Middle Age Adult

Middle-Age Adult
Jacey Mitchell, RDH, MS
Fall 2018
Copyright © 2018, Elsevier Inc. All Rights Reserved.

Biology and Genetics: Life
Expectancy and Mortality Rates
 35-65 years
 Examples of general body changes
 Thinning, graying hair
 Skin drier, wrinkles, coarsening facial features
 Fat disposition, decreased muscle mass/bone density,
osteoarthritis
 Hormonal changes
 Mortality
 Leading causes: heart disease and cancer
 Morbidity and mortality: influenced by lifestyle behaviors
Copyright © 2018, Elsevier Inc. All Rights Reserved. 2

Common Health Problems
Middle-Aged Adult
 Kyphosis: angulation of posterior spine
 Osteoarthritis: degenerative joint disease
 Osteopenia: subnormal bone mineralization
 Osteoporosis: abnormal loss of bone density
 Constipation: decreased stool frequency
 Menopause: cessation of menses
 Erectile dysfunction in males

Biology and Genetics: Gender,
Race and Genetics
 Gender and marital status
 Men: higher mortality rate
 Heart disease: number 1 cause of death
 Life expectancies—female: 80.4; male: 75.2
 Married people generally have better health
 Race
 Black Americans and Latino/Hispanic Americans
• Disproportionally low SES, less access to health care, more likely
not to have health insurance
• Higher probability of cancer, heart disease, diabetes, HIV
 Genetics
 Middle adult at higher risk for genetics-associated conditions

Gordon’s Functional Health
Patterns
 Health perception–health management pattern
 Nutritional-metabolic pattern
 Elimination pattern
 Activity-exercise pattern
 Sleep-rest pattern
 Cognitive-perceptual pattern
 Self-perception–self-concept pattern
 Roles-relationships pattern
 Sexuality-reproductive pattern
 Coping–stress tolerance pattern
 Values-beliefs pattern

Health Perception–
Health Management Pattern
 Habits: self-destructive
 Smoking, alcohol, overeating
 Visible consequences
 Risk factors: behavioral/environmental
 Age, gender, race, personal risks
 Health-promotion needs
• Health screening of diseases/behaviors
• Stop self-destructive behaviors
• Exercise

Nutritional-Metabolic Pattern
 Obesity (BMI >30; overweight: BMI 26-29)
 Substantially increased risk of chronic cardiovascular disease,
diabetes, cancer
 Risk increases with less education, low incomes, ethnicity
 Prevention/management
• Fewer calories
• Exercise 30 min/day; 3-5 days a week
• Social support groups
 High saturated fat diet
 Effect on cardiovascular/cerebrovascular morbidity/mortality
 Recommend total cholesterol is <200mg/dL
 Lifestyle modifications, medications if needed

(Cont.)
 Calcium
 Recommendations: nonpregnant adults: 1000 mg;
postmenopausal women without hormones: 1500 mg
 Absorption enhanced by vitamin D
 Caffeine
 Readily accessible
 Stimulant; be aware of addiction potential
 Controversy over health effects of moderate consumption
 High-sodium diet
 Role in hypertension; increases fluids, increases vascular
resistance

(Cont.)
 Alcohol abuse
 Depressant, chronic use produces tolerance
 Moderate drinking: ≤1 drink/day for women, ≤2 drinks/day men
 Increases risk of MVA, liver disease, cancer, heart disease,
pancreatitis
 Early detection/intervention can decrease long-term sequelae
 Laboratories indicative but not sensitive/specific for ETOH abuse
 Treatment complex
 Oral health
 Gingivitis: teeth brushing/flossing needed
 Dental hygiene/decay: checkups, water fluoridation, sealants

Elimination Pattern
 Constipation
 Risk: age, sedentary lifestyle, lack of dietary bulk
 Dietary fiber preferable to laxatives and fiber products
 Stress incontinence
 Risk: women with multiple births, little exercise

Activity-Exercise Pattern
 Exercise benefits
 Prevent/manage chronic illness (heart, diabetes, osteoporosis,
depression, cancer)
 Significant increase in life expectancy/quality of life
 Exercise recommendations
 30 minutes, 5 or more days/week
 Continuous, rhythmic exercise (e.g., walking, jogging, swimming,
bicycling)
 Initiating exercise program
 Choose activities enjoyed in past (if appropriate)
 Consider potential for injury, proper equipment
 Exercise testing if high risk

Sleep-Rest Pattern
 Compared to young adults
 Less time in deep sleep
 Less sleep overall
 Healthful guidelines
 Regularly scheduled
 Quality sleep
 Occasional napping
 Cognitive-behavioral therapy for sleep problems
 Sleep apnea common disorder adults
 Disordered breathing during sleep

Cognitive-Perceptual Pattern
 Intellectual ability—learning continues thru life
 Adult continues to accumulate “learning” intelligence
 Piaget’s stage of formal operations
 Can process complex problems of reasoning
 Bloom’s hierarchy of cognitive levels of the adult learner
 (1) knowledge, (2) comprehension, (3) application, (4)
analysis, (5) synthesis and evaluation
 Schaie’s factors that maintain cognitive function
 Focus on involvement, absence of chronic disease,
flexibility, family, complexity, favorable SES, personal
satisfaction, spouse with high cognitive function

Cognitive-Perceptual Pattern
Perceptual Changes
 Presbyopia (farsightedness)
 Glaucoma: increased intraocular pressure
 Decreased visual sensitivity and peripheral
vision
 Cataracts: opacity of lens
 Diabetic retinopathy
 Presbycusis: loss of higher frequency hearing
 Diminished sense of taste
 Macular degeneration: deterioration of retina

Self-Perception–Self-Concept
Pattern
 Levinson’s theory—“individual life structures”
 Age-associated seasons—midlife transition
 Reappraisal lie, integrate polarities, modify/move to goals
 Struggles with meaning, value, direction of lives
 Erikson’s theory—generativity vs stagnation
 Generativity: sense of productivity, creativity, caring for others
 Stagnation: lack of accomplishment, self-absorption
 Physiological changes
 Affects on self-esteem: graying hair, wrinkles, body shape
 Perimenopause and menopause:
• Mood swings, nervousness, fatigue, depression
• Hormonal therapy: indications and controversy
• Alternative products: little scientific data on benefit

Roles-Relationships Pattern
 “Midlife crisis”
 Time of reassessment, turmoil, change
 Family
 Family life cycle
• Families with children (ages 13-20)
• Families launching young adults
• Families from empty nest to retirement
 Multiple responsibilities and stresses
• Children, aging parents, job, and civic responsibilities
• Single parent families, adult children at home
• “Empty-nest syndrome”
• Over-involvement with children’s activities

Roles-Relationships Pattern (Cont.)
 Work
 Plays major role in level of wellness, self-esteem
 10 million work-related injuries yearly
 Two-or-more job family
 Role changes—family stress factors
• Reentering workforce
• Job-related travel
• Nontraditional female/male roles
• Nature of parental work environment
• Retirement planning/midcareer changes
 Elements of work site health-promotion programs

Roles-Relationships Pattern (Cont.)
 Caring for aging parents
 Additional demands of caring for parents and children (sandwich
generation)
• Changing parental living arrangement
• Guidance: discussing issues before crisis
 Divorce
 Multiple family member adaptations needed
 Potential psychological effects on children
 Death
 Spouse: grief for loss of companionship, loss of future
 Increased awareness of finite nature of life
 Midlife review common

Sexuality-Reproductive Pattern
 High proportion adults remain sexually active
 Pregnancy
 77% pregnancies unintended—perimenopause
 Higher risk of maternal death, fetal complications
 Changes in reproductive system
 Slower arousal, orgasms less intense, long refractory
between erection and ejaculation, vaginal dryness,
decreased libido
 American cultural value on youth and beauty is
challenging for middle-aged woman

Sexuality-Reproductive Pattern
Health Issues
 Men: sexual dysfunction (impotence, premature
ejaculation, retrograde ejaculation)
 Women: abnormal genital bleeding and
secondary amenorrhea
 STDs
 HPV—causes 90% cervical cancers
 HIV/AIDS—adults >50 “hidden” risk group
• Less knowledgeable
• Less likely to discuss sexual behavior with provider

Coping–Stress Tolerance Pattern
 Factors related to coping with stress and health
outcomes
 Stress hardiness—control, commitment, challenge
 Tranquilizer use <50
 Maturity of defenses against stress
 Framingham study: worry, conflict, anger, ambitiousness
affect BP
 Coping with death of a parent
 Preparation helps feelings of control
 Examples: living will, advanced directive, durable power of
attorney

Values-Beliefs Pattern
 Beliefs formed early; reviewed during crisis
 Middle-age moral transitions: valuing others,
having relationships, responsibility to others
 Developmental theories
 Erikson: caring as middle-age adult virtue
 Kohlberg: conventional and postconventional phases
 Gilligan: gender differences in moral development
• Women: Selfishness vs responsibility, avoid hurting others
• Men: justice, fairness, rights of individuals

Environmental Processes
Physical Agents
 Ionizing radiation
 Cancer caused by medical test/procedures
 Water pollution
 Benzene, chlordane
 Air pollution
 Auto emissions, burning fuels, industry
 Noise pollution—occupational hazard
 Potentiates hearing loss

Biological Agents
 Transmitted through air or food/water
 Enter respiratory or gastrointestinal tract
 Examples
 Hepatitis A: fecal-oral route, poor sanitation
 Hepatitis B
• Blood-borne pathogen
• Occupational hazard: health professionals
 Pneumonia: vaccine available
 Herpes zoster (Shingles) vaccine available

Chemical Agents
 Contaminants from workplace industry
 Pneumoconiosis—black lung disease (coal)
 Asbestos: mesothelioma
 Organic carcinogens: benzene, PVC, others
 Tobacco
 Middle age: may have 30+ packs per year history
 Risk of heart/lung disease/cancer increased
 2000 known chemicals in cigarettes
• Tar, cyanide, formaldehyde, carbon monoxide

Determinants of Health
Social Factors and Environment
 Culture and ethnicity
 Different interpretations of health/illness
 Immigrants: poverty, poor living conditions
 Economics
 Net income may be at highest level; also have greater
financial responsibilities
 Health care delivery system
 Official agencies—state and federally funded
 Voluntary agencies—American Cancer Society, American
Lung Association
 Service organizations—YMCA, hospice

Levels of Policy Making
 High cost of health care
 Changes in economy result in changes in family
patterns: housing, education
 Aging population utilizes more health resources
 Unemployment creates stressors
 Technology creates employment changes
 Health organizations and delivery services
 Affordable Care Act and political controversy

Middle Age Adult

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