MIDDLE ADULTHOOD 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
Middle adulthood, or midlife, refers to the period of the lifespan between early adulthood and
extreme fatigue. Symptoms can also include pain in the arms, legs, neck, jaw, throat, abdomen
late adulthood. Although ages and tasks are culturally defined, the most common age definition
or back (Mayo Clinic, 2014a).
is from 40-45 to 60-65. This may be the least studied time of the lifespan, and research on this
developmental period is relatively new as many aspects of midlife are still being explored. In the According to the Mayo Clinic (2014a) there are many risk factors for developing heart disease,
United States, the large Baby Boom cohort (those born between 1946 and 1964) are now midlife including medical conditions, such as high blood pressure, high cholesterol, diabetes, and
adults (and some even late adults) and this has led to increased interest in this developmental obesity. Other risk factors include:
stage. We do know that this stage reflects both developmental gains and losses and that there
 Advanced Age-increased risk for narrowed arteries and weakened or thickened heart
are considerable individual differences, but there is still much to learn about this age group.
muscle.
Physical Development in Middle Adulthood
 Sex-males are at greater risk, but a female’s risk increases after menopause.
Each person experiences age-related physical changes based on many factors: biological
 Family History-increased risk, especially if male parent or brother developed heart
factors, such as molecular and cellular changes, and oxidative damage are called primary aging,
disease before age 55 or female parent or sister developed heart disease before age
while aging that occurs due to controllable factors, such as an unhealthy lifestyle including lack
65.
of physical exercise and poor diet, is called secondary aging (Busse, 1969).
 Smoking-nicotine constricts blood vessels and carbon monoxide damages the inner
Health Concerns
lining.
Heart Disease: According to the most recent National Vital Statistics Reports (Xu, Murphy,
 Poor Diet-a diet high in fat, salt, sugar, and cholesterol.
Kochanek, & Bastian, 2016) heart disease continues to be the number one cause of death for
Americans as it claimed 23.5% of those who died in 2013. It is also the number one cause of  Stress-unrelieved stress can damage arteries and worsen other risk factors.
death worldwide (World Health Organization, 2013). Heart disease develops slowly over time
and typically appears in midlife (Hooker & Pressman, 2016).  Poor Hygiene-establishing good hygiene habits can prevent viral or bacterial infections
that can affect the heart. Poor dental care can also contribute to heart disease.
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 Complications of heart disease can include heart failure, when the heart cannot pump enough
vessels prevent the body and heart from receiving adequate blood. Atherosclerosis, or a blood to the meet the body’s needs, and a heart attack, when a blood clot blocks the blood flow
buildup of fatty plaque in the arteries, is the most to the heart. This blockage can damage or destroy a part of the heart muscle, and atherosclerosis
common cause of cardiovascular disease. The is a factor in a heart attack. Treatment for heart disease includes medication, surgery, and
plaque buildup thickens the artery walls and lifestyle changes including exercise, healthy diet, and refraining from smoking.
restricts the blood flow to organs and tissues. Sudden cardiac arrest is the unexpected loss of heart functioning, breathing, and consciousness,
Cardiovascular disease can lead to a heart often caused by an arrhythmia or abnormal heartbeat. The heart beat may be too quick, too slow,
attack, chest pain (angina), or stroke (Mayo or irregular. With a healthy heart, it is unlikely for a fatal arrhythmia to develop without an outside
Clinic, 2014a). factor, such as an electric shock or illegal drugs. If not treated immediately, sudden cardiac arrest
Figure 8.5 illustrates atherosclerosis. can be fatal and result in sudden cardiac death.

Figure 8.5: Atherosclerosis. Source.

Hypertension, or high blood pressure, is a serious health problem that occurs when the blood other parts of the body. This new metastatic tumor is the same type as the primary tumor
flows with a greater force than normal. One in three American adults (70 million people) have (National Institutes of Health, 2015). Figure 8.6 illustrates how cancers can metastasize.
hypertension and only half have it under control (Nwankwo, Yoon, Burt, & Gu, 2013). It can strain
Cancer can start almost anywhere in the human body. While normal cells mature into very
the heart, increase the risk of heart attack and stroke, or damage the kidneys (CDC, 2014a).
distinct cell types with specific functions, cancer cells do not and continue to divide without
Uncontrolled high blood pressure in early and middle adulthood can also damage the brain’s
stopping. Further, cancer cells are able to ignore the signals that normally tell cells to stop
white matter (axons), and may be linked to cognitive problems later in life (Maillard et al., 2012).
dividing or to begin a process known as programmed cell death which the body uses to get rid
Normal blood pressure is under 120/80 (Table 8.1). The first number is the systolic
of unneeded cells. With the growth of cancer cells, normal cells are crowded out and the body is
pressure, which is the pressure in the blood vessels when the heart beats. The second number
unable to work the way it is supposed to. For example, the cancer cells in lung cancer form
is the diastolic pressure, which is the pressure in the blood vessels when the heart is at rest.
tumors which interfere with the functioning of the lungs and how oxygen is transported to the rest
High blood pressure is sometimes referred to as the silent killer, as most people with
of the body.
hypertension experience no symptoms.
Figure 8.6. Source.
Risk factors for high blood pressure include:
There are more than 100 types of cancer. The American
 Family history of hypertension
Cancer Society assemblies a list of the most common types
 Diet that is too high in sodium, often found in processed foods, and too low in potassium
of cancers in the United States. To qualify for the 2016 list,
 Sedentary lifestyle
the estimated annual incidence had to be 40, 000 cases or
 Obesity
more. The most common type of cancer on the list is breast
 Too much alcohol consumption
cancer, with more than 249,000 new cases expected in 2016.
 Tobacco use, as nicotine raises blood pressure (CDC, 2014b).
The next most common cancers are lung cancer and prostate
Making lifestyle changes can often reduce blood pressure in many people.
cancer. Table 8.2 lists the estimated number of new cases and deaths for each common cancer
Cancer: After heart disease, cancer was the second leading cause of death for Americans in type (American Cancer Society, 2016).
2013 as it accounted for 22.5% of all deaths (Xu et al., 2016). According to the National Institutes
Source.
of Health (2015), cancer is the name given to a collection of related diseases in which the body’s
cells begin to divide without stopping and spread into surrounding tissues. These extra cells can Cholesterol is a waxy fatty substance carried by lipoprotein molecules in the blood. It is created
divide and form growths called tumors, which are typically masses of tissue. Cancerous tumors by the body to create hormones and digest fatty foods, and is also found in many foods. Your
are malignant, which means they can invade nearby tissues. When removed malignant tumors body needs cholesterol, but too much can cause heart disease and stroke. Two important kinds
may grow back. Unlike malignant tumors, benign tumors do not invade nearby tissues. Benign of cholesterol are low-density lipoprotein (LDL) and high-density lipoprotein (HDL). A third
tumors can sometimes be quite large, and when removed usually do not grow back. Although type of fat is called triglycerides. Your total cholesterol score is based on all three types of lipids
benign tumors in the body are not cancerous, benign brain tumors can be life threatening. (Table 8.3). Total cholesterol is calculated by adding HDL plus LDL plus 20% of the Triglycerides.
Cancer cells can prompt nearby normal cells to form blood vessels that supply the tumors with LDL cholesterol makes up the majority of the body’s cholesterol, however, it is often referred to
oxygen and nutrients, which allows them to grow. These blood vessels also remove waste as “bad” cholesterol because at high levels it can form plaque in the arteries leading to heart
products from the tumors. Cancer cells can also hide from the immune system, a network of attack and stroke. HDL cholesterol, often referred to as “good” cholesterol, absorbs cholesterol
organs, tissues, and specialized cells that protects the body from infections and other conditions. and carries it back to the liver, where it is then flushed from the body. Higher levels of HDL can
Lastly, cancer cells can metastasize, which means they can break from where they first formed, reduce the risk of heart attack and stroke. Triglycerides are a type of fat in the blood used for
called the primary cancer, and travel through the lymph system or blood to form new tumors in energy. High levels of triglycerides can also increase your risk for heart disease and stroke when
coupled with high LDL and low HDL. All adults 20 or older should have their cholesterol checked. and four times less for Alaskan Natives than the American Indians of southern Arizona (CDC,
In early adulthood, doctors may check every few years if the numbers have previously been 2014d).
normal, and there are no other signs of heart disease. In middle adulthood, this may become
The risk factors for diabetes include:
part of the annual check-up (CDC, 2015).
 Those over age 45
Risk factors for high cholesterol include: A family history for high cholesterol, diabetes, a diet
 Obesity
high in saturated fats, trans fat, and cholesterol, physical inactivity, and obesity. Almost 32% of
 Family history of diabetes
American adults have high LDL cholesterol levels, and the majority do not have it under control,
 History of gestational diabetes (Chapter 2)
nor have they made lifestyle changes (CDC, 2015).
 Race and ethnicity
Diabetes (Diabetes Mellitus) is a disease in which the body does not control the amount of  Physical inactivity
glucose in the blood. This disease occurs when the body does not make enough insulin or does  Diet
not use it the way it should (NIH, 2016a). Insulin is a type of hormone that helps glucose in the
blood enter cells to give them energy. In adults, 90% to 95% of all diagnosed cases of diabetes Diabetes has been linked to numerous health complications. Adults with diabetes are 1.7 times
are type 2 (American Diabetes Association (ADA), 2016). Type 2 diabetes usually begins with more likely to have cardiovascular disease, 1.8 times more likely to experience a heart attack,
insulin resistance, a disorder in which the cells in the muscles, liver, and fat tissue do not use and 1.5 times more likely to experience stroke than adults without diabetes. Diabetes can cause
insulin properly (CDC, 2014d). As the need for insulin increases, cells in the pancreas gradually blindness and other eye problems. In diabetics age 40 or older, 28.5% showed signs of diabetic
lose the ability to produce enough insulin. In some Type 2 diabetics, pancreatic beta cells will retinopathy, damage to the small blood vessels in the retina that may lead to loss of vision. More
cease functioning, and the need for insulin injections will become necessary. Some people with than 4% showed advanced diabetic retinopathy. Diabetes is linked as the primary cause of
diabetes experience insulin resistance with only minor dysfunction of the beta cell secretion of almost half (44%) of new cases of kidney failure each year. About 60% of non-traumatic limb
insulin. Other diabetics experience only slight insulin resistance, with the primary cause being a amputations occur in people with diabetes. Diabetes has been linked to hearing loss, tinnitus
lack of insulin secretion (CDC, 2014d). (ringing in the ears), gum disease, and neuropathy (nerve disease) (CDC, 2014d).
Figure 8.7. Source (CDC, 2014d). Typical tests for diabetes include a fasting glucose test and the A1C (Table 8.5). Fasting glucose
levels should be under 100mg/dl (ADA, 2016). The A1C provides information about the average
One in three adults are estimated to have
levels of blood glucose over the last 3 months (NIH, 2014a). The A1C should be under 5.7, where
prediabetes, and 9 in 10 of them do not know.
a 5.0 = 97mg/dl and a 6.0 = 126 mg/dl (ADA, 2016).
According to the CDC (2014d) without intervention,
15% to 30% of those with prediabetes will develop Metabolic Syndrome is a cluster of several cardiometabolic risk factors, including large waist
diabetes within 5 years. In 2012, 29 million people circumference, high blood pressure, and elevated triglycerides, LDL, and blood glucose levels,
(over 9% of the population) were living with diabetes which can lead to diabetes and heart disease (Crist et al., 2012). The prevalence of metabolic
in America, mostly adults age 20 and up. syndrome in the U.S. is approximately 34% and is especially high among Hispanics and African
Americans (Ford, Li, & Zhao, 2010). Prevalence increases with age, peaking in one’s 60s (Ford
Diabetes also affects ethnic and racial groups differently. Non-Hispanic Whites (7.6%) are less
et al., 2010). Metabolic syndrome increases morbidity from cardiovascular disease and diabetes
likely to be diagnosed with diabetes than are Asian Americans (9%), Hispanics (12.8%), non-
(Hu et al., 2004; Malik, 2004). Hu and colleagues found that even having one or two of the risk
Hispanic Blacks (13.2%), and American Indians/Alaskan Natives (15.9%). However, these
factors for metabolic syndrome increased the risk of mortality. Crist et al. (2012) found that
general figures hide the variations within these groups. For instance the rate of diabetes was
increasing aerobic activity and reducing weight led to a drop in many of the risk factors of
less for Central, South, and Cuban Americans than for Mexican Americans and Puerto Ricans,
metabolic syndrome, including a reduction in waist circumference and blood pressure, and an  Variability of symptoms among people with the disease.
increase in HDL cholesterol.
About 1.5 million people (approximately 0.6%) of Americans experience rheumatoid arthritis. It
Rheumatoid arthritis (RA) is an inflammatory disease that causes pain, swelling, stiffness, and occurs across all races and age groups, although the disease often begins in middle adulthood
loss of function in the joints (NIH, 2016b). RA occurs when the immune system attacks the and occurs with increased frequency in older people. Like some other forms of arthritis,
membrane lining the joints (Figure 8.8). rheumatoid arthritis occurs much more frequently in women than in men. About two to three
times as many women as men have the disease (NIH, 2016b). The lifetime risk for RA for women
is 3.6% and 1.7% for men (Crowson, et al., 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 increase the risk of developing RA in
Figure 8.8. Source. a genetically susceptible person (NIH, 2016b).

RA is the second most common form of arthritis after osteoarthritis, which is the normal wear Rheumatoid arthritis can affect virtually every area of a person’s
and tear on the joints discussed in chapter 9. Unlike osteoarthritis, RA is symmetric in its attack life, and it can interfere with the joys and responsibilities of work
of the body, thus, if one shoulder is affected so is the other. In addition, those with RA may and family life. Fortunately, current treatment strategies allow
experience fatigue and fever. Below are the common features of RA (NIH, 2016b). most people with RA to lead active and productive lives. Pain-
relieving drugs and medications can slow joint damage, and
Features of Rheumatoid Arthritis establishing a balance between rest and exercise can also lessen
 Tender, warm, swollen joints the symptoms of RA (NIH, 2016b).

 Symmetrical pattern of affected joints Digestive Issues

 Joint inflammation often affecting the wrist and finger joints closest to the hand Figure 8.9: Digestive system. Source.

 Joint inflammation sometimes affecting other joints, including the neck, shoulders, Heartburn, also called acid indigestion or pyrosis, is a common
elbows, hips, knees, ankles, and feet 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
 Fatigue, occasional fevers, a loss of energy discomfort. Heartburn that occurs more frequently may be due to gastroesophageal reflux
 Pain and stiffness lasting for more than 30 minutes in the morning or after a long rest disease, GERD. Normally the lower sphincter muscle in the esophagus keeps the acid in the
stomach from entering the esophagus. In GERD this muscle relaxes too frequently and the
 Symptoms that last for many years stomach acid flows into the esophagus. In the U.S. 60 million people experience heartburn at
least once a month, and 15 million experience it every day. Prolonged problems with heartburn
can lead to more serious complications, including esophageal cancer, one of the most lethal regularly. Weight lifting and stretching exercises at home can also be part of an effective
forms of cancer in the U.S. Problems with heartburn can be linked to eating fatty or spicy foods, program. Exercise is particularly helpful in reducing stress in midlife. Walking, jogging, cycling,
caffeine, smoking, and eating before bedtime (American College of Gastroenterology, 2016a). 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
Gallstones are hard particles, including fatty materials, bile pigments, and calcium deposits, that
exercise for the 78 million "baby boomers" may be one of the best ways to reduce health care
can develop in the gallbladder. Ranging in size from a grain of sand to a golf ball, they typically
costs and improve quality of life (Shure & Cahan, 1998).
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 According to the Office of Disease Prevention and Health Promotion (2008), the following are
upper abdominal pain when stones block bile or pancreatic ducts. If stones become lodged in exercise guidelines for adults:
the ducts, it may necessitate surgery or other medical intervention as it could become life-
 Adults should avoid being inactive. Any activity will result in some health benefits.
threatening if left untreated (American College of Gastroenterology, 2016b).
 For substantial health benefits, adults should engage in at least 150 minutes per week
Gallstones are present in about 20% of women and 10% of men over the age of 55 (American
of moderate intensity exercise OR at least 75 minutes of vigorous intensity aerobic
College of Gastroenterology, 2016b). Risk factors include a family history of gallstones, diets
activity. Aerobic activity should occur for at least 10 minutes and preferably spread
high in calories and refined carbohydrates (such as, white bread and rice), diabetes, metabolic
throughout the week.
syndrome, Crohn’s disease, and obesity, which increases the cholesterol in the bile and thus
increases the risk of developing gallstones (NIH, 2013).  For more extensive health benefits, adults can increase their aerobic activity to 300
minutes per week of moderate intensity OR 150 minutes per week of vigorous intensity
Sleep
aerobic activity.
According to the American Academy of Sleep Medicine adults require at least 7 hours of sleep
 Adults should also participate in muscle-strengthening activities that are moderate or
per night to avoid the health risks associated with chronic sleep deprivation. Less than 6 hours
high intensity and involve all major muscle groups on two or more days per week.
and more than 10 hours is also not recommended for those in middle adulthood. Not surprisingly,
many Americans do not receive the 7-9 hours of sleep recommended. In 1993, 67% of Nutritional concerns: Aging brings about a reduction in the number of calories a person
Americans felt they were getting enough sleep, but in 2013 only 56% felt they received as much requires (see Table 8.7 for estimated caloric needs in middle-aged adults). Many Americans
sleep as needed. 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.
Exercise, Nutrition, and Weight
Excess Sodium: According to dietary guidelines, adults should consume less than 2,300mg (1
The impact of exercise: Exercise is a powerful way to combat the changes we associate with teaspoon) per day of sodium. The American Heart Association (2016) reports that the average
aging. Exercise builds muscle, increases metabolism, helps control blood sugar, increases bone sodium intake among Americans is 3440mg per day. Processed foods are the main culprits of
density, and relieves stress. Unfortunately, fewer than half of midlife adults exercise and only excess sodium. High sodium levels in the diet is correlated with increased blood pressure, and
about 20 percent exercise frequently and strenuously enough to achieve health benefits. Many its reduction does show corresponding drops in blood pressure. Adults with high blood pressure
stop exercising soon after they begin an exercise program, particularly those who are very are strongly encouraged to reduce their sodium intake to 1500mg (U.S. Department of Health
overweight. The best exercise programs are those that are engaged in regularly, regardless of and Human Services & U.S. Department of Agriculture (USHHS & USDA), 2015).
the activity. A well-rounded program that is easy to follow includes walking and weight training.
Excess Fat: Dietary guidelines also suggests that adults should consume less than 10 percent
Having a safe, enjoyable place to walk can make the difference in whether or not someone walks
of calories per day from saturated fats. The American Heart Association (2016) says optimally
we should aim for a dietary pattern that achieves 5% to 6% of calories from saturated fat. In a being overweight is associated with a myriad of health conditions including diabetes, high blood
2000 calorie diet that is about 120 calories from saturated fat. In the average American diet about pressure, and heart disease. New research is now linking obesity to Alzheimer’s disease. Chang
34.3% of the diet comes from fat, with 15.0% from saturated fat (Berglund et al., 1999). Diets et al. (2016) found that being overweight in midlife was associated with earlier onset of
high in fat not only contribute to weight gain, but have been linked to heart disease, stroke, and Alzheimer’s disease. The study looked at 1,394 men and women who were part of the Baltimore
high cholesterol. 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 BMI, at age 50 were
Added Sugar: According to the recent Dietary Guidelines for Americans (USHHS & USDA,
more likely to develop Alzheimer’s disease. In fact, each one-point increase in BMI was
2015) eating healthy means adults should consume less than 10 percent of calories per day from
associated with getting Alzheimer’s six to seven months earlier. Those with the highest BMIs
added sugars. Yet, currently about 15% of the calories in the American adult diet come from
also had more brain changes typical of Alzheimer’s, even if they did not have symptoms of the
added sugars, or about 22 teaspoons of sugar per day (NIH, 2014c). Excess sugar not only
disease. Scientists speculate that fat cells may produce harmful chemicals that promote
contributes to weight gain, but diabetes and other health problems.
inflammation in blood vessels throughout the body, including in the brain. The conclusion of the
Metabolism and Weight Gain: One of the common complaints of midlife adults is weight gain, study was that a healthy BMI at midlife may delay the onset of Alzheimer’s disease.
especially the accumulation of fat in the abdomen, which is often referred to as the middle-aged
Concluding Thoughts: Many of the changes that occur in midlife can be easily compensated
spread (Lachman, 2004). Men tend to gain fat on their upper abdomen and back, while women
for, such as buying glasses, exercising, and watching what one eats. However, the percentage
tend to gain more fat on their waist and upper arms. Many adults are surprised at this weight
of middle adults who have a significant health concern has increased in the past 15 years.
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 According to the 2016 United Health Foundation’s America’s Health Rankings Senior Report,
calories consumed are combined with oxygen to release the energy needed to function (Mayo the next generation of seniors will be less healthy than the current seniors (United Health
Clinic, 2014b). People who have more muscle burn more calories, even at rest, and thus have a Foundation, 2016). The study compared the health of middle-aged Americans (50-64 years of
higher metabolism. age) in 2014 to middle-aged 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
However, as you get older, the amount of muscle decreases. Consequently, fat accounts for
25%. At the state level, Massachusetts ranked first for healthy seniors, while Louisiana ranked
more of one’s weight in midlife and slows down the amount of calories burned. To compensate,
last. Illinois ranked 36th, while Wisconsin scored higher at 13th.
midlife adults have to increase
their level of exercise, eat less, Climacteric
and watch their nutrition to
The climacteric, or the midlife transition when fertility declines, is biologically based but impacted
maintain their earlier physique.
by the environment. During midlife, men may experience a reduction in their ability to reproduce.
Figure 8.11: Exercise is Very Women, however, lose their ability to reproduce once they reach menopause.
Important in Middle Age.
Erikson- Generativity vs Stagnation
Source.
According to Erikson (1982) generativity encompasses procreativity, productivity, and
creativity. This stage includes the generation of new beings, new products, and new ideas, as
Obesity: As discussed in the well as self-generation concerned with further identity development. Erikson believed that the
early adulthood chapter, obesity stage of generativity, during which one established a family and career, was the longest of all
is a significant health concern the stages. Individuals at midlife are primarily concerned with leaving a positive legacy of
for adults throughout the world, and especially America. Obesity rates continue to increase, and themselves, and according to Erikson (1950) parenthood is the primary generative type. Erikson
understood that work and family relationships may be in conflict due to the obligations and taking or working. However, not feeling needed or challenged may result in stagnation, and
responsibilities of each, but he believed it was overall a positive developmental time. In addition consequently one should not fully withdraw from generative tasks as they enter Erikson’s last
to being parents and working, Erikson also described individuals being involved in the community stage in late adulthood.
during this stage. A sense of stagnation occurs when one is not active in generative matters,
Midlife Relationships
however, stagnation can motive a person to redirect energies into more meaningful activities.
The sandwich generation refers to adults who have at least one parent age 65 or older and are
Erikson identified "virtues" for each of his eight stages, and they refer to what the individual
either raising their own children or providing support for their grown children. According to a
achieves when the stage is successfully reconciled. The virtue emerging when one achieves
recent Pew Research survey, 47% of middle-aged adults are part of this sandwich generation
generativity is “Care”. Erikson believed that those in middle adulthood should “take care of the
(Parker & Patten, 2013). In addition, 15% of middle-aged adults are providing financial support
persons, the products, and the ideas one has learned to care for” (Erikson, 1982, p. 67). Further,
to an older parent while raising or supporting their own children (Figure 8.29).
Erikson believed that the strengths gained from the six earlier stages are essential for the
generational task of cultivating strength in the next generation. Erikson further argued that Middle Adult Lifestyles
generativity occurred best after the individual had resolved issues of identity and intimacy
(Peterson & Duncan, 2007). Bella DePaulo (2014) has challenged the idea that singles, especially the always single, fair
worse emotionally and in health when compared to those who are married. DePaulo suggests
Figure 8.28: Generativity at midlife. that there is a bias in how studies examine the benefits of marriage. Most studies focus on only
Source. a comparison between married versus not married, which does not include a separate
comparison between those who have always been single, and those who are single because of
Research has demonstrated that
divorce or widowhood.
generative adults possess many positive
characteristics, including good cultural Friendships
knowledge and healthy adaptation to the
world (Peterson & Duncan, 2007). Using Adults of all ages who reported having a confidante or close friend with whom they could share
the Big 5 personality traits, generative personal feelings and concerns, believed these friends contributed to a sense of belonging,
women and men scored high on security, and overall wellbeing. Having a close friend is a factor in significantly lower odds of
conscientiousness, extraversion, psychiatric morbidity including depression and anxiety. The availability of a close friend has also
agreeableness, openness to experience, been shown to lessen the adverse effects of stress on health.
and low on neuroticism (de St. Aubin & McAdams, 1995; Peterson, Smirles, & Wentworth, 1997). Women in Midlife
Additionally, women scoring high in generativity at age 52 were rated high in positive personality
characteristics, satisfaction with marriage and motherhood, and successful aging at age The description that aging men are viewed as “distinguished” and aging women are viewed as
62 (Peterson & Duncan, 2007). Similarly, men rated higher in generativity at midlife were “old” is referred to as the double standard of aging (Teuscher & Teuscher, 2006). Since women
associated with stronger global cognitive functioning (e.g., memory, attention, calculation), have traditionally been valued for their reproductive capabilities, they may be considered old
stronger executive functioning (e.g., response inhibition, abstract thinking, cognitive flexibility), once they are postmenopausal. In contrast, men have traditionally been valued for their
and lower levels of depression in late adulthood (Malone, Liu, Vaillant, Rentz, & Waldinger, achievements, competence and power, and therefore are not considered old until they are
2016). physically unable to work.

Erikson (1982) indicated that at the end of this demanding stage, individuals may withdraw as
generativity is no longer expected in late adulthood. This releases elders from the task of care