of fat in the blood used for energy . High levels of triglycerides can also increase your risk for heart disease and stroke when coupled with high and low . All adults 20 or older should have their cholesterol checked . In early adulthood , doctors may check every few years if the numbers have previously been normal , and there are no other signs of heart disease . In middle adulthood , this may become part of the annual ( 2015 ) Risk factors for high cholesterol include A family history for high cholesterol , diabetes , a diet high in saturated fats , trans fat , and cholesterol , physical inactivity , and obesity . Almost 32 of American adults have high cholesterol levels , and the majority do not have it under control , nor have they made lifestyle changes ( 2015 ) Diabetes ( Diabetes ) is oi disease in which the body does not control the amount of glucose in the blood . This disease occurs when the body does not make enough insulin or does not use it the way it should ( Insulin is a type of hormone that helps glucose in the blood enter cells to give them energy . In adults , Chapter 25 Physical Development in Middle Adulthood 973

90 to 95 of all diagnosed cases of diabetes are type ( American Diabetes Association ( ADA ) 2016 ) Type diabetes usually begins with insulin resistance , a disorder in which the cells in the muscles , liver , and fat tissue do not use insulin properly ( As the need for insulin increases , cells in the pancreas gradually lose the ability to produce enough insulin . In some Type diabetics , pancreatic beta cells will cease functioning , and the need for insulin injections will become necessary . Some people with diabetes experience insulin resistance with only minor dysfunction of the secretion of insulin . Other diabetics experience only slight insulin resistance , with the primary cause being a lack of insulin secretion ( Figure , One in three adults are estimated to have , and in 10 of them do not know . According to the ( without intervention , 15 to 30 of those with will develop diabetes within years . In 2015 , million people ( of the population ) were living with diabetes in America , mostly adults age 18 and up ( 2017 ) Table shows the numbers in millions and percentage of adults , by age and gender , with both diagnosed and undiagnosed diabetes . The median age of diagnosis is 54 ( During middle adulthood , the number of people with diabetes dramatically increases with million living with diabetes prior to age 45 , to over 13 million between the ages of 45 to 64 974 Chapter 25 Physical Development in Middle Adulthood

a increase . Men are slightly more likely to experience diabetes than are women . Ind If Mink II In van with II HIS In It ?

TIL thin nun Diabetes also affects ethnic and racial groups differently . Hispanic Whites are less likely to be diagnosed with diabetes than are Asian Americans , Hispanics , Blacks , and American Natives . However , these general figures hide the variations within these groups . For instance , the rate of diabetes was less for Central , South , and Cuban Americans than for Mexican Americans and Puerto Ricans , and less for Alaskan Natives than the American Indians of southern Arizona ( 2017 ) Additionally , educational attainment , which is linked to ones economic level , is correlated with diabetes . Percentages includes Less than a high school degree ( high school degree ( and more than a high school degree ( Chapter 25 Physical Development in Middle Adulthood 975

The risk factors for diabetes include Those over age 45 Obesity Family history of diabetes History of gestational diabetes ( see Chapter ) Race and ethnicity Physical inactivity Diet . Diabetes has been linked to numerous health complications . Adults with diabetes are times more likely to have cardiovascular disease , times more likely to experience a heart attack , and times more likely to experience stroke than adults without diabetes . Diabetes can cause blindness and other eye problems . Between of Americans with diabetes have some degree of diabetic , which is damage to the small blood vessels in the retina that may lead to loss of vision ( NEI , 2015 ) More than showed advanced diabetic . Diabetes is linked as the primary cause of almost half ( 44 ) of new cases of kidney failure each year . About 60 of limb amputations occur in people with diabetes . Diabetes has been linked to hearing loss , tinnitus ( ringing in the ears ) gum disease , and neuropathy ( nerve disease ) Typical tests for diabetes include a fasting glucose test and the ( See Table ) Fasting glucose levels should be under ( ADA , 2016 ) The provides information about the average levels of blood glucose over the last months ( The should be under , where a and a 126 ( ADA , 2016 ) fun In ! I Helm ) in , Aum um . 976 Chapter 25 Physical Development in Middle Adulthood

Metabolic Syndrome is a cluster of several risk factors , including large waist circumference , high blood pressure , and elevated triglycerides , and blood glucose levels , which can lead to diabetes and heart disease ( et , 2012 ) The prevalence of metabolic syndrome in the US . is approximately 34 and is especially high among Hispanics and African Americans ( Ford , Li , Zhao , 2010 ) Prevalence increases with age , peaking in ones 605 ( Ford et , 2010 ) Metabolic syndrome increases morbidity from cardiovascular disease and diabetes ( Hu et , 2004 Malik , 2004 ) Hu and colleagues found that even having one or two of the risk factors for metabolic syndrome increased the risk of mortality . et al . 2012 ) found that increasing aerobic activity and reducing weight led to a drop in many of the risk factors of metabolic syndrome , including a reduction in waist circumference and blood pressure , and an increase in cholesterol . Rheumatoid arthritis ( RA ) is an inflammatory disease that causes pain , swelling , stiffness , and loss of function in the joints ( RA occurs when the immune system attacks the membrane lining the joints ( see Figure ) RA is the second most common form of arthritis after osteoarthritis , which is the normal wear and tear on the joints discussed in chapter . Unlike osteoarthritis , RA is symmetric in its attack of the body , thus , if one shoulder is so is the other . In addition , those with RA may experience fatigue and fever . Below are the common features of RA ( Chapter 25 Physical Development in Middle Adulthood 977

Features of Rheumatoid Arthritis Tender , warm , swollen joints Symmetrical pattern of affected joints Joint inflammation often affecting the wrist and finger joints closest to the hand Joint inflammation sometimes affecting other joints , including the neck , shoulders , elbows , hips , knees , ankles , and feet Fatigue , occasional fevers , a loss of energy Pain and stiffness lasting for more than 30 minutes in the morning or after a long rest Symptoms that last for many years Variability of symptoms among people with the disease . About million people ( approximately ) of Americans experience rheumatoid arthritis . It occurs across all races and age groups , although the disease often begins in middle adulthood and occurs with increased frequency in older people . Like some other forms of arthritis , rheumatoid arthritis occurs much more frequently in women than in men . About two to three times as many women as men have the disease ( The lifetime risk for RA for women is and for men ( et , 2011 ) Genes play a role in the development of RA . However , individual genes by themselves confer only a small risk of developing the disease , as some people who have these particular genes never develop RA . Scientists think that something must occur to trigger the disease process in people whose genetic makeup makes them susceptible to rheumatoid arthritis . For instance , some scientists also think hormonal factors may be involved . In women who experience RA , the symptoms may improve during pregnancy and flare after pregnancy . Women who use oral contraceptives may increase their likelihood of developing RA . This suggests hormones , or possibly deficiencies or changes in certain hormones , may 978 Chapter 25 Physical Development in Middle Adulthood

increase the risk of developing RA in a genetically susceptible person ( Rheumatoid arthritis can affect virtually every area of a life , and it can interfere with the joys and responsibilities of work and family life . Fortunately , current treatment strategies allow most people with RA to lead active and productive lives . drugs and medications can slow joint damage and establishing a balance between rest and exercise can also lessen the symptoms of RA ( Fatty liver disease ( hepatic steatosis ) refers to the accumulation of fat in the liver . The liver normally contains little fat , and anything below of liver weight is considered normal . This disease is present in 33 of American adults . In the past , the main cause of fat accumulation in the liver was due to excessive alcohol consumption , often eventually leading to cirrhosis and liver failure . Today , increased caloric intake , especially resulting in obesity , and little physical activity are the main causes . Mild to moderate levels of hepatic steatosis can be reversed through healthy lifestyle changes ( Rector , 2015 ) Digestive Issues Heartburn , also called acid indigestion or pyrosis , is a common digestive problem in adults and is the result of stomach acid backing up into the esophagus . Prolonged contact with the digestive juices injures the lining of the esophagus and causes discomfort . Heartburn that occurs more frequently may be due to gastroesophageal reflux disease or . Normally the lower sphincter muscle in the esophagus keeps the acid in the stomach from entering the esophagus . In this muscle relaxes too frequently and the stomach acid flows into the esophagus . In the , 60 million people experience heartburn at least once a month , and 15 million experience it every day . Prolonged problems with Chapter 25 Physical Development in Middle Adulthood 979

heartburn can lead to more serious complications , including esophageal cancer , one of the most lethal forms of cancer in the . Problems with heartburn can be linked to eating fatty or spicy foods , caffeine , smoking , and eating before bedtime ( American College of Gastroenterology , Figure Digestive System ' Am . Gallstones are hard particles , including fatty materials , bile pigments , and calcium deposits , that can develop in the gallbladder . Ranging in size from a grain of sand to a golf ball , they typically 980 Chapter 25 Physical Development in Middle Adulthood

take years to develop , but in some people have developed over the course of a few months . About 75 of gallstones do not create any symptoms , but those that do may cause sporadic upper abdominal pain when stones block bile or pancreatic ducts . If stones become lodged in the ducts , it may necessitate surgery or other medical intervention as it could become if left untreated ( American College of Gastroenterology , Gallstones are present in about 20 of women and 10 of men over the age of 55 ( American College of Gastroenterology , Risk factors include a family history of gallstones , diets high in calories and refined carbohydrates ( such as , white bread and rice ) diabetes , metabolic syndrome , disease , and obesity , which increases the cholesterol in the bile and thus increases the risk of developing gallstones ( 2013 ) Sleep According to the American Academy of Sleep Medicine ( 2015 ) adults require at least hours of sleep per night to avoid the health risks associated with chronic sleep deprivation . Less than hours and more than 10 hours is also not recommended for those in middle adulthood ( National Sleep Foundation , 2015 ) Not surprisingly , many Americans do not receive the hours of sleep recommended . In 2013 , only 59 of adults met that standard , while in 1942 , 84 did ( Jones , 2013 ) This means 41 of Americans receive less than the recommended amount of nightly sleep . Additional results included that in 1993 , 67 of Americans felt they were getting enough sleep , but in 2013 only 56 felt they received as much sleep as needed . Additionally , 43 of Americans in 2013 believed they would feel better with more sleep . Sleep problems According to the Sleep in America poll ( National Sleep Foundation , 2015 ) of Americans report being diagnosed with a sleep disorder , and of those 71 have sleep apnea and 24 suffer from insomnia . Pain is also a contributing factor in the difference between the amount of sleep Americans say they need and the amount they are getting . An average of 42 minutes of sleep debt occur for those with chronic pain , and 14 minutes for those Chapter 25 Physical Development in Middle Adulthood 981

who have suffered from acute pain in the past week . Stress and overall poor health are also key components of shorter sleep and worse sleep quality . Those in midlife with lower life satisfaction experienced greater delay in the onset of sleep than those with higher life satisfaction . Delayed onset of sleep could be the result of worry and anxiety during midlife , and improvements in those areas should improve sleep . Lastly , menopause can affect a womans sleep duration and quality ( National Sleep Foundation , 2016 ) Children in the home and sleep As expected , having children at home affects the amount of sleep one receives . According to a 2016 National Center for Health Statistics analysis ( 2016 ) having children decreases the amount of sleep an individual receives , however , having a partner can improve the amount of sleep for both males and females . Table illustrates the percentage of individuals not receiving seven hours of sleep per night based on parental role . Presence of and Sleep , Negative consequences of insufficient sleep There are many 982 Chapter 25 Physical Development in Middle Adulthood

consequences of too little sleep , and they include physical , cognitive , and emotional changes . Sleep deprivation suppresses immune responses that fight off infection , and can lead to obesity , memory impairment , and hypertension ( et , 2007 , 2005 ) Insufficient sleep is linked to an increased risk for colon cancer , breast cancer , heart disease and type diabetes ( 2015 ) A lack of sleep can increase stress as cortisol ( a stress hormone ) remains elevated which keeps the body in a state of alertness and which increases blood pressure . Sleep is also associated with longevity . Dew et al . 2003 ) found that older adults who had better sleep patterns also lived longer . During deep sleep a growth hormone is released which stimulates protein synthesis , breaks down fat that supplies energy , and stimulates cell division . Consequently , a decrease in deep sleep contributes to less growth hormone being released and subsequent physical decline seen in aging ( 2015 ) The of Sleep Sleep disturbances can also impair glucose functioning in middle adulthood . Caucasian , African American , and Chinese working women aged years who were not taking related medications , participated in the Study of Women Health across the Nation ( SWAN ) Sleep Study and were subsequently examined approximately years later ( Taylor et , 2016 ) Body Chapter 25 Physical Development in Middle Adulthood 983

mass index ( and insulin resistance were measured at points . Results indicated that irregular sleep schedules , including highly variable bedtimes and staying up much later than usual , are associated in midlife women with insulin resistance , which is an important indicator of metabolic health , including diabetes risk . Diabetes risk increases in midlife women , and irregular sleep schedules may be an important reason because irregular bedtime schedules expose the body to varying levels of light , which is the most important timing cue for the body circadian clock . By disrupting circadian timing , bedtime variability may impair glucose metabolism and energy homeostasis . Exercise , Nutrition , and Weight The impact of exercise Exercise is a powerful way to combat the changes we associate with aging . Exercise builds muscle , increases metabolism , helps control blood sugar , increases bone density , and relieves stress . Unfortunately , fewer than half of midlife adults exercise and only about 20 percent exercise frequently and strenuously enough to achieve health benefits . Many stop exercising soon after they begin an exercise program , particularly those who are very overweight . The best exercise programs are those that are engaged in regularly , regardless of the activity . A program that is easy to follow includes walking and weight training . Having a safe , enjoyable place to walk can make the difference in whether or not someone walks regularly . Weight lifting and stretching exercises at home can also be part of an effective program . Exercise is particularly helpful in reducing stress in midlife . Walking , jogging , cycling , or swimming can release the tension caused by stressors . Learning relaxation techniques can also have healthful benefits . Exercise can be thought of as preventative health care . Promoting exercise for the 78 million 984 Chapter 25 Physical Development in Middle Adulthood

baby boomers may be one of the best ways to reduce health care costs and improve quality of life ( Shure , 1998 ) According to the Office of Disease Prevention and Health Promotion ( 2008 ) the following are exercise guidelines for adults Adults should avoid being inactive . Any activity will result in some health benefits . For substantial health benefits , adults should engage in at least 150 minutes per week of exercise OR at least 75 minutes of aerobic activity . Aerobic activity should occur for at least 10 minutes and preferably spread throughout the week . For more extensive health benefits , adults can increase their aerobic activity to 300 minutes per week of intensity OR 150 minutes per week of aerobic activity . Adults should also participate in activities that are moderate or high intensity and involve all major muscle groups on two or more days per week . Nutritional concerns Aging brings about a reduction in the number of calories a person requires ( see Table for estimated caloric needs in adults ) Many Americans respond to weight gain by dieting . However , eating less does not typically mean eating right and people often suffer vitamin and mineral deficiencies as a result . All adults need to be especially cognizant of the amount of sodium , sugar , and fat they are ingesting . Chapter 25 Physical Development in Middle Adulthood 985

TAN ' I ( abut pet Day . by lave ! In 113 Mutt ) Jan ' an Nu run run . an . Inn ! 41 260 ) BIN ! not 30 ) um II . Ih Inn . MA Nu . 2400 Um um um um mu not um moo um III ! nu mun mum . Ink all . um . lulu , um . I ! I I um Ill Ami um um nu . I var hot us do pa In humus Funk . In . Excess Sodium According to dietary guidelines , adults should consume less than ( teaspoon ) per day of sodium . The American Heart Association ( 2016 ) reports that the average sodium intake among Americans is per day . Processed foods are the main culprits of excess sodium . High sodium levels in the diet is correlated with increased blood pressure , and its reduction does show corresponding drops in blood pressure . Adults with high blood pressure are strongly encouraged to reduce their sodium intake to ( US . Department of Health and Human Services 81 US . Department of Agriculture ( 2015 ) Excess Fat Dietary guidelines also suggests that adults should consume less than 10 percent of calories per day from saturated fats . The American Heart Association ( 2016 ) says we should aim for a dietary pattern that achieves to of calories from saturated fat . In a 2000 calorie diet that is about 120 calories from saturated fat . In the average American diet about of the diet comes from fat , with from saturated fat ( et , 1999 ) Diets high in fat not only contribute to weight gain , but have been linked to heart disease , stroke , and high cholesterol . Added Sugar According to the recent Dietary Guidelines for 986 Chapter 25 Physical Development in Middle Adulthood

Americans ( 81 , 2015 ) eating healthy means adults should consume less than 10 percent of calories per day from added sugars . Yet , currently , about 15 of the calories in the American adult diet come from added sugars , or about 22 teaspoons of sugar per day ( Excess sugar not only contributes to weight gain but diabetes and other health problems . Metabolism and Weight Gain One of the common complaints of midlife adults is weight gain , especially the accumulation of fat in the abdomen , which is often referred to as the spread ( 2004 ) Men tend to gain fat on their upper abdomen and back , while women tend to gain more fat on their waist and upper arms . Many adults are surprised at this weight gain because their diets have not changed , however , their metabolism has slowed during midlife . Metabolism is the process by which the body converts food and drink into energy . The calories consumed are combined with oxygen to release the energy needed to function ( Mayo Clinic , People who have more muscle burn more calories , even at rest , and thus have a higher metabolism . Chapter 25 Physical Development in Middle Adulthood 987

However , as you get older , the amount of muscle decreases . Consequently , fat accounts for more of one weight in midlife . and fat slows down the number of calories burned . To compensate , midlife adults have to increase their level of exercise , eat less , and watch their nutrition to maintain their earlier physique . Obesity As discussed in the early adulthood chapter , obesity is a significant health concern for adults throughout the world , and especially America . Obesity rates continue to increase and the current rate for those is , which is the highest percentage per age group ( 2017 ) Being overweight is associated with a myriad of health conditions including diabetes , high blood pressure , and heart disease . New research is now linking obesity to disease . Chang et al . 2016 ) found that being overweight in midlife was associated with earlier onset of disease . The study looked at men and women who were part of the Baltimore Longitudinal Study of Aging . Their average age was around 60 , and they were followed for 14 years . Results indicated that people with the highest body mass index , or , at age 50 were more likely to develop disease . In fact , each increase in was associated with getting six to seven months earlier . Those with the highest also had more brain changes typical of , even if they did not have symptoms of the disease . Scientists speculate that fat cells may produce harmful chemicals that promote inflammation in blood vessels throughout the body , including in the brain . The conclusion of the study was that a healthy at midlife may delay the onset of disease . Concluding Thoughts Many of the changes that occur in midlife can be easily compensated for , such as buying glasses , exercising , and watching what one eats . However , the percentage of middle adults who have a significant health concern has increased in the past 15 years . According to the 2016 United Health America Health Rankings Senior Report , the next generation of seniors will be less healthy than the current seniors ( United Health Foundation , 2016 ) The study compared the health of 988 Chapter 25 Physical Development in Middle Adulthood

Americans ( years of age ) in 2014 to Americans in 1999 . Results indicated that in the past 15 years the prevalence of diabetes has increased by 55 and the prevalence of obesity has increased by 25 . At the state level , Massachusetts ranked first for healthy seniors , while Louisiana ranked last . Illinois ranked , while Wisconsin scored higher at . What can we conclude from this information ?

Lifestyle has a strong impact on the health status of midlife adults , and it becomes important for midlife adults to take preventative measures to enhance physical . Those midlife adults who have a strong sense of mastery and control over their lives , who engage in challenging physical and mental activity , who engage in bearing exercise , monitor their nutrition , receive adequate sleep , and make use of social resources are most likely to enjoy a plateau of good health through these years ( 2004 ) Climacteric The climacteric , or the midlife transition when fertility declines , is biologically based but impacted by the environment . During midlife , men may experience a reduction in their ability to reproduce . Women , however , lose their ability to reproduce once they reach menopause . Female Sexual and Reproductive Health refers to a period of transition in which a womans ovaries stop releasing eggs and the level of estrogen and progesterone production decreases . Menopause is defined as 12 months without menstruation . The average age of menopause is approximately 51 , however , many women begin experiencing symptoms in their . These symptoms occur during , which can occur to years before Chapter 25 Physical Development in Middle Adulthood 989

menopause ( Huang , 2007 ) A woman may first begin to notice that her periods are more or less frequent than before . After a year without menstruation , a woman is considered menopausal and no longer capable of reproduction . Symptoms The symptoms that occur during and menopause are typically caused by the decreased production of estrogen and progesterone ( North American Menopause Society , 2016 ) The shifting hormones can contribute to the inability to fall asleep . Additionally , the declining levels of estrogen may make a woman more susceptible to environmental factors and stressors which disrupt sleep . A hot is a surge of adrenaline that can 990 Chapter 25 Physical Development in Middle Adulthood

awaken the brain from sleep . It often produces sweat and a change of temperature that can be disruptive to sleep and comfort levels . Unfortunately , it may take time for the adrenaline to recede and allow sleep to occur again ( National Sleep Foundation , 2016 ) The loss of estrogen also affects vaginal lubrication which diminishes and becomes and can contribute to pain during intercourse . The vaginal wall also becomes thinner , and less elastic . Estrogen is also important for bone formation and growth , and decreased estrogen can cause osteoporosis resulting in decreased bone mass . Depression , irritability , and weight gain are often associated with menopause , but they are not menopausal ( Crawford , 2001 Rossi , 2004 ) Weight gain can occur due to an increase in fat followed by a loss of lean body mass after menopause ( et , 2006 ) Consequently , women may need to change their lifestyle to counter any weight gain . Depression and mood swings are more common during menopause in women who have prior histories of these conditions rather than those who have not . Additionally , the incidence of depression and mood swings is not greater among menopausal women than women . Figure identifies symptoms experienced by women during menopause , however , women vary greatly in the extent to which these symptoms are experienced . Most American women go through menopause with few problems ( Carroll , 2016 ) Overall , menopause is not seen as universally distressing ( 2004 ) Hormone Replacement Therapy Concerns about the effects of hormone replacement has changed the frequency with which estrogen replacement and hormone replacement therapies have been prescribed for menopausal women . Estrogen replacement therapy was once commonly used to treat menopausal symptoms . However , more recently , hormone replacement therapy has been associated with breast cancer , stroke , and the development of blood clots ( 2007 ) Most women do not have symptoms severe enough to warrant estrogen or hormone replacement therapy . If so , they can Chapter 25 Physical Development in Middle Adulthood 991

be treated with lower doses of estrogen and monitored with more frequent breast and pelvic exams . There are also some other ways to reduce symptoms . These include avoiding caffeine and alcohol , eating soy , remaining sexually active , practicing relaxation techniques , and using lubricants during intercourse . Menopause and Ethnicity In a review of studies that menopause , symptoms varied greatly across countries , geographic regions , and even across ethnic groups within the same region ( Henderson , 2010 ) For example , the Study Womens Health across the Nation ( SWAN ) examined white , African American , Hispanic , Japanese American , and Chinese American women menopausal experiences ( et , 2001 ) After controlling for age , educational level , general health status , economic stressors , white women were more likely to disclose symptoms of depression , irritability , forgetfulness , and headaches compared to women in the other groups . African American women experienced more night sweats , but this across research sites . Finally , Chinese American and Japanese American reported fewer menopausal symptoms when compared to the women in the other groups . Overall , the Chinese and Japanese groups reported the fewest symptoms , while white women more mental health symptoms and African American women reported more physical symptoms . Cultural Differences Cultural influences seem to also play a role in the way menopause is experienced . Further , the prevalence of language specific to menopause is an important indicator of the occurrence of menopausal symptoms in a culture . Hmong tribal women living in Australia and Mayan women report that there is no word for hot flashes and both groups did not experience these symptoms ( 2013 ) When asked about physical changes during menopause , the Hmong women reported lighter or no periods . They also reported no emotional symptoms and found the concept of emotional difficulties caused by menopause amusing ( 2005 ) Similarly , a study with First Nation 992 Chapter 25 Physical Development in Middle Adulthood

women in Canada found there was no single word for menopause in the or languages , with women referring to menopause only as that time when periods stop ( Madden , St Kelly , 2010 ) Figure While some women focus on menopause as a loss of youth , womanhood , and physical attractiveness , women tend to think of menopause as a liberating experience . Japanese women perceive menopause as a transition from motherhood to a more whole person , and they no longer feel obligated to fulfill certain expected social roles , such as the duty to be a mother ( Wu , 2002 ) In India , 94 of women said they welcomed menopause . Aging women gain status and prestige and no longer have to go through imposed menstrual restrictions , which may contribute to Indian women experiences ( Singh , 2004 ) Overall , menopause signifies many different things to women around the world and there is no typical Chapter 25 Physical Development in Middle Adulthood 993

experience . Further , normalizing rather than menopause is supported by research and womens experiences . Male Sexual and Reproductive Health Although males can continue to father children throughout middle adulthood , erectile dysfunction ( ED ) becomes more common . Erectile dysfunction refers to the inability to achieve an erection or an inconsistent ability to achieve an erection ( Intermittent ED affects as many as 50 of men between the ages of 40 and 70 . About 30 million men in the United States experience chronic ED and the percentages increase with age . Approximately of men in their , 17 of men in their , and 47 of men older than 75 experience chronic ED . Causes for ED are primarily due to medical conditions , including diabetes , kidney disease , alcoholism , and atherosclerosis ( of plaque in the arteries ) Plaque is made up of fat , cholesterol , calcium and other substances found in the blood . Over time plaque builds up , hardens , and restricts the blood flow in the arteries ( This limits the flow of oxygenated blood to organs and the penis . Overall , diseases account for 70 of chronic ED , while psychological factors , such as stress , depression , and anxiety account for 10 of all cases . Many of these causes are treatable , and ED is not an inevitable result of aging . gun ( an A MAN I 994 Chapter 25 Physical Development in Middle Adulthood

Men during middle adulthood may also experience prostate enlargement , which can interfere with urination and deficient testosterone levels which decline throughout adulthood , but especially after age 50 . If testosterone levels decline significantly , it is referred to as or . Identifying whether testosterone levels are low is difficult because individual blood levels vary greatly . Low testosterone is not a concern unless it accompanied by negative symptoms such as low sex drive , ED , fatigue , loss of muscle , loss of body hair , or breast enlargement . Low testosterone is also associated with medical conditions , such as diabetes , obesity , high blood pressure , and testicular cancer . The effectiveness of supplemental testosterone is mixed , and long term testosterone replacement therapy for men can increase the risk of prostate cancer , blood clots , heart attack , and stroke ( 2016 ) Most men with low testosterone do not have related problems ( Berkeley Wellness , 2011 ) The Climacteric and Sexuality Sexuality is an important part of people lives at any age , and many older adults are very interested in staying sexually active ( 2004 ) According to the National Survey of Sexual Health and Behavior ( Center for Sexual Health Promotion , 2010 ) 74 of males and 70 of females aged engaged in vaginal intercourse during the previous year , while 58 of males and 51 of females aged did so . Despite these percentages indicating that middle adults are sexually active , physical changes can affect sexual functioning . For women , decreased sexual desire and pain during vaginal intercourse because of menopausal changes have been identified ( et , 2010 ) A woman may also notice less vaginal lubrication during arousal which can affect overall pleasure ( Carroll , Chapter 25 Physical Development in Middle Adulthood 995

2016 ) Men may require more direct stimulation for an erection and the erection may be delayed or less firm ( Carroll , 2016 ) As previously discussed men may experience erectile dysfunction or experience medical conditions ( such as diabetes or heart disease ) that impact sexual functioning . Couples can continue to enjoy physical intimacy and may engage in more foreplay , oral sex , and other forms of sexual expression rather than focusing as much on sexual intercourse . The risk of pregnancy continues until a woman has been without menstruation for at least 12 months , however , and couples should continue to use contraception . People continue to be at risk of contracting sexually transmitted infections , such as genital herpes , chlamydia , and genital warts . In 2014 , of the country new HIV diagnoses ( of ) were among people 50 and older , according to the Centers for Disease Control and Prevention ( This was an increase from in 2005 . Practicing safe sex is important at any age , but unfortunately , adults over the age of 40 have the lowest rates of condom use ( Center for Sexual Health Promotion , 2010 ) This low rate of condom use suggests the need to enhance education efforts for older individuals regarding STI risks 996 Chapter 25 Physical Development in Middle Adulthood

and prevention . Hopefully , when partners understand how aging affects sexual expression , they will be less likely to misinterpret these changes as a lack of sexual interest or displeasure in the partner and more able to continue to have satisfying and safe sexual relationships . Brain Functioning The brain at midlife has been shown to not only maintain many of the abilities of young adults but also gain new ones . Some individuals in middle age actually have improved cognitive functioning ( Phillips , 2011 ) The brain continues to demonstrate plasticity and itself in middle age based on experiences . Research has demonstrated that older adults use more of their brains than younger adults . In fact , older adults who perform the best on tasks are more likely to demonstrate than those who perform worst . Additionally , the amount of white matter in the brain , which is responsible for forming connections among neurons , increases into the before it declines . Emotionally , the brain is calmer , less neurotic , more capable of managing emotions , and better able to negotiate social situations ( Phillips , 2011 ) Older adults tend to focus more on positive information and less on negative information than those younger . In fact , they also remember positive images better than those younger . Additionally , the older adults amygdala responds less to negative stimuli . Lastly , adults in middle adulthood make better financial decisions , which seems to peak at age 53 , and show better economic understanding . Although greater cognitive variability occurs among middle adults when compared to those both younger and older , those in midlife with cognitive improvements tend to be more physically , cognitively , and socially active . Chapter 25 Physical Development in Middle Adulthood 997

References . 2009 ) The divorce experience A study of divorce at midlife and beyond . Washington , A . 2009 ) Perception of marital quality by parents with small children A study when the firstborn is years old . Journal of Family Nursing , 15 , A . 2013 ) Relationship goals of , and Internet An analysis of online personal ads . Journal of Aging Studies , 27 , American Association of Community Colleges ( 2016 ) Plus 50 community colleges Ageless learning . Retrieved from Pages American Cancer Society . 2019 ) Cancer Facts and Figures 2019 . Retrieved from content dam org research res 2019 . American Diabetes Association ( 2016 ) Standards of medical care in diabetes . Diabetes Care . 39 ( American Heart Association ( 2016 ) Saturated fats . Retrieved from ( Nutrition Fats 301110 American Psychological Association ( 2017 ) Stress in America The state of our nation . Retrieved from ima es American Psychological Association ( 2016 ) By the numbers Hearing loss and mental health . Monitor on Psychology , 47 ( Anderson , Greene , 2011 ) My child and I are a package deal Balancing adult and child concerns in after divorce . Journal of Family Psychology , 25 ( Anderson , Greene , Walker , 2004 ) Ready to take a chance again 998 Chapter 25 Physical Development in Middle Adulthood

Transitions into dating among divorced parents . Journal of Divorce and Remarriage , 40 , Aquilino , 1991 ) Predicting parents experiences with coresidence adult children . Journal of Family Issues , 12 ( 2000 ) Undue concern for others opinions deters caregivers of impaired elderly from using public services in rural Japan . International Journal of Geriatric Psychiatry , 15 ( 10 ) 968 . Armour , 2007 , August ) Friendships and work A good or bad partnership ?

USA Today . Retrieved from monev workplace , Crawford , 2001 ) Is there a menopausal syndrome ?

Menopausal status and symptoms across ethnic groups . Social Science and Medicine , 52 ( 1999 ) Lifespan Psychology Theory and Application to Intellectual Functioning . Annual Review of Psychology , 50 , Bargh , A , 2002 ) Can you see the real me ?

Activation and expression of the true self on the Internet . Journal of Social Issues , 58 , Ryan , 2009 ) The glass ceiling in the century Understanding the barriers to gender equality . Washington , American Psychological Association . Baruch , 1984 ) Women in midlife . New York Plenum . Beach , Yee , Jackson , 2000 ) Negative and positive health effects of caring for a disabled spouse Longitudinal findings from the caregiver health effects study . Psychology and Aging , 15 ( Argyle , 1998 ) Religious behavior , belief , and experience . New York . 2001 ) Families , relationships , and in midlife . In ( Author ) Chapter 25 Physical Development in Middle Adulthood ) 999

( Ed . Handbook of midlife development ( New York Wiley . Oliver , Matthews , DELTA Investigators . 1999 ) subpopulation patterns in response to reductions in dietary total and saturated fat intakes in healthy subjects . American Journal of Clinical Nutrition , 70 , Berkeley Wellness . 2011 ) The lowdown on low testosterone . Retrieved from ( Brown , 2013 ) Job characteristics , core , and job satisfaction . International Journal of Aging Human Development , 76 ( Billings , Moos , 1981 ) The role of coping responses and social resources in attenuating the stress of life events . Journal of Behavioral Medicine , 2012 ) Till death do us part and implications of marriage , divorce , and remarriage across adulthood . Research in Human Development , 1982 ) A cohort analysis approach to the syndrome among three ethnic groups of women A theoretical position . Journal of Marriage and the Family , 44 , Kennedy , 2009 ) Life satisfaction , and subjective age in women across the life span . Journal , 2013 ) How do parents reaction when their children leave home An integrative review . Journal of Adult Development , 21 , Chang , 2013 ) Does risk for anxiety increase during the menopausal transition ?

Study of Womens Health Across the Nation ( SWAN ) Menopause , 20 ( Brown , 2010 ) The connection 1000 Chapter 25 Physical Development in Middle Adulthood Continuity , crisis and consensus . Journal of Relationships , Brown , Lin , 2013 ) The gray divorce revolution Rising divorce among middle aged and older adults . National Center for Family Marriage Research Working Paper Series . Bowling Green State University . dam sciences Bureau of Labor Statistics . 2019 ) The employment 2019 . Retrieved from , 1969 ) Theories of aging . In . Pfeiffer ( Behavior and adaptation in later life ( Boston , MA Little Brown . Reis , 2015 ) In your it quantity , in your its quality The prognostic value of social activity across 30 years of adulthood . Psychology and Aging , 30 ( Carroll , 2016 ) Sexuality now Embracing diversity ( Boston , MA Learning . Carver , 1989 ) Assessing coping strategies A theoretically based approach . Journal of Personality and Social Psychology , 56 , Center for Sexual Health Promotion . 2010 ) National survey of sexual health and behavior . Retrieved from Centers for Disease Control ( About high blood pressure . Retrieved from Centers for Disease Control and Prevention . Behaviors that increase the risk for high blood pressure . Retrieved from Centers for Disease Control and Prevention . Measuring high blood pressure . Retrieved from . ov Chapter 25 Physical Development in Middle Adulthood 1001

Centers for Disease Control and Prevention . National diabetes statistics report , 2014 . Retrieved from diabetes pubs Centers for Disease Control and Prevention . Diagnoses of HIV infection among adults aged 50 years and older in the United States and dependent areas . HIV surveillance report , 21 ( Retrieved from re surveillance Centers for Disease Control and Prevention . 2015 ) Facts about high cholesterol . Retrieved from ( Centers for Disease Control and Prevention . 2016 ) The National Center for Health Statistics . Retrieved from Centers for Disease Control and Prevention . 2017 ) National diabetes statistics report , 2017 . Retrieved from diabetes data statistics Chang , An , Wong , 2016 ) Midlife adiposity predicts earlier onset of dementia , neuropathology and presymptomatic cerebral amyloid accumulation . Molecular Psychiatry , 21 ( 2006 ) Aging and expertise . In , Cambridge Handbook of expertise and expert performance . Cambridge , United Kingdom Cambridge University Press . 1986 ) The new American grandparent A place in the family , a life apart . New York Basic Books . Cohen , Wills , A . 1985 ) Stress , social support , and the buffering hypothesis . Psychological Bulletin , 98 , Crawford , 2002 ) Dissociation between 1002 Chapter 25 Physical Development in Middle Adulthood

performance on abstract tests of executive function and problem solving in real life type situations in normal aging . Aging and Mental Health , Champagne , Lien , Zhang , Young , 2012 ) Influence of change in aerobic fitness and weight on prevalence of metabolic syndrome . Preventing Chronic Disease doi , or , Gabriel , 2011 ) The lifetime risk of rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases . Arthritis and Rheumatism , 63 ( doi . 1990 ) Flow The psychology of optimal experience . New York Harper Perennial Modern Classics . 1996 ) Creativity Flow and the psychology of discovery and invention . New York Harper Collins . Dawes , Bishop , 2014 ) Vision impairment and dual sensory problems in middle age . Ophthalmic Physiological Optics , 34 , doi , Myers , 2006 ) Women at midlife An exploration of chronological age , subjective age , wellness , and life satisfaction , Journal , Lazarus , 1988 ) The impact of daily stress on health and mood Psychological and social resources as mediators . Journal of Personality and Social Psychology , 54 , Dudley , Guthrie , 2002 ) Empty nest or revolving door ?

A prospective study of women quality of life in midlife during the phase of children leaving and the home . Psychological Medicine , 32 , 2014 ) A singles studies perspective on mount marriage . Chapter 25 Physical Development in Middle Adulthood 1003 Psychological Inquiry , 25 ( doi Desilver , 2016 ) In the and abroad , more young adults are living with their parents . Retrieved from 2016 24 de , Adams , 1995 ) The relation of generative concern and generative action to personality traits , happiness with life and ego development . Journal of Adult Development , De , I . 1987 ) Gender differences in religion A test of the structural location theory . American Sociological Review , 52 , Dew , Hoch , Monk , Reynolds , III . 2003 ) Healthy older adults sleep predicts mortality at to 19 years of . Psychosomatic Medicine , 65 ( A . 2004 ) Intimate relationships and sexual attitudes of older African American men and women . The , 44 , Drake , 2013 ) Another gender gap Men spend more time in leisure activities . Pew Research Center . Retrieved from 2013 10 , 2007 ) The roles and functions of the informal support networks of older people who receive formal support A Swedish qualitative study . Ageing Society , 27 , A . 2006 ) Life cycle happiness and its sources Intersections of psychology , economics , and demography . Journal of Economic Psychology , 27 , 1997 ) Prevalence and correlates of aggressive behaviors occurring in patients with disease . International Journal of Geriatric Psychiatry , 12 , 1004 Chapter 25 Physical Development in Middle Adulthood

, A . 2006 ) The glass partition Obstacles to friendships at work . Human Relations , 59 ( Hunt , Lyons , A . 2013 . The role of alcohol in forging and maintaining friendships amongst Scottish men in midlife . Health Psychology , 32 ( 10 , 2006 ) Studies of expertise from psychological perspectives . In , Cambridge Handbook of expertise and expert performance . Cambridge , UK Cambridge University Press . 1950 ) Childhood and society . New York Norton Company . 1959 ) Identity and the life cycle . New York Norton Company . 1982 ) The life cycle completed . New York Norton Company . 2008 ) Friendship formation . In , Wenzel , Harvey ( Handbook of Relationship Initiation ( New York , NY Psychology Press . Miller , Marmot , 2007 ) A prospective study of change in sleep duration Associations with mortality in the Whitehall cohort . Sleep , 30 ( 12 ) 1659 . Ford , Li , Zhao , 2010 ) Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US . Journal of Diabetes , 1959 ) Association of specific overt behaviour pattern with blood and cardiovascular findings . Journal of the American Medical Association , 169 , Fry , 2017 ) Its becoming more common for young adults to live at for longer stretches . Retrieved from , 2017 05 05 , Moore , Stone , A . 2015 ) differences in speech identification despite matched audio Chapter 25 Physical Development in Middle Adulthood 1005

metrically normal hearing contributions from auditory temporal processing and cognition . Frontiers in Aging Neuroscience , Fung , 2013 ) Aging in culture . 53 ( Gallagher , 1993 ) and distress Gender , recipients of care , and conflict . Journal of Marriage and the Family , 55 , Gibbons , Creese , Tran , Brazil , I ( Chambers , Weaver , 2014 ) The psychological and health consequences of caring for a spouse with dementia A critical comparison of husbands and wives . Journal of Women Aging , 26 , 2000 ) Cultures of aging Self , citizen and the body . Upper Saddle River , Prentice Hall Publishers . 2006 ) Willingness to stepparent Attitudes about partners who already have children . Journal of Family Issues , 27 , 1415 1436 . 2006 ) Creating Integrating children into the study of union formation . Journal of Marriage and Family , 68 , 275 291 . John , 2008 ) change in marital satisfaction during middle age . Psychological Science , 19 , 2000 ) The timing of divorce Predicting when a couple will divorce over a period . Journal of Marriage the Family , 62 , Greene , Anderson , 2003 ) Risk and resilience after divorce . In Walsh ( Ed . Normal family processes Growing diversity and complexity ( New York Press . Marks , 2006 ) Linked lives Adult problems and their parents psychological and relational being . Journal of Marriage and Family , 68 , Marks , 2009 ) Do formal religious participation and spiritual perceptions have 1006 Chapter 25 Physical Development in Middle Adulthood

independent linkages with diverse dimensions of psychological ?

Journal of Health and Social Behavior , 50 , 2007 ) Television and the European public sphere . European Journal of Communication , 22 , 2004 ) Toward health promotion Physical and social behaviors in complete health . Journal of Health Behavior , 28 ( Ha , Hong , Seltzer , 2008 ) Age and gender differences in the of midlife and aging parents with children with mental health or developmental problems Report of a national study . Journal of Health and Social Behavior , 49 , Harrison , Barrow , Creed , 1999 ) Social of score by postal survey . Journal of Public Health Medicine , 21 , Hughes , 2008 ) From social structural factors to perceptions of relationship quality and loneliness The Chicago health , aging , and marital status transitions and health outcomes social relations study . The Journals of Gerontology Series Psychological Sciences and Social Sciences , 63 , Henderson , Shore , 2003 ) The Structure of Grandparental Role Meaning . Journal of Adult Development , 10 ( 2002 ) Tacit knowledge and practical intelligence Understanding the lessons of experience . Retrieved from au ari tacit , 1995 ) Approach and coping Implications for adolescent mental health . Journal of Youth and Adolescence , 24 , Kelly , 2002 ) For better or worse Divorce reconsidered . New York , NY Norton . Holland , 2014 ) Why America campuses are going gray . Chapter 25 Physical Development in Middle Adulthood 1007

Retrieved from 2014 08 28 , Smith , 2010 ) Social relationships and mortality risk a review . Medicine , Hooker , Pressman , 2016 ) The healthy life . Retrieved from modules Horn , 1981 ) Apprehension , memory , and intelligence decline in adulthood . Research on Aging , House , Landis , 1988 ) Social relationships and health . Science , 241 , Hu , Qiao , 2004 ) Prevalence of metabolic syndrome and its relation to and cardiovascular mortality in European men and women . Archives of Internal Medicine , 164 ( 10 ) Huang , 2007 ) Hormones and female sexuality . In Owens ( Sexual Health , Vol Physical Foundations ( 2010 ) Measures of hearing threshold and temporal processing across the adult lifespan . Hearing Research , 264 ( International Labour Organization . 2011 ) Global Employment Trends 2011 . Retrieved from public documents , Sidney , Liu , Matthews , 2000 ) Association of hostility with coronary artery calcification in young adults . Journal of the American Medical Association , 283 , Jackson , 2000 ) Scotopic sensitivity during adulthood . Vision Research , 40 ( 18 ) 00 1008 Chapter 25 Physical Development in Middle Adulthood

Jones , 2013 ) In , 40 Get Less than Recommended Amount of Sleep . Retrieved from 166553 amount ?

202013 cam , Wu , 2002 ) Comparison of the menopause and midlife transition between Japanese American and European American women . Medical Anthropology Quarterly , 16 ( Kang , Marks , 2014 ) Parental for a child with special needs , marital strain , and physical health Evidence from National Survey of Midlife in the 2005 . Contemporary Perspectives in Family Research , 209 . Nair , 2005 ) of aging and its metabolic impact . Current Topics in Developmental Biology , 68 , 2015 ) Why you only need hours of sleep . American Academy of Sleep Medicine . Retrieved from news 2015 06 03 , 2003 . The economics of labor markets ( Mason , OH . 2016 ) How to cultivate creativity . Scientific American Mind , 27 ( Singh , A . 2004 ) How menopause affects the lives of women in suburban , India . Climacteric , Knowles , A . 1998 ) The adult learner A neglected species . Houston Gulf , Book Division . Murphy , Xu , Arias , 2019 ) Deaths Final data for 2017 . National Vital Statistics Reports , 68 ( 1998 ) Absence of social networks , social support , and health services utilization . Psychological Medicine , 28 , Chapter 25 Physical Development in Middle Adulthood 1009

, Baker , 1992 ) Providing support to others and in later life . Journal of Gerontology Psychological Sciences , 47 , 2011 ) How long do you benefit from vacation ?

A closer look at the vacation effects . Journal of Organizational Behavior , 32 , 2005 ) Sleep deprivation basic science , physiology , and behavior . London , England Informal Healthcare . 2004 ) Development in midlife . Annual Review of Psychology , 55 ( doi , 2005 ) A quantitative and qualitative approach to social relationships and in the United States and Japan . Journal of Comparative Family Studies , 36 , Leach , 1996 ) A binding tie Supportive communication of family . Journal of Applied Communication Research , 24 , Lee , Chang , 2015 ) physical activity moderates the longitudinal associations between spillover and physical health . Journal of Leisure Research , 47 ( 1978 ) The seasons of a mans life . New York . 2014 ) Four in ten couples are saying I do again . In Chapter . The differing demographic profiles of marries , remarried and divorced adults . Pew Research Center . Retrieved from 2014 11 14 Madden , St , Kelly ( 2010 ) First Nations women knowledge of menopause Experiences and perspectives . Canadian Family Physician , 56 ( Malik , 2004 ) Impact of the metabolic syndrome on mortality from coronary heart disease , cardiovascular disease , and all causes in United States adults . Circulation , 110 ( 10 ) 1010 Chapter 25 Physical Development in Middle Adulthood

Malone , Liu , 2016 ) Midlife psychosocial development Setting the stage for cognitive and emotional health . Developmental Psychology , 52 ( Marketing Charts Staff . 2014 ) Are young people watching less ?

Retrieved from television Martin , 2014 ) Aging changes in hair and nails . National Library of Medicine . Retrieved from Matthews , Glass , 1977 ) Competitive drive , pattern A , and coronary heart disease A further analysis of some data from the Western Collaborative Group Study . Journal of Chronic Diseases , 30 , Mayo Clinic . Heart disease . Retrieved from disease basics definition Mayo Clinic . Metabolism and weight loss How you burn calories . Retrieved from metabolism , A . 2008 ) MySpace or your place Relationship initiation and development in the wired and wireless world . In , Wenzel , Harvey ( Handbook of relationship initiation ( New York , NY Psychology Press . Green , 2002 ) Relationship formation on the Internet Whats the big attraction ?

Journal of Social Issues , 58 , 2011 ) study of costs to working caregivers Double jeopardy for baby boomers caring for their parents . Retrieved from ivin uploads 2011 06 , Au , Fletcher , 2012 ) Effects of systolic blood pressure on Chapter 25 Physical Development in Middle Adulthood 1011

matter integrity in young adults in the Farmington Heart Study A study . The Lancet Neurology , 11 ( 12 ) Miller , Smith , Turner , 1996 ) review of research on hostility and physical health . Psychological Bulletin , 119 , Mitchell , 2009 ) The empty nest syndrome in midlife families A exploration of parental gender differences and cultural dynamics . Journal of Family Issues , 30 , 2003 ) Lifestyles , dating , and romance A study of midlife singles . Washington , Monthly Labor Review . 2013 ) Percentage of the institutionalized civilian workforce employed by gender age . Retrieved from ( 2008 ) Biofeedback therapy in cardiovascular disease rationale and research overview . Cleveland Clinic Journal of Medicine , 75 , 2006 ) Precedence of the shift of distribution over the change in body composition after menopause . Journal of Obstetrics and Gynecology , 32 , Mayer , Nair , 2001 ) Journal of Laboratory and Clinical Medicine , 137 ( 2014 ) Wrinkles . National Library of Medicine . Retrieved from article Nakamura , 2002 ) The concept of flow . In Snyder Lopez ( Handbook of positive psychology ( New York Oxford University Press . Rector , JA . 2015 ) Pathogenesis and prevention of hepatic steatosis . Gastroenterology Hepatology , 11 ( National Alliance for . 2015 ) in the 2015 . Retrieved from . 1012 Chapter 25 Physical Development in Middle Adulthood

National Eye Institute . 2009 ) Facts about . Department of Health and Human Services . Retrieved rom National Eye Institute . 2013 ) Facts about dry eye . Department of Health and Human Services . Retrieved rom health ( National Eye Institute . 2015 ) Facts about diabetic eye disease . Retrieved from th diabetic National Eye Institute . 2016 ) Facts about presbyopia . Department of Health and Human Services . Retrieved rom . ov health errors ia National Institutes of Health . 2007 ) Menopause Medical Encyclopedia . Retrieved from National Institutes of Health . 2013 ) Gal stones . US . Department of Health and Human Services . Retrieved from Pages National Institutes of Health . The and diabetes . Retrieved from information topics Pages National Institutes of Health ( Age changes in the lungs . Retrieved from article National Institutes of Health ( 20140 ) Sweet stuff How sugars and sweeteners affect your health . Retrieved from issue National Institutes of Health . What is atherosclerosis ?

Retrieved from health topics National Institutes of Health . 2015 ) Cancer . Retrieved from . ov National Institutes of Health . Facts about diabetes . Retrieved Chapter 25 Physical Development in Middle Adulthood 1013 from topics Diabetes Pages National Institutes of Health ( Handout on Health Rheumatoid Arthritis . Retrieved from . ov health rheumatic National Institutes of Health . Older drivers How health affects driving . Retrieved from National Sleep Foundation . 2015 ) 2015 Sleep in poll finds pain a significant challenge when it comes to Americans sleep . National Sleep Foundation . Retrieved from slee National Sleep Foundation . 2016 ) Menopause and Insomnia . National Sleep Foundation . Retrieved from , Besing , 2015 ) The Effect of Background Babble on Working Memory in Young and Adults . Journal of the American Academy of Audiology , 26 ( 1968 ) The awareness of middle aging . In ( Ed . Middle age and aging ( Chicago University of Chicago Press . 1964 ) The changing American grandparent . Journal of Marriage and the Family , 26 , Newton , Buckley , Mitchell , Shaw , 2008 ) Lack of a close confidant Prevalence and correlates in a medically underserved primary care sample . Psychology , Health Medicine , 13 , Nimrod , 2012 ) Leisure in coping with depression . Journal of Leisure Research , 44 ( Norman , 2005 ) Research in clinical reasoning Past history and 1014 Chapter 25 Physical Development in Middle Adulthood

current trends . Medical Education , 39 , North American Menopause Society . 2016 ) Menopause Understanding the symptoms . Retrieved from , Yoon , Burt , Gu , 2013 ) Hypertension among adults in the US National Health and Nutrition Examination Survey , Data Brief , No . 133 . National Center for Health Statistics , Centers for Disease Control and Prevention , US Dept of Health and Human Services . Office of Disease Prevention and Health Promotion . 2008 ) The physical activity guidelines for Americans . Retrieved from ?

Organisation for Economic Cooperation and Development . 2016 ) Average annual hours actually worked per worker . Stat . Retrieved from ?

Henderson , 2010 ) Age of menopause and impact of climacteric symptoms by geographical region . 13 ( Parker , Patten , 2013 ) The sandwich generation Rising financial burdens for Americans . Pew Research Center . Retrieved from . 2013 01 30 Patel , Marmot , Terry , 1981 ) Controlled trial of behavioural methods in reducing mild hypertension . British Medical Journal ( Clinical research ed . 282 , 2015 ) Sleep deficit . Experience . Retrieved from article Payne , 2015 ) The remarriage rate Geographic variation , 2013 . National Center for Family Marriage Research . Retrieved from Chapter 25 Physical Development in Middle Adulthood 1015

resources data Peterson , Duncan , 2007 ) Midlife women and authoritarianism Marriage , motherhood , and 10 years of aging . Psychology and Aging , 22 ( Peterson , Wentworth , A . 1997 ) and authoritarianism Implications for personality , political involvement , and parenting . Journal of Personality and Social Psychology , 72 , Pew Research Center . 2010 ) The return of the family household . Retrieved from 2010 03 18 Pew Research Center . How the great recession has changed life in America . Retrieved from 2010 06 30 america Pew Research Center . Section Generations and the great recession . Retrieved from 2011 11 03 Pew Research Center . 2015 ) Caring for aging parents . Family support in graying societies . Retrieved from 2015 05 21 a in Pew Research Center . 2016 ) The Gender gap in religion around the world . Retrieved from . 2016 03 22 ! Phillips , 2011 ) The mind at midlife . American Psychological Association . Retrieved from monitor 20112 04 Proctor , Nair , 1998 ) in humans is associated with reduced synthetic rates of specific muscle proteins . Journal of Nutrition , 128 ( 1016 Chapter 25 Physical Development in Middle Adulthood

Project ( 2016 ) The state of American vacation How vacation became a casualty of our work culture . Retrieved from research Qian , Almeida , 2013 ) Does leisure time as a stress coping source increase affective complexity ?

Applying the Dynamic Model of Affect ( Journal of Leisure Research , 45 ( Ray , 2013 ) nation revisited . Center for Economic Policy Research . Retrieved from publications reports Ray , 2007 ) No vacation nation USA A comparison of leave and holiday in countries . Retrieved from programs papers No Research Network on Successful Midlife Development . 2007 , February ) Midlife Research WebSite . Retrieved from , 1995 ) The opportunity for friendship in the workplace An construct . Journal of Business and Psychology , 10 , Rossi , 2004 ) The menopausal transition and aging process . In How healthy are we A national study of health in midlife . Chicago University of Chicago Press . Rubin , Williams , Douglas , 2018 ) Older women , deeper learning , and greater satisfaction at university Age and gender predict university students learning approach and degree satisfaction . Diversity in Higher Education , 11 ( 2014 ) The 40 hour work week is actually longer by hours . Gallop . Retrieved from 175286 Salmon , 2001 ) Effects of physical exercise on anxiety , depression , and sensitivity to stress A unifying theory . Clinical Psychology Review , 21 ( Chapter 25 Physical Development in Middle Adulthood 1017

Salthouse , A . 2004 ) What and when of cognitive aging . Current Directions in Psychological Science , 13 , Jang , 2015 ) Exiting and returning to the parental home for boomerang kids . Journal of Marriage and Family , 77 , Chiu , 2005 ) A of the relationship between spirituality and quality of life . Social Indicators Research , 72 , 2005 ) Developmental influences on adult intelligence the Seattle longitudinal study . Oxford Oxford University Press . 2009 ) New territories of Positive Lifespan Development Wisdom and Life Longings . In Snyder Lopez ( Oxford handbook of Positive Psychology ( New York Oxford University Press . Reece , Sanders , Dodge , 2010 ) Sexual behaviors , condom use , and sexual health of Americans over 50 Implications or sexual health promotion for older adults . Journal of Sexual Medicine , Vinci , Roy , Evans , 2008 ) perceptions and body mass index of older African American and European American women . Journal of Gerontology , 23 ( Burton , 1997 ) Health effects of The caregiver health effects study . Annals of Behavioral Medicine , 19 , Warner , 2004 ) Marriages and families Relationships in social context . Belmont , CA Learning . Seltzer , Floyd , Song , Hong , 2011 ) Midlife and aging parents of adults with intellectual and developmental disabilities Impacts of lifelong parenting . American Association on Intellectual and Developmental Disability , 116 , 1018 Chapter 25 Physical Development in Middle Adulthood

, 1946 ) The general adaptation syndrome and the diseases of adaptation . Journal of Clinical Endocrinology , 230 . Shure , 1998 , September 10 ) Launch an exercise program today , say Aging Institute , Senator John Glenn . National Institute on Aging . Retrieved from , gov , 2010 ) If I had lots of money have a body makeover Managing the aging body . Social Forces , 88 ( Cooper , 2010 ) Reshaping the family man A grounded theory study of the meaning of grandfatherhood . Journal of Men Studies , 18 ( Spiegel , Bloom , 1989 ) Effect of psychosocial treatment on survival of patients with metastatic breast cancer . The Lancet , 334 , Stem , 2009 ) Physical Leisure activities and their role in preventing dementia A systematic review . International Journal of Healthcare , Stewart , Manning , Smock , 2003 ) Union formation among men in the US Does having prior children matter ?

Journal of Marriage and Family , 65 , 90 104 . Su , Wu , Zhang , Li , Zhang , Zhou , 2012 ) Depression and social support between China rural and urban elderly . Archives of Gerontology and Geriatrics , 55 , 2015 ) Erectile Dysfunction . Retrieved from , Thomas , 2003 ) Prediction of satisfaction among African American women . Journal of Adult Development , 10 , Taylor , Matthews , Harlow , Hall , 2016 ) Bedtime variability and metabolic health in midlife women the SWAN Sleep Study . SLEEP , 39 ( Taylor , Klein , Lewis , Chapter 25 Physical Development in Middle Adulthood 1019

, A . 2000 ) responses to stress in females , not . Psychological Review , 107 , 2008 ) Complex life course patterns and the risk of divorce in second marriages . Journal of Marriage and Family , 70 , 294 305 . 2006 ) Reconsidering the double standard of aging Effects of gender and sexual orientation on facial attractiveness ratings . Personality and Individual Differences , 42 ( 2005 ) An ecological model for understanding culture as a determinant of womens health . Critical Public Health , 15 ( Reed , A . 2004 ) A multinational review of recent trends and reports in dementia caregiver burden . Disease and Associated Disorders , 18 ( ower , 1995 ) Depressive symptoms across older spouses and the moderating effect of marital closeness . Psychology and Aging , 10 , van , 1999 ) Changes in daily hassles and life events and the relationship with coronary heart disease risk factors A longitudinal study in males and females . Journal of Psychosomatic Research , 46 , Ando , 2003 ) Prevalence of auditory problems and their relation to audiometric thresholds in a to elderly population . Acta , 123 ( 618 . Williams , Powers , Chen , Campbell , A . 2005 ) As good as it gets ?

A life course perspective on marital quality . Social Forces , 81 , United Health Foundation . 2016 ) New report finds significant health concerns loom for seniors in coming years . Retrieved from 1020 Chapter 25 Physical Development in Middle Adulthood News Articles Feeds 2016 ?

US . Bureau of Labor Statistics ( 2016 ) American time use survey 2015 . Retrieved from . ov US . Department of Health and Human Services and Department of Agriculture . 2015 ) Dietary Guidelines for Americans . Edition . Retrieved from ( 2015 ( US . Department of Labor ( 2016 ) Vacation Leave . Retrieved from . ov to ic vacation leave US . Government Accountability Office . 2012 ) Unemployed older workers Many experience challenges regaining employment and face reduced retirement security . Retrieved from products , 1977 ) Adaptation of life . Boston , MA Little , Brown , 2008 ) Spiritual evolution A scientific defense of faith . New York Broadway . 2012 ) Triumphs of experience . Cambridge , MA Harvard University Press . Weber , Cooper , 1999 ) Wisdom and life experience How grandfathers mentor their grandchildren . Journal of Aging and Identity , Wang , Parker , 2014 ) Record share of Americans have never married As values , economics and gender patterns change . Retrieved from . 2014 09 24 . 2016 ) Erectile Dysfunction Testosterone Replacement Therapy . Retrieved from ( therapy ?

Willis , 1999 ) Intellectual functioning in midlife . In Willis . Reid ( Life in the Middle Psychological and Social Development in Middle Age ( San Diego Academic . Chapter 25 Physical Development in Middle Adulthood 1021 Wong , Leung , 2012 ) care in China Issues and prospects . Journal of Social Work , 55 , World Health Organization . 2018 ) Top 10 causes of death . Retrieved from burden disease causes 10 World Health Organization . 2019 ) an occupational phenomenon International Classification of Diseases . Retrieved from mental health evidence Wu , Sun , Sun , Zhang , Tao , Cui , 2010 ) Correlation between loneliness and social relationship among empty nest elderly in rural area , China . Aging and Mental Health , 14 , Yeager , Hobbs , 2010 ) disease and vascular dementia The complex relationship between diagnosis and caregiver burden . Issues in Mental Health Nursing , 31 ( A . 2013 ) Meanings of menopause Cultural considerations . Retrieved from ?

de , 2009 ) of neuropsychiatric symptoms in nursing home patients Influence of gender and dementia severity . International Journal of Geriatric Psychiatry , 24 ( 10 ) Attribution Adapted from Chapter from Lifespan Development A Perspective Second Edition by Martha Lally and Suzanne under the Creative Commons Alike license . 1022 Chapter 25 Physical Development in Middle Adulthood