Adult Development Behavioral Development Adult Development n Eriksons

Adult Development Behavioral Development

Adult Development n Erikson’s Psychosocial Stages of Adulthood: n Young Adulthood-Intimacy vs. Isolation n 20 - 40 years § During mid-30 s many women return to work/school/resume careers n Middle Adulthood- Generativity vs. Stagnation n 40 - 65 years § Midlife crisis § Often triggered by loss of job / divorce n Old age- Integrity vs. Despair n 65 +

Adult Development n Marriage- approximately 95% of adults in U. S. marry n Most are married and have children by age 30 n Married people are found to be physically & mentally healthier than non-married n Good marriage excellent predictor of health status n In general strong social support is an excellent predictor of health status

Adult Development n Reasons most often given why marriages endure: n n n 1. My spouse is my best friend 2. I like my spouse as a person 3. Marriage is long-term commitment 4. Marriage is sacred 5. We agree on aims and goals n (Lauer & Lauer)

Adult Development n Divorce n n Approximately 50% of marriages end in divorce Factors associated with divorce: n n n Lack of family support Marriage during teen years Divorced parents Differences in SES or religious background Serious illness or death of a child

Adult Development n Reasons given why marriages fail n 1. communication problems n 2. basic unhappiness n 3. incompatibility n 4. sexual problems n n n (men say this more frequently 5. financial problems 6. emotional abuse n (women say this more often) § (Cleek & Pearson)

Adult Development n n Stress in Adulthood Top stressors in adulthood: n n n n 1. Death of a child 2. Death of a spouse 3. Marital separation/divorce 4. Jail term 5. Death of a close family member 6. Personal injury or illness 7. Marriage 8. Losing Job n (Holmes & Rahe)

Effects of stress in Adulthood n Cumulative stress impacts negatively on health n Even individual stresses (divorce / loss of child) n Can lead to Midlife crisis n n Depression Identity crisis

Demographics of Aging n Our society is rapidly aging n n n Currently individuals over 65 make up about 12% of the population In 2030 - expected to climb to ~20% This has profound effects on our health care system!

Number of Persons 65+ From 1900 to 2030 (in millions)

Aging Demographics (Census, 2000) n Individuals who reach 65 have an average life expectancy of an additional 17. 9 years n n n 19. 2 for women 16. 3 for men Many older adults live alone n n 40% for women 17% for men

Marital Status of Persons 65+ (2001)

Health care implications of aging society n In 1999, older adults were hospitalized 4 times as often as those under 65 n n The average stay was 50% longer for older adults Older adults average more contacts with doctors than did persons of all ages n 6. 8 contacts vs 3. 5 contacts

Financial resources n Median income for older adults (65+) n n n Income from n n n $19, 688 for males $11, 313 for females Social Security - 90% Assets - 59% Public / Private Pensions -41% Earnings - 22% Poverty rate for 65+ relatively stable at ~10%

Expenditures n Almost 1/3 of the drugs prescribed today are taken by older adults n n In 1999, older consumers averaged $3, 019 in out of pocket health care expenditures n n This group represents ~12% of the population A 1/3 increase since 1990 Older Americans spent 11% of their total expenditures on health

Chronic Conditions in Older Adults n 69% of older adults are either overweight of clinically obese n Rates of obesity in 65+ age group have doubled over the past 30 years n After age 65, the incidence of heart failure approaches 10 in every 1, 000 adults. n In 2000, 72% of Americans hospitalized for stroke were age 65 and older.

Chronic Conditions in Older Adults n At age 75 and older 64% of men and 77% of women have hypertension. n Of the nearly 70 million Americans affected with arthritis, 59% are 65 years and older

Chronic Conditions in Older Adults n An average of 13% of men and women ages 60+ have physician diagnosed diabetes n In 1998 an average of 18% of adults aged 65 to 85+ reported symptoms of depression

Chronic Conditions in Older Adults n The % of older adults with moderate or severe memory impairment ranges from 4% among persons 65 to 69, to up to 36% among persons age 85 or older n One out of every 2 women and one in 8 men over age 50 will have an osteoporosis-related fracture in her or his lifetime.

Falls and Falls Related Problems n 30 - 50% of individuals over 65 fall at least once a year n n n Women are more likely to fall than men Men are more likely to die from a fall 10 -15% of these falls result in a fracture n n Wrist / Hip Fractures These fractures often lead to hospitalization n Downward spiral of health

Falls and Fall Related Injury n Falls occur at all ages / n Falls may not be all that preventable n n n Can reduce environmental factors Falls occur in highly active / highly inactive individuals Not necessarily fall - but consequence of fall that is most problematic n Latest Interventions n n Promote bone health! Potentially train individuals to “fall better”

Aging & Disability n In US - Noninstitutional individuals 65+ n Over 33 million have disabilities n n n 41. 9% of the over 65 population 14% have a sensory disability 28. 6% have a physical disability 10. 8 % have a mental disability 9. 5 % have a self-care disability 20. 4% have a disability that makes it difficult to leave the home § Census, 2000

Disability increases with age (1997)

Death & Dying n Elderly and ill often wait to die until after major date n (birthdays, holidays) n Suicide: n Associated with life stress and depression n Differences by gender & race

Suicide Rates by Age & Race

Suicide Rates by Age & Sex

Stages of Death & Dying (Kubler-Ross) n Denial n n Anger n n Appeals to God / Religion Depression n n Anger at health professionals Bargaining n n Refusal believe that he/she are dying Becomes pre-occupied with death / emotionally detached Acceptance n Calm and accepting of fate

Variables Associated with Health Outcomes of Bereavement Sexmen do worse when wife dies Prior physical healthpoor health, worse outcomes Prior mental healthpoor mental health, worse outcome SESfinancial problems related to worse outcomes

Variables Associated with Health Outcomes of Bereavement: n Relationship to deceasedn n Ambivalent relationship worst Nature of death. Sudden death is not necessarily worse Suicide-often results in increased distress, self-blame n Social support Has positive outcome for bereaved Osterweis et al. (1984)

Cultures vary greatly on how they deal with death n Dia de los Muertos (Day of the Dead) n The word “death” is not pronounced in New York, in Paris, in London, because it burns the lips…. . The Mexican, in contrast, is familiar with death, jokes about it, caresses it, sleeps with it, celebrates it; it is one of his favorite toys and his most steadfast love. - Octavio Paz, Nobel Prize Winner in Literature

Final Aging Issues n How can we improve the quality of life in older adults? n Promote greater levels of activity n n Encourage older adults to try new things n n Vigorous walking 2 - 3 times per week has great benefits Novelty stimulates the brain! Reduce rates of disability