1. Later Life (65+)
1.1. Biological Changes
1.1.1. Some elderly see declines and some do not.
1.1.2. Ages 65-80 tend to see Diminished Reserve: reduced ability to adjust to physical or psychological challenges and prolonged recovery after suffering an injury or disease.
1.1.3. Neurosensory system losses and impaired regulation of body temperature are also common.
1.1.4. Reduced cardiac and pulmonary reserve contributes to a more sedentary lifestyle. Coronary arteriosclerosis is also common.
1.1.5. Decreased lung elasticity and total lung capacity.
1.1.6. Kidney function diminishes and reduced function of the gastrointestinal system.
1.1.7. Increased tissue sensitivity results in more drug side effects.
1.2. Cognitive Development
1.2.1. Dementia: an acquired, chronic impairment in global cognitive functioning that affects comprehension, memory, communication, and daily activities.
1.2.1.1. The consciousness level of the patient is usually normal and the onset of impairment is so gradual that it may not be noticed until some consistent threshold of impairment is reached.
1.2.1.2. About 10-15% of patients with dementia have a treatable, potentially reversible disorders such as CNS tumors, subdural hematomas, or alcoholism.
1.2.2. Alzheimer's Disease: diagnosable by classic symptoms, signs, course, and autopsy findings, account for about half to two thirds of all dementia cases.
1.2.2.1. - 1% of elderly in ages 65-74 - At least 25% in people above age 85
1.2.2.2. About 5 millions people suffer from Alzheimer's today, but by 2030 it is projected that the number will be up to 14 million.
1.2.3. The Mini Mental Status Exam (MMSE) is among the most commonly used tools to assess cognitive decline
1.2.3.1. Some of the newer tools that have been made to screen on a broader scale: - Mini-Cog - Montreal Cognitive Assessment - Geriatric Depression Scale
1.2.4. Depression is one of the most common disorders in later life. Especially in women.
1.2.4.1. Factors: - Bereavement - Accumulated Loss - Alcohol/Medication Abuse
1.2.4.2. Masked Depression: When one attributes symptoms of depression to the onset of cognitive impairment
1.2.4.3. Sub-threshold Depression: Associated with a perceived sense of worsening physical health and decreased emotional functioning.
1.2.5. Other Psychiatric Disorders: - Anxiety - Post-traumatic Stress Disoreder - Rational Suicide
1.3. Affective Development
1.3.1. Anxiety occurs when the person realizes their personal mental or physical limitations.
1.3.2. Sleep disturbances and changes in sleep patterns are common due to insomnia and daytime napping.
1.3.3. Loss of loved ones and friends plays a huge role at this stage in life.
1.3.3.1. Loss includes both death and onset of illness.
1.3.4. Depression is common and may lead to: - Serious Medical Conditions - Deterioration in Functioning - Social Losses.
1.3.4.1. Rates of Suicide increase in age in both men and women.
1.3.5. Alcoholism in the elderly is estimated to be around 10-15%.
1.3.5.1. - One third of elderly alcoholics begin drinking excessively later in life. - Those who have had a history of heavy drinking can develop alcoholic dementia.
1.4. Gender and Sexuality
1.4.1. Men
1.4.1.1. - Decreased Semen Production - Ejaculation is unlikely in every sexual act - Testosterone levels are decreased - Medications to improve erectile function are generally safe
1.4.2. Women
1.4.2.1. - Even with Menopause, reproductive function may cease, but sexual desire is usually unaffected. - Most surveys state that sexual activity decreases - Biological changes may occur, but the decrease in activity is usually due to social influences
1.5. Social Development
1.5.1. Ego Integrity
1.5.1.1. Maintained when the individual s overall positive feelings of self-worth and is able to view their life in an appropriate perspective.
1.5.1.2. Those who do not view their lives positively may suffer from despair, isolation, melancholia, and depression.
1.5.1.3. Isolation is the greatest threat to ego integrity.
1.5.1.4. Elderly who lack a support network may lose the will to live.
1.5.2. Physical and Neurosensory deterioration leads to reliance on others.
1.5.2.1. Family decisions about nursing homes should include a professional assessment of the elder's level of functioning and family assistance.
2. Mid-life (40-65)
2.1. Cognitive Development
2.1.1. Overall intelligence declines.
2.1.1.1. Fluid Intelligence (response speed, memory span) declines.
2.1.1.2. Crystallized Intelligence (reading comprehension, vocabulary) may increase.
2.1.2. Loss of neurons and degeneration of neuronal pathways.
2.1.2.1. Slower nerve conduction, lengthening reaction times.
2.1.2.2. Skills lost unless practiced.
2.1.3. Alzheimer's, Parkinson's, and Huntington's disease may onset during late mid-life.
2.2. Physical Diminishings
2.2.1. Immunologic
2.2.1.1. T cell function
2.2.1.2. Wound healing
2.2.2. Physiologic
2.2.2.1. Bladder reflex
2.2.2.2. Hair growth
2.2.3. Homeostasis Ability During Stress
2.2.3.1. Temperature extremes
2.2.3.2. Emotional strain
2.2.3.3. Physical injury
2.2.3.4. Neuroendocrine control
2.2.4. Diet and Exercise
2.2.4.1. Lower basal metabolic rate.
2.2.4.1.1. Decreased daily caloric needs.
2.2.4.2. Exercise can delay body changes.
2.2.4.2.1. Slows calcium loss from bones and muscles
2.2.4.2.2. Helps maintain pulmonary functioning
2.2.4.2.3. Reduces kyphotic changes in the spine
2.3. Affective Development
2.3.1. Reflect on life goals.
2.3.2. Critically think about the future.
2.3.3. Handling crisis.
2.3.3.1. Some learn from crisis.
2.3.3.1.1. This is enhanced with a good support system.
2.3.3.2. Some let crisis cripple their decision making skills.
2.4. Gender and Sexuality
2.4.1. Women
2.4.1.1. Less regular and ceasing menstrual cycle (menopause).
2.4.1.1.1. Factors - Child-bearing - Early puberty - Maternal history - This habitus - Higher SES - Northern European ancestry - Caucasian race
2.4.1.1.2. Associations - Decreased reproductive organ size - Vaginal dryness - Climacteric: atrophy due to decreased estrogen production
2.4.1.2. Peak sexual potency in mid-30s with little decrease thereafter.
2.4.1.2.1. Decreased sexual activity and frequency.
2.4.2. Men
2.4.2.1. Decreased... - Testosterone levels - Sexual interest - Erection development/stimulation - Volume/force of seminal fluid
2.5. Social Development
2.5.1. Generativity vs. Stagnation
2.5.1.1. Generativity: The guiding and contribution to the next generation.
2.5.1.1.1. Mentor younger colleagues.
2.5.1.2. Stagnation: Lack of productivity or creativity, self-centered behavior, and exploitation of others.
2.5.2. Mid-life Crisis
2.5.2.1. Caused by feelings of helplessness and sense of being "trapped."
2.5.2.2. Individuals reexamine their understanding of themselves and the meaning of life.
2.5.2.2.1. Can lead to extramarital affairs.
2.5.2.2.2. Can lead to rejuvenated marriage.
2.6. Parent-Child Relationships
2.6.1. "Empty Nest"
2.6.1.1. The period a married couple spends together from the time the last child leaves home to the time one spouse dies.
2.6.1.1.1. Difficult for women who lose role as mother.
2.6.1.1.2. Relief from the responsibility of daily child rearing.
2.6.2. "Elastic Nest"
2.6.2.1. Phenomenon of children leaving the family and then returning (boomerang effect) in response to life changes.
2.6.2.1.1. Fulfills parents who feel needed.
2.6.2.1.2. Reassures child who still feels protected.
2.6.2.1.3. Frustrates everyone who struggles with the challenge of trying to more forward.
2.6.3. "Sandwich Generation"
2.6.3.1. Caught between continuing needs of their children and needs of their aging parents.
2.6.3.1.1. Assume responsibility for providing social, financial, emotional, or physical aid to their parents.
3. Young Adulthood (20-40)
3.1. Development
3.1.1. Cognitive
3.1.1.1. Brain cell development peaks (20's)
3.1.1.2. New synaptic pathways formed to permit new information and skills
3.1.1.3. Formal operations
3.1.1.3.1. Informed
3.1.1.3.2. Knowledgable
3.1.1.3.3. Able to make complex decision with cognitive ability
3.1.1.3.4. Consider short/long term consequences of decisions
3.1.1.4. Intellectual functioning
3.1.1.4.1. Advanced phase of problem solving
3.1.1.4.2. Influenced by education, tolerance of diverse viewpoints, and dialectical thinking
3.1.1.5. Cognitive and learning impairments may continue
3.1.1.5.1. Can lead to greater challenge in college/graduate studies
3.1.2. Moral
3.1.2.1. Universal ethical principles
3.1.2.1.1. Social contract
3.1.2.1.2. Respecting individual rights
3.1.2.2. Accepting responsibility for one's actions
3.1.2.3. Empathizing with others
3.1.2.4. Sociocultural development
3.1.2.4.1. Increased prosocial behavior
3.1.2.4.2. Increased civic engagement
3.1.2.4.3. Increased sense of purpose within society's standards of morality
3.1.3. Social
3.1.3.1. Intimacy vs. Isolation
3.1.3.1.1. Intimacy - ability to form an interpersonal relationship characterized by commitment, reciprocity, attachment, and interdependency
3.1.3.1.2. Isolation - feeling victimized or exploited by others, experiencing difficulty cooperating with others, and having such a fragile sense of identity that the self-disclosure and analysis required in an intimate relationship are too threatening
3.1.3.1.3. Women establish intimate relationships earlier than men
3.1.4. Physical
3.1.4.1. Peak strength, flexibility, functioning, efficiency (20-30)
3.1.4.2. Good stamina, high resistance of disease, rapid tissue repair allows maximal athletic performance
3.1.5. Behavioral
3.1.5.1. Susceptibility to alcohol/substance abuse
3.1.5.2. Poor exercise/nutritional habits - can lead to obesity!
3.2. Gender and Sexuality
3.2.1. Reproductive system of both males and females fully mature by age 20
3.2.2. Sex hormone production peaks (20s)
3.2.3. Sexual drive remains high until 70s-80s!
3.2.4. Observable behaviors and roles are easy to manipulate
3.2.5. Consolidation of sexual identity/orientation
3.3. Sexual Relationships
3.3.1. 20% of young adults do not marry (20-30)
3.3.1.1. Rate has increased since 1970's
3.3.1.2. Women are choosing to delay marriage to take advantage of educational and career opportunities
3.3.2. Living together without marriage is common
3.3.2.1. Unmarried households are the majority of U.S. households
3.3.2.2. Most relationships are short-term and last ~2 years
3.3.3. Singlehood
3.3.3.1. Freedom of time, money, and choices
3.3.3.2. Career opportunities
3.3.3.3. Geographic independence
3.3.3.4. Sense of self-sufficiency
3.3.3.5. Psychological autonomy
3.3.4. Most women prefer to bear children between ages 20-40
3.4. Collegiality with Parents
3.4.1. View parents as complex people
3.4.2. Mutuality
3.4.2.1. Exploring interests, feelings, and values of parents
3.4.2.2. Extends until individual assumes a care taking role for the ill or elderly parent
3.4.3. Millenial Generation
3.4.3.1. Parents generally more protective than past generations
3.4.3.2. Protectionist relationship continues through college years
3.5. Gender and Career Choices
3.5.1. Women have occupational goals that have traditionally been reserved for men
3.5.2. Men prefer a partner with job aspirations for economic reasons & shared interests
3.5.3. Postpone marriage, delay parenthood, have fewer children
3.5.4. Women assume multiple roles: wife, mother, and homemaker
3.5.4.1. Career may be too stressful for physical and emotional health
3.5.4.2. Women with no career have at-risk physical and emotional health
3.5.4.3. Women who work in home have greater chance of depression, acute illnesses, chronic conditions, and healthcare visits
3.6. Marriage and Parenthood
3.6.1. 80% of college students have goal of a satisfying marriage and family life
3.6.2. Marriage partners typically share race, religion, age, social class, level of education, and mutual physical attraction
3.6.3. Marrying later typically leads to more satisfying and stable relationships
3.6.4. Average age of first marriage
3.6.4.1. Men has increased from 23 to 27
3.6.4.2. Women from 20 to 25
3.6.5. Life changes that challenge parenthood
3.6.5.1. Personal freedom
3.6.5.2. Increased financial pressure
3.6.5.3. Concerns about quality of parenthood
3.6.6. Joys of parenthood stem from child's development
3.6.6.1. Companionship
3.6.6.2. Bonding
3.6.6.3. Awareness that child is an extension of parent's own self
3.6.6.4. Even works when child is adopted!
3.6.6.5. Parenthood often promotes a sense of true adulthood